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Chin tremors

Dear Doctor,
My son has started having chin tremors.  He is an 11 yo male who has had several episodes of chin tremors over the last 5 days.  They tend to last a few seconds to several minutes.  Today they are much worse than they have been; now involving all of his lower jaw, lasting longer, and the tremor is stronger.  He feels very cold when this happens, but he does not have a fever and the ambient temperature is not cold when it happens.  Today it has occured frequently, at least 7 times in the last 8 hours.  2 of the episodes were followed by an occipital and right temporal headache, nausea, fatigue and an inability to think clearly.  This constallation of symptoms lasted about one hour each.
No history of similar episodes in the past.  No known head trauma, but previous ADD work up was suspicious for possibility of head trauma.

PMHX- allergic rhinitis/asthma - currently in remission
moderately severe ADD

SXHS - none


MEDS - started Celexa and Attend (an herbal supplement for ADD) about 10 days ago taking dimetapp prn per package directions X 4 days for uri

ROS -positive for mild rhinorrhea, sore throat is now resolved
no loss of consciousness, no blurred vision or decreased hearing, no dizziness
no cp or sob, no other tremors

PE neuro exam per ER resident and attending are normal, however after returning home I did discover a positive Chostek's sign ( this was not checked in the ER)

Impression per ER doc was tics from stimulants in Attend

Plan was to see PCP in the next day or 2 (nice way to say TURF) Discontinue Attend, and come back in if it gets worse (I was there becasue it was getting worse)  

Do you agree with this?
Can tics last several minutes and are they usually followed by headache, nausea, fatigue, and a decreased ability to think clearly?  What about the positive Chvostek's sign?


1 Responses
368886 tn?1466238884

I am surprised that an EEG was not done. This could very well be a partial seizure.

Please consult a pediatric neurologist and get an EEG done, apart from any other test that he advises. Tics do not show such features. You also need to rule out hypocalcaemia.

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