Pediatric Epilepsy

Question 1

Origin of psychogenic nonepileptic seizures (PNES)?

Answer 1

Psychological

Question 2

How do you distinguish between a PNES and epileptic seizures?

Answer 2

Epileptiform activity on an EEG is seen in Epileptic seizures but NOT PNES

Question 3

Who can have seizure?

Answer 3

Anyone

Question 4

Types of seizure?

Answer 4

Partial/Focal

Generalized

Question 5

Partial seizures?

Answer 5

Those in which the first clinical and EEG changes indicate initial activation of a system of neurons limited to part of ONE cerebral hemisphere

Question 6

Generalized seizures?

Answer 6

Those in which the first clinical changes indicate initial involvement of BOTH hemispheres

Question 7

Impaired consciousness?

Answer 7

Inability to respond normally to exogenous stimuli

Question 8

Characteristics of absence seizures?

Answer 8

Sudden onset of interruption of activity
Unresponsive if spoken to
Lasts a few seconds to half a minute
May be induced with HYPERVENTILATION

Question 9

Most common type of childhood seizures?

Answer 9

Febrile seizures

Question 10

Febrile seizures?

Answer 10

Seizures that occur in febrile children between the ages of 6 and 60 months who do not have an intracranial infection, metabolic distubance, or hx of afebrile seizures

Question 11

Simple febrile seizures?

Answer 11

Isolated (once in a 24-hr period)
Generalized
Brief (<15 mins)
Majority

Question 12

Complex febrile seizures?

Answer 12

Multiple (occur more than once in a 24-hour period)
Focal
Prolonged (>15 mins)
Associated with higher risk of AFEBRILE seizures but NOT febrile seizures

Question 13

Risk factors for febrile seizure recurrence?

Answer 13

Young age at onset (<1 hr)

Question 14

Risk factors for epilepsy in children with febrile seizures?

Answer 14

Complex febrile seizures
FHx of epilepsy
Neurologic impairment prior to the febrile seizure

Question 15

Children with FSE are at risk for?

Answer 15

Acute hippocampal injuries

Abnormalities in hippocampal development

Question 16

What infections are commonly associated with FSE?

Answer 16

HHV-6B

HHV-7

Question 17

Epilepsy?

Answer 17

Multiple UNPROVOKED seizures separated by more than 24 hours

Question 18

When do infantile spasms appear?

Answer 18

3 to 7 months

Question 19

Characteristics of infantile spasms seizures?

Answer 19

Brief bilateral symmetric contraction of the muscles of the neck, trunk, and extremities
Most commonly Flexor spasms are seen
“Stomach Crunches” reported by patents

Question 20

What does an EEG show in a pt during an infantile spasms?

Answer 20

Hypsarrhythmia

Question 21

West syndrome?

Answer 21

Triad of infantile spasms, hypsarrhythmia, and developmental arrest/regression

Question 22

Onset of Lennox-Gastaut?

Answer 22

1 to 8 years

Question 23

Lennox-Gastaut triad?

Answer 23

At least 2 seizure types
Slowing of mental development
EEG showing “slow spike and wave”
-slow background, bursts of diffuse slow spike-wave patters of 1.5-2.5 Hz

Question 24

Onset of Childhood Absence Epilepsy (CAE)?

Answer 24

4-8 yrs

Question 25

Characteristics of CAE?

Answer 25

Absence seizures occur multiple times per day May be triggered by hyperventilation Generalized 3 Hz spike-and-wave discharges

Question 26

Onset of juvenile myoclonic epilepsy?

Answer 26

Adolescence

Question 27

Types of seizures seen in juvenile myoclonic epilepsy?

Answer 27

Tonic-clonic (13-20 yrs) Myoclonic (12-18 yrs) Absence (7-13 yrs)

Question 28

Myoclonic seizures?

Answer 28

Brief, bilateral but not always symmetric, flexor jerks of the arms Highest frequency in the morning Pt is conscious

Question 29

What can be juvenile myoclonic epilepsy be precipitated by?

Answer 29

``` Sleep deprivation Alcohol ingestion Awakening from nocturnal or daytime sleep PHOTIC stimulation Menstration ```

Question 30

Genetics behind Juvenile myoclonic epilepsy?

Answer 30

AD --> chromosome 6

Question 31

Most common form of benign partial epilepsy of childhood?

Answer 31

Benign Rolandic Epilepsy (BRE)

Question 32

Where do epileptiform discharges arise from in BRE?

Answer 32

Rolandic (Central) area of the brain

Question 33

Onset of BRE?

Answer 33

4-12 yrs peak 8-9 yrs

Question 34

Most common presentation of BRE?

Answer 34

Nocturnal generalized tonic-clonic seizures

Question 35

Most specific type of BRE?

Answer 35

facial motor seizures