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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
What defines a focal seizure of parietal origin?
Sensory Sx
26
What defines a focal seizure of occipital origin?
Visual hallucinations - more crude than temporal seizures - e.g. colours and patterns
27
What is the origin of a seizure with related aura?
Simple focal origin (because patient is conscious)
28
Which types of seizure can be precipitated by hyperventilation?
Absence seizures
29
What are the types of non-epileptic myoclonus?
1) Hiccoughs | 2) Sleep myoclonus
30
What is the characteristic HxPC in juvenile myoclonic epilepsy?
Adolescent that has become 'clumsy', particularly in the morning
31
What is the triad of West syndrome?
1) Infantile spasms 2) Hypsarrhythmia - 'chaotic' - EEG 3) Mental retardation
32
What is the common misdiagnosis made of West syndrome?
Colic
33
How is West syndrome managed?
Corticosteroids
34
Which epilepsy syndrome tends to be refractory to treatment?
Lennox-Gastaut syndrome
35
What is the epilepsy syndrome that causes children to present with stroke-like Sx?
Benign epilepsy with centrotemporal spikes (BECTS)
36
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
37
What treatment should be given in BECTS?
Carbamazepine - but only treat if night-time Sx are frequent/effecting concentration
38
What defines Sandifer syndrome?
GORD + spasmodic torticollis
39
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)
40
What causes Marcus Gunn phenomena?
An aberrant connection between the trigeminal and oculomotor nerve
41
What is a hyperekplexia?
An exaggerated startle response
42
What is the first-line treatment for tonic-clonic seizures?
Valproate
43
What is the first-line treatment for absence seizures?
Ethosuximide or valproate
44
What is the first-line treatment for myoclonic seizures?
Valproate
45
What is the first-line treatment for atonic seizures?
Valproate
46
What is the first-line treatment for focal seizures?
Carbemazepine or lamotrigine
47
What is the first-line treatment for West syndrome?
Steroids
48
What is the first-line treatment for Lennox-Gastaut?
Valproate
49
What is the first-line treatment for JME?
Valproate
50
What is the first-line treatment for BECTS?
Carbemazepine or lamotrigine
51
Which drug exacerbates myoclonic seizures and JME?
Lamotrigine
52
Which drug exacerbates absence seizures?
Carbemazepine
53
What are the S/Es of valproate?
Weight gain; hair loss; (rarely = idiosyncratic liver failure)
54
What are the S/Es of carbemazepine?
Rash; neutropenia; hyponatraemia; ataxia; liver enzyme induction which can interfere with other medication
55
In what proportion of children is epilepsy improved when using the ketogenic diet?
1/3rd-1/2
56
In what proportion of children is epilepsy improved with vagal nerve stimulation?
1/3rd-1/2
57
What are the S/Es of vagal nerve stimulation?
Cough/voice change on firing

Paediatrics (27 decks)

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