Idiopathic epilepsy of childhood and potassium ion channels

Potassium can affect the development of common seizure type and can be defined seizure susceptibility allele. The existence of inward-rectifying potassium (Kir) channels was first recognized half a century ago. The biophysical fingerprint of Kir channels is inward rectification in the current-voltage relationship , which limits potassium efflux at depolarizing membrane potentials. Kir channels are essential in the control of resting membrane potential, coupling of the metabolic cellular state with membrane excitability, and maintenance of potassium homeostasis. The critical interval contains several candidate genes, one of which, KCNJ10, exhibits a potentially important polymorphism with regard to fundamental aspects of seizure susceptibility. Deletion of KCNJ10 as a seizure susceptibility gene that code for inward rectifier potassium ion channels imparts protection against seizures results in spontaneous seizures and increased seizure susceptibility. The unique role of Kir channels in membrane physiology coupled with previous strong association between ion channel gene mutations and seizure phenotypes puts even greater focus on KCNJ1

Wernekink Comissure Syndrome: a rare midbrain syndrome secondary to stroke

Wernekink commissure involves the decussation of superior cerebellar peduncle (SCP) in midbrain. We report an elderly hypertensive, diabetic man who developed slurred speech, ataxia, and internuclear ophthalmoplegia. MRI examination revealed an unusual ischemic stroke involving Wernekink commissure. This rare stroke pattern involving decussation of SCP occurs in the setting of small arterial disease. The association between the anatomic location of the stroke and clinical findings is noteworthy

Botulinum toxin type-A in the management of cerebral palsy: low or high dose?

Cerebral palsy is the most common cause of severe physical disability in childhood. Spasticity is a common and disabling symptom for many patients with cerebral palsy. Therapy for spasticity is symptomatic with the aim of increasing functional capacity and relieving discomfort. Spasticity treatment by orally administered drugs and intramuscular chemodenervation agents has become more frequent. Most oral medications to treat spasticity have been inadequately studied in children, especially those with cerebral palsy. Since its first use in pediatric patients, reported in 1993, botulinum toxin (BTX-A), a relatively recent addition to the available medical interventions for children with cerebral palsy, has rapidly gained acceptance as a treatment of spasticity. The clinical effects of BTX-A have been reported to include decreased spasticity and increased range of motion. However, no consensus exists among clinicians about how an optimal dose of BTX-A should be determined and there are no standard guidelines on doses of BTX-A in children. Doses of 2-6 U/kg with a maximum total dose of 29 U/kg have been reported. Although there are no standard guidelines on doses in children. The current practice is to inject BTX-A at higher doses than reported in the past. Larger dose of BTX-A is used more frequently, which isconsidered safe, more effective, and better tolerated by children. Titration of the dose of BTX-A is necessary because muscle spasticity affects different patients in different ways. The dosage of BTX-A must be individualized for each patient

Botulinum Toxin Type A With Oral Baclofen Versus Oral Tizanidine: A Nonrandomized Pilot Comparison in Patients With Cerebral Palsy and Spastic Equinus Foot Deformity

The objective Of this Study was to compare the effectiveness of baclofen versus tizanidine as adjuvant treatment of botulinum toxin type A botulinum toxin type A in the management of children with spasticity. Thirty children with gastroenemius spasticity were retrospectively reviewed at Gaziantep University Hospital, Gaziantep, Turkey. All Patients were treated with localized botulinum toxin injections and baclofen or tizanidine for spasticity and were followed at 2- to 4-week intervals and evaluated for a total of 12 weeks 17 children (57%) received baclofen and 13 (43%) received tizanidine. The mean score of Gross Motor Functional Measurement (76.63 +/- 5.88 vs 68.17 +/- 1.99, P \u3c .001) and caregiver questionnaire scores (70.23 +/- 4.76 vs 66.59 +/- 3.53, P = .03) for the tizanidine group were significantly higher as compared with the baclofen group. This study Suggests that combination of botulinum toxin type A with oral tizanidine is more effective with fewer side effects than combination of botulinum toxin type A and oral baclofen for spastic cerebral palsy

Acute stroke secondary to internal carotid artery pseudoaneurysm: MRI findingsand treatment with endovascularcoiling

Internal carotid artery pseudoaneurysms are uncommon. We report a young man with history of trivialtrauma who presented with middle cerebral artery stroke.Head CT scan revealed a right parapharyngeal mass. MRI confirmed the diagnosis of internal carotidpseudoaneurysm. Cerebral angiogram showed dissection of internal carotid artery with a large pseudoaneurysm and almost complete occlusion of vessel distal to aneurysm.Vessel was obliterated by fibercoiling and gluing byendovascular technique to diminish risk of furthere mbolization. MRI characteristics of carotid pseudoaneurysms and role of endovascular treatment arediscussed

Local thrombolytic treatment of cerebral venous thrombosis in three paediatric patients

There is increasing evidence that local thrombolysis can be used with relative safety and efficacy in adults with superior sagittal sinus thrombosis (SSST). However, little data is available on the use of local thrombolysis in children with SSST. We report three patients who received local thrombolysis for dural sinus thrombosis. Two patients received urokinase and one patient received urokinase followed by local TPA infusion. Recanalization was achieved in two patients

Headache in Cerebral Venous Thrombosis: incidence, pattern and location in 200 consecutive patients.

We analyzed the incidence, pattern and location of headache in consecutive 200 Patients with proven diagnosis of CVT to identify an association between localization of headache and site of sinus involvement. Headache was present in 136 (68%) Patients. The duration of headache (reported in 128 Patients) was reported as acute (1-3 days), 81 Patients (60%), sub-acute (4-14 days), 33 Patients (24%), and chronic (more than 14 days), 14 Patients (10%). The quality of headache (reported in 72 Patients) was reported as throbbing 12 (9%), band like 27 (20%), thunderclap 7 (5%), and other (pounding, exploding, stabbing, etc.) 26 (20%). The location of headache (reported in 101 Patients) was reported as unilateral (one side of head) 48 (37%), localized (frontal, temporal, occipital, and neck) 25 (19%), and diffuse (whole head) 28 (20%). 43 (32%) Patients had normal neurological examination (normal mental status, cranial nerves, motor and sensory examination with down going planters). 93 (68%) Patients have abnormal findings on neurological examination including papilledema 29 (15%) Patients, altered mental status 38 (19%), and focal neurological deficit 45 (22%) Patients. There was no association between headache and presence of hemorrhage on CT and MRI (P = 0.1) or hydrocephalus (P = 0.09). There was no association between localization of headache and site of sinus thrombosis except sigmoid sinus thrombosis, where 17 out of 28 Patients with involvement of sigmoid sinus alone or in combination with transverse sinus had pain in the occipital and neck region (P \u3c 0.05). There was no association between lateralization of pain and site of thrombosis (P = 0.66)

Paracervical block with 1% lidocaine for pain control during intrauterine device insertion: a prospective, single-blinded, controlled study

In this prospective controlled study we aimed to investigate efficacy of paracervical block with 1% Lidocaine for pain control and demographic variables which may affect pain perception during intrauterine device insertion in Turkish women. Data from 95 women assigned to paracervical block (n=34), placebo (n=30) and no treatment (n=31) arms and asked to grade the pain level they  felt during tenaculum placement, intrauterine device insertion and 5 minutes after the procedure using a visual pain scale. Demographic variables were also recorded. Pain scores were found to be lower in paracervical block group when compared to other 2 groups during tenaculum placement (p=0.00), intrauterine device insertion (p=0.00) and 5 minutes after the procedure (p=0.00). Level of pain was unrelated to mode of previous deliveries and current breastfeeding. Paracervical block is an easy, safe and effective way of pain control during intrauterine device insertion. Lack of vaginal birth history is not a reason to draw back from intrauterine device use