Epilepsy

Question 0

BECTS (benign partial epilepsy of childhood with centrotemporal spikes)

Answer 0

aka Benign Rolandic Epilepsy
most common epilepsy in childhood
onset 4-12yo, outgrown in puberty
*centrotemporal spikes especially w/sleep
*unilateral facial twitching, may spread to arm, just after falling asleep
*tx if needed carbamazepine, keppra

Question 1

Seizure Differential Diagnosis

Answer 1

Breath-holding spells
Syncope
Pseudoseizures (psychogenic nonepileptic seizures)
Sandifer syndrome (back arching d/t GERD)
Infantile self-gratification

Question 2

Myoclonic Epilepsy

Answer 2

catastrophic, poor prognosis

associated w/degenerative syndromes

Question 3

JME (Juvenile Myoclonic Epilepsy)

Answer 3

Combination absence, generalized, myoclonic seizures
Not outgrown
Tx: depakote, topamax, lamictal, keppra

Question 4

Absence Seizures

Answer 4

Childhood (CAE)- 
    5-10yo, outgrown by puberty
    tx: ethosuximide
Juvenile (JAE)-
    7-16yo
    less benign, can be associated w/generalized TC seizures
    tx: depakote or lamictal

Question 5

Infantile Spasms

Answer 5

onset ~6mos
clusters of arm flexion, head bobbing
occur just after awakening
pathognomonic EEG: hypsarrhythmia (high voltage chaotic pattern)
*associated w/Down syndrome, tuberous sclerosis, congenital brain malformations
*better prognosis if cryptogenic- no underlying etiology
*can&raquo_space; Lennox-Gastaut syndrome (disorganized EEG, multiple seizure types)
Tx: ACTH, prednisone, ketonegenic diet, topamax
Vigabatrin if tuberous sclerosis

Question 6

Febrile Seizures

Answer 6

d/t circulating cytokines during illness
often FH
6mos-6yo
Simple: <15min, no recurrence in 24hrs

Question 7

Vigabatrin

Answer 7

Infantile spasms w/tuberous sclerosis

SE: permanent visual field defect

Question 8

Phenobarbital

Answer 8

First choice in neonates
Wean slowly: w/d szr, irritability
Convert to another AED by 1yo d/t cognitive effects

Question 9

Phenytoin

Answer 9

Oldest AED
Long-Term SE: cerebellum atrophy, gingival hyperplasia
Teratogenic: fetal hydantoin syndrome

Question 10

Carbamazepine

Answer 10

Partial-onset seizures
(Can worsen generalized epilepsy)
SE: leukopenia, aplastic anemia
can affect thyroid function

Question 11

Oxcarbazepine

Answer 11

Partial-onset seizures

Hyponatremia

Question 12

Valproic acid

Answer 12

Generalized seizure (especially w/spike-wave EEG)
Mood-stabilizing
SE: weight gain, hair loss, pancreatitis, teratogenic

Question 13

Lamictal

Answer 13

Generalized or absence seizures
Can worsen myoclonic jerks
Titrate dose slowly to avoid Stevens Johnson rash
Drug interaction: lower dose if used w/depakote

Question 14

Ethosuximide

Answer 14

1st line for CAE
May not be enough for JAE
SE: GI upset

Question 15

Topamax

Answer 15

Generalized and partial-onset seizures

SE: acute angle-closure glaucoma, decreased sweating

Question 16

Zonisamide

Answer 16

long ½ life

SE: nephrolithiasis, decreased sweating, weight loss

Question 17

Keppra

Answer 17

Multiple seizure types

SE: irritability in kids