Patient's question:
At the age of 4 months, my son was diagnosed with infantile spasms. He was treated with ACTH and took Depakine. Within 3 days, his symptoms disappeared, and after 2 years, his EEG was normal. He took Depakine for 7 years, and under the guidance of his doctor, he gradually reduced the medication until April of this year. But unexpectedly, just 4 months later, he developed symptoms of arm stiffness, gritting his teeth, and involuntary spasms. From August 10th to today, he has had 7 relapses. As a mother, my heart is breaking! I urgently need expert guidance and diagnosis. Thank you in advance!Doctor's answer:
Hello! Based on the information you've provided, a simple analysis of your child's condition is offered, hoping it may be helpful:1. In clinical practice, the condition you described is typically referred to as pediatric convulsions. The main symptoms include generalized or focal muscle twitching, which may be accompanied by varying degrees of impaired consciousness. If the episode lasts for more than 30 minutes or if there is no period of between frequent convulsions, it is referred to as status epilepticus. Symptoms lasting more than 20 minutes can lead to brain damage.
First, let's look at the causes of this condition:
1. Infectious Diseases: Most cases are accompanied by fever, but if the condition is severe, fever may not occur. Infectious diseases can be further divided into intracranial and extracranial infections.
- Intracranial Infections: Examples include bacterial meningitis, brain abscess, tuberculous meningitis, and intracranial venous sinusitis; viral encephalitis, meningitis, and cerebral parasitic diseases.
- Extracranial Infections: These can lead to febrile convulsions or toxic symptoms caused by infection. Common examples include respiratory infections (such as the common cold), such as acute tonsillitis, otitis media, and pneumonia. Gastrointestinal infections, urinary tract infections, systemic infections, and infectious diseases.
2. Non-Infectious Diseases: Most cases are fever-free convulsions.
- Extracranial Non-Infectious Diseases: Metabolic—such as hypoglycemia, hyponatremia, and hypocalcemia; genetic—such as phenylketonuria; toxic—drug poisoning can also cause convulsions. Brain hypoxia caused by various factors or etiologies.
- Intracranial Non-Infectious Diseases: Primarily epilepsy, which can be either primary or symptomatic (e.g., intracranial hemorrhage, brain tumors). Clinical manifestations vary depending on the cause, but one common feature is generalized or focal muscle twitching. This will not be elaborated further.
During diagnosis, it would be helpful to know the duration of each episode, whether fever is present, and whether the condition worsens with each occurrence. When visiting the hospital, a comprehensive physical and neurological examination should be conducted, paying attention to abnormal features related to convulsions, such as:
- Changes in intelligence
- Changes in behavior
- The size and shape of the child's head
- The child's nutritional status
- Enlargement of the liver or spleen
- Limb movement during periods of no convulsions
Laboratory tests should include a full check of blood glucose, blood calcium, blood sodium, etc., and a brain or brain CT should be repeated if necessary.
Regarding treatment:
1. General Care: Maintain a quiet environment, provide enhanced care, and prevent injuries; ensure the airway is clear during episodes, promptly remove secretions from the throat and pharynx to prevent aspiration.
2. Control Convulsions: Early control is especially important for frequent recurrences, such as those seen in your child. Medications like diazepam and sodium phenobarbital may be used, with enemas administered if necessary.
3. Symptomatic Treatment:
4. Etiological Treatment: Actively identifying the cause or trigger of the condition is crucial.
In summary, it is important to take your child to a regular hospital for a comprehensive and systematic examination and treatment as soon as possible. Do not delay.