Paediatric Neurology - Non-epileptic paroxysmal events and febrile convulsions Flashcards
What are some causes of non-epileptic paroxysmal events?
Syncope Psychologically determined paroxysmal event Breath holding Self gratification Non REM Parasomnias Daydreaming Tics
What happens during an episode of syncope?
Precipitating event - fright or hair brushing
Aura or tingling
LOC and postural change with change of tone. Jerking for <1min (may not be rhythmic)
At what age do children get syncope?
> 9 months
How is syncope managed?
Rule out long QT
Reassure
Advice on hydration, salt and standing
What features are suggestive of psychologically determined paroxysmal event?
Situation specific
Thrashing movements
Eyes open
Dramatic fall to floor
At what age do children get psychologically determined paroxysmal events?
Early adolescence
How do you manage psychologically determined paroxysmal events?
Help family understand reason
Remove gains from behaviour
Psychological support
What happens when a child is breath holding and has a paroxysmal event?
Stimulus such as head bang –> short cry –> child go limp –> collapse –> brief clonic jerking
At what age do children have paroxysmal events due to breath holding?
6 months - 6 years
How do you manage children who are having paroxysmal events due to breath holding?
Reassure parents that the child will start breathing
No long lasting damage
Describe a paroxysmal event due to self gratification
Child bored and self stimulate
Legs outstretch and eyes glazed with sweating and salivation
When do children have paroxysmal events due to self gratification?
3 months to 3 years
How do you manage children having paroxysmal events due to self gratification?
Reassure parents it is normal developmental behaviour
What happens in a non REM Parasomnias?
During deep sleep, child “wake” and is inconsolable with vigorous or violent actions
After 10-20 mins they wake confused before sleeping again
How do you manage non REM Parasomnias?
Suggest clearing bedroom of obstructions
Alarms on doors and windows
What is daydreaming?
Stream of consciousness that detaches from current external tasks when attention drifts to a more personal and internal direction
Occur at school
Confused with absence seizure
What are tics?
Repetitive stereotyped movements such as face grimacing and blinking
When do tics begin?
6-7yo
How do you manage tics?
Reassure it is common
If last for >12 months - require intervention
What is a fit?
Brief moment when the person appears to be “absent” from what is going on around them
OR
Jerking/twitching of a hand, arm or leg or jerking/twitching affecting the whole body
What do you have to rule out if a child presents with a fit?
Meningitis Head Trauma Metabolic causes Hypoxia Cerebrovascular insult Fever Toxins RICP
What investigations would you order to rule out meningitis in a fitting child?
Lumbar Puncture
Bloods
What would you do to rule out head trauma in a fitting child?
Fully exposed examination
What metabolic causes would you rule out in a fitting child?
Low blood glucose
High calcium
How would you investigate RICP in a fitting child?
Ophthalmoscope
CN examination
What is the role of an EEG in a fitting child?
Done to support clinical diagnosis of epilepsy once other causes have been ruled out
What is the role of an MRI scan in a fitting child?
Done if history suggests focal onset to rule out a space occupying lesion
What are febrile convulsions?
Seizures occurring in children aged between 6 months - 5 years associated with fever but no underlying cause
What is the aetiology behind febrile convulsions?
Unknown if temperature or rate of temperature rise causes convulsions
Genetic component
What are common causes of febrile convulsions?
Otitis media
Tonsilitis
Viruses
What are serious causes to rule out?
Meningitis
Sepsis
UTI
LRTI
What categories can febrile convulsions be split into?
Simple
Complex
Status epilepticus
Describe a simple febrile convulsion
Generalised tonic clonic seizure
<15 mins
Doesn’t recur within same febrile illness
Describe a complex febrile convulsion
Focal features
>15 mins or recur with same febrile illness
20% of cases
Describe a status epilepticus febrile convulsion
Any febrile seizure > 30mins
5% of cases
How are febrile convulsions managed?
Protect from injury - don’t restrain child
> 5 mines –> rectal diazepam - repeat if still seizing 5 mins later
Admit and treat as meningitis if serious features
Can give anti-paretics and tepid sponging
Assess post seizure
Educate parents
What do you assess post febrile seizure?
Full seizure history - inc. family history
Signs of serious cause
Vitals
Bloods and urine culture
What advice do you give to parents about febrile convulsions?
Explain what they are
Treat fever - remove clothes, hydrate and give anti-paretics
Call 999 if >5mins
Check for non-blanching rash and dehydration
Recovery position if having a fit
