First seizure Flashcards
definition of epilepsy
2+ unprovoked seizures
types of seizures
Generalized Tonic-clonic (MCC)
Simple partial seizure
complex partial seizure
childhood absence epilepsy
(petit mal)
atonic (akinetic) seizure
Generalized tonic-clonic seizure
event starts with rigid stiffening of all extremities, upward deviation of eyes
Clonic jerks following tonic phase
flaccid then urinary incontinence
Simply partial seizures
motor signs in a single extremity or one side of the body
focal onset seizure may spread to become generalized
complex partial seizure
any age
altered level of consciousness (hallmark)
automatisms
usually last 30 seconds to 2
absence epilepsy
starts 3yo
Staring into space and automatisms, can have hyperventilation or photic stimulation before
no associated loss of tone or urinary continence
akinetic seizure
loss of motor tone
True seizure are supported by what in presentation?
h/o altered consciousness/LOC
incontinence
deviation of the eyes
motor movements that can’t be suppressed
postictal state
why is seizure in the presence of fever not completely specific for febrile seizure?
fever could be attributed to something more serious like meningitis or encephalitis whereas febrile seizure is usually just caused by benign viral illness
follow up questions for recent first seizure
description of event, timeline, precipitating events (fever), h/o toxic ingestion, h/o injury, PMH (h/o seizure)
16 month milestones
uses 4-6 words consistently, usese a spoon and cup, spilling occasionally, follows simple commands, stoops and recovers
What is a risk factor for subsequent development of epilepsy
pre-existing developmental abnlts
What part of a patient’s history is important for determination of febrile seizure
Febrile seizures are hereditary (different genetic loci and different inheritance patterns), family history is important risk factor for febrile seizure
ddx for first time seizure
CNS infection (30% of infants w/ meningitis present w/ a seizure)
Febrile seizure
Head injury/post-traumatic seizure (usually within 1-2hours after accident)
Ingestion/poisoning (alcohol/lead poisoning)
Idiopathic
hypoglycemia
Brain tumor (begins as a partial seizure)
Breath-holding spell (generally very brief)
serious bacterial infection includes
bacteremia
meningitis
UTI
what are risk factors for UTI
FOR MALES non-black race temperature >39 Absence of another source of infection Fever >24 hours
FOR FEMALES (2x>circumcised boys) age <12 months White temp >39 absence of source of infection Fever >2days
children at high risk of developing influenza
younger than 2
chronic conditions including: pulm (asthma), CV (not htn alone though), renal, hepatic, heme (SCD), metabolic disorder (DM), neuro/neurodevelopmental conditions, children with immunosuppression (on tx or HIV+), long term aspirin tx, American Indians/alaska natives, residents of chronic care facilities
indications for an LP
kid 6-12 months w/
-incomplete immunization hx against Hib or Strep Pneumo
–especially if neuro status is not completely recovering after seizure
what to do if seizure
do not hold child down and do not place anything in child’s mouth
place child on his side
call 911 if >5minutes
Rubeola/measles rash begins with
cough, coryza, conjuncitivitis, koplik spots on buccal mucosa
then maculopapular rash + fever
Roseola infantum virus
HHV-6
Hallmarks of roseola
- high fever 3-5days w/ abrupt resolution possibly w/ rhinorrhea
- Development of maculopapular rash
***Bulging fontanelle more s/o meningitis
Primary HHv-6 infection assoc w/ 200-30% of first febrile seizure in children
Simple versus complex febrile seizure
simple: <15 mins, generalized, self-limited and triggered by acute febrile illness
complex febrile seizure: >15 mins in duration, focal, more than once Q24hours
What age are breathholding spells commonly seen
6mos to 6years
how to differentiate between Absence seizure and ADHD
Absence seizure kids will have normal behavior in school/home (no behavioral concerns typically)
