Epilepsy

Question 1

How is epilepsy defined in children?

Answer 1

2 unprovoked seizures at least 24 hrs apart or a tendency to seizures due to abnormal electrical activity

Question 2

What can cause non-epileptic seizures?

Answer 2

Febrile convulsions
CNS infection
Metabolic - hypoglycaemia, abnormal sodium levels, hypocalcaemia, low Mg
Acute trauma 
Toxins

Question 3

What else may include convulsions but is not epilepsy?

Answer 3

Syncope
Reflex atonic seizures 
Sleep myoclonus 
Migraine 
Arrhytmia - long QT 
Tics

Question 4

Define reflex tonic seizures

Answer 4

Stimulus like pain, cold food or fright leading to asystole which leads ti generalised tonic clonic seizure due to low brain oxygen.

Question 5

Define sleep myoclonus

When does it usually start?

When does it resolve?

Answer 5

A benign random series of myoclonic movements during or just before/after sleep.

Usually happens in neonates

Infancy

Question 6

Different generalised epilepsy

Answer 6

Tonic-clonic
Absence
Infantile spasms/West syndrome
Myoclonic

Question 7

What happens in a tonic-clonic seizure?

Answer 7

Limbs stiffen - tonic phase
Forceful jerking - clonic phase
Loss of consciousness

Question 8

What happens in an absence seizure?

How long?
What happens to the eyes?

Answer 8

10 seconds

Pauses mid sentence and carries on where he left off
Eyes may roll up
They are unaware

Question 9

What happens in an infantile spasm/in West syndrome?

Answer 9

Cluster of head nodding and arm jerks every 3-30 seconds

Question 10

What happens in a myoclonic seizure?

Answer 10

Thrown directly to ground

Question 11

What happens in a partial seizure in the brain?

Presentation?

Answer 11

Just one hemisphere

Temporal lobe fits
Reduced consciousness
Automatisms - lip smacking, rubbing face, running
Fits of pure pleasure

Question 12

Imaging used

Answer 12

EEG

MRI

Question 13

Physiological and emotional episodes

Answer 13

Breath holding attacks - crying then breath holding in toddler - may become cyanosed and have a short seizure
Panic attacks

Question 14

Management:

Emergency management

What to give if temperature is high?

What is important to do once the seizure starts?

Answer 14

ABCDE

AB - Give oxygen
C - IV access - do BP, glucose, calcium

Rectal paracetamol

Start the timer

Question 15

Management:

Stepwise ladder for seizure control:

What is done at 0 minutes?

What is given at 5 minutes?

What is given at 15 minutes?

What is given and prepared at 20 minutes?

What is done at 40 minutes?

Answer 15

0 - High flow oxygen - estimate weight - check BM - IV access

5 - Lorazepam IV for Buccal Midazolam

15 - Repeat lorazepam - call for senior help - prepare phenytoin

20 - phenytoin IVI - monitor ECG / phenobarbital over 5 minutes
Call PICU and anaesthetist just in case

40 - Transfer to PICU

Question 16

Management:

Medication that can be given to long term Rx:

• Starts with C - sounds like carbon
• The main one you know
• Starts with E
• Starts with L - might have heard it in the GP
• Starts with Vig
• Starts with Leve

Answer 16

Carbamazepine

Sodium valproate

Ethosuxamide

Lamotrigine

Vigabatrin

Levetiracetam

Question 17

Management:

Diet recommended

What advice about personal hygiene is given to reduce the risks a seizure can bring?

What is kindling and why is it important?

Answer 17

High-fat ketogenic diet under specialist supervision if 2 drugs fail to work

Showers are safer than baths

Having a lower threshold for another seizure after having a seizure. Need to emphasise compliance/concordance.