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Final Notes > Paeds: Epilepsy (DrClarke) presentation > Flashcards

Paeds: Epilepsy (DrClarke) presentation Flashcards

1
Q

Definition

A

Recurrent transient paroxysmal attacks of disturbed consciousness and sensorimotor function, resulting from abnormal electrophysiological discharges of cerebral neurons

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2
Q

Epidemiology
Incidence
Age range
Sex distribution

A

I: 500/100,000 of UK population (~37,000 people)
A: extremes (congenital in kids/degeneration in elderly)
SD: M:F –> 1:1

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3
Q

Pathophysiology

A

Electrical activity spread of between cortical neurones is normally restricted. In seizures there is a failure of inhibitory synaptic contact between neurones –> overall excitation of large groups of neurones.
Each individual has a threshold for seizure activity. Some individuals have a low threshold -> having seizures in response to flashing lights stimulus.

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4
Q

International league Against Epilepsy: Classificaton

A
  1. Generalised
  2. Partial
  3. Unclassified
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5
Q

Generalised

A
  • Tonic-clonic seizures (grandmal)
  • Typical absence seizures (petit mal)
  • Myoclonic seizures
  • Tonic seizures
  • Atonic seizures/akinetic seizures/Drop attacks
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6
Q

Partial (focal)

A
  • Simple partial seizures (Jacksonian seizures)
  • Complex partial seizures
  • Partial seizures with 2ndry generalised tonic-clonic seizures
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7
Q

Tonic-clonic presentation

A
  • Vague warning - unconsciousness and generalised tonic-clonic convulsions
  • Tonic phase: body becomes rigid for up to a mintute, pt utters a cry then falls -> serious injury sometimes, tongue usually bitten may be incontinent of urine or faeces
  • Clonic phase then begins: generalised convulsions, frothing at mouth and rhythmic jerking lasting secs -> mins.
    Self-limiting -> drowsiness, confusion or coma for several hrs.
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8
Q

Typical absence seizures (petit mal)

A
  • Begins in childhood - dev. abnormality of neuronal growth
  • Brief episodes of unconsciousness with little or no motor component
  • Accompanied by3 Hz spike + wave ECG activity
  • Activity ceases, pt stares and is spaced out for a few secs. Interruption mid-sentence carries on as normal afterwards.
  • Eyelids twitch, a few muscles may jerk
  • After attack, normal activity is resumed
  • Usually develop generalised tonic-conic seizures in adult life.
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9
Q

Myoclonic seizures

A
  • Single/multple sudden or uncontrollable isolated muscle jerking
  • Juvenile myoclonic epilepsy: common, ocurs b/t 8&26 yrs of age, but usually stars between 12 and 16.
  • Girls>boys affected
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10
Q

Myoclonic seizures 3 types of epilepsy can occur

A
  1. Tonic-clonic (usually occurs AM with 1/2hrs of waking, lack of sleep)
  2. Myoclonic (soon after waking up & when getting dressed or at brekkie, can also occur in evening if tired)
  3. Absence (any time of the day, more in the morning)
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11
Q

Tonic seizures

A

Intense stiffening of body NOT followed by convulsive jerking

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12
Q

Atonic seizures/Akinetic seizures/Drop attacks

A

Sudden loss of tone with falling and LOC.

May have severe injury from falls

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13
Q

Partial (focal) seizures description

A

An ‘aura’ describes effects of initial focal electrical events e.g. unusual smell, tingling in a limb or strange inner feeling usually recognised by pt as a WARNING SIGN

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14
Q

Simple partial seizures (Jacksonian seizures

A
  • Originates in motor cortex
  • Typically begins at angle of mouth or in thumb & index finger spreading to the limbs on the side opposite epileptic focus (jacksonian march pattern)
  • WEakness of convulsive limbs for several hrs (Todd’s paralysis)
  • No impairment of consciousness!
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15
Q

Complex partial seizures

A
  • Impairment of consciousness
  • Prodrome symptoms experiences: changed hearing, Visual disturbances, smell sensations, mood changes, muscle pain, muscle tremor
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16
Q

Complex partial seizures location

A

Temporal lobe seizures
Frontal cortex
Parietal cortex
occipital cortex

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17
Q

Temporal lobe complex partial seizures

A

Simple or comples -> feelings of unreality (jamais vu) or familiarity (deja vu).
May have absence attacks, vertigo, visual hallucinations

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18
Q

Complex partial seizures Frontal cortes

A

autonomic disturbances - piloerectin, flushing, overbreathing, strange smells

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19
Q

complex partial seizures parietal cortex

A

sensory disturbance.

20
Q

Occipital cortex

A

Crude visual shapes

21
Q

Unclassified seizures

A

Seizures that don’t fit in any of the categories

22
Q

Aetiology

A
  • Trauma/hypoxia/surgery
  • Genetic/developmental abnormalities
  • Pyrexia
  • Brain tumours/absences
  • Vascular
  • Alcohol/drugs/drug withdrawal
  • Encephalitis and inflammatory conditions
  • Metabolic abnormalities
  • Degenerative brain disorders
  • Provoked seizures (e.g. photosensitivity)
  • sleep deprivation
23
Q

Trauma/hypoxia/surgery

A
  • Post traumatic epilepsy in 2%
  • Perinatal trauma and fetal anoxi are common in childhood seizures
  • Hypoxic damage to hippocampi ->childhood epilepsy
  • May get early epilepsy within a week brain injury, or late epilepsy months/yrs later.
  • 10% of neurosurgical ops on crebral hemispheres leads to seizures
24
Q

Genetic/ developmental abnormalities

A
  • 30%
  • 1st degree relative with seizures Hx
  • Inheritance mode uncertain
  • Generalised typical absence seizures: autosomal dominant with variable penetrance.
  • Developmental abnormalities e.g. harmatomas, neuronal migration abnormalities
25
Q

Pyrexia

A

Can lead to febrile convulsions in pyrexic kids

26
Q

Brain tumours/abscessess

A

Cerebral tumours –>6%

  • Mass cortex lesions -> epilepsy, (partial/secondary generalized seizures)
  • Hydrocephalus also lowers the seizure threshold.
27
Q

Vasuclar

A

May follow cerebral infarctions (esp elderly) ~15% of seizures.
- A brain arteriovenous malformation may present with a seizure

28
Q

Alcohol/drugs/drug withdrawal

A

Alcohol - 6% - drinking heavily, withdrawal or alcohol induced hypoglycaemia.

  • (overdose, theraputic levels): Phenothiazines, MAO inhibitors, tricylic antidepressants, amfetamines, lignocaine and nalidixic acid can lead to fits .
  • Anticonvulsant withdrawal.
29
Q

Encephalitis and inflammatory conditions

A

Often presenting feature of encephalitis, cerebral abscess, cortical venous thrombosis, neurosyphilis, chronic meningitis (e.g. TB) and rarely bacterial meningitis

30
Q

Metabolic abnormalities

A
  • Hypoglycaemia
  • Hypocalcaemia
  • Hyponatraemia
  • Acute hypoxia
  • Porphyria
  • Uraemia
  • Hepatocellular failure
  • Mitochondrial disease
31
Q

Degenerative brain disorders

A

e.g. alzheimers, 3 times more common in MS

32
Q

Provoked seizures (e.g. photosensitivity)

A

e.g. flashing lights, flickering TV, music

33
Q

Sleep deprivation

A

Missing a nights slepp - seizure in susceptible people

34
Q

Diagnosis of epilepsy

A
  • Confirm pt has epilepsy based on Hx and examination
  • Do FBC, glucose, U+E’s, LFT, ESR, CRP? metabolic, infective or inflammatory cause
  • EEG to investigate suspected epilepsy: ambulatory EEG, video telemetry ->? nature of attacks- CT?MRI indications: if epilepsy after 20, EEG shows focal seizure type, seizures have focal features, difficult to control seizures -> intracranial masses
35
Q

Differential diagnosis

A
  1. Hyperventilation and panic attacks
  2. Breath-holding attacks
  3. Day dreaming
  4. Migraine
  5. TIA
  6. Transient global amnesia
  7. movement disorders
  8. Hypoglycaemia
  9. Vertigo
  10. Syncope/vasovagal attacks
  11. Non-epileptic attacks (pseudoseizures)
  12. febrile convulsions
36
Q

Hyperventilation and panic attacks

A
  • During stress periods
  • Altered awareness, dizziness and LOC
  • May get chest pain, dyspnoae, blurred visions, parasathesia
  • Hyperventilation and palpitations, sweating, abdo discomfort
  • -> occasionally similar pattern to TEMPORAL seizures
37
Q

Breath-holding attacks

A
  • Occurs when child is angry
  • Period of crying - cessation of breathing
  • cyanosis and child becomes limp and unresponsive
  • Trembling and few clonic movements
  • Persists for 2 mins - rapid recovery
38
Q

Day dreaming

A

Can be mistaken for absence seizures

Child however can be easily altered here

39
Q

Migraine

A
  • Syncope may occur when vomiting
  • Basilar migraine may -> LOC followed by headache. differentiated on FH and brainstem symptoms
  • Migraine preceded by visual or sensory disturbance may be mistaken for partial seizures
40
Q

TIA

A
  • Weakness and sensory symptoms
  • TIAs usually last longer and theres raraely LOC
  • Sensory phenomenon may spread like Jacksonian march, not seen in TIA
41
Q

Transient global amnesia

A
  • Usually an isolated episode lasting several hrs
  • Pt unable to remember
  • Pt alert & communicative during the episode but may repeatedly ask the same question
  • Recovery afterwards normally complete
42
Q

Movement disorders

A
  • Tics and chorea sometimes confused with myoclonus

- paroxysmal choreoathetosis -> no LOC

43
Q

Hypoglycaemia

A
  • Uncommon: pts with DM on insulin or oral hypoglycaemic, very rarely due to insulinoma
  • Usually pt gets warning signs of autonomic changes e.g pallor, sweating, tachycardia
  • Loss of hypoglycaemic awareness/no warning signs -> coma ensues -> genuine seizures
44
Q

Vertigo

A
  • Often paroxysmal - >epilepsy

- Very occasionally is a symptoms of an epileptic seizure particularly PARIETAL LOBE EPILEPSY

45
Q

Syncope/vasovagal attacks

A

-LOC

46
Q

Non-epileptic attack (pseudoseizures)

A
  • Often resembles grand mal seizures

- Prolactin levels however are normal here (increased in a true grandmal)

47
Q

Febrile convulsions

A

Occurs in children when there is a rapid increase in body temp

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