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Abstract: Epilepsy is a condition that often occurs in children and is often characterized by shaking of the limbs, which can also occur in the case of hypocalcemia, and therefore needs to be differentiated. In this case, the child was found to have shaking limbs by his mother at the age of 3 months, and the shaking was associated with the possibility of epilepsy, so he immediately went to the hospital for examination. After examination, the results suggested hypocalcemia, but the EEG did not exclude seizures. After giving medication, the child’s symptoms decreased and all indicators gradually normalized.
[Basic information] Male, 3 months
Type of disease】Epilepsy, hypocalcemia
Hospital】Shandong Provincial Third Hospital
Date of consultation】July 2021
Treatment plan】Medication (calcium carbonate D3 tablets, cod liver oil)
Treatment Period】Outpatient consultation, followed up after 1 month
Effectiveness】Symptoms improved, blood calcium normal on recheck
I. Initial consultation
A young mother came to our hospital with her 3-month-old child. She was very anxious and anxious, and reported that she had noticed that her child had recurrent limb tremors a week ago, which lasted for a short period of time and occurred easily when she exerted herself, and the tremors usually lasted about 3 seconds. After reassuring the mother, we immediately began to examine the child. The child was assessed to have normal growth and weight gain, but the neurological examination revealed positive ankle clonus, which, combined with the medical history, was initially suspected to be a seizure. The child’s mother expressed her understanding and promised to cooperate actively.
Treatment history
The child’s blood was drawn from the clinic to check calcium, routine blood tests, liver and kidney functions, lipids and blood glucose, as well as cranial MRI and EEG. After a series of tests, the results showed that the child had a low level of 25 hydroxyvitamin D3. EEG suggested: mild abnormalities with mild abnormal epileptic waves. The cranial MRI results suggested that the child had slightly high signal in T1W1 of the internal capsule of both basal ganglia. However, considering that the child was only 3 months old and currently had hypocalcemia, hypocalcemia should be corrected first and then the need for antiepileptic drugs should be observed. The child was given calcium carbonate D3 tablets and cod liver oil, and the mother was instructed to return to the clinic in 1 month for a calcium blood test and EEG.
Treatment effect
After 1 week, the mother noticed that the shaking of the child’s limbs was less frequent than before, from 3-4 times a day to once every 2-3 days, and after 1 month, the shaking of the child’s limbs became once a week. The blood calcium concentration had returned to normal and the EEG had changed to a normal EEG. We advised the mother to take the child to play more outdoor sports and get more sunlight to help calcium absorption, and to recheck the cranial MRI in six months to assess the brain condition and explain the daily dietary precautions for the child. The child’s mother expressed her gratitude to us for her active cooperation with the above request for follow-up.
IV. Precautions
After a series of examinations and treatments, the child’s limb tremors improved significantly and the indicators gradually recovered, and we, as medical staff, were truly happy for the child. However, after discharge from the hospital, the parents still need to pay attention to the follow-up care of the child, but also need to stabilize their minds. Treatment is a long process and requires the active cooperation and patience of the family. In daily life, if your child develops inflammatory infections, you should not self-medicate, but go to the hospital promptly and follow medical advice to actively control the body temperature to avoid triggering seizures. At the same time, we should pay attention to regular review in the hospital to clarify the development of the child’s brain in order to ensure the healthy growth of the child.
V. Personal insight
When younger children have unexplained limb tremors, they may usually have seizures and need to be differentiated from hypocalcemia, neurological insufficiency and intracerebral diseases. It is the instinct of every parent to care for their child. If the child has individual discomfort, do not over-amplify the symptoms and do not be blindly reassured; you should visit a regular hospital to clarify the possibility of the disease. The mother of the content of this article showed great anxiety and uneasiness when the affected child showed symptoms of shaking limbs, which is actually an undesirable behavior. But fortunately, the subsequent mother of the affected child was able to calm her mind and actively cooperate with the treatment, which also played a more important role in the recovery of the child’s condition, and more happily, the child was able to gradually improve after a series of treatments. Therefore, if a child is found to have shaking limbs, he or she should go to the hospital for a formal examination and not be blindly anxious. At the same time, parents should actively pay attention to their children’s development when taking care of them and keep themselves happy, which is also beneficial to their children’s healthy growth. In clinical practice, doctors should actively identify children with limb tremors to rule out the possibility of brain diseases, and not blindly consider normal physiological phenomena.