1. Approach to
child with
abnormal
movement

2. Quick review of thetypesof convulsion

12. PERSONAL H/O
age
*infantile spasm 3m-8m,rare after 2 years,
*absence seizures 5-10 years ,rare before 2 years,
*febrile convulsions 6m-6years.
 sex
)absence seizures more in girls(.
 Address to know the distance.
HISTORY 

13. Pseudosiezures:
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14. H/O present illness Ictal , Preictal , Postictal.
Analysis of abnormal movement
Describe this movement,
 How does it begin,
 Is it focal or generalized,
 How much it last,
 Is it the first time or not,
 Is it associated with:
loss of consciousness ,up rolling of eye ,cyanosis,
secretions from mouth, head tilting, twitching of face ,
arching of spine, tongue bite, passage of urine or stool
during the attack.

15. the pre-attack state of child ,is it perceded by:
fever & how much it was if measured by mother
)thinkof CNS infection orfebrile convulsion “if within
suggested age”(
 Physical or emotional stress like excessive crying BHA
orangerSA.
 Loud noisy sounds or strong flashes of light
 Sleepy or just awake from sleep
 possible Drugs (TCA, sympathomimitics, amphetamine(
or toxin ingestion.
 Recent vaccinations
 Trauma : describe trauma & assess its severity

16. thepost-attack stateof thechild
1-Was the attack followed by:
-Deep sleep
-Coma
-Weakness or paralysis of limbs
&how much each of those persist
2-how was the attack finished:
spontaneously or with medications?

17. Systemic review
In systemic review try to roll out:
*-Infection of CNS or any other system
*-hi ICP :vomiting, (headache & blurred vision in
older children(.
*-Dehydration & electrolyte imbalance:
Suggested by h/o severe diarrhea or vomitting.

18. Birth H/O “Must be taken in detail”
ANH: chronic illness (DM , HTN, PE ( , any bleeding:
suggest Ischemic-hypoxic ecephalopathy.
Exposure to radiation or ingestion of teratogenic drugs
( as a cause of congenital cerebral malformations(
Natal H/O : prolonged or precipitate labour ,abnormal
presentation, cord around the neck; (as cause of
birth asphyxia(.
Maturity (premature more risk of IVH , post mature
risk of MAS(.

19. Post natal H/O
-Birth weight (LBW IVH( , cried immediately or not.
-Discharged on the same day or stayed in NN ICU.
-Any postnatal admission , h/o jaundice ( assess
whether it was significant or not , e.g. when
appeared, disappeared, how treated?...(

20. Immunization h/o : if the attack preceded by
vaccination.
Developmental h/o:
How old is child now & what can he do?
Was the child well & then regress in development
(think of neurodegenerative disorders(
Presence of any neurological abnormality exclude
febrile convulsions.

21. Past H/O:
*Ask whether this is the first attack or not, if not:
Describe the previous attacks , how treated ,and
what was the diagnosis?
*Any previous admissions to hospital
*Any significant illness:
-Cerebral palsy: risky to develop seizures
-Renal failure: presented with seizures due to
hypocalcaemia, hyponatremia
-DM : complicated by hypoglycemia

22. Family H/O
1-Of similar attacks, what was diagnosis (febrile
convulsion usually have positive family
H/O(
2-Of epilepsy
3-of consanguinity ( may suggest inherited
metabolic disorders(

23. 1-General examination
*Level of consciousness (GCS(
*Vital signs & search for any obvious focus of infection.
*Bulged AF in infant , papilledema in older children may
suggest ICP.
*In older children ,check signs of meningeal irritation.
*Examine skin for stigmata of neuro-cutaneous
disorders( café aulait spots, hypopigmented areas
,hemangioma(
2-Complete neurological examination to make
sure of normal CNS.
3-Developmental assessment
EXAMIANTION

24. *CBC
*Blood glucose
*Septic work-up:
(Blood culture,urine culture, LP, CXR, throat swab(.
*Serum electrolytes( Na ,Mg ,Ca(
*Toxicology screen ( if drug overdose suspected( or
metabolic screen
*CT,MRI : if ho trauma or suspect rise ICP.
*EEG may play a role.
INVESTIGATION

25. Initial treatment:
A-Maintain airway patent , Put child in semi
-prone position with head down to help
drainage of secretions.
B-Adequate breathing : O2 mask
C-Circulation : iv drip , normal saline & dextrose
D-Drugs : diazepam ,phenytoin ,phenobarbitone
Treatment of the cause accordingly.
Treatment

27.  ‫طاهر‬ ‫فخري‬ ‫فاطمة‬11 months old,
female Libyan patient, lives in Benghazi
(‫(الليثي‬ , blood group is A+ve , and the
history is taken from her mother.
 She’s admitted on Friday 23th of may
2008 , at 5 pm,
 Complaining of high fever and abnormal
movement for 2 days before the
admission.

28.  Fever was high grade, measuring up to 40°C ,
starting from 2 weeks back as a symptom of
gastroenteritis.
She had supportive and symptomatic treatment, but
fever didn’t relieve completely.
Not associated with sweating , skin rash, chills or
rigors.
No h/o any ill person of the family.
Panadol and cold sponging was used to decrease the
temperature. With no increasing factors.

29. Regarding the abnormal movement:
 The 1st
attack was on Friday before dawn at
2:30 am. Which persist for 15 minutes.
The mouth was cyanosed, and jerky movement
of upper and lower limbs with loss of
consciousness.
Post ictally, Fatima was sleepy and fatigue.

30.  No thing abnormal by examination.

31. Investigation done:
 CBC:
Hb 9.9 gm/dl
RBC 3800*10³
WBC 12.8*10³
MCV 86 fl
MCH 26 fl

32.  Blood glucose 77
 Blood urea 17
 S. creatinine 0.5
 Na 135
 Ca 1.14

33.  Lumber puncture: ( normal result )
CSF glucose 67 mg
CSF protein 19 mg
No RBCs or WBCs.

34.  X-ray hand is done.
 And Fatima was putted on convulsion chart.

35.  Next 2 days :
No other attacks had been happened.
Mother is advised to notice any rising in
temperature of her daughter.
And discharged!!!!!.

37.  ‫مسعود‬ ‫أشرف‬ ‫أحمد‬4 years old Libyan patient,
lives in Benghazi. History is taken from his
mother.
 Admitted to the hospital on Thursday,
12nd of June 2008 because of an
abnormal limb movements 2 days before
the admission.

38.  No thing abnormal on examination,
 Also no thing abnormal by investigation .

39.  So what’s the plan