Seizures in Peds

Question 1

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.

Answer 1

epilepsy

Question 2

progression of clinical signs that occur during the course of a seizure

Answer 2

semiologies

**differ in infants vs adults

Question 3

How can you differentiate motor phenomena of seizures from release phenomenon?

Answer 3

stand by the bedside and determine whether the movement is induced by stimulation (noise, tactile) or stopped by repositioning (ex: moving their hand)

Question 4

When are seizures most likely to occur?

Answer 4

as an infant

at the end of life (>65)

Question 5

Can occur up to 28 days post term but usu the first week of life

Answer 5

neonatal seizure

Question 6

Repetitive rhythmic jerking of a limb, face or trunk

Answer 6

focal clonic seizure

Question 7

Sustained posturing of a limb, eye deviation, assymetric trunk

Answer 7

focal tonic seizure

Question 8

Generalized tonic - sustained, symmetric posturing in children can be non-epileptic. What is this posture commonly due to?

Answer 8

GERD

Question 9

Two important causes of neonatal seizures

Answer 9

• *hypoxic-ischemic pre-or perinatal insult
• *electrolyte disturbance

also...
infection
intracranial hemorrhage
CNS congenital abnormalities
inborn errors of metabolism
toxins
genetics

Question 10

Preferred first drug for epilepsy currently

Answer 10

Levetiracetam

Question 11

Most common seizure of childhood?

Answer 11

Febrile seizures (generalized tonic clonic)

Question 12

B/w what ages do febrile seizures occur?

Answer 12

3mo to 5yr

Question 13

What are some characteristics of a simple febrile seizure?

Answer 13

lasts less than 10 minutes
generalized at onset
do not recur in first 24hrs

Question 14

Do simple febrile seizures recur in most cases? What % of febrile seizures are simple?

Answer 14

no!! can inform the parent that this is benign condition

**85% of all febrile seizures

Question 15

When should a lumbar puncture be done on a baby with meningial signs?

Answer 15

children <1 yo bc clinical signs are often absent so it is important to get an LP

Question 16

Syndromes of recurrent seizures associated with regression of developmental milestones

Answer 16

epileptic encephalopathies

Question 17

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.

Answer 17

Ohtahara’s syndrome

Question 18

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

Answer 18

Dravet’s Syndrome

Question 19

Are sodium channel blockers good for treating patient’s with Dravet’s syndrome seizures?

Answer 19

no!!! use VPA, CLBZ, TPM, etc

Question 20

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)

Answer 20

West Syndrome

**Morrow reflex is arms flung out wide like a flying squirrel

Question 21

Triad of slow spike-wave on EEG, mental retardation and mixed seizure types – myoclonic jerks, atypical absences and **drop attacks (tonic or atonic).

Answer 21

Lennox Gastaut Syndrome

Question 22

13-23% of all childhood epilepsies; most common in kids

**GTCs occur in sleep

Answer 22

benign focal epilepsy of childhood (BFEC)

Question 23

At what age does benign focal epilepsy of childhood usu remit?

Answer 23

by age 16

Question 24

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

Answer 24

hypothalamic hamartomas epilepsy (gelastic epilepsy)