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

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

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

The new trend for antiseizure medication selection in juvenile myoclonic epilepsy: A retrospective multi-center study from Turkey between 2010 and 2020

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Trends in the choice of antiseizure medications in juvenile myoclonic epilepsy: A retrospective multi-center study from Turkey between 2010 and 2020

Purpose:Valproic acid (VPA) is frequently used and effective in juvenile myoclonic epilepsy (JME). Recently, levetiracetam (LEV) has been suggested as a monotherapy in JME. This study aimed to evaluate antiseizure medication (ASM) use in patients with JME. Methods: Treatment choices in a total of 257 patients (age range 8–18 years, 152 girls, 105 boys) with JME diagnosed and treated between 2010 and 2020 were evaluated retrospectively. Seizure remission was defined as complete seizure control for at least 12 months. Results: Across the study period and entire patient group, VPA was most commonly chosen as the initial ASM (50.9%), followed by LEV (44.4%), and lamotrigine (4.7%). VPA was also the most frequent first choice in the subgroup of boys (73.3%), while LEV was the commonest first choice in girls (57.9%). The sex difference regarding the ASM of the first choice was statistically significant (p<0.001). While VPA was the most frequent initial ASM in the first 5 years of the study period (2010–2015,n = 66, 64%), LEV had taken over as the most popular first ASM in the last 5 years (n = 83, 53.9%, p = 0.005). The most frequent reasons for discontinuation were inefficacy for LEV and adverse effects for VPA (p = 0.001). During follow-up, 237 patients (92.2%) were seizure-free for at least 12 months, and 159 (61.9%) were also in electrographic remission. Seizure remission occurred earlier than electroencephalographic remission (p<0.001). Conclusion: This study revealed that LEV has become the most frequently chosen initial ASM in the treatment of JME. Although LEV appears to have a better adverse effect profile, VPA seems more likely to be effective in achieving seizure control