Seizures Flashcards
What are febrile convulsions (pathophysiology and aetiology)?
Seizures associated with fever >37.8’C and not due to other underlying pathology such as epilepsy.
children 6 months to 5 years
relatively common
common causes- respiratory tract infection otitis media UTI influenza HHV-6 (sixth disease/roseola infantum) post-immunisation (rare) 1-2 weeks after recieving the vaccine.
Clinical features of febrile seizures
Generalised tonic-clonic seizure
Muscle stiffness and jerking
Shaking of the limbs without focal features
breathing difficulties pallor cyanosis LOC post-ictal drowsiness and confusion
rarely last longer than 10 mins
occur once in 24 hours
What is a complex febril convuslion?
Similar but more focal features e.g movement is limited to one side of the body
15 mins and recur within 24 hrs
Febrile status epilepticus
Seizure lasts longer than 30 mins
Occurs in first 24 hours of febrile illness
Febrile convulsion investigation
check temp following seizure
focal neurological deficits
bloods- FBC, U+E, ESR, coagulation, glucose
urine: <18M
lumbar puncutre if suspected meningitis
EEG
brain MRI
Management of febrile convulsion
Typically self-resolves
Antipyretics- ibuprofen, paracetemol
>5 min or recur= ambulance
Buccal midazolam
Rectal diazepam
repeat if does not abate in 10 mins
Urgent referral for febrile convulsion
If alternative cause is suspected (epilpesy)
first presentation
diagnostic uncertainty
aged <18M
abx have recently been taken
What are some complications that can follow a febrile seizure?
Todd’s paresis- transient hemiparesis. potential short term complications, usually subside in 48hrs
Non febrile siezure / epilepsy
Febrile status epilepticus.
Absence seizure clinical features
“Petit mal”
age of onset 3-10 years old
pically happen in children. The patient becomes blank, stares into space and then abruptly returns to normal. During the episode they are unaware of their surroundings and won’t respond. These typically only lasts 10-20 seconds. Most patients (> 90%) stop having absence seizures as they get older. Management is:
absences last a few seconds
quick recovery
hyperventilation/stress can provoke a seizure
the child is usually unaware of the seizure
can occur many times in the day
EEG: bilateral, symmetrical 3Hz spike and wave pattern
Absence seizure management
1st line- sodium valporate, ethosuximide
Focal seizures (partial seizures)
The seizures start in a specific area on one side of the brain.
Focal seizures start in temporal lobes. They affect hearing, speech, memory and emotions. There are various ways that focal seizures can present:
Hallucinations Memory flashbacks Déjà vu Doing strange things on autopilot Motor (Jacksonian March) clonic, tonic, atonic, myoclonus automatisms (repeat automatic movements like clapping or rubbing of hands, lipsmacking, chewing or running
Non Motor (aura) change in sensation, emotion, thinking, cognition, GI, waves of hot or cold, goosebumps, heart racing.
Generalised seizures
Involves the networks on both sides of the brain
LOC immediately
- motor
- tonic-clonic (grand mal)
- tonic (tense/rigid)
- clonic (jerking)
- myoclonic (brief, rapid muscle jerks) (muscle twitching)
- atonic (muscles are weak/limp) - non-motor
- absence
Focal to bilateral seizure
the seizure starts on one side of the brain and then spreads to both lobes
2’ generalised seizures.
Psychogenic non-epileptic seizures
Pseudoseizures
Patients who present with epileptic-like seizures but no EEG changes
history of mental health/personality problems
*e.g. keep their eyes close
Infantile spasms (West’s syndrome)
This is also known as West syndrome. It is a rare (1 in 4000) disorder starting in infancy at around 6 months of age. It is characterised by clusters of full body spasms. There is a poor prognosis: 1/3 die by age 25, however 1/3 are seizure free. It can be difficult to treat but first line treatments are:
Prednisolone
Vigabatrin
