Faints, fits and funny turns Flashcards
What do you want to know when taking a history (9)
- Frequency: how often, single event, recurrent
- Timing- certain time if the day e.g., during sleep
- Trigger- tiredness, travel, exercise
- Warning beforehand- called an aura
- Duration- how long, if it occurs in clusters, if consciousness was regained halfway through
- Colour change- pallor, cyanosis
- Alteration in consciousness- is it impaired
- Recovery and any symptoms afterwards- does the child behave normally
- Record accurately- what happened just before, during and after the event
- What is a paroxysmal event
- Are they epileptic or non-epileptic?
- A seizure
- They can be epileptic or non-epileptic
Are epileptic seizures provoked?
How often do they occur?
Is an acute symptomatic seizure secondary to acute insults classed as epilepsy?
epileptic seizures are unprovoked and recurrent
Acute symptomatic seizures secondary to acute insults are NOT epilepsy E.g., if anyone’s blood glucose drops low enough, they will have a seizure
What is the value of EEG?
Role of EEG is limited and must be used judiciously, as both false positives and false negatives occur.
EEG only answers what type of seizures not where the seizures are.
Name 8 general descriptions (phenotypes) of seizures
- Tonic
- Clonic
- Atonic
- Myoclonic
- Vacant
- Focal seizures complex
- Focal seizures simple
- Focal with secondary generalisation
Tonic seizure
a prolonged period of contraction of one or several muscle groups
Rigidity- Body straightens and stiffens.
Clonic seizure
Clonic- rhythmic contractions followed by a slower relaxation phase. (febrile seizures usually tonic-clonic).
Myoclonic seizure
brief
fast contraction followed by muscle relaxation
Vacant seizure
- Absences-
- characterised by arrest of activity
- are brief and multiple
- vacant gaze
- with automatism such as lip smacking, eyelid flickering.
Focal seizure (complex)
UNconsciousness
affects certain part of the brain
action doesnt spread and affects discrete parts of the body (e.g., one arm repeatedly contracting)
Focal seizure (simple)
- characterised bY consciousness
- Affects certain parts of the brain that doesn’t spread
- Affects discrete parts of the body (e.g., one arm repeatedly contracting)
Focal seizures with secondary generalisation
starts in one area and spreads elsewhere (treat with carbamezapine)
Non epileptic conditions (12) non essential bar febrile seizures
- Benign neonatal sleep myoclonus
- Benign neonatal seizures
- Hypoglycaemia
- Day 3 seizures
- Parasomias
- Syncope
- Cyanotic breath holding spells
- Reflex anoxic seizures (pallid syncope)
- Sandifer syndrome with GORD
- Hyperekplexia
- Daydreaming
- Febrile seizures, tics, infantile shudder, shivering due to excitement, cataplexy
Cyanotic breath holding spells
cyring convulsion and blue spells
Reflex anoxic seizures (pallid syncope)-
usually caused by an acute painful event.
Sandifer syndrome with GORD,apnoea and dystonic reaction
trying to maintain a dystonic kind of posture to alleviate the symptoms of GORD.
Hyperekplexia
- whole body stiffening in response to sudden noise
Febrile seizures, tics, infantile shudder, shivering due to excitement, cataplexy
condition in which strong emotion or laughter causes a person to suffer sudden physical collapse though remaining conscious)
Epileoptic syndromes (5)
- Infantile spasms (WEST DYNDROME)
- Rolandic epilepsy. Benign epilepsy with centro-temporal spikes
- Childhood absence epilepsy
- Juvenile mycoclonic epilepsy
- Febrile seizures/ convulsion
Infantile spasms (West syndrome)
- Usually between 4-7 months
- Sudden jerking of the neck, trunk and limb contraction (Salam attacks)
- Clusters pf attacks sometimes hundreds per day
- Rolandic epilepsy. Benign epilepsy with centro-temporal spikes
- Typical age 3-12 years
- From sleep
- Focal onset- facial or perioral
- Expressive aphasia or guttural sounds
- Post-ictal drooling
- Sensory and/ or motor
- EEG shows centro-temporal spikes activated by sleep
- Childhood absence epilepsy
- 2-8 years
- More common in girls
- Typical clinical features include:
- Child freezes (typically <5secs)
- Perioral or periocular flickering movements may be seen
- Unrousable/ unresponsive during the episode
- Rapid recovery, as if nothing has ever happened
- Occurs tens or hundreds times a day
- EEG shows 3Hz generalised wave form
- Juvenile mycoclonic epilepsy
- 12-18 years onset
- First generalised tonic-clonic seizures
- GTC seizures often preceded by myoclonic jerks
- EEG shows polyspike discharges
- Awareness retained during myoclonic jerks
- Febrile seizures/ convulsion
- Very common between 6 months- 6 years
- Seizures that occur in a febrile illness in the absence of intracranial pathology
- Genetic predisposition- 10% risk in first degree relatives of index case
- Usually occur in early part of the illness when temp is rising quickly
- 30-40% risk of recurrence
- Risk is higher in <1 years
Classification of febrile seizures (2)
-
Simple-
- Generalised tonic-clonic, involves both sides of the brain
- Brief (less than 15 mins)
- Full recovery
- Occur only once per one illness
- No increased risk of future development of epilepsy
-
Complex febrile seizures
- Prolonged >15 mins
- Focal
- Multiple seizures in the same illness
- Persistent cognitive impairment (remain drowsy post-ictal)
management of febrile seizures
- Place the child on a safe flat surface, no risk of falling
- Time- if seizure lasts more than 5 minutes then ring 999 (99% terminate before this time)
Acute management (hospital setting)
- ABCD
- Give oxygen
- Note time
- Check BM
- Get IV access if possible- give benzodiazepine if possible (overdose can cause respiratory depression)
- Follow APLS algorithm if possible
infections that usually precipitate febrile seizures
- Urti
- UTI
- chest infections
