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Pediatrics > Epilepsy > Flashcards

Flashcards in Epilepsy Deck (26):
1

Prevalence in children

4 in 1000

2

Defintion

chronic brain disorder characterized by recurrent (≥ 2), unprovoked seizures
A single seizure is not considered an epileptic seizure. Epilepsy is often idiopathic, but various brain disorders, such as malformations, strokes, and tumors, can cause symptomatic epilepsy.

3

Types of generalised seizures

absence (typical or atypical), myoclonic, clonic, tonic, tonic-clonic, and atonic (astatic) types

4

Types of partial seizures

Motor
Sensory
Autonomic
Psychiatric

5

What is a seizure

transient neurological dysfunction caused by excessive activity of cortical neurons,
resulting in paroxysmal alteration of behaviour and/or EEG changes

6

Describe an absent seizure

usually only seen in children, unresponsive for 5-10 s with arrest of activity, staring, blinking or eye-rolling, no post-ictal confusion; 3 Hz spike and slow wave
activity on EEG

7

Most common cause of late onset >50 yo seizures

dementia

8

Describe the presentations of simple->motor, sensory, psychiatric

simple (preserved LOC)
ŠŠmotor: postural, phonotory, forceful turning of eyes and/or head, focal muscle rigidity/jerking ± Jacksonian march (spreading to adjacent muscle groups)
ŠŠsensory: unusual sensations affecting vision, hearing, smell, taste or touch
ŠŠautonomic: epigastric discomfort, pallor, sweating, flushing, piloerection, pupillary dilatation
ŠŠpsychiatric: symptoms rarely occur without impairment of consciousness and are more
commonly complex partial

9

Presentation of complex seizures

ƒƒcomplex (altered LOC)
ŠŠpatient may appear to be awake but with impairment of awareness
ŠŠclassic complex seizure is characterized by automatisms such as chewing, swallowing, lipsmacking,
scratching, fumbling, running, disrobing and other stereotypic movements
ŠŠother forms: dysphasic, dysmnesic (déjà vu), cognitive (disorientation of time sense),
affective (fear, anger), illusions, structured hallucinations (music, scenes, taste, smells),
epigastric fullness

10

Compare motor activity in seizure vs pseudoseizure

Seizure:
Synchronous, stereotypic, automatisms, lateral
tongue biting, eyes rolled back

Pseudoseizure/conversion:
Opisthotonos, rigidity, forced eye closure, irregular extremity movements, shaking
head, pelvic thrust, crying, geotropic eye movements, tongue biting at the tip

11

Clinical features

Key diagnostic factors
presence of risk factors (common)
staring spells or inattention (common)
tonic-clonic convulsions (common)
brief, arrhythmic muscular jerking movements (common)
unexplained falls (common)
eyes rolling back in head (common)
apnoea (common)
intercurrent illness (common)

Other diagnostic factors
incontinence (common)
tongue biting (common)
post-ictal phenomena (common)
precipitated by fatigue or lack of sleep (common)
precipitated by light or noise (common)
developmental delay (common)
neurocutaneous stigmata (uncommon)

12

Risk factors for generalised seizures

Strong
genetic predisposition or FHx
perinatal asphyxia
metabolic/neurodegenerative disorders
head trauma
structural abnormalities of the CNS

Weak
autistic spectrum disorder
CNS infection
neurocutaneous syndromes
Hx of febrile seizures

13

How is diagnosis of epilepsy made

Clinical
Use of EEG has limited value is diagnostic process

14

Four key questions to ask with possible epilepsy

1. Is the seizure epilepsy
2. What type of seizure
3. What type of epilepsy
4. What is the cause of the epilepsy

15

Prognosis

Generally good
>70% will have resolution resolution when idiopathic

16

Important components in the follow-up

1. Frequency of fits
2. Side effects
3. Psychosocial, schooling etc
4. Anticonvulsant levels if uncontrolled

17

When a neurological problem is suspected but cannot be found, name given to this type of epilepsy

Cryptogenic

18

Why is EEG not ideal to diagnose epilepsy

50% epileptics will have normal EEG and 5% of normal children will have abnormal findingd

19

When might an EEG be appropriate for diagnostic purposes

Absence seizure
Infantile seizures

20

Most common anticonvulsants started for children with generalised, for infantile, absence

Sodium valproate or carbamazepine

Steroid or vigabatrin in infantile

Ethosuxamide is alternative to valproate in absence seizures.

21

When to check anticonvulsant levels

When control is inadequate

22

Management overview

Treatment
• avoid precipitating factors
• indications for medical therapy (anticonvulsants): 2 or more unprovoked seizures, known
organic brain disease, EEG with epileptiform activity, first episode of status epilepticus,
abnormal neurologic examination or findings on neuroimaging
• psychosocial issues: stigma of seizures, education of patient and family, status of driver’s license,
pregnancy issues
• safety issues: driving, operating heavy machinery, bathing, swimming alone
• consider surgical treatment if focal and refractory

23

Number of children having a seizure in their lifetime

5% will have at least one seizure, this is not considered epilepsy

24

Causes of epilepsy

Most commonly unknown
May have genetic component
May follow head injury, stroke or infection
May be due to malformation, benign or cancerous, scar/cyst present at birth

25

Parental advice for precautions to take at home

xSwimming, bathing alone
Showers
Turn on cold first
Caution hot things
Avoid heights
Appropriate education provided to other potential carers so know what to do
Need first aid kit at home
Ensure the bedroom door remains unlocked

26

Counselling use of valproate

Mode of action
Multiple mechanisms. Prevents repetitive neuronal discharge by blocking voltage‑ and use-dependent sodium channels. Other actions include enhancement of GABA, inhibition of glutamate and blockade of T-type calcium channels.

Cautions: hepatic, pregnant/breastfeeding, pancreatic dysfunction, women (ensure on contraception)

Common (>1%)
nausea, vomiting, increased appetite, weight gain, tremor (dose-related), thinning or loss of scalp hair (usually temporary), paraesthesia, drowsiness, dizziness, memory impairment, ataxia, elevated aminotransferase concentrations (dose-related), asymptomatic hyperammonaemia, thrombocytopenia (dose-related), menstrual irregularities, polycystic ovaries, hyperandrogenism in females

Take with food
May make drowsy- avoid machiner
+Appetite: may need to watch food
Tell doctor if develop rash, easy bruising/bleeding, jaundice, abdominal pain vomiting.
Do not stop suddenly

FBE prior to commencing
LFTs monitoring not indicated
BMD if long term use

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