Fits/seizures Flashcards
What is a fit
Paroxysmal abnormality of motor, sensory, autonomic, and/or cognitive function, due to transient brain dysfunction
What is a convulsion
a seizure (epileptic or non-epileptic) with motor components,
What is a seizure
Unstimulated and usually appear as repetitive, rhythmic (clonic) movements of the limbs which PERSIST DESPITE RESTRAINT and are often accompanied by eye movements or changes in respiration
What are the causes of seizures
Epileptic: hyper-synchronous electrical activity
- Infantile spasms (west syndrome)
- benign rolandic seizures
- Lennox-gastaut
- Childhood absence epilepsy
- Myoclonic epilepsy
Structural/metabolic: cerebral dysgenesis/malformation, vascular occlusion, damage (infection, HIE, haemorrhage), tuomur
Acute symptomatic: stroke, TBI, infection, electrolyte abnormalities, poison/toxin, meningitis or encephalitis
Febrile convulsion
Paroxysmal: blue breath holding spells, vasovagal syncope, hypovolaemic syndrome
What are the causes of seizures in neonates
Hypoxic-ischaemic encephalopathy
Cerebral infarction
Septicaemia/ meningitis
Metabolic: Hypoglycaemia, Hypo/hypernatraemia, Hypocalcaemia, Hypomagnesaemia, Inborn errors of metabolism,Pyridoxine dependency
Intracranial haemorrhage
Cerebral malformations
Drug withdrawal e.g. maternal opiates
Congenital infection
Kernicterus
What investigations/initial management should be done for first seizures
Immediate hospital assessment by a paediatrician
Refer to first fit clinic
Bedside: ECG, urine dip
Bloods: GLUCOSE, U&Es, FBC, genetic testing, toxicology, serum prolactin
Other: EEG, LP
At what age do infantile spasms (west syndrome) occur
3-12 months
What are the symptoms of infantile spasms
Spasms - sudden, rapid, tonic contraction of muscles + gradual relaxation - “Salam attacks”
- Violent flexor spasms of the head, trunk, and limbs followed by extension of thee arms (“jack-knife”)
- Lasts 1-2s, often multiple bursts of 20-30
- Often on waking or many times a day
Social interaction/development often deteriorates
Hyperpigmented skin lesions
Growth restriction
(May be misinterpreted as colic)
What would EEG show for infantile spasms and what is the management
EEG: Hypsarrhythmia
Mx: Vigabatrin and/or corticosteroids
What is the prognosis for infantile spasms
70% have a good initial response to medication but not a good long term prognosis
Most lose skills and develop a learning disability + epilepsy
Describe Lennox-Gastaut - age range, symptoms
1-3yo
PMHx infantile spasms/neuro disorders
Multiple seizure types, but mostly atonic, atypical (subtle) absences, and tonic seizures in sleep
Neurodevelopmental arrest or regression and behaviour disorder
What would EEG show for Lennox-Gastaut
Slow generalised spike and wave (1-2.5Hz)
What is a blue breath holding spell
Occurs in toddlers when they are upset
Cries → holds breath → turns blue
May have LOC but should recover rapidly (NO post-ictal state)
What will EEG show for blue breath holding spells and what is the management
EEG is normal
Drug therapy is unhelpful. Attacks resolve spontaneously, but treating iron deficiency anaemia, if present, may help
Describe Anoxic reflex asystolic syncope (cause, age group, RF, symptoms)
Caused by cardiac asystole from excessive vagal inhibition
Infants and toddlers
RF: FHx of faints
Triggers: pain, discomfort, HEAD TRAUMA, cold food, fright, fever
Child gasps, becomes pale and falls to the floor
Hypoxia → generalised tonic-clonc seizure
Seizure is brief, child may not recover rapidly
Describe vasovagal syncopes
Fainting
Brief clonic movements
Preceding blurred vision, light-headedness, sweating, nausea - resolves on lying down
triggers: hot/stuffy environments, standing for long periods, fear
Describe benign paroxysmal vertigo of childhood
Primary headache disorder of childhood.
Recurrent episodes of vertigo (1-2 minutes)
+ Nystagmus, unsteadiness, falling
No postictal state
(NOT the same as benign positional vertigo)
What are tics
Rapid, repetitive, brief, involuntary movements which can be voluntarily controlled
What are night terrors
Wakes from sleep disorientated and frightened. May have autonomic signs
What is the epidemiology of childhood absence epilepsy
4-12y
2/3 female
2% of childhood epilepsy
What are the symptoms of childhood absence epilepsy
May be triggered by hyperventilation
Momentary unresponsive stare with motor arrest
May twitch eyelids of a hand or mouth minimally
Sudden onset
Lasts a few seconds (<30s)
Child has no recall, but may realise they have missed something and look puzzled/say pardon
Developmentally normal but may interfere with schooling
What are the EEG changes for childhood absence epilepsy
Generalised spike and wave (4-3Hz) discharges, bilaterally synchronous during and sometimes between absences
Can ask to blow on a windmill for 2-3mins
What is the prognosis for childhood absence epilepsy
Good, 80% in remission in adolescence
Few evolve into juvenile absence or juvenile myoclonic epilepsy
Describe childhood/benign rolandic epilepsy - age range, prevalence, symptoms
Epilepsy with centro-temporal spikes
4-10y
15% of childhood epilepsies
Tonic-clonic seizures in sleep, or simple focal seizures with awareness of abnormal feelings in the tongue
Distortion of the face (supplied by the rolandic area of the brain)
What is Panayiotopoulos syndrome (early-onset benign occipital epilepsy)
5% of childhood epilepsies, 1-5yo
S/S
Autonomic features
Vomiting
Unresponsive staring in sleep
Head and eye deviation
May progress to a convulsive seizure
What are the features of Panayiotopoulos syndrome (early-onset benign occipital epilepsy) on EEG
Posterior focal sharp wave
Occipital discharges when the eyes are shut
