Neurology, Seizures, and Spina Bifida: Key Concepts and Treatments

What does neurology specialize in?

Managing nervous system disorders, including those affecting the brain, spinal cord, nerves, and muscles.

What is the focus of neurosurgery?

Surgery for nervous system disorders.

What is the most common pediatric neurologic disorder?

Seizure disorders

What percentage of children will have at least one seizure by age 15?

4% of children, and it is mostly febrile seizures

What causes seizures?

Excessive and disorderly neuronal discharges in the brain.

What are common manifestations of seizures?

Unconsciousness or altered consciousness, involuntary movements, and changes in perception, behaviors, sensations, and posture, but it depends on the part they originate from

What characterizes epilepsy?

Two or more unprovoked seizures.

What is the significance of classifying seizures?

Classification is important for treatment.

What are Acute Symptomatic Seizures?

Seizures caused by acute insults such as head trauma or meningitis.

What are Remote Symptomatic Seizures?

Seizures associated with brain injury without immediate cause, such as major head trauma, meningitis, encephalitis, hypoxia, or stroke

What are Cryptogenic Seizures?

Seizures with no clear cause.

What are Idiopathic Seizures?

Seizures that are genetic in origin.

How do brain cells contribute to seizures?

They send electrical impulses that can overload, causing muscles to tighten and relax rapidly or stop moving completely, leading to a seizure. When the cells stop sending the signals, the seizure stops.

What percentage of individuals can recognize at least one seizure trigger?

90%

What are some common seizure triggers?

Emotional stress, sleep deprivation, fatigue, fever, illness, flickering lights, menstrual cycles, alcohol, video games, and changes in dark-light patterns.

What are Simple Partial Seizures?

Seizures that do not involve loss of consciousness and affect the body part corresponding to the seizure's brain location (small location in brain)

What are Complex Partial Seizures?

Seizures that involve alteration of awareness, causing the person to lose touch with their surroundings for 1-2 minutes; involves both hemispheres of the brain

What are Absence Seizures?

A type of generalized seizure; Brief loss of consciousness lasting 5-10 seconds, often mistaken for inattentiveness. Usually begins in childhood and more common in boys. May occur several times a day, seldom falls to the ground, and usually ceases at puberty

What are Tonic-Clonic Seizures?

Formerly known as 'grand mal' seizures, they are the most dramatic and involve a tonic phase followed by a clonic phase. They occur without warning, but can have a brief warning of a sinking/rising feeling in the stomach; may cry before losing consciousness

What occurs during the tonic phase of a Tonic-Clonic seizure?

Immediate loss of consciousness, fall to the ground if standing, limb rigidity, cessation of breathing and lips turn blue, eyes roll upward, jaws are clenched, may bite tongue or lips; lasts 10-20 seconds

What occurs during the clonic phase of a Tonic-Clonic seizure?

Rhythmic jerking of limbs, possible incontinence, may foam at the mouth and confusion post-seizure; poor coordination, visual and speech difficulties, headache and muscle aches, may want to sleep for 1-2 hours, will have no memory of the event; this can last from a few seconds to 30 minutes or more

What is involved in the diagnosis of seizure disorders?

Determining seizure existence, defining underlying causes, and reviewing patient history and diagnostic tests.

What are some medical tests used to diagnose seizures?

Physical and neurologic exams, developmental assessments, blood work (tox screens, chromosomal analysis), lumbar puncture, CT scan, MRI, and EEG.

What is the purpose of using drugs in seizure treatment?

To achieve the desired effect without undesirable side effects or toxic reactions.

What is a ketogenic diet?

A high-fat, low-carbohydrate, adequate protein diet; 56% of children saw a reduction of >50% in seizure activity

What is Vagus Nerve Stimulation?

An implantable electrode device that reduces seizures by sending impulses to the left vagus nerve; can activate with a magnet at onset of seizure

when is surgery used as a treatment for seizures?

when the seizures are incapacitating; it is successful in improving quality of life

What should you do if someone is having a seizure?

Stay calm, move them away from hazards, lay them on their side, and call 911 if it lasts more than 5 minutes.

What does 'Spina Bifida' mean in Latin?

It means 'split or open spine'.

What is the most common neural tube defect?

Spina bifida.

What are the two types of spina bifida?

Spina bifida occulta and spina bifida cystica.

What characterizes spina bifida occulta?

The defect is not visible externally; the spinal cord does not protrude through the skin; may be a patch of hair or dimple; some may not know they have it

What are the visible characteristics of spina bifida cystica?

It has an external saclike protrusion.

What are the two forms of spina bifida cystica?

Meningocele and myelomeningocele.

What is meningocele?

A form of spina bifida cystica where the meninges and spinal fluid are encased in a sac.; sac filled with fluid is visible on the back and is covered by a a thin layer of skin; can be the size of a grape to the size of a grapefruit

What is myelomeningocele?

A form of spina bifida cystica where the meninges, spinal fluid, and nerves are encased; sac bulges from back but skin may not cover it; spinal cord nerves may be exposed

What is hydrocephalus and how is it related to spina bifida?

Hydrocephalus is an enlarged head condition associated with 80-90% of children with myelomeningocele.

At what stage of gestation does the neural groove appear?

At 20 days gestation.

what causes spina bifide?

some think the tube fails to close; others think it closed and then split because of an abnormal increase in cerebrospinal fluid

What factors may contribute to the development of spina bifida?

Drugs, radiation, maternal malnutrition, chemicals, genetic mutations (trimsomy 18), maternal obesity, diabetes, and low maternal vitamin B12.

what does the degree of dysfunction of spina bifida depend on?

it depends on where the sac protrudes through the vertebrae; the higher the opening, the more paralysis

How can spina bifida be diagnosed?

Spina bifida cystica is obvious at birth; It can be diagnosed at birth, through MRI, CT scans, and ultrasounds to determine level of involvement; neurologic exam to determine involvement of bowel, bladder, and lower extremity neuromuscular involvement; can be diagnosed prenatally through ultrasound and amniocentesis between 16 and 18 weeks gestation

What is the recommended treatment for spina bifida?

Early closure within 24-72 hours, shunt for hydrocephalus, and fetal surgery to close the sac to reduce the need for shunting and improve mental and motor function

What is the prognosis for individuals with spina bifida?

It depends on neurologic deficits; many can live independently and achieve normal intelligence; in children the achievement of bladder continence is associated with improved self-concept and esteem

What are some common issues faced by individuals with spina bifida?

Hydrocephalus, shunt malfunctions, scoliosis, bowel and bladder management issues, latex allergy, and epilepsy; early treatment is key

How can spina bifida be prevented?

By daily consumption of 0.4 mg of folic acid among women of childbearing age; eat fortified foods and foods rich in folate

What foods are rich in folate that can help prevent spina bifida?

Fortified foods (cereal, bread, rice, pasta) and foods naturally rich in folate (green leafy vegetables, citrus fruits).

What are some care considerations for a child with spina bifida?

Bowel and bladder management (catheterization), urinary tract infections, pressure sores, physical therapy, and addressing self-esteem issues.

Why are individuals with spina bifida at risk for developing latex allergies?

Due to repeated exposure to latex products during surgeries and procedures.