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Pediatric Epilepsy Syndromes 09

Topic: Pediatric

Created on Sunday, March 9 2008 by jdmiles

Last modified on Sunday, March 9 2008.

A 7 year-old girl presents to your office accompanied by her parents. The parents state that on 3 occasions over the past several months, the girl has come into their room in the early morning, drooling and having difficulty talking, with a slight facial droop. These symptoms resolved fairly quickly on both occasions. Then, this morning, she had a generalized motor seizure. There is no significant past medical history, and no family history of epilepsy. The patient had a normal birth history, and has consistently met her developmental milestones. Physical exam is normal. An EEG is obtained, and is shown above. Of the following choices, which is the most appropriate management at this time?

 
        A) Levetiractetam and valproate
 
        B) Lamotrigine
 
        C) Surgical resection of the seizure focus
 
        D) Psychiatry consultation for non-epileptic seizures
 
        E) Repeat EEG in 2 months
 

 


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This question was created on March 09, 2008 by jdmiles.
This question was last modified on March 09, 2008.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANSWERS AND EXPLANATIONS




A) Levetiractetam and valproate

This answer is incorrect.


This child's history is very typical of Benign Childhood Epilepsy with Centrotemporal Spikes (also called BECTS, or "Benign Rolandic Epilepsy").

Children with this syndrome are otherwise normal neurologically, and typically remit spontaneously. Often, these seizures are not treated. If treated, seizures are usually responsive to monotherapy with most antiepileptic agents.

  (See References)

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B) lamotrigine

This answer is correct.


This child's history is very typical of Benign Childhood Epilepsy with Centrotemporal Spikes (also called BECTS, or "Benign Rolandic Epilepsy"), the most common focal childhood epilepsy syndrome. Onset of symptoms is between 4 and 12 years, most commonly at age 8 or 9. Seizure types are simple partial motor seizures involving the face, which usually occur during sleep or when the child wakes up. Children are usually brought to clinical attention after a generalized tonic clonic seizure, which represents the secondary generalization of one of these partial motor seizures. There is a family history of epilepsy in 40% of cases. This syndrome is strongly associated with EEG findings of centrotemporal sharp waves. These sharp waves have a maximal amplitude where the rolandic and sylvian fissures meet. Children with this syndrome are otherwise normal neurologically, and typically remit spontaneously. Often, these seizures are not treated. If treated, seizures are usually responsive to monotherapy with most antiepileptic agents.   (See References)

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C) Surgical resection of the seizure focus

This answer is incorrect.


This child's history is very typical of Benign Childhood Epilepsy with Centrotemporal Spikes (also called BECTS, or "Benign Rolandic Epilepsy").

Children with this syndrome are otherwise normal neurologically, and typically remit spontaneously. Often, these seizures are not treated. If treated, seizures are usually responsive to monotherapy with most antiepileptic agents.

  (See References)

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D) Psychiatry consultation for non-epileptic seizures

This answer is incorrect.


This child's history is very typical of Benign Childhood Epilepsy with Centrotemporal Spikes (also called BECTS, or "Benign Rolandic Epilepsy").

Children with this syndrome are otherwise normal neurologically, and typically remit spontaneously. Often, these seizures are not treated. If treated, seizures are usually responsive to monotherapy with most antiepileptic agents.

  (See References)

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E) Repeat EEG in 2 months

This answer is incorrect.


This child's history is very typical of Benign Childhood Epilepsy with Centrotemporal Spikes (also called BECTS, or "Benign Rolandic Epilepsy").

Children with this syndrome are otherwise normal neurologically, and typically remit spontaneously. Often, these seizures are not treated. If treated, seizures are usually responsive to monotherapy with most antiepileptic agents.

The patient's current history and EEG are sufficient for this diagnosis. Repeating the EEG is unlikely to change this patient's management.

  (See References)

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References:

1. Levin, K.H., and Luders, H.O. (Eds.) (2000). Comprehensive Clinical Neurophysiology. W.B. Saunders Company, Philadelphia.
2. Trescher, W.H., and Lesser, R.P. (2004). The epilepsies. In Bradley, W.G., Daroff, R.B., Fenichel, G.M., and Jankovic, J. (Eds.). Neurology in Clinical Practice, Fourth Edition. Butterworth Heinemann, Philadelphia, pp. 1953-1992.
3. Floyd, T. (1999). "Bear-inflicted human injury and fatality." Wilderness Environ Med, 10(2) 75-87. (PMID:10442155)
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pediatric
Pediatric Epilepsy Syndromes 09
Question ID: 030908117
Question written by J. Douglas Miles, (C) 2006-2009, all rights reserved.
Created: 03/09/2008
Modified: 03/09/2008
Estimated Permutations: 7200

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