Neurology Flashcards
Clinical features of Lennox-Gastaut syndrome and management
Generalized motor
1-3 y/o
Multiple seizure types, most commonly drop attacks
Neurodevelopment arrest/regression, behaviour disorder, poor prognosis
Needs long-term sodium valproate
Tests for febrile seizures
No need if simple, when focus of infection is identifiable clinically and child returns to baseline mental state.
Otherwise depending on presentation
LP: Must do if any S&S indicative of intracranial infection, persistent lethargy and not fully active. Consider if age <12 months, prior antibiotic therapy
Management of febrile seizure
Seizure first aid
- maintain airway by placing on lateral
- do not restrain/insert item in mouth
- ensure safe surroundings
- observe seizure and time it
- if >5 mins, rectal diazepam and go clinic
Post-seizure: child may be cranky for a day or so
Control fever: avoid excessive clothing, use anti-pyretics
Inpatient mx: if recurring prolonged febrile seizure and if febrile status epilepticus
Discharge: when return to normal mental state, when serious bacterial infection excluded
Parental education: benign, no long-term risk of brain injury but might have seizure with next fever
Active seizure + status epilepticus management
If suspected causative pathology, cardio-respiratory compromise, duration of seizure >5 minutes or unknown, need to commence active treatment.
Continuous monitoring, oxygen
Obtain venous access
Check BGL
Give benzodiazepine
If after 5 minutes still seizing, give benzodiazepine
If after another 5 minutes persisting, give levetiracetam/phenytoin
Reassess 5 minutes after infusion completed - if ongoing give the alternative 2nd agent
Reassess 5 minutes after infusion completed, if ongoing seek help from senior staff +/- airway management
Benzo dose for seizure
Midazolam 0.15mg/kg IV/IM
Levitiracetam dose seizure
40mg/kg IV/IO
Dilute to 50mg/ml, infuse over 5 mins
Phenytoin dose seizure
20mg/kg IV/IO
Infuae into large vein over 20 minutes
Migraine management
Just like adult one, but remember to review triggers,
non-pharmaco management; darkened quiet room, regular exercise, relaxation, healthy diet
Spastic cerebral palsy cause, features
Damage to UMN (pyramidal or corticospinal)
Hypertonic with associated brisk deep tendon reflexes and extensor plantar responses
Tone is velocity dependent, so faster the muscle stretched the greater the resistance
May have clasp knife rigidity
Dyskinesia cerebral palsy causes and features
Damage to basal ganglia/pathways
Fluctuating tone leading to frequent involuntary movements especially with movement/stress
- chorea
- athetosis (more distally)
- dystocia
Intellect might be relatively unimpaired
Floppy, poor trunk control, delayed motor development
May only appear towards end of first year of life
RF: Kernicterus, HIE
Ataxic cerebral palsy causes and features
Damage to cerebellum, most genetically determined
Same side as lesion, symmetrical
Early Trunk and limb hypotonia, Poor balance, delayed motor developments
Later, incoordinate movements, intention tremor and ataxic gait
Investigation for CP
TFT Urine/plasma metabolic screen Consider TORCHES Genetic testing MRI brain: periventricular leukomalacia, vascular lesion, malformation Thrombophilia screen (strong fam hx of stroke) Screening for associated disorder - EEG for seizure - hearing - vision - speech and language - formal cognitive assessment - nutrition and growth
Management for CP spasticity
Diazepam, dantrolene sodium, baclofen (generalised)
Inhibitory cast
Botulinum toxin - reduce localized
Selective dorsal rhizotomy
Dystonia CP management
Levodopa
Athetosis and chorea management
Reserpine, tetrabenezine
