18 Seizures

Seizure

• Path: synchronous firing of awake brain

• Loc

  • positive: complex

  • negative: simple

	Generalized	Focal/Partial
LOC - Complex	Grand mal	partial complex
No LOC - Simple	Pseudo seizure	partial simple

• Grandmal: loc, bowel/bladder incontinence, tongue biting, postictal

• partial complex: partial because not entire brain. Complex because loc

• partial simple: someone's hand, arm, brain twitch

• pseudo seizure: faking it

  • kids can have atonic seizure: loss of muscle tone but not loc

Seizure vs. Epilepsy

• Seizure: one time, use VITAMINS formula

• Epilepsy: recurrent, disease

Diagnosis and treatment

• diagnosis: EEG only when having seizure. Can be provoked with rapid flashing light or sleep deprivation

• treatment: anti epileptic drug. Same in kids and adults

  • levetiracetam most often

  • backup: phenytoin, valproic, lamotrigrine

  • absence: ethusuxomide

  • tic douloureux (trigeminal neuralgia. Seizure of trigeminal nerve): carbamazapine

Pediatric Diseases

Febrile Seizures

• path: fever reduce seizure threshold. Developing brain more vulnerable. Not sure if rate or height of fever matters more

• pt: fever and seizure

  • Simple febrile seizure: 1 in 24 hrs, < 15 min, must be generalized

  • Complex febrile seizure: any 1 of 3 criteria absent

• treatment

  • simple

    • actively seizing: benzo

    • acetaminophen to control fever

    • no imaging needed

    • no antiepileptic drug (not epilepsy)

  • complex

    • EEG: if not sure it's seizure

    • LP: fear of meningitis

    • MRI: better than CT, no radiation. Look for something in brain if not other two

    • Antiepileptic drugs

Infantile Spasms

• aka West Syndrome

• pt: < 1 yo

• symptoms

  • bilateral symmetrical limb jerking

  • not generalized

  • no fever

• diagnosis

  • interictal EEG show hypsarrythmia

• treatment: ACTH

• f/u

  • cognitive delay, mental retardation

  • part of tuberous sclerosis.,

Tuberous Sclerosis

• path: genetic

• Pt: <2 yo

• symptoms: angiofribromas, ashleaf spot, afebrile seizures, complex febrile seizures

• diagnosis: neuroimaging, see tubers

• treatment: supportive

• f/u: die young, MR.,

Absent

• path: hundreds to thousands per day

• pt: ADHD

• symptoms: loc, no loss of tones, generalized, no post ictal state (pt go in and out of seizures, stay up right, don't shake)

• diagnosis: EEG

• treatment: ethusuxomide, valproic

• f/u: outgrow