Seizures/Epilepsy Flashcards
What is a seizure? What is epilepsy?
- Seizure: episodic neurological phenomena resulting from excessive, hypersynchronous activity from neurons in cerebral cortex
- Epilepsy:
- = a group of diverse neurological disorders in which people have an enduring predisposition to epileptic seizures
- classical definition used in paediatrics is recurrent (two or more), unprovoked (afebrile) epileptic seizures
How many children have seizures, and what is the most common cause?
5% children have one or more in lifetime - febrile seizures most common cause.
Aetiology of seizures in children.
○ Febrile seizures (3%)
○ Acute symptomatic seizures
- In the setting of an acute medical issue, which will cease when the acuteness passes.
- eg. meningitis, trauma, hypo? (1%)
○ Single or recurrent, unprovoked seizures ie. Epilepsy (1%)
Differentiate the two broad types of seizures
Generalised:
- Bilateral
- LOC always
- No aura
- Mechanism of types distinctly different
- Symptoms of types generally similar
Focal:
- Unilateral
- LOC not always - more probable if association areas are impacted
• Focal with impaired consciousness (formerly complex partial)
• Focal -> bilaterally convulsive (formerly secondary generalised)
- Aura
- Mechanism of types roughly the same
- Types symptomatically different
Roughly describe the different types of generalised seizure.
- Tonic clonic (few mins)
- Absence
• light switch, on and off (but can happen in focal too e.g. TL)
• around 5-30s - Myoclonic (sudden, brief jerks)
- Tonic
• 1-10s of gen muscle stiffening
• Often when asleep
• Associated: apnoea, colour change, drooling - Atonic - can cause head nods, or even sudden falling (drop attacks)
- Spasm
What is the acute mx for uncomplicated afebrile seizures?
- Most convulsions are brief and self limiting, generally ceasing within 5 - 10 minutes
- Supportive care 5-10 mins:
○ DRS ABC - IV access:
○ BSL
○ Calcium/UEC
○ VBG - Benzodiazepine (midazolam/diazepam)
○ Repeat after 5 mins of continuing seizures
○ Switch to phenytoin/phenobarbitone if convulsion continues for further 5-10 mins
When does epilepsy have its highest incidence? Why?
- highest incidence in infancy (cf spectrum of childhood), due to immaturity of CNS
What is the outcome of epilepsy in childhood?
- favourable outcome, often with remission in >50%
Generally, what pathology do many genetic epilepsies involve?
Genes coded in ion channels
What are the broad groups of aetiologies of childhood epilepsy?
- idiopathic (presumed genetic predisposition to seizures)
2. symptomatic (underlying lesion or genetic/metabolic disorder)
List the main groups of childhood epilepsies.
- Genetic generalised (idiopathic, generalised)
- Benign focal (idiopathic, focal)
- Symptomatic generalised (epileptic encephalopathies)
- Symptomatic (lesional) focal
What are some DDx for childhood epilepsy?
Normal phenomenon
- sleep jerks, tantrums, inattention/day dreaming
Syncope and related episodes
- vasovagal attacks, breath-holding spells, long QT syndrome
Parasomnias and related sleep disturbances
- confusional arousals, night terrors, sleep walking, cataplexy
Migraine variant and neurovascular episodes
- complicated migraine, benign paroxysmal vertigo, TIAs
Movement disorders
- tics, clonus, chorea, shuddering attacks, tremor, stereotypies
Behavioural and psychiatric disturbances
- mannerisms, psychogenic seizures, rage attacks
Breath-holding spells:
- What happens and pathophysiology
- Outcome
- Not to do with electrical hypersynchrony, but cerebral ischaemia
- Initial noxious stimulus e.g. accident, change in breathing patterns, HR slows -> unconscious
- Benign, no Tx needed. Grow out of it ~ 6yo
What Ix could you conduct to investigate epilepsy?
- Biochemistry e.g. glucose, electrolytes, Ca/Mg → all afebrile convulsive seizures
- EEG → all afebrile epileptic seizures
- MRI → all potentially “symptomatic” epilepsies
- Metabolic and genetic investigations → MRI negative “symptomatic” epilepsies
- video-EEG monitoring ,specialised neuroimaging → uncontrolled epilepsies
What kind of general management points must you advise a family on with a dx of epilepsy?
Counselling child and family
- e.g. information, Epilepsy Foundation, emergency management, epilepsy Mx plan
Avoid precipitating factors
- e.g. sleep deprivation, flashing lights
Lifestyle precautions/restrictions
- e.g. bathing and hot water (try showers), swimming, heights, alcohol, driving, vocational
