Evaluation and Neurodevelopmental Outcomes of Infants with Hypoxic Ischemic Encephalopathy Treated with Therapeutic Hypothermia: A Single Center Experience

Hypoxic ischemic encephalopathy (HIE) is an important cause of mortality and morbidity in newborns. Our study aimed to determine the neurodevelopmental outcomes, risk factors, and the relationship between risk factors and prognosis of cases followed up with HIE diagnosis and who were treated with hypothermia treatment. Medical records of 23 patients who were followed up with HIE diagnosis in the pediatric neurology outpatient clinic between January 1, 2018, and December 31, 2021, and treated with therapeutic hypothermia in the newborn period were retrospectively reviewed. Denver Developmental Screening Test II was used in the developmental evaluation. Neurodevelopment was normal in 12 (52.2%) of 23 cases and retarded for age in 11 (47.8%) cases. Variables such as Sarnat encephalopathy score in the neonatal period, need for prolonged ventilation, presence of severe acidosis at birth, Apgar scores at the 1st and 5th minutes, and abnormal cranial magnetic resonance (Mrg) findings were determined to be major factors in determining neurodevelopmental prognosis in asphyxic cases. The male gender was found to be riskier in terms of prognosis. Of the patients with HIE, retardation was determined for fine motor skills in 52.2%, speaking in 39.1%, gross motor skills in 26.1%, and personal development in 21.7%. Epilepsy, cerebral palsy, and speech disorders were the most common chronic period problems in patients with HIE. Despite therapeutic hypothermia treatment, neurodevelopmental problems are still observed in newborns with HIE. We found that male gender, low Apgar score, severe acidosis, and abnormal cranial Mrg findings in the neonatal period are risk factors in determining the neurodevelopmental prognosis of newborns with HIE. Monitoring and supporting the development of HIE cases with risk factors from the first months of life and intervening in developmental problems promptly are crucial in order to improve long-term outcomes

Cerebral neoplasm in L-2-hydroxyglutaric aciduria: Two different presentations

Background: L-2-hydroxyglutaric aciduria (L2HGA) is a rare neurometabolic disorder characterized by a slowly progressive clinical course, psychomotor and mental retardation, macrocephaly, dysarthria, seizures, and cerebellar and extrapyramidal findings. The diagnosis depends on the presentation of increased levels of L-2-hydroxyglutaric acid in the urine, plasma, and cerebrospinal fluids. Patients with L2HGA have an increased risk for the development of cerebral neoplasms which, though rarely, can be the initial presentation of the disease. Moreover, patients with L2HGA have an increased risk for the development of cerebral neoplasms. Cases presentation: Although psychomotor and mental retardation, macrocephaly, dysarthria, seizures, and cerebellar and extrapyramidal findings are the most common characteristics of the disease, we present two rare cases admitted with tumoral symptoms. Conclusion: Patients with L2HGA have an increased risk for the development of cerebral neoplasms

The importance of hyponatremia in febrile seizure

Febril nöbet çocukluk çağında en sık görülen nörolojik durumdur. Basit, komplike ve febril status olarak görülür. Uzamış febril nöbet ve komplike febril nöbet başta olmak üzere beyinde hasarlanmalar yaratır ve elektrolit bozuklukları bu durumun ağırlaşmasına ve nöbet tekrarlamasına neden olabilir. 2014- 2018 yılları arasında çocuk bölümüne başvuran toplam 6-72 ay arası 537 çocuk (273 çocuk febril nöbet; 264 çocuk ise nöbet olmadan ateş) çalışmaya dahil edildi. Hastalar iki gruba; basit febril nöbet (BFN) ve komplike febril nöbet (KFN) olarak ayrıldı. tek nöbet 15 dakikanın altında fokalite göstermeyen; KFN ise >15 dakika ve fokalite gösteren 24 saat içinde birden çok kez tekrarlayan nöbet olarak alındı. Febril nöbetle başvuru anında elektrolit değerleri venöz kan örnekleri ile değerlendirildi. BULGULAR: : Hastaların yaştan ve cinsiyetten bağımsız olarak lojistik regresyon analizi yapıldığında sodyum değeri 15 minutes and 24 hours with focal. Electrolyte values were evaluated with venous blood samples at admission with febrile seizures When logistic regression analysis was performed, regardless of age and gender, patients with sodium values <134.5 were found to be 10.13 times more risky for febrile seizures than those with sodium values <134.5. There was no significant relationship between serum potassium and calcium levels. 66.3% of patients with febrile seizures and 64% of patients with CFN had a sodium value below 134.5 mmol / L. The sensitivity and specificity for crosstabs sodium were 66.3% and 83.7%, and the positive predictive value was 80.8% and 70.6%, respectively. Seizure frequency of patients with moderate hyponatremia (132-133) was proportional to increase in seizure frequency compared to other sodium levels (r = 0.389, r = 0.434, p <0.05). In this study; We showed that sodium levels decreased significantly in febrile seizure, low sodium was significant in children with complex febrile seizures and it was a determining risk factor for recurrence of seizures

Characteristics of Epilepsy and Attention Deficit Hyperactivity Disorder Comorbidity in Children: A Retrospective Analysis

WOS: 000478577000006INTRODUCTION: Epilepsy is often accompanied by attention deficit hyperactivity disorder (ADHD). There are different opinions about reasons. The effect of epilepsy features was not studied in ADHD before or after epilepsy. We aimed to obtain clues about this comorbidity in children. METHODS: Data of forty-four (33 males, 11 girls) consecutive epilepsy patients with ADHD were retrospectively reviewed. The binary subgroups were statistically compared. RESULTS: ADHD was diagnosed before epilepsy in 11 (25%) and after epilepsy in 33 (75%) patients. The mean age was 11.5 +/- 2.7, the first and last seizure ages were 5.2 +/- 3 and 9.5 +/- 2.8, antiepileptic drug (AED) starting and ADHD ages were 6.6 +/- 3.4 and 8.4 +/- 2 years respectively. In patients with ADHD after epilepsy, AED and first seizure ages were younger (p=0.004 and p=0.002, respectively). Gender, epilepsy type, ADHD age, electroencephalography and brain magnetic resonance imaging findings were similar. There was a shorter interval time between ADHD and epilepsy in patients with a first seizure age >5 and AED age >6.5 years (p=0.013 and p=0.000). EEG abnormalities were more frequent in patients with >1.5 years time interval between epilepsy and ADHD (p=0.044). The ages of last seizure and AED starting ages were positively correlated with ADHD age (r=0.389, r=0.434, p< 0.05). DISCUSSION and CONCLUSION: We found similar ADHD ages in patients with ADHD before or after epilepsy. However, AEDs need was observed in two separate periods, early childhood and school age. The similarity of other features suggests that common pathogenetic mechanisms may play a role in this comorbidity

Pseudo-Petit Mal Discharge: A Marker of Favorable Prognosis in Febrile Seizure

Objective:To investigate whether pseudo-petit mal discharge is a useful marker of epilepsy on electroencephalogram in patients with recurrent febrile seizures.Methods:The retrospective study included 255 out of 1255 children aged 6-66 months that were followed up in our hospital due to febrile seizures over the period 2010-2020. All the patients underwent an electroencephalogram examination and electroencephalogram abnormalities were classified into 3 groups: group I (normal), no epileptiform or background abnormalities; group II (abnormal), focal or generalized discharge or electroencephalogram slowing; group III (pseudo-petit mal discharge). Patients with pseudo-petit mal discharge were followed up for epilepsy development for a period of 7 years after the age of 72 months.Results:The prevalence of pseudo-petit mal discharge on electroencephalogram was significantly higher in patients with complex febrile seizures compared to recurrent febrile seizures (P = .005). Ten (6.1%) recurrent febrile seizure patients with normal electroencephalogram findings were followed up for epilepsy. Pseudo-petit mal discharge was found to persist in 7 (12%) out of 58 recurrent febrile seizure patients with pseudo-petit mal discharge for a period of 7 years, after which no seizure activity was detected on electroencephalogram and thus no follow-up was performed for epilepsy. Pseudo-petit mal discharge that patients with recurrent febrile seizure seizures had 2.3 (1.107-1.988) risk of having >4 seizure times and 1.9 (1.335-2.569) times more risk of being male. Compared to complex febrile seizures, those with more recurrent febrile seizure seizures had longer pseudo-petit mal discharge periods and greater frequency.Conclusions:The presence of pseudo-petit mal discharge on electroencephalogram could be an indication of especially recurrent febrile seizure in children with febrile seizures and pseudo-petit mal discharge could be a marker of favorable prognosis in long-term follow-up of febrile seizures patients in terms of epilepsy development since epilepsy was diagnosed in patients without pseudo-petit mal discharge and was not detected in patients with pseudo-petit mal discharge. Although pseudo-petit mal discharge is an important predisposing factor for the recurrence of febrile seizures, it has been shown that it is not a risk factor for epilepsy development

Wernicke's encephalopathy manifesting with diplopia after ileojejunostomy: report of a pediatric case with Hirschsprung disease

Background. Wernicke's encephalopathy (WE) is a coenzyme-induced disease with acute neuropsychiatric symptoms leading to high mortality and morbidity due to thiamine deficiency. WE is mostly caused by alcoholism in adult populations; however, it is often associated with gastrointestinal surgical procedures, recurrent vomiting, chronic diarrhea, cancer and chemotherapy treatment, systemic diseases, drugs, magnesium deficiency, and malnutrition in children. Although these predisposing factors are considered to be uncommon in children, they are actually highly frequent and can be fatal if not treated promptly

Neurological manifestations of pediatric acute covid infections: A single center experience

© 2021 The Author(s) [2021]. Published by Oxford University Press. All rights reserved. For permissions, please email: [email protected]: Coronavirus disease 2019 (COVID-19) usually leads to a mild infectious disease course in children, while serious complications may occur in conjunction with both acute infection and neurological symptoms, which have been predominantly reported in adults. The neurological complications in these patients vary based on patient age and underlying comorbidities. Data on clinical features, particularly neurological features, and prognostic factors in children and adolescents are limited. This study provides a concise overview of neurological complications in pediatric COVID-19 cases. Materials and methods: The retrospective study reviewed medical records of all patients who were admitted to our hospital and were diagnosed with COVID-19 by real-time reverse-transcription polymerase-chain-reaction (RT-PCR) assay between 11 March 2020 and 30 January 2021. Patients with a positive PCR result were categorized into two groups: outpatient departments patients and inpatient departments (IPD). Results: Of the 2530 children who underwent RT-PCR during the study period, 382 (8.6%) were confirmed as COVID-19 positive, comprising 188 (49.2%) girls and 194 (50.8%) boys with a mean age of 7.14±5.84 (range, 0-17) years. Neurological complications that required hospitalization were present in 34 (8.9%) patients, including seizure (52.9%), headache (38.2%), dizziness (11.1%) and meningoencephalitis (5.8%). Conclusion: The results indicated that neurological manifestations are not rare in children suffering from COVID-19. Seizures, headaches, dizziness, anosmia, ageusia and meningoencephalitis are major neurological manifestations during acute COVID-19 disease. Although seizures were the most common cause of hospitalization in IPD patients, the frequency of meningoencephalitis was quite high. Seizures were observed as febrile seizures for children under 6 years of age and afebrile seizures for those over 6 years of age. Febrile seizure accounted for half of all seizure children

The effectiveness and tolerability of clobazam in the pediatric population: Adjunctive therapy and monotherapy in a large-cohort multicenter study

Objective: To evaluate the effectiveness and tolerability of clobazam therapy in the pediatric population in terms of seizure semiology, epileptic syndromes, and etiological subgroups. Methods: A retrospective cohort study was conducted consisting of 1710 epileptic children from eight centers in seven geographic regions of Turkey. The initial efficacy of clobazam therapy was evaluated after three months of treatment. The long-term effectiveness of the drug, overall seizure outcomes, and overall therapeutic outcomes were evaluated during 12 months of therapy. Results: Analysis of initial efficacy after the first three months of clobazam therapy showed that 320 (18.7 %) patients were seizure-free, 683 (39.9 %) had > 50 % seizure reductions, and 297 (17.4 %) had 50 % seizure reduction) was determined for focal-onset (62.3 %) seizures, epileptic spasms (61.5 %), and generalized onset seisures (57.4). The highest positive response rate among the epileptıc syndromes was for self-limited epilepsy with centrotemporal spikes (SeLECTS). The highest negative response rate was for developmental and/or epileptic encephalopathies (DEEs). Magnetic resonance imaging (MRI) revealed a structural etiological diagnosis in 25.8 % of the cohort. A higher positive response rate was observed at MRI in patients with sequelae lesions than in those with congenital lesions. The seizure recurrence rate was higher in the patient group with epilepsy wıth genetic and metabolic causes, in individuals with more than one seizure type, and in those using three or more antiseizure drugs. Conclusions: This cohort study provides additional evidence that clobazam is an effective and well-tolerable drug with a high seizure-free rate (18.7 %), a significant seizure reduction rate (57.3 %), and with excellent overall therapeutic outcomes with a low seizure relapse rate and considerable reversible benefits in the pediatric population

The effectiveness and tolerability of clobazam in the pediatric population: Adjunctive therapy and monotherapy in a large-cohort multicenter study

Objective: To evaluate the effectiveness and tolerability of clobazam therapy in the pediatric population in terms of seizure semiology, epileptic syndromes, and etiological subgroups.Methods: A retrospective cohort study was conducted consisting of 1710 epileptic children from eight centers in seven geographic regions of Turkey. The initial efficacy of clobazam therapy was evaluated after three months of treatment. The long-term effectiveness of the drug, overall seizure outcomes, and overall therapeutic outcomes were evaluated during 12 months of therapy. Results: Analysis of initial efficacy after the first three months of clobazam therapy showed that 320 (18.7 %) patients were seizure-free, 683 (39.9 %) had > 50 % seizure reductions, and 297 (17.4 %) had 50 % seizure reduction) was determined for focal-onset (62.3 %) seizures, epileptic spasms (61.5 %), and generalized onset seisures (57.4). The highest positive response rate among the epileptic syndromes was for self-limited epilepsy with centrotemporal spikes (SeLECTS). The highest negative response rate was for developmental and/or epileptic encephalopathies (DEEs). Magnetic resonance imaging (MRI) revealed a structural etiological diagnosis in 25.8 % of the cohort. A higher positive response rate was observed at MRI in patients with sequelae lesions than in those with congenital lesions. The seizure recurrence rate was higher in the patient group with epilepsy with genetic and metabolic causes, in individuals with more than one seizure type, and in those using three or more antiseizure drugs.Conclusions: This cohort study provides additional evidence that clobazam is an effective and well-tolerable drug with a high seizure-free rate (18.7 %), a significant seizure reduction rate (57.3 %), and with excellent overall therapeutic outcomes with a low seizure relapse rate and considerable reversible benefits in the pediatric population