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Pediatric EOR exam > Pediatric seizures > Flashcards

Pediatric seizures Flashcards

1
Q

normal brain function requires a (…) discharge of impulses

A

orderly, organized, and coordinated

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2
Q

what is the definition of a seizure

A

single surge of electrical activity in the brain

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3
Q

what is the definition of a seizure disorder

A

at least 2 unprovoked seizures

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4
Q

what is the definition of non-epileptic seizures

A

triggered by a disorder, event, or other condition that irritated the brain

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5
Q

what conditions can provoke a seizure

A
  • febrile
  • birth trauma
  • brain tumor
  • pseudoseizures
  • alcohol/drug withdrawal
  • drug OD
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6
Q

If a person has an unprovoked seizure what is their chance of having another one?

A

50%

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7
Q

what is the timeframe of 2nd seizure after the first

A

2nd seizure often occurs within 6 months of the first

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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
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9
Q

what are risk factors for seizures

A
  • family history
  • brain infections/tumors
  • dementia
  • brain trauma
  • hypoxia
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10
Q

what are precipitating factors for seizures

A
  • fatigue
  • alcohol
  • stress
  • flashing lights
  • menstrual cycle
  • fever
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11
Q

what is a prodromal period

A

symptoms that precede a seizure by days or hours

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12
Q

what is pre-ictal or aura

A

Actually a focal onset seizure before the seizure

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13
Q

what is the ictal stage

A

during the seizure

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14
Q

what is the post-ictal stage

A

The state of somnolence and decreased responsiveness after a seizure

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15
Q

t/f symptoms experienced in the pre-ictal phase vary depending on the area of the brain that was affected

A

true

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16
Q

what are symptoms of the post-ictal stage

A
  • numbness
  • confusion
  • fatigue
  • focal weakness
  • unresponsiveness
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17
Q

what are the 2 primary types of seizures

A
  • focal
  • generalized
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18
Q

what are types of focal seizures

A
  • with retained awareness
  • with impaired awareness
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19
Q

what occurs during focal seizures with retained awareness

A
  • typically cause few symptoms, often overlooked or mistaken
  • no LOC or memory loss
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20
Q

what occurs during focal seizure with impaired awareness

A
  • altered consciousness and awareness
  • unusual, repetitive movements
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21
Q

what is a generalized seizure

A

a seizure that involves all areas of the brain

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22
Q

all generalized seizures except (…) involve LOC

A

myoclonic

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23
Q

what are the types of generalized seizures

A
  • absence
  • myoclonic
  • atonic
  • tonic
  • clonic
  • tonic-clonic
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24
Q

(…) is the only non-motor onset seizure

A

absence

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25
Q

what are the characteristics of absence seizures

A
  • staring and subtle body movements with impairment of consciousness
  • includes a brief loss pf awareness
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26
Q

t/f patients with absence seizures usually return to normal after the seizure ends

A

true

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27
Q

although absence seizures only last seconds, they can recur (how odten)

A

numerous times a day

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28
Q

you should suspect absence seizures in what kind of patient?

A

children that frequently space out

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29
Q

at what point would you start to suspect a focal seizure instead of absence seizures?

A

if it lasts more than 45 seconds

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30
Q

what are the characteristics of myoclonic seizures

A

sudden, irregular, brief jerks or twitches of the arms, legs, jaw, or generalized

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31
Q

what is the feeling of myoclonic seizures

A

can feel like jumps inside the body

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32
Q

t/f myoclonic seizures are the same thing as benign myoclonus of infancy

A

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

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33
Q

what is the difference between positive and negative myoclonus

A

positive: contractions
negative: relaxations

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34
Q

what are the characteristics of atonic seizures

A
  • sudden loss of muscle control without myoclonic or tonic features for less than 2 seconds (drop attacks)
  • associated with intellectual impairment
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35
Q

what areas of the body are affected by atonic seizures

A

head, neck or limbs

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36
Q

what are the characteristics of tonic seizures

A
  • causes muscles to tighten and stiffen
  • associated with intellectual impairment
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37
Q

patient with tonic seizure present how if breathing is impaired

A

may present with turning blue

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38
Q

what are the characteristics of clonic seizures

A

convulsive movements associated with bilateral, rhythmic jerking muscle movements

39
Q

how can you differentiate between clonic seizures and myoclonic?

A
  • myoclonic: irregular jerking with partial retained awareness
  • clonic: rhythmic jerking and LOC
40
Q

what are the characteristics of tonic clonic seizures

A
  • LOC
  • violent shaking
  • body stiffening
  • loss of bladder/bowel control
  • tongue biting
41
Q

Infantile Spasms (West Syndrome) occur around what age

A

4-7 months

42
Q

what is the cause of infantile spasms

A
  • abnormal interaction between cortex and brainstem
  • immature CNS
43
Q

How do you diagnose infantile spasms

A

hypsarrhythmia on EEG

44
Q

what are common features of infantile spasms

A
  • sudden, brief contractions
  • lasts 4-6 seconds
45
Q

what are pseudoseizures

A

physical manifestation of a psychological disturbance, frequently occurring with conversion disorder

46
Q

are pseudoseizures epileptic or non epileptic?

A

they are non-epileptic but resemble an epileptic

47
Q

t/f pseudoseizures are associated with malingering

A

false

48
Q

how are pseudoseizures treated?

A

psychotherapy

49
Q

what are common features of pseudoseizures

A
  • tongue biting
  • closed eyes and resist opening
  • side to side head movements
50
Q

will patients with pseudoseizures stop their hand from hitting their face?

A

yes

51
Q

how to tell if someone is faking a seizure?

A

draw a serum prolactin level 10-20 minutes after event and compare to a baseline level 6 hours later

52
Q

t/f seizures cause increase in prolactin levels

A

true

53
Q

what is an EEG

A

electrodes places on the scalp that sense and record the electrical activity taking place in the brain

54
Q

what type of EEG is usually ordered?

A

sleep deprived

55
Q

why is epilepsy monitoring typically done?

A
  • 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
Q

how do you patient prep for EEG

A
  • wash hair night before but don’t use products other than shampoo
  • avoid caffeine day of test
  • take usual medications
57
Q

why do you use an MRI in seizures

A

to look for possible causes and at the areas with decreased blood flow

58
Q

what are the uses for functional MRI in seizures

A

to see how blood flows through the brain

59
Q

use of PET scan in seizures

A

to measure blood flow and glucose uptake

60
Q

in 80% of seizure patients, there is increase in (…) and (…) in the cerebral cortex

A

blood flow and glucose metabolism

61
Q

what are the main goals of seizure management

A
  • controlling the seizures
  • avoiding treatment side effects
  • maintaining or restoring quality of life
62
Q

what is step 1 of seizure treatment

A

classify the seizure

63
Q

(…)% of people will respond positively to the first anti-epileptic prescribed

A

60

64
Q

t/f anti-epileptics are indicated after a single provoked seizure

A

false

65
Q

when is AED therapy indicated?

A

after 2 unprovoked seizures

66
Q

what are common SE of AEDs

A
  • drowsiness
  • dizziness
  • diplopia
  • imbalance
  • n/v
67
Q

which AEDs are the most problematic for DDI?

A

enzyme-inducing (phenytoin, carbamazepine, phenobarbitol, topamax)

68
Q

(…) can increase metabolism of lamictal

A

OCPs

69
Q

which AEDs are known to be teratogenic?

A

1st gen
phenytoin, carbamazepine, phenobarbital, valproic acid

70
Q

(…) is associated with phenytoin

A

gingival hyperplasia

71
Q

which AEDs do you have to check levels?

A
  • carbamazepine
  • phenytoin
  • phenobarbital
  • valproate

1st gen

72
Q

AED monitoring is for (…)

A
  • 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
Q

when should you check drug levels?

A

at least yearly

74
Q

treatment of focal seizures

A

lamictal

75
Q

treatment of generalized seizures

A
  • valproate
  • Keppra for pregnancy
76
Q

management of post-stroke epilepsy

A

AED monotherapy

77
Q

brain tumor seizures management is influenced by…

A

DDIs with other treatments

78
Q

after at least 2 years of seizure free, …

A

consider discontinuing AEDs

79
Q

t/f 50% of patients can discontinue meds after 2-5 years

A

true

80
Q

rapid changes in drug treatment increase the risk of (…)

A

provoking a seizure

81
Q

how should benzos and barbiturates be tapered?

A

very gradually

82
Q

driving with seizures

A

must go 6 months seizure free

83
Q

when is surgery considered for seizures?

A
  • breakthrough seizures on 2+ AEDs
  • cant tolerate SE
84
Q

t/f you can surgically remove the area of the brain affected by the seizure

A

true

85
Q

cutting the (…) may help with seizures that originate in several areas of the brain

A

corpus collosum

86
Q

diet that is thought to reduce seizure frequency

A

keto

87
Q

what is status epilepticus

A

state of continuous seizure activity lasting longer than 5-10 minutes or several seizures occurring during a 30 minute time frame

88
Q

what is emergency treatment for status epilepticus

A
  • large doses of AEDs
  • benzo (lorazepam) IV push
  • followed by fosfophenytoin or phenytoin for long term control
89
Q

all patients with epilepsy should be given (…)

A
  • diazepam
  • diastat rectal gel
  • valtoco nasal spray
90
Q

what are the precautions during a seizure

A
  • maintain airway
  • prevent injury
  • don’t hold person down or put anything in mouth
  • if it lasts more than 5 minutes, call 911
91
Q

what are the complications of seizures?

A
  • car accidents
  • personal injury
  • pregnancy related
  • psychosocial issues
92
Q

medical comorbidities of epilepsy

A
  • increased prevalence of cardio, respiratory, inflammatory and pain disorders
  • sleep related breathing disorders
  • cognitive impairment
93
Q

when to screen for depression with seizures?

A

at diagnosis and on annual follow up

Pediatric EOR exam (20 decks)

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