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38 Cards in this Set
- Front
- Back
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SEIZURES - BASICS
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Prevalence
25-40 k US children annually exp their first non-febrile sz Epilepsy 1% Febrile Sz 3% Diagnosis is based mainly on the HISTORY Obtain seq of events Include any aura or post-ictal sx Role of EEG Normal EEG Absolutely does NOT exclude epilepsy Absence epilepsy is unlikely Abnormal EEG Does not DX epilepsy UNLESS SZS ARE RECORDED Supportive evidence in the proper clinical context Helps classify the type of epilepsy |
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SEIZURE CLASSIFICATION
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PAROXYSMAL NON-EPILEPTIC EVENTS
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NEW ONSET SEIZURES
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STATIS EPILEPTICUS
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EVALUATION OF FIRST SEIZURE
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Lab:
Optional based on hx CSF: <6mos, persistent unknown altered MS meningeal signs EEG: YES CT/MRI Emergent imaging Postictal focal deficit (Todd's) not quickly resolving Not returning to baseline within several hrs MRI seriously considered Sig cognitive/motor impairment of unknown etiology Abnormal neuro exam Focal sz Focal EEG < 1yo |
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MANAGEMENT OF FIRST SZ
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Recurrence Risk
Neuro normal (25-50%) Remote symptomatic >50% No change to natural course of disease No evidence that tx after 1st vs 2nd sz changes likelihood of sz remission AED tx is NOT INDICATED FOR THE PREVENTION OF epilepsy AED treatment can be CONSIDERED if benefits of reducing the risk of 2nd sz outweigh the risks of pharmacological and psychosocial SE |
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WHEN TO TX SZ AND WHENT TO STOP
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Indications to TX
2 unprovoked sz Clearly defined epilepsy syndrome with expected continued sz Special circumstances General goal: Maximize one med then add another When to stop: most children (75%) with epilepsy who have been FREE OF SEIZURES FOR 2 OR MORE YEARS, antiepeleptic meds can safely be discontinued Factors: Epilepsy syndrome Seizure subtype EEG findings Age of onset |
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ANTISEIZURE DRUGS
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ANTISEIZURE DRUGS - MONITORING
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AEDS - OTHER CONSIDERATIONS
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SEIZURES - PSYCHOSOCIAL/LEGAL IMPLICATIONS
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NEONATAL SEIZURES
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FEBRILE SEIZURES
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Epidemiology
They are common - 3% of the population Frequently recur Criteria Convulsion assoc with temp >38 C 6mos - 5yrs No CNS infection No metab abnl SIMPLE COMPLEX < 15 min Prolonged Generalized Partial No repeat in 24 hrs Recurrent Normal postictal Todd's paralysis |
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FEBRILE SEIZURES
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INFANTILE SPASMS
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First idd by West in 1841
Clinical Ages 3-7 months start isolated - clusters Can be flexor or extensor 1 - 10 clusters (20-40 spasms) Decrease in intensity as cluster progresses Cognitive deterioration is common |
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INFANTILE SPASMS
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ABSENCE EPILEPSY
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COMPLEX PARTIAL SEIZURES
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BENIGN CHILDHOOD EPILEPSY WITH CENTROTEMP-
ORAL SPIKES (ROLANDIC EPILEPSY) |
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JUVENILE MYOCLONIC EPILEPSY
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TUBEROUS SCLEROSIS
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CLINICAL
Formal dx criteria - clinical dx Often presents with sz (often spasms) >/= 50% have cog impairment Benign tumors of multiple orgs Rhabdomyoma in infancy Other features ususally develop with inc age MANAGEMENT Tx of sz - usually focal Monitoring other involved orgs Opth Renal US Cardiac eval if sx |
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HEADACHES
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MIGRAINE HEADACHE
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HEADACHE CLASSIFICATION
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HEADACHE TX - ABORTIVE
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HEADACHE TX - PROPHYLACTIC
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EVALUATION OF HEADACHE
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Neuroimaging is NOT INDICATED in children and adol with
recurrent HAs and a normal neuro exam CONSIDER neuroimaging if Abnl neuro exam (focal findings, including signs of inc ICP, sig alteration of consciousness) co-existence of szs Hx features to suggest recent onset of severe HA, chge in type of HA, or features to suggest neurological dysfctn |
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RECOGNIZING INCREASE ICP
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SX
Vomiting - esp am Emesis >>> nausea HA - esp positional or wakes from sleep SIGNS Bulging fontanelle Sunset sign CN VI palsy Papilledema Visual field deficit Focal neuro deficit Any of the above are CONTRA INDICATIONS FOR IMMED LP Need to exclude lesion which would lead to herniation - HCT When clear Measure opening pressure |
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IDIOPATHIC INTRACRANIAL HYPERTENSION
(IIH) (FORMERLY PSEUDOTUMOR CEREBRI) |
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MEDICAL MGEMENT OF IIH
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Primary goal of mgement is preserving eyesight
Monitoring Serial LPs for opening pressure Papilledema Visual Field testing MEDICATIONS Acetazolamide Lasix Optic nerve fenestration Lumboperitoneal CSF shunt |
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BACTERIAL MENINGITIS
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MENINGITIS - EVALUTION
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ASEPTIC MENINGITIS
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MENINGITIS - ACUTE TX
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MENINGITIS - COMPLICATIONS
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ENCEPHALITIS
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BRAIN ABSCESS
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