Seizures (paeds) Flashcards
What are stiffening/juddering attacks?
Temporary stiffening of upper limbs
Specific to infants
Often around the time of food
Often grow out of them
What is benign sleep myoclonus?
Twitches that only occur in the period of time just after falling asleep - ask if it happens when they are awake
If prescribed drugs for epilepsy - these can make them make the twitches happen more
What is a vasovagal syncope?
A state similar to a seizure may result from the blood’s inability to return quickly to the brain upon falling after witnessing a certain trigger which results in simultaneous enhancement of parasympathetic nervous system (vagal) tone and withdrawal of sympathetic nervous system tone
Symptoms:
Light headedness, nausea, the feeling of being extremely hot or cold (accompanied by sweating), ringing in the ears, an uncomfortable feeling in the heart, fuzzy thoughts, confusion, a slight inability to speak or form words (sometimes combined with mild stuttering), weakness and visual disturbances such as lights seeming too bright, fuzzy or tunnel vision, black cloud-like spots in vision, and a feeling of nervousness
Typical triggers include: Prolonged standing Emotional stress Pain The sight of blood
About 33% of people diagnosed with epilepsy have never had a proper seizure and vaovagals are the most common true diagnosis in these instances
How can a frontal lobe seizure present?
Fencing posture -
(Because focal)
Then spreads to generalised tonic clonic
Mostly occur at night
What is the definition of myoclonic? How does this differ from clonic? And spasm?
Myoclonic = Involves one muscle group; Lasts <100ms
Clonic = involves lots of muscle groups; lasts longer than 100ms, rhythmical contractions
Spasms = in between clonic and myoclonic in length??
What are the terms you use to describe seizures?
Focal vs generalised + describe what happens to consciousness (intact/absent/impaired etc)
(no longer simple, complex or partial)
What are the characteristics of absence seizures?
Most common between ____yrs, M vs. F?
Quick onset and quick recovery - lasts <10s mostly
Possible motor movements - twitching or mouth movements
Staring/look vacant
Can have 25-30/day
Can be brought on by hyperventilation e.g. get them to blow on a tissue or windmill
May be mistaken for daydreaming, inattention/ADHD, hearing impairment - but these last longer and you can bring someone out of them I.e. by shaking them/tactile stimulation
Why do we treat epilepsy?
To keep life as normal as possible for people, improving QoL, improve learning + family dynamic, to avoid stigma
Risk of sudden death - though actually very rare, mor common in those with refractory epilepsy and those who don’t take meds and have seizures at night
Stuff on drugs in kids (this whole deck needs more and rearranging as just contains some of the info from the lecture so far)
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What are some typical EEG patterns for childhood epilepsies?
Absence seizures - 3Hz spike and wave pattern, all leads
Childhood epilepsy with central temporal spikes/Benign Rolandic seizures - central and temporal spiking (mouth tingles/twitches, often grow out of)
Infantile spasms - hyperarrhythmia - chaos on an EEG in all leads (poor prognosis)
What affects choice of antiepileptic?
Type of seizures - ethosuximide is only used for absence seizures
Sex - often start girls on non-teratogenic meds (so not valproate) as don’t want to gain good control in childhood then have to switch in adolescence; if have to use valproate then may be offered birth control when they become fertile
Side effects - e.g. valproate and weight gain (not great in already obese children)
What is juvenile myoclonic epilepsy?
Presentation: clumsiness e.g. dropping cereal is a characteristic sign, especially in the morning as seizures made worse by sleep deprivation (and photostimulation) and all teenagers are sleep deprived
Associated with: absence seizures c.10% - warn parents
Management: levetiracetam/Kepra (most commonly prescribed), valproate, lamotrigine
What are some features of febrile convulsions?
Seizure provoked by fever in otherwise healthy child
Typically occur between 6m-5yrs
Rapid rise in temperature is what leads to seizure
Seizures are mostly tonic clonic lasting <5mins (if longer call 999)
Simple febrile seizure: <15mins Generalised Typically no recurrence within 24hrs Complete recovery within 1hr - anything longer may warrant further investigation
Complex febrile seizure:
15-30 mins (longer = febrile status epilepticus)
Focal seizure
May have repeat seizures within 24hrs
How do you manage febrile seizures?
Children who have a first febrile seizure OR any features of a complex febrile seizure should be admitted to paediatrics
No evidence that giving antipyretics promptly can reduce the chance of further seizures - parents may ask, can reassure the it just happens
What is the prognosis for febrile seizures?
Overall risk of convulsions if have had on = 1/3
Risk may be greater if: Age of onset <18m Fever <39 Shorter duration of fever before seizure FHx of febrile convulsions
May also progress to epilepsy in some:
Strong FHx of epilepsy
Complex febrile seizure
Neurodevelopmental disorders (if have all three factors - 50% change of progressing to epilepsy)
