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51 Cards in this Set
- Front
- Back
What is the underlying cause of seizures?
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Abnormal, sudden electrical activity of the brain.
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Define epilepsy.
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Symptom of many diseases manifesting as recurrent seizures.
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What is the time period defining neonates
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0 to 1 months
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Majority of seizures seen in neonates is what kind of seizure?
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Partial seizure
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List possible seizure manifestations for neonates. x8
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1. Versive
2. Behavioral arrest 3. Autonomic changes 4. Tonic posturing (varies) 5. Clonic 6. Automaticism (esp. mouth) 7. Myoclonic 8. Electrical seizures |
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In neonates, symptoms are NOT seizures if: x3
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1. Clonus movement is stopped by changing the position of the limb/joint.
2. Clonus movementis stopped if limb/joint is touched. 3. Tonic posturing is stopped if is stopped by turning baby's head. |
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List the etiology of seizures for neonates. x7
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Infection
Inborn errors of metabolism Intracranial hemorrhage Imbalance of electrolytes Genetics Neurodegenerative Congenital malformaitons |
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In neonate seizures, prognosis is only dependent on what?
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Cause (etiology)
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What is the primary AED tx for neonatal seizures? x4
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1. Phenobarbital
2. Phenytoin/Fosphenytoin 3. Diazepam 4. Lorazepam |
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Describe Simple Febrile Seizures
- Initial sign - Duration - Frequency - Character - Post ictal |
Initial rise of temperature
Less than 15 minutes Once a day Generalized seizure Unremarkable |
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Describe Complex Febrile Seizures
- Initial sign - Duration - Frequency - Character - Post ictal |
Initial Rise of Temperature
Greater than 15 minutes Flurry (more than one in 24h) Some components of partial seizure. Todd's paralysis |
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Describe the risk of recurrent febrile seizures.
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33% increase after 1st one
50% increase after 2nd one |
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What type of seizures would you expect during early childhood?
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Childhood Absence seizures
Benign Rolandic seizures |
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What type of seizure conditions do you expect in infants?
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Febrile seizures
Infantile seizures Lennox-Gastaut seizures |
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50% of patients with this condition progress to Lennox-Gastaut seizures.
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Infantile spasms
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50% of tuberous sclerosis patients have this.
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Infantile spasm
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Describe the management of febrile seizures.
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1. Always check for meningitis
2. Do a LP if under 2 y.o. 3. Seizure workup if any risk factors. |
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What type of imaging should you use for febrile seizures?
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Nothing. Do No imaging
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What type of AED's should you use for febrile seizures.
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Simple Febrile seizures - nothing
Prolonged Febrile seizure - Diastat Increased risk of afib seizures - chronic AED tx |
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Prognosis for Infantile Spasms
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100% poor
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List the classic triad for infantile spasms.
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Hypsarrythmia
Mental retardation Myoclonic seizures |
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Medications and options for Infantile Spasms.
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1st line: ACTH/Corticosteroid
2nd line: AED Vigabatrin Surgery |
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What are the characteristics for Lennox Gastaut? x3
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1. Mixed seizures
(Tonic and Absence most common) 2. Mental retardation 3. EEG pattern of slow spike & wave (1.5 Hz to 2.5 Hz) |
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What is the meds treatment for Lennox Gastaut?
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Polypharmacy approach:
Valproic Acid Felbamate Ketogenic diet |
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Inheritance of typical absence seizures.
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AD
Strong family history |
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T/F - Typical absence seizures have aura associated with it.
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False
No aura. Abrupt beginning and end. |
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EEG of Typical Absence seizure.
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3 Hz with Normal background
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Typical Absence Seizures can be induced how?
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Hyperventilation
Photic stimulation |
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Imaging for typical absence seizure.
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None necessary
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Onset of typical absence seizures.
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5 to 12 years old
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Onset of atypical absence seizures.
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< 5 years old
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EEG of atypical absence seizure.
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< 2.5 Hz
Slow background |
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Compare neurologic development of patient with typical vs. atypical absence seizure.
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Typical - normal
Atypical - abnormal |
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Imaging for atypical absence seizure.
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MRI necessary
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Differentiate between absence seizures vs. partial complex seizures.
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Absence:
Shorter in duration No aura No postictal Induced by HV/photostimulation Partial complex seizures: Greater than 1 min Aura Postictal Not induced by HV/photic |
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Treatment for absence seizures
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Ethosuximide (typical)
Valproic acid (typical with GTC and with atypical) Lamotrigine Levatiracetam |
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Avoid these treatments with absence seizures.
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Carbamezapine
Vigabatrin Tiagabine |
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Inheritance of Benign Rolandic Epilepsy
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Multifactorial
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Benign Rolandic Epilepsy:
- onset - frequency |
2 - 12 years old
(but does not go beyond 16) Remits spontaneously |
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EEG of benign rolandic epilepsy
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Temporal-central spikes
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Benign Rolandic epilepsy:
- characters |
Nocturnal GTC seizures
Diurnal simple seizures |
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Benign Rolandic epilepsy:
- aura - postictal |
common
numbness (usually to one side in gums, tongue, or cheek) |
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Medication treatment for benign rolandic epilepsy.
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Most MD's don't treat, but can use
carbamezapine |
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What are the seizures prevalent in childhood and adolescence?
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Juvenile absence epilepsy
Juvenile myoclonic epilepsy |
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Juventile absence epilepsy:
- onset - symptoms |
12 to 20 years old
Absence seizures T/C seizures NO myoclonic jerks |
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T/F - Myoclonic seizures can be seen in juvenile absence seizures.
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False:
Only T/C seizures |
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Medication of Juvenile Absence Seizures.
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Ethosuximde
with Valproic acid or Lamotrigine |
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What is the classical sign for Juvenile Myoclonic epilepsy?
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AM myoclonic jerks
preceding GTC |
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Treatment of Juvenile Myoclonic epilepsy.
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Valproic acid alone
or with Lamotrigine and Topiramate |
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What condition requires a life long treatment?
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Juvenile Myoclonic epilepsy
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What induces juvenile myoclonic epilepsy?
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Sleep deprivation / fatigue
Alcohol Flickering lights Early awakening |