Pediatric Seizures Flashcards
(54 cards)
A seizure is:
a) Excessive asynchronous neuronal activity
b) Reduced asynchronous neuronal activity
c) Excessive synchronous neuronal activity
d) Reduced synchronous neuronal activity
c.
Adjusting antiseizure medications (ASMs) is:
a) Complex
b) A unique opportunity to flex pharmacist knowledge
c) Best left to neurologists
d) A & B
e) A & C
d
Status epilepticus is a _______ _________
medical emergency
What is status epilepticus? (2)
- Any recurrent or continuous seizure activity lasting > 30 minutes in which the patient does not regain baseline mental status
- Or a cluster of seizures that does not return to baseline for > 30 mins - Any seizure that does not stop within 5 minutes should be treated as impending SE
- Operationally seizures lasting >5 mins or repetitive seizures for > 5 min are treated as SE to prevent consequences and increase response to tx
Explain what t1 and t2 of seizure frequency means
t1 = When a seizure is likely to be prolonged leading to continuous seizure activity
t2 = When a seizure may cause long term consequences (including neuronal injury, neuronal death, alteration of neuronal networks and functional deficits)
What class of drugs and what dosing frequency is often given to pts for acute seizure treatment to reduce risk of progression to status epilepticus?
On demand BZDs to use prn at the onset of seizures to decrease risk of progression to SE
What are the treatment options for pediatrics (> 3 months) to treat acute seizure/reduce risk of progression to status epilepticus? (2)
- Midazolam intranasal 0.2 to 0.3 mg/kg/dose or buccal 0.2 to 0.5 mg/kg/dose (max 10mg)
- Injectable midazolam (5 mg/mL concentration preferred)
- Via nasal atomizer for nasal administration; split dose into each nostril - Not as common but lorazepam buccal 0.1mg/kg (max 4mg) could be used too.
What are the treatment options for infants (< 3 months) to treat acute seizure/reduce risk of progression to status epilepticus?
Rectal diazepam 0.5mg/kg/dose (max 20mg) - tend not to use because pretty traumatic for both the patient and the caregivers
Explain how to administer intranasal midazolam
- Nasal atomizer - creates fine mist as you push the solution through it. (That’s the cone looking thing).
- Key things are midazolam need syringes, mucosal atomizer needed to administer. Atomizer can be re-used. Tilt the pt’s head back. Go in, give a quick push and gently atomize it. Split the dose between both nostrils to maximize surface area for absorption.
The etiology of seizures is unknown, but what are some potential factors/causes? (6)
- Structural
- Genetic
- Infectious
- Metabolic
- Immune
- Unknown
Define a focal seizure
Starting/affecting one hemisphere of the brain
Define a generalized seizure
Starting/affecting both hemispheres at the same time
Define epilepsy syndromes
Refers to clusters of features that may occur together, including seizure type, EEG findings, imaging findings, age-dependent features (e.g., age at onset or remission), specific comorbidities (e.g., psychiatric illness), triggers and sometimes prognosis
What are the 2 main epilepsy syndromes we talked about?
- Lennox-Gastaut Syndrome (LGS)
- Dravet syndrome
What are the clinical features of LGS? (2)
- Tonic, atonic, myoclonic seizures
- Atypical absences
What are the clinical features of Dravet syndrome? (3)
- Prolonged, often febrile, clonic seizures.
- Repeated febrile and afebrile seizures.
- Myoclonus common
1st line for absence seizures is?
Ethosuximide
Ethosuximide for other seizure types?
No, only absence seizures. Do not use as monotherapy if mixed seizure types, even if one of these is absence seizures
What are the advantages of ethosuximide? (4)
- Lower rates of attention difficulties compared to VPA
- Works quickly
- Generally well-tolerated
- Few drug interactions
What is the disadvantage of ethosuximide? (1)
Narrow-spectrum of activity
- Only a good choice to use for uncomplicated absence seizures
- Does not confer protection for generalized tonic-clonic seizures
What are the adverse effects of ethosuximide? (3)
- CNS effects
- Drowsiness, dizziness, behavioural changes - GI effects
- Dose-related 🡪 Can divide dose to minimize - Rare: blood dyscrasias, skin rashes
What should be monitored when on ethosuximide? (2)
CBC and platelets (annually)
What is infantile epileptic spasms syndrome? (3)
- Epileptic spasms most often occur in “clusters” on awakening and involve tonic limb (+/- head) flexion or extension:
- Each spasm lasts less than 3 seconds
- Repeats every 5 to 10 seconds
- For a period of 5 to 15 mins - May have a distinctive, disordered EEG pattern called hypsarrhythmia
- May have psychomotor arrest
How should infantile epileptic spasms syndrome be treated?
Treat early and aggressively to prevent long-term sequelae (e.g., intellectual delays, refractory seizures)
