Paediatric Neurology - Epilepsy Flashcards
How common is epilepsy in children?
Twice as common as in adults
5 per 1000 school aged children
What causes epilepsy in children?
Malformations - tuberous scelerosis
Infections - meningitis, encephalitis
Electrolyte disturbances
Trauma
What is the difference between an epileptic seizure and epilepsy?
Epileptic seizure is an episode of abnormal and excessive neuronal activity in the brain that is apparent to the subject or an observer
Epilepsy is a chronic disorder characterised by recurrent, unprovoked epileptic seizures
What generalised seizures do children get?
Myoclonic Tonic Clonic Absence Tonic-clonic Atonic
What happens in a myoclonic seizure?
Shock like movement to one or several body parts
What happens in a tonic seizure?
Sustained contraction
What happens in a clonic seizure?
Rhythmic jerking of limb, side of body or whole body
What happens in an absence seizure?
Psychomotor arrest - can have movements
Lasts only seconds
What happens in a tonic-clonic seizure?
Child lose consciousness
Muscles firstly all stiffen up (tonic phase)
Extremities then jerk and twitch rhythmically (clonic phase)
What areas can focal seizures affect?
Occipital
Centroparietal
Temporal
Frontal
How would an occipital seizure manifest?
Coloured bright lights seen
How would a centroparietal seizure manifest?
Sensorimotor phenomenon spreads
How would a temporal lobe seizure manifest?
Gastric discomfort Anxiety Deja vu Plucking of clothes Smacking lips
How would a frontal lobe seizure manifest?
Dystonic posture
Guttural noises - hoarse sound made in back of throat
How would a seizure in a neonate never present?
Never tonic-clonic - brain isn’t mature enough to produce synchronous activity
What would seizures in a neonate indicate?
Severe underlying cerebral dysfunction
Never benign
What should investigations for neonatal seizures revolve around?
Looking for cause
How would infantile spasms present (age, symptoms, EEG)
4-8 months
Flexion of limbs then extension and arched back
Developmental delay
EEG shows hypsarrthythmia
When do you see severe myoclonic epilepsy of infancy and how does it present
Within 1st year of life
1 side of the body generally affected
Often due to change in temperature
Develop normally for first few years and then there is delay
When do you see juvenile myoclonic epilepsy and how does it present
Teenage years
Myoclonus seizures on waking
+/- generalised tonic clonic
When do you see Panayiotopoulos syndrome and how does it present
3-6 yo
Prolonged autonomic seizures eg vomiting
Normal development
Usually resolves by teenage years
When do you see benign childhood epilepsy with centrotemporal spikes and how does it present
Age 3-10
Occur nocturnally or on waking
Focal tingling, facial movements, tonic, clonic
Normal development
How do you take a history of a seizure?
Detailed description of:
Events before
What happened during
What happened after the suspected seizure
Distinguish between true epilepsy and mimics
What is the role of an EEG in epilepsy?
Support clinical diagnosis of epilepsy once everything else ruled out
Doesn’t prove or disprove epilepsy
When do you do neuroimaging for epilepsy?
Focal onset seizure
Seizure not responsive to first line treatment
Focal neurological deficit
Children <2 with non-febrile convulsions
What other investigations could be appropriate in epilepsy?
Plasma and urine amino acids
Biopsy of skin or muscle
Measurement of WBC enzymes
DNA analysis
How do you manage epilepsy?
Advice on safety surrounding seizure
Educate child and family
Involve child in decision
Regular review
Drug treatment
When are Anti-Epileptic drugs not normally started?
First uncomplicated seizure
Infrequent myoclonic or absence seizures
How should anti-epileptic drugs be given?
Monotherapy - achieve total seizure control in 70% of children
What anti-epileptic drugs are first line?
Generalised - sodium valproate
Partial - Carbamazepine
When can withdrawal of Anti Epileptic Drug’s be discussed?
2 year seizure free
When do you see Lennox-Gastaut and how does it present
Age <4
Complete variety of seizures and different patterns of neuro development seen (basically anything)
Slow spikes on EEG
What is the management of infantile spasms
Prednisolone
Vigabatrin
What is the common management of epilepsy syndromes (aside from infantile spasms)
Valproate is most commonly used
Lamotrigine is often second line
How would you investigate a first fit
Infection screen Temperature Blood glucose Serum calcium Fundoscopy Toxin screen
