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Flashcards in A Childs first seizure Deck (37):
1

unfunny facts:

-theyre common
-4-6% will have a seizure by 16
-transient, involuntary event caused by abnormal rhythms discharges from a group of neurons in the brain
-characterized by alterations of consciousness, behavior, motor skills, or sensation

2

most common cause of seizures in kids:

fever

3

seizure causes in kids:

fever
-idiopathic
-congenital malformation
-metabolic abnormalities
-infections
-trauma
-vascular event
-tumor
-drugs/poison

4

what to do if theres a seizure:

-walk, don't run, look at you watch
-assess ABCs
-place patient on side
-O2, O2 sat, monitor, IV access, bedside glucose
-intervene medically if needed for seizure if >3 min

5

pre-seizure focused history:

-well prior to event?
-hx of seizures
-hx of fever/ recent infections
-recent antibiotics
-recent trauma
-adult Rx medications, toxic ingestions

6

seizure focused hx:

-eye deviation, blank stare, drooling, cyanosis, incontinence
-generalized vs focal
-duration
-responsive or responsive

7

post-seizure focused hx:

-single or multiple
-mental status after event
-EMS observations at time of arrival

8

PMH to find out for seizures:

Neurosurgical procedures (VPS)
Prematurity, developmental delay
History of meningitis, CNS infections
History of head trauma
Hypercoagulable states (sickle cell disease)
Immunosuppression

9

social hx seizures:

Toxic exposures
Adult Rx medications in the home
TB exposures/access to INH
Formula mixing

10

physical exam post seizure:

Vital signs (rectal temp)
General appearance and mental status
Focused exam
Focal neurologic deficits
Signs of increased ICP (bulging fontanelle, papilledema)
Skin lesions (Ashleaf spots, shagreen patch, café au lait)
Nuchal rigidity
Poor perfusion
Altered motor tone
Prolonged post-ictal lethargy
Generalized petechiae

11

categorize the seizure:

Febrile seizure
Seizure with epilepsy syndrome
Seizure without epilepsy syndrome

12

Criteria for febrile seizure:

Seizure associated with fever > 100.4 (most have temp > 102)
Child less than 6 years
No signs of CNS infection, no meningeal signs
No acute metabolic abnormality
No history of prior afebrile seizures

13

febrile seizure facts:

- 2-5% of kids less than 5
-6 months to 6 years
-peak 12-18 months
-majority on first day of illness
-often first indication child is sick

14

predisposing febrile seizure factors:

-viral or bacterial infections
-after DTP or MMR vaccine
-familial

15

simple febrile seizures:

-less than 15 min
-generalized
-no focal features
-does not recur within 24 hrs

16

complex febrile seizures:

-last more than 15 min
-focal features or postical paresis (Todd's paralysis)
-recurrence within 24 hrs

17

eval and management of febrile seizure:

-stabilize pt
-focused hx and physical
-categorize seizure
-determine probability of intracranial infection and acute bacterial meningitis
-determine need for diagnostic studies
-establish disposition

18

Features that increase risk of ABM:

Illness > 3 days
Physician visit within last 48 hrs
Current antibiotics for extracranial infection
Immunocompromise
Unvaccinated child
Multiple seizures
Prolonged post-ictal phase

19

New AAP guidelines 2011 for LP:

LP indicated in children with obvious meningeal signs
LP is AN OPTION in children 6-12 months
Deficient in Hib and S. pneumoniae immunizations
Pretreated with antibiotics

20

ABM concerning exam findings:

Focal neurological deficits
Altered motor tone
Nuchal rigidity
Poor perfusion
Generalized petechiae

21

Status and fever greater risk for...

meningitis

22

disposition of simple febrile seizure:

-back to baseline and reassuring hx and physical can be discharged

23

febrile seizure prognosis:

-33% experience recurrent febrile seizure
-2% risk of epilepsy

24

Factors that increase recurrence risk:

Young age onset ( < 1 year)
Family history of febrile seizure
Baseline developmental delay
Complex febrile seizure

25

Reduction in temperature with acetaminophen or ibuprofen reduces the risk of subsequent febrile seizures? (t/f)

false

26

antipyretics use in febrile seizures:

Antipyretics recommended for patient comfort
Does not affect recurrence rate of febrile seizures

27

preventative tx for febrile seizures:

Neither continuous or intermittent anticonvulsant therapy recommended for children with simple febrile seizures
Risks and side effects of anticonvulsants outweigh the benefits of treating
Rectal diazepam for prn use an option

28

discharge instructions:

Give parents information about what to do
Safe place
Place child on his/her side
Nothing in mouth
Chin lift/jaw thrust
When to call EMS

29

indications for admission:

Prolonged postictal phase
Complex febrile seizure
Age < 6 months
Social concerns
Inability of caretakers to provide appropriate observation
Prolonged distance to medical care

30

Febrile Seizure Pearls

Majority are simple febrile seizures
Laboratory evaluation and neuroimaging not indicated in simple febrile seizures
Prophylactic anticonvulsants not recommended
Parental education key
33% will have recurrence
Approximately 2% will develop epilepsy

31

infantile spasms epilepsy syndrome eval:

Need urgent EEG, MRI, and metabolic evaluation with neurology consultation
Mortality as high as 15-20%
Only 5-10% or children with infantile spasms have normal intelligence

32

epilepsy syndrome tx:

Absence: ethosuximide, valproic acid, lamotrigine, levetiracetam

JME: valproic acid, topiramate, levetiracetam

BECTS:
May not require therapy; outgrow by adulthood
Can use same AEDs used to treat partial seizures
Responsive to carbamazepine

Infantile Spasms: ACTH, steroids, zonisamide, topiramate, vitamin B-6

Lennox-Gastaut Syndrome
Often requires multiple medications

33

non epilepsy sz tx?

Majority of children with first unprovoked seizure will have few or no recurrences
~10% will go on to have many seizures regardless of therapy
Treatment with AED after a first seizure as opposed to after a second seizure has not been shown to improve prognosis for long-term seizure remission

34

admission criteria for non epilepsy:

Age (< 6 months)
Etiology of seizure
Seizure control
Social concerns
Inability of caretakers to provide appropriate observation
Prolonged distance to medical care

35

pearls:

Seizures in children are common
Most first time seizures in children are febrile seizures
Evaluate the fever, not the seizure
LP not indicated in well appearing, immunized children who present with a simple febrile seizure
Most children with a non-febrile seizure will require an EEG and neuroimaging but rarely needed emergently
Exception is infantile spasms
No benefit in initiating anticonvulsant therapy after first seizure as opposed to second seizure

36

most common cause of neonate sz?

HIE

37

neonate sz tx?

phenobarbital