Neurology Flashcards
List the types of epileptic seizure.
Generalised:
- absence
- myoclonic
- tonic
- tonic-clonic
- atonic
Partial:
- focal, which can be frontal, temporal, occipital or parietal
What are absence seizures?
Transient loss of consciousness, they go blank for a few seconds
Sometimes flickering eyelids, but no other motor changes
In clinic, how can you bring about an absence seizure?
Absence seizures are often precipitated by hyperventilation. Get them to blow on a windmill
What’s a myoclonic seizure?
Brief, repetitive, jerking movements of limbs, neck or trunk.
Non-pathologic examples: hiccups, sleep myoclonus
What’s a tonic seizure?
A generalised increase in tone
What’s a tonic-clonic seizure?
Tonic phase: increase in tone held for a few seconds, they collapse to floor and don’t breathe.
Then clonic phase where there’s rhythmic muscle contractions, jerking of limbs
What’s an atonic seizure?
Transient loss of muscle tone causing a sudden fall to floor or drop of head
What are the characteristics of:
- frontal
- temporal
- parietal
- occipital lobe seizures?
Frontal: motor phenomena
Temporal: auditory, smell or taste
Parietal: contralateral altered sensation
Occipital: positive or negative visual aura
What are the causes of seizures in children?
Can be epileptic or non-epileptic
Epileptic:
- Idiopathic epilepsy
- Epilepsy syndrome
- Cerebral damage
- Cerebral tumour
- Neurodegenerative disorders
Non-epileptic:
- Febrile seizure
- Syncope
- Pseudoseizures
- Head trauma
- Meningitis
- Metabolic: hypoglycaemia etc.
Investigation of seizures?
Get all the info about the attack, eye-witness account, video
Bloods to rule out metabolic or infectious cause
EEG
Most epilepsies in children are caused by epilepsy syndromes. True or false?
False, mostly idiopathic
List as many epilepsy syndromes as you can.
West syndrome
Lennox-Gastaut syndrome
Childhood absence epilepsy
Juvenile myoclonic epilepsy
What is West syndrome? At what age does it present? What’s the prognosis?
4-6 months old
Violent flexor spasms of the head, trunk and limbs followed by extension of the arms. Multiple bursts of spasms.
Developmental regression, they lose skills
Prognosis is not great, they often have learning disabilities, developmental delay and will develop epilepsy
You see a baby with an EEG showing hypsarrhythmia. What is hypsarrhythmia? What is the diagnosis?
Chaotic EEG pattern
West Syndrome
What is Lennox-Gastaut syndrome? At what age does it present? What’s the prognosis?
1-3 yrs
Multiple seizure types and developmental arrest and regression.
Prognosis is poor, they often have other neuro problems
What’s the characteristic EEG seen in patients with absence seizures?
3 per second spike and wave discharge, seen during and sometimes between episodes
What is juvenile myoclonic epilepsy? What’s the age of onset? What’s the prognosis?
Adolescence
Mainly myoclonic seizures that occur after waking, sometimes tonic-clonic or absence seizures too.
Lifelong disease, no learning impairment
What’s the first line treatment for all generalised seizures?
Sodium valproate
What’s the first line treatment of focal seizures?
Carbemazepine
What are some second line treatments used to treat seizures?
Lamotrigine
Topiramate
Carbamazepine
Gabapentin
What are some side effects of sodium valproate?
Weight gain
Hair loss
Teratogenic
What is the significance of abnormal persistence of primitive reflexes?
Indicates atypical neurology
Motor development is affected
Could be cerebral palsy
List the primitive reflexes?
Moro reflex Grasp reflex Rooting reflex Stepping reflex Asymmetrical tonic neck reflex Parachute reflex
What is the moro reflex?
When does it disappear?
Sudden loss of support
- spreads out arms
- brings arms back in
- crying
Goes after 4 months
