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24 Cards in this Set

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what is the most common age for seizure occurrence?
neonates
what are the seizure manifestations of neonates?
behavioral arrest, versive (lateral deviation of the eyes only with no movement of head and limbs), autonomic changes, variety of tonic posturing, mouthing automatisms, clonic jerks, myoclonus, spasms, electrical seizures with clinical co-relate).
in a neonate, what signs mean its not a seizure?
if movement of the head reverses tonic posturing, if clonic movement can be stopped by changing the joint/limb position or by putting hand on the limb, or if can illicit normal act from baby during the episode.
the main etiologies of seizures in neonates are?
intracranial hemorrhage, electrolyte imbalance, infection, , congenital malformation, chromosomal abnormalities, metabolic disorders, neurodegenerative disorders.
what are the primary AED drugs for seizures in neonates and in what order should they be tried?
1st-phenobarbitol, 2nd-phenytoin or fosphenytoin, then diazepam or lorazepam
what are the three types of seizures seen in infancy?
febrile seizures, infantile spasms, lennox-gastout syndrome
what are risks of recurrent febrile seizures?
if first occurs before 18 months. If they have a 2nd seizure. family history of febrile seizures. fever peak and duration. note that a complex febrile seizure is not a risk for recurrent seizures. family history of epilepsy may be a risk
what are risks and waht are not risks for developing epilepsy later, in terms of febrile seizures.
Having febrile seizures increase epilepsy risk by 4X (complex means much bigger risk than simple). family history of epilepsy and duration of fever are also risk factors. Non risk factors are family history of febrile seizures, age of first febrile, peak temp
how should febrile seizures be managed?
always check for meningitis (LP if child is under 2 no matter what). Do a seizure workup if child has risk factors for epilepsy. No AED treatment for simple febrile seizures. Diastat if prolonged febrile seizures. Chronic AED is needed for children with increased risk for reccurence of afebrile seizures.
what is the classic triad of infantile spasms?
myoclonic seizures, hypsarrythmia, and MR
what are the known etiologies of infantile spasms?
CNS malformations, phakomatoses (hamartomas), chromosomal abnormality, infections, anoxia/hypoxia, trauma, inborn errors of metabolism, CNS degenerative disorders, pyridoxine dependency.
what are the treatments for infantile spasms?
ACTH and corticosteroids are first line. Then AED's (valproic acid and felbamate) are second line. Vigabatrin is new and is good with pt's with TS. Surgery maybe done in TS pt's to remove hot spots.
what is the main prognosis of infantile seizures? what makes this prognosis better?
MR, some die, epilepsy, lennox gastaut syndrome. Better prognosis if idiopathic, therapy works, early dx and treatment
what are the characteristics of lennox-gastaut syndrome?
more tonic types of seizures, but can be mixed, slow spike and wave on EEG, MR...
many times, the tonic seizures of lennox-gastout occur when?
during non REM sleep
what are the treatments for lennox-gastaut syndrome?
very hard to treat: helmits, polypharmacology treatments (valproic acid and felbamate), ketogenic diet seems to work well.
characterize the seizures of benign rolandic epilepsy.
general tonic/clonic with focal onset at night. diurnal simple seizures with aura (somatosensory, speech arrest) and postictally they are numb on one side in oral cavity.
characterize juvenile absence epilepsy.
typical absence seizures and generalized tonic/clonic seizures. Seize more than the childhood absence
what happens before the GTC seizure in juvenile myoclonic epilepsy?
early morning myoclonic jerks (seen with sleep deprivation and alcohol), also worsened by stress. GTC's usually in the morning
treatment for juvenile myoclonic epilepsy?
life long, avoid sleep deprivation, alcohol, flickering lights, early rising. valproic acid is drug of choice.
characterize the seizures of benign rolandic epilepsy.
general tonic/clonic with focal onset at night. diurnal simple seizures with aura (somatosensory, speech arrest) and postictally they are numb on one side in oral cavity.
characterize juvenile absence epilepsy.
typical absence seizures and generalized tonic/clonic seizures. Seize more than the childhood absence
what happens before the GTC seizure in juvenile myoclonic epilepsy?
early morning myoclonic jerks (seen with sleep deprivation and alcohol), also worsened by stress. GTC's usually in the morning
treatment for juvenile myoclonic epilepsy?
life long, avoid sleep deprivation, alcohol, flickering lights, early rising. valproic acid is drug of choice.