Pediatric Neurology Flashcards
What are common etiologies of neonatal seizures?
What defines the neonatal period for neonatal seizures?
- Electrolyte disturbances
- Bleeding
- Infection
- Inherited disorders
- Malformations
- Drugs
Birth to 8 weeks (about 4 weeks after the first 30 days, which is normal
What are common causes of seizures in children?
- Electrolyte disturbance
- Ingestion of toxins
- Trauma/intracranial bleeding
- Meningitis
- Fever
Is a seizure in a child diagnostic for epilepsy?
What defines epilepsy?
No
Epilepsy is recurrent, unprovoked seizures
Epilepsy: characterized by recurrent (2+) epileptic siezures, unprovoked by any immediate identified cause, at least > 24 hours apart
Generalized seizures are defined as motor (convulsive) or non-motor
What are the types of motor (convulsive) seizures?
- Tonic-clonic (most common)
- Clonic
- Tonic
- Myoclonic
- Atonic
Generalized seizures are defined as motor (convulsive) or non-motor
What are the types of non-motor (non-convulsive) seizures?
- Typical
- Atypical
- Myoclonic
- Eyelid myoclonic
Are febrile seizures and neonatal seizures included in the classification of epilepsy?
No, they are excluded as there is usually an identified cause
What is the most common seizure disorder of childhood?
What is the median age of diagnosis and why?
Absence Seizures
6 years is the median onset, most between 4-10 years old
Most likely diagnosed after starting school
What is the presentation of typical absence seizures?
- Brief oss of awareness, starting, eye fluttering, head bobbing/lip smacking
- Last < 10 seconds, but can have multiple in a 24 hour period
- Can be provoked by hyperventilation
What is the first line treatment for absence seizures?
Do patients with typical absence seizures require lifelong treatment?
- Ethosuximide (Zarontin) BID: first line
- Valporic acid
- Lamotrigine
No, may only require a few years of treatment
Patients with atypical require lifelong treatment
After a seizure, when should the child be evaluated by pediatric neurology?
Within 2 weeks
What is sudden enexpected death in epilepsy (SUDEP)
- Sudden, unexpected, non-traumatic, non-drowning death in a patient with epilpsy with no structural or toxicologic cause
- Usually happens in the setting of a seizure
- Risk is higher with more severe epilepsy
What skin disorders are associated with epilepsy?
- Tuberous sclerosis
- Neurofibromatosis
- Sturge Weber Syndrome
What should be included on physical exam in evaluating for an afebrile seizure?
- Fundoscopic exam (evaluate for increased ICP)
- Neurologic exam (full neuro)
- Cardiac (including pulses)
- Skin exam
What diagnosis is associated with Cafe Au Lait Spots?
Are they typical in adults presenting with this condition?
Neurofibromatosis
No, will typically see neurofibromas in adults
What is the neuroimaging study of choice for afebrile seizures?
Is this true if the child presents to the ED?
MRI
CT is often 1st study in the ED
How many EEG’s are ordered in evaluating for seizures in children?
2: both awake and asleep
Are antiepileptic medications commonly prescribed after the first seizure?
No, typically withheld due to high side effect profile
When do febrile seizures typically occur?
Can febrile seizures be the presenting sign of illness?
First day of illness
Yes, and can also present with status epilepticus
What value of elevated fever is associated with febrile seizures?
> 38 C (100.4)
What are the two types of febrile seizures?
How are the differentiated?
Simple febrile seizures and Complex febrile seizures
Simple < 15 minutes and one seizure, Complex > 15 min and multiple
What infections are most commonly associated with febrile seizures?
Human herpes virus 6 and influenza
What is the work-up for febrile seizures?
- Most kids do not need any testing and will return to baseline
- Only get lab work if clinical situation worsens
What are worrisome headache features in kids?
- Awakens the child or occurs upon waking
- Sudden severe headache
- Associated neurologic signs/symptoms (i.e. n/v, AMS, ataxia)
- Chronic progressive pattern
- Abnormal neuro exam
What is the most frequent acute recurrent headache in children?
Migraine Headache