Difficulties in the differential diagnosis of epileptic and hypocalcemic seizures in children and adolescents
https://doi.org/10.14412/2074-2711-2018-1S-66-74
Abstract
Epileptic seizures require differential diagnosis with other paroxysmal conditions, including metabolic seizures. A variety of electrolyte changes can result in central nervous system dysfunction, including that as convulsive seizures. The paper describes electrolyte disorders leading to seizures, as well as their clinical features. It separately presents the syndromes accompanied by hypocalcemia, in which there may be convulsive paroxysms. The paper describes three clinical cases of hypocalcemic seizures. It gives recommendations for the diagnosis and management of patients with suspected metabolic seizures.
About the Authors
I. O. Shchederkina
Morozov City Children’s Clinical Hospital, Moscow Healthcare Department
Russian Federation
1/9, Fourth Dobryninsky Lane, Moscow 119049
Russian Federation
1/9, Fourth Dobryninsky Lane, Moscow 119049
K. A. Orlova
Morozov City Children’s Clinical Hospital, Moscow Healthcare Department
Russian Federation
1/9, Fourth Dobryninsky Lane, Moscow 119049
Russian Federation
1/9, Fourth Dobryninsky Lane, Moscow 119049
I. E. Koltunov
Morozov City Children’s Clinical Hospital, Moscow Healthcare Department
RUDN University of Russia
Russian Federation
Russian Federation
1/9, Fourth Dobryninsky Lane, Moscow 119049
6, Miklukho-Maklai St., Moscow 117198
E. M. Orlova
National Medical Research Center of
Endocrinology, Ministry of Health of Russia
Russian Federation
11, Dmitry Ulyanov St., Moscow 117036
Russian Federation
11, Dmitry Ulyanov St., Moscow 117036
D. Yu. Korneev
Morozov City Children’s Clinical Hospital, Moscow Healthcare Department
Russian Federation
1/9, Fourth Dobryninsky Lane, Moscow 119049
Russian Federation
1/9, Fourth Dobryninsky Lane, Moscow 119049
O. F. Vykhristyuk
Morozov City Children’s Clinical Hospital, Moscow Healthcare Department
Russian Federation
1/9, Fourth Dobryninsky Lane, Moscow 119049
Russian Federation
1/9, Fourth Dobryninsky Lane, Moscow 119049
References
1. Петрухин АС, редактор. Эпилептология детского возраста: Руководство для врачей. Москва: Медицина; 2000. 624 с. [Petrukhin AS, editor. Epileptologiya detskogo vozrasta: Rukovodstvo dlya vrachey [Epileptology of childhood: A guide for doctors]. Moscow: Meditsina; 2000. 624 p. (In Russ.)].
2. Мухин КЮ, Миронов МБ, Петрухин АС. Эпилептические синдромы. Диагностика и терапия. Руководство для врачей. Москва: Системные решения; 2014 [Mukhin KYu, Mironov MB, Petrukhin AS. Epilepticheskie sindromy. Diagnostika i terapiya. Rukovodstvo dlya vrachey [Epileptic syndromes. Diagnosis and therapy. A guide for doctors]. Moscow: Sistemnye resheniya; 2014 (In Russ.)].
3. Карлов ВА. Эпилепсия у детей и взрослых, женщин и мужчин. Москва: Медицина; 2010. 720 с. [Karlov VA. Epilepsiya u detey i vzroslykh, zhenshchin i muzhchin [Epilepsy in children and adults, women and men]. Moscow: Meditsina; 2010. 720 p. (In Russ.)].
4. Beghi E, Carpio A, Forsgren L, et al. Recommendation for a definition of acute symptomatic seizure. Epilepsia. 2010;51:671-5. doi: 10.1111/j.1528-1167.2009.02285.x
5. Власов ПН. Дифференциальная диагностика основных пароксизмальных состояний в практике невролога и терапевта. Фарматека. 2008;5(159):91-4 [Vlasov PN. Differential diagnosis of the main paroxysmal conditions in the practice of a neurologist and therapist. Farmateka. 2008;5(159):91-4 (In Russ.)].
6. Белоусова ЕД, Ермакова АЮ, редакторы. Дифференциальный диагноз эпилепсии. Москва: Пульс; 2007. 364 с. [Belousova ED, Ermakova AYu, editors. Differentsial'nyy diagnoz epilepsii [Differential diagnosis of epilepsy]. Moscow: Pul's; 2007. 364 p. (In Russ.)].
7. Benbadis SR. Errors in EEGs and the misdiagnosis of epilepsy: Importance, causes, consequences, and proposed remedies. Epilepsy Behavior. 2007;11(3):257-62. doi: 10.1016/j.yebeh.2007.05.013
8. Castilla-Guerra L, del Carmen Fernandez-Moreno M, Lopez-Chozas JM, Fernandez- Bolanos R. Electrolytes disturbances and seizures. Epilepsia 2006;47(12):1990-8.
9. Shorvon SD. Introduction to the concept of symptomatic epilepsy. In: Shorvon SD, Andermann F, Guerrini R, editors. The Causes of Epilepsy: Common and Uncommon Causes in Adults and Children. Cambridge: Cambridge University Press; 2011. P. 113-7.
10. Schwartzkroin PA, Baraban SC, Hochman DW. Osmolarity, ionic flux, and changes in brain excitability. Epilepsy Res. 1998;32:275-85. doi: 10.1016/S0920-1211(98)00058-8
11. Browne TR, Holmes GL. Epilepsy. N Engl J Med. 2001;344:1145-51. doi: 10.1056/NEJM200104123441507
12. Oguni H. Diagnosis and treatment of epilepsy. Epilepsia. 2004;45(Suppl 8):13-6. doi: 10.1111/j.0013-9580.2004.458003.x
13. LaRoche SM, Helmers SL. Epilepsy in the elderly. Neurologist. 2003;9:241-9. doi: 10.1097/01.nrl.0000087719.64343.be
14. Hirtz D, Ashwal S, Berg A, et al. Practice parameter: evaluating a first nonfebrile seizure in children: report of the quality standards subcommittee of the American Academy of Neurology, The Child Neurology Society, and The American Epilepsy Society. Neurology. 2000;55:616-23. doi: 10.1212/WNL.55.5.616
15. Kunze K. Metabolic encephalopathies. J Neurol. 2002;249:1150-9. doi: 10.1007/s00415-002-0869-z
16. Kaplan PW. The EEG in metabolic encephalopathy and coma. J Clin Neurophysiol. 2004;21:307-18.
17. Smith SJ. EEG in neurological conditions other than epilepsy: when does it help, what does it add? J Neurol Neurosurg Psychiatr. 2005;76(Suppl 2):ii8–ii12. doi: 10.1136/jnnp.2005.068486
18. Lin CC. EEG manifestations in metabolic encephalopathy. Acta Neurol Taiwan. 2005;14:151-61.
19. Victor M, Ropper AH. Adams and Victor’s principles of neurology. 7th ed. New York: McGraw-Hill; 2001.
20. Messing RO, Simon RP. Seizures as manifestation of systemic disease. Neurol Clin. 1986;4:563-84.
21. Gupta MM. Medical emergencies associated with disorders of calcium homeostasis. J Assoc Phys Ind. 1989;37:629-31.
22. Mrowka M, Knabe S, Klinge H, et al. Hypocalcemic generalized seizures as manifestation of iatrogenic hypoparathyroidism months to years after thyroid surgery. Epilept Disord. 2004;6:85-7.
23. Kline CA, Esekogwu VI, Henderson SO, Newuton KI. Nonconvulsive status epilepticus in a patient with hypocalcemia. J Emerg Med. 1998;16:715-8. doi: 10.1016/S0736-4679(98)00089-4
24. Kossoff EH, Silvia MT, Marel A, et al. Neonatal hypocalcemic seizures: case report and literature review. J Child Neurol. 2002;7:236-9. doi: 10.1177/088307380201700319
25. Bellazzini MA, Howes DS. Pediatric hypocalcemic seizures: a case of rickets. J Emerg Med. 2005;28:161-4.
26. Keihani Douste Z, Haghi Ashtiani MT, Shariat M, Tehrani F. Comparative Evaluation of Corrected QT and Ionized Calcium in Children. Acta Med Iran. 2015;53(9):579-81.
27. Гузева ВВ. Подростковая эпилепсия: клинико-электрофизиологические, гормональные и терапевтические особенности. Автореф. дисс. … докт. мед. наук. Санкт-Петербург; 2014 [Guzeva VV. Podrostkovaya epilepsiya: kliniko- elektrofiziologicheskie, gormonal'nye i terapevticheskie osobennosti [Teenage epilepsy: clinical and electrophysiological, hormonal and therapeutic features. Author's abstract. diss. …Doct. Med. Sci.]. St. Petersburg; 2014 (In Russ.)].
28. Harijan P, Khan A, Hussain N. Vitamin D deficiency in children with epilepsy: Do we need to detect and treat it? J Pediatr Neurosci. 2013 Jan;8(1):5-10. doi: 10.4103/1817-1745.111413
Review
For citations:
Shchederkina I.O., Orlova K.A., Koltunov I.E., Orlova E.M., Korneev D.Yu., Vykhristyuk O.F. Difficulties in the differential diagnosis of epileptic and hypocalcemic seizures in children and adolescents. Neurology, Neuropsychiatry, Psychosomatics. 2018;10(1S):66-74. (In Russ.) https://doi.org/10.14412/2074-2711-2018-1S-66-74
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