Seizures & epilepsy Flashcards

1
Q

Seizure reoccurence after afrebrile seizure?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How common are febrile seizures?

A

3% of children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

In what ages do febrile seizures occur?

A

6mo-6yo

Reconsider Dx if outside these ages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Presentation of febrile convulsions?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Ix and Tx of febrile convulsions?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Risk of epilepsy in febrile convulsions

A

Slightly increased: 3% with no other risk factors

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Risk of epilepsy in febrile convulsions

A

Slightly increased: 3% with no other risk factors

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Breath-holding spells epidemiology and natural Hx

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Presentation of breath-holding spells

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

EEG for breath-holding spells

A

Not necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

First presentation of the seizure - what are important examination?

A
Conscious state, vitals 
ABCD if relevant 
Neurological exam - focal signs, meningism, raised ICP
Development - i.e. dysmorphic features 
Bedside BGLs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

First presentation of the seizure - what possible DDx?

A
Syncope - vasovagal/cardiac 
Epilepsy 
Normal - day-dreaming, sleep jerking 
Breath holding 
Movement disorders 
Sleep related disorder 
Behavioural/psychiatric 
Migraine variants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the definition of epilepsy?

A

> = 2 unprovoked seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the causes of seizures?

A
Structural - mass/raised ICP, sclerosis 
Metabolic - electrolytes, glucose, metabolic disorders
Infective - CNS, high fever 
Vascular - CVA
Idiopathic 
Birth injury/hypoxia
Head trauma
17
Q

What are precipitating factors for epileptic seizures?

A
Fatigue, sleep deprivation
Stress
Flashing lights
Reading/writing 
Alcohol 
Drugs
Withdrawal 
Hypoglycaemia
Fever
Electrolytes
Hypoxia
18
Q

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

A

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
Q

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

A

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
Q

What Ix are useful in afebrile seizures and why?

A

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
Q

What are the first aid instructions for managing seizures?

A
  • 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
Q

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

A
  • 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
Q

What is status epilepticus and the Rx?

A
  • 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