#Phase 2.2: Paediatrics > Epilepsy > Flashcards

Epilepsy Flashcards

(65 cards)

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1
Q

What is epilepsy an umbrella term for?

A

Condition where there is tendency to have seizures

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2
Q

What is the definition of seizures?

A

Transient episodes of abnormal electrical activity in brain

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3
Q

What are the CF of Generalised Tonic-Clonic seizures? (3 things)

A
  1. Loss of consciousness
  2. Tonic (muscle tensing) (1st)
  3. Clonic (muscle jerking) (2nd)
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4
Q

What are some associated CF of Generalised Tonic-Clonic seizures? (4 things)

A
  1. Groaning
  2. Tongue biting
  3. Irregular breathing
  4. Incontinence
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5
Q

What do you get after Generalised Tonic-Clonic seizures?

A

Post-ictal period

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6
Q

What are the CF of the Post-ictal period of Generalised Tonic-Clonic seizures? (3 things)

A
  1. Confused
  2. Drowsy
  3. Irritable
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7
Q

What is the FIRST LINE Mx of Generalised Tonic-Clonic seizures?

A

Sodium valproate

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8
Q

What is the SECOND LINE Mx of Generalised Tonic-Clonic seizures? (2 things)

A
  1. Lamotrigine
  2. Carbamazepine
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9
Q

Where in the brain do Focal seizures start?

A

Temporal lobes

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10
Q

What are the CF of Focal seizures?

A
  1. Hallucinations
  2. Memory flashback
  3. Deja vu
  4. Doing weird things on autopilot
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11
Q

What is the FIRST LINE Mx of Focal seizures? (2 things)

A
  1. Carbamazepine
  2. Lamotrigine

(opposite order of Generalised Tonic-Clonic seizures)

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12
Q

What is the SECOND LINE Mx of Focal seizures? (2 things)

A
  1. Sodium valproate
  2. Levetiracetam
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13
Q

What type of seizures typically happens in children?

A

Absence

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14
Q

What are the steps of the CF of Abscence seizures in children? (3 steps)

A
  1. Pt goes blank
  2. Stares into space
  3. Returns to normal
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15
Q

How long do Absence seizures typically last?

A

10-20 seconds

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16
Q

Do children stop having absence seizures as they get older?

A

Yes, most of them (more than 90%)

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17
Q

What is the FIRST LINE Mx of Absence seizures? (2 things)

A
  1. Sodium valproate
  2. Ethosuximide
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18
Q

What are Atonic seizures also called?

A

Drop attacks

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19
Q

What are the CF of Atonic seizures?

A

Brief lapses in muscle tone

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20
Q

How long do Atonic seizures usually last?

A

3 minutes max

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21
Q

When in the patients life do Atonic seizures typically begin?

A

Childhood

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22
Q

What syndrome do Atonic seizures possibly indicate?

A

Lennox-Gastaut syndrome (type of epilepsy)

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23
Q

What is the FIRST LINE Mx of Atonic seizures?

A

Sodium valproate

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24
Q

What is the SECOND LINE Mx of Atonic seizures?

A

Lamotrigine

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25
What are the CF of Myoclonic seizures?
Sudden brief muscle contractions (like sudden jump)
26
Do children remain awake during Myoclonic seizures?
Yes
27
What type of Epilepsy do Myoclonic seizures typically indicate?
Juvenile myoclonic epilepsy
28
What is the FIRST LINE Mx of Myoclonic seizures?
Sodium valproate
29
What is the SECOND LINE Mx of Myoclonic seizures? (3 things)
1. Lamotrigine 2. Levetiracetam 3. Topiramate
30
What are Infantile Spams also known as?
West Syndrome
31
How rare is Infantile Spasms (aka West Syndrome)?
1/4000
32
When does Infantile Spasms (aka West Syndrome) typically start?
6 months
33
What are the CF of Infantile Spasms (aka West Syndrome)?
Clusters of full body spasm
34
What is the prognosis of Infantile Spasms (aka West Syndrome)?
Poor: 1/3 die by age 25
35
What proportion of people with Infantile Spasms (aka West Syndrome) are safe?
1/3 are seizure free
36
What is the FIRST LINE Mx of Infantile Spasms (aka West Syndrome)? (2 things)
1. Prednisolone 2. Vigabatrin
37
What are Febrile convulsions?
Seizures when children have a Fever NOT CAUSED BY EPILEPSY
38
Are Febrile convulsions caused by epilepsy?
No
39
What ages do Febrile convulsions usually occur at?
6 months to 5 years
40
Do Febrile convulsions cause any lasting damage?
No
41
What proportion of children who have a Febrile convulsion will have another one?
1/3
42
Does having Febrile convulsions increase the risk of developing epilepsy in the future?
Slightly
43
What are the key parts of the Hx in the diagnosis of Epilepsy?
Distinguishing between Seizures vs Vasovagal Episodes / Febrile Convulsions
44
Do children with a clear Hx of Vasovagal Episodes / Febrile Convulsions need any further investiagations?
No
45
What investigations can you do for sus Epilepsy in children? (2 things)
1. EEG 2. MRI brain
46
What additional investigations can you do for sus Epilepsy in children? (5 things)
1. ECG 2. Blood electrolytes 3. Blood glucose 4. Blood / urine cultures 5. Lumbar puncture
47
What is the point of EEG in Epilepsy Dx?
Will show typical patterns of different types of Epilepsy
48
When should you do an EEG on a child with sus Epilepsy?
After SECOND simple tonic-clonic seizure (Kids only allowed to have ONE simple seizure before being investigated for epilepsy)
49
What is the point of an MRI brain in a child with sus Epilepsy?
Visualise brain structure --\> can diagnose structural problems (e.g tumours) associated w seizures
50
When should you consider doing an MRI brain in a child with sus Epilepsy? (3 things)
1. 1st seizure in child under 2 yrs 2. Focal seizures 3. No response to First line anti-epileptic meds
51
What is the point of doing an ECG in a child with sus Epilepsy?
Exclude heart problems
52
What is the point of doing Blood glucose in a child with sus Epilepsy?
Checking for hypoglycaemia / DM
53
What are you suspecting if you do Blood / urine cultures / Lumbar puncture in a child with sus Epilepsy? (3 things)
1. Sepsis 2. Encephalitis 3. Meningitis
54
Sodium Valproate is a FIRST LINE anti-epileptic for most types of epilepsy except which type?
Focal seizures
55
What is the MOA of Sodim Valproate?
Increases GABA activity --\> relaxes brain
56
What are the side fx of Sodium Valproate? (4 things)
1. Hair loss 2. Liver damage / hepatitis 3. Teratogenic (so be careful w contraception) 4. Tremor
57
Because of the Teratogenic fx of Sodium Valproate, what are the NICE guidelines recommendations for it? (2 things)
1. Avoid in girls unless NO suitable alternative 2. Make sure these girls DO NOT get pregnant
58
What is the FIRST LINE Mx for Focal seizures?
Carbamazepine
59
What are the side fx of Carbamazepine? (3 things)
1. Agranulocytosis 2. Aplastic anaemia 3. Enzyme inducer
60
What are the side fx of Phenytoin? (2 things)
1. Megaloblastic anaemia (bc Folate deficiency) 2. Osteomalacia (bc Vit D deficiency)
61
What are the side fx of Ethosuximide? (2 things)
1. Night terrors 2. Rashes
62
What are the side fx of Lamotrigine? (2 things)
1. Stevens-Johnson syndrome / DRESS syndrome (aka life threatening skin rashes) 2. Leukopenia (low WCC)
63
What is the definition of Status epilepticus? (2 definitions)
* Seizure lasting 5+ mins OR * 2+ seizures w/o regaining consciousness in between
64
How do you manage Status Epilepticus using the ABCE approach? (8 steps)
1. Secure airway 2. Oxygen 3. Check Heart + Lungs function 4. Check BG 5. IV access: Lorazepam (repeat after 10 mins if seizure continues) 6. If still continuing: IV Phenobarbital / Phenytoin 7. Consider Intubation / Ventilation (to secure airway) 8. ITU
65
What are some medication Mx options for Status epilepticus? (2 things)
1. Buccal midazolam 2. Rectal diazepam
#Phase 2.2: Paediatrics
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