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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?

25
Risk of febrile seizure developing epilepsy later in life
2%
26
What are the red flags for afebrile seizure?
Prolonged QT syndrome | Cardiac arrhythmia
27
What is the work up for afebrile seizures?
``` Bloods: FBC, WCC, glucose, U & 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
When to hospitalize children for afebrile seizure?
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
List the 6 Causes of epilepsy
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
What are epilepsy syndromes?
Pattern of clinical features + characteristic EEG
31
Clinical features of infantile spasms (West Syndrome)
1. Sudden Flexor Spasms (bending of waist) 2. Subsequent extension of arms 3. Lasts 1-2 sec 4. Occurs in clusters
32
EEG characteristics of West Syndrome (infantile spasms)
Hypoarrhythmia: - Irregular - High amp waves - Spikes Background chaotic & disorganized electric activity
33
What are the associated conditions with West Syndrome?
Developmental delay Regression Tuberous sclerosis
34
What is the tx for west syndrome?
Corticosteroids ACTH Vigabatrin (prevent catabolism of GABA)
35
What age does infantile spasms present at
3-8 months
36
What age does childhood absence epilepsy present
4-9 years
37
Is childhood absence epilepsy more common in boys or girls?
Girls
38
Clinical features of Childhood absence epilepsy?
- 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
EEG characteristic of childhood absence epilepsy?
Generalized bilateral synchronous spikes. 3 per second. Wave discharge.
40
Tx for focal seizures?
Carbamazepine or lamotrigine
41
1st line tx for absence, Tonic, Generalised tonic clonic seizure, or Myoclonic seizures?
Sodium valproate or lamotrigine.
42
What is status epilepticus?
1 Seizure lasting more than 30min or multiple seizures without regaining consciousness within 30 min
43
Complications with Status epilepticus?
High risk of brain injury | High risk of respiratory arrest

Paediatrics (9 decks)

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