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Neurology (Expert Forum)
Headaches, Tingling in Hands & Feet, Eye Pain & Now Stomach Pain in 4 yr old
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Headaches, Tingling in Hands & Feet, Eye Pain & Now Stomach Pain in 4 yr old
by momofmeg, Mar 07, 2007 12:00AM
DD had an unexplained seizure about 6 mths ago (she was playing on a sit n spin-less than 1 min & fell back into seizure). Apt w/ped neuro b/c I have a nephew w/Polymicro Gyria (sp? PMG)so due to family hx. Did EEG- normal, MRI w/contrast -paranasal sinus dis. Since seizure she complains of eye pain (wears glasses +2R eye +3L eye), tingling in hands & feet(not @ same time), & headaches- daily. Lasts usually up to 5 min. No pattern happens day, night, playing or resting. She is VERY active. Over the last month complains of a stomach ache lasting only mins. 4 wks ago -ambliatory EEG- "Mention is made of 3 less-than-1-second waveforms that carried a more sharply contoured configuration but all occured in drowsiness or sleep. While these waveforms had some characteristics that were suspicious, they were not definitive." Described as spike-and slow wave discharges. The Ped Neuro and PA haven't decided where to go next. Bloodwork - heavy metals, TSH, Vit D, Vit B, sed rate, CBC elevated- ALK PHOS(464) & Platelet(455). Last evening she woke w/a severe (worst yet) headache& stomach ache. Could barly control her. Have apt w/GP am, but need advice. She is growing at normal ht, but only weighs 33lbs & will be 5 this month. Was 4 wks early always been small-had eating issues till 3-good now. Sorry for all the details,make. Any advice you can give is GREATLY appreciated.
Doctor's Answer
by Forum-M.D.-SH, Apr 02, 2007 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms and story you relate is concerning and I would recommend seeing an epilepsy specialist (Neurologist that did a fellowship in epilepsy). The ambilatory EEG was a good idea, but at this point I would recommend that you be admited to an epilepsy monitoring unit (EMU)- where you can get 3-5 days of EEG recording in a more controlled setting (less chance for artifacts). The pattern of 'spike and slow wave' that you describe is commonly seen over an area of the brain where seizures come from. It is expected that these 'spikes' are mostly seen at night and are a sign of potential seizure activity (generally seen inbetween seizures). An EMU also has nurses there all the time to recognize and assist if your child has a seizure for the recording. You did not mention is you were started on any medication at this point, but the tingling and stomach pain can be side effect related as can the elevated alk phos. After the EMU evaluation, then I would recommend some metabolic testing (given her small size and eating issues) including serum/urine amino acids, urine organic acids, lactate, pyruvate, acyl carnitine profile, and a chromosomal microarray. Behavioral problems are a frequent post-ictal (after a seizure) occurance, an I am concerned that her behavior and potential epilepsy are related.
I hope this has been helpful.
The symptoms and story you relate is concerning and I would recommend seeing an epilepsy specialist (Neurologist that did a fellowship in epilepsy). The ambilatory EEG was a good idea, but at this point I would recommend that you be admited to an epilepsy monitoring unit (EMU)- where you can get 3-5 days of EEG recording in a more controlled setting (less chance for artifacts). The pattern of 'spike and slow wave' that you describe is commonly seen over an area of the brain where seizures come from. It is expected that these 'spikes' are mostly seen at night and are a sign of potential seizure activity (generally seen inbetween seizures). An EMU also has nurses there all the time to recognize and assist if your child has a seizure for the recording. You did not mention is you were started on any medication at this point, but the tingling and stomach pain can be side effect related as can the elevated alk phos. After the EMU evaluation, then I would recommend some metabolic testing (given her small size and eating issues) including serum/urine amino acids, urine organic acids, lactate, pyruvate, acyl carnitine profile, and a chromosomal microarray. Behavioral problems are a frequent post-ictal (after a seizure) occurance, an I am concerned that her behavior and potential epilepsy are related.
I hope this has been helpful.
Thanks again for your ideas. I'm up for anything that could figure this out!