Pediatric seizures Flashcards
1
Q
normal brain function requires a (…) discharge of impulses
A
orderly, organized, and coordinated
2
Q
what is the definition of a seizure
A
single surge of electrical activity in the brain
3
Q
what is the definition of a seizure disorder
A
at least 2 unprovoked seizures
4
Q
what is the definition of non-epileptic seizures
A
triggered by a disorder, event, or other condition that irritated the brain
5
Q
what conditions can provoke a seizure
A
- febrile
- birth trauma
- brain tumor
- pseudoseizures
- alcohol/drug withdrawal
- drug OD
6
Q
If a person has an unprovoked seizure what is their chance of having another one?
A
50%
7
Q
what is the timeframe of 2nd seizure after the first
A
2nd seizure often occurs within 6 months of the first
8
Q
what are some risk features that increase the risk of seizure recurrence after a 1st unprovoked seizure
A
- EEG abnormalities
- remote symptomatic cause identified by clinical history or
- abnormal neuro exam
9
Q
what are risk factors for seizures
A
- family history
- brain infections/tumors
- dementia
- brain trauma
- hypoxia
10
Q
what are precipitating factors for seizures
A
- fatigue
- alcohol
- stress
- flashing lights
- menstrual cycle
- fever
11
Q
what is a prodromal period
A
symptoms that precede a seizure by days or hours
12
Q
what is pre-ictal or aura
A
Actually a focal onset seizure before the seizure
13
Q
what is the ictal stage
A
during the seizure
14
Q
what is the post-ictal stage
A
The state of somnolence and decreased responsiveness after a seizure
15
Q
t/f symptoms experienced in the pre-ictal phase vary depending on the area of the brain that was affected
A
true
16
Q
what are symptoms of the post-ictal stage
A
- numbness
- confusion
- fatigue
- focal weakness
- unresponsiveness
17
Q
what are the 2 primary types of seizures
A
- focal
- generalized
18
Q
what are types of focal seizures
A
- with retained awareness
- with impaired awareness
19
Q
what occurs during focal seizures with retained awareness
A
- typically cause few symptoms, often overlooked or mistaken
- no LOC or memory loss
20
Q
what occurs during focal seizure with impaired awareness
A
- altered consciousness and awareness
- unusual, repetitive movements
21
Q
what is a generalized seizure
A
a seizure that involves all areas of the brain
22
Q
all generalized seizures except (…) involve LOC
A
myoclonic
23
Q
what are the types of generalized seizures
A
- absence
- myoclonic
- atonic
- tonic
- clonic
- tonic-clonic
24
Q
(…) is the only non-motor onset seizure
A
absence
25
what are the characteristics of absence seizures
* staring and subtle body movements with impairment of consciousness
* includes a brief loss pf awareness
26
t/f patients with absence seizures usually return to normal after the seizure ends
true
27
although absence seizures only last seconds, they can recur (how odten)
numerous times a day
28
you should suspect absence seizures in what kind of patient?
children that frequently space out
29
at what point would you start to suspect a focal seizure instead of absence seizures?
if it lasts more than 45 seconds
30
what are the characteristics of myoclonic seizures
sudden, irregular, brief jerks or twitches of the arms, legs, jaw, or generalized
31
what is the feeling of myoclonic seizures
can feel like jumps inside the body
32
t/f myoclonic seizures are the same thing as benign myoclonus of infancy
false. benign myoclonus of infancy is a rare condition that goes away on its own by 1 year old and the child has a normal EEG
33
what is the difference between positive and negative myoclonus
positive: contractions
negative: relaxations
34
what are the characteristics of atonic seizures
* sudden loss of muscle control without myoclonic or tonic features for less than 2 seconds (drop attacks)
* associated with intellectual impairment
35
what areas of the body are affected by atonic seizures
head, neck or limbs
36
what are the characteristics of tonic seizures
* causes muscles to tighten and stiffen
* associated with intellectual impairment
37
patient with tonic seizure present how if breathing is impaired
may present with turning blue
38
what are the characteristics of clonic seizures
convulsive movements associated with bilateral, rhythmic jerking muscle movements
39
how can you differentiate between clonic seizures and myoclonic?
* myoclonic: irregular jerking with partial retained awareness
* clonic: rhythmic jerking and LOC
40
what are the characteristics of tonic clonic seizures
* LOC
* violent shaking
* body stiffening
* loss of bladder/bowel control
* tongue biting
41
Infantile Spasms (West Syndrome) occur around what age
4-7 months
42
what is the cause of infantile spasms
* abnormal interaction between cortex and brainstem
* immature CNS
43
How do you diagnose infantile spasms
hypsarrhythmia on EEG
44
what are common features of infantile spasms
* sudden, brief contractions
* lasts 4-6 seconds
45
what are pseudoseizures
physical manifestation of a psychological disturbance, frequently occurring with conversion disorder
46
are pseudoseizures epileptic or non epileptic?
they are non-epileptic but resemble an epileptic
47
t/f pseudoseizures are associated with malingering
false
48
how are pseudoseizures treated?
psychotherapy
49
what are common features of pseudoseizures
* tongue biting
* closed eyes and resist opening
* side to side head movements
50
will patients with pseudoseizures stop their hand from hitting their face?
yes
51
how to tell if someone is faking a seizure?
draw a serum prolactin level 10-20 minutes after event and compare to a baseline level 6 hours later
52
t/f seizures cause increase in prolactin levels
true
53
what is an EEG
electrodes places on the scalp that sense and record the electrical activity taking place in the brain
54
what type of EEG is usually ordered?
sleep deprived
55
why is epilepsy monitoring typically done?
* to distinguish epileptic seizures from others
* to characterize/classify seizures for treatment
* to localize the region of brain
* to provide a guide to prognosis
56
how do you patient prep for EEG
* wash hair night before but don't use products other than shampoo
* avoid caffeine day of test
* take usual medications
57
why do you use an MRI in seizures
to look for possible causes and at the areas with decreased blood flow
58
what are the uses for functional MRI in seizures
to see how blood flows through the brain
59
use of PET scan in seizures
to measure blood flow and glucose uptake
60
in 80% of seizure patients, there is increase in (...) and (...) in the cerebral cortex
blood flow and glucose metabolism
61
what are the main goals of seizure management
* controlling the seizures
* avoiding treatment side effects
* maintaining or restoring quality of life
62
what is step 1 of seizure treatment
classify the seizure
63
(...)% of people will respond positively to the first anti-epileptic prescribed
60
64
t/f anti-epileptics are indicated after a single provoked seizure
false
65
when is AED therapy indicated?
after 2 unprovoked seizures
66
what are common SE of AEDs
* drowsiness
* dizziness
* diplopia
* imbalance
* n/v
67
which AEDs are the most problematic for DDI?
enzyme-inducing (phenytoin, carbamazepine, phenobarbitol, topamax)
68
(...) can increase metabolism of lamictal
OCPs
69
which AEDs are known to be teratogenic?
1st gen
phenytoin, carbamazepine, phenobarbital, valproic acid
70
(...) is associated with phenytoin
gingival hyperplasia
71
which AEDs do you have to check levels?
* carbamazepine
* phenytoin
* phenobarbital
* valproate
| 1st gen
72
AED monitoring is for (...)
* to establish individual therapeutic concentrations when a patient in in remission
* to assist in the diagnosis of clinical AED toxicity
* to assess compliance
* to guide dose requirements
73
when should you check drug levels?
at least yearly
74
treatment of focal seizures
lamictal
75
treatment of generalized seizures
* valproate
* Keppra for pregnancy
76
management of post-stroke epilepsy
AED monotherapy
77
brain tumor seizures management is influenced by...
DDIs with other treatments
78
after at least 2 years of seizure free, ...
consider discontinuing AEDs
79
t/f 50% of patients can discontinue meds after 2-5 years
true
80
rapid changes in drug treatment increase the risk of (...)
provoking a seizure
81
how should benzos and barbiturates be tapered?
very gradually
82
driving with seizures
must go 6 months seizure free
83
when is surgery considered for seizures?
* breakthrough seizures on 2+ AEDs
* cant tolerate SE
84
t/f you can surgically remove the area of the brain affected by the seizure
true
85
cutting the (...) may help with seizures that originate in several areas of the brain
corpus collosum
86
diet that is thought to reduce seizure frequency
keto
87
what is status epilepticus
state of continuous seizure activity lasting longer than 5-10 minutes or several seizures occurring during a 30 minute time frame
88
what is emergency treatment for status epilepticus
* large doses of AEDs
* benzo (lorazepam) IV push
* followed by fosfophenytoin or phenytoin for long term control
89
all patients with epilepsy should be given (...)
* diazepam
* diastat rectal gel
* valtoco nasal spray
90
what are the precautions during a seizure
* maintain airway
* prevent injury
* don't hold person down or put anything in mouth
* if it lasts more than 5 minutes, call 911
91
what are the complications of seizures?
* car accidents
* personal injury
* pregnancy related
* psychosocial issues
92
medical comorbidities of epilepsy
* increased prevalence of cardio, respiratory, inflammatory and pain disorders
* sleep related breathing disorders
* cognitive impairment
93
when to screen for depression with seizures?
at diagnosis and on annual follow up
