Epilepsy in children Flashcards

1
Q

Define epilepsy.

A

Two or more seizures unprovoked by an immediately identifiable cause.

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2
Q

How does the International League Against Epilepsy (ILAE) classify seizures?

A

By localisation (in which part of the brain the epileptic activity starts) and aetiology.

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3
Q

What are the different classifications for seizures?

A

Generalised: Large part of cortex is involved, consciousness in impaired

Localised (focal, local, partial): Begins in a focal area of the cerebral cortex

Symptomatic epilepsy: Cause is known

Cryptogenic epilepsy: Presumed to be symptomatic but the etiology is not known

Idiopathic epilepsy: No apparent cause

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4
Q

Explain the pathophysiology of epilepsy.

A

Imbalance between excitatory and inhibitory neurotransmission resulting in high-frequency burst activity seen as spike and wave on EEG. Seizure propagates if sufficient surrounding neurons are recruited.

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5
Q

What are risk factors and associations with epilepsy?

A

Idiopathic: Many have +ve FH

Symptomatic: Head trauma, encephalitis, meningitis, CNS tumours, hypoxic-ischaemic injury, intrauterine infections, cerebral dysgenesis

Associations: Non-epileptiform attack disorder (AKA. pseudo-seizures)

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6
Q

Summarise the epidemiology of epilepsy.

A

1% of children suffer from epilepsy

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7
Q

What are the symptoms of an absence seizure?

A

Onset 4-12y.

Short episodes (<30s) during which the child stares or blinks, with no apparent awareness of the surrounding.

No aura or postictal phase.
May present as ‘day dreaming’ in class + reduced performance in school.
Usually undergo spontaneous remission during adolescence.

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8
Q

What are the symptoms of a myoclonic seizure?

A

Sudden brief muscle contractions; often cluster within a few minutes.

If they evolve into rhythmic jerking movements, they are classified as a clonic seizure.

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9
Q

What are the symptoms of an atonic seizure?

A

Consist of brief loss of postural tone, often resulting in falls and injuries. This seizure type occurs in people with significant neurological abnormalities.

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10
Q

What are the symptoms of a clonic seizure?

A

Rhythmic, jerking movements

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11
Q

What are the symptoms of a tonic seizure?

A

Sudden-onset tonic extension or flexion of the head, trunk and/or extremities for several seconds.

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12
Q

What are the symptoms of a generalised tonic-clonic seizure?

A

Tonic extension lasting for a few seconds followed by clonic rhythmic movements and a prolonged postictal phase.

Often associated with tongue biting, urinary or faecal incontinence.

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13
Q

What are the symptoms of status epilepticus?

A

A generalised convulsion lasting > 30 minutes or repeated convulsions occurring over 30 minutes without recovery of consciousness between each convulsion.

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14
Q

What are the symptoms of a simple partial seizure?

A

Seizure with preservation of consciousness; includes sensory, motor, autonomic and psychic experiences. Tonic or clonic movements are initially localised but may move to different parts of the body if the seizure is propagated.

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15
Q

What are the symptoms of a complex partial seizure?

A

Similar to simple partial seizure but consciousness is impaired and the episode is followed by postictal phase.

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16
Q

What are symptoms of a partial seizure with secondary generalisation?

A

Focal seizure is followed by GTCS.

17
Q

What are symptoms of Lennox-Gastaut syndrome?

A

Affects children aged 1-3 years. Characterised by multiple seizure types (tonix-axial, atonic and absence seizures), developmental regression and learning disability. Often chronic epilepsy resistant to therapy.

18
Q

What are symptoms of benign childhood epilepsy with centrotemporal spike?

A

Affects children aged 4-10 years. Clonic seizures affecting face and upper limbs usually during sleep; may progress to GTCS. Also known as benign Rolandic epilepsy. Usually undergo spontaneous remission during adolescence.

19
Q

What are symptoms of juvenile myoclonic epilepsy?

A

Affects adolescents; idiopathic generalised epileptic syndrome characterised by myoclonic jerks, GTCS and sometimes absence seizures, usually on awakening. Usually require lifelong treatment but not associated with intellectual impairment.

20
Q

What are appropriate investigations for epilepsy?

A

General and neurological examination must be performed to rule out specific aetiologies and focal neurological signs.

EEG: Epileptiform spike and wave activity correlates with different forms of epilepsy (hypsarrhythmia in infantile spasms)

MRI: To rule out underlying pathology, e.g. glial tumour

Lumbar puncture: If infective cause suspected ECG/ECHO/lying/standing

BP: To exclude other causes of fit, faints and funny turns

21
Q

What is the management for epilepsy?

A

Education: Explain nature of epilepsy to parent + child. Aim is to give child the most confidence + independence possible. Avoid precipitating factors such as alcohol, sleep deprivation, drugs. Supervision when in pools or baths. Info on driving + insurance. Advice on sudden unexpected death in epilepsy (SUDEP). SEs of AED (e.g. teratogenicity of sodium valproate).

Follow-up: All children with epilepsy should have structured review at least yearly.

Acute Tx of seizure: Long-term antiepileptic medication

22
Q

What anti-epileptic medication can be used for generalised epilepsy?

A

Absence seizures: Ethosuximide, Sodium valproate

Myoclonic: Sodium valproate, lamotrigine, topiramate, levetiracetam (adjunct).

Tonic-clonic: Sodium valproate (first-line), topiramate, lamotrigine, levetiracetam (adjunct).

23
Q

What anti-epileptic medication can be used for partial epilepsy?

A

Carbamazepine (first-line), topiramate, lamotrigine, gabapentin.

24
Q

What anti-epileptic medication can be used for epilepsy syndromes?

A

Infantile spasms: ACTH, prednisolone, vigabatrin.

Lennox–Gastaut syndrome: Lamotrigine, topiramate, vigabatrin.

Benign childhood epilepsy with centrotemporal spike: Carbamazepine (problematic or daytime seizures only).

Juvenile myoclonic epilepsy: Sodium valproate.

25
Q

When may the ketogenic diet be considered for children with epilepsy?

A

Children with drug-resistant epilepsy

26
Q

What are complications associated with epilepsy?

A

Developmental delay

Poor school performance

SUDEP (500 deaths/year)

27
Q

What is the prognosis of epilepsy?

A

Remission depends predominantly on the type of epilepsy.

Patients with epilepsy have a mortality rate 2–3 x that of the general population.