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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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 [...]
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? [...]
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 [...]