Seizures in Peds Flashcards
At least 2 unprovoked (or reflex) seizures occurring more than 24 hours apart.
or
One unprovoked (or reflex) seizure and an abnormality (abnormal MRI or EEG) that puts you at risk similar to the general recurrency risk after 2 unprovoked seizures, occurring over the next 10 years.
epilepsy
progression of clinical signs that occur during the course of a seizure
semiologies
**differ in infants vs adults
How can you differentiate motor phenomena of seizures from release phenomenon?
stand by the bedside and determine whether the movement is induced by stimulation (noise, tactile) or stopped by repositioning (ex: moving their hand)
When are seizures most likely to occur?
as an infant
at the end of life (>65)
Can occur up to 28 days post term but usu the first week of life
neonatal seizure
Repetitive rhythmic jerking of a limb, face or trunk
focal clonic seizure
Sustained posturing of a limb, eye deviation, assymetric trunk
focal tonic seizure
Generalized tonic - sustained, symmetric posturing in children can be non-epileptic. What is this posture commonly due to?
GERD
Two important causes of neonatal seizures
- *hypoxic-ischemic pre-or perinatal insult
- *electrolyte disturbance
also... infection intracranial hemorrhage CNS congenital abnormalities inborn errors of metabolism toxins genetics
Preferred first drug for epilepsy currently
Levetiracetam
Most common seizure of childhood?
Febrile seizures (generalized tonic clonic)
B/w what ages do febrile seizures occur?
3mo to 5yr
What are some characteristics of a simple febrile seizure?
lasts less than 10 minutes
generalized at onset
do not recur in first 24hrs
Do simple febrile seizures recur in most cases? What % of febrile seizures are simple?
no!! can inform the parent that this is benign condition
**85% of all febrile seizures
When should a lumbar puncture be done on a baby with meningial signs?
children <1 yo bc clinical signs are often absent so it is important to get an LP
Syndromes of recurrent seizures associated with regression of developmental milestones
epileptic encephalopathies
Seen in neonatal period; 10 da – 3 mo .
EEG characterized by SUPPRESSION-BURST pattern
Seizures are tonic spasms, drop attacks and partial. Rare myoclonus can also occur.
Ohtahara’s syndrome
Unilateral clonic seizures, febrile and afebrile, in the first year of life in previously normal infant
**Associated with molecular defects in three sodium channel subunit genes
Dravet’s Syndrome
Are sodium channel blockers good for treating patient’s with Dravet’s syndrome seizures?
no!!! use VPA, CLBZ, TPM, etc
Characterized by infantile spasms – brief bilaterally symmetric contraction of muscles of neck, trunk and extremities
**EEG – hypsarrhythmia, Slow waves or slow SW, BS, rarely normal
**Can be misdiagnosed as Morrow reflex, colic, startle responses
85% symptomatic; 15% cryptogenic (no known cause)
West Syndrome
**Morrow reflex is arms flung out wide like a flying squirrel
Triad of slow spike-wave on EEG, mental retardation and mixed seizure types – myoclonic jerks, atypical absences and **drop attacks (tonic or atonic).
Lennox Gastaut Syndrome
13-23% of all childhood epilepsies; most common in kids
**GTCs occur in sleep
benign focal epilepsy of childhood (BFEC)
At what age does benign focal epilepsy of childhood usu remit?
by age 16
What is this?
Boys > Girls. Peak age 2-3. Seizures can appear throughout adulthood
**laughter w/o emotion, 10-30sec, frequent
precipitated by a hypothalamic hamartoma
hypothalamic hamartomas epilepsy (gelastic epilepsy)
