Presentations
- Breath-holding – cyanotic / pallid
- Confusion / Fugue
- Fainting / Loss of consciousness
- Fatigue
- Impaired awareness or staring, with or without motor accompaniment
- Jerky, rhythmic, or twitching motions
- Light-headedness and/or dizziness
- Muscular difficulties, such as coordination problems, stiffness, weakness, and/or paralysis
- Nausea and/or vomiting
- Poor feeding
- Seizures
- Sensory disturbances
- Speech difficulties
- Sweating
Conditions – epileptic
- Childhood epilepsy syndromes
- Developmental and epileptic encephalopathy
- First seizure
- Focal epilepsy
- Generalised epilepsy
- Immunological
- Inborn errors of metabolism associated with epilepsy
- Infantile epileptic spasms syndrome
- Inflammatory epilepsies
- Metabolic disturbance
- Provoked seizures
- Status epilepticus
Conditions – haemorrhagic
- Primary intracranial haemorrhage
- Subarachnoid haemorrhage
- Venous infarction
Conditions – ischaemic
- Amaurosis fugax
- Ischaemic stroke:
- acute thromboembolic
- arterial
- Non-atherosclerotic arteriopathies, such as moyamoya disease
- Transient ischaemic attacks
- Vasculitides
- Venous sinus thrombosis
- Watershed infarcts
Conditions – non-epileptic
- Alternating hemiplegia
- Benign neonatal sleep myoclonus
- Benign paroxysmal torticollis
- Breath-holding
- Episodic ataxias
- Febrile seizures
- Hyperekplexia
- Migraine with brainstem features
- Non-epileptic seizures:
- non-epileptic status parasomnias
- Paroxysmal dyskinesia
- Recurrent vertigo of childhood / Benign paroxysmal vertigo of childhood
- Shuddering spells
- Stereotypies
- Tics
- Tonic upgaze of infancy
Conditions – stroke mimics
- Functional neurological disorder
- Migraine
- Mitochondrial disorders
- Todd’s paresis
Conditions – syncope
- Cardiac arrhythmias
- Dehydration
- Reflex anoxic
- Vasovagal syncope
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions – dizziness / vertigo
- Benign paroxysmal positional vertigo (BPPV)
Conditions
- Autonomic failure
- Carotid sinus hypersensitivity
- New-onset refractory status epilepticus (NORSE)
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Age-related presentations in epileptic symptoms
- Arterial blood supply, vascular anatomy, and venous drainage of the brain and spinal cord
- Causes of stroke in children, such as non-atherosclerotic arteriopathies and congenital heart disease, and the potential genetic variants associated with these
- Causes of stroke syndromes:
- haemorrhagic
- ischaemic
- mimics
- Classification and clinical features of the different types of epileptic seizures, as from International League Against Epilepsy (ILAE)
- Classification of epilepsy and childhood epileptic syndromes
- Common, primary, rare, and secondary diseases that result in seizures and syncope
- Evidence-based pharmacological therapy and other forms of management of stroke and related syndromes, in relation to acute presentation, prophylaxis, and rehabilitation
- Neuroanatomy, neurophysiology, and related imaging of paediatric stroke
- Neuroanatomy, neuropharmacology, and neurophysiology involved in the generation of epilepsy and syncope
- Neuropharmacology and surgical interventions for paediatric stroke, based on national clinical guidelines
- Paroxysmal non-epileptic attacks presenting at different ages, and their key features
Cerebrospinal fluid (CSF) procedures and investigations
- Lumbar puncture (LP) and interpretations results of investigations, such as:
- basic CSF analysis:
- cell count
- cytology
- glucose level, including:
- immunological tests
- microbiological tests
- protein level
- xanthochromia
- opening pressure
- special tests:
- amino acids
- CSF lactate
- oligoclonal bands
Clinical neurophysiology investigations
- EEG:
- prolonged video EEG
- sleep-deprived EEG
- standard EEG
- stereotactic EEG (SEEG)
- Vestibular function tests
Neurogenetic investigations
- Genetic testing, including, but not limited to:
- chromosomal testing, such as:
- genomic testing, including whole exome or genome sequencing
- mitochondrial genome sequencing
- targeted panel testing
- Referral to a neurogeneticist
Neuroimaging investigations
- CT, including:
- Functional imaging:
- functional MRI (fMRI)
- PET
- single photon emission computed tomography (SPECT)
- Magnetic resonance:
- angiography (MRA)
- spectroscopy (MRS)
- venogram (MRV)
- MRI
- Vascular imaging:
- catheter angiography
- Doppler ultrasound
Neuropathology investigations
Other investigations
- Cardiac investigations:
- 24-hour electrocardiogram monitoring
- bubble study
- ECG
- echocardiography
- Other laboratory tests:
- leukocyte enzymes
- plasma amino acids
- plasma lactate
- plasma pyruvate
- thrombophilia screen
- urinary metabolic screen
- urinary porphyrins
- vasculitis screen
- Polysomnography
- Appropriate potential candidates for epilepsy diet service
- Appropriate potential candidates for evaluation for epilepsy surgery, including implantable devices
- Awareness of appropriate and timely neurogenetic testing, what is available to the neurologist, and what requires genetic referral / consultation
- Awareness of national clinical stroke guidelines, and application of this within each network employed
- Maintain up-to-date knowledge of childhood epilepsy syndromes, particularly those identified by the ILAE position papers
- Management of diagnostic uncertainty and counselling in relation to risk management
- Management strategies, such as:
- antiseizure medicine
- diet
- epilepsy surgery
- vagal nerve stimulator
- Overlap with other allied health and medical specialties, such as:
- dietetics
- general paediatricians
- occupational therapy
- physiotherapy
- rehabilitation medicine
- speech pathology
- Overlap with other medical conditions, such as:
- cardiac disorders
- functional neurological presentations
- non-epileptic disorders
- sleep disorders
- syncope
- Prognosis, implications, and management strategies for dealing with epilepsy
- Prognosis, implications, and management strategies for stroke, such as:
- acute management
- impact on the family
- rehabilitation
- secondary prevention
