A CHILD WITH AN EPILEPTIC STATUS WITH

GROWTH FALTERING

Created by :

Rahmi Mulyani Hasibuan

Defrika Muharani
Hasan Husien

Supervisor :
dr. Hotber Pasaribu. SpA(K)

PEDIATRIC DEPARTMENT
MEDICAL FACULTY UNIVERSITY OF RIAU
RSUD ARIFIN ACHMAD PEKANBARU
Background
• The Diagnosis of SE is based on seizure frequency, duration of seizure attack,
and there is no recovery of consciousness between seizures.

• The incidence of SE is estimated between 10-58 per 100.000 children

• Treatment of SE with anti-convulsants without correction of seizure for 30

minutes is indicated for intensive care

• Main Problem
Children with refractory status epilepticus
 What should we do?

Diagnosed

Competition Level 3B :
Initial treatment

Referrals
Status Epilepticus
Repeated or prolonged seizures for more
than 30 minutes
Or seizures that occur more than 2 times that last for 5 minutes or more where
conciousness between the seizures does not recover completely

Repeated seizure more than

30 minutes
Or
learning difficulties, child growth
Seizures more than 2 times instability of electrical in the brain problems, and determine the
that lasting more than 5 >> muscle coordination. quality of life.
minutes and there was no
improvement in
conciousness
 Etiology Classification
Focal seizures Generalized seizures
• Partial complex
Stroke Metabolic disease Partial • Partial simplex
/focal
Infection Drug reaction seizures
Head trauma
Idiopathic
Tumor (Neoplasm)

Dysplasia Photosensitive seizure

• Tonic
• Atonikc
Vascular malformation
Genetic factor
Generalize • Tonic clonic
d seizures • Abscent
Mesial temporal sclerosis • Myoclonic
Risk factor Pathophysiology

Decreased
Increased excitatory STATUS aminoburitic
Natal glutamate EPILEPTICUS gamma acid
neurotransmitter and inhibitory
acetylcholine neurotransmitters

Postnatal
Diagnostic for Status Epilepticus
Anamnesis, physical and neurological examination

Patient’s history (head

trauma,pregnancy,partus,
illness, family,
medicine,development)
Age at first
seizures
Other disease
Triggers
Nutritional
All bout seizures
status
Neurological
(type,duration, and
before-during-after examination
Vital sign and
of the attack)
general
physical Neuroimaging
examinantion
(CT-scan,MRI)
EEG
Status epilepticus guidelines recommendation based on IDAI
Case Illustration
IDENTITY
Name / MR : RR / 01023169
Gender : Female
Age : 2 years old
Address : Pekanbaru
Hospital lenght of stay : 4 days
Patient status : Alive
Case Report
Appearance
Tone : Active PRIMARY SURVEY
Interactability : Respond low (in
the influence of
antikonvulsan drugs)
Airway Clear
Consolability : Relaxed
Look : in the influence
of antikonvulsan drug
Breathing Spontaneous, RR : 24x/i
Speech : in the influence
of antikonvulsan drug

Work of Breathing Circulating Pulse : 117x/i,

Abnormal sound (-)
Retraction (-) nasal flare (-)
Disability Composmentis, Temperature : 36.6 ’C.

Exposure no bleeding
Circulatiaon :
Cyanotic (-) pallor (+)
 Anamnesis
Chief Complain
Clonic seizure since 2 hours before admission
 Current Illness
Since 1 day
The patient had a high fever of
38.6˚C
2 hours before
admission
Seizure described as tonic clonic.
Twitching about once with a
duration of ± 10 minutes. After
the seizure the patient is still
conscious. Fever (+)
ER RSUD Arifin Achmad
Because the patient was
unconscious and has repeated
seizures after 3 times anti-
convulsant administration, the
patient needed ICU
ER RSUD Petala Bumi
Then the seizure of> 10 times in 3
hours, the duration of ± 15 min.
Between seizures the patient is
unconscious and there is no
improvement in consciousness.
The patient was given 3 times
anti-convulsant but seizures
reappear
 History of Past Illness

Never experienced a
complaint like this
before

Never had a brain injury

before
 Patient’s History
Family History • No history of seizure in family

Parents History • Mother: 34 years old, house wife

• Multigravide, no history of fever and bleeding in pregnancy,

Pregnancy History trauma (+) at 7 month gravide, routine ANC.

• BCG(1x), DPT (3x), Polio (4x), Campak (1x), Hep B (2x)

Vaccine History • Basic immunization is incomplete, Hep b at 6 months is not given

Growth and • Birth weight 2.900 gr, length 50 cm,

Development History • Present weight 11 kg, height 83 cm

Living Environment • Permanent house, well ventilated, bright dan clean environment
History
Highlights of Anamnesis
• High fever 1 day berofe admission
• 2 hours berofe admission, the patient had clonic seizure once with a duration of ± 10
minutes
• In the emergency room of Petala Bumi Hospital, the patient had seizures again > 10
times in 3 hours, duration ± 15 minutes. Between seizures the patient is unconscious and
there is no increase in consciousness
• Has been given anti-seizure 3 times but seizures is not relieved

Highlight of Physical Examination

Temperature: 36,6 ºC
Meningeal Signs: Stiff neck(-), Brudzinski 1 (-), Brudzinski 2 (-), Kernig’s Sign (-),
Lasègue’s sign (-)
Tonsil in normal range T1-T1
Working Diagnosis
› Status Epilepticus
› Growth Faltering

Prognosis
› Quo ad vitam : Bonam
› Quo ad functionam : Bonam
 Follow up
20/04/18
30/08/19 • Seizure(-), GCS E4M5V5
29/08/2019 • Seizure(-), GCS E3M4V3
• Seizure (-), GCS E3M4V3 • Stable vital sign
• Stable vital sign • NGT(+) serous, given formula
• Stable vital sign
• Patient fasted, NGT(+) milk 30cc/3 jam
• Patient fasted, NGT(+) serous
serous Tx: transferred to Lily ward
• Lab : within normal range
Tx: Ivfd RL Inf. D10%+NS 3%+KCL 10cc+ ca
• CT Scan: suspect cerebral
Inf. D10%+NS 3%+KCL 10cc+ glukonat 5cc
edema
ca glukonat 5cc Inf. PCT 4x150mg
• Chest xray: suggestive to
Inf. PCT 4x150mg Phenytoin 2x50mg for (next 12
bronchopneumonia
Phenytoin 2x50mg (next 12 hours)
Tx: Ivfd RL
hours) Inf. Mannitol 2x25cc
Inf. PCT 4x150mg
Inf. Mannitol 2x25cc Inj. Omeprazole 2x10mg
Phenytoin 50mg dalam 25cc NS
0,9% (distributed in 30 minutes) Inf. PCT 4x150mg
Phenytoin 2x50mg (next 12 Formula milk 30 cc/3 jam
hours)
Inj. Dexametason 3x1,5mg
Inj. Furosemide 1x5mg
Inf. Mannitol 2x25cc
EEG on September 6th 2019

Conclusion
No epileptogenic Waves, EEG normal
 Tonic clonic seizures >10x
Occur without provocation
No conscious after seizure
Duration ±15 menit
one of risk factors in
this case that may
lead to Status
Epilepticus is
From history, consider complex febrile
to Status Epilepticus seizures

Sclerosis in the brain

tissue >> becomes
focus epileptic

Discussion
 Another risk factors in this case that This patient was treated by
may lead to Status Epilepticus is fenitoin 200 mg + 50 cc nacl
trauma on pregnancy 0,9% - phental 100 mg after 12
hours in PICU

But until now, there has been no According to the seizure and
research on the relationship between
the history of trauma in pregnancy with epileptic status management
a history of seizures algorithm

Ct-scan : Susp. cerebral edema

EEG: No epileptogenic wave,

normal EEG.

Discussion
THANK YOU