Pediatric Epilepsy Highlights Flashcards
Seizures
episodic events which are unexpected
and sudden resulting from abnormal and
excessive activity of neurons
– Involves the electrical functions of the brain
Epilepsy
chronic disease of recurrent
unprovoked seizures
– 2 or more unprovoked seizures separated by
greater than 24 hours or 1 seizure with studies
suggesting further risk for seizures
intractable epilepsies can be defined as seizures which do not respond to a trial of at least ________ and that approximately 30% of new onset seizure patients may develop intractable epilepsy
2-3 anticonvulsants
drug resistant
She said 2 notes say 3
epilepsy is a disorder of recurrent, spontaneous seizures epilepsy can be classified by:
generalized and partial syndromes or by etiologies
Generalized: sz involves entire brain
Partial: sz activity originates in ?
one part of the brain
Etiology of epilepsy
-Old classes?
• Symptomatic: known etiology
– 30% have structural abnormality: tumor or AVM
– Approximately ½ of patients with symptomatic remit
• Idiopathic: genetic predisposition
• Most idiopathic seizures affect children
• Cryptogenic: thought to have an etiology that is not yet proven
Benign:
– Easily treated with meds
– Normal intelligence
– Most often tests are normal and we don’t know why someone has sz
– Genetic predisposition
– Remission after a certain age (usually teens)
• Catastrophic: – Intractable to medications – Affect development with mental retardation and shortens lifespan of child – EEG, MRI and other tests are abnormal
trying to move away from these terms
New ILAE classification
Changes and proposals
- Replace idiopathic, symptomatic and cryptogenic with more meaning full categories: genetic, structural, metabolic and unknown
- Spasms are now included : epileptic spasms
- Benign and catastrophic are not used as benign have psych issues and catastrophic has a negative undertone.
Old classes of sz:
Generalized: sz involves entire brain
Febrile Seizures
: “an event in infancy or childhood, usually occurring between 3 months and 5 years of age, associated with fever but without evidence of intracranial infection or defined cause. Seizure with fever in children who have suffered a previous non-febrile seizure are excluded”
Age of Febrile Seizures
- Most common childhood seizure
- Incidence 2-4 % (US)
- Usual age 6 months to 3 years
- Almost all first febrile seizures occur by age 3
- Median age 18-22 months
Febrile Seizures stuff
Simple versus Complex • Simple- tonic clonic – Generalized – Less than 10 – 15 minutes – Do not recur within 24 hours
• Complex – Focal in nature at onset or during – Longer than 10 – 15 minutes – Recur in less than 24 hours • 20- 30% of febrile seizures are complex
timing febrile
Timing of Febrile Seizures
• Usually within first 24 hours of illness
• Not been shown to be rapid rise of fever
• No proof of occurrence with rise in fever
• Many children go on to tolerate higher
fever in the course of the illness
Important febrile stuff ***
Future Seizures? • 25-40% will have a recurrent febrile sz • ½ with recurrence will have a third • Risk factors for recurrence – Less than 1 yr age – Positive family history – Low grade fever – Brief fever
Risk factors for recurrence
– Less than 1 yr age
– Positive family history
– Low grade fever
– Brief fever
other rf
Other Possible Risk Factors • Epilepsy in first degree relative • Complex febrile seizure • Baseline neurodevelopment abnormalities • Day care attendance
Will this Affect the Child’s
Cognition?
Nearly all children will have normal cognition
– Studies have looked at IQ and academic achievement
• Children with prolonged or complex events may
be at increased risk of cognitive problems, but
most do well
• Tendency to have sleep problems
– Nightmares
– Frequent nocturnal awakenings
