Epilepsy Case Based Learning Flashcards
Which features of febrile seizures indicate an increased of underlying epilepsy?
1) Duration of seizures > 15 minutes
2) Focal or partial seizure (vs. generalized)
3) Repetitive seizure episodes within a 24 hour period of illness/ fever
These risk factors are independent and additive, and one study found up to a 49% risk of developing epilepsy if all three were present in the sam patient.
Most children with febrile seizures have only one
What is the most important risk factor for the development of epilepsy?
Having an abnormal neurologic profile or underlying brain injury is still the most important risk factor for development of epilepsy
Describe the prevalence and epidemiology of febrile seizures.
EPIDEMIOLOGY
–Febrile seizures are a common childhood occurrence and generally considered benign, the seizure susceptibility resulting from an age-related lowered seizure threshold.
-They have been classified according to features that help tease out an underlying epilepsy susceptibility (i.e. afebrile, recurrent seizures) from the garden variety, benign typical febrile seizures, which account for the vast majority of infants
PREVALENCE
-Febrile seizures affect about 5% of children between ages 6 months and 6 years, the vast majority clustering around 16-22 months.
What is the risk of epilepsy in children with febrile seizures vs. the general population?
Risk of epilepsy:
children with febrile seizures- 2%
general population- 1%
Do neurologists and pediatricians treat febrile seizures?
NO
Overall, as a group, children with febrile seizures do have a higher rate of epilepsy than the general population, but this remains low at 2% versus the population risk of 1% (these numbers may be underestimates but still underscore the reason pediatric neurologists and pediatricians generally do not treat febrile seizures).
Case #1
QD, a 20-year-old college student, was noted to be acting peculiarly on New Year’s Day, having been awake all the previous night at a fraternity party. His roommate related that QD, while discussing the night’s events, began to complain of an unpleasant burning odor. Abruptly, he began sniffing the air. This was followed by repetitive smacking and licking of his lips followed by chew¬ing and swallowing motions. He did not seem to be aware of his immediate environment and would not respond to questioning. He rose and paced rapidly about the room. His roommate tried to lead him to his bed but QD forcefully shoved him aside, and rushed, as if frightened, into the winter cold, clad only in his pajama bottoms. Approximately 3 minutes had elapsed from the onset of the episode when Q sat down in the snow, appearing very fatigued and looking about with a dazed expression. He asked his pursuing roommate what had happened.
Further questioning at the emergency department revealed that Q could recall only the acrid odor “like burning rubber” which was no longer present, and an undesirable feeling in his stomach. The remainder of the episode was related by his roommate. He reports that mother told him that when he was 2 years old he had a high fever and a prolonged seizure, but he did not know any more detail.
The complete general physical and neurological examinations were normal.
Summarize the Case.
Patient has an olfactory aura as well an epigastric aura, followed by oral automatisms and altered awareness. This is followed by postictal confusion. This represents a focal seizure with impaired consciousness (complex partial seizure.)
