Nonfebrile Seizures Research Articles

Severe Toxocariasis in Children-Diagnostic Difficulties.

ABSTRACT: We present the case of an 18-month-old girl, from rural area, admitted to our clinic for fever and cough. The anamnestic data and the clinical and radiological examinations initially suggested the diagnosis of acute interstitial pneumonia. During hospitalization, she repeatedly presented exacerbations with acute respiratory failure, but without fever. Paraclinic examinations revealed anemia, leukocytosis, inflammatory tests with highly increased values, low values of serum iron and serum calcium, hyperproteinemia with hypergammaglobulinemia, the values of IgE and IgG being highly increased. Repeated pulmonary x-rays-peribronchovascular interstitial thickening, at the level of peri-and right infrahilar area. Medullary puncture-increased percentage of eosinophils in several stages of maturity, approximately 20%, normal values for the other medullary series, without atypical cells; the fingertip hemogram showed anemia, leukocytosis, eosinophilia. The diagnosis turned to a possible toxocariasis-atc anti toxocara canis=55.6 NTU. In the third week of hospitalization, the patient presented short crises of nonfebrile seizures. Normal CT and EEG brain. The child was discharged after 5 weeks, the diagnosis being severe toxocariasis with pulmonary and neurological manifestations; she was recommended an antiparasitary treatment and remained in our clinic's records.

Neuroimaging Evaluation for First Attack of Unprovoked Nonfebrile Seizure in Pediatrics: When to Order?

Objective: To assess the value of neuroimaging studies in evaluating pediatric patients presenting with a first attack of nonfebrile seizure. Method: We reviewed the medical records of pediatric patients aged 28 days to 12 years who were admitted between 1 January and 31 December 2013 with a first attack of unprovoked, afebrile seizure. These patients had undergone neuroimaging studies. The exclusion criterion was patients with known predisposing conditions for seizure. The computed tomography (CT) scan and magnetic resonance imaging (MRI) results were either normal or abnormal, and the abnormal ones were further classified into clinically insignificant or significant. Descriptive analysis was performed to summarize the data. Result: Fifty children were identified with a mean age of 5.2 ± 3.8 years. Of the 50 subjects, 29 (58.0%) were males and 21 (42.0%) were females. Sixteen patients (32.0%) had abnormal neuroimaging studies (CT scan, MRI or both); however, only 1 was considered to have a clinically significant abnormality, later diagnosed as Moyamoya disease. Conclusion: In this study, the neuroimaging studies were found not to be useful in evaluating pediatric patients presenting with a first attack of unprovoked, nonfebrile seizures.

Emergent diagnostic testing for pediatric nonfebrile seizures

BackgroundGuidelines from the American Academy of Neurology recommend laboratory studies or computed tomography (CT) for children who experience a nonfebrile seizure if anything in their history suggests a clinically significant abnormality. ObjectiveTo ascertain if any patient or seizure characteristics are associated with a greater likelihood that laboratory studies or CT scan will yield clinically significant results. MethodsThis retrospective case series reviewed 93 children with nonfebrile seizure, who were evaluated in an urban pediatric emergency department (ED) between July 2007 and June 2011. ResultsLaboratory studies were performed in 87% of the study group; 7% of those tests gave clinically significant results. Computed tomographic scans were obtained in 35% of our patients; 9% showed clinically significant findings. Presence of an active seizure in the ED or a first nonfebrile seizure had an 8% and 11% difference, respectively, for clinically significant laboratory abnormality. Children younger than 2 years showed a 7% difference of clinically significant laboratory abnormality. ConclusionThis study did not identify statistically significant predictors of laboratory or CT abnormalities for children with nonfebrile seizure presenting to the ED. Age less than 2years, having an active seizure in the ED, and experiencing a first-time seizure showed a trend toward an increased yield of laboratory testing. In accordance with the American Academy of Neurology guidelines, we conclude that the history of a child's present illness preceding the nonfebrile seizure, not characteristics of the seizure, should be used to determine the need for further testing.

Adult epilepsy and anaesthesia

Access the CPD MCQs for this issue online here ### Key points Epilepsy is a disorder of the brain characterized by a predisposition to generate abnormal synchronous neuronal activity. This results in recurrent and unpredictable interruptions of normal brain function, observed clinically as epileptic seizures.1 Epilepsy is common; 50 million people worldwide are affected and the estimated prevalence of active epilepsy [continuing seizures or the need for antiepileptic drug (AED) treatment] is 4–10 per 1000 people.2 Within the UK, ∼600 000 people have a diagnosis of epilepsy and take antiepileptic medication.3 All anaesthetists will regularly encounter patients with epilepsy in their practice and should be aware of the special considerations when managing patients with this disorder. Planned and thoughtful care of these patients can minimize the risk of seizure occurrence in the perioperative period. ### Diagnosis of epilepsy Epilepsy is conventionally diagnosed after two unprovoked seizures occurring at least 24 h apart. This reflects the fact that after two non-febrile seizures, more than 70% of people will have another seizure within 4 yr,4 whereas only 40–50% of people will go on to develop epilepsy after a single unprovoked seizure.5 The diagnosis of epilepsy depends on a convincing history, witnessed seizures, or both in combination with investigations including …

EEG characteristics predict subsequent epilepsy in children with their first unprovoked seizure

One of the most important risk factors for seizure recurrence is the electroencephalogram (EEG) characteristics of children with a first unprovoked seizure. However, the nature of the relationship between the risk factors for subsequent epilepsy and EEG characteristics, especially the localization of EEG paroxysmal abnormalities (PAs), remains unclear. The importance of EEG characteristics, especially the localizations of PAs, as predictors for subsequent epilepsy in children with a first unprovoked seizure was investigated. The participants were recruited from University of Yamanashi Hospital between July 1, 1997 and June 30, 2010 and followed until December 31, 2014. Eligible candidates were children between 1 month and 15 years old who presented with their first unprovoked non-febrile seizure. Awake and sleep EEGs were performed on a 12- or 16-channel machine 7–20 days after a first unprovoked seizure. Agreement regarding the presence of a PA was required for inclusion of the patient in the study. EEG PAs were classified based on the presence of spikes, sharp waves, or spike-wave complexes, whether focal or generalized, that were considered abnormal for age and state. All subjects were followed for more than 4 years. Of 87 subjects, 48 (55.2%) experienced recurrence. On the other hand, of 87 subjects, 52 (59.8%) showed an EEG PA. Of 18 patients with paroxysms in the frontal region, 17 (94.4%) developed epilepsy. Patients with frontal EEG paroxysms had a significantly higher risk of developing epilepsy than those with focal paroxysms in other regions of EEG foci (p<0.05). Moreover, compared with generalized EEG foci, the odds ratios for patients with frontal, RD, occipital, and mid-temporal EEG foci were 85.0 (95% CI: 4.5–1617.1), 9.3 (0.9–96.0), 2.5 (0.1–62.6), and 7.5 (0.5–122.7), respectively. Children with a first unprovoked seizure presenting with frontal paroxysmal EEG abnormalities may be at risk for the development of epilepsy later in life.

P42 – 2808: Neuroimaging evaluation of first afebrile seizures in pediatric age group – Qatar experience

Objective To determine the prevalence of Neuro Imaging abnormality in Children (1 month to 14 years) with first afebrile seizure. To collect evidence sufficient to make a recommendation for the use of routine neuro-imaging in children with first episode of non-febrile seizure. Methods We have reviewed charts of all children who have presented to the Pediatric Emergency Centers (PECs) in Qatar with their first afebrile seizure during 2012–2013 years. Labeling and definition of seizure was up to the international league against epilepsy (ILAE) booklet. From those we have found that 96 of them underwent neuroimaging either on urgent or non-urgent basis. Patient demographics and neuroimaging were reviewed in details thereafter. Results In our study neuroimaging abnormalities were found in (33%) of children presented with their first Afberile seizure. Around ¼ of patients (27%) were below 2 years of age, who have demonstrated significantly higher percentage of abnormal imaging (59%). This risk has showed decreased as children get older. In regard to seizure semiology abnormal results were detected in a higher rates in focal seizures compared to generalized ones (35% Vs 31%). Also interesting higher rates of having abnormal neuroimaging results were noticed in those with who presented with status epilepticus (58%) as compared to (25%) in patients with short seizures. Conclusion Neuro-imaging should be considered in any and child with first afebrile seizure with those with underlying risk factors and in area having high prevalence of NCC, tuberculosis and it is highly recommended in younger infants and those with focal or prolonged seizures. Change in medical management depending on neuroimaging finding may be required in about 6–8% of all case with first afebrile seizures.

Early Onset Benign Occipital Epilepsy (Panayiotopoulos syndrome): a case Report & Literature Review

Panayiotopoulos syndrome is a type of benign childhood epilepsy syndrome characterized by episodic autonomic and mainly emetic symptoms. It predominantly affects children of 3-6 years of age (13% of those with one or more non-febrile seizures). EEG shows great variability, with occipital, extra-occipital spikes or brief generalised discharges alone or in combination; it may also be consistently normal. Despite the high prevalence of autonomic status epilepticus, the prognosis of Panayiotopoulos syndrome is usually excellent and most do not require anti epileptic medications. Remission usually occurs within 1-2 years from onset. One third have a single seizure but 5-10% may have more than 10 seizures or a more prolonged course. We present a 5 year old boy with this condition, who presented with episodes of severe vomiting, deviation of eyes, focal seizure, altered sensorium, characteristic EEG in the form of multiple occipital spikes and normal neuroimaging studies.J. Natl Inst. Neurosci Bangladesh 2015;1(1):27-30

The incidence of unprovoked seizures and occurrence of neurodevelopmental comorbidities in children at the time of their first epileptic seizure and during the subsequent six months

To evaluate the incidence of unprovoked seizures in children and the prevalence of related neurodevelopmental comorbidities at the time of the presumed first seizure and six months thereafter. The medical records of all children (0-18 years of age) seeking medical attention as the result of a first unprovoked seizure between September 1, 2001 and December 31, 2006, and registered in the population-based Stockholm Incidence Registry of Epilepsy (SIRE) were reviewed. Neurodevelopmental comorbidities were evaluated on the basis of the medical records from this first visit and from other healthcare during the following six months. The incidence of unprovoked seizures was between 30 and 204/100,000 person years (n=766) in the different age groups. It was highest among the youngest children and lowest among the 18-year-olds with small gender differences. The most common neurodevelopment comorbidities were developmental delay (22%, CI: 19-25%), speech/language and learning difficulties (23%, CI: 20-26%) and intellectual disability (16%, CI: 13-18%). The types of neurodevelopmental comorbidity varied by age at the time of seizure onset, with cerebral palsy being more common among the 0-5-year-olds, attention deficits among the 6-16-year-olds, and autism and psychiatric diagnosis among the older children. An associated neurodevelopmental comorbidity was more common among those experiencing recurrent than single seizures during follow-up six months from the index seizure (42% versus 66%). In 68% (CI: 64-71%) of the children there was no known or suspected neurodevelopmental comorbidity. The incidence of unprovoked, non-febrile seizures among 0-18-year-olds included in the SIRE was 67/100,000 person-years. Neurodevelopmental comorbidities were common already at the time of onset of the seizure disorder, indicating that neither seizure treatment nor seizures were the underlying cause of other neurodevelopmental symptoms in these patients during the period studied.

Utility of obtaining a serum basic metabolic panel in the setting of a first-time nonfebrile seizure (P6.272)

Utility of obtaining a serum basic metabolic panel in the setting of a first-time nonfebrile seizure (P6.272)

The Charges for Seizures in the Pediatric Emergency Room: A Single Center Study

BackgroundThe direct charges for emergency department visits resulting from recurrent seizures are significant, and home intervention with abortive medications can be cost-saving. Over a 1-year period, we evaluated children with seizures who were seen in the emergency department, stabilized, and released. The information is necessary to assess the pharmacoeconomic advantages of at-home interventions for seizure emergencies. MethodsWe did a retrospective chart review of 90 patients and divided them into febrile versus nonfebrile seizures and existing versus new-onset seizure disorder. The hospital accounting department performed a charge analysis. Results and ConclusionThe total charges for all 90 patients treated for seizures in the emergency department were $219,945. The minimum was $370, for a patient with no history of febrile seizures. The maximum was $17,126, for a patient with a nonfebrile seizure and a history of seizures. This information allows a comparison with the cost of preventive medications, such as diazepam rectal gel or intranasal midazolam.

EEG Profile &amp; Yield in Evaluation of First Non-febrile Seizures in Children-First Observational Study in Qatar

Introduction: Seizures are among the most common neurological disorders in the pediatric age group. Up to 10% of children might experience at least one paroxysmal episode suggestive of seizure activity in their life. It is thought that 5% of all medical attendances to emergency department are related to seizures. Whether the first nonfebrile seizure is the kick start of long term epilepsy is always a question that physicians and families encounter. Ordering Electroencephalogram (EEG) for children with first non-febrile seizure is a subject of continuous debate. Objectives: To collect demographic background data for children (1 month to 14 years) who presented with the first non-febrile seizure, To determine the prevalence and pattern of EEG abnormalities in Children (1 month to 14 years) with first non-febrile seizure, and To collect possible evidence sufficient to make a recommendation for the use versus abandoning use of routine EEG in children with first episode of non-febrile seizure. Methods: In a retrospective single-center observational study around (400) children were admitted with first nonfebrile seizure to the Pediatric Emergency Centers (PECs) and their seizure were defined using the international league against epilepsy (ILAE) between January 2012 to December 2013 were studied. EEG was requested for 76 patients. Their EEG were reviewed and interpreted by pediatric neurology consultants. Patients’ demographic data and EEG records are then analysed. Results: Infants unexpectedly represented a small proportion of our cohort. Male gender predominance was noticed. No significant correlation could be found in EEG yield in regard to seizure type. Certain patterns of EEG abnormalities were observed. Conclusions: Epileptic seizure should be diagnosed clinically and EEG is just a helpful tool. Utility of EEG is debatable in childhood first non-febrile seizure. EEG is helpful but interpretation should be individualized. EEG alone is not very good predictors of seizure recurrence or overall prognosis. Larger scale studies with longer follow up are needed.

ACEP Clinical Policy Updated for New and Refractory Seizures

Up to 5% of individuals in the United States will experience a nonfebrile seizure during their lifetime. Yet, the accurate diagnosis of seizure can be challenging for emergency department (ED) physicians. This article discusses the American College of Emergency Physicians' 2014 update regarding the evaluation and management of adult patients presenting to the ED with seizures.

PGR-3 * Longitudinal Neuropsychological Decline in a Child with Focal Electrical Status Epilepticus of Sleep

Objective: Electrical status epilepticus of sleep (ESES) is a rare childhood epilepsy that is associated with a distinct neuropsychological regression. Typically, ESES consists of bi-hemispheric epileptiform activity, however, we present an 8-year old patient with focal right hemisphere ESES. Despite the unusual focal nature of the presentation, neuropsychological regression remained characteristic. Therefore, the current case extends limited knowledge. Method: Language milestones developed within normal limits while motor skills were delayed. The patient's first febrile seizures occurred at age four (9/2009 & 1/2010). Two non-febrile seizures were also reported (5/2011 & 2/2012). In 2010, EEG showed frequent occipital right hemisphere epileptiform discharges. Eight subsequent EEGs have documented progressively increased severity of right hemisphere spike and wave activity with current frontal maximal activity. The patient met diagnostic criteria for ESES in August of 2011. Neuroimaging is within normal limits. Historically, the patient's epileptiform activity has remained treatment resistant. Results: Intellectual functioning has declined over time (2010 WPPSI-3 FSIQ = 116; 2011 WISC-4 FSIQ = 103; 2012 WISC-4 FSIQ = 92; 2013 WASI-2 FSIQ = 85). Attention difficulty is the most prominent area of concern across assessments. Additionally, working memory, executive functioning, and processing speed indices are consistent areas of weakness. Across all evaluations, verbal and memory skills emerge as relative strengths although these also show a downward trajectory over time. Conclusions: There is evidence of clear normative neurocognitive declines over time. Generalized ESES is associated with overall disruption of cognitive functioning. Similarly, this patient has shown global cognitive decline, even within the context of focal right hemisphere ESES.

Pediatric first time non-febrile seizure with focal manifestations: Is emergent imaging indicated?

PurposeTo assess the prevalence of clinically urgent intra-cranial pathology among children who had imaging for a first episode of non-febrile seizure with focal manifestations. MethodsWe performed a cross sectional study of all children age 1 month to 18 years evaluated for first episode of non-febrile seizure with focal manifestations and having neuroimaging performed within 24h of presentation at a single pediatric ED between 1995 and 2012. We excluded intubated patients, those with known structural brain abnormality and trauma. A single neuro-radiologist reviewed all cranial computed tomography and/or magnetic resonance imaging performed. We defined clinically urgent intracranial pathology as any finding resulting in a change of initial patient management. We performed univariate analysis using χ2 analysis for categorical data and Mann–Whitney U test for continuous data. ResultsWe identified 319 patients having a median age of 4.6 years [IQR 1.8–9.4] of which 45% were female. Two hundred sixty-two children had a CT scan, 15 had an MR and 42 had both. Clinically urgent intra-cranial pathology was identified on imaging of 13 patients (4.1%; 95% CI: 2.2, 7.0). Infarction, hemorrhage and thrombosis were most common (9/13). Twelve of 13 were evident on CT scan. Persistent Todd's paresis and age ≤18 months were predictors of clinically urgent intracranial pathology. Absence of secondary generalization and multiple seizures on presentation were not predictive. ConclusionsFour percent of children imaged with first time, afebrile focal seizures have findings important to initial management. Children younger than ≤18 months are at increased risk.

Autism spectrum disorders and sleep disturbances in a pediatric patient

INTRODUCTION Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that often presents before the child enters the educational system and is characterized by developmental deficits with impairments in three main areas [1] personal, [2] social, and [3] academic or occupational functioning. The neurodevelopmental disorders represent a group of conditions with an onset early in the developmental period. Sleep disorders are commonly reported by parents of children with an ASD diagnosis with between 50% to 80% of parents reporting sleep problems with their children. Problems can be categorized into dyssomnias (problems falling and/or remaining asleep) and parasomnias (abnormal and/or unnatural movements, behaviors, emotions, perceptions, and dreams).

Taenia solium Cysticercosis: The Case of Cuba

Taenia solium Cysticercosis: The Case of Cuba

Nonfebrile Seizures after Mumps, Measles, Rubella, and Varicella-Zoster Virus Combination Vaccination with Detection of Measles Virus RNA in Serum, Throat, and Urine

We report the case of a child presenting with nonfebrile seizures 6 and 13 days after the first vaccination with a measles, mumps, rubella, and varicella (MMRV) combination vaccine. Measles virus RNA was detected in the patient's serum, throat, and urine. Genotyping revealed the Schwarz vaccine virus strain.

Standardizing Evaluation of First Time Nonfebrile Seizure in Children at Children's Hospital Boston Based on Evidenced Based Guidelines (P05.094)

Standardizing Evaluation of First Time Nonfebrile Seizure in Children at Children's Hospital Boston Based on Evidenced Based Guidelines (P05.094)

Evaluation of Oral Glucose Tolerance Test in Children With Epilepsy

Glucose metabolism of children with drug-resistant epilepsy, controlled by antiepileptic drugs epilepsy, and first-time nonfebrile seizures was studied through the performance of an oral glucose tolerance test and through insulin, C-peptide, and glycosylated hemoglobin measurements. In the refractory epilepsy group, there were more abnormal oral glucose tolerance test results (62.07%) in comparison to the controlled epilepsy group (25%) and the group of first-time seizures (21.21%). There was a significant difference between the group of refractory epilepsy and every other group concerning the abnormality of the oral glucose tolerance test (P < .05). The mean values of insulin, HbA1c, and C-peptide levels were normal for all groups. The results of the present study suggest that there is a distinction of refractory epilepsies from the drug-controlled ones and the first-induced seizures relating to their metabolic profile, regardless of the type of seizures.

Isolated febrile seizures are not associated with structural abnormalities of the limbic system

The nature of the relationship between childhood febrile seizures (CFSs) and temporal lobe epilepsy (TLE) remains unknown. The purpose of this study was to perform a comprehensive analysis of measures of structural changes of the hippocampus and limbic white matter to determine whether structural abnormalities previously demonstrated in TLE were present in adults with isolated CFS. Twenty-three adults with past CFS but no history of nonfebrile seizures and 21 controls underwent research MRI for measurement of volume, T2 and mean diffusivity of the hippocampus and fractional anisotropy of the fornix and cingulum. No significant group differences were found in any of the measured parameters. These findings suggest that structural abnormalities of the hippocampus and limbic white matter that have been demonstrated in TLE are not associated with isolated CFS.