How common is it to have a single seizure among the general population?

About 5 %

What are the two terms you can use for a seizure affecting just one part of the body?

Focal (old term) or

Partial (new term)

What differentiates a “simple” from a “complex” seizure?

Simple means no change in level of consciousness

Complex means there was a change

What is a “generalized” seizure?

Seizure affecting both hemispheres from the start

What does it mean if a seizure is “secondarily generalized?”

Started in one location (partial seizure) then spread to both hemispheres

If you see an EEG on the boards, how hard should you work to read it?

Not hard at all – treat the patient, not the EEG

Which type(s) of seizure does not have a postictal phase?

Absence & Simple Partial

If the eye fields of the brain are involved in a seizure, do the eyes go toward or away from the seizure?

Away

(Overactive frontal eye fields push the eyes away)

If a child is getting into trouble for annoying behaviors or not paying attention, what sort of seizures should you consider?

Absence or complex partial

During a complex partial seizure with automatisms, will the child be able to respond to outside stimuli?

Not normally, but some responsiveness

What is the best way to test for any remaining level of consciousness in an impaired patient?

Painful stimulation

What is the most common sort of automatism to occur in an absence seizure?

Blinking

(but remember that automatisms are most common with complex partial seizures)

What is the best medication for absence seizures?

Ethosuximide

Should Benign Rolandic seizures be treated?

Only if frequent/problematic

What group of patients typically develops Rolandic seizures?

School-aged kids who are otherwise fine

What is a benign Rolandic seizure?

A partial seizure that sometimes generalizes – usually occurs at night

Why are they called “Rolandic” seizures?

There is a characteristic spike on EEG over the Rolandic fissure area

What is the other name for benign Rolandic seizures?

Benign childhood epilepsy

with CentroTemporal Spikes

(BCECTS)

What is the usual course of benign Rolandic seizures?

Spontaneously resolve

(by age 15 years)

Why is it important to know about benign Rolandic seizures?

• Common cause of epilepsy (about 15 % of childhood cases)

• No treatment needed

• Spontaneous resolution expected

The 3-Hz per second spike-and-wave pattern is famous for being associated with what type of seizure?

Absence

What are the two paths patients with absence seizures are likely to follow as they get older?

• Resolution in adolescence

• Epilepsy (30 %)

Which epilepsy syndrome is known for being induced by visual stimuli?

Juvenile myoclonic epilepsy

What sort of seizure will the patient have, if he/she has a visually induced seizure?

Could be myoclonic only, or could be myoclonic with absence or tonic-clonic

How do you treat visually induced myoclonic seizures?

Avoid the stimuli (or wear dark glasses, if needed)

“Incoordination” or jerking movements in the early morning are sometimes the first signs of which seizure disorder?

Juvenile myoclonic epilepsy

What do infantile spasms look like?

Spasms of the flexors – especially head & trunk

What is the special buzzword associated with the EEG appearance of infantile spasms?

“Hypsarrhythmia”

What does hypsarrhythmia mean?

The EEG has a slow rhythm, and is disorganized

(Specifically – very high voltage, random, slow waves and spikes in all cortical areas)

Which genetic disorder is especially associated with infantile spasms?

Tuberous sclerosis

(although lots of others cause it, too)

Which type of pediatric seizure has the worst prognosis?

Infantile spasm

What proportion of children with infantile spasm will go on to have epilepsy?

Around 60 %

When children with infantile spasms later develop epilepsy, which type of epilepsy often evolves?

Lennox-Gastaut syndrome

(difficult to control, multiple types of seizures associated with intellectual disability)

Note: The term “mental retardation” while most familiar to many medical practitioners, has now been replaced by the term “intellectual disability” in many sources. Mental retardation has also been eliminated as a term in the 2013 revision of the Diagnostic & Statistical Manual of Mental Disorders, and in US federal legislation.

In 2015, however, the ICD-11 international classification of diseases will adopt the term “intellectual developmental disorder” to replace both the terms “mental retardation” & “intellectual disability.” This term will then replace intellectual disability in many sources.

What is the main danger in treating seizure disorders?

Respiratory arrest – (more patients die of medication complications than die of seizures!)

If a child has had a febrile seizure, is there risk of developing epilepsy increased?

Yes – it’s doubled, but still very small

(0.5 vs. 1.0 – exact numbers quoted vary, some recent studies suggest it might be as high as 2.4)

The number traditionally quoted, and most likely to occur on exams, is the doubling to 1 %.

If you think you have a child with breath holding spells, what can reassure you that it is, in fact, breath holding?

The sequence –

Pain/anger/fear →

Crying →

Breath holding

If a child has jerking movements after losing consciousness, does that make it less likely that the episode was really a breath holding spell?

No – the child may jerk, be limp, or stiff after losing consciousness

Children with breath holding spells have a higher than average likelihood of also having what physiological disorder?

Anemia/iron deficiency

Why do Klippel-Feil patients have limited neck motion?

Some or all of their cervical vertebra are fused

What is the “triad” of Klippel-Feil syndrome?

Short neck

Limited neck motion

Low occipital hairline

(all neck related!)

Risk for serious neurological problems in Klippel-Feil patients is highest if the fusion occurs in what part of the c-spine?

Occipito-C1 vertebral junction

Is it common for Klippel-Feil patients to have associated anomalies?

Yes

What is lissencephaly?

Smooth brain (gyri are missing)

With which congenital syndrome is lissencephaly most associated?

Miller-Dieker

What is schizencephaly?

Clefts in the cerebral hemispheres that weren’t supposed to be there

(remember “schizo” means split, so schizencephaly is extra “splits” of the brain)

What sorts of clinical problems does schizencephaly create, if any?

Seizures, severe intellectual disability, quadriparesis

What is porencephaly?

Holes (pores) within the brain

How would a child develop porencephaly?

(2 ways)

Usually occurs due to damage from stroke or infection after birth

Can also be congenital, due to developmental error(s)

What is acquired porencephaly?

(formerly called pseudoporencephaly!)

Special name for acquired holes in the brain, not due to developmental processes

How can pseudoporencephaly be distinguished from congenital porencephaly?

Congenital porencephalic cysts communicate with the ventricle or subarachnoid space, acquired cysts generally do not

&

Acquired porencephaly is not associated with other CNS malformations

How will acquired porencephaly patients present?

Focal findings, seizures, or sometimes asymptomatic

Do congenital porencephaly patients present differently from acquired porencephaly?

Congenital patients often have more global problems, such as intellectual disability, cerebral palsy, and blindness

If you’re born without a corpus callosum, what sorts of problems should you expect to experience?

Some neuropsychiatric difficulties, but often subtle

(75 % of these patients have normal intelligence & otherwise normal appearing function)

Why would someone fail to develop a corpus callosum?

1. Inherited – both AD and AR

2. In utero injury prior to the 20th week of pregnancy

3. Association to some in utero exposures, especially alcohol

Holoprosencephaly is highly associated with what very unusual facial abnormality?

Cyclopia (single eye)

What is the most severe form of holoprosencephaly?

“Alobar”

(this means that no lobes formed in the front part of the brain at all)

What is the most obvious structural finding if you scan a patient with alobar holoprosencephaly?

Single ventricle

How long do alobar holoprosencephaly patients usually survive?

A few months

Use of which recreational drug are associated with agenesis of the corpus callosum?

Alcohol & cocaine

What is static encephalopathy?

Cerebral dysfunction that doesn’t worsen over time (it’s allowed to improve)

If a patient is encephalopathic due to high ammonia levels, would that be considered static encephalopathy?

No –

whatever caused the encephalopathy must be a completed process leaving changed cerebral function to use this label

What type of problem does the term “cerebral palsy” refer to?

Motor

Technically, what is a convulsion?

A seizure due to a cortical lesion (most seizures have this mechanism)

Is cerebral palsy a type of static encephalopathy?

Yes – motor only

What aspects of motor function can cerebral palsy affect?

Posture, tone, & movement (of course)

Do the problems that cause cerebral palsy occur during, before, or just after birth?

Any of those

(often the timing of the event is not clear)

Are sensory problems a part of cerebral palsy?

No

Is perinatal asphyxia the major causal factor in development of cerebral palsy?

No

(<10 % of cases are thought to be related to perinatal asphyxia)

What is the perinatal asphyxia-related factor that gives a high likelihood of later CP?

Metabolic acidosis

(umbilical artery pH < 7 and base deficit > 12 at time of delivery)

What are three known risk factors for the development of CP?

Prematurity/low birth weight

Intrauterine infection

Congenital malformations

Is low birth weight associated with CP?

Yes

(but the causal relationship is not clear)

Low birth weight is especially associated with what sort of CP?

Spastic diplegia

(mainly affects the legs, but arms can be involved too)

Infection is most associated with what sort of CP?

Spastic quadriplegia

(all four extremities are affected)

Which aspects of the immune system have been implicated in CP?

Immune mediators, e.g., interleukins, interferons, and TNF factors

(higher than normal levels may disrupt developing neural circuitry)

What does “spastic CP” mean?

Same types of findings as upper motor neuron lesions – hypertonic & hyperreflexic, clonus, & weakness

What are the subtypes of spastic CP?

Hemiplegia (one side)

Quadriplegia (both sides – all four extremities)

Diplegia (both sides, but legs more affected than arms or face)

Dyskinetic CP is another type of CP. What is its presentation?

Purposeless movements that disappear during sleep – often choreoathetoid and dystonic movements

(truncal twisting, grimacing, etc.)

What is the underlying problem in dyskinetic CP?

Abnormal basal ganglia

Is it possible to have both dyskinetic and spastic CP?

Yes, unfortunately

Which sort of CP has the fewest associated problems?

Dyskinetic

Which children with CP are most likely to have intellectual disability?

(2 types of CP)

Mixed (meaning spastic & non-spastic types of CP in the same person)

&

Spastic quadriplegic

Is intellectual disability common among kids with CP?

Yes – about 50 %

Which types of CP are most associated with seizure disorder?

Spastic hemiplegia & quadriplegia

Has botulinum toxin been used successfully in spastic CP?

Yes – for focal problem areas of spasm

What relatively new treatment, involving a muscle relaxant, has been shown to be helpful in spastic CP?

Intrathecal baclofen

What oral meds are used to decrease the spasticity in CP?

Baclofen

Dantrolene

Benzodiazepines (diazepam, clonazepam)

If an infant had a stroke in utero, how will that child present (assuming it is detected clinically)?

Hemiplegic CP or early hand dominance

Complications from congenital heart disease account for what proportion of strokes in children?

1/4

When is the most dangerous time for a child with congenital heart disease, in terms of stroke risk?

Cardiac cath or surgery –

1/2 of the strokes happen within 3 days of one of these

How important are pro-thrombotic factors in childhood strokes?

Important – 1/3 to 1/2 of children who stroke have them

If a child has antiphospholipid antibody, what will he/she be predisposed to develop?

Clots – including stroke

What does lupus anticoagulant put the patient at risk for?

Clotting (it was a poor name choice)

Which types of antiphospholipid antibodies are most commonly implicated in childhood stroke?

Anticardiolipin antibody & lupus anticoagulant

(these are both types of antiphospholipid antibodies)

Which other prothrombotic factors are known to be important contributors to stroke in children and young adults?

(5)

Protein C

Protein S

Antithrombin III

Elevated homocysteine

Factor 5 Leiden

If a child has a stroke between birth and age two, what are the two most common presentations?

Seizure or hemiplegia

If a child presents with an apparent hemiplegia, what two other diagnoses should you consider in addition to structural damage to the brain?

Complicated migraine

  &

Todd’s paralysis

(following a seizure)

What bizarre possibility should you consider when a child suddenly develops hemiplegia and no cause can be found?

“alternating hemiplegia”

(Very rare disorder with hemiplegia that switches sides, and seizures between episodes of hemiplegia. Course is progressive neuro deterioration)

What is ataxic CP?

Damage to cerebellum results in coordination & gait problems

How important is sickle cell disease, as a cause of stroke in children?

Important – ≥10 %

In what age range is stroke most common for SC kids?

2–5 years

(rare <2 years)

Higher levels of hemoglobin F are helpful to sickle cell patients, in general. Does it protect the patient from stroke?

No

Is it common for sickle cell children to have asymptomatic strokes?

Yes – 1 in 5

(the brain is very adaptable in young children, and if the area is small and/or non-critical, there may not be any symptoms)

Which are more common in children – ischemic strokes or hemorrhagic strokes?

Equally common

Which are more fatal in children – ischemic strokes or hemorrhagic strokes?

Hemorrhagic (>25 %!)

For sickle cell patients, how can you predict which ones are at special risk for stroke?

Transcranial Doppler flow studies – high flow means increased risk

What is moyamoya disease?

It’s really a description, not a disease – chronic occlusion of small cerebral vessels causes collaterals to form

What is the buzzword for appearance of moyamoya on scans or angiography?

“Puff of smoke” – a dense area of wispy vessels is seen

In children, moyamoya is associated with which disorders?

(4)

Sickle cell

Trisomy 21

Neurofibromatosis (type 1)

& Radiation treatment

Stroke symptoms are occasionally caused by another sort of problem, not thrombus, embolus, or hemorrhage. What problem is that?

Arterial dissection – usually of the internal carotid

What is the most common cause of CNS vasculitis in children?

Bacterial meningitis

What percentage of children who have had bacterial meningitis also have evidence of a CNS infarct?

About 10 %

When chickenpox is associated with stroke, when does the stroke develop?

Within 12 months of the rash

(recent data suggests the risk may be limited to the first 6 months, but this is still under investigation)

Which kids are most likely to develop chicken pox associated strokes?

<10 years old

Where do infarcts usually occur, when stroke follows chicken pox?

Internal capsule or basal ganglia

(think of it as subcortical motor stuff)

Which two rheumatologic diseases are rare causes of CNS vasculitis in children?

Lupus & Takayasu arteritis (usually seen in Asian females)

If a child has a stroke without a clear etiology, what metabolic disorders should you consider?

↑ homocysteine

MELAS disease

Fabry disease

What is MELAS disease?

Mitochondrial myopathy

Encephalopathy

Lactic Acidosis

Stroke-like episodes

Why does Fabry disease predispose children to stroke?

Ceramide builds up in the vascular endothelial cells, narrowing the vessels

(specifically, it is globotriaosylceramide that builds up)

(α-galactosidase deficiency)

If a child does not have homocystinuria, should you still consider elevated homocysteine as a possible contributor to a stroke?

Yes, if the stroke was ischemic –

We have recently learned that many things increase homocysteine levels (meds, cigarettes, renal disease, thyroid disease, vitamin deficiency, etc.)

Why do elevated homocysteine levels lead to stroke, anyway?

High levels damage vascular endothelium, promoting thrombus formation

Is neonatal stroke more common in full-term or preterm infants?

Full term

Are neonatal strokes usually embolic or thrombotic?

Embolic

(the placenta is thought to be the most common source)

Note: Ischemic & hemorrhagic strokes are equally common in children – ischemic stroke is more common in neonates

Which cerebral artery is most often involved in neonatal stroke?

Left MCA

(middle cerebral artery)

What is the best diagnostic for finding a stroke in a neonate?

MRI

(Remember, US is not going to show you much in an ischemic stroke)

How do neonates with stroke usually present?

Seizures

If a neonate seizes as a result of a cerebrovascular accident, is he/she likely to have a long-term seizure disorder?

No – antiseizure medication may be needed for a few months, but usually not long-term

In addition to emboli, another common cause of stroke in neonates is _________?

Hypoxic-ischemic insult

What do you expect to see in a full-term infant who has hypoxic-ischemic encephalopathy?

Quadriparesis clinically – Parasagittal damage on imaging

What do you expect to see in a preemie who has hypoxic-ischemic encephalopathy?

Lower extremity weakness clinically – periventricular leukomalacia on imaging

How does hypoxic-ischemic encephalopathy cause damage to the brain?

Multiple mechanisms:

Hypoxia & asphyxia

Ischemia & acidosis

What is the most common cause of intracranial bleeding in children?

Trauma

What are the other common reasons for intracranial bleeding in children?

Coagulopathy

Vascular malformation

Aneurysm

Typical signs of intraparenchymal bleeding are ______?

Seizure

Focal neuro problem

Headache

Change in mental status

Typical signs of subarachnoid bleeding are ________?

“Worst headache of my life” & change in mental status

What is the best diagnostic choice for acute intracranial bleeding in anyone who doesn’t have a fontanelle?

Head CT

(no contrast – new blood is bright)

What is the most common type of intracranial vascular malformation in children?

Venous angiomas – usually benign, no treatment needed

Which type(s) of intracranial malformations usually require surgical intervention?

AVMs

(some may be embolized, others require surgical removal)

Which disorders are associated with saccular aneurysms?

Aortic coarctation

Ehlers-Danlos

Marfan’s

Autosomal dominant polycystic kidney disease

(many other disorders also have some association with saccular aneurysms)

What is the other term for saccular aneurysms?

Berry aneurysms

Where are berry aneurysms usually found?

Anterior half of the circle of Willis

Should intracranial aneurysms be routinely removed?

No – it depends on the aneurysm.

(If it becomes symptomatic, it definitely needs to be removed)

The main risk for patients with berry aneurysms is _______?

Subarachnoid hemorrhage

Can a thrombotic event lead to headache, papilledema, nausea, vomiting, and 6th cranial nerve palsy – all without other localizing signs?

Yes – Superior sagittal sinus thrombosis

(CSF return to the venous system is blocked)

Proptosis, chemosis, and ophthalmoplegia can result from what thrombotic event?

Cavernous sinus thrombosis

(usually related to cavernous sinus infection from nearby facial sinuses)

The sagittal sinus and cavernous sinus are examples of what general type of structure?

Cerebral veins

What are the main risk factors for cerebral vein thrombosis?

Dehydration &

Prothrombotic disorders

(which are also called “thrombophilias”)

What is the most common presentation for a neonate with a cerebral vein thrombosis?

Seizure

What is the most common presentation for children with cerebral vein thrombosis?

Headache with nausea/vomiting

If you are worried about cerebral vein thrombosis, what will a screening head CT usually show?

Often nothing – contrast is usually needed to see the clot

What is the diagnostic test of choice to diagnose cerebral vein thrombosis?

MRI/MRA with contrast

How worried should you be about a patient who has a cerebral vein thrombosis?

Worried – 20 % bad M&M

(about 5 % mortality & 15 % with long term sequelae)

An adolescent female is diagnosed with optic neuritis on the board exam. What disorder do you suspect she has/will have?

Multiple sclerosis

(about 50 % of optic neuritis patients will develop MS)

Band-like sensory abnormalities, incoordination, oculomotor disturbance, and vision abnormalities are typical presenting symptoms for which disorder?

Multiple sclerosis

The best way to diagnose multiple sclerosis is ______?

Clinically!

It is the only way.

What is the basic clinical criterion for an MS diagnosis?

Deficits that vary in time and place (location within the brain)

What imaging test is often helpful in making a multiple sclerosis diagnosis?

MRI – looking for areas of demyelination

If you suspect MS, but the patient’s MRI is normal, does that rule-out the diagnosis?

No

If you’ve ordered an MRI on a patient with focal neurological abnormalities not consistent with MS, and the MRI report comes back with focal areas c/w MS, does that mean the patient has MS?

No – A small but significant proportion of the normal population has these “spots” on MRI

What lab test can be helpful to making an MS diagnosis?

CSF with high IgG or “oligoclonal bands”

It is rare to develop MS before what age?

10 years old

Traditional treatment for MS exacerbations relies mainly on what two medications?

Steroids & ACTH

What is the most common type of childhood seizure?

Generalized (60 %)

The buzzwords for the EEG appearance of a generalized seizure are ______ & _______?

Bilateral & synchronous

Do patients with generalized seizures typically have an aura before the seizure?

No – it would be better if they did, so they could go sit down!

Generalized seizures in very young children are often different in presentation from those of older children. How?

Usually tonic or clonic, rather than a mix of both

What is the deal with myoclonic seizures – is there a change of consciousness or not?

Depends on length of seizure – very brief ones don’t affect mental status. Long ones often do.

What is special about the relationship of myoclonic seizures to other seizure types?

Myoclonic sometimes occurs with absence or tonic-clonic seizures

Myoclonic seizures should classically have what characteristics?

Short episode of quick bilateral muscle contractions – may be one or multiple jerks involved

Do myoclonic seizures put the patient at risk for falls?

Yes

Patients with myoclonic seizure disorders are more likely than average to also have what sort of chronic diseases?

Neurodegenerative

Which seizure disorder runs in families, and is especially likely to appear with sleep deprivation or alcohol use?

Juvenile myoclonic epilepsy

A sudden loss of muscle tone, with loss of consciousness, sometimes preceded by one or two myoclonic jerks is what type of seizure disorder?

Atonic or akinetic seizure disorder (both names are used)

The common name for these is “drop attacks”

Which children are most likely to develop atonic seizures?

Static encephalopathy/Lennox-Gastaut syndrome kids

What is the treatment for akinetic seizures?

No good one

A patient of normal intelligence is presented who complains of bilateral jerking movements in the morning. Episodes began in the preteen years. What is the disorder?

Juvenile myoclonic epilepsy

In addition to bilateral involuntary jerking movements in the morning, the patient’s girlfriend told him that sometimes he has an all-out seizure in the morning. What disorder is that?

Still juvenile myoclonic epilepsy – some have generalized tonic-clonic morning seizures

Janz syndrome is the other name for which seizure disorder?

Juvenile myoclonic epilepsy (they both start with “J”)

What is the drug of choice for treating juvenile myoclonic epilepsy?

Valproate

What is the main worry in terms of serious side effects with using valproate?

1. Hepatotoxicity (especially in preschoolers)

2. Pancreatitis

What are the more common, but less worrisome, side effects of valproate?

(5)

Nausea or weight gain, hair loss, thrombocytopenia, sleepiness

Which antiseizure medication can be used with any of the common seizure types?

Valproate

Are absence seizures generalized or focal?

Generalized

How long does an absence seizure usually last?

A few seconds

(not more than 10)

Are there any movements that often accompany absence seizures?

No big movements – flickering eyelids are common, though!

What is the old (French) name for absence seizures?

Petit mal

How can you tell an absence seizure from a complex partial seizure?

Absence is:

Short (<10 s)

No aura

No postictal phase

Is it possible to induce an absence seizure in children who don’t normally have them?

Yes, with 3–4 min of hyperventilation

(even gives you classic EEG 3 cycles/second waves)

Is there a familial form of absence epilepsy, and if so, how is it inherited?

Yes – multifactorial

The children grow out of it in adolescence

What are simple partial seizures?

Seizures that affect only one area of the cortex – usually motor, but can be sensory or cognitive (e.g., hallucinations)

What is the most common type of simple partial seizure?

Motor

How long do simple partial seizures last?

Short – 10 to 20 s

Do you expect a postictal phase, or aura, with simple partial seizures?

No – neither

Complex partial seizures usually come from what part of the brain?

Limbic system

(names like amygdala, hippocampus, and “mesial” temporal lobe)

What is the most common specific anatomic abnormality seen in children with complex partial seizures?

Hippocampal sclerosis

Is a postictal phase expected with complex partial seizures?

Yes

What is the likelihood that a complex partial seizure patient will become seizure free on meds?

<1/3

What are the drugs of choice for complex partial seizures in pediatrics?

 (2 preferred, and 2 backup)

Carbamazepine & oxcarbazepine

Phenytoin & valproate are also appropriate first line agents, but the two above are generally preferred

(many antiseizure medication options, and combinations of medications, are possible)

Which type of seizure patient is most often a candidate for surgical intervention?

Complex partial

(due to poor control with meds)

Can someone have an “emotional” seizure?

Yes – complex partial temporal lobe seizures can consist mainly of an intense emotional experience

What is the other name for infantile spasms?

West syndrome

(Think of facing West to salaam, the position of an infantile spasm – Lennox-Gastaut comes later)

Infantile spasms typically occur in what age group?

Less than 12 months old, of course! (that’s why they call it infantile)

What does an infantile spasm look like?

The politically incorrect way to remember it is as a “salaam” attack – the child suddenly flexes head and trunk

How many spasms usually occur at a time?

Anywhere from several to hundreds

What is the eponymic name sometimes used for infantile spasm?

West syndrome

Is the DTaP vaccine related to the development of infantile spasms?

No

What is the most common treatment for infantile spasms?

ACTH

(vigabatrin is also used)

How successful is treatment for infantile spasms?

Not very good

What is the natural course of infantile spasms?

Spontaneously resolves by 5 years old, but the children develop severe intellectual disability & other seizure types develop (Lennox-Gastaut)

What defines Lennox-Gastaut syndrome?

(3 features)

• Severe & multiple types of seizures

• Intellectual disability

• Characteristic EEG

What is the characteristic EEG for Lennox-Gastaut patients?

Long runs of bilaterally synchronous sharp and slow-wave complexes – cycles at 2 per second

(commonly known as “atypical spike & wave pattern”)

What is the clinical presentation of a child with Lennox-Gastaut syndrome?

A mix of tonic, atonic, absence seizures, and tonic-clonic seizures – most children have two or more different seizure types each day

What is the drug of choice for Lennox-Gastaut syndrome?

There isn’t one – it is refractory to treatment

Older children with Lennox-Gastaut are more likely to have which seizure type?

Tonic-clonic

Will children outgrow Lennox-Gastaut?

No

With closed head trauma, what major risk factors make the child more likely to have a lasting seizure disorder?

Structural damage (cerebral contusion, hematoma, & penetrating head injury) or unconsciousness lasting >24 h