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Questions and Answers
What are the two main types of seizures in children based on their origin in the brain?
What are the two main types of seizures in children based on their origin in the brain?
Generalized seizures and focal seizures.
What is the term for a seizure lasting more than 30 minutes?
What is the term for a seizure lasting more than 30 minutes?
Status epilepticus.
How prevalent are febrile seizures among the population?
How prevalent are febrile seizures among the population?
They can affect 4-10% of the population.
What is Todd's paralysis?
What is Todd's paralysis?
What are infantile spasms, and at what age do they typically begin?
What are infantile spasms, and at what age do they typically begin?
List one metabolic cause of seizures.
List one metabolic cause of seizures.
What is the relationship between seizures and brain infections?
What is the relationship between seizures and brain infections?
What seizure type is characterized by 'staring spells' without jerking?
What seizure type is characterized by 'staring spells' without jerking?
Identify one cause of focal seizures.
Identify one cause of focal seizures.
What are the typical EEG findings in infantile spasms?
What are the typical EEG findings in infantile spasms?
What distinguishes pseudoseizures from epileptic seizures?
What distinguishes pseudoseizures from epileptic seizures?
What is the initial assessment for a patient suspected of having seizures?
What is the initial assessment for a patient suspected of having seizures?
What are some protective measures to take during a febrile seizure?
What are some protective measures to take during a febrile seizure?
What should you avoid doing during a seizure?
What should you avoid doing during a seizure?
What is the typical duration for a febrile seizure, and when should medical care be sought?
What is the typical duration for a febrile seizure, and when should medical care be sought?
What are some potential side effects of Valproic Acid?
What are some potential side effects of Valproic Acid?
What non-pharmacologic treatment options exist for seizures?
What non-pharmacologic treatment options exist for seizures?
What percentage of children experience at least one reoccurrence of febrile seizures?
What percentage of children experience at least one reoccurrence of febrile seizures?
What is the general population risk for developing epilepsy compared to children with febrile seizures?
What is the general population risk for developing epilepsy compared to children with febrile seizures?
What long-term effect can Lamotrigine have on cognitive ability?
What long-term effect can Lamotrigine have on cognitive ability?
What is the first-line treatment for infantile spasms?
What is the first-line treatment for infantile spasms?
What characterizes absence seizures in children?
What characterizes absence seizures in children?
What are common triggers for myoclonic seizures?
What are common triggers for myoclonic seizures?
Describe a tonic-clonic seizure's presentation.
Describe a tonic-clonic seizure's presentation.
What type of seizure is characterized by sudden loss of muscle tone and often leads to falls?
What type of seizure is characterized by sudden loss of muscle tone and often leads to falls?
Which medication is considered the first-line treatment for absence seizures?
Which medication is considered the first-line treatment for absence seizures?
How are developmental delays managed in children with epilepsy?
How are developmental delays managed in children with epilepsy?
What is a characteristic feature of myoclonic seizure episodes?
What is a characteristic feature of myoclonic seizure episodes?
What is a notable sign that may accompany tonic-clonic seizures?
What is a notable sign that may accompany tonic-clonic seizures?
Which medication alternatives exist for treating tonic-clonic seizures?
Which medication alternatives exist for treating tonic-clonic seizures?
What type of seizure is characterized by rhythmic jerking without sustained muscle stiffness?
What type of seizure is characterized by rhythmic jerking without sustained muscle stiffness?
At what age are febrile seizures most commonly observed?
At what age are febrile seizures most commonly observed?
What is the medical emergency that requires immediate intervention if seizures last more than 5 minutes?
What is the medical emergency that requires immediate intervention if seizures last more than 5 minutes?
Which epileptic syndrome is associated with multiple seizure types and a high risk of intellectual disability?
Which epileptic syndrome is associated with multiple seizure types and a high risk of intellectual disability?
What distinct EEG pattern is associated with West syndrome, commonly seen in infantile spasms?
What distinct EEG pattern is associated with West syndrome, commonly seen in infantile spasms?
What type of seizures are triggered by specific stimuli, such as flashing lights or reading?
What type of seizures are triggered by specific stimuli, such as flashing lights or reading?
What type of seizure involves sudden loss of muscle tone, often causing the individual to collapse?
What type of seizure involves sudden loss of muscle tone, often causing the individual to collapse?
What are the common features of neonatal seizures observed in infants?
What are the common features of neonatal seizures observed in infants?
What age range characterizes Benign Rolandic Epilepsy, and how does it usually manifest?
What age range characterizes Benign Rolandic Epilepsy, and how does it usually manifest?
What are the main features of juvenile myoclonic epilepsy (JME)?
What are the main features of juvenile myoclonic epilepsy (JME)?
What is the primary management for febrile seizures in children?
What is the primary management for febrile seizures in children?
Which medication is commonly used to manage myoclonic seizures in adolescents?
Which medication is commonly used to manage myoclonic seizures in adolescents?
Which type of seizure is characterized by flexor/extensor spasms and typically occurs between 3 to 12 months of age?
Which type of seizure is characterized by flexor/extensor spasms and typically occurs between 3 to 12 months of age?
What is the usual management for absence seizures in children?
What is the usual management for absence seizures in children?
In which seizure type does a child remain conscious but may experience twitching or sensory changes?
In which seizure type does a child remain conscious but may experience twitching or sensory changes?
What is the primary treatment for neonatal seizures that typically occur in the first 28 days of life?
What is the primary treatment for neonatal seizures that typically occur in the first 28 days of life?
What protective measure should be taken during atonic seizures in children?
What protective measure should be taken during atonic seizures in children?
What clinical feature is associated with tonic-clonic seizures?
What clinical feature is associated with tonic-clonic seizures?
What is the name of the seizure type characterized by brief episodes of staring, often unresponsive to stimuli?
What is the name of the seizure type characterized by brief episodes of staring, often unresponsive to stimuli?
Which seizure type can progress from focal to bilateral tonic-clonic seizures?
Which seizure type can progress from focal to bilateral tonic-clonic seizures?
What triggers febrile seizures in children, and what is the peak age range for their occurrence?
What triggers febrile seizures in children, and what is the peak age range for their occurrence?
Name one common cause of neonatal seizures.
Name one common cause of neonatal seizures.
What is the characteristic clinical presentation of infantile spasms?
What is the characteristic clinical presentation of infantile spasms?
List two management strategies for acute neonatal seizures.
List two management strategies for acute neonatal seizures.
What are two clinical signs that may indicate neonatal seizures?
What are two clinical signs that may indicate neonatal seizures?
What is the recommended management for a simple febrile seizure in children?
What is the recommended management for a simple febrile seizure in children?
Which demographic factor increases the risk of febrile seizures in children?
Which demographic factor increases the risk of febrile seizures in children?
At what age do infantile spasms typically start, and what metabolic disorder is associated with them?
At what age do infantile spasms typically start, and what metabolic disorder is associated with them?
What role do viral infections play in the occurrence of febrile seizures?
What role do viral infections play in the occurrence of febrile seizures?
What is the primary goal when managing acute neonatal seizures?
What is the primary goal when managing acute neonatal seizures?
Flashcards
What are seizures?
What are seizures?
Uncontrolled firing of nerves in the brain, causing abnormal electrical activity.
What are generalized seizures?
What are generalized seizures?
Seizures that involve both hemispheres of the brain.
What are focal seizures?
What are focal seizures?
Seizures that involve only one hemisphere of the brain.
What is a tonic-clonic seizure?
What is a tonic-clonic seizure?
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What is a focal seizure?
What is a focal seizure?
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What is a myoclonic seizure?
What is a myoclonic seizure?
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What is an atonic seizure?
What is an atonic seizure?
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What is an absence seizure?
What is an absence seizure?
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What is status epilepticus?
What is status epilepticus?
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What are infantile spasms?
What are infantile spasms?
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Febrile Seizure
Febrile Seizure
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EEG (Electroencephalogram)
EEG (Electroencephalogram)
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Vagal Nerve Stimulator
Vagal Nerve Stimulator
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Ketogenic Diet
Ketogenic Diet
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Phenytoin (Dilantin)
Phenytoin (Dilantin)
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Phenobarbital
Phenobarbital
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Lamotrigine
Lamotrigine
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Valproic Acid
Valproic Acid
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Seizure Workup
Seizure Workup
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Epilepsy
Epilepsy
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Simple Febrile Seizure
Simple Febrile Seizure
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Complex Febrile Seizure
Complex Febrile Seizure
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Neonatal Seizures
Neonatal Seizures
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Hypoxic-Ischemic Encephalopathy (HIE)
Hypoxic-Ischemic Encephalopathy (HIE)
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Infantile Spasms (West Syndrome)
Infantile Spasms (West Syndrome)
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Infantile Spasms
Infantile Spasms
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Tuberous Sclerosis Complex
Tuberous Sclerosis Complex
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ARX Gene Mutations
ARX Gene Mutations
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Hypoglycemia
Hypoglycemia
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Focal seizures
Focal seizures
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Focal aware seizures
Focal aware seizures
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Focal impaired awareness seizures
Focal impaired awareness seizures
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Generalized seizures
Generalized seizures
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Tonic-clonic seizures
Tonic-clonic seizures
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Absence seizures
Absence seizures
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Myoclonic seizures
Myoclonic seizures
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Atonic seizures
Atonic seizures
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What are febrile seizures?
What are febrile seizures?
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What is a simple febrile seizure?
What is a simple febrile seizure?
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What are neonatal seizures?
What are neonatal seizures?
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What is West syndrome?
What is West syndrome?
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What is Lennox-Gastaut syndrome?
What is Lennox-Gastaut syndrome?
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What is Benign Rolandic Epilepsy?
What is Benign Rolandic Epilepsy?
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What is Juvenile Myoclonic Epilepsy?
What is Juvenile Myoclonic Epilepsy?
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What are reflex seizures?
What are reflex seizures?
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What is hypsarrhythmia?
What is hypsarrhythmia?
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What are absence seizures?
What are absence seizures?
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What are tonic-clonic seizures?
What are tonic-clonic seizures?
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What are atonic seizures?
What are atonic seizures?
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What are myoclonic seizures?
What are myoclonic seizures?
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What is ethosuximide?
What is ethosuximide?
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What is valproic acid?
What is valproic acid?
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What is lamotrigine?
What is lamotrigine?
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Study Notes
Seizures in Children
- Seizures are uncontrolled nerve firings in the brain
- Generalized seizures involve both cerebral hemispheres
- Focal seizures involve one hemisphere
- Young infants' seizures can be subtle and look different from other seizures
Learning Objectives
- Identify different types of seizures in children
- Differentiate the causes of seizures
- Recognize components of a seizure workup
- Discuss treatment for seizures in children
Seizure Prevalence
- Seizures affect 1% of the population
- Febrile seizures occur in 4-10% of the population
- 15% of children with an initial seizure will have another within a year.
During a Seizure
- Alteration of vital signs and respiratory suppression are possible
- A period of sleepiness (post-ictal period) follows a seizure
- Transient paralysis (Todd's paralysis) can develop after a seizure
- Seizures vary depending on where they start in the brain
Types of Seizures
- Tonic-clonic (generalized): May be tonic or clonic
- Focal (one side of the body)
- Myoclonic: Few to many short jerks in the body
- Atonic/Akinetic: "Drop spells"
- Absence: No jerking; "staring spells"
Status Epilepticus
- A seizure lasting more than 30 minutes
- Can result in death
Differential Diagnosis of Seizures
- Infections (e.g., brain abscess, encephalitis, meningitis, tuberculosis, viral illnesses, HIV, toxoplasmosis)
- Toxins (e.g., cocaine, methamphetamine, lead poisoning, organophosphates, salicylates, sympathomimetics, tricyclic antidepressants, alcohol withdrawal)
- Traumatic/Vascular (e.g., cerebral contusion, stroke, child abuse)
- Idiopathic (Epilepsy)
- Congenital Anomalies
- Genetic causes
- Metabolic causes (e.g., hypercarbia, hypocalcemia, hypoglycemia, hyponatremia, hypomagnesemia, inborn errors of metabolism, pyridoxine deficiency)
- Neoplastic (e.g., brain tumors, metastatic cancers)
Infantile Spasms
- General myoclonic jerking of neck, trunks, and limbs
- Typically begins between 3-7 months old
- Associated with some genetic syndromes
- Atypical EEG finding: "hypsarrhythmia"
- Poor prognosis: Death within 3 years in 1/3 of children
- Often has profound cognitive effects
- Difficult to control seizures
- Survivors may develop other seizure types
Benign Rolandic Epilepsy
- Simple partial seizures often involving face and hands
- EEG shows centrotemporal spikes
- Seizures occur or are aggravated during or around sleep
- Almost always outgrown by adolescence
Conditions That Mimic Seizures
- Breath holding spells
- Syncope
- Panic attacks
- Tic disorders
- Benign myoclonus (infants)
- Dystonic reaction
- Pseudoseizures
- Night terrors
Seizure Workup - Basic
- EEG
- Electrolytes (to rule out metabolic anomaly)
- CBC (to rule out infection)
Additional Workup
- Depends on assessment and physical exam findings
- Sometimes requires head CT or MRI
Treatment: Febrile Seizures
- Loosen tight clothing to prevent injury
- Protect the person from injury
- Place something soft under their head if they fell
- Stay with them until fully recovered
- Call for medical help if seizure lasts over 5 minutes
- Do not try to restrain the person
- Do not put anything between their teeth
- Do not move them unless they are in danger
- Do not give them food
Acute Seizure Control
- Treatment varies depending on the duration and type of seizure, presence of complications and the underlying cause. Multiple medications are used in the acute setting.
Anticonvulsants (Medication)
- Many different drugs with varying mechanisms of action.
- Side effects are listed in the accompanying table.
Medication Side Effects
- Valproic Acid/Phenytoin: May cause fetal anomalies, gum hyperplasia. Blood levels need monitoring.
- Phenobarbital: Long-term cognitive effects
- Lamotrigine: Can lead to Stevens-Johnson syndrome
Non-Pharmacological Seizure Treatment
- Vagal Nerve Stimulator
- Surgery
- Ketogenic Diet
Febrile Seizures
- Occurs in approximately 4% of children (6-60 months) associated with a febrile illness
- Most common form of seizures and neurological disorders in children
- 30-40% of children with febrile seizures will have a recurrence.
- General risk of epilepsy 0.5 - 1%. Risk in febrile seizure patients is 1-2%.
Simple Febrile Seizures
- Symmetrical
- Lasts less than 15 minutes (Most <5 minutes)
- Only one seizure associated with a febrile illness/24 hour timeframe.
Complex Febrile Seizures
- Focal features during or after event
- Lasts more than 15 minutes.
- More than one seizure in a 24-hour period.
Febrile Seizures & Epilepsy
- Dravet Syndrome: Severe myoclonic epilepsy of infancy (prolonged, asymmetric, progressive, starts without fevers)
- Generalized Epilepsy with Febrile Seizures Plus (GEFS+): Autosomal dominant, febrile seizures can disappear by age 6, or evolve.
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