Epilepsy and Neurology

Question 1

Whats the minimum no. of seizures you must have had to be diagnosed with epilepsy?

Answer 1

2

Question 2

Status epilepticus: Def, Mx (APLS algorithm)

Answer 2

Sizure longer than 5m or when sizures occur one after the other with no recovery between.
PPx:
Highest in children and >60s
70% of children with epilepsy beginning in infancy with expererience at least 1 episode.

ABC
Vascular access?
If yes: IV Lorazepam 0.1 mg/kg
If no: Midazolam buccal [6-12m, 2.5mg, 1-5yrs 5mg, [ or rectal diazepam [dose]

Question 3

SUDEP

Answer 3

Sudden unexpected death in epilepsy in which PM exam does not reveal a toxicological or anatomical reason

Question 4

NEAD

Answer 4

Non-epileptic attack disorder. Episodes of change in behaviour or movement, not caused by primary change in electrical activity. Movements are varied and the attacks

Question 5

DDx/Ix for seizures?

Answer 5

Hypoglycaemia (blood glucose)
CNS Infection e.g. meningitis, encephalitis, TB, malaria (raised temp/WCC)
Febrile convulsions
Trauma (signs of raised ICP, child abuse)
Drugs (hx of recreational drug use)

Question 6

Juvenile myoclonic

Answer 6

15% of absence seizure epilepsy go on to this

Presents with 3 types: Tonic clonic, absence, myoclonic

Question 7

Gen tonic clonic

Answer 7

Clonic seizures - should be symmetrical (if asymmetrical pattern query NEAD)
May get tongue biting, incontinence
Post ictal confusion (want to sleep after)

Question 8

What is most common cause of neonatal seizures?

Other causes?

Answer 8

HIE (hypoxic-ischaemic encephalopathy)
Intracranial haemorrhage, metabolic disturbances (e.g. hypoglycaemia)
[FINISH]

Question 9

Seizures: Ix?

Answer 9

Video, ECG, MRI or CT brain (for haemorrhage in resus), EEG has limitations is not first line and often not diagnostic

Question 10

Epilepsy syndromes (the four syndromes that she said to learn)

Answer 10

Infancy
-West syndrome: infantile spasms, usually 3 to 18/12 MUST BE TREATED quickly OTHERWISE–> DISABILITY. Treated with steroids/IM ACTH.
Childhood period epilepsy syndromes:
-Childhood absence epilepsy
-Benign epilepsy with centrotemporal spikes
Adolescece/adult
-juvenile myoclonic (sodium valproate - TERATOGENIC 10x risk) - n.b although this is called JME this is just about the age of onset. You can be 70 years old with JME.

Question 11

Can you drive with epilepsy?

Answer 11

Yes if you’ve been seizures free for 1 day

Question 12

Cerebral palsy

Mr Cook - clinic

Answer 12

Neurological disorder caused by a non-progresive brain injury or malformation that occurs while the child’s brain is under development. Primarily affects movement and coordination.

Question 13

Classic gait fo mild hemiplegia

Answer 13

Flexion of arm at elbow/wrist

Circumduction due to tight achilles