Utility of electroencephalography in the pediatric emergency department.

To assess the role of electroencephalography (EEG) in the pediatric emergency department, we reviewed the records of all patients having an EEG in the pediatric emergency department of our hospital between 1995 and 1997. EEG findings, clinical presentations, and follow-up data were analyzed, and patients were distributed into three groups according to clinical presentation: group 1 included patients with new-onset seizures, group 2 included patients with known epilepsy presenting with worsening seizures and altered mentation, and group 3 comprised patients with acute confusional states. Overall, 56 patients with 57 EEGs were included. In group 1 (n = 36), 20 (55.6%) had an abnormal EEG. The risk of recurrence was much higher in children with abnormal EEGs (80% vs. 31%) (P < .01). In retrospect, among all of the patients receiving the diagnosis of epilepsy, 76% had an abnormal emergency department EEG. Four in group 2 (n = 14) and one in group 3 (n = 7) were proven to have nonconvulsive status epilepticus and were treated accordingly. No patients in group 1 had nonconvulsive status epilepticus. Ongoing seizures were promptly excluded in the remainder. The EEG directly contributed to the diagnosis in 84% of all referrals in the pediatric emergency department, either being abnormal and leading to a diagnosis of a seizure disorder or confirming low suspicion for seizures. Thus, a prompt EEG should be considered in children with new-onset seizures and unexplained altered consciousness.

Phenytoin-associated thrombocytopenia in a toddler.

Hematologic side effects are rare side effects of treatment with phenytoin. We report a 2-year-old girl who developed reversible thrombocytopenia following treatment with phenytoin. Thrombocytopenia as a side effect of phenytoin treatment has usually been reported in adults and generally occurs 2 to 4 weeks after initiation of therapy. In our case, the thrombocytopenia developed on the 11th day of therapy and resolved 5 days after discontinuation of the phenytoin.

Effects of respiration on left ventricular diastolic function in healthy children.

Pulsed Doppler echocardiographic indices of mitral valve filling were measured in 20 healthy children, between 3 and 12.5 years old, in order to evaluate the effects of spontaneous respiration on left ventricular diastolic filling patterns. There were significant respiratory variations in four parameters of left ventricular diastolic function: The peak early filling velocity, the ratio of early to late peak filling velocity, and the ratio of early to late diastolic velocity-time integral decreased significantly during inspiration (mean decrease 7%, P < 0.05; 16%, P < 0.01; and 12%, P < 0.05, respectively). On the other hand there was a significant increase in late peak filling velocity with inspiration (10% increase, P < 0.05). Other variables of left ventricular diastolic filling were unchanged with inspiration. These results suggest that assessment of left ventricular diastolic function in children should be standardized with regard to respiratory phases in any clinical application.