Indian J Pediatr DOI 10.1007/s12098-014-1434-3
PICTURE OF THE MONTH
Recurrent Severe Ulcers Due to Seizures Sascha Meyer & Isabel Oster & Sylvia Peterlini & Ludwig Gortner & Georg Kutschke
Received: 9 January 2014 / Accepted: 20 March 2014 # Dr. K C Chaudhuri Foundation 2014
To the Editor: A two-year-old child presented with severe, painful oral ulcerations (Fig. 1). Comprehensive diagnostic work-up including infectious causes was unrevealing. Dystonia was excluded by lumbar puncture with normal neurotransmitters. Cerebral MRI scan was also normal. On EEG recording, epileptic discharges were noted during sleep (Fig. 2) with episodes of myoclonus, increased oral muscular tone, tongue-biting and bloody discharge from the oral cavity. In addition to local treatment and use of a bite guard, the child was started on levetiracetam and the dose was gradually increased to 30 mg/kg body weight. Subsequently, seizure control was achieved with disappearance of oral lesions. It is important to take into consideration a large variety of different causes for oral ulcers in children [1], including recurrent seizures [2, 3]. This is of great importance because in addition to local treatment and use of a bite guard, administration of anti-epileptic drugs is of utmost importance.
Fig. 1 Multiple oral and tongue ulcers in a 2-y-old girl
S. Meyer (*) : G. Kutschke Department of Pediatrics, Section Neuropediatrics, University Children’s Hospital of Saarland, Building 9, 66421 Homburg, Germany e-mail: [email protected] I. Oster : S. Peterlini : L. Gortner Department of General Pediatrics and Neonatology, University Hospital of Saarland, Building 9, 66421 Homburg, Germany
Fig. 2 Sleep EEG recording demonstrating seizure activity
Indian J Pediatr Contributions SM: Patient treatment, writing of the manuscript and will act as guarantor for this paper; SP and IO: Patient treatment and making the diagnosis; LG: In charge of patient treatment and contributed to making the correct diagnosis; GK: Performed EEG recordings and was responsible for EEG assessment.
Conflict of Interest None.
Role of Funding Source None.
References 1. Le Doare K, Hullah E, Challacombe S, Menson E. Fifteen-minute consultation: a structured approach to the management of recurrent oral ulceration in a child. Arch Dis Child Educ Pract Ed. 2013. doi:10. 1136/archdischild-2013-304471 [Epub ahead of print]. 2. Cerqueira DF, Vieira AS, Maia LC, Sweet E. Severe tongue injury in an adolescent with epilepsy: a case report. Spec Care Dentist. 2007;27:154–7. 3. Sanders BJ, Weddell JA, Dodge NN. Managing patients who have seizure disorders: dental and medical issues. J Am Dent Assoc. 1995;126:1641–7.
PICTURE OF THE MONTH
Recurrent Severe Ulcers Due to Seizures Sascha Meyer & Isabel Oster & Sylvia Peterlini & Ludwig Gortner & Georg Kutschke
Received: 9 January 2014 / Accepted: 20 March 2014 # Dr. K C Chaudhuri Foundation 2014
To the Editor: A two-year-old child presented with severe, painful oral ulcerations (Fig. 1). Comprehensive diagnostic work-up including infectious causes was unrevealing. Dystonia was excluded by lumbar puncture with normal neurotransmitters. Cerebral MRI scan was also normal. On EEG recording, epileptic discharges were noted during sleep (Fig. 2) with episodes of myoclonus, increased oral muscular tone, tongue-biting and bloody discharge from the oral cavity. In addition to local treatment and use of a bite guard, the child was started on levetiracetam and the dose was gradually increased to 30 mg/kg body weight. Subsequently, seizure control was achieved with disappearance of oral lesions. It is important to take into consideration a large variety of different causes for oral ulcers in children [1], including recurrent seizures [2, 3]. This is of great importance because in addition to local treatment and use of a bite guard, administration of anti-epileptic drugs is of utmost importance.
Fig. 1 Multiple oral and tongue ulcers in a 2-y-old girl
S. Meyer (*) : G. Kutschke Department of Pediatrics, Section Neuropediatrics, University Children’s Hospital of Saarland, Building 9, 66421 Homburg, Germany e-mail: [email protected] I. Oster : S. Peterlini : L. Gortner Department of General Pediatrics and Neonatology, University Hospital of Saarland, Building 9, 66421 Homburg, Germany
Fig. 2 Sleep EEG recording demonstrating seizure activity
Indian J Pediatr Contributions SM: Patient treatment, writing of the manuscript and will act as guarantor for this paper; SP and IO: Patient treatment and making the diagnosis; LG: In charge of patient treatment and contributed to making the correct diagnosis; GK: Performed EEG recordings and was responsible for EEG assessment.
Conflict of Interest None.
Role of Funding Source None.
References 1. Le Doare K, Hullah E, Challacombe S, Menson E. Fifteen-minute consultation: a structured approach to the management of recurrent oral ulceration in a child. Arch Dis Child Educ Pract Ed. 2013. doi:10. 1136/archdischild-2013-304471 [Epub ahead of print]. 2. Cerqueira DF, Vieira AS, Maia LC, Sweet E. Severe tongue injury in an adolescent with epilepsy: a case report. Spec Care Dentist. 2007;27:154–7. 3. Sanders BJ, Weddell JA, Dodge NN. Managing patients who have seizure disorders: dental and medical issues. J Am Dent Assoc. 1995;126:1641–7.
