Seizures, epilepsy and headaches in children Flashcards
What is the cause of epileptic seizures?
An epileptic seizure is caused by acute disturbances in the electric activity of the brain. (Synchronized hyper-activation of brain cells.)
What conditions may induce an epileptic attack?
Infections, head trauma, fever (especially in children), drugs/alcohol, sleep deprivation, structural brain lesions etc.
What is meant by genetic epilepsy?
Genetic epilepsy is caused by mutations in genes that code for ion channels (or their accessory sub-units). In genetic epilepsy there is no obvious structural lesion or damage.
What are the basic classification of seizure types?
Focal onset. Aware or impaired awareness. Motor or Non-motor. (May evolve into a bilateral convulsion seizure.)
Generalized onset. Motor (tonic-clonic or other) or non-motor (absence).
Unknown onset. Motor (tonic-clonic or other) or non-motor.
What characterizes a generalized tonic-clonic seizure?
Loss of consciousness.
Initial tonic phase, subsequently a clonic phase.
May pass urine and stool.
May bite the tongue.
What are the three forms of status epilepticus (SE)?
- Early SE: Duration 5-30 min.
- Established SE: A seizure lasting longer than 30 min or a series of seizures without a return to baseline level of alertness between the seizures.
- Refractory SE: Seizures that persist despite treatment with adequate doses of an initial 2 or 3 anticonvulsant medications.
Are neonatal seizures dangerous?
Yes, it is associated with high mortality and morbidity, as well as an increased risk of neurological sequela and post-neonatal epilepsy.
What is the peak age of onset for infantile spasms (West syndrome)?
3-7 months. (Onset rarely occurs after 18 months of age.)
“Developmental stop or even regression. Spasms are variable in frequency and may be brief. Spasms might present as sudden, and subtle head nods and are easily missed” What condition is this characteristic of?
Infantile spasms (West syndrome).
What is associated with a favorable prognosis for children with infantile spasms?
Normal development at onset
Unknown cause
Rapid response to treatment
What is the peak incidence for febrile seizures?
Peak incidence between 12-24 months.
What is a febrile seizure?
Seizures in febrile children between the ages of 6 months and 5 years who do not have an intracranial infection, metabolic disturbance, or history of afebrile seizures.
How are febrile seizures classified?
Simple febrile seizure: Generalized seizure. Duration < 15 min. Occur once in a 24-h period.
Complex febrile seizure: Focal seizures, prolonged (> 15 min) and/or multiple; occur more than once in a 24-h period.
What are risk factors for development of febrile seizures? How often do febrile seizures occur on children without risk factors?
Family history, developmental delay and prematurity are risk factors.
In 50 % of cases there are no risk factors.
If a child has only 1-3 simple febrile seizure attacks there
is no increased risk of developing epilepsy. What can slightly increase the risk of epilepsy?
Complex febrile seizures
Positive family history of epilepsy
Delayed development/neurological abnormalities
True or false: In general EEG has no predictive value with regard to risk of developing epilepsy following a febrile seizure and should not be taken.
True. EEG should only be taken if there are clinical signs of neurological disease or after repeated complex seizures.
How should a febrile seizure be managed?
Antipyretics may improve the comfort of the child, but they will not prevent febrile seizures.
Always prescribe diazepam if needed later – Administer if seizure duration > 4-5 min.
Information to the parents + empathy!
When is the usual age of onset for benign childhood epilepsy? Is benign childhood epilepsy more common i girls or boys?
3-13 years.
More common in boys.
“75% of seizure attacks during sleep. Lateralized facial contraction and a grunting sound, without loss of consciousness. Sometimes the homolateral upper limb is involved. Secondary generalization 1/3 - 2/3 of cases.” What type of seizure if described?
A typical seizure in benign childhood epilepsy.
What should be included in the clinical examination during a work up investigating an unprovoked seizure in a child?
Neurological, skin, and ocular assessment, and measurement of head circumference.
What is the procedure of choice for neuroimaging?
MRI.
What are factors associated with favorable prognosis for children with seizures?
Normal intelligence No neurological abnormalities Unknown cause (”idiopathic”) Age at onset more than 2 years Infrequent seizures Limited numbers of “GTC” seizures Only one seizure type Absence of tonic-atonic seizures (drop-attacks) Rapid response to anti-epileptic drugs (AED)
What are differential diagnosis to epilepsy in children?
Psychogenic non-epileptic seizures (PNES)
Breath-holding spells
TIA (rare in children)
Migraine
Hypoglycemia (always check glucose)
Movement disorders/tics
Gastro-esophagal reflux (dystonic posturing)
Night terrors
Cardiogenic syncope (long QT-syndrome, AV-block)
Self gratification behavior (girls 2-4 years)
What is treatment of epileptic seizures outside of hospitals?
Protect the head, place patient in recovery position.
Do not put anything in the mouth.
Health personnel are required only in long standing seizures.
If the seizure lasts longer than 4-5 minutes, medical treatment is indicated:
Diazepam (rectally) or midazolam (buccal).
Call 113 if the seizure lasts longer than 5-10 minutes.
