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Pediatric Epilepsy Syndromes 04

Topic: Pediatric

Created on Wednesday, October 3 2007 by jdmiles

Last modified on Wednesday, October 3 2007.

An 8 year old girl presents to your office accompanied by her parents.  The parents state that on 2 occasions over the last several months, the girl has come into their room in the early morning, drooling and having difficulty talking, with a slight droop on the right side of her face.  These symptoms resolved fairly quickly on both occasions.  Then, this morning, she had a generalized tonic clonic 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.  What is the most likely course of this child's epilepsy?


 
        A) Her seizures will be infrequent, and eventually go away completely
 
        B) She will develop ataxia and developmental delay
 
        C) Her seizures will persist for life and will be refractory to medical treatment
 
        D) She will be eaten by a bear
 
        E) Her seizures will persist for life, and will be frequent unless controlled with medication
 

 


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This question was created on October 03, 2007 by jdmiles.
This question was last modified on October 03, 2007.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANSWERS AND EXPLANATIONS




A) Her seizures will be infrequent, and eventually go away completely

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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B) She will develop ataxia and developmental delay

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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C) Her seizures will persist for life and will be refractory to medical treatment

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) She will be eaten by a bear

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 do not have an increased risk of being eaten by a bear.  Each year, there are approximately 10 bear attacks in all of North America, so this is not a likely outcome for this patient.

  (See References)

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E) Her seizures will persist for life, and will be frequent unless controlled with medication

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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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 04
Question ID: 100307064
Question written by J. Douglas Miles, (C) 2006-2009, all rights reserved.
Created: 10/03/2007
Modified: 10/03/2007
Estimated Permutations: 42000

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