Seizures and Non-Epileptic Events Flashcards
most common MIMIC of a pediatric seizure
breath holding spells
Occur in children 6 months to 6 years, 5% of population→ associated with low iron levels
Involuntary reflex with provoking event (anger, frustration, pain), followed by crying, then the child becomes apneic and loses consciousness for up to 1 minutes.
When unconscious, child may have twitching movements, myoclonus, or clonic movements of extremities
Rarely, child could have a seizure provoked by anoxia (reflex anoxic seizure) secondary to the breath holding (the seizure is not the cause of the LOC)
Management: EKG for pallid breath holding spells, reassurance and education, call 911 if prolonged spell >1 min
differentiate between a cyanotic and pallid breatholding spell
cyanotic: due to anger and frsutration, stops breathing and turns blue, loses consciousness and might jerk around. back to normal after
pallid: fear and pain causes them to stop breathing and turn pale, leading to decerebrate posturing, irriegular tonic clonic. sleepy or tired after
do absence seizures have a post ictal phase?
no
compare and contrast absence and focal aware seizures– which one has aura? which can be triggered by hyperventilation? which one lasts longer?
focal seizure symptoms depend on what part of the brain is involved:
temporal– aura, olfatory and auditory hallucination,
frontal-hyperkinetic seizures,asymmetric motor seizures
occipital lobe– sensory visual hallucination
parietal lobe– somatosensory
JME
- onset around ___ year
- characterized by __ jerks
- _____ spikes on EEG
treatment for males:
treatment for females:
Generalized seizure onset 14-15 years.
Myoclonic jerks
EEG: 4-6 hz polyspike and wave, photoparoxysmal response
Treamtn: 1st line for males: valproic acid, lamotrigine
For females: lamotrigine, (VPA is teratogen and may cause ovarian cysts)
Genetic links→ family history of epilepsy or febrile seizures.
Epilepsy definition
2 unprovoked seizures, or 1 unprovoked seizure and high risk to have further seizures (abnormal EEG)
definition of acute symptomatic seizure
a provoked seizure due to:
- metabolic (hypoglycemia, hypocalcemia, hypo or hypernatremia)
- trauma
- bleed
- masses
- drugs/toxin/withdrawal
- autoimmune
- CNS infection
- febrile seizures
investigations for first non-febrile seizure
difference in management of imaging for generalized seizure vs focal onset seizure
for generalized, no urgent imaging needed inless abnomral neuro xam, status epilepticus, trauma, bleeding disorder
CT head is done for focal onset seizures
absence seizures often appear to have sudden behavioural arrest and loss of awareness. Automatisms like fluttering eyelids, mouth smaking might happen. there is a characteristic ___ Hz spike on EEG, and is provoked by ____
West syndrome
a pediatric emergency characteristic by epileptic spasm: rare, but most often occur in
infants 3-11mo. Sudden flexion or extension of
truncal and proximal extremity muscles. Brief 1-2s
spasms that occur in clusters of 2-3min.
- reger to peds neuro
indications for an LP in a child with a fever + seizure
signs of meningitis,
<6mo,
6-12mo unvaccinated,
Treatment: fever + seizure + pre-treament Abx. You must ALWAYS r/o CNS infection
typical management of a febrile seizure
Management: no medications needed (treat fever + infection), educate parents (see complications) Complications: 1/3 risk of having another febrile seizure, 2/3 risk of a third febrile seizure, no increased risk of epilepsy, no impact on intellect/cognitive function (unless prolonged)
childhoos absence epilepsy vs juvenile myoclonic epi
west syndrome triad
developmental delay + abnormal charotic EEG + epileptic spasms
Management:
• Generalized Seizures: ___ ___
• Generalized or Focal Seizures: __, __, ___, ___
• Focal Seizures: ___, __
• Absence: ___
- Infantile Epileptic Spasms: vigabatrin or prednisolone
- Safety: no swimming or bathing alone, life jackets, driving precautions
- Seizure Recognition + Response: recovery position, call 911 5min+ seizure
- Sudden Unexplained Death in Epilepsy (SUDEP): rare. Risk factor frequent generalized tonic- clonic seizures. Reduced risked by optimizing control
Management:
• Generalized Seizures: valproic acid
• Generalized or Focal Seizures: levetiracetam, lamotrigine, topiramate, clobazam
• Focal Seizures: Carbamazepine, oxcarbazepine
• Absence: Ethosuximide
• Infantile Epileptic Spasms: vigabatrin or prednisolone
• Safety: no swimming or bathing alone, life jackets, driving precautions
• Seizure Recognition + Response: recovery position, call 911 5min+ seizure
• Sudden Unexplained Death in Epilepsy (SUDEP): rare. Risk factor frequent generalized tonic- clonic seizures. Reduced risked by optimizing control
differnetiate between simple and complex febrile seizure
simple: generalized, <15 min, 1 seizure in 24 hours.
- no investigations needed for seizre. work up the soruce of the fever (ear exam, consider urinalysis, and culture). May need an LP if there are signs of meningitis, <6 mo, unvaccinated.
atypical/complex: focal, >15 min, >1 seizure in 24 hours.
management: EEG, consider CT/MRI esp if focal siezure. Consider LP. WOrk up the soruce of fever.
- complex febrile seizures have a slightly higher risk for underlying epilepsy
outline the sleep requirements for toddlers, newborns and for 6mo
Requirements: 16-18hr/day as a newborns; around 2-3mo will have increasing nocturnal consolidation; by 6mo typically 10-12hr/night + 2 daytime naps (total 12-16hr/d); toddlers need 11-14hr/d (including 1-2 naps)
outline the sleep onset associatino vs limit-setting types of behavioural insomnia of childhood
sleep onset: frequent/prolonged night wakings. can be positive (independent, self-soothing), or negative (need for parental intervention)
limit setting: kid refuses to go to bed at an appropriate time, stalls despite being sleepy
an EEG is almost always indicated, except for ___ ___ seizures
simple febrile seizures
