Paediatric Neurology - Epilepsy

Question 1

How common is epilepsy in children?

Answer 1

Twice as common as in adults

5 per 1000 school aged children

Question 2

What causes epilepsy in children?

Answer 2

Malformations - tuberous scelerosis
Infections - meningitis, encephalitis
Electrolyte disturbances
Trauma

Question 3

What is the difference between an epileptic seizure and epilepsy?

Answer 3

Epileptic seizure is an episode of abnormal and excessive neuronal activity in the brain that is apparent to the subject or an observer

Epilepsy is a chronic disorder characterised by recurrent, unprovoked epileptic seizures

Question 4

What generalised seizures do children get?

Answer 4

Myoclonic
Tonic
Clonic
Absence
Tonic-clonic
Atonic

Question 5

What happens in a myoclonic seizure?

Answer 5

Shock like movement to one or several body parts

Question 6

What happens in a tonic seizure?

Answer 6

Sustained contraction

Question 7

What happens in a clonic seizure?

Answer 7

Rhythmic jerking of limb, side of body or whole body

Question 8

What happens in an absence seizure?

Answer 8

Psychomotor arrest - can have movements

Lasts only seconds

Question 9

What happens in a tonic-clonic seizure?

Answer 9

Child lose consciousness

Muscles firstly all stiffen up (tonic phase)

Extremities then jerk and twitch rhythmically (clonic phase)

Question 10

What areas can focal seizures affect?

Answer 10

Occipital
Centroparietal
Temporal
Frontal

Question 11

How would an occipital seizure manifest?

Answer 11

Coloured bright lights seen

Question 12

How would a centroparietal seizure manifest?

Answer 12

Sensorimotor phenomenon spreads

Question 13

How would a temporal lobe seizure manifest?

Answer 13

Gastric discomfort
Anxiety
Deja vu
Plucking of clothes
Smacking lips

Question 14

How would a frontal lobe seizure manifest?

Answer 14

Dystonic posture

Guttural noises - hoarse sound made in back of throat

Question 15

How would a seizure in a neonate never present?

Answer 15

Never tonic-clonic - brain isn’t mature enough to produce synchronous activity

Question 16

What would seizures in a neonate indicate?

Answer 16

Severe underlying cerebral dysfunction

Never benign

Question 17

What should investigations for neonatal seizures revolve around?

Answer 17

Looking for cause

Question 18

How would infantile spasms present (age, symptoms, EEG)

Answer 18

4-8 months
Flexion of limbs then extension and arched back
Developmental delay
EEG shows hypsarrthythmia

Question 19

When do you see severe myoclonic epilepsy of infancy and how does it present

Answer 19

Within 1st year of life
1 side of the body generally affected
Often due to change in temperature
Develop normally for first few years and then there is delay

Question 20

When do you see juvenile myoclonic epilepsy and how does it present

Answer 20

Teenage years
Myoclonus seizures on waking
+/- generalised tonic clonic

Question 21

When do you see Panayiotopoulos syndrome and how does it present

Answer 21

3-6 yo
Prolonged autonomic seizures eg vomiting
Normal development
Usually resolves by teenage years

Question 22

When do you see benign childhood epilepsy with centrotemporal spikes and how does it present

Answer 22

Age 3-10
Occur nocturnally or on waking
Focal tingling, facial movements, tonic, clonic
Normal development

Question 23

How do you take a history of a seizure?

Answer 23

Detailed description of:
Events before
What happened during
What happened after the suspected seizure

Distinguish between true epilepsy and mimics

Question 24

What is the role of an EEG in epilepsy?

Answer 24

Support clinical diagnosis of epilepsy once everything else ruled out

Doesn’t prove or disprove epilepsy

Question 25

When do you do neuroimaging for epilepsy?

Answer 25

Focal onset seizure
Seizure not responsive to first line treatment
Focal neurological deficit
Children <2 with non-febrile convulsions

Question 26

What other investigations could be appropriate in epilepsy?

Answer 26

Plasma and urine amino acids
Biopsy of skin or muscle
Measurement of WBC enzymes
DNA analysis

Question 27

How do you manage epilepsy?

Answer 27

Advice on safety surrounding seizure

Educate child and family

Involve child in decision

Regular review

Drug treatment

Question 28

When are Anti-Epileptic drugs not normally started?

Answer 28

First uncomplicated seizure

Infrequent myoclonic or absence seizures

Question 29

How should anti-epileptic drugs be given?

Answer 29

Monotherapy - achieve total seizure control in 70% of children

Question 30

What anti-epileptic drugs are first line?

Answer 30

Generalised - sodium valproate

Partial - Carbamazepine

Question 31

When can withdrawal of Anti Epileptic Drug’s be discussed?

Answer 31

2 year seizure free

Question 32

When do you see Lennox-Gastaut and how does it present

Answer 32

Age <4
Complete variety of seizures and different patterns of neuro development seen (basically anything)
Slow spikes on EEG

Question 32

What is the management of infantile spasms

Answer 32

Prednisolone

Vigabatrin

Question 32

What is the common management of epilepsy syndromes (aside from infantile spasms)

Answer 32

Valproate is most commonly used

Lamotrigine is often second line

Question 32

How would you investigate a first fit

Answer 32

Infection screen
Temperature
Blood glucose
Serum calcium
Fundoscopy
Toxin screen