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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
How do you treat status
``` 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
What is most at risk
Water shed area | Basal ganglia in neonates
27
What are common causes of seizure in neonate
Hypoxia | Kernicterus
28
What is SUDIP
Not seizure related | More common in adults
29
What is West / Infantile Spasm
``` 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
What is prognosis
Other seizures occur | Development regresses
31
How do you Dx
EEG - hypoarrytmhmia | CT for brain disease - TS / encephalitis
32
How do you Rx
ACTH Vigabartan Steroid
33
What is infantile myoclonus
Repeated febrile convuslion Serious encephalopathy Aggression Regression
34
What is important to do in repeated febrile convulsion
Genetic test for SCINA gene | Could be either complex febrile or infantile myoclonus
35
What is Juvenile Myoclonus
``` Seizure Jerky / clumsy in morning - myotonic Develop tonic clonic Strong FH Good response to sodium valproate ```
36
What is characteristic of absence
``` Children 4-8 Eyes open but don't deviate Eyelid flutter No warning Quick recovery Grow out of in adulthood ```
37
How do you induce absence and treat
Hyperventilation Sodium valproate Ethoximiude
38
What can cause juvenile absence
Sleep deprivation | Alcohol
39
What is most common childhood epilepsy
Benign Rolandic Epilepsy
40
How does it present
``` Rolandic (temporal) area of brain Twitching Numb TIngling tongue Unable to speak Usually on waking up ```
41
What can they develop
2 generalised
42
What causes febrile convulsion
Seizure that occurs wiht sudden rise in temp | Commonly URTI
43
What is simple febrile convulsion
``` Single tonic clonic Symmetrical Generalised <15 minutes No post octal Doesn't recur 24 hours or same illness ```
44
When is it complex
>15 Focal Recurrent Don't recover in 1 hour
45
When do you suspect other cause
Focal CNS SLow development FHx epilpesy Complex
46
What age group is it common in
3months - 5 years
47
How do you investigate
``` Look for infection - urine / throat / swab / chest Consider other cause FBC CSF Neuroimaging + examination EEG ```
48
What other cause
``` Meningoenephalitis Epilepsy Trauma Glucose Substance use SAH SOL Syncope ```
49
When do you Admit
1st seizure or complex
50
What do you do in all
Blood glucose
51
What do you tell parents
97% not epilepsy May recur Anti-pyretic for all fever Buccal midazolam or rectal diazepam if >5 minutes + phone ambulance
52
What is a reflex anoxic seizure
``` 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
What causes acute symptomatic
Hypoxia Hypoglycaemia Trauma Infection
54
What is benign sleep myoclonus
Twitch as fall asleep or wake up
55
What are other seizures
``` Cyanotic breath holding attack Benign paroxysmal vertigo Behaviour Parasomina Pseudo Cardiac arrhythmia - ECG Infantile colic Migraine Tics ```
56
What should you do in myopathy
Screen cardiac
57
What are common causes of neonatal seizure
Hypoglycaemia Meninigitis Head trauma
58
What is a breath holding spell
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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