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My friends baby who is 7 months keeps moving his head side

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to side and also looking...
My friends baby who is 7 months keeps moving his head side to side and also looking up a lot. He has been tested and has been cleared for epilepsy and seizures. He has also been monitored over night and nothing showed up. All blood and lab work comes back negative. What else could this be?
Submitted: 8 years ago.Category: Pediatrics
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Answered in 9 minutes by:
1/6/2010
Pediatrician: Dr. David, Board Certified Pediatrician replied 8 years ago
Dr. David
Dr. David, Board Certified Pediatrician
Category: Pediatrics
Satisfied Customers: 1,281
Experience: Board-certified pediatrician at children's hospital, former chief resident, multiple publications
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Hello and thank you for the post. I am sorry to hear that this boy is having this issue.

May I ask a few questions please: is the child otherwise developing and growing well? Does he take any medications? What do these episodes look like exactly? How often do they occur and how long do they last? Has the child seen a pediatric neurologist? Has he had any imaging of the brain such as an MRI?

Please let me know and I will get back to you. Thank you, ***** *****
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Customer reply replied 8 years ago
Thank you for such a quick response. Yes, he is developing and growing well. No medications other than he had immunization shots at the time he needed those due to age. The episodes are constant when he's awake. He is always moving his head side to side and his eyes look up almost like they are rolling up, however, we you put something in front of him he does focus on it. Yes, he has seen a nuerologist and is now waiting for insurance to ok to see an eye doctor. He has also had an MRI and that was clear also.
Pediatrician: Dr. David, Board Certified Pediatrician replied 8 years ago
Thank you for the further information. I especially appreciate the level of detail you have provided. I am going to be honest and say that based on your description i am not sure what these episodes are. Clearly the fact that he is developing well is very reassuring. I assume that

(1) an EEG was done and he had these during the EEG and the EEG was normal
(2) the pediatric neurologist saw these episodes as well
(3) he does not do this during his sleep

Please let me know. Thank you, ***** *****
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Customer reply replied 8 years ago
That is all correct. All tests done at CHOC hosp. in Orange County, CA. He is now crossing his eyes now too. His doc wanted him to see an Opthomogist (spelling) but waiting for approval.
Pediatrician: Dr. David, Board Certified Pediatrician replied 8 years ago
At this point I am sorry to say that I can't give you a more definitive diagnosis but I certainly agree with the workup being done right now. I think seeing a pediatric ophthalmologist is the next logical step. Clearly watching this baby's development very closely over the next few months is very important.

I am sorry that I was not able to give you a more definitive diagnosis. If you would like me to opt-out to see if one of the other pediatricians can do so, please just let me know. Thank you and best of luck to this boy. Thank you, ***** *****
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Customer reply replied 8 years ago
please send to another doctor also. We are very concerned and any other help and ideas would greatly be appreciated. Thank you again for everything.
Pediatrician: Dr. David, Board Certified Pediatrician replied 8 years ago
You are welcome. I will opt-out. Please reply to this with "relist". If none of the other pediatricians reply in the next several hours, it is likely that they too have no specific diagnosis.

Good luck, Dr David
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Customer reply replied 8 years ago
Relist
Pediatrician: Dr. Davidson, Board Certified Pediatrician replied 8 years ago
Dr. Davidson
Dr. Davidson, Board Certified Pediatrician
Category: Pediatrics
Satisfied Customers: 1,058
Experience: Board Certified Specialist in Pediatrics, Allergy, Asthma & Immunology
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Hi there, and thanks for your question. I reviewed your text above, as well as the MD's responses, and I thought I'd add a few things. I trained in Southern California, and I'm pleased to hear that you're being treated at CHOC -- it's an excellent place with great doctors, and I hope they help figure things out. In reviewing your comments, I thought I'd offer a few conditions that are associated with seizure-like activity and eye movements. I agree with the other Pediatrician, it's important that you see an Pediatric Ophthalmologist. Nonetheless, here are a few conditions that can occur in 7 month-olds, and are associated with normal EEGs:
Spasmus Nutans
Spasmus nutans consists of a triad of symptoms including nystagmus, head nodding, and head tilt. The symptoms can wax and wane during the course of the day and, therefore, be confused with epileptic seizures. The onset of the symptoms is usually during the first few months of life. The cause of this disorder is unknown, although the triad has been associated with mass lesions at the optic chiasm or third ventricle. A head MRI scan should be obtained in these infants. Since you had one already, that is reassuring. When no abnormality is revealed, no further work-up or treatment is required. The symptoms usually resolve by age 5 years.
Oculomotor Apraxia
Oculomotor apraxia is a condition in which the child has impaired rapid eye movements. The child appears to have fixed eye positions although the visual system and eye movement ability are normal. Therefore, in order to view an object, the child will turn his head suddenly so as to move the direction of gaze. These peculiar head thrusts may be confused for epileptic seizures. The familial form of this apraxia is called Cogan's oculomotor apraxia. However, oculomotor apraxia can also be seen in other conditions like ataxia telangiectasia and lysosomal storage diseases.
Stereotypies
Stereotypic behaviors are repetitive movements such as head banging, head rolling, body rocking, and hand flapping. These behaviors can be seen in normal children but are more common in neurologically impaired infants. The behaviors may be seen while the child is awake, falling asleep, or even in early sleep stages. These behaviors are "self-stimulating" behaviors and often comfort or relax the child.
These are just a few additional possibilities. Obviously it's difficult to assess and evaluate your child online, but I'm glad to hear you're at a good facility. Feel free to ask any additional questions, and if you are satisfied with my answer, please click 'Accept.' Take care, Dr. Davidson
Dr. Davidson
Dr. Davidson, Board Certified Pediatrician
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