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Year 4 - Paediatrics > Neurology > Flashcards

Neurology Flashcards

1
Q

What is epilepsy?

A

It is an umbrella term for a condition where there is a tendency to have seizures (transient episodes of abnormal electrical activity in the brain).

Epilepsy is the presence of more than one unprovoked seizures.

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2
Q

What is the aim of treatment for epilepsy?

A

To be seizure free on ideally monotherapy with a single anti-epileptic drug.

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3
Q

What are the two main types of seizures?

A

1) Generalised

2) Focal (or partial)

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4
Q

What is the most common type of generalised seizure?

A

Tonic-clonic seizure

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5
Q

What are the types of generalized seizures?

A
  • tonic-clonic
  • absence
  • myoclonic
  • tonic
  • atonic
  • infantile spasms/ West syndrome
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6
Q

What are the types of focal seizures?

A
  • simple focal

- complex focal

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7
Q

What are generalised seizures?

A

Seizures whereby the abnormal electrical activity affects all or most of the brain.

Symptoms tend to be general and involve much of the body.

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8
Q

What are focal seizures?

A

Seizures whereby the burst of electrical activity starts in, and stays in, one part of the brain.

Therefore tend to have localised symptoms and symptoms depend on which part of the brain is affected.

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9
Q

What are tonic-clonic seizures?

A
  • Limbs stiffen and muscles tense (tonic phase) then…
  • Jerk forcefully (clonic phase)
  • LOC
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10
Q

What symptoms may be associated with tonic-clonic seizures?

A
  • tongue biting
  • incontinence
  • groaning
  • irregular breathing
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11
Q

What happens after a tonic-clinic seizure?

A

Prolonged post-ictal period where patient is confused, drowsy, feels irritable or low.

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12
Q

What is the management for tonic-clonic seizures?

A

First line: sodium valproate

Second line: lamotrigine or carbamazepine

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13
Q

What are absence seizures?

A
  • Brief (10 sec) pauses (may stop mid-sentence then carry on where left off)
  • Brief LOC or awareness and won’t respond
  • Eyes may roll up
  • Unaware of the attack
  • Typically happen in children
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14
Q

When do patients tend to stop having absence seizures?

A

As they get older (>90%)

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15
Q

What is the management for absence seizures?

A

Sodium valproate
OR
Ethosuximide

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16
Q

What is a myoclonic seizure?

A

Sudden contraction of the muscles, which causes a jerk, like a sudden ‘jump’.

Can affect the whole body but often occur in just one or both arms.

  • Usually remains awake during the episode
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17
Q

What form of epilepsy do myoclonic seizures typically happen in children?

A

Juvenile myoclonic epilepsy.

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18
Q

What is the management for myoclonic seizures?

A

First line: sodium valproate

Other options: lamotrigine, levetiracetam, topiramate

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19
Q

What are atonic seizures?

A

Also known as drop attacks.

Characterised by brief lapses in muscle tone.

Usually don’t last more than 3 minutes.

Typically start in childhood.

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20
Q

What may atonic seizures be indicative of?

A

Lennox-Gastaut syndrome.

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21
Q

What is the management for atonic seizures?

A

First line: sodium valproate

Second line: lamotrigine

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22
Q

What is ‘Infantile Spasms’?

A

Also known as West syndrome.

Rare (1 in 4000).

Starts in infancy around 6 months.

Clusters of full body spasms.

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23
Q

What is the prognosis for infantile spasms?

A

Poor.

1/3 die by age 25 BUT 1/3 are seizure free.

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24
Q

What is the management for infantile spasms?

A

Difficult to treat.

First line: prednisolone, vigabatrin

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25
Q

What are focal seizures?

A

They start in the temporal loves and can affect hearing, speech, memory and emotions.

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26
Q

How can focal seizures present?

A
  • hallucinations
  • memory flashbacks
  • deja vu
  • doing strange things on autopilot
27
Q

What is the management for focal seizures?

A

First line: carbamazepine or lamotrigine

Second line: sodium valproate or levetiracetam

(Reverse of tonic-clonic)

28
Q

What can cause seizures?

A

1) Epilepsy, status epilepticus
2) Infection e.g. encephalitis, meningitis, sepsis
3) Febrile convulsions
4) Hypoglycaemia
5) Space occupying lesion (brain tumour; intracranial bleed)
6) Medications e.g. antipsychotics that lower seizure threshold
7) Drugs
8) Electrolyte imbalances e.g. hyponatraemia, hypernatraemia, hypomagnesiaemia, hypocalcaemia
9) Encephalopathies e.g. hepatic, renal

29
Q

What main investigations are required for seizures?

A
  • a good history (KEY)
  • video of the seizure
  • EEG
  • MRI brain (diagnose structural problems e.g. tumours)
30
Q

When should a MRI brain be considered?

A
  • the first seizure is in children <2 years
  • focal seizures
  • there is no response to first line anti-epileptic medications
31
Q

What are additional investigations to consider to exclude other pathology that may cause seizures?

A
  • ECG
  • blood electrolytes (Na, K, Ca, Mg)
  • blood glucose (hypoglycaemia, diabetes)
  • blood cultures, urine cultures, lumbar puncture (infection)
32
Q

What situations must patients with seizures avoid or be cautious with?

A
  • take showers rather than baths
  • cautious with swimming unless seizures are well controlled and closely supervised
  • cautious with heights
  • cautious with traffic
  • cautious with heavy, hot or electrical equipment
  • avoid driving unless meet specific criteria regarding control of their epilepsy
33
Q

How does sodium valproate work?

A

Increases the activity of GABA, which has a relaxing effect on the brain.

34
Q

What are side effects of sodium valproate?

A
  • teratogenic (advice re contraception, avoid in girls unless no suitable alternative)
  • liver damage/hepatitis
  • hair loss
  • tremor
35
Q

What are side effects of carbamazepine?

A
  • agranulocytosis
  • aplastic anaemia
  • induces P450 system so many drug interactions
36
Q

What are side effects of phenytoin?

A
  • folate deficiency (megaloblastic anaemia)

- vitamin D deficiency (osteomalacia)

37
Q

What are side effects of ethosuximide?

A
  • night terrors

- rashes

38
Q

What are side effects of lamotrigine?

A
  • Stevens-Johnson syndrome/DRESS syndrome

- leukopenia

39
Q

What is the immediate management of seizures?

A

1) Put patient in a safe position (e.g. carpeted floor)
2) Place in recovery position
3) Put something soft under their head to protect against head injury
4) Remove obstacles that could lead to injury
5) Make a note of the time at the start and end of the seizure
6) Call an ambulance if lasting >5 mins or it is their first seizure

40
Q

What is status epilepticus?

A

Defined as seizures lasting >5 mins or >3 seizures in one hour.

Medical emergency.

41
Q

How is status epilepticus managed in the hospital setting?

A

ABCDE approach

  • secure airway
  • give high-concentration oxygen
  • assess cardiac and respiratory function
  • check blood glucose levels
  • gain IV access (insert cannula)
  • IV lorazepam (repeat after 10 mins if seizure continues)

If seizures persist:

  • infusion of IV phenytoin or phenoarbital
  • consider intubation and ventilation to secure airway
  • transfer to ICU if required
42
Q

What can be used to manage status epilepticus in the community?

A
  • buccal midazolam

- rectal diazepam

43
Q

What is spinal muscular atrophy (SMA)?

A
  • rare autosomal condition

- progressive loss of motor neurones leading to progressive muscular weakness

44
Q

Does SMA affect lower or upper motor neurones?

A
  • lower motor neurones in the spinal cord
45
Q

What lower motor neurone signs are seen in SMA?

A
  • fasciculations
  • reduced muscle bulk
  • reduced tone
  • reduced power
  • reduced/absent reflexes
46
Q

How many categories of spinal muscular atrophy are there? Which is the most common?

A 
4 categories (numbered from most to least severe).
SMA type 2 is most common.

1) SMA type 1 (onset in first few months, progresses to death within 2 years)
2) SMA type 2 (onset in first 18 months, survive into adulthood but most never walk)
3) SMA type 3 (onset after first year of life

47
Q

What are the causes of headaches in children?

A
  • tension headaches
  • migraines
  • ears, nose, throat infection
  • analgesic headache
  • problems with vision
  • raise ICP
  • brain tumours
  • meningitis
  • encephalitis
  • carbon monoxide poisoning
48
Q

What is a tension headache?

A
  • very common
  • produce a mild ache across the forehead
  • pain or pressure in a band-like pattern around the head
  • come on and resolve gradually
  • no visual changes or pulsating sensations
  • typically symmetrical
49
Q

What are symptoms of a tension headache in children?

A
  • may be very non-specific
  • quiet
  • stop playing
  • turn pale
  • become tired
50
Q

How long do tension headaches tend to last in children?

A

Generally resolve quicker in children compared with adults, often within 30 minutes.

51
Q

What are triggers for tension headaches in children?

A
  • stress, fear or discomfort
  • skipping meals
  • dehydration
  • infection
52
Q

How are tension headaches managed?

A
  • reassurance
  • analgesia
  • regular meals
  • avoid dehydration
  • reduce stress
53
Q

What types of migraine are there in children?

A
  • migraine without aura
  • migraine with aura
  • silent migraine (migraine with aura without a headache)
  • hemiplegic migraine
  • abdominal migraine
54
Q

What is the pathophysiology of migraine?

A

No simple explanation but may be a combination of structural, functional, chemical, vascular and inflammatory factors.

55
Q

How to migraines present in children?

A
  • unilateral
  • more severe than tension headaches
  • throbbing in nature
  • take longer to resolve
  • occur in ‘attacks’ that often follow a typical pattern
56
Q

What symptoms are migraines often associated with in children?

A
  • visual aura
  • photophobia
  • phonophobia (sensitive to sound)
  • N&V
  • abdominal pain
57
Q

What is the management for migraines in children?

A
  • rest, fluids and low stimulus environment
  • paracetamol
  • ibuprofen
  • sumatriptan
  • antiemtics e.g. domperidone
58
Q

What can be done if migraines are having a significant impact on a child’s life e.g. frequent attacks/missing school?

A

Prophylactic treatment to try and reduce the frequency and severity of migraines.
Migraine prophylaxis:
- propranolol (avoid in asthma)
- pizotifen (may cause drowsiness)
- topiramate (teratogenic = contraception)

59
Q

What are abdominal migraines?

A
  • more likely to occur in children than adults
  • may occur in young children before they develop traditional migraines as they get older
  • episodes of central abdo pain lasting >1 hour
60
Q

What symptoms may be associated with abdominal migraines?

A
  • N&V
  • anorexia
  • headache
  • pallor
61
Q

What infections should be considered in a child with a new headache?

A
  • viral URTI
  • sinusitis
  • otitis media
  • tonsilitis
62
Q

How should headaches caused by infection be treated?

A
  • headache should resolve with the infection

- paracetamol/ibuprofen (symptomatic relief)

63
Q

What is the headache in sinusitis associated with?

A

Inflammation in the ethmoidal, maxillary, frontal or sphenoidal sinuses which produces facial pain behind the nose, forehead and eyes and tenderness over affected sinuses.
Most sinusitis is viral.

64
Q

How long does it take for sinusitis to generally resolve?

A

2-3 weeks

Year 4 - Paediatrics (13 decks)

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