Corrections - Neurology Flashcards
What is the stepwise medical management of status epilepticus?
1) Buccal midazolam / IV lorazepam
2) IV lorazepam
3) IV phenytoin, sodium valproate or levetiracetam
4) RSI using thiopental sodium
Are girls or boys more commonly affected by JME?
Girls
What blood test can differentiate true seizures from pseudoseizures?
Prolactin (raised following a true seizure)
1st line antiepileptic in focal seizures?
Lamotrigine or levitiracetam
2nd line antiepileptic in focal seizures?
Carbamazepine
What is the only antiepileptic drug that is NOT safe in breastfeeding?
Barbiturates
What is a history of sudden collapse occurring soon after a rupture of membranes suggestive of?
Amniotic fluid embolism
When can you consider stopping antiepileptics?
Over how long should they be stopped?
Can be considered if seizure free for >2 years.
Antiepileptics should be stopped over 2-3 months.
What is a key contraindication for triptans?
Patients with a history of, or significant risk factors for, ischaemic heart disease or cerebrovascular disease.
What condition do cafe au lait spots indicate?
- Neurofibromatosis type 1
- Tuberous sclerosis
What is it important to screen for in people with Down syndrome who participate in sports that may carry an increased risk of neck dislocation (e.g. trampolining, gymnastics, boxing, diving, rugby and horse riding)?
Atlanto-axial instability
A maximum of how many doses of IV benzodiazepines can be administered during convulsive status epilepticus?
2
1st line antiepileptic in tonic or atonic seizures in females?
Lamotrigine
How long should complete recovery take in a ‘simple’ febrile convulsion?
Complete recovery within 1 hour
When do seizures in benign rolandic epilepsy typically occur?
At night
Describe seizures in benign rolandic epilepsy
Seizures are typically partial (e.g. paraesthesia affecting the face) but 2ary generalisation may occur (i.e. parents may only report tonic-clonic movements).
What does an EEG characteristically show in benign rolandic epilepsy?
Centrotemporal spikes
Prognosis of benign rolandic epilepsy?
The prognosis is excellent, with seizures stopping by adolescence.
At what age does Duchenne’s muscular dystrophy (DMD) typically present?
Boys around 3-5 y/o
What does DMD typically present with?
Large calves in a patient with weakness in the muscles surrounding their pelvis.
What is a divergent squint?
Where one or both eyes turn outward.
What is a convergent squint?
Where one or both eyes turn inward
Who should children with a squint be referred to?
Ophthalmology
How can foetal alcohol syndrome affect head shape?
Can cause microcephaly
What medication can be used to manage spasticity in patients with cerebral palsy?
Baclofen
Stepwise mx of status epilepticus in children?
1) ABCDE: secure airway, high flow O2, consider reversible causes (don’t forget glucose!)
2) Vascular access:
- yes –> IV lorazepam
- no –> buccal midazolam or rectal diazepam
3) If seizure ongoing, adminster 2nd benzo dose after 5 minutes
4) If seizure ongoing, administer IV levetiracetam (5 mins after 2nd benzo dose)
5) If seizure ongoing, consider RSI
How long does a SIMPLE febrile convulsion last?
<15 mins
Are simple febrile convulsions generalised or focal?
Generalised
3 key features of simple febrile convulsions?
1) generalised
2) last <15 mins
3) do not recur within same illness
What are reflex anoxic attacks?
Brief episodes of asystole triggered by pain, fever or anxiety.
The child becomes suddenly pale, limp and loses
consciousness, followed by a tonic-clonic phase.
Episodes usually resolve in 30-60seconds, after which children may feel tired.
These are non-epileptic events.
Typical age of reflex anoxic attack?
Can occur at any age, but most common between 6 months and 2 years or age.
Which antiepileptic medication can INCREASE frequency of absence seizures?
Carbamazepine
When do absence seizures typically remit?
Typically remit in adolescence without treatment.
Typical age of JME?
8-26 years of age
Is JME more common in males or females?
Females
Characteristics of JME?
- Tonic clonic seizures provoked by sleep deprivation
- Absence seizures
- Early morning myoclonic jerks of upper limb
What may JME be triggered by? (3)
1) sleep deprivation
2) flashing lights (40%)
3) alcohol
Mx of JME?
The majority are well controlled with anti-epileptics, which may need to be taken lifelong.
Typical age of onset of benign rolandic epilepsy?
Onset between 2-12 years of age, peak at 9 years
What characterises benign rolandic epilepsy?
- Nocturnal, benign seizures
- Unilateral paraesthesia of the face, with ipsilateral facial motor seizure
- No LOC but unable to speak, and often salivation
- Last around 1-2 minutes
- Day time seizures are rare
EEG findings in benign rolandic epilepsy?
Centrotemporal spikes
EEG findings in infantile spasms?
Asynchronous spikes on a chaotic background (i.e. hypsarrhythmia)
What triad is seen in West syndrome?
1) infantile spasms
2) developmental delay
3) typically EEG pattern
Prognosis of West syndrome?
- Poor prognosis with 5% mortality
- Survivors have severe developmental delay and persistent seizures
What can be used in mx of West syndrome?
Vigabatrin, steroids and ACTH can be used
Advice for parents of children with epilepsy:
- First aid measures during a seizure
- Patients should not lock the bathroom door when taking a bath
- Patients should wear a helmet when riding a bike
- Inform lifeguards of their diagnosis if going swimming
- Signpost the family to websites that provide further information e.g. epilepsy.org
