Neuro Flashcards
Low mood, risk of suicidal ideation
Behavioral side effects 10% - agitating, anxiety, aggression or emotional lability
Levetiracetam
Antiepileptic drug side effects:
Kidney stone
Metabolic acidosis
Language impairment
Topiramate
Rolandic Epilepsy
Characteristics
EEG pattern
Rx
Benign rolandic epilepsy of childhood (BREC)
Benign rolandic epilepsy with centrotemporal spikes (BECTS)
A common syndrome, representing approximately 15% of all epilepsy in children
Seizures that come on when the child is awake involve twitching, numbness, or tingling of one side of the child’s face or tongue without impaired awareness (called a focal aware seizure).
Seizures that come on during sleep often evolve to convulsive activity affecting both sides of the body.
In almost every case, seizures stop on their own by adolescence
Rx
Because the seizures may be infrequent and usually occur at night, many children do not need daily antiseizure medication.
The most commonly used medication islevetiracetam(Keppra).
Ix
EEG (electroencephalogram): Children with CECTs have spikes on their EEG in the centrotemporal regions of the brain. These findings help confirm the diagnosis.
MRI (magnetic resonance imaging): This test is usually normal in children with CECTS. It is often not needed if the history and EEG are very typical
Lennox-Gastaut syndrome
Lennox-Gastaut syndrome (LGS) is a severe form of childhood epilepsy with multiple types of seizures.
Type of epileptic encephalopathy = frequent seizures very abnormal EEG
In 1 out of 4 people, no cause can be found.
About 2 to 5% of children with epilepsy have LGS.
Usually, LGS persists through childhood and adolescence to adult years.
Intellectual development is almost always impaired. Behavioral problems, including hyperactivity, agitation, aggression and autism, are common.
EEG and MRI tests are essential in the medical evaluation.
The EEG during wakefulness shows diffuse or widespread background slowing and slow spike-wave bursts. In sleep, a characteristic pattern, termed “generalized paroxysmal fast activity” is seen. This may sometimes correlate with subtle tonic activity.
Genetic and metabolic studies should be done if no cause is found on MRI.
Seizure medications, dietary therapies, implanted devices and surgery can lessen seizures and offer hope and help for people with LGS.
Most common - valporate
Medicines that have proven to reduce seizures in many persons with LGS arelamotrigine,topiramate,felbamate,rufinamide,clobazam,cannabidioland most recentlyfenfluramine.
Gastaut syndrome can be mistaken for migraine but has EEG changes similar to Panayiotopoulos syndrome. Unlike Panayiotopoulos syndrome, seizures occur during the day and EEG changes are activated by eye closure.
Panayiotopoulos syndrome
Typical presentation
EEG
Rx
Panayiotopoulos syndrome is also a “benign” epilepsy but is typically associated with vomiting overnight. It can be distinguished from rolandic epilepsy by the EEG.
Panayiotopoulos syndrome starts in early childhood with the first seizure occurring between 3 and 6 years old.
Boys and girls are equally affected.
Nearly all children will stop having seizures 2-3 years after the first seizure.
Typically, children will turn pale, complain of feeling sick and often vomit during the seizure. Some children’s eyes may turn to one side, and they may make shaking movements during a seizure.
EEG
Spike discharges most commonly in occipital area
Spikes will often be more frequent when children close their eyes or are not fixating on an object, a phenomenon known as “fixation-off sensitivity.”
Background activity is normal.
MRI usually normal
Seizures in children with PS are often infrequent andantiseizure medicationmay not be needed.
When seizures are more frequent, the seizures can be controlled with antiseizure medications likeoxcarbazepine(Trileptal),carbamazepine(Tegretol or Carbatrol),levetiracetam(Keppra),gabapentin(Neurontin),zonisamide(Zonegran),lacosamide(Vimpat), and others
Seizures can be prolonged, lasting up to 20-60 minutes.
Most commonly due to a stroke in utero or in the neonatal period. This could be associated with: thrombophilic disorders; infection; congenital cause; or periventricular haemorrhagic infarction.
Which type of CP?
Spastic hemiplegia
Most commonly due toperiventricular leukomalacia, multicystic encephalomalacia, or malformations. This could be associated with:ischaemia; infection; or metabolic conditions.
Which type of CP?
Spastic quadriplegia
Type of CP?
Most commonly found in: putamen; globus pallidus; thalamus; or basal ganglia. Associated with: asphyxia; kernicterus; mitochondrial disorders
Choreoathetoid cerebral palsy
major clinical features of tuberous sclerosis:
Facial angiofibromas or forehead plaques
Shagreen patch (connective tissue nevus)
Three or more hypomelanotic maculesi.e. ash-leaf macules
Nontraumatic ungula or periungual fibromas
Lymphangioleiomyomatosis (also known as lymphangiomyomatosis)
Renal angiomyolipoma
Cardiac rhabdomyoma
Multiple retinal nodular hamartomas
Cortical tuber
Subependymal nodules
Subependymal giant cell astrocytoma
It is estimated that over 95 percent of patients with Tuberous sclerosis have one of the characteristic skin lesions. The most common lesions are:
Hypopigmented macules, also known as ash-leaf spots, which are usually elliptic in shape.
Angiofibromas (sometimes called fibroadenomas; previously called adenoma sebaceum), which typically involve the malar regions of the face.
Shagreen patches, seen most commonly over the lower trunk.
A distinctive brown fibrous plaque on the forehead, which may be the first and most readily recognised feature of TS to be appreciated on physical examination of affected neonates and infants.
Management of acute migraine
Management of an acute attack is to provide headache freedom as quickly as possible with return to normal function.
This mainly includes 2 groups of medicines: nonsteroidal antiinflammatory drugs (NSAIDs) and triptans
Most migraine headaches in children will respond to appropriate doses of NSAIDs when administered at the onset of the headache attack. When a migraine is especially severe, NSAIDs alone may not be sufficient. In this case a triptan may be considered.
The most common side effects of the triptans are due to their mechanism of action—tightness in the jaw, chest, and fingers due to vascular constriction and a subsequent feeling of grogginess and fatigue due to the central serotonin effect. The vascular constriction symptoms can be alleviated through adequate fluid hydration during an attack.
When is prophylactic therapy for migraines warranted
Goal and duration of therapy?
When the headaches are frequent (≧1/wk) or disabling (missing school, home, or social activities, or a PedMIDAS score above 20), preventive or prophylactic therapy is warranted.
The goal of this therapy should to be to reduce frequency (1-2 headaches or fewer per month) and disability (PedMIDAS <10).
Prophylactic agents should be given for at least 4-6months at an adequate dose and then weaned over several weeks.
Preventive therapies for headache and migraine
The most commonly used preventive therapies for headache and migraine are amitriptyline and pizotifen
In very young children, cyproheptadine may be effective in prevention of migraine or the related variants. Young children tend to tolerate the increased appetite induced by the cyproheptadine and tend not to be subject to the lethargy seen in older children and adults; the weight gain is limiting once children start to enter puberty.
β-Blockers have also been used for migraine prevention. The contraindication for use of propranolol in children with asthma or allergic disorders or diabetes and the increased incidence of depression in adolescents using propranolol limit its use somewhat
Antiepileptic medications are more recently commonly used for migraine prophylaxis, with topiramate, valproic acid, and levetiracetam having been demonstrated to be effective in adults.
Normal crying patterns
2 hours per day at 2 weeks, 3 hours per day by 6 weeks, Gradually decreases to about 1 hour per day by 3 months.
Birth to 6weeks: 2-3hrs per day.
Second month crying clustered in afternoon and evening.
Four months: 1 hour per day.
Considerations for crying baby
Mnemonic for a crying baby - ITCRIES
I-infections
T-trauma
C-cardiac disease
R-reflux,reaction to meds,anal fissure
I-intussusception
E-eyes-corneal abrasion
S-strangulation.Surgical process(hernia)
