Mehpare Ozkan

Neurologic Manifestations of Novel Influenza A (H1N1) Virus Infection in Childhood

The neurologic manifestations and prognoses of a novel influenza A (H1N1) virus infection in previously healthy children were evaluated. Nose and throat swabs were retrieved from all patients who met the criteria of influenza-like illness. A real time reverse-transcriptase polymerase chain reaction assay was used to confirm the novel influenza A (H1N1) virus. This viral infection was evident in 240 children between October 10 and December 22, 2009. Neurologic findings were evident in 17 (7.08%) patients, aged between 4 months and 8 years. Nine were boys. Five patients manifested simple febrile seizures, seven manifested complex febrile seizures or additional afebrile seizures, and three manifested encephalopathy. Febrile status epilepticus and flaccid paralysis were diagnosed in one patient each. All were treated with oseltamivir. Fifteen of 17 patients demonstrated complete recovery. One undergoing follow-up with a diagnosis of Guillain-Barré syndrome manifested sequelae. One patient died because of septic shock and disseminated intravascular coagulation. We suggest that neurologic manifestations occur quite often in children aged less than 5 years with novel influenza A (H1N1) virus infection. Most infections were benign, although a severe course is possible, and sequelae may be encountered.

Electroencephalogram Variations in Pediatric Migraines and Tension-Type Headaches

This study evaluates specific electroencephalogram abnormalities in pediatric migraine and tension-type headaches, and demonstrates the clinical value of these abnormalities. We studied 50 migraine patients and 50 tension-type headache patients. Their mean age ± SD was 10.62 ± 3.21 (range, 5-16) years in the migraine group, and 13.00 ± 2.37 (7-16) years in the tension-type headache group. Diagnoses were rendered according to the International Classification of Headache Disorders, 2nd Edition, First Revision, of the International Headache Society. All patients underwent two waking-state electroencephalograms, one during a headache, and the other when headache-free. Thirty-six percent (18/50) of migraine patients and 12% (6/50) of tension-type headache patients revealed specific electroencephalogram abnormalities in headache attack electroencephalograms (P < 0.05). In headache-free period electroencephalograms, 16% (8/50) of the migraine group and 2% (1/50) of the tension-type headache group revealed abnormalities (P < 0.05). Our results indicate that electroencephalogram abnormalities are particularly prevalent in migraines, especially during headache attacks. This study is the first, to the best of our knowledge, on electroencephalographic evaluation of pediatric migraine and tension-type headache patients during both headache attacks and headache-free periods.

The association of anti-glutamic acid decarboxylase antibodies with different neurological findings in childhood

Glutamic acid decarboxylase antibodies can rarely be associated with various neurological syndromes, which are usually present in adults. Here, we present 2 affected children. Our first patient had a diagnosis of epilepsy and presented with continuous involuntary movements and multifocal myoclonic seizures following an infection at the age of 9 months. Anti-glutamic acid decarboxylase antibodies were found in the serum and cerebrospinal fluid. A partial response was obtained from intravenous immunoglobulin, steroid, and plasmapheresis treatment. The other patient presented with a clinical picture of acute cerebellar ataxia and mutism at the age of 6 years and recovered fully following intravenous immunoglobulin treatment. Neurological findings due to anti-glutamic acid decarboxylase antibodies may be more common in children than previously thought, and achieving an early diagnosis can be important for prompt treatment.

A multinational survey on actual diagnostics and treatment of subacute sclerosing panencephalitis

Subacute sclerosing panencephalitis (SSPE) is a chronic infection of the central nervous system caused by the measles virus (MV). Its prevalence remains high in resource poor countries and is likely to increase in the Northern Europe as vaccination rates decrease. Clinical knowledge of this devastating condition, however, is limited. We therefore conducted this multinational survey summarizing experience obtained from more than 500 patients treated by 24 physicians in seven countries. SSPE should be considered in all patients presenting with otherwise unexplained acquired neurological symptoms. In most patients, the diagnosis will be established by the combination of typical clinical symptoms (characteristic repetitive myoclonic jerks), a strong intrathecal synthesis of antibodies to MV and typical electroencephalogram findings (Radermecker complexes). Whereas the therapeutic use of different antiviral (amantadine, ribavirin) and immunomodulatory drugs (isoprinosine, interferons) and of immunoglobulins has been reported repeatedly, optimum application regimen of these drugs has not been established. This is partly due to the absence of common diagnostic and clinical standards focusing on neurological and psychosocial aspects. Carbamazepine, levetiracetam, and clobazam are the drugs most frequently used to control myoclonic jerks. We have established a consensus on essential laboratory and clinical parameters that should facilitate collaborative studies. Those are urgently needed to improve outcome.

Ophthalmological Findings of Turkish Children With Muscular Dystrophies

PURPOSE To present the results of ophthalmological examinations in children with muscular dystrophies and highlight the importance of their ophthalmological evaluation. METHODS Retrospective analysis of the ophthalmological examination records in 74 children with a type of muscular dystrophy, examined between January 2011 and January 2015, was performed. RESULTS The most common type of muscular dystrophy observed in our patients was Duchenne muscular dystrophy (67.5%), followed by Becker muscular dystrophy (9.4%), myotonic dystrophy (8%), limb-girdle muscular dystrophy (6.7%), merosin-negative muscular dystrophy (4%), and Ullrich muscular dystrophy (4%). Ten cases of Duchenne muscular dystrophy had both macular and retinal pigmentary changes (20%) and 9 had abnormal electroretinographies with decreased photopic and scotopic responses. Ptosis was the most common finding (83.3%). No abnormalities of light reflexes, pupil size, or saccadic and smooth pursuit movements were seen among cases with myotonic dystrophy. CONCLUSIONS Ophthalmological problems are commonly seen in children with muscular dystrophies. Simple ophthalmological screening and early intervention can improve their communication skills by way of increasing their visual talents.

Bilateral Optic Neuritis—The Only Ocular Finding in a Case of Subacute Sclerosing Panencephalitis

Abstract Subacute sclerosing panencephalitis is a rare disease of central nervous system caused by defective measles virus. Chorioretinitis with macular involvement is the mostly observed ocular finding in the disease. Other reported ocular findings in the disease are cortical blindness, hemianopsia, nystagmus, extraocular muscle paresis and optic atrophy. We present a rare case of subacute sclerosing panencephalitis with isolated bilateral optic neuritis as the only ocular finding without macular involvement.

Anxiety sensitivity and dissociative experiences in adolescents with migraine and tension type headache

Objective: The aim of this study was to investigate the relationship between headache and anxiety sensitivity (AS), and also headache and dissociative experiences (DE) in adolescents. Methods: Patients were recruited from the adolescents who were admitted to Ankara University Faculty of Medicine Child Neurology Clinic with a complaint of headache and diagnoses of migraine (n=24) or tension type headache (TTH) (n=22). All patients and healthy controls (n=28) were encouraged to complete Childhood Anxiety Sensitivity Index (CASI) and Adolescent Dissociative Experiences Scale (ADES). Results: Patients with headache had higher scores from CASI and ADES instruments in comparison with the healthy adolescents. In case the patient group was divided into two groups regarding to their diagnoses, both migraine and TTH group had higher scores from CASI than control group. However, although TTH group had higher ADES scores than control group, there was no significant difference between migraine and control groups. Likewise, CASI and ADES scores of migraine and TTH groups were not different. Conclusion: Adolescents with headache are having higher AS and DE than normal controls. The diagnosis of migraine or TTH does not change these results in terms of AS. However, adolescents with migraine are not having higher DE than normal controls.