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Intermittent juvenile spasms

Discussion in 'Pediatrics' started by pgcarter, Nov 24, 2009.

  1. pgcarter

    pgcarter Well-Known Member


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    I am yet to see, but have had reported to me a case of 13 y.o. boy with involountary inversion, internal rotation, dorsiflexion of one foot, cannot walk while happenning, lasts for about 3 days, has been seen by paediatrician but no treatment or diagnosis offerred. I have never seen this before, has anybody got any suggestions in advance of me seeing him. It's not easy to get to him while the condition is active.
    regards Phill Carter
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    from my neuro lecture notes:
     
  3. pgcarter

    pgcarter Well-Known Member

    I have now seen the child, healthy normal Aussie Koorie 13 y.o. male. 1st occurred last Christmas, lasted 3 days, no noticed triggering event or injury, has occurred 3 times since. It was a non rigid inversion, dorsiflexion and adduction of the left foot, he had no other movements or tremors associated with it. While it was occurring he could move it but with less than usual control and much less eversion external range than was possible when it is not occurring. Tib post seemed to be in contraction, but not rigidly, and when I pulled him into eversion, massaged tib post track and muscle body, applied a fair bit of upward force to lateral arch/cuboid area it seemed to markedly reduce, and within 5 minutes he had gone out to play. He is hugely mobile at STJ and mid tarsal, rocker bottom foot look to it, I'm now thinking it's generated by some kind of "sub-lux" of cuboid, resulting pain and compensatory avoidance of discomfort caused by eversion and abduction.....any thoughts?
    regards Phill Carter
     
  4. drsarbes

    drsarbes Well-Known Member

    I assumed an upper motor neuron lesion has been ruled out?
    Steve
     
  5. pgcarter

    pgcarter Well-Known Member

    He has been seen by a paediatrician last March who decided the whole thing did not really warrant further investigation.
    regards Phill
     
  6. drsarbes

    drsarbes Well-Known Member

    "He has been seen by a paediatrician last March who decided the whole thing did not really warrant further investigation"

    OK, what do YOU think?

    Have you performed a neurological exam?

    Steve
     
  7. pgcarter

    pgcarter Well-Known Member

    Not specifically. The child has full normal function of each and every muscle group that contribute to foot function (except during these episodes), he has no other anomalous feelings or lack of feeling, he has no other reported diagnosed conditions or diseases, apart from these isolated episodes there has been nothing noticed. Having seen him my thoughts are that it does not look/seem like the dystonia or upper motor neurone syndrome that I have seen demonstrated in previous educational situations (Uni or conferences). I have seen positive clonus mild CP cases before and not over looked that kind of thing, which is not to say that I may not have over looked something this time...the one thing that rings bells is the spontaneous nature of the spasm like (it's not really very rigid) state.....but there appears to be nothing else going along with it. I will be seeing him again and I will look specifically at the reflexes, but he is not hypersensitive.
    regards Phill Carter
     
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