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Paediatrics > Seizures > Flashcards

Seizures Flashcards

1
Q

What is a seizure

A

Any sudden controlled electrical disturbance in the brain

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2
Q

What do you do if patient says they had a seizure

A

Ask what they mean

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3
Q

History of seizure

A 
What happened before 
During
After 
Time back to normal
Symmetrical or not
Colour - cyanosis? 
Type of jerk
What did eyes do - rolling or fixed
Response during event 
What were they doing the night and day before
Any illness or infection
Past Hx of siezure
FH
Development
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4
Q

What can cause seizure

A 
Genetic
Infectious 
Metabolic 
Hypoxic 
Trauma
Brain injury
Stroke
Immune
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5
Q

What gene is involved in infantile myoclonus / GFS

A

SCNIA

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6
Q

What is a generalised seizure

A

Both sides of brain affected

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7
Q

What is a focal seizure

A

One part of brain

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8
Q

What types of generalised seizure is there

A 
Tonic clonic
Tonic
Clonic 
Myoclonic
Atonic
West syndrome 'Infantile spasm'
Absence
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9
Q

What is simple focal

A

No LOC

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10
Q

What is complex focal

A

LOC

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11
Q

How can you work out underlying cause

A 
ECG to exclude heart 
MRI - <2, focal or no response to AED 
Genetics - TS
Metabolic - U+E
Blood glucose 
EEG
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12
Q

If child presents with 1st seizure what is important to know

A

50% 1 off
50% recurrent
The longer apart the less likely to recur

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13
Q

When do you do an EEG / investigate seizure

A

If >1 tonic clonic seizure or absence

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14
Q

What do 80% of epileptic seizures have

A

Underlying pathology

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15
Q

When do you treat

A

When you know for sure
AED’s are toxic
Want to be seizure free on minimum AED

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16
Q

How do you prevent

A

Sleep
Stress
Alcohol

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17
Q

What is 1st line in generalised

A

Sodium valproate

CI child bearing age girls

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18
Q

What are SE of AED

A 
Drowsy
LD
Behaviour
Rash
Bone marrow
Cognition
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19
Q

What other treatment is there

A

Steroid
Ig
Ketogenic diet
Vagus nerve stimulation

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20
Q

When can you do surgery

A

If focal

2+ drugs tried

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21
Q

What is epilepsy

A

2+ unprovoked recurrent epileptic seizures

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22
Q

What is epileptic seizure

A 
Abnormal and excessive discharge
Decreased inhibition (GABA)
Increased excitatory (glutamate) 
Influx of Na and Ca
Repolarisation
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23
Q

What is it important to look for

A

Epilepsy syndrome

Rare to just have seizure type

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24
Q

What is status epilepticus

A

> 30 minutes but treat if going on longer than 10

25
Q

How do you treat status

A 
ABC
Glucose
O2
IV access
G+S
Buccal Midazalam = 1st line 
Rectal Diazepam = 1st line 
IV lorazepam if have access 
Pheytoin if no response 
Mannitol to decrease ICP
26
Q

What is most at risk

A

Water shed area

Basal ganglia in neonates

27
Q

What are common causes of seizure in neonate

A

Hypoxia

Kernicterus

28
Q

What is SUDIP

A

Not seizure related

More common in adults

29
Q

What is West / Infantile Spasm

A 
Flexion of head
Extension of arm
Repeated up to 50x 
MisDx as colic 
- Colic = <3 motnths
- Benign bouts of crying and pulling up leg 
Usually around 4-8 months
30
Q

What is prognosis

A

Other seizures occur

Development regresses

31
Q

How do you Dx

A

EEG - hypoarrytmhmia

CT for brain disease - TS / encephalitis

32
Q

How do you Rx

A

ACTH
Vigabartan
Steroid

33
Q

What is infantile myoclonus

A

Repeated febrile convuslion
Serious encephalopathy
Aggression
Regression

34
Q

What is important to do in repeated febrile convulsion

A

Genetic test for SCINA gene

Could be either complex febrile or infantile myoclonus

35
Q

What is Juvenile Myoclonus

A 
Seizure
Jerky / clumsy in morning - myotonic 
Develop tonic clonic 
Strong FH
Good response to sodium valproate
36
Q

What is characteristic of absence

A 
Children 4-8 
Eyes open but don't deviate
Eyelid flutter
No warning
Quick recovery 
Grow out of in adulthood
37
Q

How do you induce absence and treat

A

Hyperventilation
Sodium valproate
Ethoximiude

38
Q

What can cause juvenile absence

A

Sleep deprivation

Alcohol

39
Q

What is most common childhood epilepsy

A

Benign Rolandic Epilepsy

40
Q

How does it present

A 
Rolandic (temporal) area of brain
Twitching
Numb
TIngling tongue
Unable to speak
Usually on waking up
41
Q

What can they develop

A

2 generalised

42
Q

What causes febrile convulsion

A

Seizure that occurs wiht sudden rise in temp

Commonly URTI

43
Q

What is simple febrile convulsion

A 
Single tonic clonic
Symmetrical
Generalised
<15 minutes
No post octal 
Doesn't recur 24 hours or same illness
44
Q

When is it complex

A

> 15
Focal
Recurrent
Don’t recover in 1 hour

45
Q

When do you suspect other cause

A

Focal CNS
SLow development
FHx epilpesy
Complex

46
Q

What age group is it common in

A

3months - 5 years

47
Q

How do you investigate

A 
Look for infection - urine / throat / swab / chest
Consider other cause
FBC
CSF
Neuroimaging + examination
EEG
48
Q

What other cause

A 
Meningoenephalitis
Epilepsy
Trauma
Glucose
Substance use 
SAH
SOL 
Syncope
49
Q

When do you Admit

A

1st seizure or complex

50
Q

What do you do in all

A

Blood glucose

51
Q

What do you tell parents

A

97% not epilepsy
May recur
Anti-pyretic for all fever
Buccal midazolam or rectal diazepam if >5 minutes + phone ambulance

52
Q

What is a reflex anoxic seizure

A 
Vagal mediated bradycardia due to pain or fever 
GO pale and pass out 
Hypotonic - fall to floor
Rigid
Upward eye
Clonic
Incontinent
<15s 
Rapid recovery
53
Q

What causes acute symptomatic

A

Hypoxia
Hypoglycaemia
Trauma
Infection

54
Q

What is benign sleep myoclonus

A

Twitch as fall asleep or wake up

55
Q

What are other seizures

A 
Cyanotic breath holding attack
Benign paroxysmal vertigo
Behaviour
Parasomina
Pseudo 
Cardiac arrhythmia - ECG
Infantile colic
Migraine
Tics
56
Q

What should you do in myopathy

A

Screen cardiac

57
Q

What are common causes of neonatal seizure

A

Hypoglycaemia
Meninigitis
Head trauma

58
Q

What is a breath holding spell

A

Long cry / tantrum so hold breath
Become cyanotic and twitch
Quick return to normal
All observation in normal range

Paediatrics (35 decks)

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