neuro Flashcards
What makes a seizure epileptic?
Caused by excessive, hypersynchronous electrical activity
What is a convulsion?
a seizure with motor components eg. stiffness (tonic), big jerk (myoclonic), jerking (clonic), trembling, thrashing about (hypermotor)
What is a non-convulsive seizure?
you get motor arrest so unresponsive stare or atonic seizure
What is a febrile seizure?
A brief tonic-clonic seizure that occurs with a rapid rise in fever
How common are febrile seizures? What makes you more predisposed to them?
3% of 6 month to 6 year olds. Genetic predisposition- 10% risk if first degree relative with febrile seizures
What makes it more likely for a febrile seizure to reoccur?
Younger child, shorter seizure, lower temp at time of seizure, positive FHx
What does the family need to know about febrile seizures
First aid management of seizures. Use of rescue therapy buccal midazolam if seizure >5min
What are the complications of simple febrile seizures?
Does not affect intellectual performance or risk of epilepsy
What makes a febrile seizure complex? What are the complications?
focal, prolonged, repeated in same illness= increased risk of epilepsy (4-12%)
Non epileptic causes of seizure?
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.
what causes epilepsy
genetic by complex inheritance- 70%
structural issues eg cerebral malformation, cerebral vascular occlusion, cerebral damage, tumour, neurodegenerative disorders
How common is epilepsy?
1 in 200 children
How is epilepsy categorised
generalised vs focal
epilepsy type eg childhood absence, benign rolandic (15%), juvenile (good prognosis)
underlying aetiology
How is epilepsy diagnosed
detailed history. phone footage
epilepsy investigations
ECG to rule out cardiac causes of convulsive syncope eg long QT
EEG
MRI
PET
Metabolic investigations if related to feeding
What drugs can be used to manage generalised seizures? (1st and 2nd line)
valproate,
clobazam
What drugs can be used to manage focal seizures (1st and 2nd line)
valproate, carbamazepine, levetiracetem
clobazam
Side effects of valproate
weight gain, hair loss, rare liver failure, teratogenic
Non medical treatment epilepsy
ketogenic diet, vagal nerve stimulation, surgery if well localised structural cause
social effects of epilepsy
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
what is status epilepticus
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
