Neurology

Question 1

Definition of seizure

Answer 1

Sudden disturbance of neurological function caused by abnormal/ excessive neuronal discharge. Can be epileptic or non-epileptic

Question 2

Causes seizures

Answer 2

epileptic

non-epileptic

Question 3

Causes epileptic seizures

Answer 3

Idiopathic (70-80%)
Secondary (cerebral dysgenesis/ malformation, vascular occlusion, damage)
Cerebral tumour
NDD
Neurocutaneous syndromes

Question 4

Causes non-epileptic seizures

Answer 4

Febrile seizures
Metabolic: hypoglycaemia, hypomagnesia, hypocalcemia, hypo/hyperNa+
Head trauma
Meningitis/ encephalitis
Poisins/ toxins

Question 5

Definition febrile seizure

Answer 5

Seizure accompanied by fever in the absence of intracranial infection due to bacterial meningitis or viral encephalitis

Question 6

Epidemiology febrile seizure

Answer 6

Occur 3% children between 6 months and 5 years
30-40% will have further febrile seizures
Genetic predisposition

Question 7

Characteristics febrile seizures

Answer 7

Usually early in viral infection when temperature is rising rapidly
Usually brief and generalised tonic-clonic

Question 8

Factors increasing likelihood further febrile seizures

Answer 8

Younger the child
Shorter duration of illness prior to seizure
Lower temp at time of seizure
Positive family history

Question 9

Complications febrile seizures

Answer 9

Simple: Do NOT cause brain damage/ affect child’s subsequent intellectual performance
1-2% risk developing epilepsy (similar as for all children)
Complex: increased risk (4-12%) subsequent epilepsy

Question 10

Complex febrile seizures definition

Answer 10

Focal
Prolonged (>5 mins)
Repeated in same illness

Question 11

Ix febrile seizures

Answer 11

Focus on cause (usually viral illness but must exclude bacterial meningitis)
Infection screen (esp if

Question 12

Mx febrile seizures (not immediate)

Answer 12

Antipyretics don’t prevent febrile seizures
Teach family first aid mx of seizures
If hx prolonged seizures, supply rescue therapy (rectal diazepam/ oral midazolam)
Oral prophylactic anti-epileptics not given (don’t reduce recurrence rate seizures/ risk epilepsy)
EEG NOT indicated

Question 13

Breath-holding attacks

Answer 13

Occur in some toddlers when upset
Child cries, holds breath and turns blue
Some briefly lose consciousness but rapidly recover
Resolve spontaenously (drugs unhelpful) but behaviour modification therapy can be helpful

Question 14

Definition epilepsy

Answer 14

Chronic neurological disorder characterised by recurrent unprovoked seizures consisting of transient signs and/ or symptoms associated with abnormal/ excessive or synchronous activity in the brain

Question 15

Classification epileptic seizures

Answer 15

General: discharge from both hemispheres. Can be:
absence
myoclonic
tonic
tonic-clonic
atonic
Focal: seizures from one or part of one hemisphere
Frontal
Temporal
Occipital 
Parietal
In many children, esp

Question 16

Features frontal lobe seizures

Answer 16

Clonic movements, which may travel proximally (Jacksonian march)
Asymmetrical tonic seizures
Atonic seizures

Question 17

Features temporal lobe seizures

Answer 17

Most common of all epilepsies
Strange aura with smell/ taste abnormalities and distortion of sound/ shape
Automatisms: lip-smacking, plucking at clothing, walking in non-purposeful manner
Deja vu, jamais vu

Question 18

Features occipital lobe seizures

Answer 18

Distortion of vision

Question 19

Features parietal lobe seizures

Answer 19

Contralat dysaesthaesias

Distorted body image

Question 20

West syndrome age of onset

Answer 20

4-6 months

Question 21

West syndrome seizure pattern

Answer 21

Violent flexor spasms of head, trunk and arms followed by extension of arms (‘salaam spasms’)
Flexor spasms last 1-2s, often multiple bursts 20-30 spasms, often on waking
Social interaction often deteriorates

Question 22

Causes west syndrome

Answer 22

2/3 underlying neurological cause

Question 23

West syndrome EEG

Answer 23

Hypsarrythmia: chaotic pattern of high-voltage slow waves and multi-focal sharp wave discharges

Question 24

Tx West syndrome

Answer 24

vigabatrin (anti-epileptic, increases GABA) or corticosteroids
Good response in 30-40% but unwanted effects common

Question 25

Prognosis West syndrome

Answer 25

Most subsequently lose skills/ develop learning disability or epilepsy

Question 26

Lennox-Gastaut syndrome age of onset

Answer 26

1-3 years | Often 2y to other neuro disorders, e.g. enceph, meningitis, brain malformations

Question 27

Lennox-Gastaut syndrome seizure pattern

Answer 27

Multiple types | Mainly drop attacks (astatic seizures)/ tonic seizures/ atypical absences

Question 28

Other sx Lennox-Gastaut syndrome

Answer 28

Neurodevelopmental arrest/ regression | Behaviour disorder

Question 29

Lennox-Gastaut syndrome EEG

Answer 29

Characteristic EEG | Interictal: generalised 1.5-2.5Hz slow spike-and-wave discharges

Question 30

Lennox-Gastaut syndrome prognosis

Answer 30

Poor, seizures often resistant to treatment | Minority able to work normally

Question 31

Lennox-Gastaut syndrome mx

Answer 31

Anti-epileptics mainstay of tx but optimum regimen uncertain | Corpus callosectomy can help w drop attacks

Question 32

Childhood absence epilepsy age of onset

Answer 32

4-12 years

Question 33

Childhood absence epilepsy seizure pattern

Answer 33

Stare momentarily and stop moving Lasts few seconds to absolute max 30s Child has no recall Episodes can be induced by hyperventilation

Question 34

Childhood absence epilepsy development

Answer 34

Normal development but seizures can interfere w schooling

Question 35

Childhood absence epilepsy epidemiology

Question 36

Childhood absence epilepsy EEG

Answer 36

Generalised 3/second spike and wave discharge | Bilaterally synchronous during and sometimes between episodes

Question 37

Childhood absence epilepsy prognosis

Answer 37

Good: 95% remission in adolescence | 5-10% may develop tonic-clonic seizures in adult life

Question 38

Benign epilepsy with centrotemporal spikes (BECTS) age of onset

Answer 38

4-10 years

Question 39

BECTS seizure pattern

Answer 39

Tonic-clonic seizures in sleep | Simple focal seizures w awareness of abnormal feelings in tongue and distortion of face

Question 40

BECTS epidemiology

Answer 40

15% of all childhood epilepsies

Question 41

BECTS EEG

Answer 41

Focal sharp waves from Rolandic or centrotemporal area

Question 42

BECTS other name

Answer 42

Benign Rolandic Epilepsy

Question 43

BECTS mx

Answer 43

Benign, doesn't always require tx | Almost all remit in adolscence

Question 44

Early-onset benign childhood occipital epilepsy (Panayiotopoulos type) age of onset

Answer 44

1-14 yrs

Question 45

Early-onset benign childhood occipital epilepsy seizure pattern

Answer 45

Younger kids: periods unresponsiveness, eye deviation, vomiting, autonomic features Older kids: headache + visual disturbance, distortions of images, hallucinations

Question 46

Early-onset benign childhood occipital epilepsy EEG

Answer 46

Occipital discharges

Question 47

Early-onset benign childhood occipital epilepsy prognosis

Answer 47

Remit in childhood

Question 48

Juvenile myoclonic epilepsy age of onset

Answer 48

Adolescence to adulthood

Question 49

Juvenile myoclonic epilepsy seizure pattern

Answer 49

Myoclonic seizures, can also get tonic-clonic and absences | Typical hx = throwing drinks/ cereal in am as myoclonus occurs at this time

Question 50

Juvenile myoclonic epilepsy EEG

Answer 50

Characteristic

Question 51

Juvenile myoclonic epilepsy mx and prognosis

Answer 51

Response to tx usually good but tx is lifelong | Remission unlikely

Question 52

Epilepsies with characteristic EEG

Answer 52

``` Juvenile myclonic epilepsy BECTS Childhood absence epilepsy Lennox-Gaustaut syndrome West syndrome ```

Question 53

Imaging afebrile seizures

Answer 53

MRI/ CT not routinely needed for childhood generalised epilepsies Ix if neuro signs between seizures or if seizures focal

Question 54

Which MRI sequences better detect mesial temporal sclerosis in temporal lobe epilepsy?

Answer 54

MRI FLAIR

Question 55

Principles mx epilepsy

Answer 55

Tx not routinely instituted after single unprovoked seizure Monotherapy at minimum dosage = required goal Children w prolonged seizures given rescue therapy to keep with them, e.g. buccal midazolam, rectal diazepam AEDs can be discontinued after 2yrs free of seizures

Question 56

AED mx epilepsy

Answer 56

``` Generalised: Tonic clonic = Valporate, carbamazepine Absence= Valproate, ethoxisumide Myoclonic = Valproate (carbamazepine can worsen absence/ myoclonic seizures) Focal: Carbamazepine, valproate ```

Question 57

Classification headaches

Answer 57

1y: (migraine, tension-type headache, cluster, other primaries) 2y: symptomatic of other underlying pathology, e.g. raised ICP, SOL Trigeminal and other cranial neuralgias, other headaches includiing root pain from herpes zoster