Pediatric Neurology
Domain focus
Pediatric neurology tests febrile and afebrile seizures, status epilepticus, headache red flags, developmental delay, and disorders such as infantile spasms.
Core rules
- Simple febrile seizure: age 6 months–5 years, generalized, <15 minutes, once in 24 hours. Routine EEG, neuroimaging, and lumbar puncture are not indicated if the child is well and has no meningeal signs.
- Complex febrile seizure: focal, >15 minutes, or recurrent within 24 hours; evaluate causes and consider EEG.
- Status epilepticus: benzodiazepine first-lorazepam IV or midazolam IM/buccal-then a second-line antiseizure medication.
- Infantile spasms: clusters of flexor/extensor spasms at 3–8 months with hypsarrhythmia; urgent EEG and treatment (ACTH or vigabatrin).
- Headache red flags: morning vomiting, worsening with Valsalva, papilledema, focal deficits, or new seizures.
Worked example
A 2-year-old has a 2-minute generalized seizure with fever. He is now alert, has a normal exam, and has no meningeal signs. Reasoning: this is a simple febrile seizure. Treat fever, counsel parents, and follow up. Do not start daily antiseizure medication or order routine imaging. If he had a focal seizure lasting 20 minutes, he would need emergency management and a broader evaluation.
Traps
- Missing meningitis because the seizure was attributed to fever.
- Treating a simple febrile seizure with long-term anticonvulsants.
- Dismissing infantile spasms as “startle” or colic.