Master the board step 3

Pediatrics
Seizure Disorder
Epilepsy is present when at least 2 unprovoked seizures occur more than 24
hours apart.
Early treatment with antiseizure medication reduces the risk of subsequent
seizures and improves time to remission. Antiseizure medications may be
stopped after the patient has been seizure-free for 2 years.
Seizure
Disorder Classic Features EEG Findings Treatment
Absence seizures
Frequent seizures with cessation of motor
activity or speech, blank facial expression, and
flickering of eyelids
More common in girls, rare in children < 5 years,
rarely lasts longer than 30 seconds
3-second spike and
generalized wave
discharge
First line:
Ethosuximide
Alternative: Valproic
acid
No aura or postictal state
Juvenile
myoclonic
epilepsy (JME)
Jerky movement occurring in the morning
Onset around adolescence
Irregular spike-andwave
pattern
First line: Valproic
acid
West syndrome
(infantile
spasms)
Infantile spasms during the first year of life
Clusters of mixed flexor and extensor spasms of
trunk and extremities, persisting for minutes
with brief intervals between each spasm
Of children with West syndrome, 75 percent
have an underlying central nervous system
disorder (Down syndrome is most common).
Hypsarrhythmia
(very highvoltage
slow
waves, irregularly
interspersed with
spikes and sharp
waves)
First line: ACTH,
prednisone,
vigabatrin,
pyridoxine
(vitamin B6)
Partial seizure
Simple: Tonic or clonic movements involving
most of the face, neck, and extremities and
lasting 10–20 seconds. There is no postictal
period.
Spike and sharp
waves or
multifocal spikes
First line:
Carbamazepine
and valproic acid
Generalized: Includes impaired consciousness
Generalized
seizure
Aura, loss of consciousness, eyes roll back, tonic
contraction, apnea then clonic rhythmic
contractions alternating with relaxation of all
muscle groups
Anterior temporal
lobe shows sharp
waves or focal
spikes
First line: Valproic
acid
Tongue biting, loss of bladder control
Prominent postictal state
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