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Paediatrics > Neurology Seizures > Flashcards

Neurology Seizures Flashcards

1
Q

Describe a tonic seizure

A

Generalized increase of tone. sudden rigidity, stiffness & muscle contraction

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2
Q

Atonic seizures

A

Jerk, sudden loss of tone

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3
Q

Clonic

A

Rhythmic muscle contractions & subsequent relaxation

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4
Q

Tonic-Clonic

A

Generalized increase in tone then rhythmic contraction + jerking + irregular breathing

Usually lasts 1 min
Generalized wave form on EEG

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5
Q

Absence

A

Sudden loss of motor activity, spont recovery

+/- flickering eyelids, staring, transient LOC

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6
Q

Myoclonic

A

Jerking of neck, trunk or limb. Repetitive & spontanteous
Usually localized to 1 part of the body

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7
Q

Frontal seizure symptom

A

Motor Disturbance

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8
Q

Parietal seizure symptom

A

Sensory disturbance. tingling, numbness

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9
Q

Temporal seizure symptom

A

Auditory, sensory disturbance
Deja vu, familiarity
Jamais Vu, unfamiliarity

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10
Q

Occipital seizure symptom

A

Visual disturbance + oculomotor signs (forced eye closure, eyelid fluttering, eye deviation, nystagmus)

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11
Q

Focal to generalised seizure

A

Any of the above + progress to GS

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12
Q

What is a complex seizure?

A

Reduced consciousness +/- aura (lip smacking)

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13
Q

How would you differentiate a focal & generalized seizure?

A

Loss of consciousness for generalized

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14
Q

DDX for seizures

A

Febrile convulsion
Epilepsy

Non-epileptic attack disorder: pseudoseizure, psych in nature, dramatic flapping of arms. tightly shut eyes that cant open. Distractible

Meningitis/Encephalitis

Organic causes: infection, tumour, metabolic, head injury

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15
Q

Common causes for LOC (loss of consciousness). Describe the conditions

A
  1. Breath holding spasms: < 3
    - hold their breath when provoked by temper or frustration
    - goes blue –> limp –> LOC –> regain
  2. Reflex anoxic seizure (usually 6 months to 2 years, triggered by event causing vagal-induced cardiac asystole or bradycardia, get hypoxia)
  3. Vasovagal syncope ( Inadequate cardiac output to brain, could be due to warm environment or standing for too long). LOC +/- seizure
  4. Cardiac arrhythmia (prolonged QT @ rest)
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16
Q

What age would you expect a child to be if they present with a febrile convulsion?

A

6 months to 6 years

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17
Q

Conditions for diagnosis of febrile seizure?

A
  1. Absence of CNS infection, metabolic imbalance or neurological conditions
  2. Temp > 38
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18
Q

What are the types of febrile seizures?

A

Simple
Complex
Status

19
Q

What is a simple febrile seizure

A 
Temp > 38
Seizure lasting no longer than 15 min (usually 5)
Generalized tonic clonic 
Not recurring w/in 24 hours
Rapid &amp; full neurological recovery
20
Q

What is a complex febrile seizure

A

Generalized tonic clonic seizure lasting > 15 min

In the presence of a temp > 38

21
Q

What is status febrile seizure?

A

Generalized tonic clonic seizure lasting > 30 min

In the presence of a temp > 38

22
Q

Aetiology of febrile seizure?

A 
Fam hx
Infection (usually viral):
- tonsillitis
- otitis media
- Herpes simplex virus
- Shigella
- Rotavirus GE
- Roseola
23
Q

Mx of febrile seizure

A

Anti-pyretics to manage fever. Does not prevent further seizure
Undress to reduce fever
Seek help if > 5 min

24
Q

Risk of febrile seizure recurring?

A

1 in 6

25
Q

Risk of febrile seizure developing epilepsy later in life

A

2%

26
Q

What are the red flags for afebrile seizure?

A

Prolonged QT syndrome

Cardiac arrhythmia

27
Q

What is the work up for afebrile seizures?

A 
Bloods: FBC, WCC, glucose, U &amp; E imbalance, Vit D
Metabolic work up
Toxic screen
Anti-epileptic drug levels
ECG
EEG
Imaging: MRI. trauma, evolving focal neurology, reduced GCS, elevated ICP
LP in stable children.
28
Q

When to hospitalize children for afebrile seizure?

A
  1. Age - < 18 months
  2. Seizure factors: > 15min. focal seizure + recurrent, incomplete recovery by 1 hr. Seizure recurring within same febrile illness
  3. Suspected serious cause of infection (e.g. pneumonia, UTI, sepsis)
  4. No focus for infection
  5. RDS
  6. Raised ICP: headache, vomiting, visual disturbances
  7. Suspected meningitis (+ve Kernig or Bubrudzinski, photophobia, neck stiffness)
29
Q

List the 6 Causes of epilepsy

A
  1. idiopathic
  2. Genetic: channelopathies
  3. Structural: Tuberous sclerosis, corticol malformation, mesial temporal lobe, epilepsy with hippocampal seizures
  4. Metabolic: pyridoxine deficiency
  5. Autoimmune mediated CNS inflammation (NMDA antibody)
  6. Infectious, causing structural changes (HIV, cerebral malaria, TB, cerebral toxoplasmosis)
30
Q

What are epilepsy syndromes?

A

Pattern of clinical features + characteristic EEG

31
Q

Clinical features of infantile spasms (West Syndrome)

A
  1. Sudden Flexor Spasms (bending of waist)
  2. Subsequent extension of arms
  3. Lasts 1-2 sec
  4. Occurs in clusters
32
Q

EEG characteristics of West Syndrome (infantile spasms)

A

Hypoarrhythmia:

  • Irregular
  • High amp waves
  • Spikes

Background chaotic & disorganized electric activity

33
Q

What are the associated conditions with West Syndrome?

A

Developmental delay
Regression
Tuberous sclerosis

34
Q

What is the tx for west syndrome?

A

Corticosteroids
ACTH
Vigabatrin (prevent catabolism of GABA)

35
Q

What age does infantile spasms present at

A

3-8 months

36
Q

What age does childhood absence epilepsy present

A

4-9 years

37
Q

Is childhood absence epilepsy more common in boys or girls?

A

Girls

38
Q

Clinical features of Childhood absence epilepsy?

A
  • lasts 5-20 sec
  • Arrest of movement + awareness
  • Blank Stare
  • But maintains tone
  • Multiple episodes in a day
  • May have purposeless movements of eyes & mouths (e.g. flickering, lip smacking)
  • Remission spontaneous
39
Q

EEG characteristic of childhood absence epilepsy?

A

Generalized bilateral synchronous spikes. 3 per second. Wave discharge.

40
Q

Tx for focal seizures?

A

Carbamazepine or lamotrigine

41
Q

1st line tx for absence,
Tonic,
Generalised tonic clonic seizure,
or Myoclonic seizures?

A

Sodium valproate or lamotrigine.

42
Q

What is status epilepticus?

A

1 Seizure lasting more than 30min or multiple seizures without regaining consciousness within 30 min

43
Q

Complications with Status epilepticus?

A

High risk of brain injury

High risk of respiratory arrest

Paediatrics (9 decks)

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