West Syndrome
Age: 3-9 months
Sx: infantile spasms with developmental regression
EEG: Hypsarrythmia
Tx: steroids, viagabatrin, ACTH
Complications: developmental delay, future seizures
Lennox Gastaut
Age: 2-5 years, males more common
Sx: Multiple seizure types, intellectual disability
EEG: slow generalized spike and wave
Tx: valproic avid, benzodiazepines, ketogenic diet
Juvenile myoclonic epilepsy
Sx: myoclonus upon awakening, GTCs
EEG: 4-6Hz spike and wave, increased with photic stimulation
Tx: valproic acid
Juvenile absence
Age: 3-10 years
Sx: multiple daily staring spells, no post ictal
EEG: 3 Hz spike and wave
Ix: brought out with photic and hyperventilation
Tx: valproic acid, ethosuximide
Benign Rolandic
Age: 3-12 years
Sx: normal neurological exam, clusters of focal motor seizures around sleep/wake times, can secondarily generalize
EEG: centrotemporal spikes
Tx: carbamezepine, often will outgrow
Benign focal seizures in infancy
Age: 3-20 months
Hx: normal development
Sx: focal/dyscognitive
Tx: carbamazepine, levitiracetam
Seizure mimics
Syncope Psychogenic Breath holding spell Benign sleep myoclonus Self stimulating benign paroxysmal vertigo
Criteria for febrile seizure
- Fever >38
- Age 6 months to 6 years
- Normal neurological exam before and after event
Simple febrile seizures
- Generalized
- Less than 15 min
- Only one seizure in 24 h
No treatment
Complex febrile seizures
- Focal neurological signs
- Greater than 15 minutes
- More than one in 24 h
Ix: LP, EEG, maybe head CT
Breath holding spells
Involuntary breath holding after noxious stimuli, can be cyanotic or pallid
Headache red flags
Systemic symptoms Neurological findgins Progressive tempo Onset sudden Pressure sx Positional
Cerebral Palsy
Def: non-progressive disorder of movement and posture, due to damage or disordered development before during and after birth
Sx: abnormal tone, developmental delay, feeding difficulties, asymmetry of movement, retained reflexes
Types: spastic*, ataxic hypotonic, dyskinetic
Management: address function