Dr. Lalit R. Bansal
Neurology
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Patient's Query
Hi doctor,
My daughter is 2 years 8 months old. We observed high temperature yesterday night. She vomited and after cleaning her mouth we gave 5 mL Panadol. Thereafter, she has lay down on bed and after roughly 15 minutes of her sleep we observed a strange physical movement and that lasted approximately 5 to 10 minutes with the following typical observations. Her arms began to twitch, no noise or liquid from her mouth and eyes are not rolling as usual. We immediately rushed to hospital. The laboratory data showed temperature 101.3 degrees Fahrenheit. Initial blood test results were WBC count 27230 cells per cubic mm, polymorphs 82%, procalcitonin 0.8 ng/mL. In chest X-ray there are some right mid zone opacities seen. She stayed there as an inpatient for three days with liquid (Nacl 0.45% and Dextrose 5%) and antibiotics. Except procalcitonin all above values are dropped. Procalcitonin increased to 8.5 in between and on final discharge day it was 2 ng/mL. She had EEG test and the 16 channel sedated pediatric record channel done according to the 10:20 system of electrode placement, which is attached for your reference. She was prescribed with the following medications. Augmentin 228 mg/5 mL - 70 mL suspension in powder form, Mucosolvan, Biogaia probiotic drops, Vitane liquid 200 mL, Nebulizer (Combivent 2.5 ml and Pulmicort 0.25 mg/mL) and Depakene 200 mg/mL.My concerns are can it be classified as a typical febrile convulsions with the present EEG report? Though the physical symptoms and a family run that is myself and her father had some sort of shivering in childhood observations show it as a normal febrile convulsions. Does a typical febrile convulsion cause any harm? With my limited knowledge and web reading, it never causes harm and also no medicine can stop the re-occurrence. But, still I am worried. What is the benefit of Depakene oral solution? Shall my daughter stop taking Depakene medicine? Please clear my doubts.
Hi,
Welcome to icliniq.com.
I have read your query thoroughly, seen the reports (attachment removed to protect patient identity) and understood your concern.
1. With your history, it sounds like a typical febrile seizure. It is atypical if seizure last for more than 15 minutes or occurs more than 24 hour of onset of fever or multiple seizures.
2. EEG (electroencephalogram) does show continuous slowing over right posterior quadrant, but I would be hesitant to call it as slow sharps by just looking at these pictures.
3. I would need to review the raw data for more details. Regardless, you would need a repeat EEG in two to three weeks to make sure if this slowing persists and if any abnormal activity is present at that time.
4. Kids with febrile seizure mostly develop normally. Since there is strong family history, she likely had a febrile seizure rather than an underlying seizure disorder with an episode during febrile illness.
5. Regarding treatment, there are multiple approaches. One can use daily medicines (like Depakene - Valproate sodium) or one can opt to use medicine like Clonazepam only during periods of illness to prevent seizure episodes. If she gets a seizure without underlying illness or fever, then go back on daily medicine.
6. You can discuss this option of intermittent medicine (Clonazepam or Clobazam) used during periods of illness with your treating physician.
Patient's Query
Thank you doctor,
Is the cause for seizure clear from earlier attached EEG report? Whether due to disorders or illness with fever. If not repeating EEG can clarify that? What does the slowing in EEG implies on my daughter's condition in a way a common man can understand? I will definitely discuss on intermittent medicine.
Hi,
Welcome back to icliniq.com.
1. Slowing on EEG means, brain function in that region is slow.
2. Repeating EEG in two to three weeks tells if brain function in that region has returned to normal or remains to be slow.
3. EEG does not tell if seizure is due to fever or anything else. It just tells if there is a risk for future seizures.
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