Non-Epileptic Paroxysmal Disorders in Children Flashcards
t/f a pause in breathing for greater than 20 s is commonly seen in premature children during active sleep
true, due to brainstem immaturity
t/f when there is a real seizure the heart rate increases
true
apnea vs seizure
apnea has eye opening or closure depending on which part of sleep
etiology of paroxysmal extreme pain disorder
scn9a sodium channel gene mutation
life-long
autonomic manifestations of pepd
skin flushing in all cases
harlequin color change and tonic attacks
dramatic syncope with bradycardia and sometimes asystole
pepd in older children
attacks of excruciating deep burning pain often in rectal, ocular, or jaw areas but also diffusely in some
triggered by defecation, cold, wind, eating, and emotion
what is jitteriness
excessive response to stimulation (touch or loud noise)
typically awake
associations of jitteriness
drug withdrawal
hypocalcemia
hypoglycemia
hypoxic ischemic encephalopathy
jitteriness is lessened by
consoling the child
removing the stimulus
relaxing the affected limb
what is paroxysmal tonic upgaze
starts before 3 mos
continuous or episodic upward gaze
preserves horizontal eye movements
normal imaging, labs, and neuro exam
what is benign neonatal sleep myoclonus
repetitive myoclonic jerks
non-rapid eye movement sleep
bilateral symmetric movement of arms and legs
factors that distinguish myoclonic jerks from epileptic events
absence of autonomic disturbances
myoclonic jerks occurring only while asleep
normal eeg
normal neuro and dev exam
what are breath holding spells
occurs 6 mos-6 yo
patho: dysfunction of ans, iron deficiency anemia
what are cyanotic breath holding spells
trivial precipitant -> emotional response > crying -> breath holding in forced expiration -> collapse with limpness and loss of consciousness
effects of prolonged apnea
decorticate or decerebrate posturing
what are pallid breath holding spells
child loses consciousness after a minor fall or blow to head or upper body
loss of consciousness delayed up to 30s after trauma
- -> pale, diaphoretic, limp
- -> generalized increased tone of trunk and extremities + incontinence + low amplitude clonus
diagnosis of pallid breath holding spells
reproduced with 10 seconds of ocular pressure during ecg monitoring
characteristics of benign myoclonus of infancy
myoclonus, spasms with brief tonic contractions, shuddering, and/or atonia
occurs in clusters, frequently mealtime
occur only when awake
shuddering attacks
brief episodes of altered muscle tone
stiffening, flexion, and elevation of the arms with a low amplitude tremor
spells during feeding, excited, or distressed (stimulus overflow)
never during sleep or being held
resolve by 2nd decade
sandifer syndrome
intermittent paroxysmal spells of generalized stiffening and opisthotonic posturing that are caused by ger in infants
pain response to acidic reflux into esophagus
associated with feeding (30 mins after)
dystonia
abnormal posture due to sustained contraction of both agonist and antagonist muscle groups
common etiology of dystonia
acute reaction to drugs
basilar type migraines
acute neurologic events without significant headache
loss or alteration of consciousness
when to suspect migrain
vomiting with the episode
history of severe headaches without neuro symptoms
a rare type of migraine with a motor aura of weakness
familial hemiplegic migraine
manifestations of familial hemiplegic migraine
negative phenomena (absence of symptoms that were there before)
positive phenomena
progressive and successive occurrence of visual, sensory, motor, aphasic, and basilar s/sx
benign paroxysmal vertigo
recurrent episodes of brief disequilibrium where child is frightened and off balance
reaching out to steady himself
<1 mi, recurring and remitting course
resolves without treatment
factors that distinguish nonepileptic staring spells from true absence seizures
when the child is bored or active
never associated with automatisms, myoclonus, or other motor signs
can be interrupted by tactile or vocal stimulation
psychogenic nonepileptic seizures
dramatic behavioral events that are misdiagnosed
teenagers with affective and anxiety disorders
generalized atypical appearing motor activity and prompt return of consciousness
t/f comorbid epilepsy is common in psychogenic nonepileptic seizures
true
syncope
abrupt loss of consciousness due to interruption of energy sources to brain because of sudden reduction of cerebral perfusion
vasovagal in origin
lack of postictal state
factors distinguishing syncope and seizures
emotional stress
prolonged upright posture
pain
motor disorders
rarely confused with seizures when its sustained rather than episodic
no impairment of consciousness
