Seizures - Infantile spasm, Lennox Gastaut, Benign rolandic, Juvenile myoclonic, Febrile seizures

Question 1

Infantile spasms
-age of onset
-presentation
-investigations
-management

Answer 1

1st year of life

Childhood epilepsy often associated with serious underlying condition
-tuberous sclerosis
-encephalitis
-birth asphixia

Flexion of head, trunk, arms => arm extension
Last seconds but repeated multiple times
Regression of development

Definitive - EEG - hypsarrythmia
CT - brain abnormality

Vigabatrin + ACTH

May develop into Lennox Gastaut syndrome

Question 2

Lennox Gastaut syndrome
-age of onset
-presentation
-investigations
-management

Answer 2

1-5years old

Often an extension of infantile spasms

Atypical absences, falls, jerks
Moderate/severe mental handicap

Definitive - EEG - slow spike

Ketogenic diet can help

Question 3

Benign rolandic epilepsy
-age of onset
-presentation
-investigations
-management

Answer 3

4-12 years old

Occur at night
Can be focal or generalised

Definitive - EEG - centrotemporal spikes

If daytime seizures or very frequent - levetiracetam

Seizures stop by teens

Question 4

Juvenile myoclonic epilepsy
-age of onset
-presentation
-investigations
-management

Answer 4

Teens - often within 30mins of waking
More likely when tired, stressed or sleep deprived

Myoclonic jerks on background of daytime absences
TC

Sodium valproate

Question 5

Febrile seizures
-what are they
-presentation
-investigations
-management

Answer 5

6months - 5 years

Occurs early in viral infection due to rapid temperature rise
Brief generalised T or TC