Epilepsies of childhood

Mind Map by , created almost 6 years ago

paeds-neurology Mind Map on Epilepsies of childhood, created by v.djabatey on 01/11/2014.

Created by v.djabatey almost 6 years ago
Secondary headaches- raised ICP & space-occupying lesions
Myotonic disorders
The inflammatory myopathies
Jekyll and Hyde
Organic Chemistry
Megan Tarbuck
Peripheral motor disorders- neuromuscular disorders
Classification of headache disorders
Epilepsies of childhood-pt2
Peripheral neuropathies
Epilepsies of childhood
1 epidemiology
1.1 incidence= 0.5%
1.1.1 but commoner after the 1st year of life
1.2 prevalence= 0.5%
2 chronic neurological disorder
2.1 recurrent unprovoked seizures
2.1.1 transient signs & sx assoc w/ abnormal, excessive or synchronous neuronal activity
3 international classification of epilepsy
3.1 generalised
3.1.1 discharge arises from both hemispheres bilat synchronous seizure discharge on EEG or varying asymmetry
3.1.2 absence transient loss of consciousness w/ an abrupt onset & termination w/ some flickering of eyelids & minor alteration in mm tone typical (petit mal) atypical precipitating factors hyperventilation
3.1.3 myoclonic brief, often repetitive, jerking movements limbs neck trunk non-epileptic movements seen physiologically in hiccoughs
3.1.4 tonic-clonic rhythmic contraction of mm groups ff the tonic phase in rigid tonic phase (1) fall to ground injury don't breathe become cyanosed clonic phase (2) limb jerking irregular breathing cyanosis persists saliva may build up in mouth tongue biting urinary incontinence duration: few seconds to mins fb unconsciousness or deep sleep for several hours
3.1.5 atonic often combined w/ a myoclonic jerk fb transient loss of muscle tone -> sudden fall to the floor or drop of the head
3.1.6 no warning
3.1.7 symmetrical seizure
3.1.8 tonic generalised increase in tone
3.2 focal
3.2.1 where seizures arise from 1 or part of 1 hemisphere manifestations depend on part of the brain where discharge originates frontal lobe seizures involve motor or premotor cortex motor phenomena may -> clonic movements may travel proximally (Jacksonian march) asymmetrical tonic seizures can be seen hyperkinetic can be mistaken for non-epileptic events atonic seizures may arise from mesial frontal discharge temporal lobe seizures commonest of all epilepsies may result in strange warning feelings or aura w/ smell taste abnormalities sound & shape distortions ff spread to pre-motor cortex automatisms lip-smacking plucking @ one's clothing walking around in a non-purposeful manner deja-vu intense feeling of having been in same situation before jamais-vu never having been in a situation before impaired consciousness length of event longer than a typical absence occipital seizures cause distortion of vision parietal lobe seizures cause contralat dysaesthesias (altered sensation) distorted body
3.2.2 consciousness may be retained or lost
3.2.3 seizure may be followed by generalised tonic-clonic seizure
3.3 can be unclear esp in < 5 years
4 diagnosis
4.1 based on hx
4.1.1 child
4.1.2 eye witnesses
4.1.3 triggers
4.1.4 impairments educational psychological social
4.2 video
4.3 examination
4.3.1 skin markers neurocutaneous syn neurological abnormalities
4.4 epilepsy usually has idiopathic cause
4.4.1 but may be presentation or complication of an underlying neurological disorder
5 Ix
5.1 EEG
5.1.1 indication whenever epilepsy suspected
5.1.2 interpreted to ID a background that is abnormal for child's age asymmetry or slowing underlying structural abnormalities evidence of neuronal hyperexcitability sharp waves spike-waves complexes
5.1.3 unless seizure is captured only adds supportive evidence or not for the diag
5.1.4 many kids w/ have a normal initial EEG and vice versa
5.1.5 if standard EEG is normal sleep or sleep-deprived record can help
5.1.6 24h ambulatory EEG
5.1.7 video-telemetry
5.1.8 subdural electrodes for assessment prior to surgery
5.2 structural imaging
5.2.1 e.g. MRI & CT scans
5.2.2 not routinely required for childhood generalised epilepsies
5.2.3 indications neurological signs btw seizures focal seizures those indicated to ID tumour, vascular lesion or area of sclerosis
5.2.4 MRI FLAIR better detect mesial temporal sclerosis in temporal lobe epilepsy
5.3 functional imaging
5.3.1 to detect abnormal hypometabolism suggestive of seizure foci
5.3.2 PET
5.3.3 SPECT
5.3.4 can use alongside psychological testing including memory assessment minimise risk of postop impairment
5.4 metabolic ix
5.4.1 indications developmental regression seizures related to feeds or fasting
5.5 genetic studies
5.5.1 due to genetic deletions causing abnormalities of Na+ & other ion chanels e.g. SCN1A mutations in severe myoclonic epilepsy of infancy
6 Mx
6.1 explanation and advice
6.1.1 to help adjustment to the condition psychological help
6.1.2 those w/ photosensivity sit at a distance from TV
6.2 specialist epilepsy nurse
6.2.1 education & advice lifestyle issues adolescents driving only after 1 year free of seizures contraception pregnancy adherence seizure precipitants alcohol poor sleep routines
6.3 Rx
6.3.1 decision to treat based on level of inconvenience seizures bring DON'T institute after single unprovoked seizure
6.3.2 Anti-epileptic drug (AED) not all seizures require AED base this decision on seizure type frequency social & educational conseq possible s/e of drugs choose the approp drug for the seizure inapprop AEDs may be detrimental carbamazepine can worsen absence & myoclonic seizures monotherapy at minimum dosage is desired drug levels not measured routinely kids w/ prolonged seizures are given rescue therapy e.g. rectal diazepam & buccal midalzolam therapy can usually be discontinued after 2 years free of seizures
6.3.3 tonic-clonic 2nd line lamotrigine, topiramate 1st line valproate, carbamazepine
6.3.4 absence 1st line valproate, ethosuximide 2nd line lamotrigine
6.3.5 myoclonic 1st line valproate 2nd line lamotrigine
6.3.6 focal 1st line carbamazepine, valproate lamotrigine most effective slow titration 2nd line topiramate, levetiracetam, oxacarbazepine, gabapentin, tiagabine, vigabatrin
6.3.7 ketogenic (fat-based) diets helpful in some kids mechanism of action poorly understood
6.3.8 vagal nerve stimulation delivered using externally programmable stimulation wire around vagal nerve on trial
6.3.9 surgery well localised seizures demonstrated by good concordance btw EEG, MRI & functional imaging findings temporal lobectomy for mesial temporal sclerosis hemispherotomy or hemispherotomy isolation of hemisphere which isn't removed so as avoid post-op in space
6.4 promote independence & confidence
6.5 informing the school
6.5.1 vigilance for absence episodes
6.5.2 avoiding deep baths, not swimming alone in deep water

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