19.2. Paediatric Neurology - Epilepsy

Question 1

What is the Definition of a Seizure / Fit?

Answer 1

Any Sudden Attack from Whatever Cause

Question 2

What is the Definition of Syncope?

Answer 2

Faint - A Neuro-Cardiogenic Mechanism

Question 3

What is the Definition of a Convulsion?

Answer 3

Seizure where there is Prominent Motor Activity

Question 4

What is the Definition of an Epileptic Seizure?

Answer 4

An Abnormal Excessive Hyper-Synchronous Discharge from a Group of Cortical Neurons
Note - Not all Seizures are Necessarily Epileptic

Question 5

What, other than Epilepsy, can cause Seizures?

Answer 5

1. Acute Symptomatic Seizures - due to Acute Insults:
2. a) Hypoxia-Ischaemia
3. b) Hypoglycaemic
4. c) Infection
5. d) Trauma
6. Reflex Anoxic Seizure - Common in Toddlers
7. Syncope
8. Parasomnias - e.g. Night Terrors
9. Behavioural Sterrotypes
10. Psychogenic Seizures

Question 6

What is a Febrile Convulsion?

Answer 6

Commonest Cause of “Acute Symptomatic Seizure”:
Convulsion Associated with Fever but without Evidence of Intracranial Infection / Defined Cause for the Seizure
Note - Seen between 3 months and 5 years

Question 7

What are the Different Seizure Types?

Answer 7

1. Tonic Clonic
2. Tonic
3. Clonic
4. Myoclonic
5. Absence

Question 8

What is the Mechanism by which an Epileptic Fit is Triggered?

Answer 8

1. Decreased Inhibition - Gamma-Amino-Butyric Acid (GABA)
2. Excessive Excitiation - Glutamate / Aspartate
3. Excessive Influx of Na and Ca Ions

Question 9

What is the Difference between:

1. Generalised Epileptic Seizures?
2. Focal (Partial) Epileptic Seizures?

Answer 9

1. a) Involves Both Sides of the Cerebral Hemispheres
2. b) Loss of Control / Awareness - Memory Gap
3. c) No Warning
4. a) Involves 1 Cortical Lobe / Part of it
5. b) No Loss of Control (Simple Partial)
6. b) Loss of Control (Complex Partial)

Question 10

What is involved in the Stepwise Approach to a Diagnosis of Epilepsy?

Answer 10

1. Is the Paroxysmal Event Epileptic in Nature?
2. Is it Epilepsy?
3. What Type of Seizure is Occurring?
4. What is the Epilepsy Syndrome?
5. What is the Aetiology?
6. What are the Social / Educational Effects on the Child?

Question 11

How is Epilepsy Diagnosed?

Answer 11

1. History
2. Video / Recording of the Event
3. ECG in Convulsive Seizures
4. Interictal / Ictal EEG
5. MRI Brain - to determine Aetiology

Question 12

How is Epilepsy Managed in Children?

Answer 12

1. Sodium Valproate - Generalised
2. Carbamazepine - Focal
   Note - Only Considered if Diagnosis is Clear
   Note - This controls Seizures, does not Cure Epilepsy