Erdinç Yalçin

Changes in Skeletal Maturation and Mineralization in Children With Cerebral Palsy and Evaluation of Related Factors

Sixty-nine (28 females, 41 males) children with spastic cerebral palsy and 26 (13 females, 13 males) healthy children were included in the study. Total- and partial-body bone mineral content and bone mineral density values of patient and control subjects were measured by dual-energy x-ray absorptiometry. Left hand and wrist radiographs of all patients and right hand and wrist radiographs of 39 randomly selected patients were taken, and the bone ages of all radiographs were determined. In both female and male tetraplegics, bone mineralization values of lower extremities, where the mobility disorder and effects of absence of weight-bearing activity were maximal, were lower than those of controls and hemiplegics (P < .05). In 47 (68%) patients, left-side bone age values were below normal ranges for their ages, and the difference was statistically significant (P < .01). Our results indicate that motor function handicap affects skeletal mineralization adversely, and skeletal maturation is frequently delayed in children with cerebral palsy. We speculated that this delay might be a result of disrupted embryologic skeletal development due to hypoxic attack, which also causes the disease. (J Child Neurol 2001;16:425-430).

Effects of carbamazepine and valproate on brainstem auditory evoked potentials in epileptic children

Brainstem auditory evoked potentials (BAEPs) were recorded in 18 epileptic children receiving carbamazepine and 10 epileptic children receiving valproate. BAEPs were recorded before the administration of antiepileptic drugs (AEDs) and 13 months later during which the children received AEDs. Statistical analysis of peak latencies and interpeak intervals of waves I–III–V were made. Carbamazepine treatment resulted in prolongation of peak latencies of waves I–III–V and interpeak intervals I–III and I–V. Valproate monotherapy, on the other hand, caused no consistent changes on BAEP. On the basis of these results we suggest that chronic carbamazepine therapy exerts a suppressive influence on the auditory pathways, both peripherally at the level of the cochlea and/or auditory nerve, and centrally at the brainstem.

The effects of long-term anticonvulsive treatment on serum lipid profile.

Serum lipids were determined in 10 untreated patients with recently diagnosed epilepsy, 21 patients treated with carbamazepine (CBZ), 10 patients treated with valproate (VPA) and in 15 healthy children. In relation to the controls, patients receiving CBZ showed increased serum high‐density lipoprotein cholesterol (HDLc), apolipoprotein A (Apo‐A) and apolipoprotein B (Apo‐B). Patients receiving VPA showed increased Apo‐B levels. There were no significant differences in total cholesterol (TC), triglycerides (TG), low‐density lipoprotein cholesterol (LDLc) or very low‐density lipoprotein cholesterol (VLDLc) between all groups. The changes in lipid metabolism may be associated with the induction of liver enzymes during anti‐epileptic drug metabolism. The CBZ‐induced change in serum lipid levels was considered to be a possible factor against atherosclerosis and coronary heart disease in epileptic patients.

Serum thyroid hormones and pituitary response to thyrotropin-releasing hormone in epileptic children receiving anti-epileptic medication

Thyroid hormones and pituitary function were assessed in 49 children with epilepsy who were receiving either a single medication of carbamazepine, phenobarbital and valproate or a combination of carbamazepine with phenobarbital or valproate. All therapeutic regimens except valproate monotherapy were associated with low levels of circulating thyroxine, free tri‐iodothyronine and free thyroxine. Carbamazepine with valproate was associated with the lowest serum concentration of thyroid hormones. It seems probable that accelerated hormone metabolism is responsible for these hormonal changes. However, all drug regimens also had effects on the function of the hypothalamic pituitary axis. Because of these findings, thyroid hormones should be checked frequently during anti‐epileptic drug treatment, although clinical hypothyroidism was not seen in our patients.

Effect of valproate and carbamazepine on visual evoked potentials in epileptic children

The effects of carbamazepine (CBZ) and sodium valproate (SV) monotherapy on visual evoked potentials (VEP) were studied in 18 epileptic children receiving CBZ and nine epileptic children receiving SV. Pattern reversal VEP were determined before the administration of antiepileptic drugs (AED) and 1 year later during which time the patients had received AED. The VEP amplitude showed no consistent changes after 1 year of CBZ and SV therapy, but VEP P‐100 latencies were significantly prolonged after 1 year of CBZ therapy. We conclude that CBZ causes a slowing down of central impulse conduction and that VEP is useful to evaluate the effects of AED within the central nervous system.

Influence of long-term carbamazepine treatment on thyroid function

We have studied the effects of carbamazepine on thyroid function in sixteen recently diagnosed epileptic children and thirteen epileptic children receiving long‐term carbamazepine therapy and compared these findings with the thyroid function of thirteen healthy control subjects. Thyrotropin (TSH), tri‐iodothyronine (T3), thyroxine (T4), free tri‐iodothyorinine (FT3) and free thyroxine (FT4) serum levels were determined in both recently diagnosed but as yet untreated epileptic children and normal controls. These hormone levels were determined again after 2 months of treatment and 12 months of treatment in epileptic children. No statistically significant difference was found in the endocrine parameters of untreated epileptic children and the normal control group. After both 2 months and 12 months of carbamazepine therapy, serum levels of T4, FT4 and FT3 were found to be low, but the serum T3 concentration was unaffected. Baseline TSH levels were not changed during carbamazepine therapy either. Serum TSH levels increased rapidly after thyrotropin‐releasing hormone stimulation in both the before and 12 months after carbamazepine treatment groups, but the response was higher in the 12 months treatment group. The findings of the present study suggest that accelerated hormone metabolism is responsible for hormonal changes found in patients treated with carbamazepine. Carbamazepine also had effects on the function of the hypothalamo‐pituitary axis.

Case Report of Homocystinuria: Clinical, Electroencephalographic, and Magnetic Resonance Imaging Findings

Patients with homocystinuria come to medical attention usually because of ophthalmologic complications, psychiatric difficulties, and/or thromboembolic accidents. Cerebral thromboembolic complications in the form of either infarction or hemorrhages can easily be diagnosed by their specific clinical and neuroradiologic findings. It is somewhat surprising, however, that although mental retardation of various degrees is present in most of these patients, data on cerebral workups in those who did not show acute cerebral thromboembolic complications is very scarce. In this report, we describe a child who presented with bilateral ectopia lentis and psychomotor retardation.

Joubert Sendromu: Olgu Bildirimi

Joubert syndrome cardinal findings of which are hypotonia severe motor and developmental retardation and which is accompanied with abnormal respiratory and ocular movements is a rare neurogenetic syndrome Cerebellar vermis disgenesis of various severity is detected in cases with this syndrome It is inherited autosomal recessively The syndrome the prognosis of which is highly correlated with exsistance of associated anamalies has poor coarse and short survival period A 2 years 9 months old boy with this syndrome presenting with convulcions is reported in view of the literature Key words: Joubert Syndrome Vermis Disgenesis Episodie Hyperpnea