Seizures

Question 1

What forms can neonatal seizures present in

Answer 1

Often subtle G to underdeveloped brain
– Facial grimacing
– Nystagmus
– Intermittent apnoiec episodes
– Myoclonus
– Sudden loss of muscle tone
– Eye blinking
– Chewing

Question 2

What does one need to consider as a potential diagnosis for neonatal seizures

Answer 2

A structural abnormality

Question 3

Jitteriness versus seizures in a newborn

Answer 3

Frequency of Jetter is faster

Can I bought jitteriness by moving or flexing the limb

Question 4

Causes of neonatal seizures

Answer 4

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

Question 5

Types of neonatal epileptic syndromes

Answer 5

Benign idiopathic neonatal convulsions
Early myoclonic encephalopathy
Early infantile epileptic encephalopathy with suppression burst – Ohtahara syndrome

Question 6

Define febrile seizures

Answer 6

Generalised seizures that occur in conjunction with the significant feeling

Question 7

Criteria for diagnosing febrile convulsions

Answer 7

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

Question 8

Prognosis of febrile convulsions

Answer 8

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

Question 9

Is prophylactic treatment of febrile seizures recommendedand what drug would be used

Answer 9

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)

Question 10

Define infantile spasms

Answer 10

Seizures limited to infants in their first year of life

Question 11

What is the triad of infantile spasms

Answer 11

Flexor extensor spasms Salam attacks
Hips arrhythmia on EEG
Mental retardation

Question 12

How to infantile spasms present

Answer 12

• 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

Question 13

Classify causes of infantile spasms

Answer 13

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

Question 14

Which carries a better prognosis in infantile spasms cryptogenic versus symptomatic

Answer 14

The crypto genic group

Question 15

Management of infantile spasms

Answer 15

Infantile spasms are very resistant to conventional anticonvulsants.
Treatment comprises of various anticonvulsants
– Benzos
– sodium valproate
– Vigabatrin
- steroids

Question 16

Prognosis of infantile spasms

Answer 16

-20% mortality and high mobility
Cerebral palsy: 33–50%
Mental retardation:70–80%
psychiatric disturbances: 28%

Question 17

What are some of the common seizure syndromes seen in early childhood?

Answer 17

Typical absent seizures
Benign rolandic epilepsy
Lennox-Gastaut
Partial complex (temporal lobe) epilepsy

Question 18

What age group do absence seizures occur in

Answer 18

5 to 15 years

Question 19

Presentation of absence seizures

Answer 19

• 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

Question 20

What is the e.g. pattern of absence seizures

Answer 20

Three per second Spike and wave pattern: hyperventilation may induce clinical and EEG findings

Question 21

Prognosis of absence seizures

Answer 21

Nature and course of seizures is usually benign

Maybe an association with later onset of tonic clonic seizures

Question 22

Management of absence seizures

Answer 22

Sodium Valporate or lamotrigine

Question 23

How does temple lobe epilepsy manifest

Answer 23

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

Question 24

Under what broad term does temporal lobe epilepsy fall

Answer 24

Complex partial seizures

Question 25

In what age group do rolandic seizures begin

Answer 25

2–14 (Peak 5–8 years)

Question 26

How do how do rolandic seizures manifest

Answer 26

Clinical features:
–A simple focal motor fits as the exclusive or dumb and type in the vast majority of cases
– – Partial fits which a brief
– –preferentially involving one side of the face, Oropharyngeal muscles and upper limbs
– – Consciousness is maintained
– – Inability to speak
– –Association with sleep
EEG spikes in the lower rolandic (sylvian fissure) area on an otherwise normal background

Question 27

Prognosis of Rolandic seizures

Answer 27

Usually remits by age 15
E.EG picture normalises of the clinical remission
Prognosis is good

Question 28

Management of rolandic seizures

Answer 28

Carbamazepine or sodium valproate

The nine nature and low-frequency mean that most doctors choose not to treat with antiepileptics

Question 29

Definition of status epilepticus

Answer 29

An epileptic seizure with episodes of continuous cerebral dysarthria lasting for 30 minutes or longer with no recovery of consciousness between seizures

Question 30

Classification of childhood seizures

Answer 30

Generalised
– Tonic clonic absence seizures
– – Typical absence
– – A typical absence
– – Myoclonic absence
– – Eyelid myoclonia 
– Myoclonic  (myoclonic tonic or myoclonic atonic seizures)
– – Clinic
– – Tonic
– – Atonic

Focal seizures

Unknown seizures