Neurology 2 Flashcards
What are the side effects of valproate?
Weight gain, hair loss Rare idiosyncratic liver failure P450 enzyme inhibitor Ataxia Tremor Pancreatitis Thrombocytopenia Teratogenic
What are the side effects of carbamazepine/oxcabazepine?
Rash, neutropenia , hyponatraemia, ataxia, liver enzyme induction, can interfere with other medication P450 enzyme inducer Dizziness, drowsiness Diplopia Leucopenia an dagranulocytosis Inappropriate ADH secretion
What are the side effects of vigabatrin?
Restriction of visual fields, sedation
What are the side effects of the other AEDs?
Lamotrigine- rash (stephen-johnson)
Ethosuximide- N+V
Topiramate- drowsiness, withdrawal and weight loss
Gabapentin- insomnia
Levetiracetam- sedation-rare
Benzos- sedation, tolerance to effect, increased secretions
What is sudden unexpected death in epilepsy (SUDEP)?
Occurs in small proportion
not due to injury, drowning or a prolonged seizure causing hypoxia
• It is estimated to cause around 500 deaths per year
• It is most common in people who have generalised tonic-clonic seizures- especially in young adults
Risk factors- poor seizure control, seizures during sleep
What is a febrile seizure?
a seizure accompanied by a fever in the absence of intracranial infection due to bacterial meningitis or viral encephalitis
6mths-6yrs
10% risk if child has first degree relative with seizures
4% of all children
What is the management for a febrile seizure?
o Safety- move any danger away from child and note the time of the seizure
o Assistance- call for help if unfamiliar with febrile seizures
o Treatment- if >10min child should be treated for status epilepticus and post the child should be assessed for source of fever, investigated and treated appropriately
o Menigitis?- consider if stiff neck, extreme lethargy >4hr post-seizure, abundant vomiting or is <12 months old
o Seizure prevention & home care- poor evidence to support intervention, give standard anti-pyretics in early febrile illness and get expert advice if seizure >10mins
What is the first aid advice for febrile seizures?
o Place them in the recovery position on a soft surface to prevent them aspirating vomit once the seizure is over
o Whilst the seizure is occurring the child should be placed in a safe location, away from objects that could cause injury
o Stay with the child and call for help if the seizure lasts >5mins
How does a febrile convulsion present?
• Typically, the child has no previous neurological disease or focal deficits on examination
• These children may have a temperature of >39oC, but temperature may have become normal by the time it is measured
• Seizure tends to occur during the first day of fever
95-98% of children who have experienced febrile seizures do not go on to develop epilepsy
• Recurrence risk of seizure is 35% over lifetime- 25% during the next 12 months
How are febrile seizures categorised?
o Simple febrile seizure (typical) -generalised tonic-clonic activity lasting <15 minutes without associated fever
o Complex febrile seizures (atypical)- these occur in up to 15% of cases and are characterized by focal seizure activity, or prolonged seizure activity (15mins) or multiple seizures within 1 day
What are the causes of funny turns?
o Breath holding attacks- toddler holds breath whilst crying and can lose consciousness but rapidly recovers
o Reflex anoxic seizures- occurs in infants or toddlers and triggers include pain or discomfort, the hypoxia may stimulate a tonic-clonic seizure
o Daydreaming- can appear very similar to absence seizure, but typically will not occur at home or during activity
o Syncope- children may faint from hot environments or prolonged standing, occurs from 7months onwards, may be preceeded by aura, loss of vision, tingling or auditory phenomenon- myoclonic jerks may follow for a few seconds post-seizure
Migraines
BPV- vertigo lasting several minutes and associated with nystagmus and possible falling- usually due to viral labyrinthitis
o Cardiac causes- cardiomyopathy or prolonged QT syndrome
o Other causes- psuedoseizures, Munchausen’s by proxy, NAI, atonic epileptic seizures
How is breath holding classified?
o Cyanotic- most common type and occurs in response to anger or frustration, a child’s skin
typically turns red or blue/purple
o Pallid- a pale appearance in response to fear, pain or injury, especially after head trauma
6mths-6yrs
Most common 1-3
What are the symptoms fo a cyanotic spell?
o A short burst of rigorous crying lasting less than 30 seconds
o Hyperventilation
o A pause in breathing after exhaling
o Red or blue skin & lips
o Seizures may occur
• Drug therapy is unhelpful, as attacks resolve spontaneously
• Behaviour modification therapy, with distraction, may help
What are reflex anoxic seizures?
Occurs in infants or toddlers
• May have a 1st degree relative with a history of faints
• Commonest triggers are pain or discomfort- particularly from minor head trauma, cold food, frights or fever
• Some children with febrile seizures may have experienced this phenomenon
• After the triggering event- the child becomes very pale and falls to the floor- the hypoxia may induce a generalised tonic-clonic seizure
• The episodes are due to cardiac asystole from vagal inhibition- the seizure is brief and the child rapidly recovers
• Ocular compression under controlled conditions often leads to asystole and paroxysmal slow-wave discharge on EEG
What are the features of infantile spasms (West’s syndrome)
Brief spasms beginning in first few months of life
1. Flexion of head, trunk, limbs → extension of arms (Salaam attack); last 1-2 secs, repeat up to 50 times
2. Progressive mental handicap
3. EEG: hypsarrhythmia
usually 2nd to serious neurological abnormality (e.g. TS, encephalitis, birth asphyxia) or may be cryptogenic
poor prognosis
Vigabatrin is 1st line
ACTH also used
