Differential diagnosis of nonepileptic twilight state with convulsive manifestations after febrile seizures

Autor: Hiroyuki Miyahara, Yoshio Arakaki, Kenji Waki, Tomoyuki Akiyama
Rok vydání: 2018
Předmět:
Male
Pediatrics
medicine.medical_specialty
Painful Stimulation
Twilight state
Status epilepticus
Electroencephalography
Seizures
Febrile
Diagnosis
Differential
03 medical and health sciences
0302 clinical medicine
Developmental Neuroscience
Seizures
Venous blood gas
Chart review
Febrile seizure
Humans
Medicine
Prolonged febrile seizure
Pathological
Retrospective Studies
Venous blood gas analysis
Clinical characteristics
medicine.diagnostic_test
business.industry
Brain
Infant
General Medicine
medicine.disease
Electroencephalogram
Child
Preschool
030220 oncology & carcinogenesis
Pediatrics
Perinatology and Child Health
Anticonvulsants
Acute encephalopathy with biphasic seizures and late reduced diffusion
Neurology (clinical)
Blood Gas Analysis
medicine.symptom
Differential diagnosis
business
030217 neurology & neurosurgery
Zdroj: Brain and Development. 40:781-785
ISSN: 0387-7604
Popis: Background Nonepileptic twilight state with convulsive manifestations (NETC) is a nonepileptic state following a febrile seizure (FS), which may be misdiagnosed as a prolonged seizure and result in overtreatment. We aimed to describe clinical manifestations of NETC and to determine characteristics that are helpful to distinguish NETC from other pathological conditions. Methods We conducted a retrospective chart review from January 2010 to December 2016 and selected the patients who presented with symptoms resembling status epilepticus with fever and a confirmed diagnosis using an electroencephalogram (EEG). We compared the NETC clinical features and venous blood gas analysis results with those of other conditions that mimic NETC. We also compared the characteristics of NETC with past reports. Results Our NETC patients presented with short durations of the preceding generalized convulsions followed by tonic posturing, closed eyes, no cyanosis, responsiveness to painful stimulation, and no accumulation of CO2 in the venous blood gas. Most of these characteristics were consistent with past reports. Prolonged FS or acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) showed several of these features, but all the characteristics were not consistent with our study. Conclusions Prolonged FS and AESD need to be differentiated from NETC, and close clinical observation makes it possible to partially distinguish NETC from the other conditions. EEG is recommended for patients with symptoms that are inconsistent with these features.
Databáze: OpenAIRE
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