Epilepsy: Continuum (Pediatrics) and Rowan's Ch 5-7 Flashcards
3 Indications for Routine EEG
initial assessment
after AED introduction
After AED cessation
4 indications for cEEG
Pre epilepsy surgery To detect subclinical seizure Psychogenic non-epileptic attacks Refractory epilepsy Status Comatose pt without clear cause
4 Elements of assessing the Background
Organization
Symmetry/frequency
Reactivity
Continuity
Systematic approach to EEG (ACNS guideline) “BDASIC”
Background, Discharges/patterns, activation procedures, events/seizure, Impression, clinical correlation
What is Normal Organization
PDR present with normal A-P gradient. Describe Sleep stages and transients.
What is normal symmetry
No focal slowing
West Syndrome:
Onset and semiology
<2 years old / clusters of neck/truncal flexion with arm abduction often seen in the AM
West Syndrome:
Clinical triad
Psychomotor arrest, hypsarrhythmia and spasms
What is hypsarrhythmia
Seen in West Syndrom. High amplitude slow waves on a background of irregular multifocal spikes.
West Syndrome:
Treatment
ACTH first line. Vigabatrin in tuberous sclerosis.
Dravet Syndrome (severe myoclonic epilepsy of infancy): Onset and Semiology
< 2 years old. Hemiconvulsions with myoclonic and atypical absence
Dravet Syndrome: EEG specific ?
No
Dravet Syndrome: clinical symptoms and tx
regression with ataxia. NEVER sodium channel blockers (scn1a mut). VPA/BZD/LTC are common first line.
Benign epilepsy with centrotemporal spikes (BECTS or benign rolandic):
Onset and Semiology
age 7 with focal seizures that can be autnomic and focal involving mouth/throat. Tonic clonic as well.
Benign epilepsy with centrotemporal spikes (BECTS or benign rolandic):
EEG prognosis and tx
Centrotemporal BIPHASIC spikes/sharps that worsen in sleep. The are usually fine by age 16. Usually no tx but can use carbamazepine.