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Pediatrics Flashcards

1
Q

What is the definition of epilepsy?

A

The occurrence of at least 2 unprovoked seizures (regardless of the type)

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2
Q

What is the definition of seizure?

A

The clinical manifestation of abnormal hypersynchronous d/c of the cortical neurons

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3
Q

What are the two general classifications of seizures?

A

Generalized

Partial

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4
Q

What are the 6 types of generalized seizures?

A
  • Absence
  • Myoclonic
  • Atonic
  • Tonic
  • Clonic
  • Tonic-clonic
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5
Q

What are absence seizures?

A

Staring episodes with cessation of activity

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6
Q

What are myoclonic seizures?

A

Brief jerking muscle movements

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7
Q

What are atonic seizures?

A

Loss of tone for a few seconds (could be whole body or only partial)

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8
Q

What are clonic seizures?

A

Regularly repeated muscle jerks

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9
Q

What is the difference between a simple and a complex partial seizure?

A

No alteration of consciousness with simple

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10
Q

What are the five characteristics used to define epilepsy syndromes?

A
  • Seizure type
  • Age of onset
  • Course
  • EEG abnormalities
  • Drug of choice
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11
Q

What are the characteristics of childhood absence epilepsy?

A

Brief staring spells with impairment of awareness and cessation of activity without loss of tone

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12
Q

What is the duration of childhood absence seizures?

A

Usually less than 20 seconds

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13
Q

What is the frequency of absence seizures?

A

Multiple times/day

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14
Q

What usually provokes absence seizures?

A

Hyperventilation

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15
Q

Is there a postictal state with absence seizures?

A

No

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16
Q

Is there a loss of muscle tone with absence seizures?

A

No

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17
Q

What age do absence seizures begin?

A

School aged (4-14 years)

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18
Q

What is the prognosis of absence seizures?

A

Usually self limited–resolve by age 18 years

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19
Q

What is the most important thing to ask in the history of seizures?

A

Any h/o developmental abnormalities

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20
Q

What are the EEG findings of absence seizures?

A

3 Hz spike and slow wave discharges

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21
Q

What is the treatment for absence seizures (3)? Which is the first choice?

A
  • Ethosuximide
  • Valproic acid
  • Lamotrigine
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22
Q

What gender is usually affected with absence seizures?

A

Females

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23
Q

Are absence seizures generalized or partial?

A

Generalized

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24
Q

What is benign childhood epilepsy with centrotemporal spikes (rolandic epilepsy)?

A

Infrequent, partial seizures that manifest with tingling in the mouth, on the face, drooling, dysphagia, speech arrest

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25
How common are generalized tonic-clonic seizures with benign childhood epilepsy with centrotemporal spikes?
Rare
26
When do seizures occur with benign childhood epilepsy with centrotemporal spikes?
During sleep or upon waking
27
What is the prognosis for benign childhood epilepsy with centrotemporal spikes?
Usually resolve with puberty, and has no effect on development
28
What are the imaging findings of benign childhood epilepsy with centrotemporal spikes?
Normal
29
What are the drugs of choice to treat benign childhood epilepsy with centrotemporal spikes (2)?
Carbamazepine | Oxcarbazepine
30
What is the MOA of carbamazepine?
Na channel blocker and GABA receptor agonist
31
What are the EEG findings of benign childhood epilepsy with centrotemporal spikes?
Centrotemporal spikes
32
What are the facial s/sx of benign childhood epilepsy with centrotemporal spikes?
- Tingling of the mouth - Drooling - Dysphagia - Speech arrest
33
What are the UE findings of benign childhood epilepsy with centrotemporal spikes?
Unilateral UE movement
34
What is the general age range for benign childhood epilepsy with centrotemporal spikes?
2-12 years
35
True or false: benign childhood epilepsy with centrotemporal spikes usually appears on both hemispheres
False--usually unilateral
36
What is juvenile myoclonic epilepsy?
Myoclonic jerking seizures that usually happen in the morning, and is without LOC
37
What is the usual age of onset for juvenile myoclonic epilepsy?
12-18 years
38
What are the EEG findings of juvenile myoclonic epilepsy?
3-6 Hz polyspikes and waves (many small spike, and then a slow wave in all leads)
39
How can juvenile myoclonic epilepsy be provoked?
Photic stimulation
40
Is there LOC with juvenile myoclonic epilepsy?
Usually not
41
What are the usual triggers of juvenile myoclonic epilepsy? (4)
- AM wakening - Lack of sleep - Fatigue - EtOH
42
What is the prognosis for juvenile myoclonic epilepsy?
Requires lifelong treatment, but good response to meds, and no developmental issues
43
What is the treatment for juvenile myoclonic epilepsy? (3) Which is the drug of choice?
- **Valproic acid** - Levetiracetam - Lamotrigine
44
True or false: Juvenile myoclonic epilepsy is a lifelong disease
True
45
Does juvenile myoclonic epilepsy usually manifest as a generalized seizure or partial?
Generalized
46
What are the side effects of valproic acid?
Teratogenic effects PCOS Hirsutism
47
What percent of juvenile myoclonic epilepsy have GTCs? What in particular provokes them?
85%--usually brought about by a lack of sleep
48
What is a febrile seizure?
Fever of more than 38 C and seizure in the absence of CNS infection
49
What ages do febrile seizures usually happen?
in children between 3 months and 6 years
50
What must be r/o with febrile seizures?
Meningitis
51
True or false: patients with febrile seizures usually have no previous h/o afebrile seizures
True
52
What is the most common type of seizure in children?
Febrile
53
True or false: a febrile seizure, by definition, has to occur in the absence of a CNS infection
True
54
What is a simple febrile seizure?
Generalized seizure of less than 15 minutes duration, that occurs one time in 24 hours
55
What is a complex febrile seizure?
Foal, more than 15 minutes in duration, or more than one seizure in a 24 hour period
56
Are febrile seizures found more often in viral or bacterial infections?
Viral
57
What is the recurrence risk of febrile seizures?
30%
58
What are the two immunizations that should be given to children who have febrile seizures?
- MMR | - DPT
59
How do you differentiate between a febrile seizure and a seizure 2/2 meningitis (lab, sign, symptom)?
- LP - Meningeal signs - Prolonged postictal state with meningitis
60
When should an LP be done in the workup of a febrile seizure? (2)
- 6-12 months old if not fully vaccinated for HiB or strep pneumonia - Taking Abx
61
Prolonged postictal state with a febrile seizure suggests what? What should be done?
Meningitis | LP
62
True or false: CBC, CMP, Ca, and Mg should be checked with febrile seizures
False
63
True or false: brain imaging and/or an EEG should be obtained with febrile seizures
False
64
When is neuroimaging indicated for a febrile seizure?
- Focal neuro deficits - Macrocephaly - S/sx of increase ICP
65
True or false: and EEG is NOT indicated for a simple febrile seizure
True--but may be indicated in complex febrile seizures
66
What is the treatment for febrile seizures? When is it indicated?
Benzos--if lasting more than 5 minutes
67
True or false: prophylactic medications should be given in cases of febrile seizures
False
68
What is the prognosis for febrile seizures?
Benign
69
What are the risk factors for the development of febrile seizures? (4)
- h/o *complex* febrile seizures - Abnormal neuro exam - Developmental delay - Family h/o epilepsy
70
What is infantile spasm?
-Epileptic spasm that usually starts in infancy.
71
What is the prognosis for infantile spasms?
Severe problem with developmental delay
72
What is the usual presentation of infantile spasms?
Sudden flexion of legs, arms, neck and head Extension rarely
73
What is the most common type of infantile spasm: flexion, extension, or mixed
Mixed--Flexion of the head and arms, with extension of the legs
74
Are infantile spasms usually singleton, or multiple?
Clusters
75
When in the day do infantile spasms usually occur?
Awakening from sleep
76
What is the prognosis of infantile spasms?
Usually associated with developmental arrest or regression
77
3 Hz spike and slow wave discharges on EEG = what type of seizure?
Absence seizure
78
3-6 Hz polyspikes and waves = what type of seizure?
Juvenile Myoclonic Epilepsy
79
Which type of childhood seizure can be provoked with hyperventilation, and which with photic stimulation?
Absence = hyperventilation Juvenile Myoclonic epilepsy = photic

Neurology (23 decks)

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