llbgurl's version from 2015-10-06 18:13

Section 1

Question Answer
abrupt, uncontrolled repetitive discharges from cortical neuronsseizures
transient and sudden abnormal discharges of group of cerebral neuronsseizures
3.5% have one by age 15seizures
1% haveepilepsy
hypoglycemia, inborn error of metabolism PKU, hypocalcemia, drug withdraw, hypoxia, CNS bleeedseizures
fever up to age 6 seizures
arise from one part of brainfocal
arise from both hemispheresgeneralized seizures
petit mal last 5-30 seconds in 4-8 year oldstypical absent seizures
onset and termination may be gradual than abruptatypical absent seizures
absent seizures also know asstarring spells
does not impair consiciousnesssmiple focal
DOES involve LOCcomplex focal
tonic clonic can occur fromdrug withdrawl, excessive sleep deprevation, brief hypotension,, metabolic factors
motor signs of generalized and partialclonic jerking
sensory signs of generalized and partialtingling, distortion of smell/vision
autonomic symptoms of generalized and partialdiaphoresis, pallor
psychiatric symptoms of generalized and partialfear, hallucinations
problem with nerve and spinal cord or brain dysfunctionfocal deficit
sounds, flashing lights, menses, stress, drugsprecipating seizures
neurodevelopmental delayds, stroke, meningitis, encephalitisseizure hx
rage outburststemporal lobe seizures
travel recent to south americacysticercosis
perform actions with out consciousness or intentionautomatisms
automatisismtemporal lobe epilepsy
odd smell prior to seizuremesial temporal lobe seizure
petechia or purpuramenningococal meningitis
hypopigmented ashleaf maculetuberous sclerosis
skin abnormalities, seizures, cognitive deficitstuberous sclerosis
genetic; non-maligant tumor forms in brain and increased risk for seizurestuberous sclerosis
congenital facial birthmark with increased BV to portions of brain = seizures, neuro deficits, NOT geneticsturge-weber disease
presents at 2 years and oldernuchal rigidity
tuberous sclerosis best diagnosed throughMRI
autosomal dominanttuberous sclerosis
LP is contraindicated ifstructural lesion present
urine amino acids, lactic acid, pyruvic acid, ammonia, urine organic acidsneonates recurring unexplained seizures
primary tool in seizures first test orderedEEG
should ALWAYS be sleep deprived with hyperventilation and photostimulationEEG
EEG resutlsnormal does not mean no seizures, abnormal with no clinical symptoms does not mean seizures
focal seizures and focal neuro findings diagnosed throughMRI or CT scan
CT without contrast can detectmass/lesions, hemorrhage, hydrocephalus, calcifications secondary to congenital disease like CMV
holds breath on inspiration ages 6 months - 4 yearsbreath holding spells
rapid increase in temp 39c ages 6 months to 6 yearsfebrile seizure
peaks 18 months to 24 monthsfebrile seizure
50% that have febrile seizure UNDER one year of age 1/2 will have another
premies, first/second relatives, in hospital over 28 days, daycare 20 hrs a weekincreased risk for febrile seizures
seizure occurs24 hours after onset of fevermost likely serious infection
generalized tonic clonic seizuresfebrile
number one organism to cause menningitis in infantsecoli
#1 organism to cause menningitis in childrenHIB
anytime indication of meningitismust get LP
a LATE s/s of meningitis in child under 2 years of agenuchal rididity
non specific s/s: lethargy, poor feeds, irritable, jaundicemeningitis neonates
vomiting, lethargy, irritable, bulging fontanelle while quiet, high ptiched crymeningitis infants and toddlers
classic symptoms: vomiting, headche + brudznki and kernigs sign, nuchal rigiditiymeningitis child above 2 years old

Section 2

Question Answer
abrupt increase in muscle tonetonic
abrupt decrease in muscle toneatonic
reptitive muscle jerkingclonic
classic gran mal seizuretonic-clonic
brief shocklike muscle contractionsmyoclonic

Section 3

Question Answer
liver damage and bone marrow suppresion, erythromycin increases blood level and birth control pills decreases levels, get CBC and LFTs when start and periodicallyCarbamazipine Tegratol
treatment of choice for absent seizures, bone marrow supression, get CBCzarontin
gum hyperplasia good dental care neededdilantin phyentonin
sedation, ataxia, hyperkinesis, nystagmusphenobarb
liver damage = cbc and lfts; bone marrow suppressionvalproic acid depakane
adjust rx for partial and generalized seizures; primarly excreted in the urineneurontin
adjut med for partial seizures, HYPOnatremia ma occur, may INCREASE pheonobarb and dilantin levelsoxycarbazepine
skin rash occurs in 10% of patientslamactil
treat child, not just drug level, start lowest dose and increase to obtain clinical responseseizure drug
controlled seizures for 2 years may slowly wean off meds
goal of seizure medsto use one drug bc more than one = toxicity
seizure free for 2 years, demonstratse good medication compliancecan drive
pregnancydoes not mix well with seizure meds EDU
never abruptly stop medsseizure meds vital
active seizure educate familyease child to floor, place on side, blanket under head, do NOT restrain
swimmingNEVER alone
9 and abovebecome fearful of dying with seizures and need reassurance

Section 4

Question Answer
40-150valproic acid
blood levels not typicall checkedneurontin

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