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C3 CLINICAL > Paediatric Epilepsy > Flashcards

Paediatric Epilepsy Flashcards

1
Q

What is epilepsy?

A

A symptom - a chronic neurological condition characterised by recurrent epileptic seizures

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2
Q

Why is epilepsy a common condition?

A

Prevalence of 0.5%
It is not a single condition - it is symptom of many different diseases
Can be difficult to diagnose
No single treatment

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3
Q

Why is epilepsy misdiagnosis rate high?

A
  1. There is no diagnostic test

2. The diagnosis is made predominantly on clinical history description of events

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4
Q

What is the percentage that the epilepsy is resistant to medication?

A

25%

More likely if lesional

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5
Q

What is an option if there is localised onset to seizures in epilepsy?

A

Surgical treatment

Define where the seizure onset is

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6
Q

What does imaging of childhood epilepsy consist of?

A
  1. Pathological substrate
  2. Source of epileptic seizures
  3. Localisation of function
  4. Secondary effects of epilepsy
  5. Underlying pathophysiology
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7
Q

What is pathological substrate concerned with?

A

The cause of epilepsy

Magnetic resonance imaging

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8
Q

What are examples of source of epileptic seizures?

A
  1. SPECT
  2. PET
  3. MRI
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9
Q

What is MRI concerned with?

A

Localisation of function

Underlying pathophysiology

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10
Q

What is PET and MRI concerned with?

A

Secondary effects of epilepsy

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11
Q

What is key in magnetic resonance imaging in childhood epilepsy?

A
  1. Malformation cortical development

2. Cortical grey matter

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12
Q

What is band heterotopia?

A

Also known as double cortex syndrome is a form of diffuse grey matter heterotopia affecting almost only women

More lateralised abnormalities

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13
Q

What is Hemimegalencephaly (HME)?

A

A rare neurological condition in which one half of the brain, or one side of the brain is abnormally larger than the other

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14
Q

What are examples of HME?

A
  1. Dysplasia
  2. Polymicrogyria
  3. Multifocal dysplasia
  4. Benign tumours
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15
Q

What is lissencephaly?

A

Smooth brain
Is a set of rare brain disorders where the whole or parts of the surface of the brain appear smooth - it is caused by defective neuronal migration during the 12th to 24fh weeks of gestation resulting in a lack of development of brain folds (gyri) and grooves (sulci)

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16
Q

What are the optional sequences ?

A
  1. Susceptibility weighted images
  2. Diffusion tensor imaging
  3. Arterial spin labelling (perfusion)
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17
Q

Why do we have to optimise the grey-white differentiation?

A

Look specifically at the grey matter

18
Q

What is also needed to be optimised?

A

Angle of sequences is important

  • straight horizontal/vertical - poor views of temporal lives
  • we want to angle our sequences parallel or perpendicular to the axes of temporal lobes

Get food view and avoid partial volume effects particularly with the mesen-temporal structures

19
Q

What shows abnormalities particularly in grey matter?

A

FLAIR

20
Q

What is the timing of scan and maturation?

A

Very early in 2 years of life - slightly different sequences are required because myelination is incomplete

Lesions May appear or disappear with myelination and therefore repeating imaging are therefore necessary

It is not a waste of time to do imaging in the first 2 years of life because you may see an abnormality that may subsequently become less apparent as they become older

Compare images - early and late life in early onset epilepsy

21
Q

What are the MRI findings?

A
  1. 26 (51%) aetiologically relevant abnormalities

2. 11 (21%) non specific structural abnormalities

22
Q

What are examples of 11 developmental malformations?

A
  1. 2 Tuberous sclerosis
  2. 2 Lobar/ multilobar focal cortical dysplasia
  3. 3 bilateral polymicrogyria ( 1 with cerebellar hypoplasia)
  4. 1 Hemimegalencephaly (+ bilateral polymicrogyria )
  5. 1 Microcephaly, absent corpus callosum
  6. 1 LisdencephAly
  7. 1 Occipital AVM
23
Q

What are the 15 acquired lesions?

A

14- secondary to infection, HIE, metabolic conditions, seizures
1 a probably MTS

24
Q

What are non-specific structural abnormalities?

A

Lack of white matter bulk, thin corpus callosum, delayed myelination, arachnoid cyst

25
Q

When should imaging be performed?

A

Neuroimaging: should perform “soon” after request

  • MRI investigation of choice in people with epilepsy
  • Particularly important for children
  • who have developed epilepsy < 2 years
  • Have any suggestion of focal onset
  • Seizures continue despite first line medication c
26
Q

What is the most common abnormalities that are determined?

A

Cortical dysplasia

27
Q

What is the epilepsy surgery?

A

The removal or modification of part of the brain with the aim of alleviating seizures

28
Q

What are the aims of surgery?

A
  1. Primary outcome aims
    - seizure freedom/reduction
  2. Secondary outcome aims:
    - neurodevelopmental gains
    - behavioural improvement
29
Q

What is the spectrum of paediatric epilepsy surgery?

A
  1. If we are looking at candidates that come for epilepsy surgery
  2. In children the most common cause is cortical dysplasia
  3. Hemispherectomy and multilobar take a good 30% cases we operate on
  4. The earlier the onset of epilepsy, the wider area of dysplasia
30
Q

What has been the most common operation performed on adult?

A

Hippocampal sclerosis
There are now less procedures for hippocampal sclerosis
Tumours and cortical dysplasia are increasing

31
Q

What are examples of resective surgery: aims of evaluation

A
  1. Localisation of responsible tissue
  2. Localisation of function
  3. Evaluation of outcome aims
32
Q

What are examples of localisation of responsible tissue?

A
  1. Clinical evaluation
  2. Interictal EEG
  3. Video EEG ictal recording
  4. Optimised structural MRI
  5. Functional imaging
33
Q

What are examples of localisation of function?

A
  1. Clinical evaluation
  2. Neuropsychology
  3. Functional MRI
34
Q

What is example of evaluation of outcome aims?

A

Neuropsychiatric evaluation

35
Q

What are features of focal cortical dysplasia in infant?

A
  1. Grey/white matter blurring
  2. Abnormal signal in T2 if the subcortical white matter
  3. Abnormal gyration/salvation
  4. Trans mantle sign
36
Q

What is FCD2a?

A
  1. Not always seen on MRI
  2. Blurring of grey/white matter junction
  3. More challenging than IIB
37
Q

What is 1.5T Avanto, 12-channel head coil?

A
  1. It takes 15-25 minutes (1.5-1mm isotropic resolution)
  2. 3 images above and a B0 and B1 map
  3. Data is combined from 3 scans
38
Q

What is automated detection of FCD?

A
  1. Artificial neural network classifier time localise Cortical lesions in a cohort of children from GOSH (sensitivity 73%)
  2. All code and data matrices for classifier training and validation freely available
39
Q

What is SPECT?

A
  1. Use of a ligand to determine study of cerebral perfusion
  2. Interictal hypoperfusion at seizure focus in 40-70% cases
  3. Ictal hyperperfusion in 72-99% cases
40
Q

What is FDG PET in childhood epilepsy?

A

Areas of hypometabolism correlate with structural malformations not readily apparent on MRI

41
Q

What is EEG activated MRI?

A
  1. Visualises brain functions non-invasively
  2. Functional maps based on the signal intensity differences between physiological states (e.g. ‘activation’ and ‘rest’)
  3. Blood Oxygenation Level Dependent (BOLD) contrast

C3 CLINICAL (27 decks)

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