Paediatric Neurology 2 - Chronic Flashcards
Define status epilepticus:
This is the term used when someone has been seizing for over 30 minutes without recovery.
What are the 3 phases of generalised childhood epilepsy?
Tonic phase
Clonic Phase
Postictal phase
What type of epilepsy is benign with centro-temporal spikes and accounts for 15% of all childhood epilepsy?
Rolandic Epilepsy
What type of seizure is seen in Rolandic Epilepsy?
Infrequent, partial fits with unilateral facial or oropharyngeal sensory motor symptoms, speech arrest and hypersalivation
What are some of the common generalised epilepsy coditions?
Tonic-Clonic (grand mal)
Absences
Infantile spasms (west’s syndrome)
What is the peak age for West’s syndrome?
5 months
What are some of the characteristic features of infantile spasms / West’s syndrome?
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
How is West’s syndrome managed?
ACTH or prednisolone first line
Vigabatrin second line
What is commonly seen on an EEG in a child with West’s syndrome?
Chaotic Hypsarrhythmia
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?
Temporal Lobe partial seizures
WHat will occur in the tonic phase of a generalise seizure?
Sudden loss of consciousness with limbs extended, back arched and breathing stops.
What will occur in the clonic phase of a generalised seizure?
Intermittent jerking and irregular breathing
Involuntary urination and salivation
What is the management for an epileptic convulsion?
Buccal midazolam / rectal diazepam if fitting more than ten minutes IV lorazepam (up to 2 doses)
What is the prevalence or cerebral palsy?
1/400 children
What are some additional problems often associated with cerebral palsy?
Epilepsy Learning difficulties Visual impairment Squint Hearing loss Speech disorders Behavioural disorders Undernutrition and poor growth GORD and swallowing problems
Define cerebral palsy:
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.
What are the features of hemiplegia cerebral palsy?
One side is affected
arm usually more involved than leg
Delayed walking
Tiptoe gait when running
What are some clinical features of diplegia cerebral pasly?
Both legs are involved with arms more or less unaffected
Scissoring of legs and excessive hip adduction
Equinovarus of feet
Tiptoe walking
What causes ataxic cerebral palsy and what are the features?
Cerebellar damage
Poor coordination and ataxic gait
What are some neonatal signs of cerebral palsy?
Difficulty sucking Irritable Convulsions Abnormal neurological exam Head lag Persistent moro reflex
What members of the MDT are essential in the management of cerebral palsy?
Physiotherapy
Occupational therapy
Dietician
Speech therapist
What are some common orthopaedic complications which can occur in cerebral palsy?
Hip dislocation due to spasticity
Equinus deformity of the ankle
Scoliosis
What is given to treat spasticity in cerebral palsy?
Baclofen first line
Botulinum injections second line
What is given to treat dystonia in cerebral palsy?
Trihexyphenidyl first line
Deep brain stimulation is a more invasive option for later
