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Pedia > Seizures and Epilepsy > Flashcards

Seizures and Epilepsy Flashcards

1
Q

Paroxysmal, time-limited changes in motor activity and/or behavior that result from abnormal electrical activity in the brain

Transient occurrence of signs/symptoms resulting from ABNORMAL EXCESSIVE or SYNCHRONOUS neuronal activity in the brain

A

Seizures/convulsions

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2
Q

General term to include any one of the ff: epilepsy, febrile seizures secondary to metabolic, infectious or other etiologies

A

Seizure Disorder

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3
Q

Disorder of the brain characterized by an enduring PREDISPOSITION TO GENERATE SEIZURES and by the neurobiological, cognitive, psychological and social consequences of this condition

2 or more unprovoked seizures occurring in a time frame of >24 hrs

A

EPILEPSY

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4
Q

Disorder that manifests one or more specific seizure types and has a specific age of onset and prognosis

A

Epileptic syndrome

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5
Q

The primary determinant of the type of MEDICATIONS the patient is likely to respond to

A

Seizure type

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6
Q

Determines the TYPE OF PROGNOSIS one could expect

A

Epilepsy syndrome

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7
Q

ILAE 2017 Classification of Seizure Types

A

FOCAL (aware or impaired consciousness)

  • Motor onset (automatisms, myoclonic etc)
  • Non-motor onset (autonomic, emotional etc)

GENERALIZED

  • Motor (tonic-clonic, tonic, clonic etc)
  • Non-motor (absence)

UNKNOWN

  • Motor
  • Non-motor
  • Unclassified
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8
Q

Partial seizure

Initial activation of a system of neurons LIMITED TO A PART OF ONE CEREBRAL HEMISPHERE

A

FOCAL SEIZURE

Focal seizure w/o impairment of consciousness

Focal seizure w/ impairment of consciousness (focal dyscognitive seizures)

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9
Q

Clinical and EEG changes indicate synchronous involvement of ALL OR BOTH HEMISPHERES

A

GENERALIZED SEIZURES

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10
Q

MC type of Benign Epilepsy Syndrome with Focal Seizures

A
  • outgrown during adolescence
  • focal seizure with buccal and throat tingling and tonic or clonic contractions of 1 side of the face, with drooling and inability to speak but with preserved consciousness and comprehension

Benign Epilepsy with Occipital Spikes

  • Panayiotopoulos type
  • Lennox-Gastaut type
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11
Q

TRIAD of West Syndrome

2-12 months (infancy stage)

A

Infantile epileptic spasms
Developmental regression
EEG - HYPSARRHYTHMIA

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12
Q

EEG in Benign Childhood Epilepsy with Centrotemporal Spike

A

broad based centrotemporal spikes

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13
Q

8 mo old boy

(+) truncal flexion (as if doing sit ups) multiple times throughout the day

lost of ability to sit w/o support which he was able to do a month ago

EEG - high voltage, slow, chaotic background w/ multifocal spike

A

West Syndrome

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14
Q

Later childhood (2-10 y/o)

complex partial seizure, visual auras, migraine headache

A

Lennox-Gastaut type

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15
Q

Triad of Lennox-Gastaut type

A

developmental delay
multiple seizure type
polyspike bursts in sleep and slow background in wakefulness

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16
Q

Early childhood

complex partial seizure with ictal vomiting

A

Panayiotopoulos type

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17
Q

AED for Focal seizures and Epilepsies

A

Oxcarbazepine

Carbamazepine

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18
Q

AED for Absence seizure

A

Ethosuximide

Lamotrigine
Valproic acid

19
Q

AED for Juvenile Myoclonic Epilepsy

A

Valproate

Lamotrigine

20
Q

AED for Lennox-Gastaut

A

Clobazam
Valproate
Topiramate
Lamotrigine

21
Q

AED for Infantile Spasms

A

ACTH

22
Q

AED for Dravet syndrome

A

Valproate + Benzodiazepine (Clobazam or Clonazepam)

23
Q

AED for Benign Myoclonic Epilepsy

A

Valproate

Benzodiazepines
Clonazepam
Lamotrigine
Topiramate

24
Q

AED for Severe Myoclonic Epilepsy

A

Topiramate
Clobazam
Valproate
Zonisamide

25
Q

AED for Partial and Secondary Generalized Tonic and Clonic Seizures

A

Oxcarbazepine
Levetiracetam
Carbamazepine
Valproic acid

Phenobarbital
Topiramate
Lamotrigine
Clobazam
Clonazepam
26
Q

generalized

< 15 minutes

no recurrence in the 1st 24
hours

absent focal signs in the
post-ictal period

A

Simple Febrile Seizure (70-75%)

MC seizure disorder during childhood

27
Q

focal

> 15 minutes

recurrence in the 1st 24
hours

(+) focal signs in the
post-ictal period

A

Complex Febrile Seizure

28
Q

Lumbar puncture should be performed in all patients below _______ for a first febrile seizure

A

18 mos (1 year and 6 mos)

29
Q

When to do lumbar tap?

A

ALL infants <6 mo of age who present with fever and seizure or if the child is ill-appearing or at any age if there are clinical signs or symptoms of concer

Option in a child 6-12 mo of age who is deficient in Hib and Strep pneumoniae immunizations

30
Q

Risk factors for recurrence of febrile seizures

A

MAJOR
<1 y/o
duration of fever < 24 hrs
fever 38 - 39 C

MINOR
family hx of febrile seizures
family hx of epilepsy
complex febrile seizure
daycare
male gender
lower serum sodium at time of presentation
31
Q

In patients developing febrile status epilepticus, what viral infection is most commonly associated in 1/3 of the cases?

A

HHV 6 and HHV 7

32
Q

Continuous seizure activity or recurrent seizure activity w/o regaining of consciousness > 5 minutes

A

STATUS EPILEPTICUS

33
Q

Status epilepticus that has FAILED to RESPOND to therapy usually with at least 2 medications (benzodiazepine and another medication)

A

REFRACTORY STATUS EPILEPTICUS

34
Q

Initial and Emergent therapy for Status Epilepticus

A

Diazepam or Lorazepam – in 3-5 mins anticipate for response

Phenytoin/Fosphenytoin and Phenobarbital - if after 5 minutes may recurrence pa din

Valproate and Levetiracetam - if wala pa din

35
Q

Only drug that may be used for benign infantile seizures

A

Phenobarbital

36
Q

Lumbar puncture indications for first febrile seizure

A

all patients <18 mos

(+) clinical signs of meningitis

37
Q

Greatest risk factor for occurrence of subsequent

A

Neurodevelopmental abnormalities

38
Q

1st step in management of status epilepticus

A

securing airway
breathing
circulation

39
Q

Most commonly associated viral infections with febrile status epilepticus

A

HHV 6

HHV 7

40
Q

ABSOLUTE contraindications to a lumbar puncture

A

signs of increased ICP

local infection at desired punctured site

radiological signs of obstructive hydrocephalus, cerebral edema or herniation, (+) intracranial lesion or midline shift

41
Q

RELATIVE contraindications to a lumbar puncture

A

signs of shock, sepsis, hypotension

coagulation defects

focal neurologic defect

GCS <8

epileptic seizure

42
Q

Recommended treatment for Neisseria meningitidis invasive infections in neonate

A

Cefotaxime

43
Q

Most frequently identified symptom in meningococcemia

A

Fever

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