Paediatric neurology Flashcards
Causes of seizures in children
Epilepsy, Syncope (Vasovagal or cardiac), Anoxic seizures, Non-epileptic or psychiatric phenomena, Sleep related syndromes (parasomnias)
Causes of cardiac syncope
Arrhythmias
Outflow obstructions
Heart muscle disease
Vasovagal syncope
Common and causes multiple seizures (>10)
Precipitated by postural, emotional or situational factors
Include a presyncopal, a syncopal phase and a post-syncopal phase
Symptoms of Presyncope
weakness, pallor, sweating & nausea
respiratory changes including yawning & hyperventilation
strange tastes, epigastric discomfort and visual distortion
Symptoms during full syncope
Progressive loss of tone, bradycardia, reduced respiratory effort and loss of consciousness. May also feature deviation of the eyes and urinary incontinence
Symptoms during post-syncopal
Tiredness and lethargy
Reflex anoxic seizures
Occur in 4% of children under 4 –> 80% of first attacks before 18 months and may start during newborn period
Can be cyanotic or vagal form
Cyanotic Reflex anoxic seizures
‘Reflex end expiratory apnoea’ The commonest form which are provoked by anger/frustration –> holds breath leading to cyanosis and loss of consciousness
Can have brief stiffening with 2-3 clonic jerks
Vagal Reflex anoxic seizures
AKA ‘Pallid Form’ – more often provoked by pain (minor)
Instant loss of consciousness without initial period of distress — Pallor, extreme stiffening, tonic jerks and down-beating eyes, Commonly incontinence
Distinguishing non-epileptic and epileptic seizures (9)
Different provoking circumstances, attacks are prolonged with non-epiletic movements, resist eye opening and pupils are responsive, often recall events during LOC, rarely injure themselves but can bite their tongue and become incontinent, tired post-itcally, unresponsive to drug treatment
Neurological disorders in children
Benign paroxysmal vertigo, Intermittent/recurrent ataxias
Paroxysmal dystonia/dyskineasia/ etc, Sandifers syndrome,Headaches
Sleep disorders in children - Primary parasomnias
Sleep onset – rhythmic movements, hypnic jerks & sleep paralysis
Non-REM disorders - confusional arousals, sleep terrors or sleep walking. REM sleep disorders - nightmares, REM sleep behaviour disorder
Sleep disorders in children - Secondary parasomnias
Medical – Frontal lobe epilepsy, asthma, sleep apnoea, GORD
Pychiatric – PTSD or panic attacks
Febrile Convulsions
Occurs between 6months to 6 years with fever
No intra-cranial infection or existing neurological disorder
Complex if lasts more than 15mins OR focal OR multiple within the same illness.
Epidemiology of febrile convulsions
2-3% of population –> most common between 1 and 2yrs
65% will only ever have one – FH in 25% of cases
Only slightly increased risk of subsequent epilepsy. 30% chance of recurrence
West syndrome (also known as infantile spasms)
A triad of infantile flexor spasms, slowing or regression in development and Hypsarrhythmia
Hypsarrhythmia
an abnormal interictal pattern, consisting of high amplitude and irregular waves and spikes in a background of chaotic and disorganized activity on an EEG
Aetiology of West syndrome
May be idiopathic, linked to brain malformations (developmental or acquired: CMV, HIE, hypoglycaemia) or neurocutaneous disorders such as tuberous sclerosis, chromosomal disorders or metabolic disorders
Benign childhood epilepsy with centrotemporal spikes (benign rolandic epilepsy)
15-20% of childhood epilepy – onset 3-12yrs. Infrequent nocturnal partial seizures –> hemifacial with speech arrest +- secondary generalisation. EEG spikes in centrotemporal region and treatment has no effect – invariably remit in their teens
Juvenile Absence epilepsy (IGE)
Onset 7-16yrs, longer but rarer absences than childhood absence epilepsy, 15% have myoclonic jerks, 80% generalized tonic clonic seizures, Have 3-4s spike wave discharges and 10-20% are photosensitive. FH is usually positive
Juvenile myoclonic epilepsy
Onset 12-18yrs, early morning myoclonic jerks involving the upper limbs – may also have generalised tonic clonic or absences. 50% photosensitive. EEG will show polyspike and wave discharges
Headaches in children
5% of children have had a migraine by age 15 and 15% have frequent headaches
Differential is as for adults - exclude ICP and identify migraines for treatment
Functional Abdominal Pain
A common cause of recurrent, severe abdo pain in children. May be associated with bowel changes and often leads to IBS. A pain amplification syndrome
Migraines in children
In children attacks may be shorter, headaches more bilateral and GI symptoms more prominent.
Morning vomiting
A cardinal sign of raised ICP. If child has personality change and is vomiting before breakfast then be very worried.
Childhood absence epilepsy
onset 3-10yrs and 1:2/M:F
absences lasting a few secs followed by a quick recovery may be provoked by hyperventiliation/stress. Bilateral, symmetrical 3Hz spike/wave pattern on EEG, Treat with valproate and ethosuximide
90-95% become seizure free in adolescence
