Fits/seizures Flashcards

1
Q

What is a fit

A

Paroxysmal abnormality of motor, sensory, autonomic, and/or cognitive function, due to transient brain dysfunction

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2
Q

What is a convulsion

A

a seizure (epileptic or non-epileptic) with motor components,

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3
Q

What is a seizure

A

Unstimulated and usually appear as repetitive, rhythmic (clonic) movements of the limbs which PERSIST DESPITE RESTRAINT and are often accompanied by eye movements or changes in respiration

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4
Q

What are the causes of seizures

A

Epileptic: hyper-synchronous electrical activity
- Infantile spasms (west syndrome)
- benign rolandic seizures
- Lennox-gastaut
- Childhood absence epilepsy
- Myoclonic epilepsy
Structural/metabolic: cerebral dysgenesis/malformation, vascular occlusion, damage (infection, HIE, haemorrhage), tuomur
Acute symptomatic: stroke, TBI, infection, electrolyte abnormalities, poison/toxin, meningitis or encephalitis
Febrile convulsion
Paroxysmal: blue breath holding spells, vasovagal syncope, hypovolaemic syndrome

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5
Q

What are the causes of seizures in neonates

A

Hypoxic-ischaemic encephalopathy
Cerebral infarction
Septicaemia/ meningitis
Metabolic: Hypoglycaemia, Hypo/hypernatraemia, Hypocalcaemia, Hypomagnesaemia, Inborn errors of metabolism,Pyridoxine dependency
Intracranial haemorrhage
Cerebral malformations
Drug withdrawal e.g. maternal opiates
Congenital infection
Kernicterus

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6
Q

What investigations/initial management should be done for first seizures

A

Immediate hospital assessment by a paediatrician
Refer to first fit clinic

Bedside: ECG, urine dip
Bloods: GLUCOSE, U&Es, FBC, genetic testing, toxicology, serum prolactin
Other: EEG, LP

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7
Q

At what age do infantile spasms (west syndrome) occur

A

3-12 months

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8
Q

What are the symptoms of infantile spasms

A

Spasms - sudden, rapid, tonic contraction of muscles + gradual relaxation - “Salam attacks”
- Violent flexor spasms of the head, trunk, and limbs followed by extension of thee arms (“jack-knife”)
- Lasts 1-2s, often multiple bursts of 20-30
- Often on waking or many times a day
Social interaction/development often deteriorates
Hyperpigmented skin lesions
Growth restriction

(May be misinterpreted as colic)

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9
Q

What would EEG show for infantile spasms and what is the management

A

EEG: Hypsarrhythmia

Mx: Vigabatrin and/or corticosteroids

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10
Q

What is the prognosis for infantile spasms

A

70% have a good initial response to medication but not a good long term prognosis
Most lose skills and develop a learning disability + epilepsy

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11
Q

Describe Lennox-Gastaut - age range, symptoms

A

1-3yo
PMHx infantile spasms/neuro disorders
Multiple seizure types, but mostly atonic, atypical (subtle) absences, and tonic seizures in sleep
Neurodevelopmental arrest or regression and behaviour disorder

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12
Q

What would EEG show for Lennox-Gastaut

A

Slow generalised spike and wave (1-2.5Hz)

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13
Q

What is a blue breath holding spell

A

Occurs in toddlers when they are upset
Cries → holds breath → turns blue
May have LOC but should recover rapidly (NO post-ictal state)

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14
Q

What will EEG show for blue breath holding spells and what is the management

A

EEG is normal
Drug therapy is unhelpful. Attacks resolve spontaneously, but treating iron deficiency anaemia, if present, may help

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15
Q

Describe Anoxic reflex asystolic syncope (cause, age group, RF, symptoms)

A

Caused by cardiac asystole from excessive vagal inhibition
Infants and toddlers
RF: FHx of faints

Triggers: pain, discomfort, HEAD TRAUMA, cold food, fright, fever
Child gasps, becomes pale and falls to the floor
Hypoxia → generalised tonic-clonc seizure
Seizure is brief, child may not recover rapidly

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16
Q

Describe vasovagal syncopes

A

Fainting
Brief clonic movements
Preceding blurred vision, light-headedness, sweating, nausea - resolves on lying down
triggers: hot/stuffy environments, standing for long periods, fear

17
Q

Describe benign paroxysmal vertigo of childhood

A

Primary headache disorder of childhood.
Recurrent episodes of vertigo (1-2 minutes)
+ Nystagmus, unsteadiness, falling
No postictal state

(NOT the same as benign positional vertigo)

18
Q

What are tics

A

Rapid, repetitive, brief, involuntary movements which can be voluntarily controlled

19
Q

What are night terrors

A

Wakes from sleep disorientated and frightened. May have autonomic signs

20
Q

What is the epidemiology of childhood absence epilepsy

A

4-12y
2/3 female
2% of childhood epilepsy

21
Q

What are the symptoms of childhood absence epilepsy

A

May be triggered by hyperventilation
Momentary unresponsive stare with motor arrest
May twitch eyelids of a hand or mouth minimally
Sudden onset
Lasts a few seconds (<30s)
Child has no recall, but may realise they have missed something and look puzzled/say pardon
Developmentally normal but may interfere with schooling

22
Q

What are the EEG changes for childhood absence epilepsy

A

Generalised spike and wave (4-3Hz) discharges, bilaterally synchronous during and sometimes between absences
Can ask to blow on a windmill for 2-3mins

23
Q

What is the prognosis for childhood absence epilepsy

A

Good, 80% in remission in adolescence
Few evolve into juvenile absence or juvenile myoclonic epilepsy

24
Q

Describe childhood/benign rolandic epilepsy - age range, prevalence, symptoms

A

Epilepsy with centro-temporal spikes
4-10y
15% of childhood epilepsies
Tonic-clonic seizures in sleep, or simple focal seizures with awareness of abnormal feelings in the tongue
Distortion of the face (supplied by the rolandic area of the brain)

25
Q

What is Panayiotopoulos syndrome (early-onset benign occipital epilepsy)

A

5% of childhood epilepsies, 1-5yo

S/S
Autonomic features
Vomiting
Unresponsive staring in sleep
Head and eye deviation
May progress to a convulsive seizure

26
Q

What are the features of Panayiotopoulos syndrome (early-onset benign occipital epilepsy) on EEG

A

Posterior focal sharp wave
Occipital discharges when the eyes are shut