Fits Faints Funny turns.txt

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Fits Faints Funny turns.txt
2011-07-11 08:13:38

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  1. what Qs need to be asked in hx of funny turn?
    • consciousness: loss, awareness, altered
    • abnormal movements: limbs, face
    • altered tone
    • altered colour
    • eye movements
    • sphincter control
    • trigger factor - flashing light
    • birth, development
    • recent head injury
    • FH: epilepsy, febrile convulsions
  2. what is a seizure?
    transient episode of abnormal and excessive neuronal activity in the brain
  3. what is epilepsy?
    tendency to recurrent seizures
  4. what is the differential diagnosis of a seizure in an infant?
    • jitteriness
    • benign myoclonus
    • apnoeas
    • GORD
  5. what is the differential diagnosis of a seizure in a toddler?
    • breath holding attack
    • reflex anoxic seizure
    • rigors
  6. what is the differential diagnosis of a seizure in a child?
    • vaso vagal syncope
    • tics
    • night terror
    • day dreaming
    • migraine
    • panic attack, tantrum
    • BPPV
  7. what is a breath holding attack precipitated by?
    anger or frustration
  8. what is a breath holding attack - what happens?
    scream - hold breath in expiration - blue - pale - limp
  9. what is the recovery of a breath holding attack like?
    • rapid
    • spontaneous recovery
  10. what is a reflex anoxic seizure precipitated by?
    • pain
    • fright
  11. what happens in a reflex anoxic seizure?
    • stimulus - stop breathing - pale - LOC syncope due 2ry to vagal induced BRADYCARDIA
    • hypoxia can induce tonic clonic seizure
  12. what is recovery of reflex anoxic seizure like?
    rapid recovery
  13. what are the features of BPPV?
    • vertigo
    • nystagmus
    • ataxia - unsteady, falling
  14. what is BPPV due to?
    viral labyrinthitis
  15. what type of seizures are febrile seizures?
    generalised tonic clonic seizure
  16. what must be ruled out in all children with fever and seizure?
    • meningitis
    • encephalitis
  17. what are the features of generalised tonic clonic seizure?
    • tonic phase of rigidity
    • loss of posture
    • then clonic movements of all 4 limbs
    • LOC
  18. how long does generalised tonic clonic seizure last?
    2-20 minutes
  19. what is the recovery of generalised TC seizure like?
    post ictal drowsiness
  20. what age do absence seizures affect children?
  21. does absence affect girls or boys more?
  22. how do absence seizures affect development?
    • no effect
    • may interfere with schooling
  23. what are features of absence seizure?
    • brief unawareness lasting few seconds
    • no loss of posture
    • may stare momentarily, stop moving, eyelid twitch
  24. how long do absence seizures last for?
    30secs max
  25. how long does it take to recover from absence seizure?
  26. what is absence seizure associated with?
    • blinking
    • lip smaking
  27. are absence seizures partial or generalised? what were old name for them?
    • generalised
    • petit mal
  28. what is typical EEG of absence seizure?
    • generalised bilaterally synchronous
    • 3 per second spike and wave discharge
  29. what can absence seizures be induced by?
  30. what is the drug of first choice for absence seizures?
    • sodium valproate
    • (2nd = ethosuximide)
  31. what is the prognosis of absence seizures?
    • good
    • 95% remission in adolescence
  32. what age do absence seizures affect children?
    4-12 years old
  33. what age does juvenile myoclonic epilepsy affect children?
    adolescent - adult
  34. what is juvenile myoclonic epilepsy?
    myoclonic seizures
  35. what is typical history of JME?
    throwing drinks or cereal about in the morning as myoclonus occurs at this time
  36. what is prognosis of JME?
    • lifelong
    • but good response to Rx
  37. what are the 3 main focal epilepsy syndromes in children?
    • BCECTS: benign childhood epilepsy with centrotemporal spikes
    • benign occipital epilepsy
  38. what age does BCECTS aka rolandic epilepsy affect?
  39. what type of seizure do you get with BCECTS?
    • tonic clonic
    • or
    • simple partial
  40. what time of day does BCECTS occur?
  41. what does the person experience during BCECTS?
    • abnormal feeling in tongue - tingling
    • distortion of face (supplied by rolandic area of brain)
    • can have speech arrest
  42. what is more common BCECTS or absence?
    BCECTS - 15% of all childhood epilepsies
  43. what does EEG of BCECTS look like?
    focal sharp waves from rolandic or centrotemporal area
  44. how does BCECTS affect someone?
    • it is benign
    • but can affect daily life
  45. what is prognosis of BCECTS?
    • good
    • almost all remit in adolescence
  46. what is a partial seizure?
    involvement of only part of body
  47. what are partial seizures associated with?
  48. what is it called when partial seizure then spreads to involve whole body?
    secondary generalised epilepsy
  49. what is the difference between a simple and complex partial seizure?
    • simple no LOC
    • complex LOC
  50. what are the features of frontal seizures?
    • motor cortex
    • clonic movements
  51. what is a Jacksonian march?
    clonic movements travel proximally
  52. which is the most common type of epilepsy?
    temporal lobe epilepsy
  53. what are the features of TLE?
    • aura with smell and taste abnormalities
    • distortion of sound or shape
    • lip smacking, plucking at clothes, automatisms after spread to pre-motor cortex
  54. what does occipital seizures cause?
    distortion of vision
  55. what are feature of parietal lobe seizure?
    • contralateral dysaesthesia - altered sensation
    • or distorted body image
  56. which type of seizures require brain scans?
    children with partial seizures
  57. which part of the body should always be examined in children with recurrent seizures? why?
    • skin
    • wood's light examination - ashleaf patch hypopig (tuberous sclerosis)
    • neurocutaneous syndromes
  58. what are indications for neuroimaging in epilepsy?
    • partial seizures
    • intractable, difficult to control seizures
    • focal neurological deficit
    • neurocutaneous or neurodegenerative syndrome
    • child <2yo with non febrile convulsions
  59. what age do children get west syndrome?
    4-6 months (infantile)
  60. what is West syndrome? characterised by?
    • infantile spasms
    • salaam attacks - violent flexor spasm of head, trunk and limbs followed by extension of arms
  61. what are infantile spasms misdiagnosed as?
  62. what cause west syndrome?
    2/3 may have underlying neurological cause - tuberous sclerosis or perinatal HIE
  63. what does ECG of west syndrome look like?
    hypsarrhythmia - chaotic pattern of large amplitude slow waves with spikes and sharp waves
  64. are most causes of west syndrome idiopathic or symptomatic?
    • symptomatic
    • tuberous sclerosis
    • perinatal HIE
  65. what is Rx of west syndrome?
  66. what is Rx of west syndrome if assoc with tuberous sclerosis?
    viGABAtrin if associated with tuberous sclerosis (inhibits GABA)
  67. what SE is vigabatrin associated with?
    permanent visual field defects
  68. what is prognosis of west syndrome?
    • poor
    • most have LD and epilepsy later
  69. what age does lennox gastaut syndrome affect?
  70. what type of seizure occurs in LG?
    • multiple seizure types
    • astatic - drop attacks, atypical absence, tonic seizure
  71. what may a child with LG have in PMH?
    infantile spasms
  72. what are other features of LG?
    neurodevelopment arrest or regression
  73. what is prognosis of LG?
  74. what special precautions must be taken with children with epilepsy?
    • certain activities
    • swimming
    • bathing
    • climbing
    • cycling - helmet at all times, avoid traffic
  75. what is the recommended first line Rx for generalised epilepsy?
    sodium valproate
  76. what is the recommended first line Rx for partial epilepsy?
  77. what is the most common cause of seizures in childhood?
    febrile seizures
  78. what age do febrile seizures occur?
    6months to 6 years
  79. what is a febrile seizure?
    • seizure associated with fever
    • in absence of intracranial infection (meningitis encephalitis)
    • or an identifiable neurological disorder
  80. what % of children get febrile seizures?
  81. what kind of predisposition may there be to febrile seizures?
  82. when do febrile seizure occur?
    when body temperature rises rapidly
  83. how long does febrile seizure last and what type of seizure is it?
    • brief 1-2 minutes
    • generalised tonic clonic
  84. what are the clinical features of a febrile seizure?
    • child noted to suddenly go stiff
    • eyes stare ahead or roll up
    • then shaking movements of all 4 limbs
    • 1-2 mins
  85. what Qs do you need to ask the parents?
    • fever
    • duration
    • focal elements
    • happened before
    • FH
  86. what is the differential diagnosis?
    • rigors: v brief tremulous movements of limbs occurring with high fever - UTI
    • meningitis or encephalitis
  87. what may examination of the child reveal?
    • source of infection causing fever
    • otitis media
    • pneumonia
    • UTI
    • tonsillitis
  88. what are features O/E towards meningitis?
    identify features which may raise suspicion of meningitis - rash, level of consciousness, meningeal irritation eg neck stiffness, tense/bulging anterior fontanelle
  89. which Ix is needed in children <18/12 with febrile seizure?
    lumbar puncture to exclude meningitis
  90. if convulsion is prolonged what is Rx?
    terminate with rectal diazepam after ensuring blood glucose checked with BM stick to exclude hypoglycaemia
  91. what is management of febrile seizure?
    • identify infection: FBC, blood culture, urine microscopy, CXR, LP
    • keep patient cool with antipyretic and tepid sponging
    • terminate prolonged convulsion with rectal diazepam
    • antibiotics if bacterial infection has been identified
    • parental education
  92. what is the recurrence risk of febrile seizures?
  93. parents: will febrile seizure happen again?
    about a third get recurrent
  94. what makes recurrence more likely?
    • if first seizure occurs under age of 18 months
    • or if FH
  95. how can further febrile seizure be prevented?
    during febrile illnesses, child kept cool with antipyretics, removal of clothing, tepid sponging
  96. what should i do if another convulsion occurs?
    • child in recovery position
    • rectal diazepam if seizure is >5mins
  97. is febrile seizures epilepsy?
    febrile seizures are not classified as epilepsy
  98. what % of children with febrile seizure go on to develop epilepsy (afebrile recurrent seizures) in later childhood?
  99. what are the 5 risk factors for epilepsy in someone with febrile seizures?
    • focal seizures
    • prolonged > 15 mins
    • recurrent seizures in same illness
    • first degree relative with epilepsy
    • neurological abnormality