COW MILK PROTEIN ALLERGY ( CMPA) MIMICKING EPILEPTIC SEIZURE

Hi ,

SHARING WITH YOU ALL , COMMON BUT INTERESTING CASE

28 days old male baby came to our neonatal emergency department with complaints of abnormal posturing of limbs , arching of back , abdominal distension and not accepting feeds . Baby was referred from govt hospital in view of ? EPILEPTIC SEIZURES ? VIRAL ENCEPHALITIS . Immediately inj midazolam , loading dose of Inj Levipil , IV fluids , IV antibiotics and other supportive measures were given and shifted to NICU for further management . On general examination baby was euthermic , lethargic , irritable, with abnormal posturing . CNS examination showed hypertonia , arching of back and neck , pupils were bilateral equal and reactive , reflexes (++). Per Abdomen examination showed abdominal distension with increased bowel sounds , no organomegaly .other systems were normal .Blood Investigations , EEG and neuroimaging showed normal study, abdominal x ray showed dilated bowel loops. So we strongly suspected GERD with Infantile colic. History of formula feeding along with breastfeeding was present . Baby responded immediately to anti reflux , anticolic measures and probiotics. Formula feeds was stopped immediately . Exclusive breastfeeding was advised .Antibiotics and antileptic were immediately stopped. Baby was reinitiated breastfeeding within 12 hours of admission, proper counseling was done regarding GER , infantile colic , CMPA and about the measures to be taken . Baby was successfully discharged after 48 hours of admission with oral medications.

NOTE : Gastroesophageal reflux disease (GERD) and infantile colic secondary to Cow milk protein allergy (CMPA) can mimic epileptic seizure, and may be misdiagnosed as epilepsy. On the other hand, GERD can be more commonly seen in children with neurological disorders such as cerebral palsy (CP) , this co-incidence may complicate the management of patients by mimicking refractory seizures. Early diagnosis and management is very important as it prevents giving unnecessary medications to baby and also decreases the stress and panic state of parents.