Seizures and Infantile spasms

Question 1

What is West syndrome

Answer 1

Rare disorder starting at age 6 months where there are clusters of full body spasms. Poor prognosis

Question 2

What are benign rolandic seizures

Answer 2

Characteristly have tonic seizures overnight

Question 3

What are seizures

Answer 3

Transient episodes of abnormal electrical activity in the brain. Many different types

Question 4

Generalised tonic clonic seizures

Answer 4

Loss of consciousness.
Tonic and clonic movements (tensing and jerking).
Associated tongue biting, incontinence, groaning and irregular breathing.

Question 5

Phase after tonic clonic seizures

Answer 5

Post-ictal period - confused, drowsy, feels irritable or low

Question 6

First line management of tonic clonic seizures

Answer 6

Sodium valproate

Question 7

Second line management of tonic clonic seizures

Answer 7

Lamotrigine or carbamazepine

Question 8

Focal seizures

Answer 8

Start in temporal lobes.
Affect hearing, speech, memory and emotions.

Question 9

Presentation of focal seizures

Answer 9

Hallucinations.
Memory flashbacks
Deja vu
Dong strange things on autopilot

Question 10

First line treatment of focal seizures

Answer 10

Carbamazepine or lamotrigine

Question 11

Second line treatment of focal seizures

Answer 11

Sodium valproate or levetiracetam

Question 12

Absent seizures

Answer 12

Patient becomes blank, stares into space, abruptly returns to normal. During episodes are unaware of surroudings and won’t respond. 10 - 20 seconds

Question 13

Management of absent seizures

Answer 13

Sodium valproate or ethosuximide

Question 14

Prognosis of absent seizures

Answer 14

Most grow out of them as they get older

Question 15

Atonic seizures

Answer 15

Characterised by brief lapses in muscle tone. They don’t usually lastmore then 3 minutes. They typically begin in childhood.

Question 16

What can atonic seizures be indicative of

Answer 16

Lennox-Gastaut syndrome

Question 17

First line treatment for atonic seizures

Answer 17

Sodium valproate

Question 18

Second line treatment for atonic seizures

Answer 18

Lamotrigine

Question 19

Myoclonic seizures

Answer 19

Present as sudden brief muscle contractions. Usually remains awake, like a sudden jump

Question 20

When do children experience myoclonic seizures

Answer 20

Typically happen as part of juvenile myoclonic epilepsy

Question 21

First line treatment of myoclonic seizures

Answer 21

Sodium valproate

Question 22

Other treatment options for myoclonic seizures

Answer 22

Lamotrigine, levetiracetam or topiramate

Question 23

Treatments for West syndrome

Answer 23

Prednisolone and Vigabatrin

Question 24

Prognosis of West syndrome

Answer 24

1/3 die by age 25, 1/3 seizure free

Question 25

When is an EEG performed

Answer 25

After second simple tonic-clonic seizure, used to support diagnosis

Question 26

When is an MRI brain performed

Answer 26

First seizure is in child under 2 years.
Focal seizure.
No response to anti-epileptic medications.

Question 27

Investigations to exclude differentials

Answer 27

ECG - heart
Blood electrolytes
Blood glucose - hypos
Blood, urine cultues, LP - sepsis, enceph or meningitis

Question 28

Side effects of sodium valproate

Answer 28

Teratogenic, liver damage and hepatitis, hair loss, tremor

Question 29

Side effects of carbamazepine

Answer 29

Agranulocytosis, aplastic anaemia, induces P450 enzyme so drug interactions

Question 30

Side effects of phenytoin

Answer 30

Folate and vitamin D deficiency, megaloblastic anaemia (folate deficiency) and osteomalacia (vit D def)

Question 31

Side effects of ethosuximide

Answer 31

Night terrors and rashes