Ayse Serdaroglu

Evaluation of Bone Mineral Metabolism in Children Receiving Carbamazepine and Valproic Acid

Dual energy X-ray absorptiometry (DXA) was used to assess lumbar spine (L2-4) and femoral neck bone mineral density (BMD) in 36 children taking either carbamazepine or valproic acid for longer than one year, for generalized idiopathic epilepsy. Patients were matched with controls. Biochemical parameters of bone mineral metabolism were also measured. BMD values at both the femur neck and lumbar spine in both the carbamazepine and valproic acid groups were not significantly different from that of the control group. Serum levels of calcium were subnormal and alkaline phosphatase levels were high in the carbamazepine group. Urinary calcium levels were significantly lower in both groups than in the control group (p< or =0.05) and also significantly lower in the valproic acid group than in the carbamazepine group (p< or = 0.05). There were no other significant biochemical changes in either group. In conclusion, the results suggest that valproic acid and carbamazepine monotherapies have minimal effects on bone mineral metabolism, but routine monitoring of risk and consideration of prophylactic vitamin D supplementation is important.

Prevalence of cerebral palsy in Turkish children between the ages of 2 and 16 years

The aim of this cross-sectional study was to determine the prevalence of cerebral palsy (CP) among children in Turkey between the ages of 2 and 16 years. Samples were selected from cities, towns, districts, and villages using the cluster sampling method; 41,861 children were selected. Data was collected by parental interview and physical examination. One hundred and eighty-six children were identified with CP. The prevalence of CP was determined as 4.4 per 1,000 live births and included postnatally acquired CP. Origin of CP was classified as prenatal in 49 (26.6%), perinatal/neonatal in 34 (18.5%), postnatal in 11 (5.9%), and unclassifiable in 90 participants (48.9%; data was unobtainable for two individuals). Type of CP was diplegia in 39.8% of children, hemiplegia in 28%, tetraplegia in 19.9%, ataxia in 5.9%, and dyskinetic in 6.4%. Prenatal factors were seen more frequently in the groups with a high socioeconomic status while perinatal factors were encountered more often in those with a low socioeconomic status (p<0.05). Place of residence and sex had no significant effect on the prevalence of CP (p>0.05). This cross-sectional study shows that the prevalence of CP in Turkey is higher than that in developed countries but the aetiology is probably similar. Although the high prevalence of CP in Turkey could originate from an increased level of obstetric and neonatal problems, the lack of a possible aetiological factor in approximately half the children suggests that the high level might also be due to other factors, such as genetic disorders.

Serum Insulin, Leptin, and Neuropeptide Y Levels in Epileptic Children Treated With Valproate

Weight gain is a common side effect of valproate treatment. The potential mechanisms of valproate-associated weight gain are not yet clear. Decreased blood glucose level, impairment of β-oxidation of fatty acids, and increased insulin levels are some of the possible mechanisms. The aim of the present study is to evaluate the role of insulin, leptin, and neuropeptide Y in valproate-related weight gain in epileptic children. In 20 epileptic children treated with valproate before treatment and after a follow-up period of 3 and 6 months, body mass index and fasting insulin glucose ratio were calculated and serum glucose, insulin, cortisol, leptin, and neuropeptide Y levels were measured. At the end of 3 months, the mean body mass index values and the mean serum insulin, fasting insulin glucose ratio, and neuropeptide Y levels increased, whereas the serum glucose levels decreased. After 6 months of treatment, the mean serum cortisol and leptin levels were high, in addition to the body mass index, neuropeptide Y, and fasting insulin glucose ratio. These results suggest that weight gain during valproate treatment might be related to low glucose and high insulin, cortisol, leptin, and neuropeptide Y levels. (J Child Neurol 2005;20:848—851).

Do knowledge of, perception of, and attitudes toward epilepsy affect the quality of life of Turkish children with epilepsy and their parents?

The main goal of this study was to evaluate knowledge of, perceptions of, and attitudes toward epilepsy and then to correlate knowledge with quality of life and stigmatization of children with epilepsy and their families. Specific questionnaires were administered to children aged 8 to 17 with epilepsy (n=220) and their parents (n=313). Poor school performance, less social support, less self-esteem, higher anxiety, greater stigmatization, and more depressive symptoms were documented in children who were less knowledgeable (P<0.05). Parents were found to be more knowledgeable about the antiepileptic drugs used, understanding both the effects and the side effects of the medications (P<0.05). Family activities were less restricted if they were more knowledgeable and these parents reported worrying less about their children (P<0.05). Knowledge about epilepsy is associated with less perceived stigmatization and social isolation, as well as fewer depressive symptoms and misperceptions.

Evaluation of Bone Turnover in Epileptic Children Using Oxcarbazepine

This study evaluated the effects of oxcarbazepine monotherapy on bone turnover in prepubertal and pubertal children. Thirty-four newly diagnosed pediatric patients with normal bone mineral density, serum biochemical markers of bone formation, and hormonal markers participated. Levels of 25-hydroxyvitamin D were significantly decreased after therapy compared with baseline values. Levels of gamma-glutamyl transferase, phosphorus, alkaline phosphatase, osteocalcin, parathyroid hormone, and calcitonin had increased. However, only changes in osteocalcin and gamma-glutamyl transferase levels were statistically significant compared with baseline values. Drug-induced osteopenia was evident in 3 patients with z scores of bone-mineral density less than -2.0, whereas these patients had z scores of less than -1.5 before treatment. Although 18 months of oxcarbazepine treatment exerted slightly adverse effects on bone metabolism, the effect seems insignificant in children with normal bone-mineral density. Although alterations in bone metabolism do not always suffice to explain the decrease in bone-mineral metabolism, we think that patients with osteopenia before the initiation of oxcarbazepine therapy should be followed carefully, especially in long-term treatment.

Prevalence of Epilepsy in Turkish Children Between the Ages of 0 and 16 Years

The aim of this cross-sectional study was to determine the prevalence of epilepsy in Turkey among children between the ages of 0 and 16 years. The study population consisted of 24,773,569 children living in Turkey. Because the prevalence of childhood epilepsy is reported to be 0.001 to 1% in the literature, the sample size was determined as 48,260, with 0.05 error type I and 0.10 error type 2 (power 0.90), and the effect size was 2. With the cluster sampling method, samples were selected from cities, towns, districts, and villages, and 46,813 (97%) children were reached. The study questionnaire contained sections with individual informational questions and questions for the selection of suspected epilepsy cases and physical examination results. The epilepsy classification was designed according to the classification of the International League Against Epilepsy (ILAE). The prevalence of epilepsy was determined as 0.8%; 55.2% of the subjects with epilepsy were grouped as generalized, 39% as partial, and 5.8% as unidentified. Age, place of residence, route of delivery, place of delivery, and social and economic status had no statistically significant effect on the development of epilepsy. Male gender, preterm, and post-term delivery increased the risk of developing epilepsy. Early diagnosis and treatment of epilepsy, as well as the education of health workers and families, are very important. (J Child Neurol 2004;19:271-274).

The evaluation of thyroid functions, thyroid antibodies, and thyroid volumes in children with epilepsy during short-term administration of oxcarbazepine and valproate

Summary:  Purpose: The aim of this study was to evaluate the effects of short‐term oxcarbazepine (OXC) and valproate (VPA) monotherapy on thyroid functions in children.

Thyroid function and volume in epileptic children using carbamazepine, oxcarbazepine and valproate

Background: The aim of the present study was to investigate the effects of carbamazepine (CBZ), oxcarbazepine (OXC), and valproic acid (VPA) on thyroid function and volume in epileptic children.

Functional Brain Imaging in Sydenham's Chorea and Streptococcal Tic Disorders

Group A streptococcal infections cause a wide range of neuropsychiatric disorders, such as Sydenhams chorea, tics, obsessive-compulsive disorders, and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Structural (computed tomography and magnetic resonance imaging) and functional (positron emission tomography, single-photon emission computed tomography) imaging studies in patients with Sydenhams chorea have suggested reversible striatal abnormalities. The objective of this study was to investigate the cerebral perfusion patterns of the subcortical structures by using hexamethylpropylenamine oxime single-photon emission computed tomography (HMPAO-SPECT) in seven cases of Sydenhams chorea and two cases of streptococcal tic disorder. HMPAO-SPECT studies revealed a hyperperfusion pattern in two and a hypoperfusion pattern in five of the chorea patients and in two patients with tic disorder. The results are discussed in relation to the duration and severity of the symptoms and the response to therapy. Functional imaging findings can be variable in Sydenhams chorea, and hyperperfusion of the striatum and thalamus could be an indicator of the response to therapy and the severity of symptoms. However, the number of cases so far investigated by either SPECT or positron emission tomography is still too limited to draw any firm conclusions. (J Child Neurol 2004;19:387-390).

Assessment of citrullinated myelin by 1H-MR spectroscopy in early-onset multiple sclerosis.

BACKGROUND AND PURPOSE: Myelin instability and citrullinated myelin basic protein have been demonstrated in the brains of patients with chronic and fulminating forms of multiple sclerosis (MS). Our aim was to trace citrulline in the brains of patients with early-onset MS by using proton MR spectroscopy (1H-MR spectroscopy). MATERIALS AND METHODS: A short-echo single-voxel 1H-MR spectroscopy by using the point-resolved proton spectroscopy sequence was performed in 27 patients with MS and 23 healthy subjects. Voxels of interest were chronic demyelinating lesions (CDLs, n = 25) and normal-appearing white matter (NAWM, n = 25) on T2-weighted imaging, and when available in patients with MS, enhancing demyelinating lesions (EDLs, n = 8). Frontal white matter (WM) was studied in control subjects. N-acetylaspartate, choline, and myo-inositol (mIns)-creatine (Cr) ratios and the presence of a citrulline peak were noted. RESULTS: Citrulline peaks were more frequently observed in patients with MS than in control subjects (P = .035), located in the NAWM in 8/25 (32%), in CDLs in 7/25 (28%), and in EDLs of 1/8 (12.5%) patients with MS. The presence of citrulline and measured metabolite/Cr ratios was not related to age at imaging, age at disease onset, duration of disease, or number of relapses. There was no significant metabolic difference between the NAWM of patients with MS and the WM of the control subjects. mIns/Cr was significantly greater in CDLs compared with the NAWM of patients with MS and the WM of healthy subjects. CONCLUSIONS: Citrulline was more frequently identified in the brains of patients with early-onset MS than in healthy subjects by 1H-MR spectroscopy, suggesting an association of increased citrullination of myelin proteins with demyelinating diseases.