Nursing

May 2016 Pediatric Clips Pediatric Nursing Pediatric Clips by Pediatric Elizabeth Medaugh, MSN, CPNP-PC , Pediatric Nurse Practitioner,

Advanced Practice Sophia had been exceeding down to sleep, mother heard a Nurses at Dayton Case Study the expectations of school. thump and went to check on her. Her teachers report her being Sophia’s eyes were wide open Children’s provides Sophia is a 7 year old Caucasian focused the first two quarters, and deviated left, left arm was quick reviews of female who presented to her but have found her attention to stiffened with rhythmic shaking, be somewhat off over the last Sophia’s mouth was described common pediatric primary care physician with concerns of incontinence few weeks. Teachers have asked as “sort of twisted” and Sophia conditions. in sleep. Sophia is an parents if Sophia has been was drooling. The event lasted otherwise healthy child, with getting good rest as she has 90 seconds. Following, Sophia uncomplicated birth history, been falling asleep in class. was disoriented and very sleepy. Father reports his sister Dayton Children’s appropriate developmental Sophia’s mother and father had similar events as a child. progression with regards note that she has had is the region’s Sophia’s neurological exam to early milestones, and several episodes of urinary was normal, therefore her pediatric referral previously diurnal/nocturnally incontinence each week over pediatrician made a referral toilet trained. No report of the last 3-4 weeks. Parents center for a to pediatric neurology. Given recent illness, infection or ill have limited fluids prior to bed Sophia’s presentation, what 20-county area. exposures. Sophia has had without improvement in the differential diagnoses would no polyuria, polydipsia or frequency of events. One night As the only facility one have for Sophia? change in her eating habits; her shortly after Sophia had laid in the region weight is at the 50th% for age. with a full-time What is BECTS? have only in sleep, commitment to Case Discussion however 15% will have seizures BECTS, also known as benign while awake and 15% while both pediatrics, Dayton rolandic epilepsy, is an epileptic Given Sophia’s history, the awake and asleep (Fenichel, syndrome with onset between Children’s offers pediatric neurologist followed 2009). 3 and 13 years of age and peak up by performing an EEG a wide range of incidence at 7-8 years of age. It Typically presentation (electroencephalogram). High is often genetically transmitted with BECTs wakes the child from services in general voltage interictal (defined as an autosomal dominant trait sleep. There may be associated as time between attacks or pediatrics as well as (Fenichel, 2009). Frequently, paresthesias or numbness around ) right and bilateral children diagnosed with BECTS the mouth as well as ipsilateral in 35 subspecialty centrotemporal spikes were have a close relative with history “mouth twisted” twitching of noted during drowsiness and areas for infants, of febrile seizures or epilepsy. the face, mouth and pharynx sleep. These interictal spikes Without medication therapy, resulting in drooling and inability children and teens. suggest potential for epilepsy ~10% of patients with BECTS to speak. Consciousness is often which is focal in nature. The We welcome your will have only one seizure in preserved. Daytime seizures pediatric neurologist started their lifetime, 70% have isolated typically do not generalize, inquiries about Sophia on oxcarbazepine infrequent seizures and 20% will however nocturnal seizures (Trileptal) 150 mg twice daily services available – have frequent seizure activity may spread to limb movements given presenting history and EEG (Fenichel, 2009). Typically or even a generalized tonic call 937-641-3666 findings consistent with Benign seizures associated with BECTs clonic seizure presentation. Epilepsy with Centrotemporal or email marketing @ spontaneously stop following Most of these type seizures will Spikes (BECTS). Since the start puberty. While termed benign, self-resolve within 1-2 minutes. childrensdayton.org. of medication, parents have not these seizures can appear scary Children with BECTs may be appreciated any seizure like and threatening to parents as well at greater risk for cognitive or activity and Sophia has had as the child experiencing them. behavioral problems, centered no further episodes of urinary With anti-epileptic medication, primarily around focus, reading incontinence in sleep. Sophia’s 20% of children with BECTs will and language processing teachers feel her attention and have isolated seizures and 6 % difficulty. Therefore, it is performance has returned to childrensdayton.org will have frequent seizures. The important following diagnosis normal. majority of patients with BECTS to monitor school function (Fenichel, 2009).

All Rights Reserved. Rights All

©2016 Dayton Children’s Hospital Children’s Dayton ©2016 Nonprofit Organization U.S. Postage Paid Permit Number 323 Dayton, Ohio

Dayton Children’s Hospital One Children’s Plaza

Dayton, Ohio 45404-1815

syndrome. syndrome.

migraine and Tourette’s Tourette’s and migraine

pediatric epilepsy, epilepsy, pediatric

since 2013 with focus in in focus with 2013 since

department as a CPNP CPNP a as department

worked in the neurology neurology the in worked

primary care. Elizabeth has has Elizabeth care. primary

concentration in pediatric pediatric in concentration

Science and Nursing with with Nursing and Science

receiving her Masters in in Masters her receiving

Wright State University, University, State Wright

attended Elizabeth

further her career, career, her further

for 7 years. Wanting to to Wanting years. 7 for

determination can be made based based made be can determination

the first unprovoked seizure, seizure, unprovoked first the working as a staff nurse nurse staff a as working

parts of the involved. This This involved. brain the of parts (Fenichel, 2009). Following Following 2009). (Fenichel, Three-East on home

generalized depending on the the on depending generalized and sensory phenomenon phenomenon sensory and a found Elizabeth

classified as complex partial or or partial complex as classified graduation, Upon and may involve motor, psychic psychic motor, involve may and

department. surgical et. Al, 2014). Seizures may be be may Seizures 2014). Al, et. Seizures are sudden and transient transient and sudden are Seizures

the in extern nurse a as an epilepsy syndrome (Fisher (Fisher syndrome epilepsy an alter level of consciousness. consciousness. of level alter

52 (6), 1052-1057. (6), 52 Epilepsia

working graduation, to

risk of ~60% 3.) diagnosis of of diagnosis 3.) ~60% of risk that may or may not impair or or impair not may or may that

classification of epilepsy. epilepsy. of classification prior Children’s Dayton

similar to the general recurrence recurrence general the to similar

leading to clinical manifestations manifestations clinical to leading

started her career at at career her started Shorvan, S.D. (2011). The etiologic etiologic The (2011). S.D. Shorvan,

probability of further seizures seizures further of probability of neurons in the gray matter matter gray the in neurons of

Kentucky in 2006. She She 2006. in Kentucky

2.) one unprovoked seizure and and seizure unprovoked one 2.) excessive, rapid discharges discharges rapid excessive,

More College in Northern Northern in College More

occurring at least 24 hours apart apart hours 24 least at occurring Seizures are defined as a sudden, sudden, a as defined are Seizures

and Nursing from Thomas Thomas from Nursing and

55(4), 475-482. 55(4), Epilepsia epilepsy.

two or more unprovoked seizures seizures unprovoked more or two

her Bachelor’s in Science Science in Bachelor’s her

Epilepsy Discussion Epilepsy

practical clinical diagnosis of of diagnosis clinical practical

epilepsy in terms of 1.) at least least at 1.) of terms in epilepsy

years. Elizabeth received received Elizabeth years.

Fisher, R.S. et al. (2014). A A (2014). al. et R.S. Fisher,

Against Epilepsy has defined defined has Epilepsy Against

Children’s Hospital for 10 10 for Hospital Children’s

The International League League International The 2009). (Fenichel, lesion been employed at Dayton Dayton at employed been

MSN, CPNP-PC CPNP-PC MSN, has has

complex partial form of epilepsy. epilepsy. of form partial complex or abnormality structural

edition). Saunders/Elsevier. edition).

Elizabeth Medaugh, Medaugh, Elizabeth presentation, is classified as a a as classified is presentation, brain is indicated to rule out out rule to indicated is brain

and symptoms approach (sixth (sixth approach symptoms and

was discussed in the above case case above the in discussed was the of imaging) resonance

pediatric neurology: A signs signs A neurology: pediatric

(Shovron, 2011). BECTs, which which BECTs, 2011). (Shovron, (magnetic MRI an therapy

Fenichel, G. (2009). Clinical Clinical (2009). G. Fenichel,

and electroencephalogram electroencephalogram and medication with controlling

Resources: Resources: and observation through video video through observation and difficulty or Paralysis, Todd’s

careful attention to history history to attention careful seizure, of duration prolonged

based upon presentation, presentation, upon based including features atypical are

having. having. made by pediatric neurologist neurologist pediatric by made there if however neuroimaging,

the type of seizures he/she is is he/she seizures of type the of an epilepsy syndrome may be be may syndrome epilepsy an of require not do history family

Specialist

is tailored to the individual and and individual the to tailored is unprovoked seizures, diagnosis diagnosis seizures, unprovoked and findings phalogram

Featured Featured

EEG findings. Medication therapy therapy Medication findings. EEG 76%. When there are two or more more or two are there When 76%. electroence- centrotemporal

upon clinical presentation and and presentation clinical upon recurrence risk ranges from 27- from ranges risk recurrence typical with Children