Seizures PEDIATRICS Flashcards by Deependra Singh

Refractory status epilepticus

Used 1 :1st Line Drug
Used 1 :2nd Line Drug
Still seizure not controlled

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Epilepsy syndromes by Age
🧠⚡WOD FEB LARJ ⚡
🧠⚡LG - 2 Letters and LG SYNDROME= 2+8=10 Letters ⚡

<1 yr:
Ohtahara syndrome
Dravet Syndrome
West Syndrome.

6month-5yrs: FEBRILE SEIZURES

2yrs-10yrs: Lennox Gestaut syndrome

> 5 yrs-8yrs : Absence Seizure

> 5yrs to Adolescent: Rolandic Seizures

> 10yrs Adolescents : Juvenile Myoclonic Epilepsy

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Early Infantile Epileptic Encephalopathy

Ohtahara Syndrome
Ass. with Brain Malformation

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Mutation in DRAVET SYNDROME
🧠⚡DRAVid SCANS the field ⚡

SCN1A GENE DEFECT
1ALPHA- SODIUM CHANNEL

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KCNJ10 MUTATION IS ASSOCIATED WITH
🧠⚡Kyoto and ChiNa in EAST ⚡

East Syndrome

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EAST SYNDROME
🧠⚡ SeSAME⚡

Seizures
SNHL
Ataxia
Mental Retardation
Electrolyte imbalances

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West Syndrome
🧠⚡ West(US) Great beacuse of –HIMS (Mens)⚡

Hypsarrythmic pattern on EEG
Infantile Spasm
Mental Retardation
Salaam Spells

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LGS
🧠⚡ SIM⚡

Slow spike and wave pattern
Intractable Seizures
Multiple seizure types
Mental Retardation

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DOC FOR DRAVET SYNDROME/JME/ ABSENCE SEIZURES
🧠⚡DRAVID aka JaMMY aka WALL ⚡

VALPROATE

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DOC of ABSENCE SEIZURE

> 2 yrs : VALPROATE
< 2 yrs : ETJOSUXIMIDE

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Landau Kleffner Syndrome
🧠⚡ L⚡
🧠⚡ Age - Rotate L to form 7⚡

Abruptly lost ⭐ LANGUAGE comprehension and Verbal Comprehension
Anger
Frustration

⭐ AGE 3-7 yrs

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BECTS aka

⭐ ROLANDIC EPILEPSY
Benign Epilepsy with Centro-temporal spikes

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Epilepsy that occurs in NIGHT
🧠⚡R = Raat ⚡

Rolandic Epilepsy
✨ tingling sensation in buccal mucosa or throat
⭐ tonic clonic contraction on one side of face

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💊💉 MANAGEMENT West Syndrome

DOC: ACTH
In case of Tuberous Sclerosis patient
DOC: VIGABATRIN
High Dose steroids

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PUFF of SMOKE APPEARANCE on Cerebral Angiography

MOYAMOYA DISEASE

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MOYAMOYA Disease

Progressive cerebrovascular disorder caused by blockade of arteries at BASE of BRAIN AND BASAL GANGLIA

TANGLES OF BLOOD VESSELS SEEN

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🧑🏻‍⚕️ Clinical Features of MOYA MOYA DISEASE

Stroke or recurrent TIA
Muscle weakness or Paralysis
Focal neurological deficits

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DROP ATTACKS are associated with

JANZ SYNDROME

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Genetic abnormality in JANZ/ JME

GABRA1
CLNC2
Myoclonin 1

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Small muscles of Hand and foot involved in

Janz syndrome

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Triggers for JANZ SYNDROME

Sleep deprivation
Alcohol
Photic stimulation
Reflex Seizures

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⚡⚡ MOST COMMON Epilepsy in Young adults and adolescents

Janz syndrome
JME

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Simple Febrile Seizures and Complex Febrile Seizures
🧠⚡SI =15 ⚡
🧠⚡Complex = F³ ⚡

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⚡⚡ MOST COMMON type of Seizure in NEONATES

Subtle /Minimal

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⚡⚡ MOST COMMON TYPE OF SEIZURE IN OLDER CHILDREN

GTCS

⚡⚡ MOST COMMON Etiology of Seizure in NEONATES

HIE Hypoxia induced Encephalopathy

⚡⚡ MOST COMMON Etiology of Seizure in OLDER CHILDREN

Febrile Seizure

⚡⚡ MOST COMMON CAUSE of SEIZURE IN PRETERM

Intracranial HEMORRHAGE 🩺 IOC TRANSCRANIAL USG through Ant Fontanelle

Risk factor for RECURRANCE of FEBRILE SEIZURES 🧠⚡Major: ONCE Dhoni Fan ⚡ 🧠⚡ Minor: Always MSD Fan⚡

Risk factor for subsequent Epilepsy after Febrile Seizures 🧠⚡ if 1ST FAN - He might develop EPILEPSY⚡

Indications for Febrile Seizures Prophylaxis 🧠⚡ F18⚡

Frequent Seizures Family History ➕ First seizure at Low Temperature Age <18months

Drugs used in prophylaxis of Febrile Seizure

3days Oral CLOBAZAM in India Oral Diazepam in World

💊💉 MANAGEMENT of Febrile Seizures

✨ Anti Epileptic diazepam lorazepam oral/ intranasal Midazolam/ per rectal Diazepam ✨ Antipyretics

EEG PATTERN IN ATYPICAL, TYPICAL AND JME 🧠⚡ A COMES 1st⚡

FIRES More common in

Febrile Infection Related Refractory Epilepsy Syndrome ⭐ Males; ⭐ >5yrs AGE

Early ONSET ABSENCE SEIZURE IS ASSOCIATED WITH

Glucose Transporter Defect

Day dreaming seizure

Absence seizure

Hyperventilation is the trigger for which seizure

ABSENCE SEIZURE

Cause of SEIZURES 🧠⚡ VITAMIN D⚡

DOC for Focal SEIZURE 🧠⚡ fOCA-L⚡

OxCarbazepine and Levetiracetam

Doll's Eye Reflex Oculocephalic Reflex Mediated by? Use?

MLF Used to examine 3 6 8 Brain stem nuclei

🚦DIFFERENTIAL DIAGNOSIS🚦 HYPOTONIA IN UTERO 🧠⚡HAR ⚡

HIP DISLOCATION ARTHROGRYPOSIS: Multiple contractures ➕ 🧑🏻‍⚕️ Clinical Features Reduced fetal movements Polyhydramnios

ISSAC SYNDROME 🧠⚡ISSAC NEWTON ⚡ 🧠⚡NEUromyoTONia ⚡

Auto antibodies against VOLTAGE GATED K➕ CHANNELS

FEBRILE SEIZURE PLUS SYNDROME

1st FEBRILE seizure at later age > 5 yrs 6-8yrs Treat like SIMPLE FEBRILE SEIZURE

GENERALIZED EPILEPSY FEBRILE SEIZURE ➕

Febrile seizure in children ➕ Generalized epilepsy in Parent

Fever RELATED EPILEPSY SYNDROMES 🧠⚡DG-FT ⚡

⭐ DRAVET Syndrome ⭐ FIRES ⭐ GEFS Plus (Generalized Epilepsy with Febrile Seizures ➕) ⭐ Temporal Lobe Epilepsy

SEIZURE MIMICS 🚦DIFFERENTIAL DIAGNOSIS🚦 🧠⚡ B²SC M⚡

✨ Behavioural outburst ✨ Breath Holding Spells ✨ Migraine ✨ Syncope ✨ Cyclical Vomitting

TRUE SEIZURES occurs with EYES ?

OPEN

Frontal Lobe SEIZURE

Mimics PSEUDOSEIZURE BRIEF IN CLUSTERS

Parietal LOBE SEIZURES

✨ Somatosensory symptoms ✨ Opposite side HAND AND FACE AFFECTED

Occipital Lobe Seizure

Visual Hallucination Eye blinking

Temporal Lobe Seizure

MOST COMMON EYE DEVIATION ➡️ STARING LOOK Upper Limb Tonic movements

Indication of EEG in EPILEPSY

Best Neuroimaging IN EPILEPSY

MRI > CT

Indications for NEUROIMAGING in SEIZURES

All focal epilepsies except BECT H/O Developmental delay/ Regression Child <2yrs SYNDROME west LGS REFRACTORY EPILEPSY RAISED ICT

REFRACTORY EPILEPSY Definition

Failure of adequate trial of 2 appropriately chosen well tolerated AEDs in Right dosage either as MONOTHERAPY or combination to achieve sustained seizure free period

Ketogenic Diet used as TREATMENT FOR?

✨ Refractory Epilepsy ✨ LGS ✨ Infantile spasm refractory to steroids ✨ Dravet Syndrome (Severe Myoclonic Epilepsy of Infancy)

🚫 CONTRAINDICATION of KETOGENIC DIET 🧠⚡ P²⚡

PEM PORPHYRIA

Vagus Nerve Stimulation USE

⭐ Focal onset Epilepsy ⭐ Implantation of Bipolar pulse generator only chest wall, sends impulse to Lt Vagal Nerve

Todd's Paralysis

Weakness of Limbs lasting for 24-48 hr following STATUS EPILEPTICUS

Difference between ENCEPHALITIS ENCEPHALOPATHY ACUTE FEBRILE ENCEPHALOPATHY

⭐ Encephalitis: Inflammation of brain parenchyma ⭐ Encephalopathy: Noninflammatory diffuse cerebral dysfunction (altered sensorium due to any cause) ⭐ Acute febrile encephalopathy: A febrile illness with altered sensorium of ≤2 weeks duration in a previously well child. May have infectious or noninfectious causes ⭐ Meningitis: Inflammation of leptomeninges.

Causes of Acute Febrile Encephalopathy

Difference between Meningitis and Encephalitis

Meningitis Meningeal signs present predominantly Seizure Present/Absent Encephalitis Sensorium affection (coma) Seizures

Investigation of Choice in AFE

MRI

CT Brain before Lumbar Puncture

Suspected Space occupying Lesion Papilledema Asymmetric pupils Severe raised ICT

Acute Encephalitis CAUSES

A person with acute onset of fever with change in mental status and/or new onset seizures

Acute Encephalitis Clinical Pointers

Encephalitis vs Encephalopathy

Burst suppression Pattern seen in EEG in 🌟After 1st ATTACK ➡️ SUPPRESS COMPLICATIONS 🌟

SSPE Subacute sclerosing panencephalitis After measles

Periodic Lateralization in EEG IN

HSE

Generalised Slowing in EEG seen in ✨when infection is generalized/disseminated ➡️ Slowing is generalized ✨

ADEM Acute DISSEMINATED ENCEPHALO-MYELITIS

Acute Cerebral Injury

Coma

Difference between different coma states? ✨Sleep wake cycle is NEVER PRESENT IN COMA, as everytime sleeping✨ ✨Awareness + in ML ✨ Noxious stimulus response absent in COMA VEGETATIVE STATE

✨Awareness + in Minimal Conscious State, Locked in Syndrome✨

Causes of COMA in children

Neurological Examination Scales in Children

1. Pediatrics GCS 2. AVPU

Lumbar Puncture: Maximum volume for tests

15 mL

SUPER Refractory Seizure ✨MITH (Mythical) seizure✨

If seizures present even after using MIDAZOLAM/ THIOPENTONE

Management of SUPER Refractory Seizure

Ketamine infusion IVIG Plasmapheresis

Theta point alternans in EEG is diagnostic of 🧠⚡The-tab FaNS ⚡

Benign familial Neonatal Seizures

MIZRAHLI AND KELLAWAY CLASSIFICATIO USED FOR

Neonatal Seizure

STURGE WEBER SYNDROME 🧠⚡STURGE ⚡

Seizures ; Sporadic Tram track Calcification Total Cerebral Atrophy U/L PORTWINE STAIN UMN PARALYSIS RETARDATION GLAUCOMA EPILEPSY EyE PROBLEMS (BUPHTHALMOS)

5th DAY SEIZURES

Benign FAMILIAL NEONATAL SEIZURES Potassium Channel Defect

Dyke Davidoff Syndrome 🧠⚡RCH ⚡

Seen in CHILDREN Refractory unremitting focal seizure Cerebral Hemiatrophy Hemiparesis C/L

Laforas Disease 🧠⚡ PL MDH⚡

Seen in Children aged

NORSE New Onset Refractory Status EPILEPTICS Cause

Viral encephalitis

Anti-Yo antibodies ➕ epilepsy

Para neoplastic encephalitis

Anti-NMDA ANTIBODY ➕ Epilepsy

Autoimmune encephalitis

⚡⚡ MOST COMMON ELECTROLYTE ABNORMALITY IN HOSPITALIZED PATIENT CAUSING EPILEPSY

Hyponatremia

Definition of SEIZURES

Transient occurance of signs and symptoms DUE TO: Abnormal Excessive Hypersynchronous Neuronal activity in Brain