Paediatric Neurology - Non-epileptic paroxysmal events and febrile convulsions

Question 1

What are some causes of non-epileptic paroxysmal events?

Answer 1

Syncope
Psychologically determined paroxysmal event
Breath holding
Self gratification
Non REM Parasomnias
Daydreaming
Tics

Question 2

What happens during an episode of syncope?

Answer 2

Precipitating event - fright or hair brushing

Aura or tingling

LOC and postural change with change of tone. Jerking for <1min (may not be rhythmic)

Question 3

At what age do children get syncope?

Answer 3

> 9 months

Question 4

How is syncope managed?

Answer 4

Rule out long QT

Reassure

Advice on hydration, salt and standing

Question 5

What features are suggestive of psychologically determined paroxysmal event?

Answer 5

Situation specific
Thrashing movements
Eyes open
Dramatic fall to floor

Question 6

At what age do children get psychologically determined paroxysmal events?

Answer 6

Early adolescence

Question 7

How do you manage psychologically determined paroxysmal events?

Answer 7

Help family understand reason

Remove gains from behaviour

Psychological support

Question 8

What happens when a child is breath holding and has a paroxysmal event?

Answer 8

Stimulus such as head bang –> short cry –> child go limp –> collapse –> brief clonic jerking

Question 9

At what age do children have paroxysmal events due to breath holding?

Answer 9

6 months - 6 years

Question 10

How do you manage children who are having paroxysmal events due to breath holding?

Answer 10

Reassure parents that the child will start breathing

No long lasting damage

Question 11

Describe a paroxysmal event due to self gratification

Answer 11

Child bored and self stimulate

Legs outstretch and eyes glazed with sweating and salivation

Question 12

When do children have paroxysmal events due to self gratification?

Answer 12

3 months to 3 years

Question 13

How do you manage children having paroxysmal events due to self gratification?

Answer 13

Reassure parents it is normal developmental behaviour

Question 14

What happens in a non REM Parasomnias?

Answer 14

During deep sleep, child “wake” and is inconsolable with vigorous or violent actions

After 10-20 mins they wake confused before sleeping again

Question 15

How do you manage non REM Parasomnias?

Answer 15

Suggest clearing bedroom of obstructions

Alarms on doors and windows

Question 16

What is daydreaming?

Answer 16

Stream of consciousness that detaches from current external tasks when attention drifts to a more personal and internal direction

Occur at school

Confused with absence seizure

Question 17

What are tics?

Answer 17

Repetitive stereotyped movements such as face grimacing and blinking

Question 18

When do tics begin?

Answer 18

6-7yo

Question 19

How do you manage tics?

Answer 19

Reassure it is common

If last for >12 months - require intervention

Question 20

What is a fit?

Answer 20

Brief moment when the person appears to be “absent” from what is going on around them

OR

Jerking/twitching of a hand, arm or leg or jerking/twitching affecting the whole body

Question 21

What do you have to rule out if a child presents with a fit?

Answer 21

Meningitis
Head Trauma
Metabolic causes
Hypoxia
Cerebrovascular insult
Fever
Toxins
RICP

Question 22

What investigations would you order to rule out meningitis in a fitting child?

Answer 22

Lumbar Puncture

Bloods

Question 23

What would you do to rule out head trauma in a fitting child?

Answer 23

Fully exposed examination

Question 24

What metabolic causes would you rule out in a fitting child?

Answer 24

Low blood glucose

High calcium

Question 25

How would you investigate RICP in a fitting child?

Answer 25

Ophthalmoscope

CN examination

Question 26

What is the role of an EEG in a fitting child?

Answer 26

Done to support clinical diagnosis of epilepsy once other causes have been ruled out

Question 27

What is the role of an MRI scan in a fitting child?

Answer 27

Done if history suggests focal onset to rule out a space occupying lesion

Question 28

What are febrile convulsions?

Answer 28

Seizures occurring in children aged between 6 months - 5 years associated with fever but no underlying cause

Question 29

What is the aetiology behind febrile convulsions?

Answer 29

Unknown if temperature or rate of temperature rise causes convulsions

Genetic component

Question 30

What are common causes of febrile convulsions?

Answer 30

Otitis media
Tonsilitis
Viruses

Question 31

What are serious causes to rule out?

Answer 31

Meningitis
Sepsis
UTI
LRTI

Question 32

What categories can febrile convulsions be split into?

Answer 32

Simple
Complex
Status epilepticus

Question 33

Describe a simple febrile convulsion

Answer 33

Generalised tonic clonic seizure
<15 mins
Doesn’t recur within same febrile illness

Question 34

Describe a complex febrile convulsion

Answer 34

Focal features
>15 mins or recur with same febrile illness
20% of cases

Question 35

Describe a status epilepticus febrile convulsion

Answer 35

Any febrile seizure > 30mins

5% of cases

Question 36

How are febrile convulsions managed?

Answer 36

Protect from injury - don’t restrain child

> 5 mines –> rectal diazepam - repeat if still seizing 5 mins later

Admit and treat as meningitis if serious features

Can give anti-paretics and tepid sponging

Assess post seizure

Educate parents

Question 37

What do you assess post febrile seizure?

Answer 37

Full seizure history - inc. family history
Signs of serious cause
Vitals
Bloods and urine culture

Question 38

What advice do you give to parents about febrile convulsions?

Answer 38

Explain what they are
Treat fever - remove clothes, hydrate and give anti-paretics
Call 999 if >5mins
Check for non-blanching rash and dehydration
Recovery position if having a fit