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child health diploma > Epilepsy > Flashcards

Epilepsy Flashcards

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1
Q

Epilepsy

A

Psychic /physical changes that occur associated with abnormal electrical activity

Provoked fever, illness medication ( eg high dose paradox)
Epilepsy is rpt unprovoked seizures

Definition
2 unprovoked seizures occurring >24hours apart
OR
One unprovoked seizure and high Probability of further seizure
OR
Diagnosis of epilepsy syndrome

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2
Q

Epilepsy resolved

A

1 an age dependent epilepsy now past that age

Or
2 remained seizure free for at least 10years and off anti seizure meds for the last 5 years

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3
Q

Epilepsy is treatment responsive in what %

A

70% of kids responds to treatment with epilepsy

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4
Q

Incidence of Epilepsy

A

5/1000

10% of pt in developed countries DONT get treatment
30-90% Don’t get treatment in developing countries

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5
Q

Epilepsy

A

Higher unemployment/
2-3x depression / suicide
School and workplace
Social withdrawal

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6
Q

Co morbidities of Epilepsy

A

1 learning disorders ID
2 ASD
3 anxiety and depression 2-3x incidence of general population
4 motor dysfunction

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7
Q

Mortality of E

A

Young child with E about the same as other children
Adolescent with poorly controlled Epilepsy
1. SUDEP sudden unexplained death with epilepsy
2 status epilepticus
HI drowning burns with epilepsy

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8
Q

Classification of E

A

1 Focal/ generalized
2Genetic ( idiopathic ) / Symptomatic ( secondary to something wrong with the brain eg TS, NF1, Retts trisomy 21, fragile x
3 unknown etiology (30-40% of all Epilepsy)
Genetic single gene disorder
Or complex inheritance eg JME

If you know the diagnosis you can work out the prognosis

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9
Q

DD of E

A

Neurological epilepsy,migraines, episodeic ataxia
Movement disorder

Other 
Faint
Cardiac prolonged QT syndrome
Normal behavior ( esp <2year)
GIT
metabolic 
Psychological
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10
Q

Syncope VS epilepsy

A 
1 triggers   Syncope FREQ. ( rare in epilepsy 
2 preceding symptoms 
    Faint N,V, blurring of vision headache 
    Epilepsy. AURA sensory somatic 
3 blanks.  Faint ‘fading away’
    Epilepsy  abrupt loss
4 fall fluid ,slow faint
Epilepsy fast and tonic

Fit
faints can fit brief irregular jerking
Epilepsy tonic clonic and tonic

Duration
15-30Sec in a faint
Epilepsy 30S -5mins

Post ictal
Faint tired and headache
Epilepsy. Confusion / headaches

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11
Q

Triggers in syncope

A 
Mictuiciton 
Defecation 
Trumpet playing 
Cough 
Post prandial
Sneezing 
Diving 
Crowded places
Standing too long
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12
Q

Benign rolandic epilepsy

A

Commonest school age Epilepsy
Age 3-13year
Simple focal seizure awareness can be preserved and then become GTCE
Often have oral /facial symptoms
Unilateral or Tonic clonic face and then spread generalized TCE
Speech arrest
Lots of saliva
Preservation of consciousness
Characteristics EEG
EEG changes can be seen in kids with no seizures

Status E is rare
Nocturnal Seizures >50%
Prognosis EXCELLENT

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13
Q

Childhood absence Epilepsy

A 
2nd most common in childhood 
Onset 5-7years 
EEG characteristic 3 pcs spike wave
Short 5-20s
Abrupt onset and termination (eg stop walking/stop eating)
They are unaware
Remission about 80% by puberty 
20% don’t can go on the GTCE
May be associated with poor social achievement and cognitive difficulties
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14
Q

FRONTAL lobe epilepsy

A

2x more common than temporal lobe epilepsy

Brief multiple often NOCTURNAL seizures

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15
Q

Treatment of epilepsy

A 
1 patient factors 
Epilepsy type 
Weight
Comorbities 
Sex females 
Compliance once a day Vs tds

2 drug factors
Side effects ( most drugs being stopped because of side effects)
Toxicity
Efficacy old vs the new about same effectiveness
Different side effects

Side effects weight and cognitive issues important and behavioral effects

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16
Q

Stopping / discontinuing medications

A

Recommendation is seizure free >= 2 years

Overall60% chance of successful withdrawal

17
Q

Therapeutic options for sever childhood epilepsy

A

Ketogenic diet good alternative esp <5yr bad epilepsy
Surgery good outcomes in well chosen pt
Vagal nerve stimulation palliative does decrease number of fits
New AEDs

18
Q

Juvenile myoclonic epilepsy JME

A

Common
Onset 13-15 years
90% present with GTC seizure
<10% abscences

Treatment
Males is valproate
Females NOT VALPORATE because 15X more likely to have fetal malformations and learning difficulties (keppra)

19
Q

Baby with a funny turn

A 
Benign neonatal sleep mycolonis 
Only in sleep 
Goes away when they wake up 95% of cases
Normal development 
Grow out of them by 6/12
Can startle /jerkers with noise or tactile stimulus

Infantile spasm
2-12/12 of age
DEVELOPMENTal regression ( if child normal development NOT likely infantile spasm
Cause chromosome or lesion in head

Investigations urine metabolic scree FBC/Elfts EEG ca++ Mg++ Phophae
B12 <2year TREATABLE cause
AVOID VALPORATE in children <2year
Could have a mitochondrial cause and adding VALPORATE will kill them

20
Q

NonEpiletic episodes in children funny turns

A 
20-25% of children referred with diagnosis of epilepsy don’t have it 
Common ones 
Staring 35%
Sleep changes 30%
Movement disorders 30% shuddering tremor dystopia 
Migraine normal movement 
Masturbation 
Aponea 
CVS problem
21
Q

Paroxysmal non epileptic disorders

A 
Syncope
Movement disorders 
Psychological pseudo seizures
Migraines 
Toxic/metabolic
Sleep problems 
Others
22
Q

Syncope

A 
Common 30-50% of people have them 
Peak in adolescence
CARDIAC causes needs to be ?
Family history of sudden death /arryhthmia /cardiomyopathy 
Can be triggered lots of stress/ exercise 
Supine posture
Swimming/diving breath holding 
Investigations ECG and EEG

Infant fainting. 5% of children who are well
Family history 20-35%
Cyanotic 54% breathholding

Can try iron supplementation may help

23
Q

Sleep related events

A

Epilepsy
Arousal disorders ( night terrors sleep walking)
Sleep wake transition-disorder ( jerking, rhythmic movement disorder
REM sleep disorders eg nightmares

Night terrors 
Sudden onset unresponsive inconsolable 
usually <15mins ( but can be up to 30m)
1-5% 5-7 years of age
May sleepwalk 
>90% have a family history 
Ppt by stress, fatigue,medications 
Rhythmic movement disorder of sleep 
Stereotype rpt movements body and head 
Occurs between sleep wake transition
Onset <18/12 of age
Child will h ave a normal healthy life
24
Q

Blank staring episodes

A

Focal epilepsy brief freq interrupt play/speaking/eating
Absence epilepsy (warning, longer events, stereotype sequence)
Daydreaming happen in low stimulation environments
Diagnosis video the events
Routine EEG

25
Q

Movement disorders

A

Jitters ( common in infants)
Shuddering
GOR ( arching back neck ext)
Remor

26
Q

Stereotypes

A

Repetitive purposeless movements body rocking flapping
See in development delay ASD normal

Body rocking head banging head rolling

In normal children has a good prognosis

27
Q

Pseudoseizures

A

Marker of stress trauma sexual abuses
Dd movement disorder frontal lobe epilepsy

Clues 
Gradual onset 
Prolonged duration 
Eyes closed 
Failure to respond to medication 
Temporal relationship to stress
28
Q

Non epileptic events do require investigation T/F

A

Sometimes need investigations eg cardiac causes

GORD migraine vertigo

29
Q

Evaluating a seizure in an adolescent

A

Who wittnessed
When did it happen? Day/night
Did it happen during drowsiness or sleep or wakefulness
Assoc with sleep depreciation JME
Drugs/alcohol JME
Provoking factors loud noise/ flickering lights emotion
Aura ( ask about early morning days weeks before the turn lightening like jerks or arms and legs JME)
Assoc injury/ Urineary incontinence
Weakness confusion post ictal

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