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Doctors evaluated a 4-year-old girl with daily seizures followed by leaking of feces. Neurologists found no evidence of neurological disorders, despite significant electroencephalography, CT imaging, and other diagnostic tests. Antiseizure medication did not resolve the episodes. The patient was ultimately diagnosed with chronic constipation. Her 'seizures' were manifestations of stool withholding to avoid the discomfort of defecating. Stool withholding behavior is very common in constipated children.

Piperacillin treatment may increase the likelihood of a seizure in isolated patient populations. Other beta-lactam antibiotics have been shown to stimulate seizures. However, there has been only one report of seizures associated with piperacillin treatment in humans. This patient was a child with leukemia previously treated with chemotherapy but with no history of seizures. Seizures occurred in this patient shortly after taking piperacillin. Brain scans and brain wave and spinal fluid tests did not reveal any other abnormality.

Thyroid storm, an extreme manifestation of hyperthyroidism, is very rare because hyperthyroidism is usually treated successfully with medication. (In hyperthyroidism the thyroid gland secretes excessive amounts of thyroid hormone, which increases the body's metabolism.) While rare in adults, thyroid storm is even more unusual in children. However, thyroid storm can still occur in patients whose thyroid condition is not well controlled, or who are subjected to extreme physical stress, such as a serious infection. Typical symptoms include a high fever, increased heart rate, neurologic symptoms, jaundice (yellow skin), and digestive problems, such as vomiting and diarrhea. The case of a 3.5-year-old girl who developed thyroid storm is described. Her earliest signs of hyperthyroidism, which were not initially recognized as symptoms of illness, included greatly increased appetite, protruding eyes, and intolerance to heat. Even though it was winter, the child would not wear warm clothing, and she ate as much as an adult. Although she had been fine when she went to bed, the child became seriously ill overnight. In the morning her parents could not wake her. At the hospital she was found to be in a coma, and to have greatly elevated blood pressure, temperature and heart rate, dilated pupils, and difficulty breathing, which necessitated the use of a respirator. The patient was transferred to a medical center where physicians noted that she had an enlarged thyroid gland. Her blood level of thyroxine, a thyroid hormone, was elevated. Thyroid storm was diagnosed and medication therapy was begun. She was also treated for seizures, which began soon after her transfer to the medical center. Within two days, the child was much improved. She was taken off the respirator and regained alertness, but remained irritable and had some trouble remembering names. By the time that she was discharged from the hospital, all her neurologic problems had resolved. She was maintained on antithyroid medication. The various diagnostic tests that were performed and treatments are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Some patients taking piperacillin as an antibiotic may, under certain circumstances, experience seizures. An 11-year-old patient recently treated with chemotherapy for leukemia was treated with piperacillin for two blood infections. The patient had seizures on two separate occasions. Both seizures occurred two hours after taking the morning antibiotic treatment and lasted for two to three minutes. There was no indication of brain abnormalities or meningitis as seen on brain scans and in spinal fluid tests, respectively. The patient had no more seizures after changing medication.

It is not uncommon for episodic phenomena in infancy to be mistaken for signs of epilepsy. Paroxysmal torticollis is a benign, self-limited disorder in which episodes of sudden, stereotyped head-tilting recur; it is often associated with pallor, agitation, nystagmus and emesis. The frequency of the episodes vary, and if they are brief, they can be mistaken for seizures. A case of paroxysmal torticollis in a 3-month-old infant is reported. The patient's past medical history was unremarkable, and there was no family history of epilepsy or other paroxysmal disorders. She was alert upon admission and suffered no further episodes during the 2 days she was hospitalized. Two weeks later, she was reevaluated on an emergency basis when the same events recurred. After a neurologic examination and performance of the Hallpike maneuver by the examining physician, she was diagnosed with paroxysmal torticollis. It is important for physicians to recognize this disorder so that costly, incorrect treatment can be avoided.

When infants lose significant quantities of water due to intestinal infections, there is a risk of hypernatremic dehydration (insufficient water associated with high levels of sodium). When rehydrating the patient (re-establishing normal water balance), it is possible to give fluids in a manner that causes seizures and may lead to long-term impaired neurological function. It is thought that seizures may occur because of the rate of decrease in the sodium level in the blood. A case study describes a three-month-old female infant, who had a two-day history of watery diarrhea, which was preceded by four days of poor eating, fussiness, and decreased urine output. The infant was found to be dehydrated and she was rehydrated by intravenous fluid administration. Shortly thereafter, the patient developed seizures, which were difficult to control, but eventually treated successfully. Her blood sodium level was normal when measured after the seizure. Subsequent rehydration was accomplished slowly. Hypernatremic dehydration, which can be recognized by signs of central nervous system dysfunction, should be corrected slowly. The recommended rate of intravenous fluid administration is no faster than 0.5 mEq per liter per hour, a rate that was exceeded by a factor of seven in this patient. Additional water administered by the mother further complicated this too-rapid rehydration. (Consumer Summary produced by Reliance Medical Information, Inc.)