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Year 4 - Paediatrics > Neurology - Epilepsy > Flashcards

Neurology - Epilepsy Flashcards

1
Q

What is epilepsy?

A

Umbrella term for a condition where there is a tendency to have seizures

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2
Q

What is a seizure?

A

Transient episode of abnormal electrical activity

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3
Q

What are the different types of seizures?

A

Generalised tonic-clonic seizures
Focal seizures
Absence seizures
Atonic seizures
Myoclonic seizures
Infantile spasms
Febrile convulsions

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4
Q

What is a generalised tonic-clonic seizure?

A

Loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) movements

Tonic usually before clonic

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5
Q

What can happen during a generalised tonic-clonic seizure?

A

Tongue biting
Incontinence
Groaning
Irregular breathing

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6
Q

What happens in the post-ictal period after a generalised tonic-clonic seizure?

A

Prolonged post-ictal period
- Confused
- Drowsy
- Irritable
- Low mood

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7
Q

How are tonic-clonic seizures managed?

A

First line
Sodium valproate

Second line
Lamotrigine or carbamazepine

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8
Q

What are focal seizures?

A

Seizures affecting
- Hearing
- Speech
- Memory
- Emotions

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9
Q

Where do focal seizures start?

A

Temporal lobes

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10
Q

How can a focal seizure present?

A

Hallucinations
Memory flashbacks
Déja vu
Strange things on autopilot

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11
Q

How are focal seizures managed?

A

Reverse of tonic-clonic seizures

First line
Carbamazepine or lamotrigine

Second line
Sodium valproate or levetiracetam

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12
Q

Who is typically affected by absence seizures?

A

Children

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13
Q

What happens in absence seizures?

A

Patient becomes blank, stares into space then abruptly goes back to normal

Unaware of surroundings and won’t respond

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14
Q

How long do absence seizures last?

A

10 to 20 seconds

Most patients stop having them as they get older

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15
Q

How are absence seizures managed?

A

First line
Sodium valproate or ethosuximide

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16
Q

How are atonic seizures also known?

A

Drop attacks

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17
Q

What happens in an atonic seizure?

A

Brief lapses in muscle tone

Patient drops to the floor

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18
Q

How long do atonic seizures last?

A

Usually less than 3 minutes

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19
Q

When do atonic seizures usually start?

A

Childhood

20
Q

What can atonic seizures indicate?

A

Lennox-Gastaut syndrome

21
Q

How are atonic seizures managed?

A

First line
Sodium valproate

Second line
Lamotrigine

22
Q

How do myoclonic seizures present?

A

Sudden brief muscle contraction

Patient still awake

23
Q

When do myoclonic seizures happen?

A

Various forms of epilepsy

Typically part of juvenile myoclonic epilepsy

24
Q

How are myoclonic seizures managed?

A

First line
Sodium valproate

Second line
Lamotrigine or
Levetiracetam or
Topiramate

25
Q

How are infantile spasms also known?

A

West syndrome

26
Q

When do infantile spasms start?

A

In infancy at around 6 months

27
Q

How are infantile spasms characterised?

A

Cluster of full body spasms

28
Q

What is the prognosis in infantile spasms / West syndrome?

A

1/3 die by age 25
1/3 seizure free

29
Q

How are infantile spasms treated?

A

Prednisolone or vigabatrin

30
Q

What are febrile convulsions?

A

Seizures that occur in children while they have a fever

Not caused by epilepsy or other neuro pathology

31
Q

By definition what age are children affected by febrile convulsions?

A

Between 6 months and 5 years

32
Q

What is the prognosis for febrile convulsions?

A

Usually no lasting damage

1/3 will have another convulsion

Slight increased risk of developing epilepsy

33
Q

What investigations are used for epilepsy?

A

Good history
Identify seizures vs vasovagal episodes or febrile convulsions

EEG
- Performed after second simple tonic-clonic seizure
- Children allowed one simple seizure before being investigated for epilepsy

MRI brain
- Visualise brain structures
- When child under 2
- Focal seizures
- No response to first line anti-epileptics

34
Q

What investigations can be used to exclude other pathology that may cause seizures?

A

ECG
Blood electrolytes - sodium, potassium, calcium and Mg
Blood glucose - hypoglycaemia and diabetes
Blood cultures, urine cultures and LP

35
Q

What general advice should be given to patients and families regarding epilepsy?

A
  • Showers rather than baths
  • Cautious swimming unless seizures well controlled
  • Careful with heights
  • Cautious with traffic
  • Avoid heavy, hot or electric equipment
  • Avoid driving unless seizure free for 2 years
36
Q

Outline sodium valproate

A

Increases GABA effects
- Teratogenic
- Liver damage and hepatitis
- Hair loss
- Tremor

Avoided in girls unless no alternatives
Strict criteria regarding pregnancy

37
Q

Outline carbamazepine

A

First line for focal seizures
- Agranulocytosis
- Aplastic anaemia
- CYP450 system

38
Q

Outline phenytoin

A
  • Folate and Vitamin D deficiency
  • Megaloblastic anaemia
  • Osteomalacia
39
Q

Outline ethosuximide

A

Night terrors
Rashes

40
Q

Outline lamotrigine

A
  • Steven-Johnson syndrome or DRESS syndrome
  • Leukopenia
41
Q

How should seizures be managed immediately?

A
  • Patient in recovery position
  • Something soft under head to protect against head injury
  • Remove obstacles
  • Make note of time at start and end of seizure
  • Ambulance if over 5 minutes or first seizure
42
Q

What is status epilepticus?

A

Seizure lasting more than 5 minutes or 2 or more seizures without regaining consciousness in interim

43
Q

How is status epilepticus managed?

A

A-E
- Secure airway
- High concentration oxygen
- Assess cardiac and respiratory function
- Check BMs
- IV access
- IV lorazepam, repeated after 10 minutes if seizure continues

44
Q

If seizures persist in status epilepticus what is the final step?

A

IV phenobarbital or phenytoin

Intubate and ventilation
ICU transfer

45
Q

What are the medical options in the community?

A

Buccal midazolam
Rectal diazepam

Year 4 - Paediatrics (150 decks)

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