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109 Cards in this Set

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Which anti-seizure medication can cause neural tube defects?
Valproic acid and carbamazepine
After how much seizure-free time would most neurologists attempt withdrawal from antiepilepsy meds?
Two years
What is myoclonic epilepsy of Janz?
Juvenile myoclonic epilepsy
What are 5 risk factors for seizure recurrence?
1-motor handicap, 2-mental retardation, 3-onset of seizures after age 12 years, 4-neonatal seizures, and 5-multiple medications required before obtaining control.
When can anticonvulsants be withdrawn in juvenile myoclonic epilepsy?
Never
How is Juvenile myoclonic epilepsy treated?
Usually with valproic acid
Which anticonvulsants interact with contraceptives?
Hepaticallly metabolized ones e.g. oxcarbazepine
What is an advantage of Gabapentin?
its renal excretion without any metabolism avoids any drug interactions.
Can gabapentin be used for juvenile myoclonic epilepsy?
no
Which children do not get anticonvulsants after their first nonfebrile seizure?
Neurologically normal with negative EEG and no FH of epilepsy in first degree relatives
Which anticonvulsants are most likely to produce untoward behavior and cognitive side effects?
Phenobarbital and primidone
What does a history of aura indicate?
That the seizure has a focal onset
What is epilepsy?
spontaneous recurrent seizures unrelated to fever
Who is more likely to become seizure free in adolescence, a child with absence seizures or focal seizures?
Absence
Name 6 types of generalized seizures?
Absence, myoclonic, clonic, tonic, tonic-clonic, atonic
Name two types of absence seizures?
Typical and atypical
what is a partial seizure?
Focal onset
what is “simple partial”?
focal onset, consciousness retained
what is “complex partial”?
consciousness impaired
Name 3 categories of partial seizures
simple partial, complex partial, partial seizure with secondary generalization
What kind of seizure is this: forced deviation of head and eyes to one side
Simple partial seizure
What is the characteristic EEG pattern with a simple partial seizure?
Unilateral spikes or sharp waves in anterior temporal region
How long does a simple partial seizure usually last?
10-20 sec
How long does a complex partial seizure usually last?
1-2 min
How common is aura in complex partial seizures?
Occurs in about 30%
Name 2 typical auras
epigastric discomfort and fear
What is the characteristic EEG pattern for complex partial seizures?
Sharp waves or spikes in anterior temporal or frontal lobe or multifocal spikes
When is the typical onset of Simple absence seizures?
5-6 years of age
How long does a simple absence seizure last?
5-20 sec
How long is the postictal period after an absence seizure?
There is none
Are auras or automatisms associated with absence seizures?
Auras are not; automatisms may be
What is the characteristic EEG finding with absence seizures?
3 per second generalized spike and wave discharges
What is the characteristic EEG pattern associated with atypical absence seizures?
2 to 2.5 per second or 3.5 to 4.5 per second generalized spike and wave discharges
What do atypical absence seizures look like?
associated myoclonic movements of the face and body, sometimes leading to loss of body tone, which causes the child to fall
What do myoclonic seizures look like?
brief, often repetitive symmetric muscle contractions with loss of normal body tone
What do atonic seizures look like?
typically cause the child to fall because of the sudden loss of postural tone
When do infantile spasms have their onset?
4-8 months of age
What are characteristic EEG findings in infantile spasms?
High-voltage bilaterally asynchronous, and irregular high-voltage spike and wave pattern
How are infantile spasms treated?
ACTH, benzodiazepnes, vigabatrin, s.t. surgery
When is surgery used for infantile spasms?
When focal onset
Prognosis for infantile spasms?
Guarded; majority poor
In whom does Lennox Gastaut occur?
Preschool children, especially those who previously had encephalopathy
What kind of seizures occur in Lennox Gastaut?
A mixture
What are characteristic EEG findings in Lennox Gastaut?
Abnormal background activity, slow spike-waves, and multifocal abnormalities
How is Lennox Gastaut treated?
Valproic acid, Benzodiazepines, Ketogenic diet
Prognosis for Lennox Gastaut?
High association with mental retardation and behavioral problems
What is the age of onset of Landau-Kleffner?
3-5 years
In whom does Landau-Kleffner occur?
More common in boys
What are characteristic EEG findings in Landau-Kleffner?
High-amplitude spike and wave discharges may be bitemporal, multifocal, or generalized. EEG changes always more apparent during nonREM sleep
How is Landau-Kleffner treated?
Valproic acid, Prednisone, Speech therapy, Subpial resection
Prognosis for Landau-Kleffner?
Variable; onset before 2 years of age has poor outcome. Most have significant speech dysfunctions as adults.
What is the presentation of Landau-Kleffner syndrome?
Loss of language (slow or rapid) in a previously healthy child. 70% have an associated seizure disorder as well as behavioral problems.
When does Juvenile myoclonic epilepsy have its onset?
12-16 years
What is Juvenile Myoclonic epilepsy?
Myoclonic jerks on awakening that diminish later in day. Most patients develop early morning generalized tonic-clonic seizures.
What is the characteristic EEG finding in Juvenile myoclonic epilepsy?
A 4 to 6 per second irregular spike and wave pattern enhanced by photic stimulation.
What is the treatment of juvenile myoclonic epilepsy?
Valproic acid
Prognosis for Juvenile myoclonic epilepsy?
Excellent but requires lifelong valproic acid
What is the characteristic EEG finding in benign childhood epilepsy?
Repetitive spike discharges confined to the centrotemporal area with normal background activity.
When is the peak onset of benign childhood epilepsy?
9-10 years of age
When do seizures occur in benign childhood epilepsy?
During sleep
What are seizures like in benign childhood epilepsy?
Child awakened by unilateral tonic-clonic contractions of the face, paresthesias of tongue and cheek, and occasional clonic seizures of ipsilateral upper extremity. Child is conscious but aphasic for several minutes.
Treatment for benign childhood epilepsy
frequent seizures controlled by carbamazepine
Prognosis for benign childhood epilepsy
excellent, usually remits by adolesence
For what kind of seizure is ACTH used?
Infantile spasms
For what kind of seizure is carbamazepine used?
Partial epilepsy; tonic clonic
What are the side effects and toxicities of carbamazepine?
Dizziness, drowsiness, liver dysfunction, anemia, leucopenia, diplopia
For what kind of seizure is clonazepam used?
Myoclonic Infantile spasms Absence
What are the side effects and toxicities of clonazepam?
Drowsiness, irritability, drooling, behavioral abnormalities, depression
For what kind of seizure is Ethosuximide used?
Absence Myoclonic
What are the side effects and toxicities of Ethosuximide
Drowsiness, nausea, rarely blood dyscrasias
For what kind of seizure is Gabapentin used?
Partial epilepsy Tonic-clonic
What are the side effects and toxicities of Gabapentin
Somnolence, dizziness, ataxia, headache, tremor, vomiting, nystagmus, fatigue. Gabapentin is cleared by the kidney; few side effects.
For what kind of seizure is Vigabatrin used?
Partial epilepsy Infantile spasms (tuberous sclerosis)
What are the side effects and toxicities of Vigabatrin?
Agitation, drowsiness, weight gain, dizziness, headache, ataxia
For what kind of seizure is Sodium valproate used?
Tonic-clonic Absence Myoclonic Partial epilepsy Unclassified
What are the side effects and toxicities of Sodium valproate
Weight gain, alopecia, tremor, hepatotoxicity
For what kind of seizure is Phenytoin used?
Partial epilepsy, Tonic-clonic
What are the side effects and toxicities of Phenytoin?
Hirsutism, gum hypertrophy, ataxia, skin rash, Stevens-Johnson syndrome
For what kind of seizure is Phenobarbital used?
Tonic-clonic, Partial epilepsy
What are the side effects and toxicities of Phenobarbital?
Hyperactivity, irritability, short attention span, temper tantrums, altered sleep pattern, Stevens-Johnson syndrome, depression of cognitive function
For what kind of seizure is Primidone used?
Tonic-clonic, Partial epilepsy, Myoclonic
What are the side effects and toxicities of Primidone?
Aggressive behavior and personality changes similar to those for phenobarbital
For what kind of seizure is Lamotrigine used?
Partial epilepsy, Tonic-clonic, Lennox-Gastaut
What are the side effects and toxicities of Lamotrigine?
Severe skin rashes, especially when given in combination with valproic acid. Drowsiness, headache, blurred vision
What is the most common cause of seizures in the newborn?
Hypoxic-ischemic encephalopathy
What should be suspected when seizures begin in utero?
Pyridoxine dependency
What is benign paroxysmal vertigo?
Causes a normal toddler to stagger or fall suddenly and to become pale and frightened. Vertigo. 25% have nystagmus.
How long do BPV attack last?
1-2 minutes
How is syncope distinguished from a seizure?
Tilt-table testing
During what stage of sleep do night terrors occur?
Early stages
When do pseudoseizures develop?
Preadolescent or adolescent periods
Do EEGs show abnormalities between seizures?
Only in 60% of patients
What does head CT show in congenital CMV infection?
Periventicular calcifications
Which children with seizures need an MRI?
Complex partial seizures, focal neurologic deficit, increasing frequency or severity of seizures, all adolescents with a first seizure
What is the risk of recurrence following absence seizures?
certain
What is the risk of recurrence following myoclonic seizures?
certain
What is the risk of recurrence following infantile spasms?
Certain
What is the risk of recurrence following tonic-clonic seizure?
Low if child has normal neurologic exam and EEG and if it occurs upon awakening
Which anticonvulsant interacts with erythromycin?
carbamazepine
For what kind of seizures is the ketogenic diet most likely to help?
Complex myoclonic epilepsy associated with tonic-clonic convulsions
Is an aura associated with absence seizures?
No
What anticonvulsants are used to treat absence seizures?
Ethosuximide, valproic acid or lamotrigine
What anticonvulsant worsens absence seizures?
Carbamazepine
How are absence seizures provoked?
Hyperventilation and photic stimulation
How can atypical absence seizures be distinguished from complex partial seizures?
Atypical absence seizures are shorter and may occur repeatedly during day; complex partial seizures last more than 30 seconds, occur 1-2 times per day, may be associated with an aura, aren’t induced by photic stimulation, difference on EEG
How does EEg distinguish between absence an complex partial seizures?
Absence seizures are assoc with 3/second spike and wave while Complex partial seizures are associated with focal epileptiform discharges or spikes, often in the temporal lobe.
Define complex febrile seizure
any of the following: 1) duration longer than 15 minutes, 2) recurrence within 24 hours, and 3) focal nature
name 3 risk factors for developing epilepsy after a febrile seizure
1) complex seizure 2)family history of epilepsy 3)developmental or neurologic abnormalities
Name 3 risk factors for recurrence of febrile seizure
1) Family history of febrile seizures, 2)onset of febrile seizures before 1 year of age, and 3) a low degree of fever at the time of the seizure