Q&A Seizures

Creating clinical scenario questions based on the provided content on pediatric seizures involves crafting realistic situations that test understanding of definitions, etiologies, presentations, diagnostic criteria, and management strategies. Here are 30 questions with answers:

1. Question: A 6-month-old infant presents with repetitive lip-smacking and staring episodes lasting about 30 seconds. What type of seizure is most likely occurring?

   • Answer: These symptoms suggest a complex partial seizure, commonly seen in temporal lobe epilepsy.

2. Question: A 3-year-old child experiences a generalized tonic-clonic seizure lasting 3 minutes after a fever of 39°C. What is the most likely diagnosis?

   • Answer: This is likely a simple febrile seizure, characterized by a generalized seizure associated with fever.

3. Question: What is the primary difference between a provoked and an unprovoked seizure?

   • Answer: A provoked seizure occurs due to an identifiable systemic factor or acute brain insult, while an unprovoked seizure occurs without an immediate precipitating factor.

4. Question: A 10-year-old girl has episodes of sudden, brief lapses in consciousness without any postictal confusion. What type of seizure is this?

   • Answer: These are absence seizures, characterized by brief lapses in consciousness, typically seen in childhood absence epilepsy.

5. Question: What is the first-line treatment for a child experiencing status epilepticus?

   • Answer: Benzodiazepines, such as lorazepam or diazepam, are the first-line treatment for status epilepticus.

6. Question: A 7-year-old boy presents with morning myoclonic jerks and occasional generalized tonic-clonic seizures. What is the likely diagnosis?

   • Answer: This presentation is consistent with juvenile myoclonic epilepsy.

7. Question: What EEG pattern is characteristic of West syndrome?

   • Answer: West syndrome is characterized by an EEG pattern known as hypsarrhythmia.

8. Question: A 5-year-old child has a seizure characterized by sudden loss of muscle tone and falls to the ground. What type of seizure is this?

   • Answer: This is an atonic seizure, also known as a drop attack.

9. Question: What is the most common cause of seizures in children aged 6 months to 5 years?

   • Answer: Febrile seizures are the most common cause of seizures in this age group.

10. Question: A child with a history of epilepsy presents with a prolonged seizure lasting more than 5 minutes. What is the immediate concern?

    • Answer: The child is likely experiencing status epilepticus, which is a medical emergency requiring immediate treatment.

11. Question: What is the typical age of onset for benign rolandic epilepsy?

    • Answer: Benign rolandic epilepsy typically presents between ages 2 and 12, with a peak onset between 5 and 10 years.

12. Question: What is the recommended management for a simple febrile seizure in the emergency department?

    • Answer: Management includes reassurance, antipyretics for fever, and observation. No anticonvulsant therapy is typically required.

13. Question: A 4-year-old child has a seizure with head deviation and jerking of the right arm, followed by confusion. What type of seizure is this?

    • Answer: This is likely a focal seizure with secondary generalization.

14. Question: What are the risk factors for developing epilepsy after a febrile seizure?

    • Answer: Risk factors include complex febrile seizures, family history of epilepsy, and neurodevelopmental abnormalities.

15. Question: What is the significance of automatisms during a seizure?

    • Answer: Automatisms, such as lip-smacking or picking at clothes, suggest a complex partial seizure.

16. Question: A child experiences a seizure characterized by sudden, brief muscle contractions. What type of seizure is this?

    • Answer: This describes a myoclonic seizure.

17. Question: What is the typical EEG finding in absence seizures?

    • Answer: Absence seizures typically show a 3 Hz spike-and-wave pattern on EEG.

18. Question: What is the first step in managing a child with a suspected seizure disorder?

    • Answer: The first step is to obtain a detailed history and description of the events from witnesses.

19. Question: A 2-year-old child presents with clusters of brief flexor spasms. What syndrome should be considered?

    • Answer: Infantile spasms, often associated with West syndrome, should be considered.

20. Question: What is the prognosis for children with benign rolandic epilepsy?

    • Answer: The prognosis is generally good, with most children outgrowing the seizures by adolescence.

21. Question: What is the role of EEG in the diagnosis of epilepsy?

    • Answer: EEG helps confirm the diagnosis of epilepsy and can identify specific epilepsy syndromes.

22. Question: A child with epilepsy has a seizure triggered by flashing lights. What type of epilepsy is this?

    • Answer: This is likely photosensitive epilepsy, a type of reflex epilepsy.

23. Question: What is the typical treatment approach for a newly diagnosed case of epilepsy in a child?

    • Answer: The approach includes confirming the diagnosis, identifying the seizure type, and starting monotherapy with an appropriate antiepileptic drug.

24. Question: What are the common side effects of antiepileptic drugs?

    • Answer: Common side effects include drowsiness, dizziness, and gastrointestinal disturbances.

25. Question: What is the significance of a postictal state following a seizure?

    • Answer: The postictal state is a period of altered consciousness and recovery following a seizure, often characterized by confusion and fatigue.

26. Question: What is the main difference between generalized and focal seizures?

    • Answer: Generalized seizures involve both hemispheres of the brain and typically result in loss of consciousness, while focal seizures originate in one hemisphere and may or may not affect consciousness.

27. Question: What is the recommended action if a child experiences a seizure lasting more than 5 minutes?

    • Answer: Immediate medical intervention is required, often starting with administration of a benzodiazepine.

28. Question: What is the typical presentation of Lennox-Gastaut syndrome?

    • Answer: Lennox-Gastaut syndrome presents with multiple seizure types, intellectual disability, and a slow spike-wave pattern on EEG.

29. Question: What is the role of neuroimaging in the evaluation of a child with seizures?

    • Answer: Neuroimaging, such as MRI, is used to identify structural brain abnormalities that may be causing seizures.

30. Question: What is the importance of family education in managing febrile seizures?

    • Answer: Educating families about febrile seizures helps reduce anxiety, ensures proper management during future episodes, and emphasizes when to seek medical attention.