Recurrence of Febrile Seizures in Yazd Shahid Sadoughi Hospital

ObjectiveFebrile seizure is the most common problem in pediatric neurology that occurs in 3- 4 % of children. The purpose of this study was to determine febrile seizure recurrence frequency and to evaluate its risk factors.Materials & MethodsIn a descriptive prospective study, 139 children (6 months to 6 years) with first febrile seizure were admitted to Yazd Shaheed Sadoughi Hospital between March 2004 and August 2005 and were followed up for at least 15 months for febrile seizure recurrence.ResultsSeventy six boys and 63 girls with a mean age of 2.03 ± 1.21 years were followed up for 25.1±5.5 months. About 30% of them had complex febrile seizures and 37.4% had febrile seizure recurrence with a mean recurrence time of 6.7 ± 5.9 months. About 65% of the children younger than one year and 30% of those older than one year had febrile seizure recurrence. (P value= 0.0001) Recurrence of seizure was seen in 63% of those who had seizure within an hour from the onset of fever and in 33% of those who had seizure after one hour from the onset of fever. (P value = 0.005) Seizures in children younger than one year old and seizures occurring in association with a fever lasting less than an hour were risk factors of febrile seizure recurrence.ConclusionFebrile seizure is more disturbing in children younger than one year old. Antipyretic usage was not effective in preventing seizure recurrence but may reduce discomfort and is reassuring.

Efficacy and Safety of Lamotrigine in Lennox - Gastaut Syndrome

ObjectiveThe Lennox-Gastaut syndrome (LGS), one of the most difficult epilepsy syndromes to treat, is characterized by a triad of intractable seizures of various types, a slow (< 2.5-hertz) spike-wave pattern in EEG and mental retardation. The aim of this study was to evaluate the efficacy and safety of lamotrigine as add-on therapy in intractable epilepsy of children with LGS.Materials & MethodsIn a quasi- experimental study, 40 children with LGS referred to the pediatric neurology clinic of Shaheed Sadoughi Hospital in Yazd, between August 2007 and to November 2008, were evaluated.ResultsTwenty-two boys and 18 girls with a mean age of 4.12 ±1.8 years were evaluated. At the end of three months of treatment with lamotrigine, 12 % were seizure free, 52% had> 50% reduction in seizure frequency and 12% had increase in seizures. Means of seizure frequency/per week, before and after treatment were 70 (range 1-180) and 18.6 (range 0-60) respectively, indicating effectiveness of the drug in seizure reduction (P value = 0.003). The drug was effective in 72 % of mixed type seizures, 40 % of generalized tonic-clonic and 33% of drop attack and tonic seizures. Transient side effects were seen in 12.5 % (drowsiness in 3 and ataxia in 2 children). No serious side effects were seen.ConclusionLamotrigine should be considered as an add-on therapy in management of intractable epilepsy in LGS

Mothers’ Experience Regarding the Relationship between Dairy Products and Their Children’s Seizures

ObjectiveEpilepsy is one of the most important problems in neurology. The purpose of this study was to evaluate the relationship between dairy products and seizures of the epileptic children based on their mothers' experience.Materials & MethodsIn a descriptive- analytic study, mothers' experience regarding the relationship between dairy products and seizures of their children was evaluated via a questionnaire. This research was done in the pediatric neurology clinic of Shaheed Sadoughi Medical Sciences University- Yazd- Iran in 2007.ResultsOne hundred and forty eight mothers with an age range of 17-52 years (mean ± SD: 31.6 ± 6.6 years) were evaluated. Their children were 58.5% boys and 41.5% girls with an age range of 1-18 years (mean ± SD: 6.6 ± 4.2 years).The most common dairy products which provoked seizure based on mothers' experience, were milk and ice cream. The effect of different kinds of dairy products was not different between males and female children. Mothers who experienced the effect of dried whey (kashk in Persian) on seizure were younger than others. Lack of correlation between milk and ice cream on seizures was reported in educated mothers.ConclusionParent education on the diet of their epileptic children is necessary. On the other hand, extracting of suspicious food ingredients and testing them on animal models, should be done by other researches.

Assessment of the Preventive Effect of Pilocarpine on Radiotherapy-Induced Xerostomia in Patients with Head and Neck Cancers

Introduction Xerostomia is one of side-effects of radiotherapy for head and neck cancers. No definitive method has been proposed for the treatment of this condition. However, pilocarpine is considered effective for the management of chronic xerostomia. The purpose of the present study was to assess the preventive effect of pilocarpine. Materials and Methods This study was performed on 34 patients with head and neck cancers, undergoing radiation therapy (5000 cGy). The patients were randomly divided into two groups. The case group was administered 16 drops of pilocarpine (2%) eye drops per day, while the control group received normal saline; the treatment plan continued for four weeks. Unstimulated whole saliva flow rate was measured at four stages: two weeks before radiotherapy (baseline), the first day of radiotherapy, and two and four weeks after the initiation of radiotherapy. Results At baseline and the first day of radiotherapy, no significant differences were observed in the amount of saliva between the case and control groups (P<0.76 and P<0.054, respectively). However, by starting radiotherapy, a statistically significant improvement was reported in saliva production in the case group, compared to the control group (P<0.00); this trend continued during the next four weeks of radiotherapy (P<0.003). Generally, a significant difference was observed between the two groups at all stages of data evaluation (P<0.00). Conclusion According to the findings, pilocarpine was found to be effective for the prevention of xerostomia. Moreover, it could restrain the decline in the amount of saliva and reduce the rate of xerostomia

Randomised Clinical Efficacy Trial of Topiramate and Nitrazepam in Treatment of Infantile Spasms

How to Cite This Article: Fallah R, Salor F, Akhavan Karbasi S, Motaghipisheh H. Randomised Clinical Efficacy Trial of Topiramate and Nitrazepam in Treatment of Infantile Spasms. Iran J Child Neurol. 2014 Winter; 8(1):12-19.ObjectiveInfantile spasms (IS) are among the most catastrophic epileptic syndromes of infancy. The purpose of this study was to compare efficacy and safety of topiramate (TPM) and nitrazepam (NZP) as first-line drugs in the treatment ofIS.Materials &amp; MethodsIn a parallel single-blinded randomized clinical trial, 50 patients with IS referred to Pediatric Neurology Clinic of Shahid Sadoughi University of Medical Sciences, Yazd, Iran, were evaluated from September 2008 to March 2010.Patients were randomly assigned to two groups to be treated with TPM or with NZP for 6 months. The primary endpoint was efficacy in cessation of all spasms or reduction of more than 50% in weekly seizure frequency, which was evaluatedbefore and 6 months after the drug use. Secondary outcome was clinical sideeffects of the drugs.ResultsTwenty boys (40%) and 30 girls (60%) with the mean age of 9.4±3.8 months were evaluated. Cessation of all spasms occurred in 12 (48%) infants in TPM group and 4(16%) in NZP group. Eight (32%) children in TPM group and 7 (28%) in NZP group had more than 50% reduction in spasms frequency. So,TPM was more effective. Side effects were seen in 32% of TPM and in 36% of NZP groups.ConclusionTopiramate is an effective and safe drug, which might be considered as the firstline drug for the treatment of ISs.References:Watemberg N. Infantile spasms: treatment challenges. Curr Treat Options Neurol 2012;14(4):322-31.Tsao CY. Current trends in the treatment of infantile spasms. Neuropsychiatr Dis Treat 2009;5:289-99.Sankar R, Koh S, Wu J, Menkes JH. Paroxysmal disorders. In: Menkes JH, Sarnat HB, Maria BL, editors Child Neurology,7th ed. Philadelphia: Lippincott; 2006.p. 877.Engel J Jr. International League against Epilepsy (ILAE). A proposed diagnostic scheme for people with epileptic seizures and with epilepsy: a report of the ILEA task force on classification and terminology. Epilepsia 2001; 42(6):796–803.Riikonen RS. Favourable prognostic factors with infantile spasms. Eur J Paediatr Neurol 2010;14(1):13-18.Lagae L, Verhelst H, Ceulemans B, De Meirleir L, Nassogne MC, De Borchgrave V, et al. Treatment and long term outcome in West syndrome: the clinical reality. A multicentre follow up study. Seizure 2010;19(3):159-64.Fois A. Infantile spasms: review of the literature and personal experience. Ital J Pediatr 2010;36:15-21.Jaseja H. Justification of vigabatrin administration in West syndrome patients? Warranting a re-consideration for improvement in their quality of life. Clin Neurol Neurosurg 2009;111(2):111-14.Hwang H, Kim KJ. New antiepileptic drugs in pediatric epilepsy. Brain Dev 2008,30(9);549–55.Mikaeloff Y, de Saint-Martin A, Mancini J, Peudenier S, Pedespan JM, Vallée L, et al. Topiramate: efficacy and tolerability in children according to epilepsy syndromes. Epilepsy Res 2003;53(3):225-32.Peltzer B, Alonso WD, Porter BE. Topiramate and Adrenal-Cortico-tropic Hormone as Initial Treatment of Infantile Spasms. J Child Neurol 2009;24(4):400-5.Zou LP, Lin Q, Qin J, Cai FC, Liu ZS, Mix E. Evaluation of open-label topiramate as primary or adjunctive therapy in infantile spasms. Clin Neuropharmacol 2008;31(2):86-92.Korinthenberg R, Schreiner A. Topiramate in children with west syndrome: a retrospective multicenter evaluation of 100 patients. J Child Neurol 2007;22(3):302-6.14. Kwon YS, Jun YH, Hong YJ, Son BK. Topiramate monotherapy in infantile spasm. Yonsei Med J 2006;47(4):498-504.Hosain SA, Merchant S, Solomon GE, Chutorian A. Topiramate for the treatment of infantile spasms. J Child Neurol 2006;21(1):17-9.Glauser TA, Clark PO, McGee K. Long-term response to topiramate in patients with West syndrome. Epilepsia 2000;41(Suppl. 1):S91-4.Albsoul-Younes AM, Salem HA, Ajlouni SF, Al-Safi SA. Topiramate slow dose titration: improved efficacy and tolerability. Pediatr Neurol 2004;31(5):349-52.Hsieh MY, Lin KL, Wang HS, Chou ML, Hung PC, Chang MY. Low-dose topiramate is effective in the treatment of infantile spasms. Chang Gung Med J 2006;29(3):291-6.Auvichayapat N, Tassniyom S, Treerotphon S, Auvichayapat P. Treatment of infantile spasms with sodium valproate followed by benzodiazepines. J Med Assoc Thai 2007;90(9):1809-14.Karvelas G, Lortie A, Scantlebury MH, Duy PT, Cossette P, Carmant L. A retrospective study on aetiology based outcome of infantile spasms. Seizure 2009;18(3):197-201.Chen CC, Chen TF, Lin HC, Oon PC, Wu HM, Wang PJ, et al. Estimation of prevalence and incidence of infantile spasms in Taiwan using capture–recapture method. Epilepsy Res 2004;58(1):37–42.Parisi P, Bombardieri R, Curatolo P. Current role of vigabatrin in infantile spasms. Eur J Paediatr Neurol 2007;11(6):331-6.Cvitanović-Sojat L, Gjergja R, Sabol Z, Hajnzić TF, Sojat T. Treatment of West syndrome. Acta Med Croatica 2005;59(1):19-29. (Full text in Croatian)Watemberg N, Goldberg-Stern H, Ben-Zeev B, Berger I, Straussberg R, Kivity S, et al. Clinical experience with open-label topiramate use in infants younger than 2 years of age. J Child Neurol 2003;18(4):258-62.Grosso S, Franzoni E, Iannetti P, Incorpora G, Cardinali C, Toldo I, et al. Efficacy and safety of topiramate in refractory epilepsy of childhood: long-term follow-up study. J Child Neurol 2005;20(11):893-7.Capovilla G, Beccaria F, Montagnini A, Cusmai R, Franzoni E, Moscano F, et al. Short-term nonhormonal and nonsteroid treatment in West syndrome. Epilepsia 2003;44(8):1085-8.Chamberlain MC. Nitrazepam for refractory infantile spasms and the Lennox-Gastaut syndrome. J Child Neurol 1996;11(1):31-4.28. Hosain SA, Green NS, Solomon GE, Chutorian A. Nitrazepam for the treatment of Lennox-Gastaut syndrome. Pediatr Neurol 2003;28(1):16-9.Rintahaka PJ, Nakegawa JA, Shewmom DA, Kyynnem P, Shields WD. Incidence of death in patients with intractable epilepsy, during nitrazepam treatment. Epilepsia 1994;40(4):492-6.Djurić M, Marjanović B, Zamurović D. West syndrome--new therapeutic approach. Srp Arh Celok Lek 2001;129(Suppl.1):72-7. (Full text in Serbian

The Efficacy and Safety of Topiramate for Prophylaxis of Migraine in Children

How to Cite This Article: Fallah R, Akhavan Karbasi S, Shajari A, Fromandi M. The Efficacy and Safety of Topiramate for Prophylaxis of Migraine in Children. Iran J Child Neurol. 2013 Autumn; 7(4):7-11.Objective Migraine is the most common acute intermittent primary headache in children and prophylactic therapy is indicated in children with frequent or disabling headaches. The purpose of this study was to evaluate the efficacy and safety of topiramate (TPM) for migraine prophylaxis in children. Materials &amp; Methods In a quasi-experimental study, monthly frequency, severity and duration of headache, migraine disability, and side-effects were evaluated in 100 children who were referred to the Pediatric Neurology Clinic of Shahid Sadoughi University of Medical Sciences, Yazd, Iran from April 2011 to March 2012, and were treated with 3 mg/kg/day of TPM for three months. Results Fifty eight (57.4%) girls and 42 (41.6%) boys with the mean age of 10.46±2.11 years were evaluated. Monthly frequency, severity, and duration of headache decreased with treatment from 15.34±7.28 to 6.07±3.16 attacks, from 6.21±1.74 to 3.15±2.22, and from 2.28±1.55 to 0.94±0.35 hours, respectively, and the Pediatric Migraine Disability Assessment score reduced with TPM from 32.48±9.33 to 15.54±6.16. Transient side-effects were seen in 21% of the patients, including hyperthermia in 11%, anorexia and weight loss in 6%, and drowsiness in 4%. No serious side-effects were reported.  Conclusion TPM could be considered as a safe and effective drug in pediatric migraine prophylaxis. ReferencesHershey AD. Migraine. In: Kliegman RM, Stanton BF, Schor NF, St. Geme JW, Behrman RE, editors Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Saunders; 2011. p. 2040-5.The International Classification of Headache Disorders:2nd ed. Headache Classification Subcommittee of the International Headache Society. Cephalalgia 2004;24 Suppl 1:9-160.Hershey AD, Winner PK. Pediatric migraine: recognition and treatment. J Am Osteopath Assoc 2005;105(4 Suppl 2):2S-8S.Jayapal S, Maheshwari N. Question 3. Topiramate for chronic migraine in children. Arch Dis Child  2011;96(3):318-21.Fallah R. Topiramate as a new antiepileptic drug in epileptic children in Iran. Indian J Pediatr 2006;73(12):1073-5.Hershey AD, Powers SW, Vockell ALB, LeCates SL, Kabbouche MA, Maynard MK. PedMIDAS: Development of a questionnaire to assess disability of migraines in children. Neurology 2001;57(11):2034-9.Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 1990;13(4):227-36.Ashtari F, Shaygannejad V, Akbari M. A doubleblind, randomized trial of low-dose topiramate vs propranolol in migraine prophylaxis. Acta Neurol Scand 2008;118(5):301-5.Tonekaboni SH, Ghazavi A, Fayyazi A, Khajeh A, Taghdiri MM, Abdollah Gorji F, Azargashb E.Prophylaxis of childhood migraine: Topiramate versus Propranolol. Iran J Child Neurol 2013 ; 7(1):9-14.Winner P, Pearlman EM, Linder SL, Jordan DM, Fisher AC, Hulihan J; Topiramate Pediatric Migraine Study Investigators. Topiramate for migraine prevention in children: a randomized, double-blind, placebo-controlled trial. Headache 2005;45(10):1304-12.Lewis D, Winner P, Saper J, Ness S, Polverejan E, Wang S, et al. Randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of topiramate for migraine prevention in pediatric subjects 12 to 17 years of age. Pediatrics 2009;123(3):924-34.Borzy JC, Koch TK, Schimschock JR. Effectiveness of topiramate in the treatment of pediatric chronic daily headache. Pediatr Neurol 2005;33(5):314-6.Campistol J, Campos J, Casas C, Herranz JL. Topiramate in the prophylactic treatment of migraine in children. J Child Neurol 2005;20(3):251-3.Cruz MJ, Valencia I, Legido A, Kothare SV, Khurana DS, Yum S, et al. Efficacy and tolerability of topiramate in pediatric migraine. Pediatr Neurol 2009;41(3):167-70.Aydin M, Kabakus N, Bozdag S, Ertugrul S. Profile of children with migraine. Indian J Pediatr 2010;77(11):1247-51.Unalp A, Uran N, Oztürk A. Comparison of the effectiveness of topiramate and sodium valproate in pediatric migraine. J Child Neurol 2008;23(12):1377-81. Lakshmi CV, Singhi P, Malhi P, Ray M. Topiramate in the prophylaxis of pediatric migraine: a double-blind placebo-controlled trial. J Child Neurol 2007;22(7):829-35.Vollono C, Ferraro D, Valeriani M. Antiepileptic drugs in the preventive treatment of migraine in children and adolescents. Drug Development Research 2007;68:355-9.  19. Ferraro D, Di Trapani G. Topiramate in the prevention of pediatric migraine: literature review. J Headache Pain 2008;9(3):147-50

FREQUENCY AND PREDICTOR FACTORS OF IRREVERSIBLE PULPITIS

Abstract. Objective: Referral pains are one of the most common challenges which dentists are faced with them during diagnosis and before treatment. Pain referral can take place in tooth and other craniofacial structures and influence the diagnostic process. The present study was accomplished to evaluate the prevalence of irreversible pulpitis in patients refferd to Endodontic department of dental school of shahid Sadoughi University in 2017 with chief complaint of pain. Methods: This study is a descriptive and cross-sectional type of study conducted on 100 patients(21 males and 79 females) refferd to Endodontic department of dental school of shahid Sadoughi University in 2017 with chief complaint of pain.Informed consent was taken from patients. Data obtained from medical history, dentistry history, clinical examinations, and radiography were recorded in questionnaire developed for this purpose. Finally, the data were analyzed using SPSS18 software, Chi-square and Fisher exact test. Results: In the present research, the prevalence of irreversible pulpitis was obtained to be 77%. This prevalence in female was significantly more than males (P-value = 0.021). Patients with irreversible pulpit significantly reported more severe pain (p-value=0.000) and pain at the real site (p-value=0.028).The frequency of irreversible pulpitis showed no significant correlation with age and type of pain (P-value&lt;0.05). Conclusion: Considering the findings of this research, the prevalence of irreversible pulpitis in patients refferd to Endodontic department of dental school of shahid Sadoughi University in 2017 with chief complaint of pain was three times more than that of other diseases. This frequency showed significant relationship with factors of gender, pain severity, and the pain feeling site.Keywords: Irreversible pulpitis, pain, root canal treatment

Evaluation of polymorphism of P53 protein codon 72 in oral lichen planus by PCR technique

Background. Our research was aimed to study p53 protein codon 72 polymorphism, a single base pair change of either arginine (Arg; CGC) or proline (Pro; CCC) that creates 3 distinct genotypes in reticular oral lichen planus (OLP) in comparison to oral SCC which is the most common oral mucosal malignancy as positive control and inflammatory fibrous hyperplasia (IFH) lesion as negative control. Methods. Seventy paraffin-embedded tissue samples (30 OLP, 20 OSCC and 20 IFH) were studied. DNA was purified and amplified using allele-specific polymerase chain reaction to detect polymorphism. The final amplified products were identified using gel electrophoresis. Data were analyzed using chi-squared test and odds ratio. Results. The mean ages in the OLP, OSCC and IFH groups were 43.28, 58.2 and 53.47 years, respectively, with significant differences. There were no significant differences in gender between the three groups (P=0.413); however, the differences in genotypes and alleles were significant between the three groups (P=0.021 and P=0.030, respectively). By considering IFH as a reference, the frequency of proline allele in OLP and OSCC was significantly higher than that of arginine allele (P=0.015 and P=0.028, respectively). In addition, by considering OSCC as a reference and at P=1, there were no significant differences in the frequencies of alleles between OSCC and OLP. Conclusion. The results might indicate the premalignant potential of OLP, and such polymorphism might be a genetic predisposing factor for conversion of OLP to OSCC. In addition, in the subjects evaluated the proline allele was considered a risk factor

A 10-year study on the prevalence of cardiovascular affliction among Kawasaki patients in Yazd, Iran

Background: Kawasaki syndrome is considered as the leading cause of cardiovascular disease among children. The aim of the present study was to determine the prevalence of cardiovascular complications among Kawasaki patients of Yazd province. Materials and Methods: In this cross-sectional study, the medical documents of all patients (no = 48) referring to Yazd hospitals with a diagnosis of Kawasaki syndrome (during the march 1996 � march 2006) were reviewed and the related demographic, clinical, paraclinical, echocardiographical and therapeutical data were collected through the questionnaire. The obtained data were analyzed using the Chi�square and t-test statistical tools.Results: Nineteen (39.5) out of the 48 Kawasaki diagnosed patients had cardiovascular affliction (male 63.2). All Cardiovascular afflicted patients had coronary aneurysm and a history of more than 5 days fever, whereas this was the case in 89.7 of non- cardiovascular afflicted . ESR mean in cardiovascular afflicted patients was higher than that in the non-afflicted ones (p = 0.04) . Conclusion: The high affliction of cardiovascular and coronary aneurysm among the Yazd Kawasaki patients is considerable. ESR levels may be helpful in diagnosing the high risk patients for Kawasaki syndrome

Comparison of the Effectiveness of Mellisan Gel and Acyclovir 5% Cream in the Improvement of Recurrent Herpes Labialis

BACKGROUND AND OBJECTIVE:&nbsp;Recurrent herpes labialis is a common infection of the mouth area, caused by herpes simplex virus. This infection appears in the mucus or lip skin and is commonly known as oral herpes. The purpose of this study was to compare the effectiveness of Mellisan gel and acyclovir 5% cream in the improvement of recurrent herpes labialis. METHODS:&nbsp;This double-blind clinical trial was conducted on 60 patients (14 men and 46 women), with the average age of 23.8 years (minimum of 20 and maximum of 32 years) and a prior history of recurrent herpes labialis three times a year. The previously-coded medicines were randomly distributed among patients. The subjects were asked to apply the cream or gel locally on the infected region three times a day, according to the manufacturer&#39;s instructions. All patients were examined within one, two, four and seven days after using the cream or gel to determine the changes in pain intensity, size of the ulcer, inflammation and recovery time. IRCT: 13870819144281.&nbsp; FINDINGS:&nbsp;Mellisan gel and acyclovir cream were not significantly different in reducing the size of the ulcer, inflammation or the associated side-effects. Mellisan gel was accompanied by a significant reduction in pain intensity in patients on the second and fourth days of the examination (p=0.0001 and p=0.02, respectively). Moreover, on the second day, there was a significant difference in recovery (p=0.001). CONCLUSION:&nbsp;The results of this study suggested that Mellisan gel is more effective than acyclovir cream in terms of pain reduction and recovery, whereas no significant difference was observed regarding the size of the ulcer or inflammation. Also, the administration of Mellisan gel and acyclovir cream was associated with no side-effects