Neurology - CP/Epilepsy Flashcards
What are the causes of cerebral palsy?
80% in antenatal origin due to vascular occlusion/cortical migration disorders/structural maldevelopment of the brain during gestation.
10% due to hypoxic ischaemic injury during delivery
10% are postnatal origin (preterm infants esp vulnerable - IVH, encephalopathy etc)
What are the different types of cerebral palsy?
spastic cerebral palsy (90%)
dyskinetic cerebral palsy (6%)
ataxic (hypotonic) cerebral palsy (4%)
Describe spastic CP
limb tone is increased due to UMN damage
associated with brisk reflexes
presents early
What are the three categories of spastic CP?
Hemiplegia - unilateral involvement of the arm and leg involvement, may be due to neonatal stroke
Quadriplegia - all four limbs affected, often severely, poor head control and low central tone. Associated with seizures, microcephaly
Diplegia - affects legs > arms, likely to be preterm
What is dyskinetic CP?
Choreic movements
Athetosis - slow writing distal movements
Dystonia - twisting appearance
Extrapyramidal system affected, used to be due to rhesus disease of the newborn
What is ataxic CP?
Mostly genetic, may be acquired brain injury in cerebellum
- Trunk and limb hypotonia
- delayed motor development
- intention tremor
What is craniosynostosis?
early fusion of cranial sutures - may cause raised ICP
What are the features of CP?
- abnormal limb/trunk posture and tone, delayed motor milestones
- feeding difficulties
- abnormal gait
- asymmetric hand function before 1 year
- primitive reflexes persist
What is cerebral palsy?
Abnormality of movement and posture, limiting activities, due to non-progressive disturbances in developing brain
May see disturbance of cognition, communication, perception, sensation, seizure, musculoskeletal problems
Affects 2/1000 live births
How are children with CP treated?
Physiotherapy - to prevent muscle weakness and to prevent muscles getting stuck in a rigid position
Drugs - Diazepam (muscle relaxant but lots of SEs), botox injectionscan be used, finally baclofen intrathecal therapy can be used
Orthopaedic surgery - used to lengthen muscles which are causing problems
What is epilepsy?
- incidence 0.05%
- recurrent unprovoked seizures associated with abnormal, excessive or synchronous neuronal activity
- mostly idiopathic causes
What are generalised seizures?
- arise from both hemispheres
- loss of consciousness
- no warning
- symmetrical seizures
bilateral synchronous EEG discharge
What are the different types of generalized seizures?
absence myoclonic tonic tonic-clonic atonic
What is an absence seizure?
- transient loss of consciousness with an abrupt onset and termination
- flickering eyelids, altered muscle tone
- typical = petit mal
- hyperventilation may proceed seizure
What is a myoclonic seizure?
brief repetitive jerking limbs, neck or trunk
physiological appearance - hiccoughs or Stage II sleep
What is a tonic seizure?
generalised increase in tone
What is a tonic clonic seizure?
- rhythmic muscle group contraction after tonic phase
- may fall while rigid tonic, become cyanosed
- clonic = jerking of limbs
- cyanosis, irregular breathing, possible tongue biting and incontinence
- may last seconds to minutes
- followed by LoC or deep sleep
What is an atonic seizure?
- often combined with myoclonic jerk and transient loss of muscle tone
- sudden fall, or drop of head
What are focalised seizures?
- onset limited to one cerebral hemisphere
- relatively small group of dysfunctional neurones
- may see an aura dependent on origin
- may see change in consciousness
What happened during a frontal focal seizure?
motor phenomena e.g. Jacksonian march, clonus, atony
What happened during a temporal focal seizure?
auditory or sensory phenomena, autosomatisms, déjà vu
What happened during a occipital focal seizure?
positive or negative visual phenomena
What happened during a parietal focal seizure?
contralateral altered sensation (dysaethesia)
What investigations should be carried out when epilepsy is suspected?
EEG - unless seizure is captured, an EEG only supports diagnosis
MRI/CT - assess brain structure if there are neurological signs between seizures or if focal seizures
Other - functional scans (PET/SPECT scan), metabolic and genetic studies
What is the first and second line treatment for tonic clonic seizures?
1 - valproate, carbamazepine
2 - lamotrigine
What is the first and second line treatment for absence seizures?
1 - valproate, ethosuximide
2 - lamotrigine
What is the first and second line treatment for myoclonic seizures?
1 - valproate
2 - lamotrigine
What is the first and second line treatment for focal seizures?
1 - carbamazepine, valproate
2 - topiramate
What are the principles of epileptic treatment?
- anti-epileptic drugs can be used for treatment
- not all seizures require AED
- all AEDs have unwanted SEs
- Children with prolonged seizures are given rescue therapy (rectal/buccal diazepam)
- AED discontinued is seizure free for 2 years
What are the SEs of valporate?
weight gain
hair loss
rarely liver failure
** teratogenic **
What are the SEs of carbamazepine?
rash neutropenia hyponatraemia ataxia liver enzyme induction
What are the SEs of lamotrigine?
rash
What are the SEs of ethosuximide?
nausea and vomiting
What are the SEs of benzodiazepines
sedation
tolerance to effect and increased secretions
What is SUDEP?
sudden unexpected death in epilepsy
most common in young adults who have generalised tonic-clonic seizures
RFs - poor seizure control and seizures occurring in sleep
What are febrile convulsions?
Short, generalized epileptic seizure
With fever or systemic illness e.g. URTI
Otherwise normal
Do not cause brain damage
What are the ddx for febrile convulsions?
epilepsy triggered by fever CNS infection Rigors Syncope Tetany Occulo-gyric crisis
How common is a febrile convulsion?
aged 6 months to 5 years
often FHx
Common (3%)
30% recur
What first aid should you tell parents about if there child has had a febrile convulsion?
recovery position
soft surface away from anything that could cause injury
stay with the child
call for help if lasts longer than 5 mins
