Neurology Flashcards
What defines a seizure as epileptic?
It is due to excessice and hypersynchronous electrical activity in all or part of the cerebral cortex
What are the features of a tonic clonic seizure?
There is a tonic muscle tensing phase followed by a clonic jerking phase
They is often tongue biting, incontinence, groaning and irregular breathing
There is a prolonged post ictal period where the person is confused, drowsy and feels low
What is the management of generalised seizures?
First line is sodium valproate
Second line is lamotrigine or carbamazepine
Which part of the brain do focal seizures affect and how do they present?
They start in the temporal lobe They affect hearing, memory, speech and emotions These can cause: -Hallucinations -Deja vu -Memory flashbacks
What is the treatment of focal seizures?
This is the opposite waya round to generalised
First line Lamotrigine or Carbamazepine
Second line is sodium valproate or levetiracetam
What is the presentation of absence seizures?
Usually present in children and last 10-20 seconds
Will typically grow out of them
What is the management of absence seizures?
Sodium valproate
How do atonic seizures present?
These are brief lapses in muscle tone that usually don’t last more than 3 mins
Typically begin in childhood
May be indiciative of Lennox-Gastaut syndrome
What is the management of atonic seizures?
First line Sodium Valproate
Second line is Lamotrigine
What is Lennox-Gastaut syndrome?
It is usually in 1-3 year olds and causes mostly atonic seizures and tonic seizures in sleep
Is associated with neurodevelopmental arrest
What are the presenting features of juvenile myoclonic epilepsy?
Usually 10-20 years
Have sudden brief muscle contractions, usually occur shortly after waking
What is the treatment of myoclonic epilepsy?
First line sodium valproate
Second line lamotrigine or levetiracetam
What is the definition of a typical febrile seizure?
It is tonic clonic in nature
Lasts less than 15 mins
Occurs during febrile illness
What is the management that should be advised to parents for febrile conculsions?
Try to keep child away from dangerous objects Put in recovery position Do not put anything in their mouth Stay with child Call abulance if lasts over 5 mins
What is the risk of developing epilesy after febrile convulsion?
1.8% for general population
2-7.5% if have had febrile convulsion
What are cyanotic breath holding spells?
When the child gets upset they can hold their breath and cause syncope, no assocaition with epilepsy
What is a reflex anoxic seizure?
This is when a child is startled vagal nerve activity causes heart to stop and go pale and lose consiousness, within 30 seconds heart starts and regain consiousness
How are tension headaches treated in children?
They are treated with reassurance, regular meals, hydration, analgesia and reducing stress
What are the treatments for acute migraine and preventative treatments?
Acutely: -Rest, fluids, Dark room -Nsaids -Sumitriptan -Antiemetics Prophylactic: -propanolol -Pizotifen -Topiramate
What are the causes of cerebral palsy?
Post natal; -Infections -Trauma Perinatal: -asphyxia -Pre-term birth Postnatal: -Meningitis -Head injury
What are the types of cerebral palsy?
Spastic - hypertonia due to UMN damage
Dyskinetic - problems with muscle tone causing writhing movements due to damage to the basal ganglia
Ataxic - problems with coordiated movement due to damage to cerebellum
Mixed
What is the management of cerebral palsy?
MDT appraoch Physio to optimise muscle function OT to make adaptations to house Speech and language therapy to improve speech and swallow, can have NG or peg Dieticians Surgery to lengethen tendons Paeds: -muscle relaxants -Antiepilaptics to reduce seizures
