Seizures

Question 1

What can cause seizures in children?

Answer 1

Febrile convulsions
Epilepsy
Electrolyte abnormalities
Meningitis

Question 2

What electrolyte abnormalities can cause seizures?

Answer 2

Hypocalcaemia
Hyponatraemia
Hypoglycaemia

Question 3

What are the defining features of febrile convulsions?

Answer 3

Age 6 months - 5 years
Generalised tonic-clonic seizure
<15 minute duration
Absence of CNS infection
No history of previous afebrile seizures

Question 4

How are febrile convulsions managed?

Answer 4

Anti-pyretics

Safety net

• stay with child if happens aain
• keep child safe
• call ambulance if more than 5 min duration

Question 5

What is the prognosis of having a further febrile seizure?

Answer 5

1/3

Question 6

What is epilepsy?

Answer 6

2 or more seizures without a cause

Question 7

What are the types of seizures?

Answer 7

Focal

Generalised

• tonic-clonic
• tonic
• clonic
• abscnence
• myoclonic
• atonic

Question 8

What are the features of generalised tonic-clonic seizures?

Answer 8

Loss of consciousness
Muscle tensing (tonic)
Muscle jerking (clonic)

Post-ictal period

Associated
with
- tongue biting
- incontinence

Question 9

What are features of focal seizures?

Answer 9

Affect hearing, speech, memory and emotions

Question 10

What are features of absence seizures?

Answer 10

Patient becomes blank and stares into space

Last 10-20 seconds

Question 11

What is management for tonic-clonic seizures?

Answer 11

1st line - sodium valproate

2nd line - lamotrigine/carbamazepine

Question 12

What is the management for focal seizures?

Answer 12

1st line - carbamazepine/lamotrigine

2nd line - sodium valproate

Question 13

What is the management for absence seizures?

Answer 13

1st line - sodium valproate

Question 14

What are features of atonic seizures?

Answer 14

‘drop attacks’

Brief lapses in muscle tone

Question 15

How are atonic seizures managed?

Answer 15

1st line - sodium valproate

2nd line - lamotrigine

Question 16

What are features of myoclonic seizures?

Answer 16

Brief muscle contractions

Remain conscious

Question 17

How are myoclonic seizures managed?

Answer 17

1st line - sodium valproate

Question 18

What is West syndrome?

Answer 18

Infantile spasms

Rare disorder starting in first few months of life

Question 19

What are the features of West syndrome?

Answer 19

Full body spasms

Flex

• head
• limbs
• trunk

Extend
- arms

Question 20

How is West syndrome managed?

Answer 20

Prednisolone

Vigabatrin

Question 21

How are seizures investigated?

Answer 21

Refer to first fit clinic

Ask parent to video

EEG
MRI brain
ECG
Bloods

Question 22

What is benign sleep myclonus?

Answer 22

Myoclonic jerks during sleep only

Question 23

When does benign sleep myoclonus first present?

Answer 23

1st month

Question 24

When does benign sleep myoclonus resolve?

Answer 24

Self limiting

Resolves by 2

Question 25

What are breath holding spells also known as?

Answer 25

Reflex anoxic seizures

Question 26

What happens in a breath holding spell?

Answer 26

Occur when crying or startled

Child goes pale and cyanotic

Question 27

What investigation should be done with a child with breath holding spells?

Answer 27

ECG - rule out cardiac arrhythmias

Question 28

What is self gratification behaviour?

Answer 28

Repetitive/stereotypic behaviour

Rhythmic contraction of legs and trunk