Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

B - Paediatrics MANAGEMENT > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is epilepsy?

A

A group of neurological disorders characterised by epileptic seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are epileptic seizures?

A

Episodes that vary from brief, nearly undetectable periods, to long periods of vigorous shaking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a seizure?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does the term ‘seizure’ include?

A
  • Epileptic
  • Syncopal (anoxic)
  • Brainstem
  • Emotional
  • Functional
  • Undetermined
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the types of brainstem seizures?

A
  • Hydrocephalic

- Coning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are functional seizures also known as?

A

Psychogenic pseudo-seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What makes a seizure epileptic?

A

The nature of the underlying electrical activity in the brain, especially the cerebral cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the problem with the thing that makes seizures epileptic being the nature of the underlying electrical activity in the brain?

A

They can be difficult to distinguish from a non-epileptic seizure clinically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are epileptic seizures due to?

A

Excessive and hypersynchronous electrical activity, typically in neural networks in all or part of the cerebral cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When can an epilepsy generally be recognised?

A

After two or more unprovoked epileptic seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the incidence of epilepsy in childhood?

A

0.05%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does the incidence of epilepsy in children compare to other age groups?

A

It affects infants and children more than any other age group

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are seizures, in terms of pathophysiology?

A

A paroxysmal manifestation of the electrical properties or the cerebral cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When does a seizure result?

A

When there is a sudden imbalance between the excitatory and inhibitor forces within the network of cortical neurones in favour of sudden-onset net excitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What % of epilepsies are genetic?

A

70-80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is meant by ‘genetic’ epilepsies?

A

Idiopathic syndromes with complex inheritance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the other causes of epilepsy?

A
  • Cerebral dysgenesis/malformation
  • Cerebral vascular occlusion
  • Cerebral damage
  • Cerebral tumour
  • Neurodegenerative disorders
  • Neurocutaneous syndromes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Give two examples of causes of cerebral damage that can lead to epilepsy

A
  • Congential infection

- Hypoxic-ischaemic encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Give an example of a neurocutaneous syndrome that can cause epilepsy

A

Tuberous sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the risk factors for epilepsy

A

Family history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What can epilepsies be broadly classified as?

A
  • Generalised

- Focal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When do focal seizures occur?

A

When the seizures arise from one or part of the hemisphere

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What does the manifestation of focal seizures depend on?

A

The part of the brain where the discharge originates and moves too

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What happen to the level of consciousness during focal seizures? `

A

May be retained or lost

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How can a focal seizure progress?

A

May evolve to a generalised secondary tonic-clonic seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What region of the brain do frontal seizures affect?

A

The motor or pre-motor cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How might frontal seizures present?

A
  • Clonic movements, which may travel proximally (Jacksonian march)
  • Tonic seizure with both upper limbs raised high for several seconds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How might temporal seizures present?

A
  • Aura
  • Smell or taste abnormalities
  • Distortion of sound and shape
  • Automatisms, e.g. lip smacking, plucking at one’s clothing
  • Deja-vu
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How might occipital seizures present?

A
  • Stereotyped visual hallucinations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How might parietal seizures present?

A
  • Contralateral dysesthesias

- Distorted body image

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is dysesthesias?

A

Altered sensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are generalised epileptic seizures?

A

Where discharges arise from both hemispheres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the types of generalised epileptic seizures?

A
  • Absence
  • Myoclonic
  • Tonic-clonic
  • Atonic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How do absence seizures present?

A

Transient loss of consciousness, with abrupt onset and termination unaccompanied by motor phenomena apart from some flickering of eyelids and minor alteration in muscle tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What can absence seizures often be precipitated by?

A

Hyperventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How do myoclonic seizures present?

A

Brief, often repetitive jerking movements of the limbs, neck, or trunk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How do tonic seizures present?

A

Generalised increase in tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How does the tonic phase of tonic-clonic seizures present?

A
  • May fall to ground

- Do not breath, become cyanosed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What might happen when the patient falls to the ground in tonic-clonic seizures?

A

May injure themselves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What happens in the clonic phase of tonic-clonic seizures?

A
  • Jerking of limbs
  • Breathing is irregular and cyanosis persists
  • Saliva may accumulate in mouth
  • Biting of tongue
  • Incontinence of urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How long do tonic-clonic seizures last?

A

From a few seconds to minutes, followed by unconsciousness or deep sleep for up to several hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How do atonic seizures present?

A

Transient loss of muscle tone, causing sudden fall to floor or drop of head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are atonic seizures often preceded by?

A

Myoclonic jerk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is a seizure pattern?

A

A pattern of epileptic seizures that has different clinical features and different ages of onset

45
Q

Give 7 seizure patterns seen in children

A
  • Infantile spasms (West syndrome)
  • Lennox-Gastaut syndrome
  • Childhood absence epilepsy
  • Benign rolandic epilepsy
  • Panaviotopolous syndrome
  • Juvenile absence epilepsy
  • Juvenile myoclonic epilepsy
46
Q

What is the age of onset of West syndrome?

A

3-12 months

47
Q

Describe the seizures in West syndrome

A

Violent flexor spasms of the head, trunk,and limbs, followed by extension of the arms
Lasts 1-2 seconds, often in multiple bursts of 20-30, often on walking or many times a day

48
Q

What is the age of onset of Lennox-Gastaut syndrome?

A

1-3 years

49
Q

Describe the seizures in Lennox-Gastaut syndrome?

A

There are multiple seizure types, but mostly atopic, atypical (subtle absences), and tonic seizures in sleep

50
Q

What other disorders are associated with Lennox-Gastaut syndrome?

A

Neurodevelopmental arrest or regression and behaviour disorder

51
Q

What is the age of onset of childhood absence epilepsy?

A

4-12 years

52
Q

Describe the seizures in childhood absence epilepsy

A

Momentary unresponsive state with motor arrest, may twitch their eyelids or hand/mouth minimally.
Only lasts a few seconds (<30s)

53
Q

Does the child recall the episodes in childhood absence epilepsy?

A

No, except realises they’ve missed something

54
Q

Does childhood absence epilepsy impact the child developmentally?

A

No, they are developmentally normal, but can interfere with schooling

55
Q

What is the age of onset of benign rolandic epilepsy?

A

4-10 years

56
Q

Describe the seizures in benign rolandic epilepsy

A

Tonic-clonic seizures in sleep, or simple focal seizures with awareness of abnormal feelings in tongue, and distoration of face

57
Q

What is the age of onset of panaviotopoulous syndrome?

A

1-5 years

58
Q

Describe the seizures in panaviotopoulous syndrome

A

Autonomic features with vomiting and unresponsive staring in sleep, with head-eye deviation, progressing sometimes to convulsive seizure

59
Q

What is the age of onset of juvenile absence epilepsy?

A

10-20 years

60
Q

Describe the seizures in juvenile absence epilepsy?

A

Absences and generalised tonic-clonic seizures, often with photosensitivity

61
Q

Is learning impaired in juvenile absence epilepsy?

A

No

62
Q

What is the age of onset of juvenile myoclonic epilepsy?

A

10-20 years

63
Q

Describe the seizures in juvenile myoclonic epilepsy

A

Myoclonic, generalised tonic-clonic, and absences may occur, mostly shortly after walking

64
Q

Is learning impaired in juvenile myoclonic epilepsy?

A

No

65
Q

What is the diagnosis of epilepsy based on?

A

Primarily on a detailed history from the child and eyewitnesses, sustained by video if available

66
Q

What should particular attention be paid to when taking a history for epilepsy?

A
  • Any specific triggers

- If the child has any impairment

67
Q

What investigations may help in epilepsy?

A
  • EEG
  • Neuroimaging
  • Blood and urine biochemistry
  • Neuropsychological assessment
  • ECG
68
Q

What is the purpose of EEG in epilepsy?

A

Should be performed only to support a diagnosis of epilepsy where the clinical history suggest a seizure is likely to be epileptic in origin

69
Q

What should the EEG in epilepsy involve?

A
  • Photic stimulation

- Hyperventilation

70
Q

What should be done when a standard EEG has not contributed to diagnosis or classification?

A

A sleep EEG should be performed

71
Q

How is a sleep EEG best performed in children and young people?

A

Sleep deprivation or the use of melatonin

72
Q

What does the EEG show in infantile spasms?

A

Hypsarrhythmia

73
Q

What does the EEG show in Lennox-Gastaut syndrome?

A

Slow generalised spike and wave (1-3Hz)

74
Q

What does EEG show in childhood absence epilepsy?

A

Fast generalised spike and wave (3-4Hz) discharges, bilaterally synchronous during and sometimes between absences

75
Q

What does the EEG show in benign rolandic epilepsy?

A

Focal sharp waves from rolandic area

76
Q

What does the EEG show in Panaviotopoulous syndrome?

A

Posterior focal sharp waves and occipital discharges when eyes are shut

77
Q

What is the purpose of neuroimaging in epilepsy?

A

Should be used to identify structural abnormalities that cause certain epilepsies

78
Q

What is the neuroimaging investigation of choice in epilepsy?

A

MRI

79
Q

What in the purpose of functional neuroimaging, e.g. PET and SPECT, in epilepsy?

A

Can detect areas of abnormal metabolism by using isotopes and ligands injected and taken up by metabolically active cells

80
Q

When is functional neuroimaging done in epilepsy?

A

Used in the workup for patients for possible epilepsy surgery

81
Q

When should investigations such as blood and urine biochemistry?

A

Should be done at discretion of specialist, to exclude other diagnoses and determine an underlying cause of epilepsy

82
Q

When should neuropsychological assessment be performed in epilepsy?

A

When it is important to evaluate learning disabilities and cognitive dysfunction, particularly in regard to language and memory

83
Q

Who is ECG recommended for in epilepsy?

A

All children with seizures, even when epilepsy is most likely

84
Q

What is the purpose of ECG is epilepsy?

A

To ensure there is no convulsive syncope to arrhythmia, e.g. long-QT syndrome

85
Q

What are the differentials for epilepsy?

A
  • Syncope
  • Night terrors
  • Reflex anoxic seizures
  • Febrile convulsions
  • Fabricated or induced illness by carers
  • Migraine
86
Q

What things should be considered when deciding on a drug management for epilepsy?

A
  • Not all children with epileptic seizures require anti-epileptic drug (AED) therapy
  • Choose an appropriate AED for the seizure and epilepsy
  • All AEDs have potential unwanted effects
87
Q

What should the decision as to whether a child needs AED therapy be made based on?

A
  • Seizure type
  • Epilepsy type
  • Frequency
  • Social and educational consequences of the seizures set against the possibility of unwanted effects of AED
88
Q

What is the desired goal of AED therapy?

A

Monotherapy at the minimum dosage, to prevent seizures without adverse effects

89
Q

Who should the potential unwanted effects of AED therapy be discussed with?

A

Child and parent

90
Q

When can AED therapy be discontinued?

A

After 2 years free of seizures, depending on the seizure syndrome

91
Q

What are the first line drug options for tonic-clonic, absence, and myoclonic seizures?

A
  • Valproate
  • Carbamazepine
  • Lamotrigine
92
Q

What are the first line drug options for focal seizure?

A
  • Carbamazepine
  • Valproate
  • Levetiracetam
  • Lamotrigine
93
Q

What are the second-line drug options for tonic-clonic and absence seizures?

A
  • Clobazam
  • Levetiracetam
  • Topiramate
94
Q

What are the second-line drug options in myoclonic seizures?

A
  • Clobazam

- Piracitam

95
Q

What are the second line drug options in focal seizures?

A
  • Clobazam
  • Topiramate
  • Gabapentin
  • Tigabine
96
Q

What other treatment options are there for children with intractable epilepsies?

A
  • Ketogenic diet
  • Vagal nerve stimulation
  • Surgery
97
Q

How is vagal nerve stimulation delivered?

A

Using an externally programmable stimulation of a wire implanted around the afferent (left) vagal nerve

98
Q

What is the purpose of surgery in epilepsy?

A

Cessation of seizures and AED therapy

99
Q

When can surgery be performed in epilepsy?

A

When epilepsy has a well-localised structural cause or epileptogenic zone

100
Q

How can a well-localised structural cause or epileptogenic zone be demonstrated?

A

Good concordance between ictal EEG, MRI, and functional imaging findings

101
Q

What is the main surgical procedure used in epilepsy?

A

Temporal lobectomy

102
Q

What is temporal lobectomy used for in epilepsy?

A

Mesial temporal sclerosis

103
Q

What other surgical procedures may be used in epilepsy?

A
  • Hemispherotomy

- Focal restrictions

104
Q

What is a hemispherotomy?

A

Disconnection of the hemisphere

105
Q

What biopsychosocial considerations are there when managing epilepsy?

A
  • Some children with epilepsy and their families need psychological help to adjust to the condition
  • School needs to be aware of the child’s problem, and teachers advised on the management of seizures
  • Situations where having a seizure could lead to injury or death should be avoided, e.g. swimming
106
Q

What biopsychosocial considerations are there specifically regarding adolescents when managing epilepsy?

A

Issues to discuss around driving, contraception, and pregnancy. May also be issues with concordance and the precipitation of seizures by alcohol and poor sleep routines

107
Q

How do the educational and social outcomes of epilepsy compare to those of other chronic illnesses such as diabetes?

A

They are worse

108
Q

What are the potential complications of epilepsy?

A
  • Status epilepticus

- SUDEP

B - Paediatrics MANAGEMENT (106 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions