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Paediatrics > Fits and 'funny turns' > Flashcards

Fits and 'funny turns' Flashcards

1
Q

What is the most common cause of epileptic seizures?

A

70-80% are ‘idiopathic’ - this is likely a genetic cause/disposition

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2
Q

Aside from genetics, what are the other causes of epileptic seizures?

A

Cerebral tumour
Neurodegenerative disorders
Neurocutaneous disorders
Secondary to cerebral dysgenesis/malformation, vascular occlusion or damage from IVH, HIE or congenital infection

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3
Q

What is the initial management to stop a seizure with vascular access?

A

Vascular access? - Lorazepam 0.1mg/kg

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4
Q

What is the initial management to stop a seizure without vascular access?

A

No vascular access? - Diazepam 0.5mg/kg PR or Midazolam (buccal) 0.5mg/kg

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5
Q

Is there a genetic predisposition to febrile seizures?

A

Yes

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6
Q

What proportion of children will go on to have subsequent febrile seizures following their first?

A

30-40%

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7
Q

What type of febrile seizures carries an increased risk of developing epilepsy?

A

Complex febrile seizure

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8
Q

What is the increase in risk of developing epilepsy in complex febrile seizures?

A

4-12%

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9
Q

What is a complex febrile seizure?

A

A seizure that is focal, prolonged or repeated in the same illness

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10
Q

What is the most important differential of a febrile seizure?

A

Bacterial meningitis

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11
Q

What features should trigger you to admit and treat as meningitis?

A
  1. Drowsy before seizure of GCS<15 one hour after seizure
  2. Neck stiffness
  3. Petechial (non-blanching) rash
  4. Bulging fontanelle
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12
Q

What is the medical term for a non-blanching rash?

A

Petechial

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13
Q

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?

A
  1. Under 18 months
  2. Complex seizure
  3. The child has had antibiotics
  4. No other focus of the infection is found
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14
Q

What are the contraindications for LP?

A
  1. GCS <13
  2. Septic shock - low BP, poor perfusion, tachycardia
  3. Likely invasive meningococcal disease - rapid onset, haemorrhagic rash
  4. Signs of raised ICP
  5. Focal neurology
  6. Bleeding tendency
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15
Q

What is a reflex anoxic seizure?

A

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

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16
Q

What are the common triggers for reflex anoxic seizures?

A
  1. Pain - esp. minor head trauma, i.e. a bump
  2. Cold food
  3. Fright
  4. Fever
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17
Q

How many hemispheres does a focal seizure effect?

A

1

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18
Q

How many hemispheres does a generalized seizure effect?

A

2 (both)

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19
Q

How can a generalized seizure be defined?

A

A seizure that effects both hemispheres and causes a loss of/severe impairment of consciousness

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20
Q

What are the different types of generalized seizure?

A
  1. Absence
  2. Myoclonic
  3. Tonic
  4. Clonic
  5. Tonic-clonic
  6. Spasms
  7. Atonic
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21
Q

How can a simple focal seizure be defined?

A

A seizure that effects only one hemisphere and causes NO impairment of conciousness

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22
Q

How can a complex focal seizure be defined?

A

A seizure that effects only one hemisphere and causes a mild impairment of conciousness

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23
Q

What defines a focal seizure of frontal origin?

A

Motor Sx (due to presence of the motor cortex)

24
Q

What defines a focal seizure of temporal origin?

A

Visual and auditory hallucinations (due to being responsible for speech and language) that may make the child fearful

25
Q

What defines a focal seizure of parietal origin?

A

Sensory Sx

26
Q

What defines a focal seizure of occipital origin?

A

Visual hallucinations - more crude than temporal seizures - e.g. colours and patterns

27
Q

What is the origin of a seizure with related aura?

A

Simple focal origin (because patient is conscious)

28
Q

Which types of seizure can be precipitated by hyperventilation?

A

Absence seizures

29
Q

What are the types of non-epileptic myoclonus?

A

1) Hiccoughs

2) Sleep myoclonus

30
Q

What is the characteristic HxPC in juvenile myoclonic epilepsy?

A

Adolescent that has become ‘clumsy’, particularly in the morning

31
Q

What is the triad of West syndrome?

A

1) Infantile spasms
2) Hypsarrhythmia - ‘chaotic’ - EEG
3) Mental retardation

32
Q

What is the common misdiagnosis made of West syndrome?

A

Colic

33
Q

How is West syndrome managed?

A

Corticosteroids

34
Q

Which epilepsy syndrome tends to be refractory to treatment?

A

Lennox-Gastaut syndrome

35
Q

What is the epilepsy syndrome that causes children to present with stroke-like Sx?

A

Benign epilepsy with centrotemporal spikes (BECTS)

36
Q

When do Sx with BECTS tend to be worse?

A

Night time - hence always bear in mind in a child that presents with ‘stroke’ in ED at night-time

37
Q

What treatment should be given in BECTS?

A

Carbamazepine - but only treat if night-time Sx are frequent/effecting concentration

38
Q

What defines Sandifer syndrome?

A

GORD + spasmodic torticollis

39
Q

What is Marcus Gunn phenomena?

A

Rhythmic upward jerking of the upper eye lid that occurs with sucking and swallowing (i.e. while infants are feeding)

40
Q

What causes Marcus Gunn phenomena?

A

An aberrant connection between the trigeminal and oculomotor nerve

41
Q

What is a hyperekplexia?

A

An exaggerated startle response

42
Q

What is the first-line treatment for tonic-clonic seizures?

A

Valproate

43
Q

What is the first-line treatment for absence seizures?

A

Ethosuximide or valproate

44
Q

What is the first-line treatment for myoclonic seizures?

A

Valproate

45
Q

What is the first-line treatment for atonic seizures?

A

Valproate

46
Q

What is the first-line treatment for focal seizures?

A

Carbemazepine or lamotrigine

47
Q

What is the first-line treatment for West syndrome?

A

Steroids

48
Q

What is the first-line treatment for Lennox-Gastaut?

A

Valproate

49
Q

What is the first-line treatment for JME?

A

Valproate

50
Q

What is the first-line treatment for BECTS?

A

Carbemazepine or lamotrigine

51
Q

Which drug exacerbates myoclonic seizures and JME?

A

Lamotrigine

52
Q

Which drug exacerbates absence seizures?

A

Carbemazepine

53
Q

What are the S/Es of valproate?

A

Weight gain; hair loss; (rarely = idiosyncratic liver failure)

54
Q

What are the S/Es of carbemazepine?

A

Rash; neutropenia; hyponatraemia; ataxia; liver enzyme induction which can interfere with other medication

55
Q

In what proportion of children is epilepsy improved when using the ketogenic diet?

A

1/3rd-1/2

56
Q

In what proportion of children is epilepsy improved with vagal nerve stimulation?

A

1/3rd-1/2

57
Q

What are the S/Es of vagal nerve stimulation?

A

Cough/voice change on firing

Paediatrics (27 decks)

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