Epilepsy: Continuum (Pediatrics) and Rowan's Ch 5-7

Question 1

3 Indications for Routine EEG

Answer 1

initial assessment
after AED introduction
After AED cessation

Question 2

4 indications for cEEG

Answer 2

Pre epilepsy surgery 
To detect subclinical seizure
Psychogenic non-epileptic attacks
Refractory epilepsy
Status
Comatose pt without clear cause

Question 3

4 Elements of assessing the Background

Answer 3

Organization
Symmetry/frequency
Reactivity
Continuity

Question 4

Systematic approach to EEG (ACNS guideline) “BDASIC”

Answer 4

Background, Discharges/patterns, activation procedures, events/seizure, Impression, clinical correlation

Question 5

What is Normal Organization

Answer 5

PDR present with normal A-P gradient. Describe Sleep stages and transients.

Question 6

What is normal symmetry

Answer 6

No focal slowing

Question 7

West Syndrome:

Onset and semiology

Answer 7

<2 years old / clusters of neck/truncal flexion with arm abduction often seen in the AM

Question 8

West Syndrome:

Clinical triad

Answer 8

Psychomotor arrest, hypsarrhythmia and spasms

Question 9

What is hypsarrhythmia

Answer 9

Seen in West Syndrom. High amplitude slow waves on a background of irregular multifocal spikes.

Question 10

West Syndrome:

Treatment

Answer 10

ACTH first line. Vigabatrin in tuberous sclerosis.

Question 11

Dravet Syndrome  (severe myoclonic epilepsy of infancy):
Onset and Semiology

Answer 11

< 2 years old. Hemiconvulsions with myoclonic and atypical absence

Question 12

Dravet Syndrome: EEG specific ?

Answer 12

No

Question 13

Dravet Syndrome: clinical symptoms and tx

Answer 13

regression with ataxia. NEVER sodium channel blockers (scn1a mut). VPA/BZD/LTC are common first line.

Question 14

Benign epilepsy with centrotemporal spikes (BECTS or benign rolandic):
Onset and Semiology

Answer 14

age 7 with focal seizures that can be autnomic and focal involving mouth/throat. Tonic clonic as well.

Question 15

Benign epilepsy with centrotemporal spikes (BECTS or benign rolandic):
EEG prognosis and tx

Answer 15

Centrotemporal BIPHASIC spikes/sharps that worsen in sleep. The are usually fine by age 16. Usually no tx but can use carbamazepine.

Question 16

Lennox Gastaut (LGS: 
Triad

Answer 16

multiple seizure types, cognitive impairment, and slow spike and wave (1.5-2.5 Hz)

Question 17

Syndrome that can precede LGS

Answer 17

West syndrome

Question 18

LGS:

Tx and Prognosis

Answer 18

Can try ACTH, ketogenic diet but very pharmacoresistant with poor outcome.

Question 19

Childhood Absence epilepsy:

Onset and semiology

Answer 19

ages 4-8 (age >9 is juvenile absence)

Staring spells but 30% can have GTC

Question 20

Childhood Absence epilepsy:

EEG

Answer 20

3 Hz spike an wave with no post ictal slowing

Question 21

Bedside test for childhood absence epilepsy

Answer 21

Hyperventilation for 3 minutes

Question 22

Childhood Absence epilepsy:

Tx and Prognosis

Answer 22

Ethosuximide

70 % remit with 30% developing GTC which merits an added AED.

Question 23

JME:

Onset and semiology

Answer 23

teenage years
Mycolonic jerks (clumsy in AM) with potential for GTC

Question 24

JME:

EEG

Answer 24

4-6 Hz Generalized spike/polyspike and wave discharge that are photosensitive

Question 25

JME:

Tx and Prognosis

Answer 25

Lamotrigine or VPA indefinitely . Avoid photic stimuli/alcohol/stress and sleep deprivation

Question 26

What is epilepsia partialis continua and what is it associated with ?

Answer 26

continuous focal clonic seizures without impairment of consciousness. Associated with Rasmussen’s encephalitis.

Question 27

Tonic seizures, burst squppression, abnormal CT head

Answer 27

Ohtahara syndrome

Question 28

Besides 3hz spike-wive what other finding in absence ?

Answer 28

OIRDA - occipitaly perdominant generalized rhythmic delta activity

Question 29

Gene for Autosomal dominant partial epilepsy with auditory features

Answer 29

LGI1

Question 30

Syndrome with language regression and electrical status epileptics in sleep

Answer 30

Landau-Kleffner