Overview

• West Syndrome (Infantile Spasms)
  • Type of childhood epilepsy presenting in first 4-8 months of life. More common in male infants.
  • Associated with serious underlying condition and has poor prognosis.
  • Sx → ‘Salaam’ Attacks: flexion of head/trunk/arms followed by extension of the arms. Lasts 1-2 seconds but may be repeated up to 50 times.
  • Ix → EEG shows hypsarrhythmia. CT may show diffuse or localised brain disease.
  • Mx → vigabatrin is first-line therapy. Urgent referral to tertiary paediatric neurology service.
  • Poor prognosis with loss of skills, learning disabilities and continuing epilepsy.
• Epilepsy
  • Tonic-Clonic → falls unconcious, preceding aura, muscle contractions, shaking, tongue biting, incontinence, post-ictal symptoms.
    • Mx → Valproate.
  • Absence → brief impairment of consciousness (5-10 seconds), behavioural arrest or staring. ‘3 spike wave per second pattern bilaterally’.
    • Mx → Valproate or Ethosuximide.
  • Myoclonic → brief arrhythmic musclular jerking, lasts few seconds.
    • Mx → Valproate.
  • Focal Seizure → temporal: strange tastes or smells before seizure, lip smacking, plucking at clothes.
    • Mx → Carbamezapine or Lamotrigine.
• Benign Rolandic Epilepsy → 3-12 years old, partial seizures of upper limb / face during sleep with hypersalivation. EEG shows centrotemporal spikes. Excellent prognosis, seizures usually stop by adolescence.
• Juvenile Myoclonic Epilepsy → 12-18 years old, myoclonic (quick, involuntary jerks) seizures after waking up.
• Head Swelling in Newborns
  • Capput Succedaneum → localised, soft tissue oedema. Due to pressure from the cervix on the baby’s head during labour. Poorly defined outline. Resolves within days. Crosses suture lines.
    • Cranial Ultrasound Scan to rule out subgaleal haemorrhage.
  • Cephalohaematoma → soft, fluctuant, localised swelling. Due to subperiosteal haemorrhage. Well-defined outline. Takes months to resolve. Doesn’t cross suture lines. Complications include jaundice, defective blood clotting and intracranial bleeding.
  • Intraventricular Haemorrhage → may occur spontaneously in premature neonates. Treatment is largely supportive.
• Hydrocephalus
  • Sx → vomiting, irritable, impaired consciousness, increased head circumference, sunset sign (eyes driven down bilaterally).
  • Mx → ventriculoperitoneal shunt.
• Migraine
  • Acute Management (12-17 years old) → step 1: simple analgesia (don’t give aspirin <16yo due to Reye’s syndrome), step 2: nasal sumatriptan.

CT HEAD INDICATIONS → If a child has more than one of the specified features such as loss of consciousness for more than five minutes, abnormal drowsiness, three or more episodes of vomiting, a dangerous mechanism of injury, or amnesia lasting more than five minutes, a CT scan should be done within one hour. If they have only one of these features, observation for a minimum of four hours is recommended.

Making Diagnosis

Clinical Features

Investigations

Management Plan

Complications →