Pediatric Seizures - Swartz

Question 1

what type of imaging do you use for seizures?

Answer 1

MRI

Question 2

How do you differentiate motor phenomena of seizuers from release phenomena?

Answer 2

if it is induced by stimulation (noise, tactile, passive movement) or stopped by repositioning

Question 3

Generalized tonic, sustained symmetric posturing is seen in what non-epiletpic issue?

Answer 3

GERD

Question 4

What, in order, are the most common causes of neonatal seizures?

Answer 4

1. Hypoxic-ischemic pre or perinatal insult
2. infx: septicemia, meningitis
3. intracranial hemorrhage
4. congenital CNS abn.
5. ELECTROLYTE DISTRUBANCE

Question 5

Do you need to use an AED in brief and infrequent focal motor, focal tonic, or myoclonic siezures?

Answer 5

nope

Question 6

When do you stop using an AED?

Answer 6

two weeks after the last seizure if EEG is negative

Question 7

WHat are the meds you use for neonatal seizures?

Answer 7

Levetiracetam
Phenobarbitol
Phenytoin
Ativan or midazolam if still seizing

Question 8

what is the most common seizure of childhood?

Answer 8

GTC

Question 9

when do GTC occur?

Answer 9

3 mo to 5 years

Question 10

What is a simple seizure?

Answer 10

less than 10 minutes
generalized at onset
does not recur in first 24 hours

Question 11

what type of seizure are most febrile seizures?

Answer 11

simple

Question 12

Is an EEG needed in a seizure eval?

Answer 12

no

Question 13

is bloodwork needed in a seizure eval?

Answer 13

no

Question 14

what will neuroimaging show in a normal kid who had a seizure

Answer 14

nothing

Question 15

when should an LP be done after a seizure?

Answer 15

every child with first febrile seizure or in any child older than 18 mo with meningeal signs
OR LESS THAN 1 YEAR OLD BECAUSE CLINICAL SIGNS ABSENT

Question 16

what are the risk factors for recurrent fS?

Answer 16

first at less than 1 year old
FS following low grade fever
complex febrile seizures
neurodev abnormalities

Question 17

Otahara’s syndrome or EIEE has what type of finding on EEG?

Answer 17

suppression-burst pattern

Question 18

What are the imaging findings in EIEE?

Answer 18

hemimegencephaly or just atrophy

Question 19

What is the Pxin otoharas?

Answer 19

100% ID with seizure

Question 20

what is the tx for otohara?

Answer 20

ACTH, steroids, VPA

Question 21

Dravet’s syndrome SEI is associated with defects in what type of channel?

Answer 21

three sodium channel genes and a GABA subunit gene

Question 22

what types of drugs makes Dravet’s worse?

Answer 22

sodium channel blockers

Question 23

What do you see on the EEG for Dravet’s?

Answer 23

GSW or slow poly SW in sleep
MRI normal
Intellectual decline in 50%

Question 24

what are the seizures like in otohara’s?

Answer 24

neonatal period from 10 day to 30 mo; Seizures are tonic spasms, drop attacks and partial.

Question 25

what are the seizures like in DRavet’s?

Answer 25

Unilateral clonic seizures, febrile and afebrile, in the first year of life in previously normal infant
Recur at 6-8 wk intervals. May cause status – convulsive or subtle

Question 26

What is seen on the EEG in West Syndrome SEEI

Answer 26

hypsarrhythmia, Slow waves or slow SW, BS, rarely normal

Can be misdiagnosed as Morrow reflex, colic, startle responses

Question 27

What are the causes of West syndrome sEEI?

Answer 27

head injury, CNS infx, ICH, dysgenesis, inborn errors of met.

Question 28

Do you see cog and neuro disabilityin West syndrome?

Answer 28

in 90 % of cases

Question 29

WHat is the Tx in wEst syndrome?

Answer 29

ACTH, steroids,

Question 30

what are the seizures like in West syndrome?

Answer 30

Characterized by infantile spasms – brief bilaterally symmetic contraction of muscles of neck, trunk and extremities
Subtle or generalized
3-100’s a day
Occur on sleep transition or with stimulation

Question 31

What does the EEG look like in Lennox Gastaut?

Answer 31

Triad of slow spike-wave on EEG, mental retardation and mixed seizure types – myoclonic jerks, atypical absences and drop attacks (tonic or atonic).

Question 32

The drop attacks of Lennox Gastaut have what response on EEG>

Answer 32

electrodecremental response

Question 33

What is the name for acquired epileptic aphasia?

Answer 33

Landau-Klefner syndrome

Question 34

what does the eeg show in LK syndrome?

Answer 34

EEG shows multifocal SW
Child develops verbal agnosia and decreased spontaneous speech
Remits before age 15
Etiology unknown

Question 35

Electrical status epilepticus during sleep on EEG shows what?

Answer 35

some bursts of SW while awake become continuous in sleep

Question 36

what type of involvement are absence seizures?

Answer 36

Bihemispheric initial involvement of 3 Hz GSW lasting 3-10 sec

Question 37

what is the most common epilepsy syndrome?

Answer 37

Juvenile myoclonic epilepsy

Question 38

WHat are the hallmarks of juvenile myoclonic epilepsy?

Answer 38

myoclonic jerks, fast GSW (4-6 Hz) normal IQ and development

Question 39

WHat do you use to treat juv. myoc. epi?

Answer 39

LEV, VPA, LTG

Question 40

Benign focal epilepsy of childhood aka rolandic epilepsy remits by what age?

Answer 40

16

Question 41

what is the most common of childhood epilepsies?

Answer 41

BFEC

Question 42

What has spikes in occipital or anterior areas?

Answer 42

Panayiotopolus Syndrome

Question 43

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

Answer 43

Atypical Benign Partial Epilepsy of Childhood

Question 44

Laughter without emotion, 10-30 sec, frequent

Answer 44

Hypothalamic Hamartomas (Gelastic) Epilepsy.