Paediatric Neurology 2 - Chronic

Question 1

Define status epilepticus:

Answer 1

This is the term used when someone has been seizing for over 30 minutes without recovery.

Question 2

What are the 3 phases of generalised childhood epilepsy?

Answer 2

Tonic phase
Clonic Phase
Postictal phase

Question 3

What type of epilepsy is benign with centro-temporal spikes and accounts for 15% of all childhood epilepsy?

Answer 3

Rolandic Epilepsy

Question 4

What type of seizure is seen in Rolandic Epilepsy?

Answer 4

Infrequent, partial fits with unilateral facial or oropharyngeal sensory motor symptoms, speech arrest and hypersalivation

Question 5

What are some of the common generalised epilepsy coditions?

Answer 5

Tonic-Clonic (grand mal)
Absences
Infantile spasms (west’s syndrome)

Question 6

What is the peak age for West’s syndrome?

Answer 6

5 months

Question 7

What are some of the characteristic features of infantile spasms / West’s syndrome?

Answer 7

sudden clusters of head nodding (tonic flexor spasm of head)
Salaam attack
Arm jerking
Relaxation after 3-30 seconds, spasms may occur up to 20 times a day

Question 8

How is West’s syndrome managed?

Answer 8

ACTH or prednisolone first line

Vigabatrin second line

Question 9

What is commonly seen on an EEG in a child with West’s syndrome?

Answer 9

Chaotic Hypsarrhythmia

Question 10

A child presents with altered/ impaired consciousness, lip smacking, hallucinations and chewing motions. When they come round they show signs of postictal amnesia? What is the most likely diagnosis?

Answer 10

Temporal Lobe partial seizures

Question 11

WHat will occur in the tonic phase of a generalise seizure?

Answer 11

Sudden loss of consciousness with limbs extended, back arched and breathing stops.

Question 12

What will occur in the clonic phase of a generalised seizure?

Answer 12

Intermittent jerking and irregular breathing

Involuntary urination and salivation

Question 13

What is the management for an epileptic convulsion?

Answer 13

Buccal midazolam / rectal diazepam if fitting more than ten minutes
IV lorazepam (up to 2 doses)

Question 14

What is the prevalence or cerebral palsy?

Answer 14

1/400 children

Question 15

What are some additional problems often associated with cerebral palsy?

Answer 15

Epilepsy
Learning difficulties
Visual impairment
Squint
Hearing loss
Speech disorders
Behavioural disorders
Undernutrition and poor growth
GORD and swallowing problems

Question 16

Define cerebral palsy:

Answer 16

This is a disorder of movement caused by permanent, non progressive brain damage acquired in early brain development, before 2 y/o, often due to hypoxia of the brain.

Question 17

What are the features of hemiplegia cerebral palsy?

Answer 17

One side is affected
arm usually more involved than leg
Delayed walking
Tiptoe gait when running

Question 18

What are some clinical features of diplegia cerebral pasly?

Answer 18

Both legs are involved with arms more or less unaffected
Scissoring of legs and excessive hip adduction
Equinovarus of feet
Tiptoe walking

Question 19

What causes ataxic cerebral palsy and what are the features?

Answer 19

Cerebellar damage

Poor coordination and ataxic gait

Question 20

What are some neonatal signs of cerebral palsy?

Answer 20

Difficulty sucking
Irritable
Convulsions
Abnormal neurological exam
Head lag
Persistent moro reflex

Question 21

What members of the MDT are essential in the management of cerebral palsy?

Answer 21

Physiotherapy
Occupational therapy
Dietician
Speech therapist

Question 22

What are some common orthopaedic complications which can occur in cerebral palsy?

Answer 22

Hip dislocation due to spasticity
Equinus deformity of the ankle
Scoliosis

Question 23

What is given to treat spasticity in cerebral palsy?

Answer 23

Baclofen first line

Botulinum injections second line

Question 24

What is given to treat dystonia in cerebral palsy?

Answer 24

Trihexyphenidyl first line

Deep brain stimulation is a more invasive option for later