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59 Cards in this Set
- Front
- Back
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What are differential diagnoses for epilepsy?
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Syncope
Migraine Sleep disorders Psuedo seizures |
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What are tools for diagnosis of epilepsy?
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history and decription of events
ask family member to "act out" the event videotape event find provoiking factors EEG |
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Seizure type:
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an ictal event belived to represent a unique pathophysiological mechanism
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sudden, <100ms involuntary contraction of muscles or muscle groups
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myoclonic
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repetitive, rhythmic myoclonus at 2-3 Hz
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clonic
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sustained muscle contraction for seconds to minutes
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tonic
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Bilateral symmetrical tonic contraction, then bilateral clonic contractions
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genralized tonic-clonic
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sudden brief, 1-2 sec decrease in tone without preceding myoclonic or tonic event
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atonic
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loss of posture (=drop) due to atonic, myoclonic, or tonic event
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Astatic
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axial contrction, may be asymetric
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spasm
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Benign myoclonic epilepsy in infancy
Epilepsy with myoclonic-astatic seizures Epilepsy with myoclonic absence seizures Childhood absence epilepsy IGE with variable phenotypes Juvenile absence, JME, epilepsy with GTC only Generalized epilepsies with febrile seizures plus |
Idiopathic generalized epilepsy
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Syndromes of infancy Early myoclonic encephalopathy; Ohtahara, Dravet, West syndromes
Lennox-Gastaut syndrome Landau-Kleffner syndrome Epilepsy with continuous spike waves in SW sleep |
epileptic encephalopathies
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with elementry sensory sx
with experimental sensory sx |
focal sensory seizures
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with elementary clonic motor signs
with symmetric tonic motor signs with automatisms |
focal motor seizure
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Deep and regular respirations at a rate of 20 / minute for 2 to 4 minutes
Drop in plasma CO2 by 4-7 ml% Normal response (and best seen in children) is high amplitude slow activity |
EEG activation vis hyperventialition
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What forms can be induced on the EEG via hyperventilation?
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diffuse sharp waves or spike-wave complexes
ususally with genrealized epilepsy |
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What frequecy of strobe light flashes can activate EEG?
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1-30Hz
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What photic stimulation will cause rhythmic activity over the posterior head regions?
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photic driving
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What is the name for repetitive muscle spikes over the anterior regions of the head?
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photo myoclonic response
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What is constituted by:
Generalized spike and wave complexes 15-20 Hz May have jerking or impairment of consciousness Photosensitive epilepsies |
Photo convulsive (paroxsysmal response)
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Peak onset age 4-6 years
Many seizures daily Seizures last seconds 70+% have associated automatisms eyelid flutter simple vocalizations picking movements Typical EEG with 3 Hz spike wave Majority resolve by adolescence |
Childhood absence (petit mal) epilepsy
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What is used to treat absence seizures?
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Ethosuximide
Valproic Acid Lamotrigine |
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Onset ages 3-12 months
Brief axial contractions usually bilateral, may be asymmetrical typically flexor, may be extensor usually in clusters, less likely random typically on awakening, or when drowsy EEG shows hypsarrhythmia multifocal spikes high voltage, chaotic background |
Infantile spasms - West Syndrome
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“Symptomatic” cases
-congenital infections -CNS malformations -metabolic disorders -genetic syndromes -tuberous sclerosis -perinatal asphyxia -postnatal trauma -acquired infections -immunizations |
Possible causes of infantile spasms
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Often “cryptogenic”
no definite cause established but child is delayed Rarely “idiopathic” no cause established and child is normal |
Infantile spasms
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What steroid can be given for possible short term improvement of infantile spasms (via EEG)?
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ACTH
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What drug can be given for infantile spasms, particularly in tuberous sclerosis and can be retino-toxic?
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Vigabatrin
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What constitutes West Syndrome?
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Infantile spasms
hypsarrhythimia on EEG Developmental regression that begins concurrently with the onset of spasms |
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Which type of West Syndrome is more lethal, and prone to neurological and developmental abnormalities?
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Symtomatic cases
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What are two other indicators of poor prognosis in West Syndrome?
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Spasms begin at less than 4 months of age
More severe initial EEG activity (other “epileptic” activity in addition to hypsarrhythmia) |
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Onset ages 2-12 yrs, peak 5-10 yrs
Characteristic seizures Infrequent simple partial seizures -tingling in mouth, on face,speech arrest -rare GTCS in sleep Resolve by puberty Characteristic EEG -high voltage centrotemporal spikes -usually bilateral Imaging normal Considered an idiopathic focal epilepsy -some evidence for genetic basis Treatment -may not be necessary -may respond to many drugs |
Rolandic Epilepsy
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What kind of spikes will show on EEG in Rolandic epilepsy?
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Centrotemporal
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What are two predictors of recurrence in neurologically normal children?
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-abnormal EEG best predictor of recurrence in neurologically normal children
-abnormal neuro exam also strong predictor of recurrence |
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What if:
postictal focal deficit, or not at baseline in several hours |
Emergent imaging
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What if:
with significant neuro abnormalities of unknown etiology a seizure of focal onset in children under 1 year of age |
non Urgent MRI
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What if:
in the very young child (<6 months) in the patient who fails to return to baseline in any patient with meningeal signs if increased ICP suspected, image before LP |
LP
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What is the usual time frame for recurrences?
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in 1st year post primary ictus
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What factors increase risk of recurrence?
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Abnormal EEG
Etiology symptomatic > idiopathic |
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What % will have frequent seizures regardless of Rx?
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10%
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Does Rx after 1st or 2nd seizures affect long term prognosis?
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NO
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Is preventative treatment indicated for epilepsy after 1st seizure?
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NO
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Is treatment after first seizre broad spectrum?
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No, it must be individualized
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The most common seizures in childhood
In US affect 2-4% of children < age 5 yrs -8% Japan, 14% Guam 1/3 have at least 1 recurrence |
Febrile seizures
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What are risk factors for recurrence of Febrile Seizures?
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-first febrile seizure < 1 year of age
-low degree of fever at first febrile seizure -family history of febrile seizures -brief duration between fever onset and febrile seizure 4 risk factors = 70% recurrence No risk factors = 20% recurrence |
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Simple Febrile Seizures...
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Genealized and < 15 min in duration
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Complex Febrile Seizures
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Focal or >15 min, or recurrent within 24 hrs
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When should a LP be done to evaluate a kid with simple febrile seizures?
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If there are meningeal signs
in infants <12 months with prior antibiotic Rx |
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Are blood studies, imaging and EEG necessary for evaluation of simple febrile seizures in kids?
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NO
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What can be used to treat simple febrile seizures, but with possible side effects?
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continuous phenobarbital or valproic acid
intermittent diazepam |
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What diet can be used in pharmacoresistant patients for an efficacy of 30-50%?
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Ketogenic Diet
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What is the ratio of fat to CHO in a ketogenic diet?
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4:1 or 3:1
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What surgical procedure is palliative and done when the focus is in the "eloquent cortex"?
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Multiple subpial transections
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Where is the most frequent temporal lobectomy performed?
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Anterior lobe with ~70% efficacy
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What surgery is done in cases of extensive pathology?
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Hemispherectomy, multi lobar resections
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What is rarely performed as a sole procedure?
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Corpus callostomy
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What determines the results of extratemporal resection?
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nature and extent of pathology
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What imaging techniques are used for surgical evaluation?
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MRI, MRA, SPECT, PET
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What are speech and memory tests used to test for surgical evaluation?
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Wada Test
Neuropsych test fMRI |
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Which Vagus nerve is stimulated by the PG?
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Left Vagus
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