Child With Seizures - Pediatric Oncall

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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	Specialist Answers
Question
A 6 month old male presented with 2 months history of seizures. He was thoroughly investigated with neuroimaging (MRI) which was normal. Biochemical parameters (rbs, calcium, magnesium,potassium,chlorides) repeatedly normal,EEG was normal done twice during inter ictal period. The boy was born of a cesarean section with normal apgar. Had one episode of seizure on 4th day of life which was due to hypoglycemia since the mother was known to be diabetic and was on insulin since the second trimester. The boy had an uneventful recovery following treatment with glucose at that time and was apparently normal for 4 months with normal growth and milestones. Phenytoin was started at 7mg/kg dose and was increased to 10mg/kg/day because of recurrent episodes of seizures. Has seizures every 10-15 days which are serial seizures and is being admitted into NICU for phenytoin loading dose which he received thrice till now in the span of 2 months. Then phenobarbitone at 5mg/kg has been started after the recent serial seizures which occurred on phenytoin 10mg/kg. Seizures are generalized with loss of consciousness. Never had a status epilepticus. Occurs even during sleep and also during activity. General examination is unremarkable. All systems are normal.
Answer
He requires a Video EEG to determine the type of seizure and Na Valproate would be a good option in such cases. Metabolic workup in form of Urinary aminoacidogram, plasma aminoacidogram would be useful. Rule out pyridoxine deficiency. Back to All Questions

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