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Pediatrics > Seizures& Managment Of Seizures > Flashcards

Seizures& Managment Of Seizures Flashcards

1
Q

In status epilepticus, what is the time threshold for tonic clonic?

A

5 minutes

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2
Q

A patient came to you with absence seizure , when do you consider it abscence status?

A

10-15

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3
Q

A patient came to you with focal complex seziure , what is the time threshold for it to consider it status?

A

10 minutes

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4
Q

A patient came to you with an attack of seizure for 20 minutes , whats your next step of management ?

A

Give benzodiazepines:
1-Iv lorazipam
2-Iv diazipam , Iv midazolam
3-IM midazolam , buccal- intranasal any one of them <— if can’t tolerate oral

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5
Q

A patient came to you seizing for two minutes, whats your next step?

A

Stabilize the patient
ABC
Oxygen , pulse ox
Iv access : 2 Iv lines/ intraosseous
Lab:
Glucose
BMP
Anticonvulsant drug level
Tox studies
CBC

YOU MIGHT GIVE:
Initial supportive measures according to the cause
Nalaxone/thiamine/glucose

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6
Q

If a patient came to you seizing for 5 minutes, whats your next step in management? ,
If the seizure stops whats your next step?

A

1-benzodiazepines

2-further diagnostic approach:
EEG
CT
LP if needed

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7
Q

When do you give non benzos? And what are they?

A

As a second line of TT
If the patient was seizing for 20-40 minutes

Iv fosphenytoin
Iv phenobarbital
Iv levetiracetam
Iv valproic acid

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8
Q

When is it considered refractory status? How do you treat it

A

40-60 minutes

In the ICU!

Third treatment phase:
IV infusion:
Phenobarbital or Midazolam

General anesthesia:
Thiopental
Propofol

+ monitor , intubate, continuous EEG

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9
Q

A patient came to you with convulsive syncope , what would you order other than EEG?

A

ECG , to exclude prolonged QT interval

(Its recommended in all children with seizures , especially convulsive)

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10
Q

In which types of seizures you can use an ictal EEG?

A

1-suspected childhood absence
2-suspected infantile spasm (west syndrome)

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11
Q

When is it indicated to ask for metabolic investigations?

A

1-developmental arrest
2-related to feed/ fasting
3-epilepsy starting in the first 2 years of life (excluding febrile)

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12
Q

Who do you give rescue therapy?

A

Convulsive epileptic seizures with loss of consciousness >5

Buccal midazolam

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13
Q

You can discontinue therapy after 2 years free of seizure, except young people who have

A

1-juvenile abscence epilepsy
2-juvenile myoclonic epilepsy

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14
Q

Is it indicated to use steroids in seizures?

A

If its infantile spasm (west syndrome)

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15
Q

Whats the CP of west syndrome
And how would you treat it

A

Violent flextion lf head, trunk, limbs
Followed by extension of the arms
Lasts for 1-2 seconds
20-30 times

Give
Corticosteroids
Vigabatrin

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16
Q

Whats the specific EEG of
1-west syndrome
2-absence

A

1-hypsarrhytmia
2-3 hz spikes and waves

17
Q

What kind of motor affection happens in absence seizure?

A

Flickering of the eyelid (mouth hands)?

18
Q

Risk factors for west
Syndrome?

A

TB
HIE
PKU
PERINATAL INFECTION

19
Q

Trigger for absence?
First line of tt?

A

Hyperventilation
Ethosuximide

20
Q

1-What is the most common childhood epilepsy?
2-what will you find in the EEG
3-CP?
4-how would you treat

A

1-benign rolandic epilepsy

2-centrotemporal spikes (rolandic area)

3-usually during sleep
Facial twitching/ numbness
Hyper salivation
Speech arrest

Tonic clonic while he’s sleeping
Or simple focal seizure with abnormal feelings in the tongue and distortion of the face

4-maybe no tt / or
Levetiracetam
Carbamazepine

RONALDO LEV THE CARBS!!

21
Q

The most common type of seizure ?
And which age group does it effect

A

Febrile
6 months to 5 years

22
Q

Risk factors for febrile?

A

1-family

2-rapid rise 38 or more

3-viral :
Rosela, influenza
URI
otitis media

4-recent immunization
DTAP
MMR

23
Q

Risk factors for epilepsy after FS

A

SRC FFFCN

Simple 1%

Recurrent 4%

Complex febrile ( >15, >2 a day) 6%

Fever <1 hour before FZ 11%

Family of epilepsy 18%

Focal complex febrile 29%

Neuro developmental 33%

24
Q

Risk factors for recurrence of FS
And how do you calculate it

A

MAJOR
age <1 year
Duration of fever <24 h
Degree of fever 38-39

MINOR
Family + for FS
Family + for epilepsy
Daycare
Male
Complex febrile seizure
Hyponatremia

No risk 12%
1 risk 25-50%
2 risks 50-59%
3 risks 73-100%

25
Q

Management of febrile

A

Uncomplicated : reassure , NSAId

Abortive ( rescue ) if
>5 minutes
Or
Complex FZ
Give benzos
Choice #1 lorazepam IV

High risk:
Non benzos
Sodium valproate
Phenobarbitone
For 1.5 years- 2 years

26
Q

What type of seizure is jacksonian seizure ?

A

Secondary generalized

27
Q

A patient was brought to the ER seizing
, both his upper limbs were raised , he had gaze deviation , excessive salivation and impairment of speech
Which lobe is mainly effected , and what type of seizure is this?
What is likely to be seen after the seizure

A

Frontal lobe

Simple focal seizure

Tods paralysis
(No confusion)

28
Q

Which lobe is affected if the patient had dejavu, james vu or fear? And what other findings would be found too

A

Temporal ( focal complex )
Timing: 1-2 minutes

Pre ictal: aura

Ictal
Automatism: lip smacking, walking in non purposeful manner (premotor) , decrease of consciousness, autonomic , daydreaming

Post ictal: confusion

29
Q

Whats petit mal, and whats grand mal?

A

1-absence
2-tonic clonic

30
Q

Characters of generalized seizures

A

1-both hemispheres

2-loss consciousness for MORE than 3 seconds

3-aura

4-symmetrical bilateral

5-EEG: synchronous , bilateral

31
Q

Atonic (drop attacks) characteristics ?

A

Sudden transient loss of muscle tone for less than 15 seconds
“Sudden head drop”

Mistaken for syncope

32
Q

What is the most common form of epilepsy ?

A

Complex partial - temporal lobe

33
Q

Most common childhood epilepsy?

A

Rolandic

Pediatrics (5 decks)

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