Neurology Flashcards
Causes of non-epileptic seizures…
- Febrile seizures
- Metabolic: hypoglycaemia, hypo/hypernatraemia
- Head trauma
- Meningitis/ encephalitis
- Toxins
What is a febrile seizure?
- Mainly occurs from 6mths - 6yrs
- Brief generalised tonic-clonic seizure where the temperature rises rapidly - usually occurs in early viral infection
Management of febrile seizures…
Parents need to be educated in management - supportive care during seizure
Rescue pack - containing buccal midazolam and rectal diazepam - if seizure > 5mins
What is a breath holding attack, and how is it treated?
Occur in some toddlers when they are upset- leading to fits of crying where they hold their breath - become cyanotic and may lose consciousness.
Attacks resolve spontaneously but may need behaviour modification therapy.
What are reflex anoxic seizures, and why do they occur?
Triggered by pain, cold food, fright or fever - child becomes pale and then has tonic-clonic seizure.
Caused my cardiac asystole which leads to significant hypoxia which induces the seizures.
How are generalised and focal seizures different?
- Generalised seizures affect both hemispheres of the brain and cause complete loss of consciousness.
- Focal seizures affects one foci of the brain with partial LoC
Different types of focal seizures…
Focal seizures can be classified by which part of the brain is affected:
Temporal lobe seizures:
- Pre-ictal= aura - deja vu, fear, unusual smell; fixed stare
- Ictal= fixed stare, lip smacking, pulling at clothes
Frontal seizures:
- Twisting, turning, grimacing
- Clonic movements proximally - Jacksonian March
Occipital seizures:
- Distortion of vision
Parietal lobe seizures:
- Contralateral dysesthesia (unpleasant feeling when touched), distorted body image
Different types of generalised seizures…
Absence seizure:
- Patient is suddenly vacant for seconds- minutes multiple times in a day
- Motor sx = mouth and finger movements
Myoclonic seizure:
- Single or few jerking movements
- Can include all four limbs
Tonic seizure:
- More prolonged spasm
Tonic-clonic seizure:
- Tonic phase= contraction of muscle groups- do not breathe and become cyanotic
- Clonic phase = irregular breathing,, cyanosis, tongue biting, incontinence
Atonic seizure:
- Complete loss of tone
- Progressive mental handicap
Specific epilepsy syndromes in children and their treatment…
Infantile spasm/ West syndrome:
- Salaam attacks: flexion of the head, trunks and arms followed by arm extension –> up to 50 spasms
- Tx = vigabitrin/ steroids
Lennox-Gastaut syndrome:
- May be extension of infantile spasms
- Atypical absences, falls, jerks - multiple seizure types
- 90% have moderate-severe mental handicap
- Tx= ketogenic diet
Benign Rolandic epilepsy:
- Stroke like sx - patient may be weak with paraesthesia on one side, usually upon waking
Diagnosis of epilepsy…
- Need detailed history from child and eyewitnesses - videos are very useful
- Examination - looking for skin signs of neurocutaneous disorders e.g. NF1
- EEG should only be used if epilepsy is already suspected and need conirmation
- CT/MRI if neuro signs are also present between seizures
Management of epilepsy…
Parents need to be educated on management - specialist epilepsy nurse
Medical management:
- Generalised seizures = sodium valproate 1st line, lamotrigine 2nd line
- Focal seizures = carbamazepine/ lamotrigine
- Absence seizures = ehtosuximide
Other:
- Vagal nerve stimulation
- Neurosurgery - remove affected lobe
What medication should NOT be given for absence or myoclonic seizures?
Carbamazepine - can trigger/ worsen seizures
Treatment of status epilepticus in children…
- A-E assessment
- High flow oxygen
Vascular access gained:
3. IV lorazepam 0.1mg/kg (max 4mg) OR IV diazepam 0.25mg/kg (max 10mg) over 60s
WAIT 10 MINUTES…
4. Give same dose of IV lorazepam/ diazepam again
WAIT 10 MINUTES…
5. Give IV phenytoin 18mg/kg over 20 min
6. Call anaesthetist at 20 mins - IV Thiopentone 4mg/kg
- No vascular access:
3. Buccal midazolam (dose dependent on age) OR rectal diazepam 0.5mg/kg
Try gain IO access at this point - carry on from step 4 above
What is cerebral palsy?
Disorder made up of movement disorderss due to a lesion of the motor pathways in the brain
What are some causes of cerebral palsy?
Antenatal (80%) = cerebral malformation, congenital infection - TORCH
Intrapartum = birth asphyxia, trauma
Postnatal = intraventricular haemorrhage, meningitis, head trauma
