Seizures Flashcards
What is a seizure
Any sudden controlled electrical disturbance in the brain
What do you do if patient says they had a seizure
Ask what they mean
History of seizure
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
What can cause seizure
Genetic Infectious Metabolic Hypoxic Trauma Brain injury Stroke Immune
What gene is involved in infantile myoclonus / GFS
SCNIA
What is a generalised seizure
Both sides of brain affected
What is a focal seizure
One part of brain
What types of generalised seizure is there
Tonic clonic Tonic Clonic Myoclonic Atonic West syndrome 'Infantile spasm' Absence
What is simple focal
No LOC
What is complex focal
LOC
How can you work out underlying cause
ECG to exclude heart MRI - <2, focal or no response to AED Genetics - TS Metabolic - U+E Blood glucose EEG
If child presents with 1st seizure what is important to know
50% 1 off
50% recurrent
The longer apart the less likely to recur
When do you do an EEG / investigate seizure
If >1 tonic clonic seizure or absence
What do 80% of epileptic seizures have
Underlying pathology
When do you treat
When you know for sure
AED’s are toxic
Want to be seizure free on minimum AED
How do you prevent
Sleep
Stress
Alcohol
What is 1st line in generalised
Sodium valproate
CI child bearing age girls
What are SE of AED
Drowsy LD Behaviour Rash Bone marrow Cognition
What other treatment is there
Steroid
Ig
Ketogenic diet
Vagus nerve stimulation
When can you do surgery
If focal
2+ drugs tried
What is epilepsy
2+ unprovoked recurrent epileptic seizures
What is epileptic seizure
Abnormal and excessive discharge Decreased inhibition (GABA) Increased excitatory (glutamate) Influx of Na and Ca Repolarisation
What is it important to look for
Epilepsy syndrome
Rare to just have seizure type
What is status epilepticus
> 30 minutes but treat if going on longer than 10
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
What is most at risk
Water shed area
Basal ganglia in neonates
What are common causes of seizure in neonate
Hypoxia
Kernicterus
What is SUDIP
Not seizure related
More common in adults
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
What is prognosis
Other seizures occur
Development regresses
How do you Dx
EEG - hypoarrytmhmia
CT for brain disease - TS / encephalitis
How do you Rx
ACTH
Vigabartan
Steroid
What is infantile myoclonus
Repeated febrile convuslion
Serious encephalopathy
Aggression
Regression
What is important to do in repeated febrile convulsion
Genetic test for SCINA gene
Could be either complex febrile or infantile myoclonus
What is Juvenile Myoclonus
Seizure Jerky / clumsy in morning - myotonic Develop tonic clonic Strong FH Good response to sodium valproate
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
How do you induce absence and treat
Hyperventilation
Sodium valproate
Ethoximiude
What can cause juvenile absence
Sleep deprivation
Alcohol
What is most common childhood epilepsy
Benign Rolandic Epilepsy
How does it present
Rolandic (temporal) area of brain Twitching Numb TIngling tongue Unable to speak Usually on waking up
What can they develop
2 generalised
What causes febrile convulsion
Seizure that occurs wiht sudden rise in temp
Commonly URTI
What is simple febrile convulsion
Single tonic clonic Symmetrical Generalised <15 minutes No post octal Doesn't recur 24 hours or same illness
When is it complex
> 15
Focal
Recurrent
Don’t recover in 1 hour
When do you suspect other cause
Focal CNS
SLow development
FHx epilpesy
Complex
What age group is it common in
3months - 5 years
How do you investigate
Look for infection - urine / throat / swab / chest Consider other cause FBC CSF Neuroimaging + examination EEG
What other cause
Meningoenephalitis Epilepsy Trauma Glucose Substance use SAH SOL Syncope
When do you Admit
1st seizure or complex
What do you do in all
Blood glucose
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
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
What causes acute symptomatic
Hypoxia
Hypoglycaemia
Trauma
Infection
What is benign sleep myoclonus
Twitch as fall asleep or wake up
What are other seizures
Cyanotic breath holding attack Benign paroxysmal vertigo Behaviour Parasomina Pseudo Cardiac arrhythmia - ECG Infantile colic Migraine Tics
What should you do in myopathy
Screen cardiac
What are common causes of neonatal seizure
Hypoglycaemia
Meninigitis
Head trauma
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
