Neurology

Question 1

What defines a seizure as epileptic?

Answer 1

It is due to excessice and hypersynchronous electrical activity in all or part of the cerebral cortex

Question 2

What are the features of a tonic clonic seizure?

Answer 2

There is a tonic muscle tensing phase followed by a clonic jerking phase
They is often tongue biting, incontinence, groaning and irregular breathing
There is a prolonged post ictal period where the person is confused, drowsy and feels low

Question 3

What is the management of generalised seizures?

Answer 3

First line is sodium valproate

Second line is lamotrigine or carbamazepine

Question 4

Which part of the brain do focal seizures affect and how do they present?

Answer 4

They start in the temporal lobe
They affect hearing, memory, speech and emotions
These can cause:
-Hallucinations
-Deja vu
-Memory flashbacks

Question 5

What is the treatment of focal seizures?

Answer 5

This is the opposite waya round to generalised
First line Lamotrigine or Carbamazepine
Second line is sodium valproate or levetiracetam

Question 6

What is the presentation of absence seizures?

Answer 6

Usually present in children and last 10-20 seconds

Will typically grow out of them

Question 7

What is the management of absence seizures?

Answer 7

Sodium valproate

Question 8

How do atonic seizures present?

Answer 8

These are brief lapses in muscle tone that usually don’t last more than 3 mins
Typically begin in childhood
May be indiciative of Lennox-Gastaut syndrome

Question 9

What is the management of atonic seizures?

Answer 9

First line Sodium Valproate

Second line is Lamotrigine

Question 10

What is Lennox-Gastaut syndrome?

Answer 10

It is usually in 1-3 year olds and causes mostly atonic seizures and tonic seizures in sleep
Is associated with neurodevelopmental arrest

Question 11

What are the presenting features of juvenile myoclonic epilepsy?

Answer 11

Usually 10-20 years

Have sudden brief muscle contractions, usually occur shortly after waking

Question 12

What is the treatment of myoclonic epilepsy?

Answer 12

First line sodium valproate

Second line lamotrigine or levetiracetam

Question 13

What is the definition of a typical febrile seizure?

Answer 13

It is tonic clonic in nature
Lasts less than 15 mins
Occurs during febrile illness

Question 14

What is the management that should be advised to parents for febrile conculsions?

Answer 14

Try to keep child away from dangerous objects
Put in recovery position
Do not put anything in their mouth
Stay with child
Call abulance if lasts over 5 mins

Question 15

What is the risk of developing epilesy after febrile convulsion?

Answer 15

1.8% for general population

2-7.5% if have had febrile convulsion

Question 16

What are cyanotic breath holding spells?

Answer 16

When the child gets upset they can hold their breath and cause syncope, no assocaition with epilepsy

Question 17

What is a reflex anoxic seizure?

Answer 17

This is when a child is startled vagal nerve activity causes heart to stop and go pale and lose consiousness, within 30 seconds heart starts and regain consiousness

Question 18

How are tension headaches treated in children?

Answer 18

They are treated with reassurance, regular meals, hydration, analgesia and reducing stress

Question 19

What are the treatments for acute migraine and preventative treatments?

Answer 19

Acutely:
-Rest, fluids, Dark room
-Nsaids
-Sumitriptan
-Antiemetics
Prophylactic:
-propanolol
-Pizotifen
-Topiramate

Question 20

What are the causes of cerebral palsy?

Answer 20

Post natal;
-Infections
-Trauma
Perinatal:
-asphyxia
-Pre-term birth
Postnatal:
-Meningitis
-Head injury

Question 21

What are the types of cerebral palsy?

Answer 21

Spastic - hypertonia due to UMN damage
Dyskinetic - problems with muscle tone causing writhing movements due to damage to the basal ganglia
Ataxic - problems with coordiated movement due to damage to cerebellum
Mixed

Question 22

What is the management of cerebral palsy?

Answer 22

MDT appraoch
Physio to optimise muscle function
OT to make adaptations to house
Speech and language therapy to improve speech and swallow, can have NG or peg
Dieticians
Surgery to lengethen tendons
Paeds:
-muscle relaxants
-Antiepilaptics to reduce seizures