Seizures & epilepsy Flashcards Preview

MD 3: Paeds > Seizures & epilepsy > Flashcards

Flashcards in Seizures & epilepsy Deck (23):
1

Seizure reoccurence after afrebrile seizure?

1/3 over the next 2 years and 50% of these occur in next 6 months

2

How common are febrile seizures?

3% of children

3

In what ages do febrile seizures occur?

6mo-6yo
Reconsider Dx if outside these ages

4

Presentation of febrile convulsions?

GTCS, lasting 15 minutes
Occur once in a febrile illness
Onset is sudden

Complex: >15min, occur in same illness
- R/F = previous afebrile seizures, CNS infection, underlying neurological condition

5

Ix and Tx of febrile convulsions?

No standard, treat specific infection
- EEG is not indicated
Educate parents: benign, no risk of intellectual impairment/brain damage
1/3 chance of recurrence, especially if young
No effect of panadol on risk

6

Risk of epilepsy in febrile convulsions

Slightly increased: 3% with no other risk factors

If have other R/F: risk can increase up to 10%

7

Risk of epilepsy in febrile convulsions

Slightly increased: 3% with no other risk factors

If have other R/F: risk can increase up to 10%

8

Breath-holding spells epidemiology and natural Hx

Very common in toddlers: start at 1-2yo, resolve by 3-4yo
Benign, no risk of death/ID etc. (reassure parents)
May be linked to iron def anaemia

9

Presentation of breath-holding spells

Precipitated by emotional or physical trauma
Hold breath, become bradycardic, cyanotic/pale
May have hypoxic jerks/convulsive movements
May become floppy and LOC which will terminate event
Recovery is rapid, but may be drowsy

10

EEG for breath-holding spells

Not necessary

11

First presentation of the seizure - what are important points to ask on history?

Eye witness account of actual seizure
Previous seizure events?
Before - warning/prodrome/aura, precipitant? (fatigue, alcohol, fever, lights, reading/writing)
Context - febrile/illness, dehydration, environment, activity at time, time of the day/sleeping
After - Consequences/injuries from seizure, drowsiness/confusion
PMHx, FHX and social as per normal

12

First presentation of the seizure - what are important examination?

Conscious state, vitals
ABCD if relevant
Neurological exam - focal signs, meningism, raised ICP
Development - i.e. dysmorphic features
Bedside BGLs

13

First presentation of the seizure - what possible DDx?

Syncope - vasovagal/cardiac
Epilepsy
Normal - day-dreaming, sleep jerking
Breath holding
Movement disorders
Sleep related disorder
Behavioural/psychiatric
Migraine variants

14

First presentation of the seizure - what Ix would you perform?

Bloods - glucose, electrolytes
EEG - if afebrile
? MRI if suspected mass effect as cause

15

What is the definition of epilepsy?

>= 2 unprovoked seizures

16

What are the causes of seizures?

Structural - mass/raised ICP, sclerosis
Metabolic - electrolytes, glucose, metabolic disorders
Infective - CNS, high fever
Vascular - CVA
Idiopathic
Birth injury/hypoxia
Head trauma

17

What are precipitating factors for epileptic seizures?

Fatigue, sleep deprivation
Stress
Flashing lights
Reading/writing
Alcohol
Drugs
Withdrawal
Hypoglycaemia
Fever
Electrolytes
Hypoxia

18

What are the differences between genetic (idiopathic/primary) and structural/metabolic (secondary/symptomatic) seizures?

Primary
- Age dependent (different for different syndromes)
- associated with specific epileptiform EEGs but otherwise generally well and no neurological features.
-FHX
-Good prognosis and control of seizures

Secondary
- Variable but usually young age presentation
-Variable findings on EEG but generally abnormal neurological exam or developmental delay
-Generally poor prognosis and control of seizures
-Typically history of prior cerebral insult - i.e. hypoxia in birth, CNS infection with scarring

19

What are the general clinical features of tonic-clonic and absence seizures?

Tonic-clonic
-Tonic-stiffening, eyes open, moan/cry
-Clonic-rapid jerking movements
-Usually last 1-5mins
-Cyanosis or plethora
-Post-ictal confusion, drowsiness or agitation

Absence
-Brief pauses <10s
-Sudden with no warning
-Generally look blank
-May have associated automatisms
-Remain upright

20

What Ix are useful in afebrile seizures and why?

EEG
-All afebrile seizures have one
-Epileptiform patterns can help diagnosis specific types of epilepsy
-Helps characterise seizure, direct medication choice and need for futher brain imaging
-Video EEG may be helpful as inter-ictal usually normal
-Can't exclude epilepsy purely on normal EEG

Brain imaging
-If suspect structural cause
-MRI better than CT

21

What are the first aid instructions for managing seizures?

-Time seizure from onset
-Do not hold/restrict child but remove obstacles and support head with something soft
-Do not put anything in their mouth
-Once seizure finished put in recovery position and call ambulance
-If seizure lasting >3-4 minutes provide rectal or buccal benzo (diazepam or midazolam)

22

What advice do you give parents when providing diagnosis of epilepsy?

-Explanation of diagnosis and condition
-Reassure that medications to control it and if idiopathic generally good prognosis and ~25% grow out of it
-Discuss triggers to seizures and avoidance
-Discuss management plan - first aid advice, instructions on providing cessation medication if seizure prolonged
-Discuss safety re heights, water (swimming, baths, showers), driving, high-risk hobbies
-Medications - monotherapy usually, slowly titrate up, S/E (ataxia, drowsiness, tremor, N+V, mood disturbance, rash) and may need some monitoring of levels

23

What is status epilepticus and the Rx?

-Prolonged seizure >10 mins
-Can cause hypoventilation - hypoxaemia and hypercarbia - cardiac arrest, brain damage, MSK injury
-Prepare treatment and provide if lasting >~4m
-Rectal, buccal or IV diazepam or midazolam
-Prepare for ventilation support - O2, CPAP, ventilation
-Investigations - BGLs, U&Es, CMP, septic screen, blood gas