Pediatric neurology I

Question 1

epilepsy is the occurrence of at least ____ unprovoked seizures

Answer 1

2

Question 2

what is seizure?

Answer 2

clinical manifestation of abnormal hyper synchronous discharge of the cortical neurons

Question 3

what is the other name for a tonic clonic seizure?

Answer 3

grand mal

Question 4

what is the primary difference between simple partial and complex partial seizures?

Answer 4

• simple partial: no loss of consciousness

- complex partial: loss / alteration of consciousness

Question 5

what are the features that constitute epilepsy?

Answer 5

• type
• age of onset
• course
• characteristic EEG abnormalities
• drug of choice

Question 6

what is the duration / onset / provocation / and age onset for childhood absence epilepsy?

Answer 6

• duration: usually less than 20 seconds with multiple seizures throughout the day
• onset: sudden onset and resolution (no post ictal confusion or sleepiness)
• provoked by: hyperventilation
• age onset: 4-14 years

Question 7

what is the EEG finding in childhood absence epilepsy?

Answer 7

generalized 3 Hz spike and slow wave discharges

Question 8

what is the treatment for childhood absence epilepsy?

Answer 8

• ethosuxamide (primary)
• valproic acid
• lamotrigine

Question 9

what are the seizure characteristics for benign childhood epilepsy with centrotemporal spikes (Rolandic epilepsy)?

Answer 9

• infrequent partial seizures
• tingling in mouth, face, drooling, dysphagia, speech arrest
• unilateral upper extremity movement
• rare generalized tonic clinic seizures

Question 10

what are the EEG findings in benign childhood epilepsy with centrotemporal spikes (Rolandic epilepsy)?

Answer 10

centrotemporal spikes

Question 11

what is the treatment for benign childhood epilepsy with centrotemporal spikes (Rolandic epilepsy)?

Answer 11

carbamazepine or oxcarbazapine

Question 12

when do most benign childhood epilepsy with centrotemporal spikes (Rolandic epilepsy) seizures occur?

Answer 12

while sleeping or on awakening

Question 13

what are the EEG findings in juvenile myoclonic epilepsy?

Answer 13

3-6 Hz polyspikes and wave

Question 14

juvenile myoclonic epilepsy can be provoked by _________ and triggered by _________________

Answer 14

• photic stimulation

- AM awakening, lack of sleep, fatigue, ETOH

Question 15

what is the treatment of choice for juvenile myoclonic epilepsy?

Answer 15

• valproate (avoid in adolescent girls)

- can also use levetiracetam, lamotrigine

Question 16

is juvenile myoclonic epilepsy a lifelong condition or specific to juvenile aged patients?

Answer 16

lifelong

Question 17

febrile seizures occur in what age range?

Answer 17

3 months - 6 years

Question 18

what is the most common seizure in children?

Answer 18

febrile

Question 19

what is the duration and frequency of simple febrile seizures? what if it is more frequent / longer?

Answer 19

• 15 minute duration, once per day

- if more than that, it is a complex febrile seizure

Question 20

what should be the first concern for febrile seizure (pathogen)?

Answer 20

meningitis

Question 21

how do you differentiate between febrile seizure and meningitis?

Answer 21

history and possibly LP

Question 22

what is the diagnostic workup for febrile seizure?

Answer 22

• LP for meningitis s/sx
• LP for children 6-12 months of age if not vaccinated for HIB / s. pneumo
• LP for patient taking abx
• CBC / electrolytes / blood sugar / Ca / Mg
• imaging: heat CT, MRI (**NOT FOR SIMPLE FEBRILE)

Question 23

is CT / MRI indicated for simple febrile seizure? what about EEG?

Answer 23

NO (to both)

Question 24

what is the treatment for febrile seizure?

Answer 24

• seizure abortion: benzodiazepine (if longer than 5m)
• febrile status epilepticus: treat like afebrile
• prophylactic antiepileptic medications are not indicated given benign nature

Question 25

what are the 3 types of infantile spasm?

Answer 25

- flexion: sudden flexion of legs, arms, neck, head - extension: sudden extension of head, neck, arms - mixed: flexion of head and arms with extension of legs

Question 26

what are the features of infantile spasm?

Answer 26

- occur in clusters - occur on awakening from sleep - usually associated with developmental arrest or regression

Question 27

what are the different etiologies of infantile spasm?

Answer 27

- symptomatic IS: identified etiology and / or significant developmental delay - cryptogenic IS: no known etiology and normal development

Question 28

what are the causes of infantile spasm?

Answer 28

- CNS malformation (*common cause*) - tuberous sclerosis (*common cause*) - hypoxic ischemic encephalopathy - inborn error of metabolism - chromosomal abnormalities - congenital infection

Question 29

infantile spasm is associated with what characteristic EEG abnormality?

Answer 29

hypsarrhythmia

Question 30

hypsarrhythmia on EEG indicates what condition?

Answer 30

infantile spasm

Question 31

what is the treatment for infantile spasm? what about infantile spasm due to tuberous sclerosis?

Answer 31

- ACTH | - vigabatrin

Question 32

vigabatrin is reserved for what condition?

Answer 32

infantile spasm due to tuberous sclerosis

Question 33

what test should follow vigabatrin administration? why?

Answer 33

eye exam - side effect is visual field restriction that could be permanent)