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#phase 2.2: paediatrics > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is epilepsy an umbrella term for?

A

Condition where there is tendency to have seizures

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2
Q

What is the definition of seizures?

A

Transient episodes of abnormal electrical activity in brain

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3
Q

What are the CF of Generalised Tonic-Clonic seizures? (3 things)

A
  1. Loss of consciousness
  2. Tonic (muscle tensing) (1st)
  3. Clonic (muscle jerking) (2nd)
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4
Q

What are some associated CF of Generalised Tonic-Clonic seizures? (4 things)

A
  1. Groaning
  2. Tongue biting
  3. Irregular breathing
  4. Incontinence
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5
Q

What do you get after Generalised Tonic-Clonic seizures?

A

Post-ictal period

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6
Q

What are the CF of the Post-ictal period of Generalised Tonic-Clonic seizures? (3 things)

A
  1. Confused
  2. Drowsy
  3. Irritable
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7
Q

What is the FIRST LINE Mx of Generalised Tonic-Clonic seizures?

A

Sodium valproate

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8
Q

What is the SECOND LINE Mx of Generalised Tonic-Clonic seizures? (2 things)

A
  1. Lamotrigine
  2. Carbamazepine
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9
Q

Where in the brain do Focal seizures start?

A

Temporal lobes

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10
Q

What are the CF of Focal seizures?

A
  1. Hallucinations
  2. Memory flashback
  3. Deja vu
  4. Doing weird things on autopilot
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11
Q

What is the FIRST LINE Mx of Focal seizures? (2 things)

A
  1. Carbamazepine
  2. Lamotrigine

(opposite order of Generalised Tonic-Clonic seizures)

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12
Q

What is the SECOND LINE Mx of Focal seizures? (2 things)

A
  1. Sodium valproate
  2. Levetiracetam
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13
Q

What type of seizures typically happens in children?

A

Absence

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14
Q

What are the steps of the CF of Abscence seizures in children? (3 steps)

A
  1. Pt goes blank
  2. Stares into space
  3. Returns to normal
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15
Q

How long do Absence seizures typically last?

A

10-20 seconds

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16
Q

Do children stop having absence seizures as they get older?

A

Yes, most of them (more than 90%)

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17
Q

What is the FIRST LINE Mx of Absence seizures? (2 things)

A
  1. Sodium valproate
  2. Ethosuximide
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18
Q

What are Atonic seizures also called?

A

Drop attacks

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19
Q

What are the CF of Atonic seizures?

A

Brief lapses in muscle tone

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20
Q

How long do Atonic seizures usually last?

A

3 minutes max

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21
Q

When in the patients life do Atonic seizures typically begin?

A

Childhood

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22
Q

What syndrome do Atonic seizures possibly indicate?

A

Lennox-Gastaut syndrome (type of epilepsy)

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23
Q

What is the FIRST LINE Mx of Atonic seizures?

A

Sodium valproate

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24
Q

What is the SECOND LINE Mx of Atonic seizures?

A

Lamotrigine

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25
Q

What are the CF of Myoclonic seizures?

A

Sudden brief muscle contractions (like sudden jump)

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26
Q

Do children remain awake during Myoclonic seizures?

A

Yes

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27
Q

What type of Epilepsy do Myoclonic seizures typically indicate?

A

Juvenile myoclonic epilepsy

28
Q

What is the FIRST LINE Mx of Myoclonic seizures?

A

Sodium valproate

29
Q

What is the SECOND LINE Mx of Myoclonic seizures? (3 things)

A
  1. Lamotrigine
  2. Levetiracetam
  3. Topiramate
30
Q

What are Infantile Spams also known as?

A

West Syndrome

31
Q

How rare is Infantile Spasms (aka West Syndrome)?

A

1/4000

32
Q

When does Infantile Spasms (aka West Syndrome) typically start?

A

6 months

33
Q

What are the CF of Infantile Spasms (aka West Syndrome)?

A

Clusters of full body spasm

34
Q

What is the prognosis of Infantile Spasms (aka West Syndrome)?

A

Poor: 1/3 die by age 25

35
Q

What proportion of people with Infantile Spasms (aka West Syndrome) are safe?

A

1/3 are seizure free

36
Q

What is the FIRST LINE Mx of Infantile Spasms (aka West Syndrome)? (2 things)

A
  1. Prednisolone
  2. Vigabatrin
37
Q

What are Febrile convulsions?

A

Seizures when children have a Fever

NOT CAUSED BY EPILEPSY

38
Q

Are Febrile convulsions caused by epilepsy?

A

No

39
Q

What ages do Febrile convulsions usually occur at?

A

6 months to 5 years

40
Q

Do Febrile convulsions cause any lasting damage?

A

No

41
Q

What proportion of children who have a Febrile convulsion will have another one?

A

1/3

42
Q

Does having Febrile convulsions increase the risk of developing epilepsy in the future?

A

Slightly

43
Q

What are the key parts of the Hx in the diagnosis of Epilepsy?

A

Distinguishing between Seizures vs Vasovagal Episodes / Febrile Convulsions

44
Q

Do children with a clear Hx of Vasovagal Episodes / Febrile Convulsions need any further investiagations?

A

No

45
Q

What investigations can you do for sus Epilepsy in children? (2 things)

A
  1. EEG
  2. MRI brain
46
Q

What additional investigations can you do for sus Epilepsy in children? (5 things)

A
  1. ECG
  2. Blood electrolytes
  3. Blood glucose
  4. Blood / urine cultures
  5. Lumbar puncture
47
Q

What is the point of EEG in Epilepsy Dx?

A

Will show typical patterns of different types of Epilepsy

48
Q

When should you do an EEG on a child with sus Epilepsy?

A

After SECOND simple tonic-clonic seizure

(Kids only allowed to have ONE simple seizure before being investigated for epilepsy)

49
Q

What is the point of an MRI brain in a child with sus Epilepsy?

A

Visualise brain structure –> can diagnose structural problems (e.g tumours) associated w seizures

50
Q

When should you consider doing an MRI brain in a child with sus Epilepsy? (3 things)

A
  1. 1st seizure in child under 2 yrs
  2. Focal seizures
  3. No response to First line anti-epileptic meds
51
Q

What is the point of doing an ECG in a child with sus Epilepsy?

A

Exclude heart problems

52
Q

What is the point of doing Blood glucose in a child with sus Epilepsy?

A

Checking for hypoglycaemia / DM

53
Q

What are you suspecting if you do Blood / urine cultures / Lumbar puncture in a child with sus Epilepsy? (3 things)

A
  1. Sepsis
  2. Encephalitis
  3. Meningitis
54
Q

Sodium Valproate is a FIRST LINE anti-epileptic for most types of epilepsy except which type?

A

Focal seizures

55
Q

What is the MOA of Sodim Valproate?

A

Increases GABA activity –> relaxes brain

56
Q

What are the side fx of Sodium Valproate? (4 things)

A
  1. Hair loss
  2. Liver damage / hepatitis
  3. Teratogenic (so be careful w contraception)
  4. Tremor
57
Q

Because of the Teratogenic fx of Sodium Valproate, what are the NICE guidelines recommendations for it? (2 things)

A
  1. Avoid in girls unless NO suitable alternative
  2. Make sure these girls DO NOT get pregnant
58
Q

What is the FIRST LINE Mx for Focal seizures?

A

Carbamazepine

59
Q

What are the side fx of Carbamazepine? (3 things)

A
  1. Agranulocytosis
  2. Aplastic anaemia
  3. Enzyme inducer
60
Q

What are the side fx of Phenytoin? (2 things)

A
  1. Megaloblastic anaemia (bc Folate deficiency)
  2. Osteomalacia (bc Vit D deficiency)
61
Q

What are the side fx of Ethosuximide? (2 things)

A
  1. Night terrors
  2. Rashes
62
Q

What are the side fx of Lamotrigine? (2 things)

A
  1. Stevens-Johnson syndrome / DRESS syndrome (aka life threatening skin rashes)
  2. Leukopenia (low WCC)
63
Q

What is the definition of Status epilepticus? (2 definitions)

A
  • Seizure lasting 5+ mins

OR

  • 2+ seizures w/o regaining consciousness in between
64
Q

How do you manage Status Epilepticus using the ABCE approach? (8 steps)

A
  1. Secure airway
  2. Oxygen
  3. Check Heart + Lungs function
  4. Check BG
  5. IV access: Lorazepam (repeat after 10 mins if seizure continues)
  6. If still continuing: IV Phenobarbital / Phenytoin
  7. Consider Intubation / Ventilation (to secure airway)
  8. ITU
65
Q

What are some medication Mx options for Status epilepticus? (2 things)

A
  1. Buccal midazolam
  2. Rectal diazepam

#phase 2.2: paediatrics (18 decks)

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