seizures

Question 1

What is a seizure?

Answer 1

A seizure is a sudden, transient disturbance of brain function, manifested by involuntary motor, sensory, autonomic, or psychic phenomena, alone or in combination, often accompanied by alteration or loss of consciousness.

Question 2

Seizures may occur after a ____, ____, ____ or ___ insult to the brain (symptomatic seizures) occurs or spontaneously without prior known CNS insult.

Answer 2

metabolic, traumatic, anoxic, infectious

Question 3

Epilepsy is defined as

Answer 3

Epilepsy is defined as two seizures that are separated by at least 24 hours, a single seizure associated with a greater than 60% risk of recurrence or the diagnosis of an epilepsy syndrome

Question 4

During childhood, the incidence of epilepsy is highest in what age period?

Answer 4

newborn

Question 5

The chance of having a second seizure after an initial unprovoked episode in a child is about ___%.

Answer 5

50

Question 6

Etiology of epilepsy and seizures

Answer 6

genetic (usually due to multiple genes)
idiopathic (accounts for >60%)
acquired (injury, brain, tumors, strokes, previous infections, electrolyte imbalance, autoimmune disordes)

Question 7

classification of seizures (3)

Answer 7

1. focal
2. generalized
3. unknown

Question 8

There are several types of generalized seizures that are recognized with the new classification: (7):

Answer 8

1. generalized tonic- clonic,
2. absence (typical, atypical, and with special features),
3. myoclonic,
4. myoclonic atonic,
5. tonic,
6. clonic, and
7. atonic seizures.

Question 9

What are 2 types of focal seizures

Answer 9

Focal seizure with retained awareness
Focal seizure with altered awareness

Question 10

Describe focal seizure with retained awareness

Answer 10

(simple partial seizures)
- arise from a specific anatomical focus.
- Clinical symptoms include motor (tonic, clonic, myoclonic), sensory, psychic, or autonomic abnormalities, but consciousness is preserved.
- The location and extent of spread of the seizure focus determine the clinical symptoms.

Question 11

Describe focal seizure with altered awareness

Answer 11

(complex partial seizures)
- similar sensorimotor signs + alteration of consciousness.
- dyscognitive features may occur
- patients may have automatisms or stare during these seizures

Question 12

Describe generalized seizures

Answer 12

Tonic, clonic, and biphasic tonic-clonic seizures may occur alone or in association with other seizure types.

seizure begins abruptly but occasionally is preceded by a series of myoclonic jerks

consciousness and control of posture are lost, followed by tonic stiffening and upward deviation of the eyes.

Pooling of secretions, pupillary dilation, diaphoresis, and hypertension are common.

Question 13

What can help define the location of seizure onset?

Answer 13

specific symptoms, eg deja vu suggests temporal lobe onset

Question 14

Questions that help clarify the type of seizure (5)

Answer 14

Was any warning noted before the onset?
What did the patient do during the event?
Was there urinary or fecal incontinence?
How long did it last?
How was the child behaving after the seizure? (Any postictal events?)

Question 15

what can cause febrile seizures?

Answer 15

(meningitis, encephalitis, brain abscess)

Question 16

types of febrile seizures and their description (2)

Answer 16

1. Simple febrile seizures

last < 15 minutes, and occur only once in a 24-hour period in a neurologically and developmentally normal child.

2. Complex febrile seizures

lasts >15 minutes, recurs within 24 hours, or the child has preexisting neurological challenges

Question 17

Treatment of febrile seizures

Answer 17

most children require no treatment

Rectal diazepam can be administered during a seizure

Question 18

Do paracetamol or ibuprofen decrease the chance of having febrile seizure?

Answer 18

NO

Question 19

What is epilepsy syndrome?

Answer 19

Epilepsy syndromes have
distinctive EEG and clinical features (age of seizure onset, specific seizure types)

At least two unprovoked (or reflex) seizures occurring >24h apart

One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years

Question 20

What is benign epilepsy of childhood with centrotemporal spikes

Answer 20

self limited epilepsy with spontaneous remission, usually by age 15-17;

age of onsent 4-10 y

unknwon etiology, but family history of epilepsy is common

pharmacoresponssive but preventive medication could not be required

normal cognition, although learning ad behavioral disorders can occur

Question 21

What is childhood absence epilepsy

Answer 21

blank stare, daydreaming, mimics attentional disorder

mostly self-limited epilepsy, age of onsent 3-10 years, peaks at 6-7 years

first choice of medication: ethosuximide

generalized tonic clonic: valproic acid

comorbid learning disabilites and ADHD

Question 22

What is juvenile myoclonic epilepsy

Answer 22

Juvenile myoclonic epilepsy (JME) begins in adolescence (12 – 18 years old) and, notably, involves myoclonic seizures.

photosensitive epilepsy: seizures can be triggered by flashing or flickering lights.

Question 23

what are myoclonic seizures

Answer 23

Myoclonic seizures manifest with symmetric, irregular, shock-like, jerks of the shoulders and arms, most notably, which can cause the person to drop items, but can also affect the legs, which can cause falls.

Question 24

What is west syndrome

Answer 24

West syndrome is the triad of infantile spasms, developmental regression, and a dramatically abnormal EEG pattern (hypsarrhythmia—a pattern of chaotic high-voltage slow waves, spikes, and polyspikes).

Question 25

What are infantile spasms

Answer 25

Infantile spasms are brief contractions of the neck, trunk, and arm muscles, followed by a phase of sustained muscle contraction lasting less than 2 seconds

Question 26

What is Lennox-Gastaut Syndrome

Answer 26

is a severe epilepsy syndrome with variable age of onset.
Most children present before age 5 years
multiple seizure types are present
Many children have underlying brain injury, malformations, or genetic etiologies.
The seizures are typically difficult to control, and most patients have significant intellectual disability.

Question 27

What is status epilepticus

Answer 27

Status epilepticus is a neurological emergency and is defined as

ongoing seizure activity or
repetitive seizures without recovery of consciousness for greater than 30 minutes.

Question 28

Possible triggers of Status Epilepticus

Answer 28

epilepsy syndromes
cerebral damage
brain tumor
electrolyte abnormalities
drug/alcohol overdose or withdrawal
encephalits

Question 29

Status epilepticus management

Answer 29

Stabilization:

ABC
Cardiac monitoring
Oxygen
IV access
LAB

Pharma:

Benzodiazepine
Standard anticonvulsant med
Continuous infusion
General anesthesia

Question 30

Laboratory evaluation for an otherwise healthy child with a self-resolved, unprovoked seizure and a normal physical and neurological examination

Answer 30

no laboratory evaluation is required

Question 31

Laboratory evaluation for Children with simple febrile seizures who have recovered completely

Answer 31

require little or no laboratory evaluation other than studies necessary to evaluate the source of the fever.

Question 32

Children with clinical signs and symptoms of meningitis (neck stiffness, Kernig sign, Brudzinski sign), or history or physical examination suggestive of intracranial infection, should undergo what diagnostic procedure?

Answer 32

lumbar puncture

Question 33

What does complete LAB for evaluation of seizure consist of? (4)

Answer 33

complete blood count and
measurement of glucose, and
electrolytes,
also blood or urine toxicology screening.