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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).

Different clinical features of amitraz poisoning in children

Objective: To evaluate clinical experience of amitraz poisoning in children. Methods: In this study, the clinical and laboratory features of amitraz poisoning in 14 children are presented and compared with previous studies. Results: This study revealed that clinical manifestations of poisoning by oral and dermal routes appeared within 30–150 min, and that central nervous system (CNS) depression, which is the most important sign, improved within 6–24 hours and other signs within 24–72 hours. Unlike the findings in other studies, three severe cases in our study had reversible mydriasis and one of them required resuscitation because of cardiopulmonary arrest occurring as a result of serious respiratory depression. In addition, hepatic function test levels had increased in these three cases, and aspiration pneumonitis existed because of emesis in two of them. Conclusion: There is little information in the literature about dermal poisoning. The signs and symptoms of dermal poisoning were relatively mild compared with oral poisoning, and there were no topical signs. The classical signs of¬small2small-adrenergic stimulation such as marked sinusal bradycardia and mydriasis as reported in many poisoning cases of animals have not been reported before our three severe cases among children.

Amitraz poisoning in children.

There is no information available in the general paediatric literature about amitraz poisoning. In the present study, which is the largest series in the literature, we report 24 children with amitraz poisoning.

Iodine and selenium deficiency in school-children in an endemic goiter area in Turkey.

Endemic goiter is one of the most important health problems in Turkey. However, there are not enough studies associated with iodine and selenium status. This study was carried out to establish the effects of iodine and selenium levels on thyroid gland size and thyroid functions in 73 healthy school-children, 7-12 years old (mean 9.56 +/- 1.77 years), 38 girls (52%) and 35 boys (48%), living in an endemic goiter area. Goiter was found in 32 of the children (43.8%) by palpation, and 56 of the children (76.7%) by ultrasonography. Mean serum T3 and TSH levels were in the upper limit of normal, and mean serum T4 levels were within the normal limits, but mean serum thyroglobulin levels were higher than the normal limits. Mean serum selenium level was 30.84 +/- 23.04 microg/l, and mean urinary iodine level was 3.91 +/- 3.77 microg/dl, appropriate for moderate iodine and selenium deficiency. Thyroid volumes of the children were negatively correlated with serum selenium levels, but there was no correlation with urinary iodine levels and thyroid hormones. In conclusion, school-children in this area had significant goiter problems, probably due to the iodine and selenium deficiencies.

Insulin-like growth factor-I and insulin-like growth factor binding protein-3 levels of children living in an iodine- and selenium-deficient endemic goiter area.

Serum insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) levels were investigated in 31 children living in an endemic goiter area and 33 healthy subjects living in an nonendemic area. Serum IGF-I and IGFBP-3 levels of iodine- and selenium-deficient children were found to be lower than those of control subjects (p<0.001). There was a positive correlation between the IGF-I with chronological age and body mass index. There was also positive correlation between the IGF-I and IGFBP-3. No significant difference was found between the goitrous and nongoitrous children. These results suggest that IGF-I and IGFBP-3 levels are affected by thyroid dysfunction as a result of iodine and selenium deficiency. However, IGF-I and IGFBP-3 levels are not associated with goiter.

Acute childhood hemiplegia associated with chickenpox and elevated anticardiolipin antibody

Chickenpox is a common infection of childhood. Central nervous system complications, such as cerebellar ataxia and meningoencephalitis, are estimated to occur in less than 1% of cases of chickenpox. Although transverse myelitis and hemiplegia have also, although rarely, been reported, hemiplegia associated with chickenpox and elevated anticardiolipin antibody has not been reported in the literature. We report the case of a 2.5-year-old boy who developed a right hemiplegia 3 weeks after the onset of a primary varicella infection. The serum level of anticardiolipin antibody IgG was markedly elevated. Brain magnetic resonance imaging (MRI) revealed an infarction involving the left globus pallidus, caudate nucleus, and posterior leg of the internal capsule. Laboratory studies ruled out all known causes of stroke. Neurologic signs and symptoms slowly improved with supportive treatment. Varicella infection should be considered one of the possible causes of acute ischemic strokes in children. Usually, two or more risk factors are detected in children with ischemic strokes, and we suggest that all possible causes of strokes be investigated in children with ischemic strokes. (J Child Neurol 2006;21:890—893; DOI 10.2310/ 7010.2006.00206).

Moyamoya Disease Presented With Migrainelike Headache in a 4-Year-Old Girl

A 4-year-old girl was admitted to our department with the complaints of severe headache, nausea, vomiting, and photophobia. She had a 1-year history of migrainelike headache that occurred every 1 to 2 months. Her neurologic examination was normal, but T2-weighted axial magnetic resonance imaging (MRI) of the brain showed flow void within the basal ganglia owing to parenchymal vascular collaterals. Magnetic resonance angiography and digital substraction carotid angiography showed both occlusion of the internal carotid artery in the supraclinoid portion and extensive parenchymal vascular collaterals. Because there was no evidence of risk factors for cerebral arterial occlusion and cerebral infarct or hemorrhage, she was diagnosed as having moyamoya disease. In any case of atypical migrainelike headache, a detailed investigation should be kept in mind to detect an underlying vascular disease such as moyamoya. (J Child Neurol 2003;18:361—363).

Proton magnetic resonance spectroscopy findings and clinical effects of montelukast sodium in a case with Sjögren-Larsson syndrome.

Sjögren-Larsson syndrome is a rare hereditary metabolic disorder characterized by congenital ichthyosis, mental retardation, and spastic diplegia or tetraplegia. This genetic disease is caused by fatty acid aldehyde dehydrogenase deficiency, leading to an accumulation of long-chain alcohols. The role of enzyme in the degradation of leukotrienes paved the way to the development of a new therapeutic strategy for Sjögren-Larsson syndrome, leukotriene antagonists. We describe a 3-year-old boy with Sjögren-Larsson syndrome who had a lipid peak on proton magnetic resonance spectroscopy despite normal findings on cerebral magnetic resonance imaging. He benefited from treatment with montelukast sodium, especially with respect to the agonizing pruritus.

Fatal valproate overdose in a newborn baby

Valproate is a widely used drug in the treatment of epilepsy in children and adults. However, it is not safe for patients under two years of age, especially during the newborn period. This study presents a case of fatal valproate overdose in a 26-day-old female newborn, who is the youngest patient in the literature. Human & Experimental Toxicology, (2007) 26, 453—456

KLUVER-BUCY SYNDROME IN A BOY WITH NON-HODGKIN LYMPHOMA

Kluver-Bucy syndrome is a rare neurobehavioral condition characterized by visual agnosia, excessive oral tendency, hypermetamorphosis, placidity, altered sexual behaviors, and changes in dietary habits. The authors report a case of Kluver-Bucy syndrome in a 10-year-old boy with non-Hodgkin lymphoma after intratechal methotrexate administration. He was treated by risperidone without any sequels.