Aycan Ünalp

Efficacy and Safety of IV Levetiracetam in Children With Acute Repetitive Seizures

BACKGROUND Levetiracetam has been proven to be effective in both partial and generalized seizures in children. However, few studies have reported its efficacy in the treatment of acute repetitive seizures. We aimed to investigate the efficacy and safety of levetiracetam in children with acute repetitive seizures. METHODS The medical records of children from the age of 1 month-18 years who received levetiracetam because of acute repetitive seizures in the pediatric intensive care unit between 2010 and 2013 were reviewed retrospectively. RESULTS Of the 133 patients, levetiracetam terminated seizures in 104 (78.2%). Side effects such as agitation and aggression were observed in three patients (2.2%). The likelihood of treatment failure was increased by four times by younger age at seizure onset; by six times in the individuals with neurological abnormalities; and by 22 times in the patients with West syndrome. The patients who used levetiracetam as the first treatment option for acute repetitive seizures had a longer duration of epilepsy, a higher rate of neurological abnormality, and a higher proportion of medically resistant epilepsy compared with the individuals who used levetiracetam as an add-on treatment to the other intravenous antiepileptic drugs. However, no differences were detected between these two groups in terms of treatment response. CONCLUSIONS Intravenous levetiracetam appears to be effective and safe in the treatment of acute repetitive seizures. Randomized clinical trials are needed to determine whether intravenous levetiracetam may replace other antiepileptic drugs as the first-line therapy in the management of acute repetitive seizures.

Lack of association of childhood partial epilepsy with brain derived neurotrophic factor gene.

Brain-derived factor (BDNF) is a member of neurotrophin family and is localized and upregulated in areas implicated in epileptogenesis. Several lines of evidence make the BDNF gene a plausible candidate gene for predisposition to epilepsy. In this study, we tested that BDNF might be involved in the etiology of childhood PE. To assess whether BDNF gene C270T polimorphism could be implicated in vulnerability to PE, we conducted a case-control association analysis (112 partial epileptic and 100 controls) in Turkish children. Epileptic children were divided into two groups: 1—idiopathic (n = 85) and 2—symptomathic epilepsy (n = 27). There was no significant difference in genotypic distribution and allelic frequencies of the BDNF gene C270T polimorphism between the PE and control groups. However, the BDNF gene TT genotype was more frequently seen in the epileptic children (15 versus 11 patients, resp.). Interestingly, in the epilepsy group, both two children with TT genotype have posttraumatic epilepsy. The data indicate a possible association with the 270T genotype of the BDNF gene with a posttraumatic epilepsy. To draw any conclusion, further studies using larger sample sizes should be carried out in various ethnic populations in childhood epilepsies.

Evaluation of the relationship between migraine disorder andoral comorbidities: multicenter randomized clinical trial.

BACKGROUND/AIM Although migraine is a common disorder, there is a lack of research investigating the possible relationship between migraine and oral health. The aim of the present study was to explore the relationship between temporomandibular disorders, bruxism, dental caries, periodontal status, and migraine disorder in a multicenter, parallel, case-controlled clinical study. MATERIALS AND METHODS A total of 2001 participants were divided into two groups: migraineurs (nm = 998) and nonmigraineurs (nh = 1003). International Headache Societys Second Edition of International Classification of Headache Disorders and modified Migraine Disability Assessment surveys were administered to evaluate the level of migraine; a pretreatment questionnaire and the World Health Organization oral health assessment form were used to determine the oral comorbidities and their possible effects on DMFT index, gingival plaque index, existence of temporomandibular disorders, bruxism, and consistency of daily oral hygiene habits. RESULTS The mean age was 39.6 ± 10.5 years. Female patients seemed to experience migraine attacks more than male patients (64%). The frequency of gastroesophageal reflux was higher in migraineurs in comparison with nonmigraineurs (47%) and tooth wear and abrasion also seemed more frequent (76%). DMFT and plaque index scores showed significant differences for both groups. CONCLUSION There is a strong relationship between migraine and oral health status. The existence of reflux in addition to migraine leads to higher dental problems.

Role of Apolipoprotein E in Febrile Convulsion

Apolipoprotein E is consistently associated with the progression of some common human neurodegenerative diseases, e.g., epilepsy. We hypothesized that genetic variations in the apolipoprotein E gene have implications for susceptibility to, and prognoses in, febrile convulsion, which plays an apparent role in the development of epilepsy. We used the polymerase chain reaction and restriction enzyme digestion to characterize variations of the apolipoprotein E gene. Sixty-nine patients with febrile convulsion (simple/complex) and a corresponding cohort of healthy patients (n = 75) were used. There was no significant difference in genotypic distribution and allelic frequencies of the apolipoprotein E gene between the febrile convulsion and control groups. Comparing subpopulations of the febrile convulsion group (patients with simple and complex febrile convulsion), we noted that no patients with the epsilon3/epsilon4 genotype had complex febrile convulsions. The apolipoprotein E epsilon3/epsilon4 genotype was more frequently seen in the simple febrile than in the complicated febrile convulsion group (9 versus 0 patients, respectively). The data indicate an association with the epsilon3/epsilon4 genotype of the apolipoprotein E gene with a milder phenotype. Although apolipoprotein E4 is not a vulnerability factor regarding febrile convulsions, it seems effective in regard to prognoses.

Serum concentration of brain-derived neurotrophic factor in epileptic children.

There are interesting evidences for the involvement of the neurotrophin brain-derived neurotrophic factor in the mechanism of epileptogenesis. In this study we measured the serum concentrations of brain-derived neurotrophic factor in children with epilepsy and age-matched healthy controls. There was no statistically significant difference between the mean serum concentrations of brain-derived neurotrophic factor in epileptic children (13.8 ± 1.1 ng/mL) and age-matched healthy controls (13.9 ± 0.1 ng/mL). The mean concentration of serum brain-derived neurotrophic factor was not different between generalized epilepsy and partial epilepsy. We also did not find significant difference regarding the associated clinical features of epilepsy (the presence of history of febrile convulsion, cerebral palsy). However, epileptic children with mental retardation showed lower levels of brain-derived neurotrophic factor (P = 0.015). Here we studied serum brain-derived neurotrophic factor concentration in a group of children without an active epileptogenesis based on the clinical and electroencephalographic state. Brain-derived neurotrophic factor concentrations should be investigated in children with active epileptogenesis who had refractory epilepsy and epileptic encephalopathy.

High-fibre enteral feeding results in improved anthropometrics and favourable gastrointestinal tolerance in malnourished children with growth failure

The practical value of using fibre‐enriched enteral feeding regimens to rehabilitate malnourished children remains inconclusive. This study determined the usage patterns, gastrointestinal tolerance, anthropometrics and safety of high‐fibre enteral feeding in malnourished children with growth failure.

P117 – 2587: Assessment of patients who were admitted to pediatric intensive care unit with neurological disorders

Objective Pediatric neurocritical care is developing specialization within pediatric intensive care and pediatric neurology practice. Increased attention is also being paid to the broader application of neuromonitoring and neuroprotective strategies in the pediatric intensive care unit, in both primary neurological and primary non-neurological disease states. We aimed to assess the profile and prognosis of children with neurologic disorders, admitted into our Pediatric Intensive Care Unit (PICU) between 2011 and 2013. Methods In this retrospective study we enrolled 292 of 2843 children who were admitted to PICUwith neurologic disorder. Demographics, neurologic disorder variety, neuroradiologic results, EEG findings, externation status and causes of mortality – if exists – of all patients were documented. Results The study period was 3 years. 37.3% (n=109) of the patients were under 1 year old, 58% (n=170) were male. The most common neurologic disorder was convulsion (n=111), 75 of them were status epilepticus. Most common seizure type was generalized tonic clonic. 40.1% (n=117) of the patients were hospitalized more than 48 hours in PICU and 11.3% (n=33) patients were hospitalized more than 4 weeks. 276 patients had at least 1 neurodiagnostic assesment like cranial USG, cranial CT, cranial MRI. Major neurodiagnostic finding was cerebral atrophy with the persantage of 16.1 (n=47). 131 (44.9%) patients have sequelle formation after externation. 28 (9.6%) children with neurological disorders died in PICU. Conclusion Neurological disorders represent a large part of the activity in our PICU. Patients with congenital neurologic disorders and patients under age of three have higher risk of mortality in PICU. There is a huge necessity to improve the pediatric neurointensive care units in tertiary health centers. Pediatric neurointensive care is thus an emerging subspecialty that optimally functions by applying a broad collaborative effort among colleagues across multiple medical specialties. Innovations in clinical services, educational pathways, and research agendas need to be developed for neurologically handicapped children.

Kabuki-Make Up Sendromu: Olgu Sunumu

Kabuki make-up sendromu, ilk kez Niikawa ve Kuroki tarafindan tanimlanan multiplkonjenital anomaliler, mental retardasyon, karakteristik yuz gorunumu, iskelet anormallikleri, eklem laksisitesi, kisa boy, parmak ucu yastikciklarinin belirginlesmesi veanormal dermatoglifik patern ile karakterize bir durumdur. Japonya’da daha sik oldugubilinen bu sendrom dunyanin degisik bolgelerinden bildirilmektedir. Unutkanlik, asirihareketlilik ve konusma bozuklugu nedeniyle getirilen olgu, mental retardasyon,davranis ve fonolojik bozukluklara eslik eden atipik yuz gorunumu olan olgularda Kabukimake-up sendromunun da dusunulmesi gerektigine dikkati cekmek amaciylasunulmustur