Ref Number = PITIKA-ASPR0405
Auza Flora O. Alba, MD, Nida A. Guiao, MD
This case report is presented for its clinical significance as it is the first case of Sandifer Syndrome confirmed at the National Children’s Hospital (NCH). Key points will be presented on its clinical manifestation, approach to diagnosis, and management.
Case description: 
This reports a case of a 2-month-old male with generalized epilepsy secondary to craniosynostosis maintained on phenobarbital and phenytoin, presenting with stiffening of extremities and arching of the back during feeding since first day of life. He was admitted for the second time at NCH for bronchopneumonia, moderate; epilepsy, generalized secondary to craniosynostosis. Ampicillin (200mg/kg/day) and gentamicin (4mg/kg/day) were started, completing seven days of treatment. He was referred to neurology service for co-management. Phenobarbital (5mg/kg/day) and phenytoin  (5mg/kg/day) were continued. On the second hospital day, patient had one episode of post-tussive vomiting with allegedly three episodes of seizures described as stiffening of extremities, jerky movements, with arching of the back. On the third and fourth hospital day, he still had seizure episodes with the same characteristics despite being maintained on anti-epileptic drugs. He was then referred back to neurology service and the diagnosis of Sandifer Syndrome was considered. Nasogastric tube was inserted and omeprazole was started. Upper GI series was done revealing one episode of high-grade gastroesophageal reflux confirming the diagnosis of Sandifer Syndrome. The patient was discharged improved after eight days of hospitalization, with ranitidine (4mg/kg/day) and domperidone (1mg/kg/day) as home medications. The patient since then had regular follow-up with neuro and GI services, with decreased episodes of stiffening of extremities and resolution of the jerky movements and arching of the back. 
Health care workers should be made aware of this rare condition as the success of the management lies on the early recognition and treatment of the gastro-esophageal reflux found in this condition.
Keywords: epilepsy, generalized, sandifer syndrome, craniosynostosis
Disclaimer: The Views and opinions expressed in the articles are of the authors and not of the journal.
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