Unexplained Seizures Research Articles

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Medicolegal Problems in the Management of Cardiac Arrhythmias in Children

Malpractice actions against pediatricians treating patients with arrhythmias have been recurrent in four general areas. Optimal medical management may not be widely recognized. Cases illustrating the following concepts are presented. Intravenous verapamil therapy in babies may cause apnea, hypotension, and bradycardia; continued episodes of atrial flutter in a child may cause sudden death; quinidine may be related to the death; children with "familial seizure disorders" may in fact have the long QT interval syndrome. The QT interval must be measured on the ECG in patients with unexplained seizures; "supraventricular tachycardia with aberration" is uncommon in children. Rapid heart rates with QRS complexes that are different from the sinus complexes are likely to be ventricular tachycardia. These situations must be recognized as potential problems and must be treated appropriately.

Absence of the Septum Pellucidum

A patient with absence of the septum pellucidum, optic hypoplasia, congenital nystagmus, hemiatrophy, and seizures fulfilled clinical and radiological criteria for diagnosis of both septo-optic dysplasia and the syndrome of absent septum pellucidum with porencephalies. The anatomical and clinical similarities between these two syndromes suggest a common embryological basis. Their simultaneous presence in this case further supports this explanation. Clinically mild forms of both septo-optic dysplasia and the syndrome of absent septum pellucidum with porencephalies are now detected with the aid of computed tomographic scanning in patients with unexplained hemiatrophy, congenital nystagmus, seizures, and short stature.

Incidence and Prognosis of Seizures in Infants After Cardiac Surgery With Profound Hypothermia and Circulatory Arrest

Fifteen of 165 infants and young children who underwent surgical correction of congenital cardiac defects using profound hypothermic and circulatory arrest experienced generalized or focal seizures postoperatively. The cause of the seizures was unexplained in ten. Among these ten, the onset of seizures was 25 to 48 hours after surgery. With appropriate treatment, all had complete seizure control by the third postoperative day. During 11 to 54 months (mean, 35.6 months) of follow-up, no further seizures occurred and none had neurological abnormalities. Long-term anticonvulsant therapy was not required for any of the children. There was no correlation between the type of cardiac abnormality (cyanotic v acyanotic) or the duration of hypothermic circulatory arrest and the development of seizures. Unexplained seizures following cardiac surgery with hypothermia and circulatory arrest are not a sign of permanent brain damage and do not detract from the use of this technique for early definitive repair of congenital heart defects.

Incidence and prognosis of seizures in infants after cardiac surgery with profound hypothermia and circulatory arrest

Fifteen of 165 infants and young children who underwent surgical correction of congenital cardiac defects using profound hypothermic and circulatory arrest experienced generalized or focal seizures postoperatively. The cause of the seizures was unexplained in ten. Among these ten, the onset of seizures was 25 to 48 hours after surgery. With appropriate treatment, all had complete seizure control by the third postoperative day. During 11 to 54 months (mean, 35.6 months) of follow-up, no further seizures occurred and none had neurological abnormalities. Long-term anticonvulsant therapy was not required for any of the children. There was no correlation between the type of cardiac abnormality (cyanotic<i>v</i>acyanotic) or the duration of hypothermic circulatory arrest and the development of seizures. Unexplained seizures following cardiac surgery with hypothermia and circulatory arrest are not a sign of permanent brain damage and do not detract from the use of this technique for early definitive repair of congenital heart defects. (<i>JAMA</i>1984;252:3165-3167)

Seizures and Dermatitis After Exposure to Caprolactam

A 22-year-old man was initially seen with dermatitis, fever, and seizures after three days of occupational exposure to caprolactam, a nylon fiber precursor. A comprehensive neurological investigation showed no organic CNS abnormalities. Although caprolactam has been shown to induce convulsive disorders in experimental animals, to our knowledge, there are no reports of caprolactam-induced seizures in man. The coincidence of typical skin lesions with otherwise unexplained grand mal seizures in this strongly suggests that caprolactam was the cause.

Gross hematuria in a child with tuberous sclerosis complex

Tuberous sclerosis is an under diagnosed autosomal dominant neurocutaneous syndrome characterized by the presence of benign congenital tumors in multiple organs expression and a prevalence of 1/6,000-1/12000 newborns. There are varying degrees of renal involvement in tuberous sclerosis complex, which is usually bilateral and asymptomatic. We report a case of Tuberous sclerosis with left sided renal angiomyolipoma and bilateral multiple renal cysts in a 12-year-old boy, who presented with massive hematuria warranting blood transfusion and urosepsis. There was past medical history of repeated seizures. This case highlights the need for a high index of suspicion in a child with un-explained skin lesions, recurrent seizures, mental retardation and symptoms referable to the urinary system.

Convulsive seizures in infants with pyridoxine-deficient diet.

In the fall of 1951, four young infants with hyperirritability and recurrent seizures were admitted to the pediatric department of the Saint Joseph's Hospital. Extensive clinical and laboratory evaluations were made, including complete blood cell counts, urinalysis, blood urea nitrogen, electrolyte determinations, glucose tolerance test, x-ray survey, phenylpyruvic acid test, spinal tap, and electroencephalogram. All laboratory procedures on each patient were within normal limits. During their hospital stay, all of the infants clinically improved, with rapid decrease of their hyperirritability and cessation of their seizures. Without benefit of medication, all have remained free from seizure throughout the succeeding two years. The appearance of this small group of unexplained seizures prompted a review of the cases, with the revelation of one pertinent observation. From birth each infant had been fed on liquid SMA formula, which consists principally of defatted cow's milk, vegetable and animal fats, and vitamins, plus iron. Furthermore, the