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Flashcards in Pediatric Epilepsy Deck (32):
1

Non-Epileptic Events

-breath holding spells
-hyperventilation attacks
-motor tics
-movement disorders
-parasomnias (nightmares, terrors, sleep walking)
-syncope
-spasmus nutans
-remination
-sleep myoclonus
-head banging

2

Psychogenic nonepileptic seizures (PNES)

-previously known as pseudoseizures
-paraoxysmal episodes that resemble epileptic seizures; PNES are psychological in origin
video EEG monitoring is an epilepsy monitoring unit (EMU) is helpful in diagnosis of this condition
(epileptiform activity is seen during seizures but NOT during psychodenic nonepileptic seizures)
some patients have both types of events

3

Who has seizures?

-anyone

4

Seizure Precautions

-showers are recommended rather than baths (must be supervised to prevent drowning)
-swimming should always be supervised
-biking & roller blading
-no driving for 6 months after seizure in TN

5

Seizure First Aid

-stay calm & with child
-protect child from injury (move away sharp stuff)
-do not hold them down, turn on side
-do not put anything in mouth or try to hold tongue, impossible to swallow tongue (can wipe excess saliva)
-something flat & soft under head

6

Seizure in Hospital

-ABCs: place patient on side, give oxygen
-ask nurse to give benzodiazepine (lorazepam, midazolam, diazepam)
-consider loading with an antiepileptic med

-if not sure: get EEG before you treat
-longer seizure lasts, the harder it is to treat

7

Classification of Seizures

-Partial/Focal
-Generalized

8

Partial Seizures

-those in which the 1st clinical & EEG changes indicate initial activation of a system of neurons limited to part of one cerebral hemisphere
-2 types: simple & partial (is consciousness impaired)

9

Generalized Seizure

-are those in which the first clinical changes indicated initial involvement of both hemispheres

10

Impaired Consciousness

-inability to respond normally to exogenous stimuli

11

Simple Partial Seizure

-consciousness preserved

12

Complex Partial Seizure

-consciousness is impaired

13

Absence Seizures

-Generalized Seizures
-characterized by sudden onset of interruption of activity (if walking will stop)
-usually the patient will be unresponsive if spoken to
-lasts a few seconds to half a min
-stops as rapidly as it started
-may be induced with hyperventilation
-no warning

14

Febrile Seizures

-most common type of childhood seizures, affecting 2-5% of children in USA
-peak incidence at 18 months of age
-occur in febrile children b/w 6-60 months who do not have intracranial infection, metabolic disturbance or history of afebrile seizures

15

Classicfication of Febrile Seizures

-Simple: isolated (once in 24 hr period), generalized brief (15min), associated with higher risk of afebrile seizures but not of febrile seizure recurrence

16

Recurrence of Febrile Seizures

-32% have recurrent (9% 2 times, 6%>3 times)
-90% of children have recurrence within 1 yr onset
-Risk Factors for Recurrence:
young age at onset <1hr)

17

Risk Factors for Epilepsy in Children with Febrile Seizures

-complex febrile seizures
-a family history of epilepsy
-neurologic impairment prior to the febrile seizure

18

Neurodiagnositc Evaluation of Child with 1st Simple Febrile Seizure

-Practice Guideline
*Lumbar puncture: strongly considered in 12, <18 month, strongly considered in all children on prior antibiotic treat.
*EEG: should not be performed in evaluation of neruologically healthy with first simple febrile seizure
*Blood Studies: should not be routinely performed (electrolytes, Ca, Mg, CBC), lab testing directed towards identifying fever source
-Neuroimaging: should not be performed

19

Long-term management of child with Simple Febrile Seizures

-anticonvulsant therapy for kids with 1 or more simple febrile seizures
-if parental anxiety is severe give oral diazepam at onset of febrile illness to prevent recurrence
-antipyretics do not prevent seizures
-discharge patient with Diastat prn seizure more than 3 min or seizure cluster (do not administer Diastat until dr. says its safe)

20

Evaluating a First Non-Febrile Seizure in Children

-immediate: stabilization of the child, determine if a seizure has occurred, determine the cause of seizure
-Lab: individual circumstances, chemistries, CBC, tox screen considered
-Lumbar Puncture: optional (meningitis?)
-EEG: recommended, focal slowing, epileptiform discharges predictive of seizure recurrence (helps tell seizure type)
-Neuroimaging: MRI

21

Epilepsy

-occurrence of multiple unprovoked seizures separated by more than 24 hrs

22

Infantile Spasms

-onset 3-6 months
-seizures: brief bilateral symmetric conc. of the muscles of the neck, trunk, & extremities (flexor spasms, head is flexed arms extended, legs are drawn up, may cry or giggle, flush or pale or cyanotic, stomach crunches)
-extensor spasma - extension of arms, legs, trunk
-head nodding or lightening attacks which have single, momentary shock-like contraction of the entire body

23

EEG of Infantile Spasms

-hypersarrhythmia, b/w seizures there is high voltage, chaotic activity, diffuse voltage depression during seizures

24

West Syndrome

-triad of infantile spasms, hyperrhythmia, & developmental arrest/regression

25

Lennox-Gastaut

-onset 1 to 8 yrs
-some of the patients have had infantile spasms (9-39%)
-Triad of specific seizures, specific EEG, and mental deficiencies (at least 2 seizure types: tonic, atypical absence and atonic seizures, slowing of mental development, "slow spike & wave"" of 1.5-2.5Hz)

-life long, difficult to control

26

Treatment of Lennox-Gastaut

-valproic acid, lamotrigine, topiramate, zonisamide, felbamate, benzodiazepines
-ketogenic diet
-corpus callostomy
-vagus nerve stimulator

27

Childhood Absence Epilepsy

-onset 4-8 yrs
-normal neurologic status
-absence seizures occur multiple times per day
-generalized 3 Hz spike-and-wave discharges (may be triggered by hyperventilation)
-normal EEG background
-ethosuximide treatment if patient only has absence seizures, but CAE may also be treated with valproic acid or lamotrigine
-tegretol may worsen seizures
-benign outcome, treat 2-3 yrs

28

Juvenile Myoclonic Epilepsy

-onset in adolescence
-seizures may be tonic-clonic, myoclonic or absence
~7-13 yrs onset for absence, myoclonic jerks is 12-18 yrs, generalized tonic-clinic seizures 13 to 20 yrs
-brief, bilateral but not always symmetric, flexor jerks of the arms which may be repetitice
-jerks sometimes affect the legs, causing the patient to fall
-(highest frequency of myoclonic jerks is in morning, consciousness retained)
-Diagnosis is often delayed until a generalized tonic-clonic seizure brings the patient to medical attention

29

Juvenile Myoclonic Epilepsy Seizures

-precipitated by sleep deprivation, alcohol ingestion, stress, & awakening from sleep
-menstruation may also trigger
-photic stimulation is a precipitating factor
-neurologic examination is normal
-neuroimaging is normal

30

Juvenile Myoclonic Epilepsy Treatment

-usually requires life-long treatment
-valproic acid, topiramate, levetiracetam, lamotrigine, zonisamide
-Hereditary disorder (AD), linked to chromosome 6

31

Benign Rolandic Epilepsy

-most common form of benign partial epilepsy of childhood
-epileptiform discharges arise from lower Rolandic area of the brain
-also known as benign epilepsy with centrotemproal spikes and benign focal epilpsy of childhood

32

Benign Rolandic Epilepsy 2

-onset 4-12 yrs, peak at 8-9 yrs
-normal neurologic status & imaging
-most specific type of seizure: facial motor seizures
-most common presentation: nocturnal generalized tonic-clonic seizures (80% of patients)
-usually respond to carbamazepine or valproate but may not need to be treated
-seizures usually remit by age 14-16
-characteristic EEG findings: central-temproal spikes