Seizures + Epilepsy Flashcards
What is a seizure?
- Clinical event in which there is a sudden disturbance of neurological function caused by abnormal/excessive neuronal excitation.
- Can be epileptic or non-epileptic.
Causes of epilepsy in children?
1) Idiotpathic
2) Secondary: cerebral dysgenesis/malformation, vascular occlusion, or damage (infection, hypoxic-ischaemic encephalopathy).
3) Cerebra tumour
4) Neurodegenerative disease
Causes of non-epileptic seizures?
1) Febrile seizures
2) Meningitis/encephalitis
3) Metabolic - hypoglycaemia, hypomagnesiaemia, hypocalcaemia, hypo/hypernatraemia.
4) Posions/toxins
5) Head trauma
What are febrile seizures?
- Single tonic-clonic, symmetrical generalised seizure lasting <15 minutes occurring alongside fever - typically in a normal developing child (6m-6yrs).
- Does NOT cause brain damage.
- Complex febrile seizures (focal, prolonged, or repeated in same illness) have an increased risk of developing into epilepsy.
- 10% risk if child has a first-degree relative with febrile seizures.
Presentation and diagnosis of febrile seizures?
Sx: Generalised tonic-clonic seizure lasting <15 minutes
Dx: Seizure normally occurs in a viral infection when the temperature rises rapidly. If there is neck-stiffness - think meningitis.
AVOID LP in post-octal periods as CNS assessment impossible.
Complex seizure causes?
IF:
1) Focal CNS signs/abnormality
2) >15 minutes
3) >1 attack in 24 hours
4) Previous Hx of epilepsy
THINK:
Meningo-encephalitis, trauma, epilepsy, CNS lesion, hypoglycaemia, hypocalcaemia, hypomagnesiaemia.
Treatment of febrile seizure?
1) Put in recovery position
2) If seizure >5 minutes give benzodiazepine e.g. rectal diazepam or buccal midazolam.
3) Find underlying infection
4) Educate and reassure parents
What are paroxysmal disorders? Aetiology?
- Cause funny turns and mimic epilepsy.
Ax:
- Breath-holding attack - toddlers: precipitated by anger, holds breath, goes blue then limp, rapid recovery.
- Reflex anoxic seizures - toddlers: triggered by pain/discomfort from minor head trauma/fear/fright. After triggering event - child becomes very pale and falls to the floor. Hypoxia may induce a generalised tonic-clonic seizure. Episodes due to cardiac systole from vagal inhibition. Rapid recovery.
- Syncope - due to hot and stuffy environment, clonic movements may occur.
- Migraine
- Benign paroxysmal vertigo - recurrent episodes of vertigo, lasting from one to several minutes, associated with nystagmus, unsteadiness and falling.
- Primary headache disorder occasionally due to viral labrynthitis.
Childhood epilepsy definition and Ax?
- Chronic neurological disorder characterised by recurrent, unprovoked seizures, consisting of transient signs of excess and abnormal neuronal activity in the brain.
- RF: FH
- Idiopathic, infection (meningitis), hyponatraemia, hypoglycaemia, hypocalcaemia, hypomagnesaemia, CNS tumours, flickering lights.
Childhood epilepsy PPx?
- Generalised: discharge arises from both hemispheres - absence, myoclonic, tonic, tonic-clonic, atonic.
- Focal - seizures arise from one part/hemisphere:
1) Frontal seizures - Involve motor/premotor cortex - may lead to clonic movements - Jacksonian March
2) Temporal seizures (MOST COMMON) - strange warning feelings or aura with smell and taste abnormalities and distortions of sound and shape. Lip-smacking, plucking nothing and walking in a non-purposeful manner.
3) Occipital seizures - vision distortion
4) Parietal lobe seizures - contralateral dysaesthesias (altered sensation) or distorted body image. - Conscious may or may not be altered, or the seizure may be followed by generalised tonic-clonic seizure.
Ddx of childhood epilepsy?
1) Arrhythmias (prolonged QT)
2) Migraine, narcolepsy, night terrors
3) Paroxysmal disorders (reflex anoxic seizure)
Dx of childhood epilepsy?
- Primarily clinical diagnosis
- Focused on specific triggers and if child has any impairments
- Check skin markers for a neurocutaneous syndrome/neurological abnormality
- EEG
- MRI/CT head
Tx of childhood epilepsy?
- Generalised seizures:
1) Tonic-clonic - Sodium Valproate (weight gain and drowsiness) or Carbamazepine (agranulocytosis, rash)
2) Absence - Sodium Valproate
3) Myoclonic - Sodium Valproate - Focal seizures:
1) Carbamazepine, Sodium Valproate
2) Lamotrigine
Other: Ketogenic diet, vagal stimulation, temporal lobectomy
Advice: Avoid baths/swimming alone, don’t sit too close to TV (f photophobic), do not drive until 1 year after seizure.
Name 4 childhood epilepsy syndromes?
1) West syndrome
2) Lennox-Gastaut syndrome
3) Absence epilepsy
4) Juvenile myoclonic epilepsy
West syndrome brief:
- 4-6 months
- Violent flexor spasms of head, trunk and limbs - followed by extension of the arms
- Social interaction deteriorates
- Most develop learning disability or epilepsy
- Treatment - Vigabatrin or corticosteroids
