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When can anticonvulsants be withdrawn in juvenile myoclonic epilepsy?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