Epilepsy in Children Flashcards
most common reasons for pediatric er visits
febrile seizures
motor symptoms of a seizure
convulsions
sudden, involuntary, time-limited alteration in behavior including a change in motor activity, autonomic function, consciousness or sensation + abnormal electrical discharge in the brain
seizures
enduring predispositiong to generate seizures
epilepsy
definition of epilepsy
- at lest 2 provokes seizures ocurring >24 h
- one unprovoked seizure and a probability of further seizures similar to the general recurrence risk
- after two unprovoked seizures ocurring over the next 10 years
- diagnosis of an epilepsy syndrome
decreased inhibition of the brain
defective gaba-a inhibition
defective gaba-b inhibition
defective activation of gaba neurons
defective intracellular buffering of calcium
increased activation of the excitable channels and receptors
increased activation of nmda receptors
increased synchrony between neurons
increased synchrony and/or activation due to recurrent excitatory collaterals
etiology of seizures in neonates
acute metabolic cerebrovascular cns infection developmental conditions others
etiology of seizures in infants and children
genetic metabolic neurodev problems cns infections head trauma vascular neurocutaneous syndromes
what is a focal seizure
arising from a specific location in one cerebral hemisphere
what is generalized seizure
first clinical and eeg changes indicate synchronous involvement on all or both hemispheres
originating at one point and engages both hemispheres
involves corticothalamic and subcortical structures
presentationi of childhood absence epilepsy
brief and frequent absence seizures with abrupt and severe impairment of consciousness
normal neuro exam and development
clinical features of benign focal epilepsy with centrotemporal spikes (bects)
unilateral sensorimotor symptoms oropharyngeal menifestations speech arrest hypersalivation eeg: centrotemporal spikes
benign occipital epilepsy: panayiotopoulos type
benign susceptibility to autonomic seizures and autonomic status epilepticus autonomic: pallor, flushing, cyanosis vomiting behavioral changes deviation of the eyes usual convuslions are not seen eeg: focal spikes good prognosis
benign occipital epilepsy: gastaut type
purely occipital
visual: elementary visual hallucinations, blindness, deviation of the eyes, post-ictal headache
?? prognosis
juvenile myoclonic epilepsy
generalized tonic clonic seizure later myoclonic jerks typical absences perioral reflex myoclonias eeg: polyspike and wave discharges
epileptic encephalopathy
cognitive and behavioral impairments
part of a group of syndromes
early infantile epileptic encephalopathy
onset: 10d-3 mos
tonic spasms, results in developmental delay
eeg: burst suppression pattern
can evolve to west syndrome
severe myoclonic epilepsy of early infancy: dravent syndrome
onset: first year
clinical features**
infantile spasms: west syndrome
onset: 3-10 mos
spasms of head neck trunk extremities
developmental regression
hypsarrhythmia
lennox gestaut syndrome
triad: multiple seizure types, cognitive impairment, eeg 1-2 hz diffuse slow spike and wave discharge (awake)
definition of status epilepticus
>/= 5 mins continuous seizure >/= 2 discrete seizures between which there is incomplete recovery of consciousness
etiology of status epilepticus
the failure of mechanisms responsible for seizure termination OR initiation of mechanisms which lead to abnormally prolonged seizures
long term consequences after t2
why aggressively treat se
mortality rate 10%
overall mortality rate in children 6%
developmental deterioration
