First seizure

Question 1

definition of epilepsy

Answer 1

2+ unprovoked seizures

Question 2

types of seizures

Answer 2

Generalized Tonic-clonic (MCC)

Simple partial seizure

complex partial seizure

childhood absence epilepsy
(petit mal)

atonic (akinetic) seizure

Question 3

Generalized tonic-clonic seizure

Answer 3

event starts with rigid stiffening of all extremities, upward deviation of eyes

Clonic jerks following tonic phase

flaccid then urinary incontinence

Question 4

Simply partial seizures

Answer 4

motor signs in a single extremity or one side of the body

focal onset seizure may spread to become generalized

Question 5

complex partial seizure

Answer 5

any age

altered level of consciousness (hallmark)

automatisms

usually last 30 seconds to 2

Question 6

absence epilepsy

Answer 6

starts 3yo

Staring into space and automatisms, can have hyperventilation or photic stimulation before

no associated loss of tone or urinary continence

Question 7

akinetic seizure

Answer 7

loss of motor tone

Question 8

True seizure are supported by what in presentation?

Answer 8

h/o altered consciousness/LOC

incontinence

deviation of the eyes

motor movements that can’t be suppressed

postictal state

Question 9

why is seizure in the presence of fever not completely specific for febrile seizure?

Answer 9

fever could be attributed to something more serious like meningitis or encephalitis whereas febrile seizure is usually just caused by benign viral illness

Question 10

follow up questions for recent first seizure

Answer 10

description of event, timeline, precipitating events (fever), h/o toxic ingestion, h/o injury, PMH (h/o seizure)

Question 11

16 month milestones

Answer 11

uses 4-6 words consistently, usese a spoon and cup, spilling occasionally, follows simple commands, stoops and recovers

Question 12

What is a risk factor for subsequent development of epilepsy

Answer 12

pre-existing developmental abnlts

Question 13

What part of a patient’s history is important for determination of febrile seizure

Answer 13

Febrile seizures are hereditary (different genetic loci and different inheritance patterns), family history is important risk factor for febrile seizure

Question 14

ddx for first time seizure

Answer 14

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)

Question 15

serious bacterial infection includes

Answer 15

bacteremia

meningitis

UTI

Question 16

what are risk factors for UTI

Answer 16

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

Question 17

children at high risk of developing influenza

Answer 17

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

Question 18

indications for an LP

Answer 18

kid 6-12 months w/

-incomplete immunization hx against Hib or Strep Pneumo

–especially if neuro status is not completely recovering after seizure

Question 19

what to do if seizure

Answer 19

do not hold child down and do not place anything in child’s mouth

place child on his side

call 911 if >5minutes

Question 20

Rubeola/measles rash begins with

Answer 20

cough, coryza, conjuncitivitis, koplik spots on buccal mucosa

then maculopapular rash + fever

Question 21

Roseola infantum virus

Answer 21

HHV-6

Question 22

Hallmarks of roseola

Answer 22

1. high fever 3-5days w/ abrupt resolution possibly w/ rhinorrhea
2. Development of maculopapular rash

***Bulging fontanelle more s/o meningitis

Primary HHv-6 infection assoc w/ 200-30% of first febrile seizure in children

Question 23

Simple versus complex febrile seizure

Answer 23

simple: <15 mins, generalized, self-limited and triggered by acute febrile illness

complex febrile seizure: >15 mins in duration, focal, more than once Q24hours

Question 24

What age are breathholding spells commonly seen

Answer 24

6mos to 6years

Question 25

how to differentiate between Absence seizure and ADHD

Answer 25

Absence seizure kids will have normal behavior in school/home (no behavioral concerns typically)