Paediatric Neurology Clinical Letter

Medical profile - Epilepsy - Attention Deficit Hyperactivity Disorder (ADHD) Current medications - Levetiracetam 500mg twice daily - Methylphenidate 10mg once daily Allergies - Nil Relevant investigations - EEG: Abnormal with generalized spike-and-wave discharges - MRI Brain: Normal Current age: 8 years and 4 months Current weight: 25 kg (50th centile) Current height: 130 cm (75th centile) Head circumference: 52 cm (50th centile) It was a pleasure to review Emily Johnson in my clinic. Present were her mother, Mrs. Sarah Johnson, and her school nurse, Ms. Linda Green. Current Concerns / Medical update Emily was referred to the clinic due to recurrent seizures and difficulties with concentration at school. Her mother reports that the seizures have been occurring more frequently, approximately twice a week, and are characterized by sudden staring spells lasting about 30 seconds, followed by confusion. Emily also experiences daily challenges with attention and hyperactivity, impacting her academic performance. Emily's seizures began approximately one year ago, initially occurring monthly but have increased in frequency over the past three months. The seizures are generalized absence seizures, with no specific triggers identified. Emily recovers quickly, within a minute, but remains confused for a short period afterward. Her ADHD symptoms have been present since early childhood, with increasing severity noted in the past year. Background Emily has a history of febrile seizures as a toddler but no other significant medical or surgical history. She has not been hospitalized for her current conditions. Her developmental milestones were achieved within normal limits. Family history reveals that her father had epilepsy during childhood, which resolved in adolescence. Emily lives with her parents and two younger siblings. Neurological examination Vitals: Blood pressure 110/70 mmHg, Heart rate 80 bpm Physical examination revealed normal mental status, intact cranial nerves, normal motor strength and tone, and no sensory deficits. Reflexes were brisk but symmetrical, and coordination and gait were normal. Discussion Emily's clinical presentation and EEG findings are consistent with generalized epilepsy, likely childhood absence epilepsy. Her ADHD symptoms are also significant and require management. Differential diagnosis includes other forms of generalized epilepsy, but the EEG findings support the current diagnosis. Patient education was provided regarding epilepsy and ADHD, emphasizing the importance of medication adherence and regular follow-up. Emily's mother was advised on recognizing seizure activity and when to seek urgent care. Plan - Continue Levetiracetam 500mg twice daily - Increase Methylphenidate to 15mg once daily - Referral to a psychologist for ADHD management - Follow-up EEG in 6 months - Review in clinic in 3 months to assess response to treatment