Fits and 'funny turns' Flashcards
What is the most common cause of epileptic seizures?
70-80% are ‘idiopathic’ - this is likely a genetic cause/disposition
Aside from genetics, what are the other causes of epileptic seizures?
Cerebral tumour
Neurodegenerative disorders
Neurocutaneous disorders
Secondary to cerebral dysgenesis/malformation, vascular occlusion or damage from IVH, HIE or congenital infection
What is the initial management to stop a seizure with vascular access?
Vascular access? - Lorazepam 0.1mg/kg
What is the initial management to stop a seizure without vascular access?
No vascular access? - Diazepam 0.5mg/kg PR or Midazolam (buccal) 0.5mg/kg
Is there a genetic predisposition to febrile seizures?
Yes
What proportion of children will go on to have subsequent febrile seizures following their first?
30-40%
What type of febrile seizures carries an increased risk of developing epilepsy?
Complex febrile seizure
What is the increase in risk of developing epilepsy in complex febrile seizures?
4-12%
What is a complex febrile seizure?
A seizure that is focal, prolonged or repeated in the same illness
What is the most important differential of a febrile seizure?
Bacterial meningitis
What features should trigger you to admit and treat as meningitis?
- Drowsy before seizure of GCS<15 one hour after seizure
- Neck stiffness
- Petechial (non-blanching) rash
- Bulging fontanelle
What is the medical term for a non-blanching rash?
Petechial
What features should trigger you to at least and admit and review (within 2 hours for LP) for potential bacterial meningitis cause of febrile seizure?
- Under 18 months
- Complex seizure
- The child has had antibiotics
- No other focus of the infection is found
What are the contraindications for LP?
- GCS <13
- Septic shock - low BP, poor perfusion, tachycardia
- Likely invasive meningococcal disease - rapid onset, haemorrhagic rash
- Signs of raised ICP
- Focal neurology
- Bleeding tendency
What is a reflex anoxic seizure?
Cardiac asystole from vagal inhibition results int he child becoming very pale and falling to the floor. Hypoxia may induce a generalized tonic-clonic seizure, followed by rapid recovery
What are the common triggers for reflex anoxic seizures?
- Pain - esp. minor head trauma, i.e. a bump
- Cold food
- Fright
- Fever
How many hemispheres does a focal seizure effect?
1
How many hemispheres does a generalized seizure effect?
2 (both)
How can a generalized seizure be defined?
A seizure that effects both hemispheres and causes a loss of/severe impairment of consciousness
What are the different types of generalized seizure?
- Absence
- Myoclonic
- Tonic
- Clonic
- Tonic-clonic
- Spasms
- Atonic
How can a simple focal seizure be defined?
A seizure that effects only one hemisphere and causes NO impairment of conciousness
How can a complex focal seizure be defined?
A seizure that effects only one hemisphere and causes a mild impairment of conciousness
What defines a focal seizure of frontal origin?
Motor Sx (due to presence of the motor cortex)
What defines a focal seizure of temporal origin?
Visual and auditory hallucinations (due to being responsible for speech and language) that may make the child fearful
What defines a focal seizure of parietal origin?
Sensory Sx
What defines a focal seizure of occipital origin?
Visual hallucinations - more crude than temporal seizures - e.g. colours and patterns
What is the origin of a seizure with related aura?
Simple focal origin (because patient is conscious)
Which types of seizure can be precipitated by hyperventilation?
Absence seizures
What are the types of non-epileptic myoclonus?
1) Hiccoughs
2) Sleep myoclonus
What is the characteristic HxPC in juvenile myoclonic epilepsy?
Adolescent that has become ‘clumsy’, particularly in the morning
What is the triad of West syndrome?
1) Infantile spasms
2) Hypsarrhythmia - ‘chaotic’ - EEG
3) Mental retardation
What is the common misdiagnosis made of West syndrome?
Colic
How is West syndrome managed?
Corticosteroids
Which epilepsy syndrome tends to be refractory to treatment?
Lennox-Gastaut syndrome
What is the epilepsy syndrome that causes children to present with stroke-like Sx?
Benign epilepsy with centrotemporal spikes (BECTS)
When do Sx with BECTS tend to be worse?
Night time - hence always bear in mind in a child that presents with ‘stroke’ in ED at night-time
What treatment should be given in BECTS?
Carbamazepine - but only treat if night-time Sx are frequent/effecting concentration
What defines Sandifer syndrome?
GORD + spasmodic torticollis
What is Marcus Gunn phenomena?
Rhythmic upward jerking of the upper eye lid that occurs with sucking and swallowing (i.e. while infants are feeding)
What causes Marcus Gunn phenomena?
An aberrant connection between the trigeminal and oculomotor nerve
What is a hyperekplexia?
An exaggerated startle response
What is the first-line treatment for tonic-clonic seizures?
Valproate
What is the first-line treatment for absence seizures?
Ethosuximide or valproate
What is the first-line treatment for myoclonic seizures?
Valproate
What is the first-line treatment for atonic seizures?
Valproate
What is the first-line treatment for focal seizures?
Carbemazepine or lamotrigine
What is the first-line treatment for West syndrome?
Steroids
What is the first-line treatment for Lennox-Gastaut?
Valproate
What is the first-line treatment for JME?
Valproate
What is the first-line treatment for BECTS?
Carbemazepine or lamotrigine
Which drug exacerbates myoclonic seizures and JME?
Lamotrigine
Which drug exacerbates absence seizures?
Carbemazepine
What are the S/Es of valproate?
Weight gain; hair loss; (rarely = idiosyncratic liver failure)
What are the S/Es of carbemazepine?
Rash; neutropenia; hyponatraemia; ataxia; liver enzyme induction which can interfere with other medication
In what proportion of children is epilepsy improved when using the ketogenic diet?
1/3rd-1/2
In what proportion of children is epilepsy improved with vagal nerve stimulation?
1/3rd-1/2
What are the S/Es of vagal nerve stimulation?
Cough/voice change on firing
