Pediatric Neurology
This domain tests febrile and epileptic seizures, status epilepticus, headache red flags, and the recognition of neuromuscular disease.
Seizures
- Simple febrile seizure: 6 months to 5 years, generalised, under 15 minutes, once in 24 hours, in a neurologically normal child. Reassure the family; no routine EEG, imaging or long-term antiepileptic drug is indicated.
- Complex febrile seizure: focal, over 15 minutes, or recurrent within 24 hours; investigate further.
- Absence epilepsy: brief staring spells, 3 Hz spike-and-wave, treated with ethosuximide.
- Infantile spasms (West syndrome): flexion spasms, hypsarrhythmia, treated with ACTH or vigabatrin.
Status epilepticus
Give a benzodiazepine first (intravenous lorazepam 0.1 mg/kg, or buccal or intramuscular midazolam), then a second-line agent such as levetiracetam, fosphenytoin or valproate, then move to anaesthesia. Always check glucose at the outset.
Headache red flags
Headache waking the child at night or on waking with vomiting, focal deficits, onset under 6 years, or a change in established headache pattern warrant imaging.
Neuromuscular and other disorders
- Guillain-Barre syndrome: ascending symmetrical weakness with areflexia and albuminocytological dissociation; treat with IVIG.
- Juvenile myasthenia: fatigable ptosis and diplopia.
- Cerebral palsy is a non-progressive motor disorder; the key is that it does not regress.
- Neural tube defects are prevented by 400 micrograms of folic acid before conception.
Worked example
A 3-year-old has a focal seizure lasting 20 minutes with fever. Reasoning: this is a complex febrile seizure because it is focal and prolonged. Assess for meningitis, consider EEG and MRI, and do not start long-term antiepileptic therapy.
Traps
Treating simple febrile seizures with maintenance antiepileptic drugs; omitting a glucose check in status epilepticus; and imaging every headache without red flags.