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Paediatrics > Approach to Seizures > Flashcards

Approach to Seizures Flashcards

1
Q

What are the 5 questions you have to ask when a child presents with seizures?

A
  1. Is a true seizure?
  2. What type of seizure is it?
  3. Is it unprovoked or provoked?
  4. Special investigations we have to do
  5. The management
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2
Q

What other conditions mimic seizures?

A
  1. Day dreaming
  2. Syncope
  3. Night terrors
  4. Sleep myoclonus
  5. Infantile self gratification
  6. Pseudo seizures
  7. Breath holding episodes
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3
Q

What age does breath holding usually occur?

A

18 months to 6 years

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4
Q

How does breath holding present clinically?

A
  • usually preceded by crying, anger or being frightened
  • child stops breathing, becomes rapidly cyanosed and loses consciousness
  • may have brief tonic posturing of the limbs
  • recovers rapidly
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5
Q

How does sleep myoclonus present?

A
  • cessation upon waking

- hypnagogic jerks especially on the onset of sleep

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6
Q

How do pseudo seizures present?

A
  • usually triggered by emotional factors
  • child has seen a seizure before
  • alert to sexual abuse!
  • semi-purposeful limb movement
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7
Q

What type of seizures are there?

A
  1. Generalised seizures

2. Focal or partial seizures

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8
Q

What type of generalised seizures are there?

A
  1. Tonic
  2. Clonic
  3. Myoclonic
  4. Tonic-clonic
  5. Absence
  6. Infantile spasms
  7. Atonic
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9
Q

What type of partial seizures are?

A
  1. Simple partial(no loss of awareness)
  2. Complex partial(loss of awareness)
  3. Secondary generalised seizures
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10
Q

What symptoms would we expect in the frontal lobe?

A

-motor symptoms

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11
Q

What symptoms do we expect in temporal lobes?

A

-emotions, smells, hearing(often feels like deja vu or butterflies in the stomach)

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12
Q

What symptoms can we expect in the occipital lobe?

A

Visual symptoms

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13
Q

What symptoms can we expect in parietal lobe?

A

Sensation or pain

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14
Q

What does post-it all mean?

A

After a seizure

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15
Q

What does aura mean?

A

Sensation seconds before a seizure

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16
Q

What are provoked seizures?

A 
These are seizures caused by a acute or CNS event
These include:
1. Hypoglycaemia 
2. Fever-febrile seizures
3. Acute ischaemic stroke 
4. CNS infection/meningitis 
5. Toxins
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17
Q

What is an unprovoked seizure?

A

A seizure that occurs spontaneously without a known cause

18
Q

What are remote symptomatic seizures?

A

These are seizures that are a sequalae of progressive or static CNS disorder

  1. Congenital brain malformation
  2. Previous stroke
  3. Perinatal asphyxia
19
Q

What special investigations would you do?

A
  1. Do urea and electrolytes if there is a history of vomiting and diarrhea
  2. Do toxicology screen if hx of substance abuse
  3. Do LP if there is fever+ meningeal signs and under 18 months because signs may be absent provided there are no contra-indications
20
Q

When would we do EEG?

A
  1. When there has been >2 seizures
  2. Do not delay EEG in infantile spasms because it is a neurological emergency
  3. Sleep increases the chance of a positive result in 30% of children especially in temporal lobe seizures
21
Q

What neuroimaging do we prefer doing?

A

MRI

22
Q

When do we urgently do an neuroimaging(MRI)

A
  1. Status epilepticus without obvious cause
  2. Child who does not return to baseline quickly
  3. Child suspected with raised intracranial pressure
23
Q

When do we do an MRI routinely?

A
  1. Significant neuro development delay of unknown cause
  2. Child <1 year with unprovoked seizure
  3. Child who is stable and has a focal seizure of unknown cause
  4. Unexplained abnormal neurological findings
24
Q

What is the recurrence rate of seizures after the 1st seizure?

A
  1. Majority reoccur in the 1st-2nd year after they occur

2. 3% chance after 5 years

25
Q

What are infantile seizures?

A

Unique form of seizure with clusters of head nodding, trunk flexion, eye deviation and crying and facial flushing

  • they are usually for 1-2 seconds
  • they are repetitive, bilateral and symmetrical
26
Q

What are the two types of infantile spasms?

A
  1. Symptomatic

2. Cryptogenic

27
Q

Which ages are usually affected by infantile spasms?

A

3-6 months but may present later

28
Q

What are the causes of the symptomatic type of infantile spasms?

A
  1. Infections-torch, meningitis and encephalitis
    • tuberous sclerosus
  3. Hypoxia/ischaemia
  4. Metabolic and toxic-, maple syrup ursine disease
  5. Structural abnormalities- hydrocephaly, absent corpus colossum
29
Q

What is the cryptogenic infantile spasm characterised by?

A
  1. A better prognosis

2. No specific causes

30
Q

What is the treatment for infantile spasms?

A
  1. Steroids or vigabatrin

2. For long-term use: sodium valproate or benzodiazepines

31
Q

What are temporal lobe seizures?

A

They are complex partial seizures arising from the temporal lobe

32
Q

What does the temporal lobe affect?

A
  1. Olfactory
  2. Gustatory
  3. Psychosensory (auditory and hallucinations)
33
Q

What are the clinical symptoms of temporal lobe seizures?

A
  1. Feeling of deja vu
  2. Sensations of pleasure/displeasure
  3. Fear+anxiety
  4. Hollow feeling in stomach/butterflies in stomach
    Later presents with tonic clonic seizures if it eventually spreads to other parts of the brain
34
Q

What is benign partial epilepsy with rolandic/centro-temporal spikes?

A

These are seizures that occur mostly in 2-14 year olds(peaks at 5-8 years)

35
Q

What are the clinical features of benign partial epilepsy with rolandic spikes?

A

-usually occur nocturnally or early morning
-usually unilateral face movements
Movement of the mouth, contraction of the jaw, feelings of suffocation, guttural vocalisations, drooling
-most are brief but if they are longer can become Todd’s paresis

36
Q

What is the prognosis we can expect in patients with benign partial epilepsy with rolandic spikes?

A

Good prognosis

  • usually ends by end of 15 years
  • treat with sodium valproate or carbamazepine but we hardly use anti-convulsants to treat it
37
Q

What is status epilepticus?

A

These are seizures that last longer than 30 minutes and have no recovery of consciousness in between seizures

38
Q

Which age group is affected by by status epilepticus?

A

<5 years

39
Q

How does it usually present?

A

It is caused by any seizure but more so generalised and tonic clonic

40
Q

What is the immediate effect on the brain when it happens?

A
  1. Compensatory phase-increased brain flow and causes tachycardia, hypertension, increased central venous pressure
  2. decompensation phase: decrease in tachycardia, decreased cardiac output, raised intracranial pressure, metabolic acidosis and cell death
41
Q

What is the management for status epilepticus?

A
  1. It is a medical emergency
  2. Start with benzodiazepines
    Diazepam 0,5mg/kg rectally or Lorazepam 0,1mg/kg IV which is faster

Then get IV access-take bloods, FBC, Blood gas, blood culture, elcterolytes and glucose!

  1. Wait 3 minutes then repeat the benzos if patient is still convulsing
  2. Wait 10 minutes
  3. Give anti-convulsant: phenobarbitone 20mg/kg loading dose over 5 minutes
  4. Repeat phenobarbitone 3-4 x and wait 10 minutes each time (10mg/kg)
  5. Give phenytoin 10mg/kg( make sure you attach to cardiac monitor)
  6. If still having a seizure then give lignocaine (2-3mg/kg initial dose)
  7. If the person is still convulsing take to ICU and give thiopentone and intubate(RSI)

Paediatrics (40 decks)

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