Pediatric Neurology

Question 1

Why do seizures occur?

Answer 1

because of sudden abnormal electrical activity in the brain.

A single seizure, or convulsion, is a symptom of abnormal electrical activity in the brain.

Question 2

How are seizures diagnosed?

Answer 2

• The diagnosis of a seizure disorder is first made on the history of the event: what happened before, during, and after the seizure.
• An EEG should be performed with the child awake and asleep.
• An MRI of the brain should be performed if the EEG is abnormal, showing an irritable focus in the brain.

Question 3

How are seizures treated?

Answer 3

Treatment is aimed at the frequency and type of seizures.
-Antiepileptic medications may be used to reduce the seizure frequency and severity.
-For febrile seizures, it is important to identify the source of the infection causing the fever and adequately treat the fever at its inception in susceptible children.
-If a seizure lasts longer than 2 minutes and includes loss of awareness, parents can be taught to administer rectal diazepam gel (Diastat) or intranasal midazolam (Versed) at home to attempt to stop the seizure.
If the seizure does not respond to the administration of rectal diazepam gel and continues longer than 5 minutes, the parents should call 911 to summon help.
-Lengthy seizures may require IV medications to stop the seizure.
-Lengthy seizures may also require respiratory support and administration of supplemental oxygen.

Question 4

What are nursing interventions for a seizure?

Answer 4

The child should be turned to his or her side when experiencing a seizure to help the airway remain open and allow fluids or emesis to drain from the mouth. -Turning the person to the left side is preferable if she is pregnant to avoid compression of the inferior vena cava by the gravid uterus.

• Nothing should be placed in the mouth of a person having a seizure.
• The child should not be restrained during the seizure.
• Clothing that is tight around the neck should be loosened when the child is experiencing a seizure.
• The child should be protected from injury caused by the movements of the seizure.
• The child should be comforted and allowed to rest after the seizure has ended.
• Children may be incontinent of urine or stool during the seizure.
• Some children may vomit during or after the seizure.
• Brief periods of confusion may occur after the seizure.
• Many children report headache after a seizure.
• Prolonged seizures that last longer than 5 minutes may require emergency care, such as respiratory support and IV medication to abort the seizure. It is important to time the seizure from the onset of jerking, loss of consciousness, or other involuntary behaviors to the end of the behaviors. The post-ictal period, in which the child may be in a deep sleep, is not part of the seizure behavior and does not need to be timed.
• If the child in the hospital is at risk for seizure, there should be oxygen and suction at the bedside and IV access should be established. Some institutions provide bumper pads around the inner aspect of the bed’s side rails.
• If the child has epilepsy or recurrent seizures, antiepileptic medication may be administered. These medications are selected based on the seizure type and frequency

Question 5

What are safety measures to protect children who have seizures frequently?

Answer 5

• Nurses should help parents plan for safety in the event of seizures, such as ensuring children wear helmets and protective gear when playing sports.
• The nurse should promote water safety by instructing parents to allow children to bathe with supervision (with unlocked doors and within earshot of parents), and teens should not be allowed to shower or bathe unless another responsible person is in the home.
• Swimming should never occur without direct supervision.
• Instruct parents to provide a bed of lower height for the child with seizures if possible—sleeping on an upper-level bunk bed should be avoided.

Question 6

What is a focal seizure?

Answer 6

A partial seizure

They begin in just one part of the brain and spread to other regions.

• The symptoms of focal seizures vary according to the location of origin of the seizure and the area to which the seizure spreads.
• Focal seizures are usually brief and confined to small movements with no or mild loss of awareness.
• Sometimes this seizure can spread widely throughout the brain and become secondarily generalized, meaning that tonic-clonic (alternating periods of rigidity and jerking) movements and loss of consciousness occur after the focal seizure behavior spreads.

Question 7

What is temporal lobe epilepsy?

Answer 7

Temporal lobe epilepsy is the most common partial seizure or localization-related epilepsy

Temporal lobe seizures are often resistant to treatment with medication, so this condition is sometimes called drug-resistant epilepsy.

Temporal lobe epilepsy is associated with a specific lesion in the medial aspect of the temporal lobe called hippocampal sclerosis. This condition is characterized by neuronal cell loss and gliosis (formation of a lesion) in the hippocampus, which leads to scarring in the temporal lobe.

Question 8

What is juvenile myoclonic epilepsy

Answer 8

an epilepsy syndrome in which myoclonic seizures or rapid brief jerks of the arms and legs occur, most frequently in the early morning soon after awakening

These seizures can be photosensitive, or triggered by flickering light, such as strobe lights, television, video games, sunlight shining through trees, or sunlight reflecting off snow or water.

One of the most common epilepsy syndromes in children

Question 9

What is benign rolandic epilepsy?

Answer 9

an epilepsy syndrome in children between the ages of 3 and 13, most often occurring between 6 and 8 years.

The child exhibits twitching, numbness, or tingling in the face and tongue

• The seizure interferes with speech.
• Drooling may occur as well.
• The seizure lasts less than 2 minutes.
• The child remains fully conscious.

Question 10

What is Todd’s paresis?

Answer 10

This is a weakness on one side of the body that may last between 30 minutes and 36 hours after a seizure

Question 11

What is Dravet syndrome?

Answer 11

a rare, genetic epileptic encephalopathy, formerly called severe myoclonic epilepsy in infancy, that begins in the first year of life in an otherwise healthy infant and continues throughout life.

Question 12

What is panayiotopoulos syndrome?

Answer 12

early-onset occipital epilepsy that usually manifests between 3 and 10 years of age.

Seizures begin as partial or focal seizures that may or may not spread to a generalized seizure.

This condition is sometimes misdiagnosed as encephalitis, syncope, migraine, cyclic vomiting, motion sickness, sleep disorder, or gastroenteritis.

Question 13

What is Landau-Kleffner syndrome?

Answer 13

When seizures are infrequent and typically occur during sleep.

Question 14

What is electrical status epilepticus in sleep?

Answer 14

The first symptom most commonly reported is a significantly slowed rate of learning. Many children also exhibit receptive and/or expressive dysphasia. This means that they have difficulty understanding and using speech. Children with this syndrome can have many types of seizures, including absence, myoclonic, and focal seizures, particularly during sleep.

Question 15

What are generalized seizures?

Answer 15

seizures in which both cerebral hemispheres are involved and the person suffers a loss of awareness or loss of consciousness

Question 16

What is status epilepticus?

Answer 16

a condition in which the brain is in a state of constant seizure. Some evidence suggests that seizures that last 2 minutes or longer may be unable to stop on their own and progress to status epilepticus.

Children who experience status epilepticus events in early life are at risk for hippocampal sclerosis and temporal lobe epilepsy.

Question 17

What are tics?

Answer 17

Sudden, repetitive, involuntary movements

Question 18

What involuntary movements are associated with tics?

Answer 18

• Eye blinking
• Grimacing
• Neck jerks
• Movements of the shoulder
• Nose twitches
• Grinding of the teeth
• Tensing of the muscles of the chest or abdomen

Question 19

What sounds are examples of vocal tics?

Answer 19

Sniffing

• Clearing of the throat
• Grunting
• Squeaking
• Humming sounds
• Clicking the teeth together
• Sucking sounds
• Complex vocal tics may be repetition of words or syllables, spoken syllables or words, shouts, or obscenities.

Question 20

At what age are tics most common?

Answer 20

Tics usually appear before the age of 10 years, with the most common age at diagnosis being 6 to 7 years.

Tics may worsen at around age 12 years and usually disappear completely by age 18.

Question 21

What is the difference between tics and Tourette’s syndrome?

Answer 21

Transient tic of childhood is typically a disorder of motor or vocal tics that may last for several months but not greater than 1 year.
-Tourette’s syndrome is a disorder of complex motor and vocal tics that have been present for more than 1 year and began before the child’s 18th birthday

Question 22

What disorders can tics be a secondary symptom of?

Answer 22

-Infections—particularly streptococcal infections
-Medication effects—tics are common side effect to neurostimulants such as methylphenidate (Ritalin) or Adderall (amphetamine, dextroamphetamine mixed salts) for ADHD
-Developmental—such as the transient tic of childhood; this is usually a simple tic that appears between the ages of 3 and 9 years, and lasts for less than 1 year
-Genetic disorders—often Tourette syndrome is familial
-Neurocutaneous disorders—such as tuberous sclerosis
Degenerative disorders—such as Rett syndrome
-Stroke—thought to be caused by damage to the basal ganglia
-Head trauma—thought to be caused by damage to the basal ganglia

Question 23

How are tics assessed?

Answer 23

General physical examination

In evaluating a movement disorder, ask:

• Whether the frequency of the movement in question is abnormal
• If the character of the movement is abnormal
• If anything in the environment is causing the disorder (such as a foreign body in the eyes of a child, thus causing the ticlike movement of the eyes)
• Whether the movement can be voluntarily suppressed

Question 24

What ways are tics treated?

Answer 24

Treatment focuses on supportive care.

• Most children learn to manage the tic on their own, with supportive parents and teachers who do not focus on the behavior.
• By their mid-teens, most have developed social relationships with people who show acceptance of the tic as part of the person.
• Medications to suppress the tic can be considered if the tic is emotionally distressing to the child or if the tic causes pain or discomfort.
• Screening for other health problems should be performed.

Question 25

What is cerebral palsy?

Answer 25

The name given to a group of conditions that affect motor development in children. It can be quite mild, with abnormal tone and weakness in one extremity, or severe, affecting all extremities, growth and development, and the intellectual capabilities of the child.

Question 26

What causes cerebral palsy?

Answer 26

damage to the brain before, during, or after the child is born

If the damage occurs before or during birth, it is called congenital cerebral palsy. If it occurs afterward, due to injury or illness, it is called acquired cerebral palsy.

Question 27

What are the types of cerebral palsy?

Answer 27

spastic, athetoid, ataxic, mixed

Question 28

What is spastic cerebral palsy?

Answer 28

• most common; about 70% of affected children have this type
• Spastic diplegia/diparesis—stiffness in the legs with difficulty walking as stiffness in the hips causes a scissor-like gait
• Spastic hemiplegia/hemiparesis—stiffness on one side of the body, usually in the arm more than the leg
• Spastic quadriplegia/quadriparesis—stiffness in all of the limbs of the body, the trunk, and the face; often associated with difficulty with swallowing, intellect, sight, and hearing

Question 29

What is athetoid/dyskinetic cerebral palsy?

Answer 29

difficulty controlling movements of the body and can have sudden, uncontrollable changes in muscle tone

Question 30

What is ataxic cerebral palsy?

Answer 30

problems with balance and coordination, especially with purposeful movements like writing or reaching for objects

Question 31

Who should be screened for cerebral palsy?

Answer 31

Infants and young children not meeting developmental milestones should be screened.

• Infants and young children with hypertonia or hypotonia should be screened.
• Infants and young children who have had accidental or nonaccidental trauma or a central nervous system infection should be screened.

Question 32

What is the treatment for cerebral palsy?

Answer 32

There is no cure for cerebral palsy. Treatment is aimed at early intervention and aggressive institution of physical, occupational speech, and educational therapies. Treatment is lifelong to reduce disability and maximize the child’s potential for independent functioning.

Question 33

What is meningitis?

Answer 33

Inflammation of the coverings of the brain and spinal cord (meninges)

May result in hearing loss, mental retardation, learning disabilities and seizures

Question 34

What are symptoms of meningitis?

Answer 34

Severe headache
●Stiff neck
●Sudden high fever
●Photosensitivity
●Bulging fontanel in infants
●Altered mental status
●Rash- petechiae
●Kernig's sign: With the child lying on his or her back, flex the hip and knee 90 degrees. If the Kernig's sign is positive, pain will prevent the child from extending the knee
Brudzinski's sign: Flexion of the neck causes involuntary flexion of the knee and hip

Question 35

How is meningitis diagnosed?

Answer 35

elevated WBC, lumbar puncture- cloudy spinal fluid Streptococcus pneumonia, Neisseria meningitides, and Haemophilus influenzae type b are common causes, protein in CSF

Question 36

What is treatment for meningitis?

Answer 36

Early diagnosis, broad spectrum antibiotics infection control precautions (airborne/ droplet)

Question 37

What are symptoms of migraines?

Answer 37

●disabling symptoms of severe throbbing or pounding unilateral pain.
●They worsen with exertion.
●Sensitivity to light and sound is common.
●Nausea, vomiting, and stomach pain can occur.

Question 38

What are meds for migraines?

Answer 38

Topamax, beta blockers, Zofran, Motrin

Question 39

What are signs/symptoms of Down syndrome?

Answer 39

Small head (microcephaly)
●Flattened, broad head with flat posterior areas
●Underdeveloped, flattened middle of face (midface hypoplasia)
●Almond-shaped, up-slanting eyes, with redundant tissue along inside
●Prominent epicanthal folds, with small, downturned mouth
●Small oral opening with protruding tongue
●Small, low-set ears that may be cupped (Fig. 18-13)
●Chest may be broad, with heart murmurs related to defects
●Short hands that may have a single crease (Fig. 18-14)
●Congenital heart defects—very high incidence rate of about 44%
●Endocardial cushion effect (atrioventricular canal)—connection between the atria, upper chambers, and ventricle, lower chambers, most common
●Low tone; can be floppy, with breathing and feeding problems at birth

Question 40

What are signs/symptoms of fetal alcohol spectrum disorder?

Answer 40

●Typical facial features at birth:
●Flat midface
●Thin upper lip
●Small chin (micrognathia)
●Short, upturned nose
●Short palpebral fissures
●Prominent epicanthal fold at inner portion of eyes
●Growth deficiency, starting at infancy and lasting throughout life
●Brain anomalies/defects can include abnormalities of the corpus callosum, cerebellum, and frank microcephaly.
●Sensory, motor, and regulatory behaviors are also affected at the cellular level.
●Communication and language can be affected.
Organ damage, including congenital heart defects, can occur

Question 41

What are signs of night terrors?

Answer 41

Awakening in the first one-third of the night, usually between midnight and 2 a.m., screaming in fear, disoriented upon awakening; parents unable to comfort the child

triggered by fever, emotional stress, or sleep deprivation