Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Block 8 week 3 > Pediatric Seizure - Swartz > Flashcards

Pediatric Seizure - Swartz Flashcards

1
Q

What is a seizure?

A

A phenomenon of heightened neuronal excitability and depolarization which spreads to neighboring neurons, columns, gyri, lobes to produce a loss of function with or without obvious clinical manifestations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the new definition of epilepsy?

A
  1. At least 2 unprovoked (or reflex) seizures occurring more than 24 hours apart.
  2. One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrency risk after 2 unprovoked seizures (at least 60%), occurring over the next 10 years.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Diagnosis of an epilepsy syndrome involves what?

A

Constellation of signs and symptoms with known etiology, pathophysiology and outcome.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Neonatal seizures and pediatric febrile seizures are different from adult seizures. They involve what?

A

Unique time period, etiologies and semiologies ( progression of clinical signs that occur during the course of a seizure, behavior of seizure).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Do pediatric epileptic encephalopathies have a unique and different course from adult?

A

Yes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Metabolic syndrome and genetic syndromes are both what?

A

Age dependent.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How are pediatric seizures similar to adult seizures?

A
  1. Importance of ictal recordings for diagnosis and prognosis - CEEG
  2. Importance of semiology – the clinical characteristics of the seizures – for diagnosis and prognosis
  3. Need for sensitive neuroimaging
    CT- 50%; MRI – 80%
  4. Need for rapid initiation of treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the overall prevalence of epilepsy in children?

A

5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the epidemiology of epilepsy in children.

A
  1. Increased in teen years in third-world countries
  2. Studies may include acute symptomatic seizures and over-represent incidence
  3. Incidence 0.2% at birth. Drops to 0.1% age three and stabilizes at .05%. (USA), Prevalence 0.7%
  4. Life time incidence of epilepsy - 1/26.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are acute symptomatic seizures?

A

Seizure following head trauma within 24 hours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Neonatal seizures occur when?

A

Up to 28 days post term but usually in the first week of life.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How can you differentiate the motor phenomena of seizures from release phenomenon?

A

By whether the movement is induced by stimulation such as noise, tactile, passive movement or if the movement is stopped by repositioning.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

If neonatal seizures are diagnosed, what is the therapy?

A
  1. specific treatment

2. AED’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What type of seizures are unique to childhood?

A

Febrile seizures and epileptic encephalopathies.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What types of motor phenomenon are there?

A
  1. focal clonic
  2. focal tonic
  3. generalized tonic
  4. myoclonic - can be epileptic or non-epileptic
  5. spasms - epileptic
  6. motor automatisms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe focal clonic motor phenomenon.

A

These are epileptic, repetitive rhythmic jerking of a limb, face or trunk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe a focal tonic motor phenomenon.

A

These are epileptic, sustained posturing of a limb, eye deviation, asymmetric trunk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe generalized tonic motor phenomenon.

A

These are non-epileptic, are sustained, symmetic posturing of the muscles of the limbs, neck and trunk. Can involve flexors, extensors or both. A common cause is GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe motor automatisms.

A

These are non-epileptic movements of the eye, or mouth. They can be semi purposeful or complex purposeless movements.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are some causes of neonatal seizures?

A
  1. Hypoxic-ischemic pre-or perinatal insult
  2. Infection – septicemia, meningitis, meningo-encephalitis, HIV
  3. Intracranial hemorrhage - premature
  4. Congenital CNS abnormalities
  5. Electrolyte disturbance – Ca++, Na+,Glu, Mg++ (babies more likely to have seizures due to this reason)
  6. Inborn errors of metabolism - pyridoxine
  7. Toxins – bilirubin,
  8. medications, drugs in mother
  9. Genetic – BNFC (benign neonatal familial convulsions), chromosomal, Leigh’s,
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What if the treatment of neonatal seizures?

A
  1. Treat etiology – hypocalcemia, hypomagnesemia, hypogycemia, hyponatremia, pyridoxine
  2. Treat with an AED (ASD)
  3. Brief and infrequent focal motor, focal tonic or myoclonic seizures may not need AED
  4. Withdraw AED two weeks after the last seizure if EEG is negative
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Medications for seizures include?

A
  1. Levetiracetam - first line Tx
  2. Phenobarbital
  3. Phenytoin
  4. if still seizing - treat with Ativan or Midazolam plus high does phenobarbital or DPH
  5. Newer AED’s such as Lacosamide may work
23
Q

Febrile seizures are?

A

The most common seizure of childhood - are generalized tonic clonic seizures.

24
Q

Describe some characteristics of febrile seizures.

A
  1. Occurs ages 3 mo to 5 years – 2-5% in USA and Europe. Up to 14% in Guam
    Median age 18-22 mo.
    “Not caused by an infection of the CNS and not associated with prior non-febrile seizures and not meeting criteria for any other acute symptomatic seizure.
  2. In most T>39o.
  3. Usually in first 24 hrs of an illness
  4. Simple = last less than 10 minutes, generalized at onset AND do not recur in first 24 hours – 85% of all FS
  5. Complex = longer than 10 min or focal in onset or recur within 24 hours
25
Q

CNS infections can cause seizures as well as high temperatures. In the case of infections such as meningitis, the situation is a medical emergency while febrile seizures are benign. Describe how a seizure should be evaluated in this context.

A
  1. Was it simple or complex?
  2. Does anything suggest meningitis?
  3. Was the child neurologically normal beforehand?
  4. Could something else have caused the seizure?
  5. EEG not needed. Routine blood work not typically useful. Neuroimaging not needed in normal child
  6. LP? Should be done in every child with a first complex febrile seizure or in any child > 18 mo with meningeal signs.
  7. LP should be done in children
26
Q

How are febrile seizures treated?

A
  1. Symptomatically. If they are prolonged then can use Benzodiazepines - ativan and midazolam.
  2. If recurrent - can use rectal valium
27
Q

What are the risk factors for febrile seizures?

A 
Age (6 mo – 3 yrs)
Degree of temperature elevation
FS in 1st or 2nd degree relatives
Family hx of afebrile seziures
Slow development of child
Maternal smoking and EtOH during pregnancy
Day care attendance
28
Q

What are the risk factors for recurrent febrile seizures?

A 
First at <1 yr old			     		     Family Hx of retardation
FS following low grade or brief fever
Epilepsy in 1st degree relative
Complex febrile seizures
Neurodevelopmental abnormalities
Attendance at day care
29
Q

Those with recurrent febrile seizures may be at more risk of developing epilepsy later on. What risk factors contribute?

A
  1. abnormal neonatal history

2. family history of retardation

30
Q

What are epileptic encephalopathies? Give examples.

A

Syndromes of recurrent seizures associated with regression of developmental milestones. Examples are:

Ohtahara Syndrome
Dravet Syndrome
West Syndrome
Lennox Gastaut Syndrome
Landau Klefner
ESES
31
Q

What is Ohtahara’s syndrome?

A
  1. Seen in neonatal period; 10 da – 3 mo .
  2. Seizures are tonic spasms, drop attacks and partial. Rare myoclonus can also occur.
  3. Cryptogenic = imaging normal in 15%.
    Some inborn errors of metabolism.
  4. Symptomatic – abnormal imaging. 85% -hemimegencephaly or just atrophy
  5. Poor Px – 100% intellectually disabled (profound MR) with severe seizures
32
Q

What is another name for Otahara’s syndrome?

A

Early infant epileptic encephalopathy or EIEE.

33
Q

What is the EEG pattern for Otahara’s syndrome?

A

EEG is characterized by suppression - burst patterns.

34
Q

What is the treatment for Otahara’s syndrome?

A
  1. ACTH
  2. Steroids
  3. valproic acid
  4. klonadine
  5. Topiramate
  6. Clobazam
  7. felbimate
35
Q

What is Dravet’s syndrome (Severe myoclonic epilepsy of infancy or SEI)?

A
  1. Unilateral clonic seizures, febrile and afebrile, in the first year of life in previously normal infant
  2. Recur at 6-8 wk intervals. 3. May cause status epilepticus – convulsive or subtle, Followed by absence then partial seizures.
  3. Family Hx + 25-50% - epilepsy or Febrile Seizures
  4. Appears to be the severe end of the GEFS+ (generalized epilepsy with febrile seizures +) spectrum
36
Q

Dravet’s syndrome is associated with what molecular defects?

A

Associated with molecular defects in three sodium channel subunit genes and a gamma-aminobutyric acid (GABA) subunit gene.

37
Q

What is the pattern on EEG with Dravet’s syndrome?

A

Generalized spike waves or slow spike waves seen in sleep. The background is normal at onset but deteriorates with time.

38
Q

Describe some other characteristics of Dravet’s syndrome including treatment.

A
  1. MRI – normal
  2. intellectual decline develops in 50%
  3. Can be stopped if seizures controlled
  4. Rx = VPA, CLBZ, TPM, Bromide, Benzo, KD, FELB
39
Q

What are some seizure meds?

A
  1. VPA - valproic acid
  2. CLBZ - clobazam
  3. TPM - topiramate
  4. KD - klonadine
  5. bromide
  6. benzodiazepines
  7. FELB - felbimate
40
Q

What should not be given for Dravet’s syndrome?

A

Sodium channel blockers - these make the condition worse.

41
Q

What is West syndrome (Severe encephalopathic epilepsy in infants or SEEI)?

A
  1. Characterized by infantile spasms – brief bilaterally symmetic contraction of muscles of neck, trunk and extremities
  2. Subtle or generalized
    3-100’s a day
    Occur on sleep transition or with stimulation
  3. Onset in first 4-8 mo of life 4. 90% have some degree of cognitive and neurologic disability
  4. Treatment – ACTH, Steroids, VGB (vigabatrin), CLB, KD, TOP, RUF (rufinamide)
  5. PX – 5% normal outcome; severe impairment 67%; cryptogenic better than symptomatic (38% vs 5% nearly normal)
42
Q

What are some causes of West syndrome?

A
  1. head injury
  2. CNS infection
  3. intracranial hemorrhage
  4. dysgenesis
  5. tuberous sclerosis
  6. inborn errors of metabolism
43
Q

What is the pattern on EEG for West syndrome?

A

EEG – hypsarrhythmia, Slow waves or slow SW, BS, rarely normal
Can be misdiagnosed as Morrow reflex, colic, startle responses
85% symptomatic; 15% cryptogenic (with or without abnormal MRI)

44
Q

What is Lennox Gastaut syndrome?

A
  1. an epileptic encephalopathy
    2.Triad of slow spike-wave on EEG, mental retardation and mixed seizure types – myoclonic jerks, atypical absences and drop attacks (tonic or atonic).
  2. Mean age = 2 y/o, usually preschool (10% of sz up to age 5) but 1-14 y/o = range.
    Males>females
  3. Drop attacks have “electrodecremental response” on EEG
45
Q

What is Acquired epileptic aphasia or Landau-Klefner syndrome?

A
  1. Ages 3-9 y/o, Males > Females
  2. EEG shows multifocal SW
  3. Child develops verbal agnosia and decreased spontaneous speech
  4. Remits before age 15
  5. Etiology unknown
  6. Seizures may not be prominent feature
  7. Treatment – steroids, KD, felbamate, early speech therapy. 40-50% recover to a normal life.
46
Q

What is Electrical status epileptics during sleep?

A
  1. EEG – some bursts of SW while awake become continuous in sleep (1.5-2Hz)
  2. Seizures – partial, generalized, atypical absence
  3. Normal development until onset – may return to near normal with control of S/W
  4. Rx - ? CBZ, TOP, ACTH, VPA
47
Q

What are Absence seizures?

A
  1. Bihemispheric initial involvement of 3 Hz GSW lasting 3-10 sec
  2. Average age of onset 5.7 yrs (3-9 y/o)
    Childhood absence(3-5 y/o) – strong genetic, girls>boys, self limited
    Juvenile absence – begins around puberty. Boys=girls, SW 4 Hz
    Juvenile myoclonic epilepsy- 12-18 y/o, rarely remits, shorter bursts
  3. Risk factors – febrile sz; family Hx
  4. Medications – ETX (Ethuxamide), LTG (lamotrigine), LEV (Levetiracam), VPA, TOP, ZON (zonisamide)
  5. Typical = normal IQ, faster SW (3-3.5 Hz), normal background
    65% remit by puberty; 15% evolve to JME;
    Atypical – slower SW – 1.5-3Hz, abnormal background, lower IQ’s,
48
Q

Absence seizures are the only indication for what med?

A

Ethuxamide.

49
Q

What is Juvenile myoclonic epilepsy?

A
  1. Most common epilepsy syndrome
    Possibly 20% of all epilepsies
  2. Hallmark is myoclonic jerks, fast GSW (4-6 Hz) normal IQ and development
  3. Lifelong (maybe 10% remit)
    Onset 5 – absence in 20%, 8-10 – myoclonus, 15 – GTC -60%
  4. Rx – LEV, VPA, LTG, TOP, ZON, CLNZ, LAC?
  5. Several associated gene loci – myoclonic gene involved in spindle body directing cell division and neuronal migration
50
Q

What is Benign focal epilepsy of childhood or BFEC (also called Rolandic epilepsy)?

A
  1. 13-23 % of all childhood epilepsies =MOST COMMON EPILEPSY
  2. Onset 3-13 y/o, peak 7-8 years
  3. Normal NE, IQ, MRI and EEG background
  4. GTC’s occur in sleep, 15% have in day time also
    Partial seizures are unilateral paresthesias +/- clonus of face, lips, tongue. Also salivation, speech arrest but preserved consciousness.
    EEG – centro-temporal spikes, high amplitude, triphasic
  5. Genetic predisposition
  6. Remit by age 16
  7. Similar condition is Benign Epilepsy of Childhood with Occipital Paroxysms:

Ictal visual symptoms, amaurosis, hallucinations
High amplitude diphasic occipital spikes.
Eye opening suppresses spikes.

51
Q

What is Panayiotopolus syndrome?

A

Benign occipital; spikes occipital or anterior

With autonomic onset, autonomic status

52
Q

What is Atypical benign partial epilepsy of childhood?

A

CTSW bilateral. Focal ones produce focal atonias, when they generalize produce atonic drops. Nocturnal seizures = Rolandic, GTC or jerks. EEG in sleep = ECSWS. All recover

53
Q

What is Hypothalamic Hamartomas or Gelastic epilepsy?

A
  1. Boys > Girls. Peak age 2-3. 2. Seizures can appear throughout adulthood
  2. Laughter without emotion, 10-30 sec, frequent
  3. Can have autonomic, complex partial GTC as well.
  4. Can be associated with precocious puberty, behavioral and cognitive difficulties
  5. rare

Block 8 week 3 (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions