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Flashcards in peds seizure Deck (48):
1

generalized seizures

Tonic clonic (including febrile sz)
Absence
Atypical Absence
Myoclonic tonic (or atonic)

(epileptic encephalopathy: infantile spasms)

2

generalized seizures

Tonic clonic (including febrile sz)
Absence
Atypical Absence
Myoclonic tonic (or atonic)

(epileptic encephalopathy: infantile spasms)

3

partial seizures

Simple Partial Seizure: initial clinical signs begin focally and no impairment of consciousness

Complex Partial: focal neurologic signs with impairment of consciousness (may have secondary generalization)

4

paroxysmal events that are not a seizure

Breath holding spells
Tics
Sleep disorders (ie Night terrors)
GE reflux (Sandifer Syndrome)
ADHD
Pseudoseizures
Migraines
Etc.

5

is a seizure and may be missed

Absence Seizure
Infantile spasms

6

most common peds seizures causes

Fevers
Infections: meningitis
encephalitis
brain abscess
Head injury

7

Perinatal Conditions:

congenital malformations, hypoxic-ischemic injury, hemorrhage, infection, trauma




8

Metabolic Conditions:

hypoglycemia, hypoglycemia, hypomagnesemia, hyponatremia, hypernatremia, storage diseases, Reye syndrome, degenerative disorders, Porphyria,Pyridoxine dependency and deficiency

9

infant tonic clonic seizures

don't look like typical, less shaking, still eye movement, tongue biting

10

poisoning

lead, cocaine, drug toxicity, drug withdrawal

11

Neurocutaneous Syndromes:

Tuberous sclerosis, Neurofibromatosis, Sturge-Weber syndrome,etc.

12

systemic diseases

Vasculitis, SLE, renal failure, hepatic encephalopathy

other: : trauma, tumor, febrile, idiopathic, familial/genetic

13

this hx tidbit is v. important

immunization hx

pneumococcal, hib

14

criteria for febrile seizure

cannot if have other metabolic/neurog. factor
just lowers threshold
(normal CNS for criteria)

15

important fam hx

febrile seizures
migraines
tics or Tourettes’
rheumatic fever or metabolic disorders
meds are in the home
if syncope; add fmhx of SVT, prolonged QTc syndrome

16

most common peds seizures causes

Fevers
Infections: meningitis
encephalitis
brain abscess
Head injury

17

Perinatal Conditions:

congenital malformations, hypoxic-ischemic injury, hemorrhage, infection, trauma




18

50% chance of having second

19

typically walking by

15 mos

20

other seizure causes

trauma, tumor, febrile, idiopathic, familial/genetic

21

at risk for ??? if mom is giving lots of water
or diluting formula

hyponatremia

22

little child may not have tip. ??? if have meningitis

Kurnig, Brudzinski sign
need LP

23

want CSF to be about

50% serum glucose

24

seizures in febrile child

•meningitis
febrile seizure
•encephalitis
•epilepsy
•electrolyte imbalance
•poisoning
•hypoglycemia
•severe myoclonic epilepsy in infancy (Dravet syndrome)(1)
•intracranial lesion, such as(3)◦brain abscess
◦brain tumor
•traumatic brain injury

25

may mimic seizures in febrile child

rigors
•febrile delirium
•breath-holding spell
•syncope

26

cafe au lair spots in...

neurofibromatosis

27

unilateral port-wine facial nevus
CNS aneurysms
seizures

Sturge-Weber syndrome

28

Facial angiofibromas (adenoma sebaceum, hypopigmented ash leaf spots)

tuberous sclerosis

29

von Hippel landauRetinocerebellar Angiomatosis

Rare, dominant inheritance

Retinal and cerebellar hemangioblastomas
Cysts of kidneys, pancreas, epidydimis
Renal cancers

Can present with retinal detachment,
or cerebellar signs from the hemangioblastoma

30

repetitive movements arms forward legs up

infantile spasms
Hypsarrhthmia on EEG
assoc. with tuberous sclerosis
tx with ACTH (not antiepilptics)
can be very severe

31

Kernig:
Brudzinski:

flex hib to 90d, extending the knee
reflex flexion of thighs when pt nk passively flexed
not reliable

32

GI: ??? toxin can cause seizure

Shigella

33

midline defect may imply seizures

??

34

neuro exam

Dysarthria (not able to evaluate in young child)
Visual field deficits (not able to evaluate in young child)
Cranial nerve palsies
Sensory deficits
Focal weakness (Todd’s paralysis
Ignoring ½ body for transient time after)
Babinski (rub on pre-tibial region)
Achilles reflex
Developmental milestones

35

typically walking by

15 mos

36

slide 49, 51

??

37

at risk for ??? if mom is giving lots of water
or diluting formula

hyponatremia

38

lab exam

CBC
Glucose
Electrolytes: Calcium, Magnesium
Ammonia (?)
Urine toxicology
Anticonvulsant levels (if on meds)
Consider: LP
imaging based on hx
eeg (usually not done emergently)

39

want CSF to be about

50% serum glucose

40

classic febrile seizure

Brief Generalized seizure
Seizure less than 15 minutes
Fever on presentation
Normal developmental history
often ….Positive family history of febrile Seizure
*No CNS infection
*typical age: 6months to 60 months (5 years)

41

febrile seizures

Occur AFTER 1 month of age
Associated with febrile illness but NOT CNS infection
No hx of neonatal or other seizures
Typical ages 6m to 5years
Incidence 3-8%

42

risk of febrile seizure reoccurrence is

60%
2-7% with febrile sz have risk of developing epilepsy
Risk factors for epilepsy: fmhx of epilepsy, complex febrile sz, neurodevelopmental abnormalities

43

febrile seizure risk factors

Peak temperature during illness
Hx of febrile sz in first degree relative
Increased exposure to HHV-6
Vaccinations with MMR, DTaP, influenza vaccines
50% have no risk factors
Sodium channel mutations
see slide 68 for tx

44

febrile seizure tx: antipyretics

While will not prevent febrile seizure, may make febrile child more comfortable

45

ash leaf spots

tuberous sclerosis

46

repetitive movements arms forward legs up

infantile spasms
Hypsarrhthmia on EEG
assoc. with tuberous sclerosis
tx with ACTC (not antiepilptics)
can be very severe

47

febrile seizures in kids ages: ??

50% chance of having second if

6 mos - 6 yrs


have seizure when

48

+ babinski up to

18 mos
do pre-tibial instead