neuro

Question 1

What makes a seizure epileptic?

Answer 1

Caused by excessive, hypersynchronous electrical activity

Question 2

What is a convulsion?

Answer 2

a seizure with motor components eg. stiffness (tonic), big jerk (myoclonic), jerking (clonic), trembling, thrashing about (hypermotor)

Question 3

What is a non-convulsive seizure?

Answer 3

you get motor arrest so unresponsive stare or atonic seizure

Question 4

What is a febrile seizure?

Answer 4

A brief tonic-clonic seizure that occurs with a rapid rise in fever

Question 5

How common are febrile seizures? What makes you more predisposed to them?

Answer 5

3% of 6 month to 6 year olds. Genetic predisposition- 10% risk if first degree relative with febrile seizures

Question 6

What makes it more likely for a febrile seizure to reoccur?

Answer 6

Younger child, shorter seizure, lower temp at time of seizure, positive FHx

Question 7

What does the family need to know about febrile seizures

Answer 7

First aid management of seizures. Use of rescue therapy buccal midazolam if seizure >5min

Question 8

What are the complications of simple febrile seizures?

Answer 8

Does not affect intellectual performance or risk of epilepsy

Question 9

What makes a febrile seizure complex? What are the complications?

Answer 9

focal, prolonged, repeated in same illness= increased risk of epilepsy (4-12%)

Question 10

Non epileptic causes of seizure?

Answer 10

cardiac syncope, expiratory apnoea syncope (blue breath holding- child cries, holds breath, goes blue, briefly loses consciousness), hypovolaemic syncope, sudden rise in ICP, sleep disorders, dissociative states that are medically unexplained.

Question 11

what causes epilepsy

Answer 11

genetic by complex inheritance- 70%
structural issues eg cerebral malformation, cerebral vascular occlusion, cerebral damage, tumour, neurodegenerative disorders

Question 12

How common is epilepsy?

Answer 12

1 in 200 children

Question 13

How is epilepsy categorised

Answer 13

generalised vs focal
epilepsy type eg childhood absence, benign rolandic (15%), juvenile (good prognosis)
underlying aetiology

Question 14

How is epilepsy diagnosed

Answer 14

detailed history. phone footage

Question 15

epilepsy investigations

Answer 15

ECG to rule out cardiac causes of convulsive syncope eg long QT
EEG
MRI
PET
Metabolic investigations if related to feeding

Question 16

What drugs can be used to manage generalised seizures? (1st and 2nd line)

Answer 16

valproate,

clobazam

Question 17

What drugs can be used to manage focal seizures (1st and 2nd line)

Answer 17

valproate, carbamazepine, levetiracetem

clobazam

Question 18

Side effects of valproate

Answer 18

weight gain, hair loss, rare liver failure, teratogenic

Question 19

Non medical treatment epilepsy

Answer 19

ketogenic diet, vagal nerve stimulation, surgery if well localised structural cause

Question 20

social effects of epilepsy

Answer 20

No driving until seizure free. Teachers need to be made aware, no deep baths/swimming, contraception and pregnancy (some drugs teratogenic). Worse outcomes educationally, socially and employment than other chronic illnesses

Question 21

what is status epilepticus

Answer 21

epileptic seizure lasting >30 mins, or repeated epileptic seizures for 30 mins. prescribe lorazepam (IV) or diazepam (rectal) then lorazepam once they’ve calmed down and can get vascular access. Give phenytoin if it continues. May need induction of anaesthesia