Seizures in children Flashcards
What is Benign Rolandic Epilepsy?
Benign Rolandic Epilepsy is a form of childhood epilepsy that occurs between the ages of 4 and 12 years.
How do seizures in Benign Rolandic Epilepsy typically present?
Seizures usually occur at night and are typically partial, often starting as paraesthesia affecting the face with possible secondary generalisation to tonic-clonic movements.
How does an EEG appear for a patient with Benign Rolandic Epilepsy?
EEG for Benign Rolandic Epilepsy characteristically shows centrotemporal spikes.
What is the prognosis for Benign Rolandic Epilepsy?
The prognosis for Benign Rolandic Epilepsy is excellent, with seizures generally stopping by adolescence.
How is a child’s overall condition with Benign Rolandic Epilepsy outside of seizure episodes?
Outside of seizure episodes, a child with Benign Rolandic Epilepsy is generally normal.
A 7-year-old girl presents to the emergency department accompanied by her mother. While trying to wake her up this morning, her mother noticed her face twitching and mouth drooling. This episode lasted for 30 seconds and the girl was fully aware of what was happening. The girl was drowsy and confused for the subsequent 15 minutes.
She has been well in herself and has no conditions. The pregnancy and vaginal birth have been uncomplicated. Her mother is worried that she has been tired as she has been going to bed later than usual for the past couple of weeks.
What is the most likely diagnosis?
Absence seizure
Benign rolandic epilepsy
Infantile spasms
Juvenile myoclonic epilepsy
Reflex anoxic seizures
Benign rolandic epilepsy is characterised by partial seizures at night
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Benign rolandic epilepsy is the correct answer. Benign rolandic epilepsy (BRE) is a syndrome seen in childhood, usually between the ages of 4-12. The children will usually have a focal seizure, involving their face, drooling, and one side or one limb twitching (that can sometimes progress to secondary generalised seizure) either before or after bedtime. It is common for children to be sleep deprived. The EEG classically shows centrotemporal spikes, as the seizure is initiated in the rolandic fissure (central sulcus), hence the name. It carried a really good prognosis, and might not even need treatment depending on the severity and frequency of the seizures.
Absence seizure is incorrect. This is a type of epilepsy in children (commonly misdiagnosed as attention deficit hyperactivity disorder) that is characterised by periods of absence and quick recovery. This is a generalised type of seizure, which means that the patient will not have awareness, unlike in this case. Moreover, there would not be any twitching of limbs, again suggesting this patient has a focal seizure.
Infantile spasms is incorrect. This is a condition that commonly occurs in infants (up to 1 year old) and involves ‘spasm’ like movements that are usually associated with developmental delay in the milestones. This is a very heavy diagnosis as it carries a poor prognosis, and is unlikely in this case.
Juvenile myoclonic epilepsy is incorrect. This is a relatively common syndrome and is focal and in fact associated with sleep deprivation. However, it would characteristically produce ‘myoclonic’ jerks, meaning fast and rhythmic movements of the limbs, commonly on a background of daytime absences. These have the potential to become secondarily generalised seizures, just like BRE.
Reflex anoxic seizures is incorrect. Also, known as a pallid breath-holding spell, this would commonly be seen in infants and children up to 2 years of age. They tend to be triggered by stress and pain (it is presumed they occur due to very sensitive cardiac reflexes in babies). The baby will go pale and become unresponsive for a short period of time and then have a quick recovery. These are benign in nature and have a good prognosis.
summarise
Benign rolandic epilepsy
Benign rolandic epilepsy is a form of childhood epilepsy that typically occurs between the age of 4 and 12 years.
Features
seizures characteristically occur at night
seizures are typically partial (e.g. paraesthesia affecting the face) but secondary generalisation may occur (i.e. parents may only report tonic-clonic movements)
the child is otherwise normal
EEG characteristically shows centrotemporal spikes
The prognosis is excellent, with seizures stopping by adolescence
