Many a migraine headache is encountered in the ED. The evidence is reasonably clear that the antiemetics (prochlorperazine/metoclopramide - Compazine/Reglan) combined with ketorolac (Toradol) will treat >90% of patients effectively. What about those that don't respond and are still in (dramatic pause) status migrainosus. The intravenous dose is 15-20 mg/kg IV (max of 1 gram). It turns out that a [...]
No, this edition of Briefs was not an excuse to use a tongue twister as the title. It is however viral season. An viruses can cause (through some undetermined mechanism) a condition called acute cerebellar ataxia which generally occurs in children less than 5 years of age. It manifests in a wobble (or per the parents "drunk") gait. Dysmetria, nystagmus and [...]
If you missed 'em, here are all of the posts from the recent febrile seizure series. Part 1 Seize the day! Why do kids have febrile seizures? Part 2 K.I.S.S. (Keep it simple seizure) What is the difference between simple & complex febrile seizures? Part 3 Again, and again, and again Recurrence risk Part 4 (Long-term) Risky Business Risk of epilepsy and serious neurologic [...]
Finally, let's look at treatment. Which need to be treated with anti-epileptics? Most don't. Rectal diazepam can be used if they last greater than 5 minutes. You may want to consider prescribing it for children with recurrent febrile seizures. Parents should be instructed on how to use it at home. It is true that phenobarb, depakote or diazepam can prevent [...]
When should you perform an LP? The short answer - not often. Kimia et al studied patients with first simple febrile seizures and noted that no patients out of their 704 had meningitis - even those with elevated CSF wbc counts. Interestingly this study also chronicled changes in practice. The LP rate declined greatly during the course of the study. Kimia et al [...]
Moving right along, let us take a look at risk of recurrence and subsequent epilepsy. What is the longterm prognosis/risk of epilepsy? The short answer - great/low. Nelson et al in the NEJM noted that the risk of epilepsy at age after at least one febrile seizure was 2%. This is a 100% increase over the baseline prevalence - which is 1%. [...]
This is one of the main questions that parents have - namely, what are the chances that this will happen again? If a child has one, what is the risk of recurrence? One seizure: 1 in 3 (33%) chance of another 2+ seizures in separate events: 1 in 2 (50%) chance of having more In a prospective cohort Berg et [...]
Moving on, let's keep things "simple" lest we risk making them too "complex." What makes a febrile seizure simple? Simple 6 months to 5 years of age Generalized (no focal findings) Less than 15 minutes Single episode Neurologically normal child on exam/history with normal development on history Fever (and seizure) is not caused by meningitis, encephalitis, or other CNS illness/process [...]
Febrile seizures seem to be all the rage. You've been seeing a lot recently, and several questions keep cropping up. This is the first in a series attempting to answer these questions. What better way to start than at the start... Why do they happen? The short answer is "who knows?" There are several theories however. It is felt that [...]
A reasonably terrified mom brings her 17 month old boy into the ED after an apparent seizure. She states that her older daughter took a piece of candy away from the toddler, and then her son started to cry, and then "turned blue" and fell to the ground. He had not eaten any candy yet, and did not appear to be [...]
