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Pediatric Neurology Cases

Pediatric Neurology Cases . Case 3 . The Child with a Seizure. Salient Points:. R.R., 5 yrs old, male brought to the ER because of convulsions. 1 day pta, had colds and mild fever

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Pediatric Neurology Cases

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  1. Pediatric Neurology Cases Case 3 . The Child with a Seizure

  2. Salient Points: • R.R., 5 yrs old, male brought to the ER because of convulsions. • 1 day pta, had colds and mild fever • Few hours later. On waking up, had twitchings of the left face followed by clonic movements of the hand and left leg for 2 min. • After the episode he was awake with headache and dizziness.

  3. Salient Points: Past History: (-) trauma; at 2 yrs old , had febrile convulsions (2 x) (Dx. Benign febrile seizures, acute tonsillopharyngitis) (+) febrile seizures – sibling 2 months ago – he was diagnosed to have Primary TB and given anti Koch medications

  4. Examination on admission: P.E. • Temp=37.6’C; RR= 35/min; CR = 94/min Weight = 42 lbs • Congested posterior pharyngeal wall • Heart and Lungs unremarkable • No hepatosplenomegaly

  5. Neuro Exam • Awake, alert, active, playful • No cranial deficits • DTR= ++; No pathological reflexes • (-) Kernigs, (-) Brudzinski

  6. Is there a neurologic disease? • The description of event appears to be a seizure. • Seizures refer to excessive neuronal discharge with change in motor activity or behavior. • Seizures may be due to non-neurologic causes as: metabolic disorders, electrolyte imbalance, hypoglycemia, hypoxia, fever, systemic infections, toxins, drug-related.

  7. Seizure Types: • Partial seizures Simple partial-(as seen in this patient) Jacksonian seizure Complex Partial seizures- behavioral manifestations, with impairment of consciousness.

  8. Seizure types • Generalized seizures Tonic Clonic Gran mal (tonic clonic) Myoclonic Absence Atonic • Unclassified seizures

  9. Is there a neurologic disease? • Neurologic causes of seizures include: 1. Tumors 2. CNS malformation 3. Vascular disorders 4. Idiopathic epilepsy

  10. What is the neurologic disease? In this patient, the seizures are ushered in by fever and respiratory infection. • Benign Febrile Seizures should be ruled out. • The typical benign FS is characterized by: 1. Grand mal lasting for <15 min 2. Occurring once in the same illness 3. Age incidence: 3 months to 5 years 4. Occurs at temperature 380 C and above 5. Normal neurological examination 6. Family history (+) for FS 7. CNS infection absent

  11. Is this a simple febrile seizure? Although the patient was previously diagnosed to have simple febrile seizure, the present episode does not appear to be BFC. 1st -Seizures happened at a very low temperature. (37.6’C); 2nd – focal seizures

  12. Is it a Complex febrile seizure? • Complex febrile seizures are febrile seizures which are atypical. They may occur more than once in an illness, a focal seizure, more than15 minutes • May need investigation to rule out epilepsy.

  13. Is this Epilepsy? • Epilepsy is defined as recurrent unprovoked seizures. • No fever nor any provoking factors as electrolyte imbalance, hypoglycemia, anoxia • A small percentage of patients with simple febrile seizures may later develop epilepsy.

  14. Diagnostic possibilities: • A seizure disorder is considered in the absence of a provoking factor. • A CNS infection should always be ruled out especially with a history of mild fever. The P.E. however did not show any meningeal signs.

  15. Where is the lesion? • The presence of seizures tell us that the cerebral cortex is affected. • The focal seizures over the left suggests a lesion over the right. • The absence of abnormal neuro findings make it difficult to pinpoint specific area. • Lesion must be on the right cerebral hemisphere.

  16. What is the lesion? • The acute course should make us consider: infectious vascular trauma paroxysmal

  17. Diagnostic Approach • An electroencephalogram is indicated. Epileptiform patterns may be seen over the right hemisphere. A normal EEG does not rule out a seizure disorder. • If the EEG is abnormal, a cranial CT scan or MRI may be done to rule out structural causes. • Seizure disorders with no clear cause, and negative tests are labeled idiopathic.

  18. Therapeutic Approach • The first episode of afebrile seizure may not need any anticonvulsant drugs. • Commonly used drugs in epilepsy are: Phenobarbital Phenytoin Valproic Acid Carbamazepine Oxcarbazepine Topiramate

  19. Prognosis • Depends on the etiology of the seizures. • Benign epileptic syndromes as the Rolandic seizures are of good prognosis. • Seizures from inherited metabolic disorders and degenerative diseases are usually intractable.

  20. Good Morning !

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