Paediatric neurology

Question 1

Causes of seizures in children

Answer 1

Epilepsy, Syncope (Vasovagal or cardiac), Anoxic seizures, Non-epileptic or psychiatric phenomena, Sleep related syndromes (parasomnias)

Question 2

Causes of cardiac syncope

Answer 2

Arrhythmias
Outflow obstructions
Heart muscle disease

Question 3

Vasovagal syncope

Answer 3

Common and causes multiple seizures (>10)
Precipitated by postural, emotional or situational factors
Include a presyncopal, a syncopal phase and a post-syncopal phase

Question 4

Symptoms of Presyncope

Answer 4

weakness, pallor, sweating & nausea
respiratory changes including yawning & hyperventilation
strange tastes, epigastric discomfort and visual distortion

Question 5

Symptoms during full syncope

Answer 5

Progressive loss of tone, bradycardia, reduced respiratory effort and loss of consciousness. May also feature deviation of the eyes and urinary incontinence

Question 6

Symptoms during post-syncopal

Answer 6

Tiredness and lethargy

Question 7

Reflex anoxic seizures

Answer 7

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

Question 8

Cyanotic Reflex anoxic seizures

Answer 8

‘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

Question 9

Vagal Reflex anoxic seizures

Answer 9

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

Question 10

Distinguishing non-epileptic and epileptic seizures (9)

Answer 10

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

Question 11

Neurological disorders in children

Answer 11

Benign paroxysmal vertigo, Intermittent/recurrent ataxias

Paroxysmal dystonia/dyskineasia/ etc, Sandifers syndrome,Headaches

Question 12

Sleep disorders in children - Primary parasomnias

Answer 12

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

Question 13

Sleep disorders in children - Secondary parasomnias

Answer 13

Medical – Frontal lobe epilepsy, asthma, sleep apnoea, GORD

Pychiatric – PTSD or panic attacks

Question 14

Febrile Convulsions

Answer 14

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.

Question 15

Epidemiology of febrile convulsions

Answer 15

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

Question 16

West syndrome (also known as infantile spasms)

Answer 16

A triad of infantile flexor spasms, slowing or regression in development and Hypsarrhythmia

Question 17

Hypsarrhythmia

Answer 17

an abnormal interictal pattern, consisting of high amplitude and irregular waves and spikes in a background of chaotic and disorganized activity on an EEG

Question 18

Aetiology of West syndrome

Answer 18

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

Question 19

Benign childhood epilepsy with centrotemporal spikes (benign rolandic epilepsy)

Answer 19

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

Question 20

Juvenile Absence epilepsy (IGE)

Answer 20

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

Question 21

Juvenile myoclonic epilepsy

Answer 21

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

Question 22

Headaches in children

Answer 22

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

Question 23

Functional Abdominal Pain

Answer 23

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

Question 24

Migraines in children

Answer 24

In children attacks may be shorter, headaches more bilateral and GI symptoms more prominent.

Question 25

Morning vomiting

Answer 25

A cardinal sign of raised ICP. If child has personality change and is vomiting before breakfast then be very worried.

Question 26

Childhood absence epilepsy

Answer 26

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