12 YEARS OLD CHILD CAME WITH HISTORY OF SEIZURE , NOT WELL EXPLAINED BY ATTENDANTS BUT WHAT I CAUGHT, NATURE WAS GENERALISED TONIC NOT CLONIC WITH UPROLLING OF EYEBALLS , SIMILAR EPISODE IN PAST TWO TIMES, EVER TIME NOT EXCEEDING FIVE MINUTES NO HISTORY OF EPILEPSY IN FAMILY NO FEVER NO FOCAL NEUROLOGICAL DEFICIT ON EXAMINATION NO HISTORY OF CONSTIPATION DEVELOPMENT HISTORY NAD PERINATAL HISTORY NAD OPHTHALMOLOGIST OPINION NAD FUNDUS EEG NAD MRI BRAIN ATTACHED PVL ? HIE I HAD TALKED TO RADIOLOGIST I WAS KEEN TO SEARCH METABOLIC CAUSE OF SUCH FINDINGS OR WHITE MATTER DISEASE BECAUSE MOTHER WAS NOT GIVING HISTORY OF PERINATAL ASSAULT BUT RADIOLOGIST SAID BASAL GANGLIA INVOLVEMENT IS MUCH MORE IN KRABEE LIKE DISEASES HOW TO FURTHER APPROACH,SHOULD WE START ANTIEPILEPTIC TSH PTH REPORTS AWAITING ATTACHED MY PRESCRIPTION TOO@Dr. Manish Verma @Dr. Minol Amin @Dr. Sree Harsha @Dr. Brahmananda Merugu @Dr. Saumya Mittal @Dr. Mohd Izhar Jaweed @Dr. Ahemad Karim

2 Likes

LikeAnswersShare

GTC Seizures (unlikely petit mal as written in proscription slip). Plz start AED, valproate or tegretol. The cause probably post NN ashaxia with HIE( many times mothers not informed ). Opinion of epileptologist is worth taking

I TOLD ATTENDANTS FOR A VIDEO TOO,PERSONALLY I WAS HESITATING TO START AED , CLONIC NATURE OF SEIZURES WERE NOT GIVEN IN HISTORY FROM MOTHER SO I MENTIONED PROVISIONALLY PETIT ,AND ? Seizures, mother is sure about no perinatal ASPHYXIATION,SO do you think should we investigate for white matter disease before starting of AED
0

Unprovoked seizure 3rd episode Description favour more of epileptic seizure, video of attack would help better. About MRI not sure but opacification seen in basal ganglia complex. Late onset Krabbe and ALD is dd here. Radiologist opinion would guide better. Also seek for development history. If third episode then I think AED should be started if reliable history is there.

If no h/o definitive hypoxia then PVL may be d/t intrapartum hypoxia or hypoperfusion or perinatal infection.
1

View 1 other reply

3 rd episode a febrile seizure EEG normal HIE to manifest at 12 years less likely I am not an expert at MRI reading sir but grossly looks normal Think of seizure mimicking disorder/assess school, home situations

Agreed Dr sree ,I was too HESITATING to start AED ,
0

View 4 other replies

If it's hie sequelae development of child would have been affected . It's wise to start the child on anticonvulsants as further seizure episodes will further put the child at risk of hypoxic injury to brain.

3rd Episode of SEIZURE DISORDER. Age 12 year S. When is the 1st episode of SEIZURE at what age ? TONIC TYPE OF SEIZURES. EACH SEIZURE LASTING FOR 5 Minutes. * MILESTONES HISTORY IS MANDATORY & IMPORTANT. * COGNITIVE FUNCTIONS. * IN A SEIZURE DISORDER "EEG" STILL CAN BE NORMAL. MRI REPORT NEEDS RADIOLOGIST OPINION. *FOR THE DX OF SEIZURE DISORDER WHAT IS IMPORTANT IS WITNESING OF THE SEIZURE. * SEIZURE DISORDER DIAGNOSTIC TEST CAN BE STILL NORMAL. WHAT I FEEL IS IF IT'S A METABOLIC SEIZURE DISORDER, IT WOULD HAVE MANIFESTED AT EARLIER AGE, NOT AT 12 YEAR. STILL BSL, & SERUM CALCIUM, SERUM ELECTROLYTES, & ECG ARE MANDATORY. RX : DEFINENTLY NEEDS AED'S. FOLLOW UP THE CASE FOR PROPER DX.

FIRST EPISODE 10 months back As I told DEVELOPMENT absolutely normal all aspects gross social RADIOLOGIST reports suggest of PVL HYPOXIC INJURY ELECTROLYTE NORMAL EEG NAD
0

View 1 other reply

I think in this case we need not bother about MRI ,EEG or blood reports ,we are justified in starting AED preferably valproate, or we can wait also because EEG MRI not grossly abnormal and no neurodeficit and no status , but three episodes in a short span we can start because there is very chance of fourth episode

Start antiepileptics

Any unprovoked seizure must b treated Start valproate n evaluate further most of seizure is idiopathic if no GDD.

PVL in this boy is very mild and nonprogressive though it might be a predisposing factor for seizure episodes. Antiepileptics definitely indicated. Most likely JME.

Dear Dr Ashok sir, If PVL then prognosis is bad. Need to have NEUROLOGIST OPINION. Better to Start AED'S. NEEDS GENETIC COUNSELLING & EVALUATION.

Thanks Dr merugu
0

View 1 other reply

Load more answers

Diseases Related to Discussion