Dr. Sagraves
Spring 1998
Dr. Sagraves
Spring 1998
Pediatric Neurology
TT is a 6-year-old boy who was noted by his teacher to be "daydreaming" during class, and at times he appeared to stare motionlessly. During the last grading period, TT's grades significantly declined.
After talking to his teacher, TT's parents decide to take him to a pediatrician who recommends hyperventilation and an EEG to help determine TT's problem.
Questions:
1. What appears to be TT's problem? (2 pts)
2. What signs and symptoms does TT have that helped you make your decision in question 1 above? (3 pts)
3. What is the purpose of having TT hyperventilate? How is it done? (2 pts)
4. Please develop a therapy plan for TT based on the diagnosis that you answered in question 1 above. (4 pts)
RM is a 2-year-old girl who is noted by her parents to have a brief, self-limiting seizure that lasted approximately 5 minutes (although to them it seemed to last much longer). After the child began recovering, her parents swiftly took her to University Hospital Emergency Department where she was seen by a pediatrician.
HPI: RM had one seizure that was to be a simple seizure that occurred after she developed fever. She had one dose of acetaminophen (? dose) one time before the seizure occurred.
PMH: Normal healthy child. She has been treated with amoxicillin for acute otitis media X 2 with the last episode being approximately 6 months prior to the seizure. RM was up-to-date (UTD) on her immunizations having received her most recent immunizations at age 18 months.
FH: No family history of seizures or neurologic problems
SH: RM lives with parents and older sister (age 6 yrs). Father and mother both work outside the home.
MH: No current medications except the one dose of acetaminophen mentioned previously. No known allergies.
Physical: Upon physical examination, RM was noted to be lethargic and had a temperature of 103o F (rectally) but did not appear to have a source of infection (ears, throat, lungs all appeared to be WNL). Her blood pressure, heart rate, and respiratory rate were WNL. The remainder of her physical examination was WNL.
Diagnosis: Simple febrile seizure
Questions:
1. What signs and symptoms does RM have that helped in making the diagnosis of simple febrile seizure? (3 pts)
2. Why was it important to learn RM's immunization history? (2 pts)
3. What should RM's parents be taught about trying to prevent a future febrile seizure? Be complete in your answer. (4 pts)
Answers
TT is a 6-year-old boy who was noted by his teacher to be "daydreaming" during class, and at times he appeared to stare motionlessly. During the last grading period, TT's grades significantly declined.
After talking to his teacher, TT's parents decide to take him to a pediatrician who recommends hyperventilation and an EEG to help determine TT's problem.
Questions:
1. What appears to be TT's problem? (2 pts)
• Typical absence seizures
2. What signs and symptoms does TT have that helped you make your decision in question 1 above? (3 pts)
• Daydreaming during class
• Appeared to stare motionlessly
• Grades significantly declined
3. What is the purpose of having TT hyperventilate? How is it done? (2 pts)
Hyperventilation may induce seizures so that the physician may observe or EEG can be performed for diagnosis. Breath into and out of a paper bag
4. Please develop a therapy plan for TT based on the diagnosis that you answered in question 1 above. (4 pts)
Accept either of the following:
• Ethosuximide: initially 15 - 20 mg/kg/day then may be increased to as much as 40 mg/ke/day, if needed
• Valproic acid: initially 10 - 15 mg/kg/day in 1 to 2 divided doses; may increase the dose by 5 - 10 mg/kg/day at 3 - 7 day increments. Usual maintenance doses are 30 - 60 mg/kg/day divided in 2 to 3 doses per day. Usual serum concentrations of 50 - 100 mcg/mL to be in the therapeutic range.
RM is a 2-year-old girl who is noted by her parents to have a brief, self-limiting seizure that lasted approximately 5 minutes (although to them it seemed to last much longer). After the child began recovering, her parents swiftly took her to University Hospital Emergency Department where she was seen by a pediatrician.
HPI: RM had one seizure that was to be a simple seizure that occurred after she developed fever. She had one dose of acetaminophen (? dose) one time before the seizure occurred.
PMH: Normal healthy child. She has been treated with amoxicillin for acute otitis media X 2 with the last episode being approximately 6 months prior to the seizure. RM was up-to-date (UTD) on her immunizations having received her most recent immunizations at age 18 months.
FH: No family history of seizures or neurologic problems
SH: RM lives with parents and older sister (age 6 yrs). Father and mother both work outside the home.
MH: No current medications except the one dose of acetaminophen mentioned previously. No known allergies.
Physical: Upon physical examination, RM was noted to be lethargic and had a temperature of 103o F (rectally) but did not appear to have a source of infection (ears, throat, lungs all appeared to be WNL). Her blood pressure, heart rate, and respiratory rate were WNL. The remainder of her physical examination was WNL.
Diagnosis: Simple febrile seizure
Questions:
1. What signs and symptoms does RM have that helped in making the diagnosis of simple febrile seizure? (3 pts)
• brief, self-limiting seizure that lasted approximately 5 minutes
• presence of fever
• no signs of infection
2. Why was it important to learn RM's immunization history? (2 pts)
• Immunizations such as pertussis whole cell vaccine may be associated with seizures
• Anytime there is an interaction of a child with the medical system, need to check to see if the child is up-to-date or immunizations
3. What should RM's parents be taught about trying to prevent a future febrile seizure? Be complete in your answer. (4 pts)
No need for prophylaxis
Control fever by the following:
• Remove excess clothing and blankets, decrease room temperature
• Administer an antipyretic such as acetaminophen (10 - 15 mg/kg/dose given every 4 - 6 hrs as needed for fever not to exceed 5 doses within 24 hrs) or ibuprofen (5 - 10 mg/kg/dose given every 6 - 8 hrs; maximum 40 mg/kg/day)
• Tepid sponge baths – after administering an antipyretic, use tepid water to decrease the temperature. Administer the antipyretic before sponging
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