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Eight-year old child brought by mum to present test results requested in connection to abnormal body movements.
The onset dates to two weeks prior to this consultation when child had generalized tonic-clonic movements with no sphincter release. Mum quickly took the child to a clinic where temperature recorded was 37.2 degrees and a number of work-ups were done. FBC showed mild neutropenia. Thick Blood smear, Urine dipstick were all negative. The child was treated for 3 days for malaria with injectable Atresunate, after which oral relay was given for 3 days with no other symptoms. About two days later, mum brought child to our health structure, where an electroencephalogram (EEG) was requested. EEG was only done the following day after the child experienced another episode of convulsion with no fever perceived. The mother, two days later, brings back the child with EEG results for the present consultation.

Past Personal History reveals no previous history of convulsions. Child was treated for atopic condition by Ear, Nose and Throat specialist with corticosteroids and 2nd generation antihistaminic started one day prior to convulsion. History of febrile convulsions in her elder sister.

Physical examination was unremarkable except for some very brief abnormal eye movements (nystagmus). EEG results revealed spike waves starting from the frontal lobe.

STOP, READ OVER AND DIAGNOSE….

Our Diagnosis was Epilepsy of new onset. We ruled out febrile convulsions given the age and no clear history of fever. Infectious origins were also ruled out in the absence of fever and other symptoms. Seizures seemed generalized so with a neuropediatric opinion, the girl was placed on sodium valproate 10mg/kg daily for first 3 days, then 20mg/kg for the next 3 days, then 30mg/kg thereafter. A consultation with a neuro pediatrician was booked for later.

Presented by Dr. P.O

Key Points:

*Two unprovoked seizures were enough for the diagnosis.

*The first treatment in clinic was not indicated but rather delayed management, could give room for progression of brain damage.

Question: How could we tag/classify the nystagmus observed..?

Feel free to add, discuss and share.

4 responses to “Tonic-clonic seizures in a male child with no fever or other symptom 🤔”

  1. Leonard NGARKA avatar

    There is no mention on what was done about the mild neutropenia. It could be due to an infection, poor quality lab results or just normal for the patient . It would be good to do a control FBC

    1. admin avatar

      Thanks very much Dr. A control FBC was requested. The results had not yet been collected at the time the case was written.

  2. Kenn Chi Ndi avatar

    Thanks for the interesting case. Its true your EEG has shed some light. But I’ll like us to dig more into infectious causes for learning purposes. We don’t know for how long she has been on steroids and at what dose. Steroids are known to mask fever. Also, what’s her HIV status? HIV patients can have CNS affections without fever, especially given you mentioned she has a mild neutropenia. This raises a question to whether she is immunocompromised.

    1. Ayuketah Pearl avatar

      Thanks very much Dr. I’m sure others would share their views on this.
      She had been on steroids for less than 24 hours before the first convulsion and the drug was stopped immediately after that. The doses were given as in a case of mild atopy. Her current HIV status was not known, just mum’s negative antenatal status. Patient was seen already with results of the above tests, but sure, probing should go deeper.

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Tonic-clonic seizures in a male child with no fever or other symptom 🤔