Kids First Seizure

Question 1

When are bzd indicated for seizure

Answer 1

If lasting more than 3 min

Question 2

5 criteria febrile sz

Answer 2

Temp over 100.4 
Less than 6yo 
No sign infxn 
No metabolic abnormality 
No hx of previous afebrile sz

Question 3

When do febrile sz occur?

Answer 3

Typically often 1st indication child is sick

Question 4

What 2 vaccinations have sz risk?

Answer 4

DTP and MMR up to 14 days after vaccination

Question 5

Simple vs complex febrile siezhre?

Answer 5

Occurs either less than or more than 15 min

Complex also can have reoccurance within 24 hours and post octal paresis or todds paralysis

Question 6

With febrile sz what do u need to ask?

Answer 6

Are vaccinations utd

Are they on or recently on abx? Can mask a meningitis infxn

Question 7

Status eptileticus and fever are considered

Answer 7

Clear indication for lp to ro meningitis

Question 8

What is an option for peds seizure prevention?

Answer 8

Rectal diazepam prn

Only for kids with complex febrile seizure

Question 9

3 main indications for seizure admission

Answer 9

Less than 6 mo
Post octal phase is prolonged
Complex febrile seizure

Question 10

Infantile spasms require

Answer 10

Urgent eeg, MRI and metabolic evaluation

Question 11

Jme tx options

Answer 11

Valorous acid lamtrigene levetiracetam

Question 12

Infantile spasm treatment options (5)

Answer 12

ACTH 
Steroids 
Zonisamide 
Topiramate 
Vitamin B6

Question 13

Definition absence epilepsy

Answer 13

absent staring with/without eyelid flutter

Question 14

JME is…

Answer 14

Juvenile Myoclonic epilepsy: 
myoclonic jerks in am 
onset in adolescence 
triggered by stressors 
can have TC and absence as well

Question 15

Benign Epilepsy of Childhood with Centrotemporal spikes

Answer 15

somatosensory changes (numb/tingle) 
speech arrest 
facial twitching 
drooling 
tonic clonic seizures at night often during sleep

Question 16

infantile spaspms

Answer 16

sudden flexion, extension or mixed mvmts of trunk and proximal muscles EMERGENCY - high mortality rate

Question 17

Lennox-Gastaut Syndrome

Answer 17

onset at 3-5 years, mixed seizure types most have other comorbiditieis

Question 18

BECT / Rolandic aka

Answer 18

benign epilepsy of child with centrotemporal spikes

Question 19

treatment for BECTS

Answer 19

may outgrow by adulthood without treatment

Carbamazepine is an option

Question 20

Lennox Gastaut syndrome tx

Answer 20

many meds

Question 21

when is urgent eeg needed?

Answer 21

infantile spasms

including urgent: EEG, MRI, and metabolic evalutation

Question 22

first time afebrile sz that doesn’t seem to be part of epilepsy syndrome.. what labs should be run? 4 main categories

Answer 22

1. electrolytes, glucose, Ca, Mg, Phos
2. Ammonia and Lactic aicd - looking for met. syndrome
3. Drugs screen - looking for toxins
4. LP with antibodics: if sustained AMS or meningeal signs

Question 23

when is emergent CT used with seizure?

Answer 23

only of it was focal or predisposing condition (AMS, ICP, VP shunt, IC, sickle cell, trauma etc)

signs of intracranial mass effect - bulging fontanelles, papilledema, AMS

Question 24

An EEG should be performed after all first _________

Answer 24

nonfebrile unprovoked seizure

Question 25

seizure in a kid younger than ___ is typically admitted

Answer 25

6 mo

Question 26

what is most common cause of neonatal seizure

Answer 26

hypoxic ischemic encephalopathy (damage to brain cells due to low oxygen) Other cause: metabolic or brain abnormality (pyridoxine deficiency)

Question 27

how to treat a neonatal seizure?

Answer 27

phenobarbital is common first line | levetiracetam is also an option