Risk of recurrent seizures after the first afebrile grand mal seizure in childhood]

A cohort of 74 children three months to 16 years-old who presented with a first unprovoked seizure were followed for five years to assess the risk of recurrence. Children with febrile convulsions, immediate posttraumatic seizures, meningitis and encephalitis were not included. The risk of recurrence was 68% for a second seizure. 47% of the patients developed an epilepsy. 85% of recurrences occurred within the first 6 months and 100% within 2 1/2 years. A history of epilepsy in a first degree relative, age at first seizure, duration of seizure, initial EEG or neurologic status were not associated with significantly higher risk of recurrence.     

Neurocysticercosis: an unusual cause of seizure in the New Zealand setting

Neurocysticercosis is an unusual cause of seizure in the New Zealand setting. We report on the presentation of a 12-year-old Indian boy, who was found to have neurocysticercosis after presenting with a generalized seizure. Treatmeant of neurocysticercosis is controversial, and the evidence from the literature regarding treatment with anthelmintic (or cysticydal) medication is reviewed. Other treatment measures including anticonvulsant therapy and corticosteroids is also discussed.     

Evidence based medicine: An example in the pediatric setting

OBJECTIVE: This paper reviews the main steps to incorporate into clinical practice the concepts of evidence-based medicine, which is a strategy to help clinicians take more suitable decisions when confronted with clinical problems. METHOD: Search in Medline database of articles related with evidence-based medicine, review of a number of clinical epidemiology textbooks and selected articles. RESULTS: Evidence-based medicine recognizes two main sources of information for clinical decision making: 1) the individual patient; and 2) clinical epidemiological research. Trough evidencebased medicine the experience accumulated by a trained clinician should be integrated with the best external evidence obtained from systematic research. The appraisal of external evidence requires new knowledge and skills for the practicing clinician. These skills aim at enabling the clinician to make independent critical judgement of the quality of information that will translate into medical actions for his/her patients. Evidence-based medicine provides the tools to 1) keep up with an ever growing burden of health information; 2) efficiently select best available information; 3) critically appraise selected information; 4) synthesize selected information; and 5) integrate selected information into clinical experience in the management of diagnosed health problems. CONCLUSIONS: Evidence-based medicine could be seen as a way to bridge knowledge, skills, and attitudes acquired from clinical experience with the ability to evaluate the best available external evidence generated by scientific research.     

Risk of seizure recurrence following a first unprovoked seizure in children

The aim of the study was to determine seizure recurrence rate and risk factors of a first unprovoked seizure in children. Ninety-one children aged 2 months-15 years who had a first unprovoked seizure were enrolled and followed-up. History and physical examination were undertaken. The results were displayed as a Kaplan-Meier survival curve. Multivariate analysis was performed with Cox proportional-hazards model. The cumulative probability of recurrence rate was 68 per cent and incidence density was 6.85 per 100 person-months. The cumulative risk of recurrence was 50 per cent at 4 months and 66 per cent at 12 months. No risk of seizure recurrence was found in this study.     

Eye emergencies: acute management in the pediatric ambulatory care setting.

Pediatric emergency department visits commonly relate to eye problems. Over 70,000 children under the age of 15 years are treated annually for eye injuries. Ocular examination is also often performed in the ambulatory care setting when the physician is evaluating systemic problems, such as head trauma, to look for abnormalities such as papilledema. For these reasons, it is essential that the acute care physician becomes familiar with the initial evaluation and management of ocular disorders. Unfortunately, this evaluation may be hampered by inadequate instrumentation, an uncooperative patient, or a fear of causing further damage to the eye. However, primary care physicians can perform a wide range of diagnostic and therapeutic interventions with a minimum of technology and a modicum of patience and understanding.