Pediatric Neurology
Domain focus
Pediatric Neurology tests seizures and status epilepticus, febrile seizures, headache red flags, meningitis, hypotonia and developmental regression.
Core rules
- A simple febrile seizure is generalised, lasts under 15 minutes and does not recur within 24 hours in a child aged 6 months to 5 years without CNS infection.
- Do not routinely give long-term antiseizure drugs, perform EEG or image the brain after a simple febrile seizure.
- Status epilepticus: give a benzodiazepine first-line, then a second benzodiazepine or a loading antiseizure drug according to protocol; check glucose and electrolytes.
- Headache red flags: morning vomiting, waking from sleep, focal signs, papilloedema, growth faltering or new seizures.
- Developmental regression always needs urgent evaluation.
Worked example
An 18-month-old has a generalised seizure lasting 2 minutes during fever. Afterwards he is alert, has no meningism and returns to baseline. This is a simple febrile seizure. Explain the benign prognosis, use antipyretics for comfort, and give safety advice. Do not order routine EEG, neuroimaging or phenobarbital.
Traps
Performing lumbar puncture in every febrile seizure; missing meningitis because postictal drowsiness is assumed; using long-term phenobarbital for simple febrile seizures; ignoring regression or a new focal deficit.