Pediatric Seizure Principles Flashcards
(41 cards)
Status epilepticus is a medical emergency where…
Any recurrent or continuous seizure activity lasting 30+ minutes where the patient does not regain baseline mental status
Any seizure that does not stop within ____ should be treated as impending status epilepticus
5 minutes
Patients are often given ____ to use at onset of seizures to decrease risk of progression to status epilepticus
On demand benzodiazepines PRN
BZD’s used in pediatrics include…
Injectable midazolam via nasal atomizer
Infants - rectal diazepam
Epilepsy syndromes refer to…
Cluster of features that may occur together
Including seizure type, EEG findings, imaging findings, age-dependent features, specific comorbidities, triggers, + prognosis
Some examples of epilepsy syndromes include…
Childhood absence epilepsy
Juvenile absence/myoclonic epilepsy
Lennox-Gastuat Syndrome
Dravet Syndrome
Ethosuximide is a ____ ASM.
Narrow-spectrum
Ethosuximide is only indicated for…
Absence seizures
NOT FOR ANY OTHER SEIZURE TYPE
Advantages of ethosuximide include…
Lower rates of attention difficulties compared to VPA
Works quickly
Generally well tolerated
Few drug interactions
Disadvantages of ethosuximide is primarily its…
Narrow-spectrum of activity
Only a good choice to use for uncomplicated absence seizures
Potential AE’s with ethosuximide include…
CNS effects (drowsiness, dizziness, behavioural)
GI effects
Rare - blood dyscrasias, skin rashes
Monitor CBC + platelets annually for rare
Infantile epileptic spasm syndrome decribes…
Epileptic spasms that most often occur in “clusters” on awakening, and involve tonic limb flexion/extension
May have distinctive, disordered EEG = hypsarrhythmia
May have psychomotor arrest
Ideally, infantile epileptic spasms syndrome should be treated early + aggressively to prevent…
Long-term sequelae - intellectual delays, refractory seizures
Treatment options for infantile epileptic spasms syndrome include…
Hormonal therapy
Vigabatrin
Other ASM’s are ineffective
MOA of vigabatrin is
Irreversible inhibition of GABA-transaminase, leading to increased GABA concentrations in the CNS to increase neuro inhibition
AE’s with vigabatrin include…
Visual abnormalities, including permanent vision loss
Vomiting, URTI’s
Asymptomatic MRI changes
Lennox-Gastaut Syndrome presents with…
Multiple drug-resistant seizure types (tonic, atonic, atypical absence, tonic-clonic)
Typical EEG pattern
Intellectual disability - comorbid neurodevelopmental and behavioural disorders
Some options for LGS treatment include…
Valproate
Rufinamide
Lamotrigine
Combo treatment for LGS is likely due to…
Multiple seizure types
Rufinamide MOA is…
Unknown - prolongs inactive state of sodium channels
Rufinamide is approved for…
Adjunctive treatment of seizures associated with LGS in patients 4+
Some AE’s with rufinamide include…
CNS - headache, drowsiness, dizziness, fatigue, trmeor
GI - vomiting, nausea
Shortened QT interval
Multiorgan hypersensitivity
Dravet syndrome encompasses…
Drug-resistant developmental and epileptic encephalopathy - seizures of various types + progressive cerebral atrophy
Poor prognosis
80% of dravet syndrome cases are due to ____. This is significant because…
Loss of function mutation in sodium channel gene. Sodium channel blocking ASM’s are not effective
