Neurology Flashcards
What is the epidemiology of febrile convulsions?
- Provoked by fever in otherwise normal children
- 6months–>5years old (peak at 18months)
What are the clinical features of febrile convulsions?
- Usually occur early in a viral infection as temperature increases.
- Seizures usually brief <5mins
- Tonic-clonic
What are the type of febrile convulsions?
Simple, complex or febrile status epilepticus
What are the features of simple febrile convulsions?
<15mins
Generalised seizure
Typically no recurrence within 24hrs
Complete recovery within 1hr
What are the features of complex febrile convulsions?
15-30mins
Focal seizure
May have repeat within 24hrs
What are the features of febrile status epilepticus?
> 30mins
What is the prognosis in febrile convulsions?
- Risk of further febrile convulsions 1 in 3.
- Background risk of developing epilepsy= 1%.
What are the risks of further febrile seizure development dependent on?
- Age onset <18months
- Fever <39 degrees
- Shorter duration of fever before seizure
- FHx of febrile convulsions
What is the tx of febrile convulsions?
If recurrences, teach parents how to use buccal Midazolam or rectal Diazepam
What are the risks of febrile convulsions for developing epilepsy?
- FHx epilepsy
- Complex febrile seizures
- Background of neurodevelopment disorder
- If no risk factors= 1.5% risk
- If all 3 risk factors= 50%
What parental advice should be given regarding febrile convulsions?
Benign condition
Risk of recurrence
Risk of epilepsy
Risk of developmental delay or LD
What are some of the associations with epilepsy?
Cerebral Palsy
Tuberose Sclerosis
Mitochondrial disease
Name some focal seizures
- Focal aware or focal impaired awareness
- Motor: Jacksonian March (distal–>proximal limb)
- Non-motor: déjà vu, jamais vu, aura
What is the epidemiology of infantile spasms (West’s Syndrome)?
Brief spams in the first few months of life
4-6months old
Often preceded by developmental delay
What are the features of infantile spasms (West’s Syndrome)?
- Flexion of the head, trunk, limbs–>extension of arms (Salaam attacks) last 1-2s, repeat up to 50x.
- Progressive mental handicap.
- EEG: hypsarrhythmia
What are the features of Lennox-Gaustat Syndrome?
- May be an extension of infantile spasms
- Onset 1-5years
- Atypical absences, falls, jerks
- 90% moderate-severe handicap
- EEG slow spike
What are the features of Benign Rolandic Epilepsy?
- 3-10years old
- Tonic clonic seizures during sleep
- Parasthesia (unilateral face) usually on waking up
What are the features of Juvenile Myoclonic Epilepsy?
- Typical onset in teens, more common in girls
- Responds well to sodium valproate.
- Infrequent generalised seizures, often in morn
- Daytime absences
- Sudden, shock like myoclonic seizure.
What are the general AED rules?
Generalised= Na Valproate Partial= Carbamazepine Absence= Na Valproate or Ethosuximide
Sodium Valproate: mechanism and s/e
Increases GABA activity, P450 enzyme inhibitor.
S/e: Alopecia, increased weight gain and appetite, hepatitis.
Carbamazepine: mechanism and s/e
Binds to Na channels, increases their refractory period, P450 enzyme inducer.
S/e: SIADH, visual disturbances
Lamotrigene: mechanism and s/e
Na channel blocker.
S/e: Stevens-Johnson Syndrome
Phenytoin: mechanism and s/e
Binds to Na channels, increases their refractory period.
Bad s/e profile “ugly”
What are some of the clinical features of Cerebral Palsy?
Abnormal tone in early infancy, delayed motor milestones, abnormal gait, feeding difficulties.
Non-motor: LD (60%), epilepsy (30%), squints (30%), hearing impairment (20%)
