import json

data = {
 "topic": "Seizures",
 "slug": "seizures",
 "category_id": 15681,
 "summary": "Seizures are transient neurologic events from abnormal, excessive, synchronous cortical neuronal discharge, classified as generalized or focal, provoked or unprovoked, and managed acutely with benzodiazepines first-line followed by phenobarbital or phenytoin for seizures that persist.",
 "written_by": "claude-sonnet",
 "references": [
  {"title": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub", "author": None, "pages": []},
  {"title": "Netters Pediatrics (Florin Т., Ludwig St.)", "author": None, "pages": [85, 489, 490]},
  {"title": "Pediatric Decision-Making Strategies", "author": "Pomeranz, Albert J.", "pages": [204]},
  {"title": "Pediatric Dentistry: Infancy through Adolescence - Arthur J. Nowak, John R. Christensen, Tad R. Mabry, Janice A. Townsend, Martha H. Wells - 6th Edition (2018) 656 pp., ISBN: 978-0-323-60826-8", "author": "Arthur J. Nowak, John R. Christensen, Tad R. Mabry, Janice A. Townsend, Martha H. Wells", "pages": [192]},
  {"title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024", "author": None, "pages": [2188]},
  {"title": "Cover", "author": "Vitalsource Download", "pages": [8495]},
  {"title": "MedStudy Pediatrics Core 11th Edition 2024-2025", "author": None, "pages": [456]},
  {"title": "Update in Pediatrics", "author": None, "pages": [564]}
 ],
 "short": [
  {"title": "In short", "content": (
   "- A seizure is a transient, involuntary alteration of consciousness, behavior, motor activity, sensation, and/or autonomic function caused by excessive, hypersynchronous discharge of a group of cerebral (mostly cortical) neurons; a convulsion specifically denotes a seizure with prominent motor activity\n"
   "- About 3-6% of children will have at least one seizure in the first 16 years of life; many pediatric seizures are associated with fever\n"
   "- Epilepsy is a condition of susceptibility to recurrent, unprovoked seizures; it is the most common serious neurologic condition worldwide (about 50 million people), with US prevalence around 1% and incidence peaks in early childhood and in adults over 65\n"
   "- Seizures can be provoked (trauma, infection, hemorrhage, metabolic abnormality, drug exposure) or unprovoked (no identifiable/reversible trigger); the immature brain is more seizure-prone than the adult brain but pediatric seizures are also more likely to remit as the child grows\n"
   "- Generalized seizures involve both hemispheres from onset, with no warning, symmetrical and bilaterally synchronous EEG discharge, and loss of consciousness if lasting more than about 3 seconds; subtypes include absence, myoclonic, tonic, clonic, atonic, and tonic-clonic\n"
   "- Absence seizures (formerly petit mal): brief lapses in awareness (10-20 seconds), no aura, amnesia for the event, abrupt onset/offset (often mid-activity or mid-conversation), staring/behavioral arrest with possible eyelid flickering or mouth automatisms, and NO postictal period; can be precipitated by hyperventilation; atypical absence seizures can additionally show brief limb/eyelid jerks, transient tone change, pupillary dilation, skin color change, and tachycardia\n"
   "- Generalized tonic-clonic seizures have 4 phases: prodrome (subtle changes over minutes-hours, often not clinically evident), aura (a stereotyped pre-seizure sensation specific to the seizure focus - taste, smell, hallucination, motor activity), the tonic-clonic ictal phase (rigid tonic phase with apnea/cyanosis, followed by rhythmic clonic contractions), and the postictal phase\n"
   "- Broad seizure etiologies include infectious (meningitis, encephalitis, brain abscess, febrile), metabolic (hypoglycemia, hyponatremia, hypocalcemia, hypomagnesemia, hyperosmolarity, hypoxia, inborn errors, pyridoxine deficiency, uremia), toxicologic (subtherapeutic anticonvulsant level, withdrawal, many specific toxins/drugs including lead, isoniazid, TCAs, organophosphates), vascular, traumatic, oncologic, endocrine, and congenital causes\n"
   "- A well-appearing, fully immunized child aged 6-12 months with a simple febrile seizure does NOT routinely need a lumbar puncture given extremely low bacterial meningitis risk; LP should be considered an option if the child received antibiotics before the seizure or has unknown/deficient immunization status (particularly for Hib and pneumococcus)\n"
   "- Status epilepticus is classically defined as continuous seizure activity for 30+ minutes or repetitive seizures without return to baseline consciousness, but many authorities now treat seizures lasting more than 5 minutes (or multiple seizures without return to baseline) as early status epilepticus warranting aggressive treatment; benzodiazepines are first-line (diazepam 0.4 mg/kg IV or rectal, or lorazepam 0.1 mg/kg IV/IO, repeatable once if seizure persists 5 minutes after the first dose, but not combining benzodiazepines due to respiratory depression risk); for persistent seizures, phenobarbital (15-20 mg/kg slow IV push) or phenytoin (18 mg/kg diluted in 100 mL normal saline, infused over 20 minutes) are standard next-line agents; routine labs and acute neuroimaging are unnecessary for most children with a first-time seizure"
  )}
 ],
 "long": [
  {"title": "Definition", "content": (
   "A seizure is a transient, involuntary alteration of consciousness, behavior, motor activity, sensation, and/or autonomic function resulting from an excessive rate and hypersynchrony of electrical discharges from a group of cerebral neurons, primarily within the cortex. A convulsion refers specifically to a seizure with prominent alterations of motor activity. Epilepsy (seizure disorder) is a condition of susceptibility to recurrent, unprovoked seizures. Seizures are classified as provoked (triggered by an identifiable cause such as trauma, infection, hemorrhage, a metabolic abnormality, or drug exposure) or unprovoked (no identifiable or reversible trigger)."
  )},
  {"title": "Epidemiology", "content": (
   "Approximately 3-6% of children will experience at least one seizure during the first 16 years of life, and many of these are associated with fever. Epilepsy affects an estimated 50 million people worldwide, making it the most common serious neurologic condition; US prevalence is approximately 1%, with incidence showing peaks in early childhood and again in adults older than 65. Children with epilepsy are at higher risk for learning disorders and behavior problems. The immature brain, particularly in neonates and young infants, differs from the adult brain in its basic mechanisms of epileptogenesis and seizure propagation - it is more prone to seizures, but seizures are also more likely to remit as the child matures."
  )},
  {"title": "Etiology", "content": (
   "Seizure etiologies span multiple categories. Infectious causes include brain abscess, encephalitis, meningitis, CNS parasitic infection, syphilis, and nonspecific febrile seizures. Metabolic causes include hyperosmolarity, hypocalcemia, hypoglycemia, hypomagnesemia, hyponatremia, hypoxia, inborn errors of metabolism, pyridoxine deficiency, and uremia. Toxicologic causes include subtherapeutic anticonvulsant levels, withdrawal (alcohol, hypnotics), and a wide range of specific toxins and drugs - anticonvulsants themselves, camphor, carbon monoxide, cocaine, heavy metals (lead), hypoglycemic agents, isoniazid, lithium, methylxanthines, organophosphate pesticides, phencyclidine, sympathomimetics, tricyclic antidepressants, and topical anesthetics. Other categories include degenerative cerebral disease, hypoxic-ischemic injury, hepatic failure, vascular causes (cerebrovascular accident, hypertensive encephalopathy), oncologic causes (primary or metastatic brain tumor), endocrine causes (Addison disease, hyper-/hypothyroidism), obstetric causes (eclampsia), and traumatic causes (cerebral contusion, diffuse axonal injury, intracranial hemorrhage), as well as congenital anomalies. By presumed mechanism, seizures are further categorized as symptomatic (secondary to a known cause), idiopathic (presumed genetic), or cryptogenic (presumed symptomatic but with an unidentified underlying abnormality)."
  )},
  {"title": "Clinical features", "content": (
   "Generalized seizures reflect involvement of both cerebral hemispheres from onset, occur without warning, are symmetrical, and show bilaterally synchronous discharge on EEG; consciousness is impaired if the event lasts more than about 3 seconds, and this impairment may be the first noticeable sign. Generalized seizure subtypes include absence (petit mal), myoclonic, tonic, clonic, atonic, and tonic-clonic (grand mal) seizures. Absence seizures are characterized by extremely brief lapses in awareness (10-20 seconds), no aura, amnesia during the episode, abrupt onset and termination (often interrupting mid-conversation or mid-activity), staring with behavioral arrest (sometimes with eyelid flickering, eye rolling, or mouth automatisms), no postictal period, and can be precipitated by hyperventilation; atypical absence seizures can additionally show brief jerks of the eyelids and limbs, transient changes in postural tone, pupillary dilation, skin color changes, and tachycardia. Myoclonic seizures present as brief, often repetitive jerking movements of the limbs, neck, or trunk (distinct from benign nonepileptic myoclonus seen physiologically with hiccoughs or in stage II sleep). Tonic seizures show a generalized increase in muscle tone. A classic generalized tonic-clonic seizure progresses through four phases: a prodromal phase (subtle changes over minutes to hours, often not clinically evident), an aura (a stereotyped sensory experience specific to the seizure's cortical origin - a taste, smell, hallucination, or motor sensation - occurring immediately before the seizure and typically consistent from episode to episode for a given patient), the ictal (convulsive) phase, in which a rigid tonic phase with apnea and cyanosis is followed by rhythmic clonic muscle contractions, and a postictal phase."
  )},
  {"title": "Diagnostics", "content": (
   "Routine laboratory studies and acute neuroimaging are unnecessary for the majority of children presenting with a first-time seizure. For a well-appearing, fully immunized infant aged 6-12 months who has had a simple febrile seizure, lumbar puncture is not routinely recommended given the extremely low risk of bacterial meningitis in this population. However, LP should be considered an option when the child has received antibiotics (by any route) in the days preceding the seizure, or has unknown or deficient immunization status - particularly for Hib and pneumococcal vaccines, since most outcome data on febrile seizures come from highly immunized populations and the risk profile in undervaccinated or antibiotic-pretreated children is less well established."
  )},
  {"title": "Treatment", "content": (
   "Most childhood seizures are brief, lasting less than 5 minutes, and resolve spontaneously. Status epilepticus was classically defined as continuous seizure activity for 30 minutes or longer, or repetitive seizures between which the patient does not regain consciousness; many authorities now consider seizures lasting longer than 5 minutes, or multiple seizures without return to baseline, to constitute early status epilepticus warranting aggressive treatment to minimize neurologic damage. Initial management focuses on supportive care, timely seizure termination with antiepileptic drugs, and identification of any treatable underlying cause. Benzodiazepines are first-line therapy: diazepam 0.4 mg/kg can be given IV or per rectum, or lorazepam 0.1 mg/kg IV or intraosseously; either dose can be repeated once if the seizure has not stopped within 5 minutes of the initial dose, but different benzodiazepines should not be combined given the risk of respiratory depression. For seizures that persist despite benzodiazepines, phenobarbital (15-20 mg/kg by slow IV push) or phenytoin (18 mg/kg diluted in 100 mL normal saline, infused over 20 minutes) are the standard next-line agents; phenytoin may be preferred in some settings. This same general approach (first benzodiazepines, then phenobarbital/phenytoin) is described specifically for seizures related to severe malaria - which occur in up to 70% of children with severe malaria, with subclinical seizures in an additional 15-20% - underscoring that even when a specific provoking illness is identified, hypoglycemia and fever should also be evaluated for and treated as contributing factors."
  )}
 ],
 "clinical": [
  {"title": "Approach at the bedside", "content": (
   "For any child presenting after a seizure, first classify the event: was it generalized or focal, provoked (identifiable trigger) or unprovoked, and did it show the abrupt-onset/no-postictal-period pattern of absence seizure or the prodrome-aura-ictal-postictal sequence of a tonic-clonic seizure. For a well-appearing, fully immunized 6-12 month old with a simple febrile seizure, do not routinely perform a lumbar puncture; reserve it as an option specifically when the child received antibiotics before the seizure or has an unknown/deficient immunization history (especially for Hib and pneumococcus). For most children with a first-time seizure who are back to baseline, avoid routine labs and neuroimaging unless the history or exam suggests a specific secondary cause (trauma, toxin exposure, focal deficits, signs of infection).\n\nIf a seizure is ongoing, treat any seizure lasting more than about 5 minutes as early status epilepticus and act quickly rather than waiting for the classic 30-minute threshold: give a benzodiazepine first (diazepam 0.4 mg/kg IV or rectal, or lorazepam 0.1 mg/kg IV/IO), and repeat once if the seizure persists 5 minutes after the first dose - but do not combine different benzodiazepines given the additive respiratory depression risk. If seizures continue despite two benzodiazepine doses, move to phenobarbital (15-20 mg/kg slow IV push) or phenytoin (18 mg/kg in 100 mL normal saline over 20 minutes) as second-line therapy. Throughout, actively screen for and correct reversible contributors - check a bedside glucose, consider electrolyte derangements (sodium, calcium, magnesium), and ask about medication nonadherence (subtherapeutic anticonvulsant level) or toxin/drug exposure - since these can both explain the seizure and change immediate management independent of the antiepileptic drugs given."
  )}
 ]
}

with open("/tmp/seizures.article.json", "w") as f:
    json.dump(data, f, indent=1)
print("written")