Pediatric Neuro

Question 1

seizures abnormal______ in the _______

Answer 1

abnormal neuronal discharges in the cerebral cortex

Question 2

afebrile seizures affect ____ % up to age 16
developmental disbilities ____%
____% of children have afebrile seizure in first 5 years of life

Answer 2

.5-1% of children up to age 16
30-50% children with disabilities have afebrile seizures
3-5% of children have seizure in first 5 years of life

Question 3

most common periods of seizures

Answer 3

neonatal and 70+

Question 4

gold standard for id of epilepsy
-what must they have to be diagnosed??

most common types

Answer 4

EEG- 2 or more unprovoked seizures or one unprovoked seizure with an abnormal EEG

simple partial and complex seizures (both FOCAL) account for >50%

Question 5

classification of seizures

Answer 5

localized (partial or focal, starts in one hemisphere)

vs.

generalized (BOTH hemispheres)

Question 6

Partial seizures aka 
Consciousness? 
What does it look like? Symptoms (3 types)
-
-
-

Answer 6

partial aka focal 
CONSCIOUSNESS maintained 
-motor signs (smacking, purposeful) 
-autonomic (crying, laughing) 
-somatosensory symptoms (tingling hot cold)

Question 7

Complex partial seizures

Consciousness?

Answer 7

impaired consciousness
evolve to tonic-clonic seizures

hand–arm—thrashing

Question 8

Generalized seizures (convulsive and nonconvulsive) TYPES
-
-
-
-
-

Answer 8

• absence (LOC, starring) aka Petit mal
• atypical absence (LOC, change in tone, with automatisms, ex. blinking, chewing movements, hand jerking)
• myoclonic (jerking)
• tonic (stiffening)
• atonic (drop attacks)

Question 9

myoclonic…

Answer 9

jerking

Question 10

tonic…

Answer 10

stiffening

Question 11

atonic…

Answer 11

drop attacks

Question 12

Generalized seizures affect _________
involve______
NO _______

Answer 12

generalized seizures affect BOTH hemispheres
involve LOC
and NO AURA

Question 13

Complex partial seizures 
Starts with \_\_\_\_ 
then\_\_\_\_ 
then \_\_\_\_\_ 
then \_\_\_\_\_\_

Answer 13

starts with one area
then an aura
then LOC
then secondary generalization

Question 14

Complex partial seizures vs. generalized– key differences

Answer 14

Complex partial has an AURA and starts in one hemisphere

Generalized has no AURA and starts in both hemispheres simultaneously

Question 15

Idiopathic epilepsy 
underlying\_\_\_\_\_
seen in pts with 
-
-
-

Answer 15

genetic 
seen in pt with: 
-without a neuro d/o 
-normal development 
-normal neuro exam

Question 16

1st thing to do at a visit after seizure:

most important:

Answer 16

• determine whether seizure has occurred

- history

Question 17

Labs

Answer 17

serum glucose 
magnesium 
calcium 
CBC 
urine toxicology

Question 18

Diagnostics

Answer 18

EEG

MRI

Question 19

Medications- dependent upon____ and _____

goal?

Answer 19

seizure type and eeg findings (also existence of underlying syndrome, age, se)

goal is monotherapy with few side effects

Question 20

Before initiating seizure medication order

generics??

Answer 20

CBC platelets
LFT
Amylase/lipase
Monitor q3 months

generics: dont generate same blood levels, may experience breakthrough seizures or SE, make sure it is the same manufacturer every time

Question 21

Narrow spectrum 
-
-
-
-
-
-

Answer 21

• dilantin
• phenobarbital
• tegretol
• trileptal
• neurontin
• vimpat
• sabril

Question 22

Broad spectrum
-
-
-
-
-
-
-

Answer 22

• depakote
• lamictal
• topamax
• zonegran
• keppra
• klonopin
• banzel

Question 23

medications- how to maintain blood level

Answer 23

half life

Question 24

Localized and complex seizures

Answer 24

• tegretol
• depakote
• topamax
• dilantin
• lamictal
• trileptil
• keppra

Question 25

Absence seizures medication

Answer 25

Ethosuximide*** (zarontin)

depakote

Question 26

Primary generalized tonic clonic seizures

Answer 26

topamax

trilpetil

Question 27

Most common form of childhood seizures

define

Answer 27

febrile seizures

> 1 month of age, absence of cognitive delay or brain abnormality, electrolyte imbalance without prior afebrile seizures

Question 28

Febrile seizures types define

Answer 28

Simple: all others

Complex: focal, prolonged lasting >10-15 minutes or multiple within same illness

Question 29

Increased risk febrile seizures 
- 
-
-
-

% of children w/o risk factors

Answer 29

• family history 1st 2nd degree relative
• developmental delay
• neonatal nursery stay >30 days
• attendance at day care

50% of children do not have risk factors

Question 30

Diagnosis of febrile seizures

Focus is on _____

18 months if history/PE not suggestive of_____? risk factors of _____?

Answer 30

excluding CNS infection: LP

18 month history PE not suggestive of meningitis

risk factors of meningitis: focal (complex) or prolonged seizure, abnormal findings on neuro or PE

Question 31

Indications for LP in febrile seizures
Simple:

Complex:

Answer 31

simple: consider if

Question 32

Febrile seizures diagnostics

exception?

Answer 32

(generally referring to SIMPLE FEBRILE)
LP: recommended if meningeal signs
EEG: generally not recommended if neuro healthy ***
lytes, ca, phos, mag, ca, glucose, CBC: not done routinely
neuroimaging: not recommended for routine eval of simple febrile seizures

exception: >30 minutes= febrile status epilepticus

Question 33

Treatment febrile seizures

Focus is on _____

Answer 33

focus is on prevention of prolonged febrile seizures

• diastat orally or rectaly given AT TIME of fever
• antipyretic- not effective at prevention

simple- no tx

Question 34

Used to think febrile seizures associated with

Answer 34

high temp or increase quickly- not true

Question 35

PRIMARY mode of treatment of febrile seizures (both simple or complex)

Answer 35

education and counseling