Darto Saharso

Unusual location of fibrous plaque in Indonesian child with tuberosclerosis complex

Tuberosclerosis complex (TSC) is one of the most frequent genetic causes of epilepsy. A 3-year-old boy was reffered to Soetomo Hospital, Surabaya, Indonesia with chief complain of intractable seizures. The seizures were frequent and various in type. The skin present red dome shaped papules on face and smooth, firm, nodular or fleshy lesions referred to fibrous plaque on gum, right tarsal and right hallux region. Tarsal and hallux region were unusual skin collagenous fibroma area found in TSC. Five white macules with diameter 4-5mm were also found on the trunk. Electroencephalography resulted epileptiform discharges originating from left temporal posterior and right temporal. Head MRI showed multiple tubers at bilateral cortical-subortical fronto-temporo-parieto-occipital. The patient was diagnosed as tuberous sclerosis and received 3 types of anti epileptic seizure drugs (levetiracetam, carbamazepine and vigabatrin). The treatment resulted decrease of seizure frequency.

Serum neuron specific enolase is increased in pediatric acute encephalitis syndrome

Purpose This study aimed to investigate whether serum neuron-specific enolase (NSE) was expressed in acute encephalitis syndrome (AES) that causes neuronal damage in children. Methods This prospective observational study was conducted in the pediatric neurology ward of Soetomo Hospital. Cases of AES with ages ranging from 1 month to 12 years were included. Cases that were categorized as simple and complex febrile seizures constituted the non-AES group. Blood was collected for the measurement of NSE within 24 hours of hemodynamic stabilization. The median NSE values of both groups were compared by using the Mann-Whitney U test. All statistical analyses were performed with SPSS version 12 for Windows. Results In the study period, 30 patients were enrolled. Glasgow Coma Scale mostly decreased in the AES group by about 40% in the level ≤8. All patients in the AES group suffered from status epilepticus and 46.67% of them had body temperature >40℃. Most of the cases in the AES group had longer duration of stay in the hospital. The median serum NSE level in the AES group was 157.86 ng/mL, and this value was significantly higher than that of the non-AES group (10.96 ng/mL; P<0.05). Conclusion AES cases showed higher levels of serum NSE. These results indicate that serum NSE is a good indicator of neuronal brain injury.