Durriyah Sinno

Quality of life after surgery for intractable partial epilepsy in children: A cohort study with controls

PURPOSE Investigate if quality of life (QOL) normalizes on long-term follow-up after surgery for partial epilepsy in children. METHODS This is a cohort study with controls in which a consecutive cohort of nineteen 2-14-year-old children who underwent focal resections for intractable partial seizures between 1996 and 2006, were matched with 19 non-surgery intractable partial epilepsy patients, and with 19 healthy subjects. The two epilepsy groups were matched for age, sex, socio-economic status (SES), cognitive level, seizure type, and seizure frequency. The healthy group was matched with the two epilepsy groups for age, sex, SES, and cognitive level. QOL was assessed using the QOLCE (Quality of Life in Childhood Epilepsy Questionnaire). RESULTS In the surgery group (follow-up 3.84+/-2.26 years), 78.9% had Engel class-I versus 21.1% in non-surgery (p=0.01) (follow-up 3.44+/-2.95 years). Surgery patients were similar to healthy subjects in the social, emotional, cognitive, behavioral, and overall QOL (p>0.05) but had lower scores in the total QOL, physical, and health domains (p<0.05). Surgery patients scored better than non-surgery in the behavioral domain and the HASES (Hague Side Effects Scale) score (p<0.05). Non-surgery patients scored worse than healthy in total QOL, physical, behavioral, health, and overall QOL (p<0.05). IQ, HASS (Hague Seizure Severity Scale), and HASES scores were positively associated with total QOL score (p<0.05). Subgroup analysis on seizure-free surgery patients showed that they did not differ from healthy subjects in any of QOL domains (p>0.05, power>0.8). CONCLUSION Our data indicate that epilepsy surgery for partial seizures in children is associated with better QOL as compared to children with intractable epilepsy who are not operated on, and suggest that in those who achieve seizure freedom normal QOL may at least potentially be possible.

RESPONSE OF INFANTILE SPASMS TO LEVETIRACETAM

Levetiracetam is a suitable drug for investigation in infantile spasms (IS) because it is effective against multiple seizure types, does not have systemic toxicity, has favorable kinetics, and had efficacy against IS in two previous cases.1–3 Here we report our experience in seven cases. ### Methods. Seven patients (six boys) were studied. Inclusion criteria were IS refractory to ≥2 antiepileptic drugs (AEDs) including vigabatrin and ACTH unless either was contraindicated due to the patients medical status and family willing and able to accurately report seizure frequency and side effects. Exclusion criteria were history of other significant serious medical disease, history of poor compliance, and use of an investigational drug within <30 days of levetiracetam. Dose was 20 mg/kg/day then increased in weekly increments to 80 mg/kg/day, then individualized. Follow-up was once/month starting 1 month before levetiracetam and for 3 months after starting it, then once/3 months up to 12 months, unless the patient was dropped out due to the necessity of stopping levetiracetam …

Ages and Stages Questionnaires: Adaptation to an Arabic speaking population and cultural sensitivity

BACKGROUND Early detection of developmental delay is essential to initiate early intervention. The Ages and Stages Questionnaires (ASQ) correlate well with physicians assessment and have high predictive value. No such tool exists in Arabic. AIMS Translate and test the applicability and reliability of Arabic translated Ages and Stages Questionnaires (A-ASQ) in an Arabic speaking population. METHODS 733 healthy children were assessed. ASQ-II for 10 age groups (4-60 months) were translated to Arabic, back translations and cultural adaptation were performed. Test-retest reliability and internal consistency were evaluated using Pearson Correlation Coefficient (CC) and Cronbachs alpha (Cα). Mean scores per domain were compared to US normative scores using t-test. RESULTS A-ASQ, after culturally relevant adaptations, was easily administered for 4-36 months age groups but not for 4-5 year old due to numerous cultural differences in the later. For the 4-36 month age groups Pearson CC ranged from 0.345 to 0.833. The internal consistency coefficients Cα scores ranged from 0.111 to 0.816. Significant differences were found in the mean domain scores of all age groups between Lebanese and US normative sample (p-value <0.001) with some exceptions in gross motor, fine motor and personal social domains. CONCLUSION A-ASQ was easily translated and administered with acceptable internal consistency and reliability in the younger age groups. It proved to be culturally sensitive, which should be taken into consideration when adapting such tool to non-western populations.

Long-term patterns of weight changes during topiramate therapy: an observational study.

Our aims were to document long-term weight changes during topiramate therapy up to 5 years and to determine predictors of these changes. ### Methods. A cohort of children and adults started on topiramate during 1997 to 2002 was studied. Follow-up was for 1 to 5 years, until the patient discontinued topiramate or until the end of the study on December 31, 2005. Topiramate was started then adjusted according to clinical practice criteria. For most, this was 25 mg/day (1 week), then increased by 25 mg/day each week until 50 mg BID. Further adjustments were individualized. Inclusion criteria were definite diagnosis of epilepsy, failure of at least 2 antiepileptic drugs (AEDs), ability to come for regular follow-up, and topiramate judged to be appropriate. Exclusion criteria were preexisting eating disorder, presence of metabolic abnormalities known to affect weight, and inadequate follow-up. The following were collected at baseline and at each follow-up performed as a rule once every 3 months: age, gender, weight, height, topiramate dose, and concomitant medications (valproate, other AEDs). Baseline body mass index (BMI) (kg/m …

A complex breastfeeding promotion and support intervention in a developing country: study protocol for a randomized clinical trial.

BackgroundBreastfeeding has countless benefits to mothers, children and community at large, especially in developing countries. Studies from Lebanon report disappointingly low breastfeeding exclusivity and continuation rates. Evidence reveals that antenatal breastfeeding education, professional lactation support, and peer lay support are individually effective at increasing breastfeeding duration and exclusivity, particularly in low-income settings. Given the complex nature of the breastfeeding ecosystem and its barriers in Lebanon, we hypothesize that a complex breastfeeding support intervention, which is centered on the three components mentioned above, would significantly increase breastfeeding rates.Methods/DesignA multi-center randomized controlled trial. Study population: 443 healthy pregnant women in their first trimester will be randomized to control or intervention group. Intervention: A “prenatal/postnatal” professional and peer breastfeeding support package continuing till 6 months postpartum, guided by the Social Network and Social Support Theory. Control group will receive standard prenatal and postnatal care. Mothers will be followed up from early pregnancy till five years after delivery. Outcome measures: Total and exclusive breastfeeding rates, quality of life at 1, 3 and 6 months postpartum, maternal breastfeeding knowledge and attitudes at 6 months postpartum, maternal exclusive breastfeeding rates of future infants up to five years from baseline, cost-benefit and cost-effectiveness analyses of the intervention. Statistical analysis: Descriptive and regression analysis will be conducted under the intention to treat basis using the most recent version of SPSS.DiscussionExclusive breastfeeding is a cost-effective public health measure that has a significant impact on infant morbidity and mortality. In a country with limited healthcare resources like Lebanon, developing an effective breastfeeding promotion and support intervention that is easily replicated across various settings becomes a priority. If positive, the results of this study would provide a generalizable model to bolster breastfeeding promotion efforts and contribute to improved child health in Lebanon and the Middle East and North Africa (MENA) region.Trial registrationCurrent Controlled Trials ISRCTN17875591

MOTOR VARIANT OF CHRONIC INFLAMMATORY DEMYELINATING POLYNEUROPATHY IN A CHILD

Only 2 cases of pure motor chronic demyelinating inflammatory polyneuropathy in the pediatric age group have been reported in the literature. We report on a motor variant of chronic demyelinating inflammatory polyneuropathy with anti-ganglioside antibodies, diagnosed in a 5-year-old girl who presented with progressive motor weakness over a period of 12 months with no sensory involvement. She initially responded partially to intravenous immunoglobulin therapy (1 gm/kg/month for 6 months), and then demonstrated sustained but incomplete improvement on chronic prednisone therapy (1-2 mg/kg/day), on which she has continued since 1 year and 4 months after her initial presentation 3 years ago.

The pattern of self-poisoning among Lebanese children and adolescents in two tertiary care centres in Lebanon

Aim: Self‐poisoning in childhood and adolescence is a major problem for health authorities all over the world. The objective of this study was to determine the pattern of self‐poisoning in Lebanese children and adolescents.

Ophthalmologic Outcomes of Children Born Premature Without ROP: Correlations With Gestational Age and Psychomotor Development

PURPOSE To study ophthalmological outcomes of premature children with no retinopathy of prematurity (ROP) and correlate with neurodevelopmental outcomes. METHODS A total of 69 former preterm infants were evaluated at 2 to 7 years of age. Detailed ophthalmologic examinations were performed. Neurodevelopment was assessed using the Peabody Developmental Motor Scale and Wechsler Preschool and Primary Scale of Intelligence. Another 69 healthy children served as controls. RESULTS The 69 preterm children (38 of 69 boys) and 69 controls (38 of 69 boys) had a mean age of 4.9 ± 1.5 and 4.9 ± 1.4 years, respectively. Compared to controls, preterm infants had vision impairment of 19% versus 1.4% (P = .001), hyperopia of 87% versus 98.5% (P = .21), myopia of 11% versus 1.4% (P = .017), and astigmatism of 39% versus 30.4% (P = .37). Children with any motor disability tended to have worse vision. CONCLUSIONS In the absence of ROP, hyperopia was more common in infants 32 weeks or older who weighed more than 1,500 g at birth; other vision problems were similar in subgroups. This may represent impending myopia in those younger than 32 weeks weighing less than 1,500 g. [J Pediatr Ophthalmol Strabismus. 2017;54(1):32-38.].

Enhancing Childhood Development in Children with Cerebral Palsy and Other Disorders

Infants and children who manifest motor dysfunction early in life have decreased ability to interact with their environment which results in less learning opportunities; hence, the consequent cognitive impairment often seen in these circumstances. During this period of brain growth, the brain plasticity allows the rewiring and the creation of new synapses that would compensate for the motor and cognitive deficits [1]. Therefore, early intervention to limit the physical disability and encourage motility, especially before the age of three has the potential to increase the chances of limiting or overcoming further developmental disabilities and promoting alternative learning methods to accomplish challenging tasks.

Exacerbation of vocal tics after temporal lobectomy

We describe a woman with intractable temporal lobe epilepsy secondary to dysgenesis of the left temporal lobe who had a marked and long-term exacerbation of her preexisting vocal tics after a temporal lobectomy that completely controlled her seizures. The patient was determined to have right-sided speech dominance by the Wada test. This is, to our knowledge, only the second reported case of exacerbation of tics after resection of the nondominant temporal lobe.