Fits

Question 1

After how long does a fit continue for before it is required to call an ambulance?

Answer 1

If a fit lasts for more than 5 mins, an ambulance should be called.

Question 2

What are the non-seizure events of fit-like episodes?

Answer 2

Syncope/Faints

Cardiac syncope

Question 3

What are the possible causes of true seizures?

Answer 3

Febrile convulsions
Primary epilepsy
Secondary epilepsy: due to cerebral palsy, structural brain lesions or syndromes
Reflex anoxic seizures
Alcohol and drug intoxication or withdrawal
Head injuries (can also include non-accidental injuries, in the case of child abuse)
Infections: Meningitis or Encephalitis
Metabolic: Hypoglycaemia, Hyponatraemia or Hypocalcaemia

Question 4

What is convulsive status epilepticus?

Answer 4

Convulsive status epilepticus is a convulsive seizure lasting for more than 5mins, or when convulsive seizures occur one after another with no recovery in between

Question 5

What is the treatment given for those with convulsive status epilepticus?

Answer 5

Buccal Midazolam (Buccolam).
Alternatively, rectal diazepam or IV lorazepam

Question 6

What is the common post-ictal symptom?

Answer 6

Drowsiness

Question 7

What is a common complain after the post-ictal period when the child comes around?

Answer 7

Headache

Irritability in young children

Question 8

What must be checked in any children who have collapsed or are unconscious?

Answer 8

Blood sugar level

Question 9

What is given if seizures continues for over 20 mins?

Answer 9

Phenytoin 18mg/kg

If Phenytoin is already taken by the patient, give phenobarbitone 20mg/kg over 10mins

Question 10

What is SUDEP?

Answer 10

SUDEP stands for Sudden Unexpected Death in Epilepsy

Question 11

How can the risk of SUDEP be minimised?

Answer 11

By optimising seizure control and being aware of potential consequences of nocturnal seizures

Question 12

What are breath holding spells? Describe the process.

Answer 12

Breath holding spells are characteristically precipitated by crying due to pain or temper. The child cries once or twice, stops breathing and becomes deeply cyanotic.
Transient loss of consciousness and convulsive jerks or stiffening of limbs may occur.
The child then goes limp, resumes breathing and is fully alert again.

Question 13

When should MRI be done?

Answer 13

MRI is indicated in those:

• who develop epilepsy before age 2 years or in adulthood
• who have any suggestion of a focal onset on history examination or EEG
• in whom seizures continue despite 1st line medication

Question 14

What are the key diagnostic features of breath-holding spells?

Answer 14

Breath-holding spells are typically preceded with crying and breath-holding. There is also no post-ictal phase.

Question 15

How long does the whole episode of breath-holding spells lasts for?

Answer 15

Breath-holding spells typically lasts for less than 1 minute.

Question 16

What is the condition:
A 6 month old child who turns pale and collapse following a bump to the head. There is eye-rolling backwards and clonic stiffening of the limbs. Rapid recovery with no postictal drowsiness.

Answer 16

Reflex anoxic seizures

Question 17

What is the peak age range of children with reflex anoxic seizures?

Answer 17

6 months to 2 years

Question 18

What usually precedes reflex anoxic seizures?

Answer 18

A bump to the head or other minor injury that triggers an excessive vagal reflex, causing transient bradycardia and circulatory impairment.

Question 19

When is hypsarrhythmia seen?

Answer 19

Hypsarrhythmia is seen in infantile spasms

Question 20

Infantile spasms peaks during?

Answer 20

Infantile spasms peaks between 4 - 8 months

Question 21

What is the characteristic feature of infantile spasm?

Answer 21

A sudden tonic flexor spasm of the head and trunk, causing the child to bend forward.
Although extensor spasms are sometimes seen

Question 22

What is the other name for infantile spasm?

Answer 22

West’s Syndrome

Question 23

When are clusters of West’s syndrome more common?

Answer 23

Clusters are more common on awakening or just before sleep.