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Y3 paediatrics > paediatric neurology - paroxysmal events > Flashcards

paediatric neurology - paroxysmal events Flashcards

1
Q

define seizure/fit

A

any sudden attack from whatever cause

  • lots of different mechanisms
    • many aren’t epileptic in nature
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2
Q

define syncope

A

faint

neuro-cardiogenic mechanism

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3
Q

define convulsion

A

seizure where there is prominent motor activity

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4
Q

what is an epileptic seizure

A

electrical phenomenon

abnormal excessive hyper synchronous discharge from a group of cortical neurons

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5
Q

effects of an epileptic seizure

A

may have clinical manifestations

paroxysmal change in motor, sensory or cognitive function

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6
Q

what does the effect a seizure have depend on

A

seizure’s location

degree of anatomical spread over cortex

duration

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7
Q

what is epilepsy

A

a tendency to recurrent, unprovoked (spontaneous) epileptic seizuires

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8
Q

diagnosis of epilepsy

A

clinical features

EEG for supportive evidence

single seizure isn’t necessarily epilepsy

consequences of misdiagnosis can be serious

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9
Q

types of non-epileptic seizures and seizure mimics in children

A

acute symptomatic seizures

reflex anoxic seizure

syncope

parasomnias e.g. night terrors

behavioural stereotypies

psychogenic non-epileptic seizures (PNES)

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10
Q

what are acute symptomatic seizures

A

due to acute insults

e.g. hypoxia-ischaemia, hypoglycaemia, trauma

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11
Q

what are reflex anoxic seizures

A

result of vagal overstimulation

common in toddlers

always provoked/triggered by certain stimuli e.g. fear, excitement, upset etc

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12
Q

how does vagal overactivity result in reflex anoxic seizure

A

vagal activity → slows down heart

bradycardia → decreased cerebral perfusion

→ LOC and abnormal movements

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13
Q

parasomnias as seizure mimics

A

e.g. night terrors

common in pre-school and early school age

can resemble epileptic sei`ures

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14
Q

behavioural stereotypies as seizure mimic

A

intellectual disability

often have repetitive movements which are behavioural

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15
Q

at what age do PNES occur

A

adolescents

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16
Q

what are febrile convulsions

A

a seizure occuring in infancy/childhood

usually between 3mths and 5yrs of age

associated w/ fever but w/o evidence of intracranial infection or defined cause for the seizure

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17
Q

how common are febrile convulsions

A

commonest cause of acute symptomatic seizure in childhood

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18
Q

different seizure types

A

jerk/shake - clonic, myoclonic, spasm

stiff - tonic

fall - atonic, tonic, myoclonic

vacant attack - absence, complex partial seizure

19
Q

mechanism of epileptic fit - chemical trigger

A

decreased inhibition - GABA (gama-amino-butyric acid)

excessive excitation - glutamate and aspartate

excessive influx of Na and Ca ions

20
Q

how does chemical stimulation result in an epileptic seizure

A

chemical stimulation produces an electric current

summation of a multitude of electrical potentials results in depolarisation of many neurons which can lead to seizures - can be recorded from surface electrodes

21
Q

what are the 2 different seizure types on this EEG

A

partial and generalised

22
Q

what is a focal/partial seizure

A

seizure activity is restricted to one hemisphere/part of a hemisphere

23
Q

what is different about childhood vs adult onset epilepsies

A
  • majority are idiopathic in origin - both focal and generalised
  • majority of epilepsies and generalised
  • seizures can be subtle - absences, myoclonus, drop attacks
24
Q

why is making a diagnosis of epilepsy challenging

A
  • non-epileptic paroxysmal disorders are more common in children
  • difficulty in explaining events
  • difficulty in interpretation - witness
    • difficulty in interpretation and synthesising info - physician
25
Q

stepwise approach to diagnosis of epilepsy

A
  1. is the paroxysmal event epileptic in nature
  2. is it epilepsy
  3. what seizure types are occurring
  4. what is the epilepsy syndrome - certain types of epilepsy are more common at certain ages
  5. what is the aetiology
  6. what are the social and educational effects on the child
26
Q

EEG in epilepsy diagnosis- sensitivity

A

interictal EEG has limited value in deciding when the individual has epilepsy

  • sensitivity of first routine interictal EEF - 30-60%
27
Q

EEG in epilepsy diagnosis - false +ve rates

A

paroxysmal activity in 30%

frankly epileptiform activity in 5% of normal children - will never have a seizure

28
Q

EEG in epilepsy diagnosis - when is it useful

A

useful in identifying seizure types, seizure syndrome and aetiology

29
Q

what is needed to diagnose epilepsy

A
  • hx
  • video recording of event
  • ECG in convulsive seizures - rule out long QT syndrome which can be the cause of seizure
  • interictal/ictal EEG
  • MRI brain: determine aetiology - brain malformations/damage
  • genetics: idiopathic epilepsies are mostly familial, also single gene disorders e.g. tuberous sclerosis
  • metabolic tests: esp if associated w/ developmental delay/regression
30
Q

management of epilepsies in children

A

anti-epileptic drugs

31
Q

when should anti-epileptic drugs be considered

A

only if the diagnosis is clear

even if this means delaying the treatment

32
Q

what is the role of AEDs

A

control seizures, not cure the epileptic

33
Q

choosing which AED to use

A

start with one - slow upward titration until side effects manifest or drug is considered to be inefficient

age, gender, type of seizures and epilepsy should all be considered in selecting AEDs

34
Q

side effects of AEDs

A

CNS related SEs can be detrimental

drowsiness, effect on learning, cognition and behavioual

35
Q

what drugs are first line for generalised epilepsies

A

sodium valproate (NOT IN GIRLS) or levetiracetam

36
Q

what is the first line drug for focal epilepsies

A

carbamazepine

37
Q

what new AEDs have more tolerability and fewer side effects

A

levatiracetam

lamotrigine

perampanel

38
Q

other therapies for epilepsy apart from AEDs

A

steroids

immunoglobulins

ketogenic diet

  • mostly for drug-resistant epilepsies

sometimes considered for surgery

39
Q

when is epilepsy drug refractory

A

tried 2 different AEDs and still having seizures

40
Q

what are the 2 types of epilepsy surgery

A

curative

palliative

41
Q

epilepsy surgery - vagal nerve stimulator

A

palliative

lessens the burden of seizures on everyday life for the child

sends electrical impulses to the L vagus nerve (afferent to the brain) - suppresses seizures

effective in ⅓ of drug refractory epilepsy

42
Q

equipment in vagal nerve stimulator

A

programmable generator

lead w/ 2 coils at the end

hand-held magnet - can be used to set off pulse generator and terminate seizure

43
Q

resection for epilepsy

A

EEG on surface of brain to try and determine where the seizures are located

may facilitate resection which can be curative

Y3 paediatrics (45 decks)

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