Seizures Flashcards
What forms can neonatal seizures present in
Often subtle G to underdeveloped brain – Facial grimacing – Nystagmus – Intermittent apnoiec episodes – Myoclonus – Sudden loss of muscle tone – Eye blinking – Chewing
What does one need to consider as a potential diagnosis for neonatal seizures
A structural abnormality
Jitteriness versus seizures in a newborn
Frequency of Jetter is faster
Can I bought jitteriness by moving or flexing the limb
Causes of neonatal seizures
Perinatal
– Anoxia, Trauma, intracranial haemorrhage
Metabolic
– Hypoglycaemia,
- hypocalcaemia, hypomagnesaemia, Hyper or hypo natraemia
- jaundice
– Paradox seen deficiency
– Disorders of amino acid is organic acids
Infections example bacterial menigitis
Developmental or structural abnormalities
Drug withdrawal example in a substance abusing mother
Types of neonatal epileptic syndromes
Benign idiopathic neonatal convulsions
Early myoclonic encephalopathy
Early infantile epileptic encephalopathy with suppression burst – Ohtahara syndrome
Define febrile seizures
Generalised seizures that occur in conjunction with the significant feeling
Criteria for diagnosing febrile convulsions
Age: 6months-5 years
Extracranial cause of fever
Family history of febrile convulsions
Significant temperature: great greater than 38.5
Generalised convulsion duration not longer than 15 minutes
No neurological deficit pre-or post convulsion
Normal eeg after one week
Prognosis of febrile convulsions
40% will have a second febrile seizures Development of non-febrile convulsions depends on other associated risk factors – Complicated seizures: Focal recurrent – Prolonged seizures – Family history of non-febrile seizures – Associated neurological deficit
None febrile seizures will occur in the first year to the first three years following the febrile seizures
Is prophylactic treatment of febrile seizures recommendedand what drug would be used
No only if indicated by one or more respect has being present
Sodium valproate or phenobarbitone
(intermittent diazepam orally or per rectum given at the time of the fever that may also be used)
Define infantile spasms
Seizures limited to infants in their first year of life
What is the triad of infantile spasms
Flexor extensor spasms Salam attacks
Hips arrhythmia on EEG
Mental retardation
How to infantile spasms present
- Large spasms flexor more predominant then extensors characterised by repetitive bilateral and symmetrical movements movements
- They may occur in clusters of minor movements: Head bobbing Eye deviation, crying, facial flushing seen on awakening and falling asleep
- mental retardation/regression may precede spasms
Classify causes of infantile spasms
Divided into two categories:
– Cryptogenic: None identified causes -normal development before spasms
– Symptomatic: identified causes
– – Dysgenic: example tubular sclerosis neurofibromatosis Sturge-Weber syndrome
– – Hypoxic/Ischaemic: prenatal perinatal postnatal
– – Infections: e.g. CMV rubella toxoplasmosis meningitis, encephalitic brain abscess
– – Metabolic and toxic: inborn errors of metabolism, hypoglycaemia et cetera
– – Cambridge and trauma
Which carries a better prognosis in infantile spasms cryptogenic versus symptomatic
The crypto genic group
Management of infantile spasms
Infantile spasms are very resistant to conventional anticonvulsants.
Treatment comprises of various anticonvulsants
– Benzos
– sodium valproate
– Vigabatrin
- steroids
Prognosis of infantile spasms
-20% mortality and high mobility
Cerebral palsy: 33–50%
Mental retardation:70–80%
psychiatric disturbances: 28%
What are some of the common seizure syndromes seen in early childhood?
Typical absent seizures
Benign rolandic epilepsy
Lennox-Gastaut
Partial complex (temporal lobe) epilepsy
What age group do absence seizures occur in
5 to 15 years
Presentation of absence seizures
- Brief lapses of consciousness
- associated with :staring, Eye flattering and find movements of the mouth
- no loss of body tone but child may drop objects held in the hand
- episodes last less than 10 seconds
- no post ictal phase
What is the e.g. pattern of absence seizures
Three per second Spike and wave pattern: hyperventilation may induce clinical and EEG findings
Prognosis of absence seizures
Nature and course of seizures is usually benign
Maybe an association with later onset of tonic clonic seizures
Management of absence seizures
Sodium Valporate or lamotrigine
How does temple lobe epilepsy manifest
Olfactory
Gustatory
Psychosensory (Visual and auditory hallucinations)
Memory distortion and emotional disturbances
Visceral disturbances e.g. a hollow feeling in the stomach,nausea choking, palpitations
Autonomic symptoms
All of these may manifest with or without impaired consciousness as well as tonic/clonic seizures
Under what broad term does temporal lobe epilepsy fall
Complex partial seizures
