Peds Epilepsy Flashcards
Epilepsy (operational definition) (3)
- 2 or more unprovoked seizures
- single seizure with a likelihood of a second
- known epilepsy syndrome
What type of seizure is more worrisome: Focal or generalized?
Focal
What is HIE? When does it typically cause seizures?
Hypoxic-ischemic encephalopathy
- most common cause of neonatal seizures (50-60%)
- seizures start within 24-72 hrs after birth, and remit after a few days
- asphyxia usually prior to or during birth
4 types of neonatal seizures
- subtle (50%)
- clonic (25%)
- myoclonic (20%)
- tonic (5%)
Define subtle seizure
- any subtle paroxysmal event that interrupts expected behavior of a newborn
- appears stereotypical or repetitive
Tonic seizures:
- preterm or term?
- focal or generalized?
- Differentiate between decerebrate vs decorticate posturing
- Usually preterm, likely due to ICH
- can be focal or generalized
- Decerebrate posturing: sustained extension of upper and/or lower extremities
- Decorticate: sustained flexion of UEs and/or LEs
Clonic seizures:
- preterm or term?
- focal or generalized?
- limb movement features
- type of injury association
- Usually term
- Focal/multifocal
- –Migrates from limb to limb (Jacksonian March)
- clonic limb movements with slow return movement
- Associated with focal cortical injury:
- -infection, hemorrhage, trauma, infarcts (most common)
Myoclonic seizures:
- focal or generalized?
- type of movements
- how to differentiate from benign neonatal sleep myoclonus?
- Rare
- can be focal, multifocal, or generalized
- rapid jerks of extremities (UE>LE)
- -lacks slow return phase seen with clonic movements
- benign sleep myoclonus ONLY occurs during sleep (and normal EEG)
Status epilepticus
continuous seizures lasting 30 minutes
-associated with worse outcomes
What age group has highest incidence of seizures? When are you most likely to see them?
Neonates
-Majority on the 1st day, most in the first 10 days
Main causes of seizure in term infants (7)
- HIE (hypoxic-ischemic encephalopathy)
- Infection
- ICH (intracranial hemorrhage)
- Inborn error of metabolism
- Perinatal stroke
- Malformation syndromes
- Genetic diseases
Define febrile seizure
Seizure occurring in childhood after age 1 month associated with febrile illness NOT caused by an infection of the CNS (and with no previous seizures)
- upper age limit around 6-7 y/o
- not always w/ convulsive activity
- strong genetic component
Complex febrile seizure features
- focal features
- duration >10-15 mins
- recurrent seizures w/in 24 hrs
3 most commonly used seizure medications
- Phenobarbital
- Keppra
- Dilantin
Define hypsarrythmia. What syndrome is it a diagnostic tool for?
Chaotic EEG pattern, very high amplitudes, “spikes” cross over each other.
“If you turn the EEG reading upside down it looks the same”.
-Diagnostic tool for infantile spasms
Infantile spasms features:
- type of movement
- when does it typically occur
- Epileptic spasms: sudden movement forward or backward of neck, trunk, or extremities followed by stiffening of arms/legs/body lasting 2-10 seconds.
- usually occurs at sleep transition
Infantile spasms:
-2 important diagnostic features
EYES WIDEN and Hypsarrythmia on EEG
Infantile spasms:
- prognosis/long term effects
- Txs
- leads to developmental delay or regression. Early diagnosis and treatment= better developmental outcome
- Tx: Vigabatrin (VGB) or ACTH (1st line if idiopathic)
Lennox Gestaut:
- define
- M or F?
- triad
-childhood epileptic encephalopathy
-5x more common in males
Triad:
-multiple types of seizures
-developmental delay or regression
-characteristic EEG: paroxysmal fast activity (PFA) and slow spike-and-wave discharges
Lennox Gestaut prognosis
Poor, significant intellectual disabilities or death
-worse with symptomatic and early onset of seizures
Self limited (benign) Rolandic epilepsy:
- features
- more common in males or females?
- when do seizures usually stop?
- treatment and prognosis
- occurs more frequently during sleep (like sleepwalking)
- -drooling and facial twitching
- more common in males
- stops at puberty
- treatment usually not necessary
- good prognosis typically (unless abnormal EEGs, may be learning disabilities)
Childhood absence epilepsy (pyknolepsy)
- features
- more common in M or F?
- age onset
- Petit mal, look like staring spells
- most common type of childhood onset epilepsy
- frequent and brief seizures (>100x/day and <10 secs)
- more common in females
- onset 4-8 y/o, peak 6-7 y/o
Childhood absence seizures features
- staring spells, abrupt onset, short, unaware, no postictal phase
- Can have myoclonic and GTC seizures as well
- Can reproduce by having child hyperventilate
Childhood absence:
- Tx (1st line)
- Prognosis
Tx: ethosuximide (if no GTCs), most respond well to medication
-good prognosis typically