Paediatric epilepsy Flashcards
Define epilepsy (2)
- A condition characterised by abnormal electrical brain activity
- Causes seizures over a long period of time, that may or may not have an identifiable cause
Define seizure
- An abnormal, unregulated electrical discharge that occurs within the brain and temporarily interrupts normal brain function
What are 6 types of childhood epilepsy conditions?
- Rolandic epilepsy
- West’s syndrome
- Rett syndrome
- Angelman syndrome
- Dravet syndrome
- Lennox-Gastaut syndrome
What is the aetiology of childhood epilepsy? (5)
- Mostly unknown
- Brain damage
- High fever
- Genetically inherited
- Hydrocephalus
What causes of brain damage can lead to epilepsy? (6)
- Lack of O2 during birth
- Head injury
- Birth defects of brain
- Brain infections
- Metabolic disorders
- Illegal drug use in pregnancy
What are 5 possible symptoms of seizures?
- Uncontrollable jerking and shaking
- Losing awareness and staring blankly into space
- Becoming stiff, arching back
- Strange sensations (eg. rising feeling in stomach, unusual smells/tastes, tingling in arms/legs)
- Collapsing
What are 3 possible symptoms of seizures in a newborn?
- Smacking lips or chewing motions
- Look in different directions with each eye
- Become limp
What are 7 types of seizures?
- Simple partial (focal) seizures
- Complex partial (focal) seizures
- Tonic-clonic seizures
- Myoclonic
- Status epilepticus
- Absences
- Atonic
Describe simple partial (focal) seizures (7)
- General strange feeling
- “Rising” feeling
- Deja vu
- Unusual smells/tastes
- Tingling in arms and legs
- Intense fear or joy
- Stiffness of twitching
Describe complex partial (focal) seizures (7)
- Smacking lips
- Rubbing hands
- Making random noises
- Moving arms around
- Picking at clothes/fiddling with objects
- Chewing or swallowing
- Won’t respond during and won’t remember it
What is the tonic stage of tonic-clonic seizures?
- Lose consciousness
2. Body goes stiff and may fall
What is the clonic stage of tonic-clonic seizures?
- Limbs jerk
- Lose control of bladder/bowel
- Bite tongue/cheek
- Difficulty breathing
How long do tonic-clonic seizures last?
- Usually stop after a few minutes
2. May have headache/confusion/fatigue after
Describe myoclonic seizures (3)
- Some or all of body twitches/jerks
- Usually only last a fraction of a second, but several can occur in a short space of time
- Often happen soon after waking up
Describe status epilepticus seizures (2)
- Lasts long period of time or a series of seizures where the person doesn’t regain consciousness
between - Medical emergency
Describe absences or “petit-mal” seizures (6)
- Lose consciousness of surroundings
- Stare blankly
- “Daydreaming”
- Flutter their eyes
- Slight jerking movements of body
- Usually only last up to 15s and won’t remember them
Describe atonic seizures (2)
- All muscles relax suddenly, may fall to the group
2. Tend to be very brief
Give 6 triggers of seizures
- Stress
- Lack of sleep
- Waking up
- Alcohol/illegal drugs
- Some medications
- Flashing lights
What is the most common form of childhood focal epilepsy syndrome?
Rolandic epilepsy (15-20%)
When does Rolandic epilepsy occur? (2)
- Usually between 6-8 years
2. Most grow out of the condition
What is the cause of Rolandic epilepsy?
Not fully established but thought to be genetic
What type of seizures does Rolanic epilsepsy cause?
- Focal seizures that usually occur during sleep or before awakening
- Involve face, mouth and speech organs
How is Rolandic epilepsy treated?
Usually not treated with anti-epileptic drugs as seizures occur at night and learning is not usually impaired
What are the implications of Rolandic epilepsy?
Can affect attention, learning and neurological development (must be considered in treatment
When does West’s syndrome develop?
- Usually develops at 6 months or before 1 year
What is the prevalence of West’s syndrome?
Disorder of the brain occurring in approx. 1/5,000 babies
What is West’s syndrome characterised by? (4)
- Infantile spasms
- A specific EEG pattern
- Developmental regression
- Often learning/physical disabilities
What is the cause of West’s syndrome? (2)
- Many of the conditions which cause West’s syndrome are genetically inherited
- Exact cause has to be establish as each child can differ
How is West’s syndrome treated? (3)
- Anti-epileptic drugs
- Steriods
- Surgery (if unresponsive)
What are the characteristics of Rett syndrome? (4)
- Neurodevelopmental syndrome
- Almost exclusively girls
- Normal development and early growth
- Followed by slowing development and other symptoms
What are 6 symptoms of slowing development in Rett syndrome?
- Loss of purposeful use of hands
- Distinctive hand movements
- Slowed brain and head growth
- Walking problems
- Seizures
- Intellectual disability
How is Rett syndrome treated? (3)
- No cure and treatments are often symptomatic
- Anti-epileptic drugs
- Other medications (eg. breathing, movement)
What is Angelman syndrome?
A genetic neurological disorder
What is the prevalence of Angelman syndrome?
1/25,000 children
When is Angelman syndrome diagnosed?
Usually between 3-7 years
But developmental delay may begin as early as 6m
What are 5 characteristics of Angelman syndrome?
- Intellectual and developmental delay
- Sleep disturbance
- Seizures
- Jerky movements (especially hand flapping)
- Frequent laughter or smiling
How is Angelman syndrome treater?
- Seizures are usually treated
2. MDT to maximise developmental potential - physio, OT, SLT
What is the prevalence of Dravet syndrome?
1/30,000
Describe Dravet syndrome
A severe form of epilepsy usually beginning during 1st year of life
What is Dravet syndrome characterised by?
- Frequent prolonged seizures
- Often triggered by high body temperature, developmental delay, speech impairment, ataxia, hypotonia, sleep disturbances and other health problems
What is the course of seizures in Dravet syndrome? (3)
- First seizures occur with fever and are generaised tonic-clonic or one-sided convulsions (usually prolonged and may require intervention)
- Seizures usually increase in frequency over following weeks and months, begin to occur without fever
- 2nd-4th year: developmental delay apparent, some seizure types disappear but convulsive seizures persist (often in sleep)
What is the treatment of Dravet syndrome?
- Anti-epileptic drugs but response is variable
2. Ketogenic diet
What is the prognosis of Dravet syndrome? (2)
- Increased risk of sudden unexpected death in epilepsy (SUDEP) than other types of epilepsy
- 85% survive to adulthood
- Behavioural problems
Describe Lennox-Gastaut syndrome
Form of childhood epilepsy which is difficult to treat
Cause cannot be found in up to 1/3 of cases
When does Lennox-Gastaut syndrome typically begin?
- 2nd-6th years of life
What is Lennox-Gastaut syndrome characterised by? (4)
- Frequent seizures of different types
- Intellectual impairment
- Psychological problems
- Behavioural problems
What is the treatment of Lennox-Gastaut syndrome? (4)
- Resistant to anti-epileptic drugs
- Often require high doses of multiple drugs
- Ketogenic diet
- Epilepsy surgery
What is the prognosis of childhood epilepsy syndromes? (3)
- Depends on the cause
- Seizures do not appear to damage the brain unless it continues for more than one hour
- Many disorders cause seizures that can cause long lasting problems eg. development
How are childhood epilepsy syndromes diagnosed? (3)
- EEG
- Eyewitness accounts
- Other tests
What other tests may be used to diagnose epilepsy? (6)
- Pulse oximetry
- Blood tests
- Lumbar puncture
- Blood ad urine cultures
- CT or MRI scan
- Genetic tests
What are 3 treatments of epilepsy?
- Surgery
- Ketogenic diet
- Antiepileptic drugs
Describe the use of anti-epileptic drugs (3)
- 70% people respond and seizures are controlled
- Most continue taking until 2 years without seizure as risk is less than 50%
- Change chemical balance in brain
What is a ketogenic diet? (2)
- Low in carbs and high in fat
2. Body breaks down fat to form ketones which may control seizures
What are the side effects of a ketogenic diet? (3)
- Low blood sugar
- Lethargic
- Weight loss
When is surgery considered? (2)
- When children continue to have seizures whilst taking two or more anti-seizure drugs
- Experience intolerable side effects
What does surgery typically involve? (2)
- Removing area of brain (causing seizures) when it won’t significantly impact on function
- Stimulating the vagus nerve
Describe vagus nerve stimulation
Small device implanted near collarbone, connected to vagus nerves to send electrical signals to reduce frequency and duration of seizures
