peds seizure

Question 1

generalized seizures

Answer 1

Tonic clonic (including febrile sz)
Absence
Atypical Absence
Myoclonic tonic (or atonic)

(epileptic encephalopathy: infantile spasms)

Question 2

generalized seizures

Answer 2

Tonic clonic (including febrile sz)
Absence
Atypical Absence
Myoclonic tonic (or atonic)

(epileptic encephalopathy: infantile spasms)

Question 3

partial seizures

Answer 3

Simple Partial Seizure: initial clinical signs begin focally and no impairment of consciousness

Complex Partial: focal neurologic signs with impairment of consciousness (may have secondary generalization)

Question 4

paroxysmal events that are not a seizure

Answer 4

Breath holding spells
Tics
Sleep disorders (ie Night terrors)
GE reflux (Sandifer Syndrome)
ADHD
Pseudoseizures
Migraines
Etc.

Question 5

is a seizure and may be missed

Answer 5

Absence Seizure

Infantile spasms

Question 6

most common peds seizures causes

Answer 6

Fevers
Infections: meningitis
encephalitis
brain abscess
Head injury

Question 7

Perinatal Conditions:

Answer 7

congenital malformations, hypoxic-ischemic injury, hemorrhage, infection, trauma

Question 8

Metabolic Conditions:

Answer 8

hypoglycemia, hypoglycemia, hypomagnesemia, hyponatremia, hypernatremia, storage diseases, Reye syndrome, degenerative disorders, Porphyria,Pyridoxine dependency and deficiency

Question 9

infant tonic clonic seizures

Answer 9

don’t look like typical, less shaking, still eye movement, tongue biting

Question 10

poisoning

Answer 10

lead, cocaine, drug toxicity, drug withdrawal

Question 11

Neurocutaneous Syndromes:

Answer 11

Tuberous sclerosis, Neurofibromatosis, Sturge-Weber syndrome,etc.

Question 12

systemic diseases

Answer 12

Vasculitis, SLE, renal failure, hepatic encephalopathy

other: : trauma, tumor, febrile, idiopathic, familial/genetic

Question 13

this hx tidbit is v. important

Answer 13

immunization hx

pneumococcal, hib

Question 14

criteria for febrile seizure

Answer 14

cannot if have other metabolic/neurog. factor
just lowers threshold
(normal CNS for criteria)

Question 15

important fam hx

Answer 15

febrile seizures
migraines
tics or Tourettes’
rheumatic fever or metabolic disorders
meds are in the home 
if syncope; add fmhx of SVT, prolonged QTc syndrome

Question 16

most common peds seizures causes

Answer 16

Fevers
Infections: meningitis
                      encephalitis
                       brain abscess
Head injury

Question 17

Perinatal Conditions:

Answer 17

congenital malformations, hypoxic-ischemic injury, hemorrhage, infection, trauma

Answer 18

50% chance of having second

Question 19

typically walking by

Answer 19

15 mos

Question 20

other seizure causes

Answer 20

trauma, tumor, febrile, idiopathic, familial/genetic

Question 21

at risk for ??? if mom is giving lots of water

or diluting formula

Answer 21

hyponatremia

Question 22

little child may not have tip. ??? if have meningitis

Answer 22

Kurnig, Brudzinski sign

need LP

Question 23

want CSF to be about

Answer 23

50% serum glucose

Question 24

seizures in febrile child

Answer 24

•meningitis
 febrile seizure
•encephalitis
•epilepsy
•electrolyte imbalance
•poisoning
•hypoglycemia
•severe myoclonic epilepsy in infancy (Dravet syndrome)(1)
•intracranial lesion, such as(3)◦brain abscess
◦brain tumor
•traumatic brain injury

Question 25

may mimic seizures in febrile child

Answer 25

rigors •febrile delirium •breath-holding spell •syncope

Question 26

cafe au lair spots in...

Answer 26

neurofibromatosis

Question 27

unilateral port-wine facial nevus CNS aneurysms seizures

Answer 27

Sturge-Weber syndrome

Question 28

Facial angiofibromas (adenoma sebaceum, hypopigmented ash leaf spots)

Answer 28

tuberous sclerosis

Question 29

von Hippel landauRetinocerebellar Angiomatosis

Answer 29

Rare, dominant inheritance Retinal and cerebellar hemangioblastomas Cysts of kidneys, pancreas, epidydimis Renal cancers Can present with retinal detachment, or cerebellar signs from the hemangioblastoma

Question 30

repetitive movements arms forward legs up

Answer 30

``` infantile spasms Hypsarrhthmia on EEG assoc. with tuberous sclerosis tx with ACTH (not antiepilptics) can be very severe ```

Question 31

Kernig: Brudzinski:

Answer 31

flex hib to 90d, extending the knee reflex flexion of thighs when pt nk passively flexed not reliable

Question 32

GI: ??? toxin can cause seizure

Answer 32

Shigella

Question 33

midline defect may imply seizures

Answer 33

??

Question 34

neuro exam

Answer 34

Dysarthria (not able to evaluate in young child) Visual field deficits (not able to evaluate in young child) Cranial nerve palsies Sensory deficits Focal weakness (Todd’s paralysis Ignoring ½ body for transient time after) Babinski (rub on pre-tibial region) Achilles reflex Developmental milestones

Question 35

typically walking by

Answer 35

15 mos

Question 36

slide 49, 51

Answer 36

??

Question 37

at risk for ??? if mom is giving lots of water | or diluting formula

Answer 37

hyponatremia

Question 38

lab exam

Answer 38

``` CBC Glucose Electrolytes: Calcium, Magnesium Ammonia (?) Urine toxicology Anticonvulsant levels (if on meds) Consider: LP imaging based on hx eeg (usually not done emergently) ```

Question 39

want CSF to be about

Answer 39

50% serum glucose

Question 40

classic febrile seizure

Answer 40

Brief Generalized seizure Seizure less than 15 minutes Fever on presentation Normal developmental history often ….Positive family history of febrile Seizure *No CNS infection *typical age: 6months to 60 months (5 years)

Question 41

febrile seizures

Answer 41

``` Occur AFTER 1 month of age Associated with febrile illness but NOT CNS infection No hx of neonatal or other seizures Typical ages 6m to 5years Incidence 3-8% ```

Question 42

risk of febrile seizure reoccurrence is

Answer 42

60% 2-7% with febrile sz have risk of developing epilepsy Risk factors for epilepsy: fmhx of epilepsy, complex febrile sz, neurodevelopmental abnormalities

Question 43

febrile seizure risk factors

Answer 43

Peak temperature during illness Hx of febrile sz in first degree relative Increased exposure to HHV-6 Vaccinations with MMR, DTaP, influenza vaccines 50% have no risk factors Sodium channel mutations see slide 68 for tx

Question 44

febrile seizure tx: antipyretics

Answer 44

While will not prevent febrile seizure, may make febrile child more comfortable

Question 45

ash leaf spots

Answer 45

tuberous sclerosis

Question 46

repetitive movements arms forward legs up

Answer 46

``` infantile spasms Hypsarrhthmia on EEG assoc. with tuberous sclerosis tx with ACTC (not antiepilptics) can be very severe ```

Question 47

febrile seizures in kids ages: ?? 50% chance of having second if

Answer 47

6 mos - 6 yrs have seizure when

Question 48

+ babinski up to

Answer 48

18 mos | do pre-tibial instead