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Block 8 Week 3 > Seizures in Pediatric Patients-Swartz > Flashcards

Seizures in Pediatric Patients-Swartz Flashcards

1
Q

A (blank) is a phenomenon of heightened neuronal excitability and depolarization which spreads to neighboring neurons, columns, gyri, lobes to produce a loss of function with or without obvious clinical manifestations.

A

seizure

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2
Q

What is epilepsy?

A
  • At least 2 unprovoked (or reflex) seizures occurring more than 24 hours apart. (ie have 2 seizures and dont find an abnormality still considered epilepsy)
  • One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrency risk after 2 unprovoked seizures (at least 60%), occurring over the next 10 years. (ie if you have a seizure and some sort of abnormality, treat as epilepsy)
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3
Q

How do you diagnose epilepsy?

A

Constellation of signs and symptoms with known etiology, pathophysiology and outcome

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4
Q

What seizures are seen in childhood?

A
  • neonatal seizures (unique etiologies and semiologies)
  • febrile seizures
  • epileptic encephalopathies
  • metabolic syndromes
  • genetic syndromes-
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5
Q

What are semiologies?

A

progression of clinical signs that occur during the course of a seizure

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6
Q

How are seizures in children similiar to seizures in adults?

A

you need ictal recordings for diagnosis and prognosis-CEEG

  • importance of semiology (for diagnosis and prognosis)
  • Need neuroimaging
  • need for rapid initiation of treatment
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7
Q

What neuroimaging do you want to use for epilepsy?

A

MRI (80% effective)

CT (50%))

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8
Q

What is the prevalence of epilepsy in children?

A

up to 5% overall

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9
Q

Epilepsy increases in (blank) years in third world countries

A

teen

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10
Q

What is an acute symptomatic seizure?

A

seizure following head trauma within 24 hours

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11
Q

What is the lifetime incidence of epilepsy?

A

1/26

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12
Q

What is the incidence of epilepsy in children at birth? at three? stabilizes at?

A

Incidence 0.2% at birth. Drops to 0.1% age three and stabilizes at .05%. (USA)

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13
Q

When do neonatal seizures typically occur?

A

Occur up to 28 days post term but usually in first week of life

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14
Q

You can differentiate the motor phenomena of seizures from release phenomenon by whether the movement(s) is induced by (blank) or (blank).
If it is a seizure what should you do?

A

stimulation (noise, tactile, passive movement) or stopped by repositioning.

treat specifically and with AED

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15
Q

What is this:

Repetitive rhythmic jerking of a limb, face or trunk

A

focal clonic-epileptic

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16
Q

What is this:

Sustained posturing of a limb, eye deviation, assymetric trunk

A

focal tonic-epileptic

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17
Q

What does a generalized tonic non-epileptic seizure cause?

A

sustained, symmetric posturing in the limbs, neck and trunk. Can effect or flexor, extensors or both.

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18
Q

What is a generalized tonic non-epileptic seizure commonly caused by?

A

GERD

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19
Q

Is myoclonic epileptic or non epileptic?

A

can be beoth

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20
Q

Are spasms epiletic or nonepileptic?

A

epileptic

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21
Q

What is this:

eye movements, oral – buccal, semipurposeful, complex purposeless – Non-epileptic

A

motor automatisms

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22
Q

What causes neonatal seizures?

A
  • hypoxic-ischemic pre-or perinatal insult
  • infection
  • intracranial hemorrhage
  • congenital CNS abnormality
  • electrolyte disturbance
  • inborn errors of metabolism
  • toxins
  • genetics
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23
Q

What infections can cause neonatal seizures?

A

septicemia
meningitis
meningoencephalitis
HIV

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24
Q

What electrolyte disturbances can cause neonatal seizures?

A

Ca, Na, Mg, Glu

25
Q

What inborn error of metabolism can cause neonatal seizures?

A

pyridoxine

26
Q

What toxins can cause neonatal seizures?

What genetic causes can cause neonatal seizures?

A

Toxins – bilirubin, medications, drugs in mother

Genetic – BNFC, chromosomal, Leigh’s,

27
Q

How do you treat neonatal seizures?

A 
Treat etiology (hypocalcemia, etc)
Treat with an AED or ASD (anti-seizure drug)
28
Q

What three seizures may not require AED?

A
  • brief and infrequent focal motor

- tonic or myoclonic seizure

29
Q

When can you withdraw AED?

A

two week after the last seizure if EEG is negative

30
Q

What is the first line seizure med?

What are other ones and what are their downfalls?

A

Levetiracetam

  • phenobarbital (IQ depression)
  • phenytoin (hemorrhagic disease of the newborn)
31
Q

If given drugs and patient is still seizing, what do you give them?

A

Ativan or midazolam + high dose of phenobarbital or Diphenhydramine

32
Q

What is a new AED?

A

lacosamide

33
Q

What is the most common seizure of childhood?
When age does it occur?
How long do they last?

A

Febrile seizures (a type of generalized tonic clonic seizure)
3 months to 5 years
less than 10 minutes

34
Q

Do febrile seizures recur? How long do they last? Are they partial or generalized at onset? How do you treat these?
A very small amount of febrile seizures are recurrent, how do you treat these?

A 
no
10 minutes
generalized
Usually self-limitied, Benzo (ativan, midazolam)
Home diastat (rectal valium)
35
Q

For a child having febrile seizures, when should you do a lumbar puncture?

A

in children less than 1 yr old.

36
Q

A febrile seizure is a seizure that has a fever (blank) an INFECTION of the CNS

A

WITHOUT

37
Q

What are risk factors for recurrent FS?

A
  • first seizure at <1 yr
  • FS following low grade or brief fever
  • epilepsy in 1st degree relative
  • complex febrile seizures
  • neurodevelopmental abnormalities
38
Q

What are risk factors for FS becoming epilepsy?

A
  • abnormal neonatal hx

- family hx of retardation

39
Q

What are syndromes of recurrent seizures associated with regression of development milestones?
What do these cause?

A 
Ohtahara Syndrome
Dravet Syndrome
West Syndrome
Lennox Gastaut Syndrome
Landau Klefner
ESES

Epileptic encephalopathies

We (west) Left (Lennox) Essex (ESES) for the land (Laundau) of the Ohtahara Dragon (Dravet)

40
Q

What is this:

  • EEG characterized by suppression-burst pattern
  • seen in neonatal period (10da-3 months)
  • seizures are tonic spasms, drop attacks and partion (rare myoclonus can also occur)

What is the prognosis like?
How do you treat it?

A

Ohtahara’s Syndrome or EIEE (early infantile epileptic encephalopathy)

Very poor (100% Intellectual disability)

Tx: ACTH, steroids, Valproic acid (depakote), ketogenic diet, Topiramate, Clobazam, Felbamate

41
Q

What is this:
unilateral clonic seizures, febrile and afebrile in 1st year of life in previously normal infant. Recur at 6-8 wk intervals.
May cause STATUS (continual seizing)

A

Dravet’s syndrome (SEI, severe myoclonic epilepsy of infancy)

42
Q

What is will increase you chances of getting Dravets syndrome?
Is this severe?
What is the molecular defect associated with this?

A

Family hx of epilepsy or FS
YES
defects in 3 Na channel subunit genes and a GABA subunit gene

43
Q

What will make Dravet’s syndrome worse?

A
  • sodium channel blockers!! DO NOT GIVE THESE
  • carbamazepine
  • diphenhydramine
  • oxcarbazepine
  • lamotrigine
44
Q

What is this:
characterized by infantile spasms-brief bilateral contraction of muscles of neck, trunk and extremities
-onset in first 4-8 months of life.

A 
West Syndrome (SEEI)
Severe encephalopathic Epilepsy in Infants
45
Q

What is this:
EEG – hypsarrhythmia, Slow waves or slow SW, BS, rarely normal
Can be misdiagnosed as Morrow reflex, colic, startle responses
85% symptomatic; 15% cryptogenic (with or without abnormal MRI
“jack-knife seizures”

A 
West Syndrome (SEEI)
Severe encephalopathic Epilepsy in Infants
46
Q

What is this:
Triad of slow spike-wave on EEG, mental retardation and mixed seizure types – myoclonic jerks, atypical absences and drop attacks (tonic or atonic).

A

Lennox Gastaut Syndrome

47
Q

What is this:
Mean age = 2 y/o, usually preschool (10% of sz up to age 5) but 1-14 y/o = range.
Males>females
Drop attacks have “electrodecremental response” on EEG

A

Lennox Gastaut syndrome

48
Q 
What is this:
Ages 3-9 y/o, Males > Females
EEG shows multifocal SW
Child develops verbal agnosia and decreased spontaneous speech
Remits before age 15
Etiology unknown
Seizures may not be prominent feature
Treatment – steroids, KD, felbamate, early speech therapy. 40-50% recover to a normal life.
A

Landau-Klefner syndrome

49
Q

What is this:
EEG – some bursts of SW while awake become continuous in sleep (1.5-2Hz)
Seizures – partial, generalized, atypical absence
Normal development until onset – may return to near normal with control of Spike waves
Rx - ? CBZ, TOP, ACTH, VPA

A

Electrical Status Epilepticus During Sleep

50
Q

What is this:
Bihemispheric initial involvement of 3 Hz GSW lasting 3-10 sec
Average age of onset 5.7 yrs (3-9 y/o)
Risk factors – febrile sz; family Hx
Medications – ETX(Ethosuximide), LTG, LEV, VPA, TOP, ZON
Typical = normal IQ, faster SW (3-3.5 Hz), normal background
65% remit by puberty; 15% evolve to JME;
Atypical – slower SW – 1.5-3Hz, abnormal background, lower IQ’s,

A

Absence seizures

51
Q

What are the three types of absence seizures?

A 
childhood absence (3-5 y/o)
juvenile absence (puberty)
Juvenile myoclonic epilepsy (12-18 y/o)
52
Q

What is the most common epilepsy syndrome?

A

Juvenile myoclonic epilepsy

53
Q

What is this:
Most common epilepsy syndrome
Possibly 20% of all epilepsies
Hallmark is myoclonic jerks, fast GSW (4-6 Hz) normal IQ and development
Lifelong (maybe 10% remit)
Onset 5 – absence in 20%, 8-10 – myoclonus, 15 – GTC -60%
Rx – LEV, VPA, LTG, TOP, ZON, CLNZ, LAC(locasamide)?
Several associated gene loci – myoclonic gene involved in spindle body directing cell division and neuronal migration

A

Juvenile myoclonic epilepsy

54
Q

What is this:
13-23 % of all childhood epilepsies = most common
When does this remit?

A

Benign Focal Epilepsy of Childhood (BFEC or Rolandic epilepsy)
-by age 16

55
Q

What is this:
Onset 3-13 y/o, peak 7-8 years
Normal NE, IQ, MRI and EEG background
GTC’s occur in sleep, 15% have in day time also
Partial seizures are unilateral paresthesias +/- clonus of face, lips, tongue. Also salivation, speech arrest but preserved consciousness.
EEG – centro-temporal spikes, high amplitude, triphasic

Is it genetic?

A

BFEC

Yes

56
Q

What is this:
Benign occipital; spikes occipital or anterior
With autonomic onset, autonomic status,

A

Panayiotopolus syndrome

57
Q

What is this:
CTSW bilateral. Focal ones produce focal atonias, when they generalize produce atonic drops. Nocturnal seizures = Rolandic, GTC or jerks. EEG in sleep = ECSWS. All recover

A

Atypical Benign Partial Epilsepy of Childhood

58
Q

What is this:
Boys > Girls. Peak age 2-3. Seizures can appear throughout adulthood
LAUGHTER W/OUT EMOTION 10-30 sec, frequent
Can have autonomic, complex partial GTC as well.
Can be associated with precocious puberty, behavioral and cognitive difficulties

A

Hypothalamic Hamartomas (gelastic) Epilepsy. Rare

Block 8 Week 3 (11 decks)

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