Seizures Flashcards
Epilepsy, DDx in neonates/infants (2)
benign neonatal myoclonus
shuddering attacks
Epilepsy, DDx in toddlers (5)
breath holding
febrile convulsions
masturbation and gratification
night terrors
BPPV of childhood
Epilepsy, DDx in older children (5)
daydreaming (not present during fun activities)
reflex anoxic seizures
pseudoseizures
vasovagal syncope
cardiac dysryhtmias
(stay off Rx if in doubt, consider hypoglycaemia in all ages)
Features of reflex anoxia seizures (4)
triggered by pain, mild head trauma, fear
child goes deathly pale>hypotonic/rigid w. upward eye deviation
urinary incontinence
> vasovagal syncope and LOC
Features of breath holding (4)
in toddlers
triggered by anger/frustration
child holds breath>blue>LOC>spontanenous recovery
brief jerks may occur
Ix for seizure of unknown cause (3)
MRI not indicated after 1st seizure
EEG normal in 50%
ECG is 1st line: cheapest and most effective
Specific epileptic syndromes (11)
Neonatal:
- epileptic encephalopathy
- West syndrome
- Lennox-Gestaut syndrome
- benign myoclonic epilepsy of infancy
- severe myoclonic epilepsy of infancy
Idiopathic generalised epilepsies:
- myoclonic absence epilepsy: cornflake epilepsy
- childhood absence epilepsy
- juvenile absence epilepsy
- juvenile myoclonic epilepsy: after waking
Idiopathic partial epilepsies:
- rolandic epilepsy
- panayiotopoulos syndrome
- NB in focal seizures, MRI always indicated
Features of epileptic encephalopathy (2)
tonic spasms+/- clustering
transforms into west syndrome
Presentation and features of West syndrome (5)
triad of:
- infantile spasms
- characteristic hypsarrythmia on EEG
- LD and developmental regression
most have underlying co-morbidity e.g. Down’s, hydrocephalus,microcephaly, trauma, encephalitis. therefore poor prognosis
often progresses to Lennox-Gestaut syndrome
Rx of West syndrome (2)
1st: vigabatrin-SEs: visual impairment
ACTH
Features, associations and Rx of Lennox-Gestaut syndrome (4)
tonic seizures w. truncal flexion
developmental delay
assoc. w. tuberous sclerosis
Rx w. lamotrigine
Features of benign myoclonic epilepsy of infancy
requires no Rx
Rx of severe myoclonic epilepsy of infancy
sodium valproate
Features of Rolandic epilepsy (5)
benign childhood epilepsy w. controtemporal spikes
15% of childhood epilepsies-v. common
symptoms typically occur at night
partial seizures w. unilateral facial/oropharyngeal motor-sensory Sx which spread from one arm to one leg.
hypersalivation and speech arrest
Features of Panayiotopoulos syndrome (4)
Benign focal syndrome in early/mid childhood
Sx mainly at night
get vomitting and eye deviation (occipital predominance)
Seizures can last for >30mins
Conservative measures for epilepsy and Mx of general, partial and absence seizures (4)
keto-diet, educate teachers and parents
generalised: valproate 1st, lamotrigine 2nd
partial: carbemazepine
absence: ethosuxemide
Sturge-Weber syndrome
do MRI at birth for any child w. port wine stain in trigeminal distribution to look for seizure activity.
Features of febrile convulsions (5)
single tonic clonic seizure lasting <20mins as temperature rises in absence of intracranial infection/neurological disorder
most common cause of seizure in childhood
peak incidence: 6mo-6yrs
1/3 will have recurrence in future fevers: higher if <18mo or FHx
often occur on 1st day of fever
Red flag features of febrile convulsions (5)
lasting >15mins
febrile status epilepticus
focal features at onset or during seizure
incomplete recovery after 1hr
recurs w/i 24hrs or w/i same febrile illness
DDx if red flag features present in febrile convulsion (6)
meningo-encephalitis
trauma
hypoglycaemia
hypomagnesaemia/hypocalcaemia
CNS lesion
epilepsy
Ix for febrile convulsions (3)
Bloods:
-FBC, ESR, U+Es, coagulation
Urine MC&S
Consider LP if <12mo/suspicious features:
-CI in decreased consciousness, raised ICP, meningitis, shock, focal neurology, bleeding disorder.
Mx of febrile convulsions (4)
Find cause:
- exclude meningitis, septicaemia, UTI, LRTI, cerebral malaria
- most common causes: viral illness, otitis media, tonsilitis
- can be caused by gastroenteritis
place in recovery position, paracetemol if extremely hot
if lasting >5mins, standard status protocol: IV Lorazepam, buccal midazolam, rectal diazepam.
Admit and Rx as meningitis if: drowsy before fit/1hr after, neck stiffness, rash, bulging fontanelle
