Muhammad Akbar Malik

Predictors of Clinical Course of Subacute Sclerosing Panencephalitis: Experience at the Children's Hospital, Lahore

OBJECTIVE To determine the clinical course of Subacute Sclerosing Panencephalitis (SSPE) and different factors affecting the clinical course. STUDY DESIGN Descriptive study. PLACE AND DURATION OF STUDY The Childrens Hospital, Lahore, from October 2005 to May 2008. METHODOLOGY All serologically confirmed patients of SSPE were registered and clinical staging of these patients were done from stage-I to stage-IV. Clinical course of these patients was classified by using neurological disability index as fulminant, acute, subacute, and chronic course. Clinical course was analyzed for any difference with age, gender, immunization for measles, measles infection, nutritional status and correlation with age of onset of SSPE, (Spearmans correlation), using statistic package for social science (SPSS) V. 14. RESULTS A total of 57 cases (41 males, 16 females) with mean age of 7.45 years were studied. Forty (71.4%) of them were vaccinated with single dose at about 9 months of age, 41% (23/57) had measles infections ≤ 2 years of age. Using the Neurology Disability Index for these patients 10.5% had fulminant, 17.5% had acute, 49.2% subacute and 22.8% had chronic course. Age, gender, age at measles infection, SSPE onset age and nutritional status were poor predictors of clinical course of SSPE. Unvaccinated patients showed significantly more rapid course of disease (p = 0.04). CONCLUSION Clinical course of SSPE cannot be predicted at the onset of this catastrophic disorder. Children not immunized against measles had a significant rapid course of disease.

Evaluation of Factors Influencing Medication Adherence in Children with Epilepsy in Under- Resource Community at Bhakhar City of South-Punjab, Pakistan

Medication nonadherence to antiepileptic medications is detrimental to the perceived outcome of treatment in children with epilepsy (CWE). There is lack of information in Pakistan on adherence to antiepileptic drugs and the factors that affect this among CWE.

Maintenance Treatment of Childhood Primary Angiitis of Central NervousSystem with Aspirin and Azathioprine

Objectives: We aimed to assess the efficacy and safety of Aspirin and Azathioprine in prevention of recurrence of childhood primary angiitis of central nervous system (cPACNS) after induction therapy with intravenous pulse Methylprednisolone/ Immunoglobulin, and describe long-term neurological outcomes in a cohort of children with this disorder. Study type: Case series Methods: The cohort comprised of consecutive patients diagnosed as having childhood primary angiitis of central nervous system (cPACNS), based on clinical and vascular imaging findings, including identification of arterial stenosis on conventional angiography or Magnetic Resonance (MR) angiography. Over the period of 2 years, 68 children with cPACNS were admitted, who presented within 14 days of onset of the symptoms. Patients with ischemic infarcts were initially treated in conjunction with Heparin/ Oral Anticoagulant and IV Methylprednisolone and/or Immunoglobulin, and this was followed by long term use of Aspirin and Azathioprine. Patient were followed in the out patients clinics and were systemically assessed for clinical presentation, hospital course, adverse effects of anticoagulants, aspirin and Azathioprine. The primary outcomes were 1) morbidity and mortality, 2) Paediatric Stroke Outcome Measure (PSOM) scores after the median follow-up of 34 months. Statistical analysis: Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 12.0 (Chicago, IL). Frequencies were calculated for categorical data including gender, final outcome and complications of anticoagulation therapy. Mean with 95% SD was calculated for nominal variables including age. Fisher’s exact test or chi squared test were used, where appropriate to determine any significant difference in outcome with different presenting features, taking p<0.05 as significant. Results: From January 2008, to December 2010, 94 patients with cPACNS were enrolled, 68 of whom met the inclusion criteria and were given induction therapy. The median age at diagnosis was 8.5 years (range 1•6-16 years). 56 patients (boys 35/56, 62%, girls 21/56, 38%) completed induction therapy (with acute mortality of 12/68, 18.5%) and received maintenance therapy with aspirin (n=40) or aspirin and azathioprine (n=16). At the median follow-up of 34 months, of the total 56 patients is; total 30 (30/56, 53.5%) had relapse/flare: first relapse within 24 months after discharge 35.7%: 20 (20/56, 35.7%) died, 15 (15/56, 26.7%) in association with relapse of cPACNS, 5 (5/56, 9%) died due to other causes:14 (14/56, 25%) were receiving Aspirin only: 11 (11/56, 19.6%) were off any medication : 7 (7/56, 12.3%) were receiving both Azathioprine and Aspirin and 4 (4/56, 7.2%) were lost in follow-up. The Neurological findings among 32 patients available to be assessed at last follow up by Paediatric Stroke Outcome Measurement (PSOM) were; normal 8 (8/32, 25%); minor disabilities 10 (10/32, 31.25%; moderate disabilities 10 (10/32, 31.25%) and severe disabilities 4 (4/32, 12.5%). No serious side effects were documented due to low dose aspirin and azathioprine therapy. Conclusion: The spectrum of cPACNS in children includes both progressive and non-progressive forms. Recurrence of cPACNS was high within six months after discharge with high mortality, more among the patients treated with Aspirin than with Azathioprine in conjunction with Aspirin, after initial treatment with IV Methylprednisolone / Immunoglobulin and heparin/ oral anticoagulants.

Prevalence of Behavioural Disorders and SchoolUnderachievement’s in Newly Diagnosed Childhood Idiopathic Generalized Epilepsies (CIGEs):Effect of Antiepileptic Drugs

Prevalence of Behavioural Disorders and School Underachievement’s in Newly Diagnosed Childhood Idiopathic Generalized Epilepsies (CIGEs):Effect of Antiepileptic Drugs Children with epilepsy are known to be prone to educational underachievement as a result of learning and behavioural problems. Identification of these comorbidities and their early intervention will go a long way in improving quality of life of children with epilepsies.