peds seizure Flashcards
generalized seizures
Tonic clonic (including febrile sz)
Absence
Atypical Absence
Myoclonic tonic (or atonic)
(epileptic encephalopathy: infantile spasms)
generalized seizures
Tonic clonic (including febrile sz)
Absence
Atypical Absence
Myoclonic tonic (or atonic)
(epileptic encephalopathy: infantile spasms)
partial seizures
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)
paroxysmal events that are not a seizure
Breath holding spells Tics Sleep disorders (ie Night terrors) GE reflux (Sandifer Syndrome) ADHD Pseudoseizures Migraines Etc.
is a seizure and may be missed
Absence Seizure
Infantile spasms
most common peds seizures causes
Fevers Infections: meningitis encephalitis brain abscess Head injury
Perinatal Conditions:
congenital malformations, hypoxic-ischemic injury, hemorrhage, infection, trauma
Metabolic Conditions:
hypoglycemia, hypoglycemia, hypomagnesemia, hyponatremia, hypernatremia, storage diseases, Reye syndrome, degenerative disorders, Porphyria,Pyridoxine dependency and deficiency
infant tonic clonic seizures
don’t look like typical, less shaking, still eye movement, tongue biting
poisoning
lead, cocaine, drug toxicity, drug withdrawal
Neurocutaneous Syndromes:
Tuberous sclerosis, Neurofibromatosis, Sturge-Weber syndrome,etc.
systemic diseases
Vasculitis, SLE, renal failure, hepatic encephalopathy
other: : trauma, tumor, febrile, idiopathic, familial/genetic
this hx tidbit is v. important
immunization hx
pneumococcal, hib
criteria for febrile seizure
cannot if have other metabolic/neurog. factor
just lowers threshold
(normal CNS for criteria)
important fam hx
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
most common peds seizures causes
Fevers
Infections: meningitis
encephalitis
brain abscess
Head injuryPerinatal Conditions:
congenital malformations, hypoxic-ischemic injury, hemorrhage, infection, trauma
50% chance of having second
typically walking by
15 mos
other seizure causes
trauma, tumor, febrile, idiopathic, familial/genetic
at risk for ??? if mom is giving lots of water
or diluting formula
hyponatremia
little child may not have tip. ??? if have meningitis
Kurnig, Brudzinski sign
need LP
want CSF to be about
50% serum glucose
seizures in febrile child
•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
may mimic seizures in febrile child
rigors
•febrile delirium
•breath-holding spell
•syncope
cafe au lair spots in…
neurofibromatosis
unilateral port-wine facial nevus
CNS aneurysms
seizures
Sturge-Weber syndrome
Facial angiofibromas (adenoma sebaceum, hypopigmented ash leaf spots)
tuberous sclerosis
von Hippel landauRetinocerebellar Angiomatosis
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
repetitive movements arms forward legs up
infantile spasms Hypsarrhthmia on EEG assoc. with tuberous sclerosis tx with ACTH (not antiepilptics) can be very severe
Kernig:
Brudzinski:
flex hib to 90d, extending the knee
reflex flexion of thighs when pt nk passively flexed
not reliable
GI: ??? toxin can cause seizure
Shigella
midline defect may imply seizures
??
neuro exam
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
typically walking by
15 mos
slide 49, 51
??
at risk for ??? if mom is giving lots of water
or diluting formula
hyponatremia
lab exam
CBC Glucose Electrolytes: Calcium, Magnesium Ammonia (?) Urine toxicology Anticonvulsant levels (if on meds) Consider: LP imaging based on hx eeg (usually not done emergently)
want CSF to be about
50% serum glucose
classic febrile seizure
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)
febrile seizures
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%
risk of febrile seizure reoccurrence is
60%
2-7% with febrile sz have risk of developing epilepsy
Risk factors for epilepsy: fmhx of epilepsy, complex febrile sz, neurodevelopmental abnormalities
febrile seizure risk factors
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
febrile seizure tx: antipyretics
While will not prevent febrile seizure, may make febrile child more comfortable
ash leaf spots
tuberous sclerosis
repetitive movements arms forward legs up
infantile spasms Hypsarrhthmia on EEG assoc. with tuberous sclerosis tx with ACTC (not antiepilptics) can be very severe
febrile seizures in kids ages: ??
50% chance of having second if
6 mos - 6 yrs
have seizure when
+ babinski up to
18 mos
do pre-tibial instead
