Transcript ELS 2010...PEDS - McGill University

ELS 2010...PEDS !
MCH protocols and peds exam
for adult trainees
Headaches and Migraines
Migraines in childhood
• Prevalence
– 3 to 7 years
• 1 to 3 %
• ♂>♀
– 7 to 11 years
• 4 to 11%
• ♂=♀
– Above 15 years
• 8 to 24%
• ♀>♂
Migraines in childhood
• 2003 IHS Diagnostic Criteria for Pediatric Migraine
without aura
A) At least 5 attacks fulfilling criteria B through D
B) Lasting 1 to 72 hours
C) At least 2 of the following
•
•
•
•
Unilateral or bilateral frontotemporal (not occipital)
Pulsing quality
Moderate or severe pain
Aggravation by or causing avoidance of routine physical activity
D) During the headache, at least 1 of the following
• Nausea and/or vomiting
• Photophobia and phonophobia with may be inferred from behavior
E) Not attributed to another disorder
Migraines in childhood
• Migraine equivalents
– Benign paroxysmal torticollis
• Attacks of head tilt lasting hours to days
• Onset between 2 and 8 months of age
– Benign paroxysmal vertigo of childhood
• Abrupt and brief episodes of unexplained unsteadiness
• Onset usually in toddlers
– Abdominal migraine
• Recurrent episodes of moderate-to-severe intensity midline
epigastric pain lasting 1 to 72 hours associated with vasomotor
symptoms (flushing, pallor) and N/V
• Onset during childhood
– Cyclic vomiting
• Recurrent episodes of intense vomiting recognizable by their
stereotypical time of onset, duration and symptomatology
• Onset during childhood
Febrile seizures
Febrile seizures
• 2 to 5% of children
• Most common form of childhood seizures
• Definition: (International League Against
Epilepsy)
– “Seizure occurring in association with a febrile illness
in the absence of a central nervous system infection
or acute electrolyte imbalance in children older than 6
month of age without prior afebrile seizures.”
• Peak incidence: 18 months
Febrile seizures
• Simple vs complex
Simple
Complex (30%)
6 months to 6 years
<6 months, >6 years
Generalized
Focal
Brief
<15 minutes
Prolonged
>15 minutes
Isolated
1 seizure per 24 hrs
Multiple
> 1 seizure per 24 hrs
Normal development
& neurological exam
Abnormal
Febrile seizures
• Recurrence of Febrile
Seizures:
– 1/3 will experience
recurrence
– 10% will have ≥3
episodes
Factors for development of
Epilepsy
(Swaiman, Fourth Edition)
Definite Risk Factor
• Neurodevelopmental abnormality
• Complex Febrile Seizure
• Family history of Epilepsy
• Duration of fever
Possible Risk Factor
• More than one complex feature
Not a Risk Factor
• Family history of Febrile Seizures
• Age at first Febrile Seizure
• Height of peak temperature
• Gender and Ethnicity
First seizure, status epilepticus
and breakthrough seizure in a
known epileptic
Tics and Tourette syndrome
Peds Neuro Exam
Primitive Reflexes
Reflex
Method
Response
Disap-pearance
Palmar grip
Placing index in palm of
infant
Flexion of fingers
6 months
Plantar grip
Pressing a thumb against the
sole just behing the toe
Flexion of toes
15 months
Galant
Scratching the skin of the
infant’s back from the
shoulder downward, 2-3 cm
lateral from the spinous
process
Incurvation of the trunk with
the concavity on the
stimulated side
4 months
ATN
Rotation of the infant’s head
to one side for 15 sec
Extension of the extremities
on the chin side and flexion of
those on the other side
3 months
Moro
Sudden head extension
produced by a linght drop of
the head
Abduction followed by
adduction and flexion of the
upper extremities
6 months
Questions ?