Seizures Flashcards
How would you approach a child (>1month) presenting in Status Epilepticus?
ABCDE approach
Give Oxygen
Always be sure to check glucose
If vascular access has been established in a child in status epilepticus, what is the first line medication that would be given after 5 minutes of convulsing?
Lorazepam (0.1mg/kg)
If vascular access has NOT been established in a child in status epilepticus, what is the first line medication that would be given after 5 minutes of convulsing?
Midazolam (buccal) 0.5mg/kg
Diazepam (rectal) 0.5mg/kg
What is the 2nd line medication that can be given to children who are still convulsing after 10 minutes?
Lorazepam 0.1mg/kg
If a child is still convulsing after 10 minutes, what is the action you must take (if not done so already as an FY1)?
Call for senior help immediately
If the patient is still fitting in status epilepticus after step 1 and 2 have been administered and it has been ongoing for >10minutes, what medication options do you have?
- If the patient is not on phenytoin give phenytoin 20mg/kg
- If the patient is on phenytoin, given phenobarbitone 20mg/kg
AT THIS POINT ICU/ANAESTHETIST INPUT IS MANDATORY
What are the differential diagnoses of a child with a seizure, having received treatment and still has a reduced level of consciousness?
- Febrile seizures
- Encephalopathy
- Encephalitis
- Meningitis
- Post-ictal phase
- Sepsis/shock
- Brian tumour
- Epilepsy
- Metabolic disorder
- Poisining
- Intoxication
- NAI
What questions do we need to ask a parent/guardian/carer about a child who has had a seizure about; things prior to the episode?
- Any change in behaviour?
- Health that day?
- When did it happen?
- Where did it happen?
- Activity when the seizure began?
- Any complaints from the child before; headache, vision, fever, sweaty, lightheaded?
- Trigger they can think of?
- Time of last meal?
- Have they taken drugs/unusual substance?
What questions do we need to ask a parent/guardian/carer about a child who has had a seizure about; what happened during the episode?
- Onset - was it sudden?
- Responsiveness of the child
- Awareness
- Symmetrical seizure?
- Facial movements?
- Eye movements?
- Posturing
- Motor movements
- Clonic/myoclonic/tonic
- Breathing changes
- Incontinence
- Autonomic
- Visual disturbances
- Duration of the seizure
What questions do we need to ask a parent/guardian/carer about a child who has had a seizure about; the period after the seizure?
- Were they sleepy/disorientated?
- Nauseous/vomited
- Amnesia
- Strange behaviour
- Weakness
- Injuries to the tongue
- Time to recover
What questions do we need to ask a parent/guardian/carer about a child who has had a seizure about; recent illnesses?
- FEVER
- Infective signs (all systems)
- Weight loss
- Recent headaches
- Head trauma/injury
- Personality change
- Poor co-ordination
- New weakness
How would you define ‘Simple Febrile Seizure’?
A short generalised seizure last less than 15 minutes, not recurring in 24 hours occurring during a febrile episode (temp over 38). This is not caused by an acute disease of the nervous system and not present with neurological deficits. Only in children aged 6 months to 5 years.
How would you define a ‘Complex Febrile Seizure’?
A focal, or generalised and prolonged seizure of duration greater than 15 minutes recurring more than once in a 24 hour period. This is associated with postictal neurological abnormalities and more frequently Todd’s Palsy (temporary paralysis).
What 3 signs would indicate an urgent CT/MRI head in a child?
- Encephalopathic or coma
- Suspected raised ICP
- Progressive neurological deficit
What 5 signs/characteristics would suggest the need for an elective MRI in a child presenting with seizures?
- In a child under 2 years of age at onset
- Hard focal neurological signs
- Focal epilepsy
- Associated significant learning difficulties
- Epilepsy resistant to full doses of 2 appropriate drugs
Why do we not regularly use an EEG?
They frequently give false positives and false negatives, they are not very useful
When is an elective EEG standard in children?
- When there is a strong clinical suspicion of epilepsy
2. If there is developmental or language regression
When is an EEG urgently indicated in a child with seizures?
- Suspected non-convulsive status
- Non-traumatic encephalopathy
- Coma of unknown cause
What are the 3 defining features of epilepsy?
- At least 2 unprovoked seizures occurring >24h apart
- One unprovoked seizure and a probability of further seizures similar to general recurrence risk (at least 60%) after 2 unprovoked seizures, occurring over the next 10 years
- Diagnosis of an epilepsy syndrome
What is an epileptic seizure?
A transient occurrence of signs and/or symptoms due to an abnormal excessive or synchronous neuronal activity in the brain.
When a child has a seizure, what should we counsel patients on?
- Recurrence risk and risk of epilepsy
- First Aid training
- Training to administer rescue medication (buccal midazolam)
- Be aware when to call an ambulance (after 5 minutes of non-stop seizing)
When children show a hand preference before 12 months old, what are they are higher risk of?
Hemiplegia in the non-dominant side
What are the central causes of delayed walking?
- Delayed maturation
- Global developmental issues - chromosomal abnormalities, genetic disorders
- All causes of hemiplegia - often with hypertonia (including cerebral palsy)
What are the peripheral causes of delayed walking?
Spina Bifida
What is a muscular/neuromuscular cause of delayed walking?
Duchenne Muscular Dystrophy (DMD)
What are some environmental causes for delayed walking?
- Bottom shufflers
2. Institutionalised - chronic illness, prematurity, gross psycho-social deprivation
What is the most common orthopaedic cause of delayed walking?
Developmental dysplasia of the hip
What are the metabolic/hormonal causes of delayed walking?
- Hypothyroidism
- Rickets
- Mucopolysaccharidosis
What could be the possible causes (14 total) of the following presentation; unilateral brisk tendon reflexes, upgoing plantar reflex and ankle clonus as well as antigravity movements of legs and gait?
- Stroke
- Intraventricular haemorrhage (IVH)
- Venous sinus thrombosis
- Complicated migraine syndrome
- Head trauma
- Sturge-Weber syndrome
- Todd’s paralysis
- Brain tumour
- Infection (meningitis, brain abscess, encephalitis)
- Vasculitis
- Demyelinating disease
- Congenital
- Ateriovenous malformations
- Perinatal injury
What is the neuro imaging of choice in paediatrics and why?
MRI as CT scans are very high in their radiation dose and should be avoided. MRI scans require to be very still therefore a child may sometimes need to be under general anaesthetic or sedated.
What is cerebral palsy (CP)?
A group of conditions causing permanent neurological problems (movement and co-ordination) resulting from damage to the brain around the time of birth, or soon after. This is a collective name for many problems and therefore patients with CP all present differently.
