A
The handwritten note appears to list known conditions:
Cornelia de Lange syndrome
Epilepsy
PEG fed (feeding tube)
Small Patent ductus arteriosus (PDA)
Syringomyelia
Clinical picture you gave
9-year-old girl
Right foot pain
Difficult (refractory) epilepsy
Repetitive yawning
Key interpretation
1. Repetitive yawning + epilepsy
This is important: repetitive yawning can be a seizure manifestation, especially in focal seizures (often temporal lobe or brainstem-related).
It may represent:
A seizure aura
Autonomic seizure activity
Or part of a non-convulsive seizure
👉 In a child with difficult epilepsy, this should be treated as possible ongoing seizure activity until proven otherwise.
2. Right foot pain
Given the background, consider:
Neuropathic pain from Syringomyelia
Musculoskeletal issue (less likely if chronic/neurologic signs present)
Focal seizure-related sensory symptoms (rare but possible)
3. Big picture concern
This combination raises concern for:
Poorly controlled focal epilepsy with atypical features
Possible neurological progression (given syringomyelia history)
Need to rule out non-convulsive status epilepticus
What should be done urgently
EEG (ideally video EEG) → check if yawning = seizure activity
Neurology review (urgent if frequent yawning episodes)
Consider MRI brain/spine if new symptoms (foot pain progression)
Review anti-epileptic medications and compliance
Red flags 🚨
Seek urgent care if:
Yawning episodes are frequent or clustered
Altered awareness or unresponsiveness
New weakness, gait change, or worsening pain
If you want, I can help you figure out whether the yawning episodes you’re seeing are likely seizures (you can describe exactly what happens step by step).
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