peds60 Flashcards
neuroimaging studies in kids with seizure?
yes, in all kids with seizures except absence seizures or benign rolandic epilepsy
first time seizure in an otherwise healthy child- evaluation?
no, no further investigation
febrile seizure
must rule out CNS infection
treatment of status epilepticus
IV anticonvulsants such as short-acting benzos (lorazepam or diazepam) followed by loading dose of either phenobarbitol or pheytoin
drugs for generalized epilepsy
valproic acid or phenobarbitol
drugs for absence epilepsy
ethosuximide
drugs or partial epilepsy
carbamazepine or phenytoin
surgery for what kind of seizures
temporal lobe seizures that are refractory to meds; 75% have complete seizure control after surgery
alternative treatments for seizures
vagal nerve stimulator (side effect is hoarseness) and ketogenic diet
prognosis for epilepsy
about 70% of epileptic kids can be weaned off after 2 years of seizure free; NOT a lifelong disorder
febrile seizure
fever with seizure, 6 months to 6 years of age by definition
simple febrile seizure
lasts less than 15 mins and is generalized
complex febrile seizure
last more than 15 mins, has focal features, or recurs within 24 hours
treatment for febrile seizure
anticonvulsants not needed for first time or occasional febrile seizure; antipyretic treatment; recurrent, frequent febrile seizures need meds
meds for frequent recurrent febrile seizures
daily anticonvulsant prophylaxis wth valproic acid or phenobarbitol; also abortive treatment with rectal diazepam
prognosis for febrile seizures
30% of patients with one febrile seizure will have a recurrance; recurrance risk decr with incr age
three common epileptic syndromes
infantile spasms, absence epilepsy of childhood, and benign rolandic epilepsy
infantile spasms
aka West syndrome; age of onset 3-8 months; tuberous sclerosis is the most commonly identified cause
most commonly identified cause of infantile spasms
tuberous sclerosis
tuberous sclerosis
non-malig tumors in many different organs
clinical features of infantile spasms
brief myoclonic jerks lasting 1-2 sec, occuring in clusters over 3-5 min
jackknife seizures or salaam seizures
suggen arm extension or head and trunk flexion; seen in infantile spasms
eeg for infantile spasms
characteristic hypsarrhythmia (hghly disorganized, high amplitude occurign in both hemispheres)
management of infantile spasms
IM injection of ACTH for 4-6 weeks; valproic acid is second line; vigabatrin is most effective for patients with infantile spasms assoc w tuberous sclerosis
prognosis for infantile spasms
poor; usually kids develop moderate to severe mental retardation
absence epilepsy of childhood
age of onset 5 to 9 years; females more common; inheritance aut dom with age-dep penetrance
