Nursing May 2016 Pediatric Clips Pediatric Nursing Pediatric Epilepsy Clips by Pediatric Elizabeth Medaugh, MSN, CPNP-PC , Pediatric Nurse Practitioner, Neurology 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 seizures 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 seizure 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 convulsions) 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). Children with typical recurrence risk ranges from 27- upon clinical presentation and centrotemporal electroence- 76%. When there are two or more EEG findings. Medication therapy phalogram findings and unprovoked seizures, diagnosis is tailored to the individual and Featured family history do not require of an epilepsy syndrome may be the type of seizures he/she is Specialist neuroimaging, however if there made by pediatric neurologist having. are atypical features including based upon presentation, prolonged duration of seizure, careful attention to history Todd’s Paralysis, or difficulty and observation through video Resources: controlling with medication and electroencephalogram Fenichel, G. (2009). Clinical therapy an MRI (magnetic (Shovron, 2011). BECTs, which pediatric neurology: A signs resonance imaging) of the was discussed in the above case and symptoms approach (sixth brain is indicated to rule out presentation, is classified as a edition). Saunders/Elsevier. Elizabeth Medaugh, structural abnormality or complex partial form of epilepsy. MSN, CPNP-PC has lesion (Fenichel, 2009). The International League been employed at Dayton Children’s Hospital for 10 Against Epilepsy has defined Fisher, R.S. et al. (2014). A epilepsy in terms of 1.) at least years. Elizabeth received Epilepsy Discussion practical clinical diagnosis of her Bachelor’s in Science two or more unprovoked seizures epilepsy. Epilepsia 55(4), 475-482. Seizures are defined as a sudden, occurring at least 24 hours apart and Nursing from Thomas excessive, rapid discharges 2.) one unprovoked seizure and More College in Northern Kentucky in 2006. She of neurons in the gray matter probability of further seizures Shorvan, S.D. (2011). The etiologic started her career at leading to clinical manifestations similar to the general recurrence classification of epilepsy. Dayton Children’s prior that may or may not impair or risk of ~60% 3.) diagnosis of Epilepsia 52 (6), 1052-1057. to graduation, working alter level of consciousness. an epilepsy syndrome (Fisher as a nurse extern in the Seizures are sudden and transient et. Al, 2014). Seizures may be surgical department. and may involve motor, psychic classified as complex partial or Upon graduation, and sensory phenomenon generalized depending on the Elizabeth found a (Fenichel, 2009). Following parts of the brain involved. This home on Three-East the first unprovoked seizure, determination can be made based working as a staff nurse for 7 years. Wanting to further her career, Elizabeth attended Wright State University, receiving her Masters in Science and Nursing with concentration in pediatric primary care. Elizabeth has worked in the neurology department as a CPNP since 2013 with focus in pediatric epilepsy, migraine and Tourette’s syndrome. 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