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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
what is a seizure?
transient episode of abnormal and excessive neuronal activity in the brain
what is epilepsy?
tendency to recurrent seizures
what is the differential diagnosis of a seizure in an infant?
- benign myoclonus
what is the differential diagnosis of a seizure in a toddler?
- breath holding attack
- reflex anoxic seizure
what is the differential diagnosis of a seizure in a child?
- vaso vagal syncope
- night terror
- day dreaming
- panic attack, tantrum
what is a breath holding attack precipitated by?
anger or frustration
what is a breath holding attack - what happens?
scream - hold breath in expiration - blue - pale - limp
what is the recovery of a breath holding attack like?
- spontaneous recovery
what is a reflex anoxic seizure precipitated by?
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
what is recovery of reflex anoxic seizure like?
what are the features of BPPV?
- ataxia - unsteady, falling
what is BPPV due to?
what type of seizures are febrile seizures?
generalised tonic clonic seizure
what must be ruled out in all children with fever and seizure?
what are the features of generalised tonic clonic seizure?
- tonic phase of rigidity
- loss of posture
- then clonic movements of all 4 limbs
how long does generalised tonic clonic seizure last?
what is the recovery of generalised TC seizure like?
post ictal drowsiness
what age do absence seizures affect children?
does absence affect girls or boys more?
how do absence seizures affect development?
- no effect
- may interfere with schooling
what are features of absence seizure?
- brief unawareness lasting few seconds
- no loss of posture
- may stare momentarily, stop moving, eyelid twitch
how long do absence seizures last for?
how long does it take to recover from absence seizure?
what is absence seizure associated with?
- lip smaking
are absence seizures partial or generalised? what were old name for them?
what is typical EEG of absence seizure?
- generalised bilaterally synchronous
- 3 per second spike and wave discharge
what can absence seizures be induced by?
what is the drug of first choice for absence seizures?
- sodium valproate
- (2nd = ethosuximide)
what is the prognosis of absence seizures?
- 95% remission in adolescence
what age do absence seizures affect children?
4-12 years old
what age does juvenile myoclonic epilepsy affect children?
adolescent - adult
what is juvenile myoclonic epilepsy?
what is typical history of JME?
throwing drinks or cereal about in the morning as myoclonus occurs at this time
what is prognosis of JME?
- but good response to Rx
what are the 3 main focal epilepsy syndromes in children?
- BCECTS: benign childhood epilepsy with centrotemporal spikes
- benign occipital epilepsy
what age does BCECTS aka rolandic epilepsy affect?
what type of seizure do you get with BCECTS?
- tonic clonic
- simple partial
what time of day does BCECTS occur?
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
what is more common BCECTS or absence?
BCECTS - 15% of all childhood epilepsies
what does EEG of BCECTS look like?
focal sharp waves from rolandic or centrotemporal area
how does BCECTS affect someone?
- it is benign
- but can affect daily life
what is prognosis of BCECTS?
- almost all remit in adolescence
what is a partial seizure?
involvement of only part of body
what are partial seizures associated with?
what is it called when partial seizure then spreads to involve whole body?
secondary generalised epilepsy
what is the difference between a simple and complex partial seizure?
what are the features of frontal seizures?
- motor cortex
- clonic movements
what is a Jacksonian march?
clonic movements travel proximally
which is the most common type of epilepsy?
temporal lobe epilepsy
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
what does occipital seizures cause?
distortion of vision
what are feature of parietal lobe seizure?
- contralateral dysaesthesia - altered sensation
- or distorted body image
which type of seizures require brain scans?
children with partial seizures
which part of the body should always be examined in children with recurrent seizures? why?
- wood's light examination - ashleaf patch hypopig (tuberous sclerosis)
- neurocutaneous syndromes
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
what age do children get west syndrome?
4-6 months (infantile)
what is West syndrome? characterised by?
- infantile spasms
- salaam attacks - violent flexor spasm of head, trunk and limbs followed by extension of arms
what are infantile spasms misdiagnosed as?
what cause west syndrome?
2/3 may have underlying neurological cause - tuberous sclerosis or perinatal HIE
what does ECG of west syndrome look like?
hypsarrhythmia - chaotic pattern of large amplitude slow waves with spikes and sharp waves
are most causes of west syndrome idiopathic or symptomatic?
- tuberous sclerosis
- perinatal HIE
what is Rx of west syndrome?
what is Rx of west syndrome if assoc with tuberous sclerosis?
viGABAtrin if associated with tuberous sclerosis (inhibits GABA)
what SE is vigabatrin associated with?
permanent visual field defects
what is prognosis of west syndrome?
- most have LD and epilepsy later
what age does lennox gastaut syndrome affect?
what type of seizure occurs in LG?
- multiple seizure types
- astatic - drop attacks, atypical absence, tonic seizure
what may a child with LG have in PMH?
what are other features of LG?
neurodevelopment arrest or regression
what is prognosis of LG?
what special precautions must be taken with children with epilepsy?
- certain activities
- cycling - helmet at all times, avoid traffic
what is the recommended first line Rx for generalised epilepsy?
what is the recommended first line Rx for partial epilepsy?
what is the most common cause of seizures in childhood?
what age do febrile seizures occur?
6months to 6 years
what is a febrile seizure?
- seizure associated with fever
- in absence of intracranial infection (meningitis encephalitis)
- or an identifiable neurological disorder
what % of children get febrile seizures?
what kind of predisposition may there be to febrile seizures?
when do febrile seizure occur?
when body temperature rises rapidly
how long does febrile seizure last and what type of seizure is it?
- brief 1-2 minutes
- generalised tonic clonic
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
what Qs do you need to ask the parents?
- focal elements
- happened before
what is the differential diagnosis?
- rigors: v brief tremulous movements of limbs occurring with high fever - UTI
- meningitis or encephalitis
what may examination of the child reveal?
- source of infection causing fever
- otitis media
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
which Ix is needed in children <18/12 with febrile seizure?
lumbar puncture to exclude meningitis
if convulsion is prolonged what is Rx?
terminate with rectal diazepam after ensuring blood glucose checked with BM stick to exclude hypoglycaemia
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
what is the recurrence risk of febrile seizures?
parents: will febrile seizure happen again?
about a third get recurrent
what makes recurrence more likely?
- if first seizure occurs under age of 18 months
- or if FH
how can further febrile seizure be prevented?
during febrile illnesses, child kept cool with antipyretics, removal of clothing, tepid sponging
what should i do if another convulsion occurs?
- child in recovery position
- rectal diazepam if seizure is >5mins
is febrile seizures epilepsy?
febrile seizures are not classified as epilepsy
what % of children with febrile seizure go on to develop epilepsy (afebrile recurrent seizures) in later childhood?
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