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Paeds > Seizures > Flashcards

Seizures Flashcards

1
Q

What is a seizure

A

Clinical event where there is sudden disturbance of neurological function caused by abnormal or excessive synchronous discharge of neurons.
Results in abnormal paroxysmal activity which is intermittent and self limiting
Can be epileptic or non-epileptic

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2
Q

What is epilepsy

A

A disorder of the brain characterised by an enduring predisposition to generate epileptic seizures and by the neurobiologic, cognitive and psychological and social consequences of the condition.
Requires occurrence of at least one epileptic seizure

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3
Q

How should you approach suspected seizures

A
  1. was the episode an epileptic seizure
  2. what type of seizrue - generalised, focal or epilepsy syndrome
  3. what is the cause of the seizure
  4. which investigations should be done
  5. Does the child need treatment
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4
Q

What are some examples of paroxysmal events i.e. funny turns?

A

Psychological: breath holding, self gratification, tics, daydreaming, night terrors, pseudoseizures
Cardiac: reflex asystolic syncope, long QT syndrome,
syncope
Inner ear: benign paroxsymal vertigo
CNS: Migraine
Gastro: Sandifer syndrome (rare manifestation of GORD

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5
Q

What are the different types of epilepsy?

A 
Generalised = discharge from both hemispheres with loss of consciousness for >3 seconds 
Focal = seizures originate from one part of one hemisphere
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6
Q

What are absence seizures

A

Brief episodes of unresponsiveness (no more than 10 seconds)
occasionally associated with repetitive purposeless movements of the fingers, hand or mouth such as lip smacking. May be eye fluttering or flickering
Starts between 4 and 7 years of age

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7
Q

What are the features of a generalised seizure

A

loss of consciousess for >3 seconds
symmetrical seizures
synchronous discharge on EEG

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8
Q

When do absence seizures usually resolve

A

by adolescence

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9
Q

How are absence seizures confirmed

A

Confirmed by typical EEG - 3Hz spike and wave pattern

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10
Q

What are myoclonic seizures

A

brief repetitive jerking movements of the limbs, neck and trunk
Events range from head nod to being thrown across room
(may need helmets)

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11
Q

What are tonic seizures

A

Increased in tone
occurs in isolation or as part of a syndrome
difficult to control

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12
Q

What are tonic-clonic seizures

A

Rhythmic contraction of muscle groups followed by tonic phase

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13
Q

What is the sequence of tonic-clonic seizures

A

a) rigid tonic phase: fall to ground, apnoea, cyanosis
b) clonic phase: jerking limbs breathing irregular, cyanosis persists, frothing at mouth, may bite tongue, incontinent of urine

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14
Q

What happens after a tonic-clonic seizure

A

Last seconds to minutes and followed by deep sleep or unconsciousness for up to several hours

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15
Q

what are atonic seizures

A

Often combined with a myoclonic jerk followed by transient loss of muscle tone
Causes sudden fall to floor or drop of head
Not associated with post ictal dorwsiness

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16
Q

How does a focal seizure from the frontal lobe present

A

Involves the motor or premotor cortex
May lead to clonic movements which travel proximally (Jacksonian march)
or tonic seizures with both upper limbs raised high for a few seconds

17
Q

How does seizures present that originate from the temporal lobe

A

Auditory or sensory (smell or taste) phenomenon
associated automatisms e.g. lip smacking, plucking ones clothing
Deja-vu feelings
last longer than absence seizures

18
Q

How do occipital seizures present

A

Stereotypical visual phenomena

19
Q

How do parietal lobe seizures present

A 
Contralateral dysaethesias (altered sensations) 
Distorted body image
20
Q

What are some epilepsy syndromes

A

West syndrome
Lennox-Gastaut Syndrom
Benign rolandic epilepsy
Juvenile myoclonic epilepsy

21
Q

What is west syndrome

A

Known as infantile spasms
onset: 3-12 months
Multiple bursts (20-30) of violent flexor spasms of head, trunk and limbs lasting 1-2 seconds
Episodes distress baby
Most will lose skills and develop LD and continuing epilepsy
Undergoing a neuro-degenerative neuro-encephalopathic process

22
Q

How is west syndrome diagnosed

A

EEG features of hypsarrthymia and burst suppression

23
Q

How is west syndrome treated

A

Steroids (ACTH) and Vigabatrin

24
Q

What is lennox-gastaut syndrome

A

uncommon form of epilepsy but commonest type of intractable epilepsy
- atonic seizures
- absences
- tonic seizures that may only happen at night
Onset: 1-3 years

25
Q

What does EEG show in Lennox-Gastuat

A

When child is not obviously fitting shows slow generalised spike and wave

26
Q

What is benign rolandic epilepsy

A

Benign because outcome is usually good
Rolandic because seizures begin in the part of the brain called rolandic area
Most common type of epilepsy in children: 15% of all epilepsies
Often start in sleep or just about to wake up
Onset: 4 - 10 years

27
Q

What are the EEG findings in benign rolandic epilepsy

A

posterior sharp waves or occiptal discharges

28
Q

What is the treatment for lennox-gastaut syndrome

A

sodium valproate
Lamotrigine
Topiramate

29
Q

What is the treatment for benign rolandic epilepsy

A

Medications are not always indicated. Consider:
Carbamazepine
Levetiracetam

30
Q

What is juvenile myoclonic epilepsy

A

Onset: 10-20 years of age
Common epilepsy syndrome
Most commonly occurs shortly after waking with
- myoclonic seizures
- tonic-clonic seizures
- absence seizures
learning is unimpaired, remission unlikely but response to treatment is good

31
Q

How is juvenile myoclonic epilepsy treated

A

Levetiracetam

Sodium Valproate

32
Q

What are the concerns with sodium valproate

A

Teratogenic - caution in menstruating girls (lamotrigine is the alternativ)
Associated with liver dysfuntion (including fatal liver failure) in children <3 years old

33
Q

What is status epilepticus

A

Prolonged seizure lasting >30 mins or recurrent seizures where the patient does not fully regain consciousness within a 30 min period

34
Q

What are common causes of Status epilepticus in children

A 
Infection: meningitis
Electrolyte disturbances 
Fever 
Trauma 
Drugs: subtherapeutic anticonvulsant levels, poisoning
Metabolic: metabolic abnormalities
35
Q

What is the management of SE

A 
A-E assessment 
- secure airway 
- IV access 
- High flow oxygen 
- Check BM
5-15 mins 
- IV lorazepam (50-100 micrograms/kg)
- Rectal Diazepam 
If no response repeat dose after 5-10mins
25 mins - IV phenytoin or phenobarbital 
45 mins - Rapid induction of anaesthesia

Paeds (7 decks)

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