Long term video-EEG monitoring findings in children and adolescents with intractable epilepsy

Introduction:   In spite of appropriate management, seizures are not controlled in10 to 20 percent of epileptic children. If we can find the epileptogenic focus and resect it by surgery, patient may be cured from refractory seizures. Long Term Video-EEG Monitoring (LTM) may give us important information in the preoperative assessment of these patients. We performed this study for the first time in pediatric age group in Iran.Materials and Methods: In this cross-sectional study, 43 children between 4 to 18 years, with intractable epilepsy who were Referred to Shefa Neuroscience Research Center between 1386_1391, were enrolled to study in order to evaluate their long-term video EEG findings.Results: Forty-three children were enrolled to this study with mean age of 10.07 years, that 24(65.9%) were boys and 19(44.1%) were girls.Seven patients with definite epileptogenic zone were advised to perform lesionectomy surgery, in 2 patients there was not any seizure onset focus but corpus callosotomy was advised to control their frequent falling. Eight cases were recommended to perform Electrocorticography or invasive EEG monitoring. Twenty-six cases were recommended to adjust medical treatment. In 3 cases there was not any electrical seizure activity during clinical attacks, so discontinuing anti-epileptic drugs were recommended with diagnosis of conditions that mimic epilepsy.Conclusions:   It is necessary to perform LTM in patients with refractory epilepsy in order to determine their treatment strategy. If there is any doubt about pseudoseizure LTM can help to differentiate epilepsy from conditions that mimic epilepsy

Comparison of food intake in multiple sclerosis patients and healthy individuals – A hospital-based case-controlled study

ObjectivesNutritional factors affect the incidence, severity of symptoms and progression of multiple sclerosis (MS). However, the role of specific nutritional factors remains largely unknown in MS. We conducted this hospital-based case-controlled study to investigate the association between dietary intake and risk of MS.Methods: This study was conducted on 93 MS patients and 94 age-matched controls. MS was diagnosed based on 2010 McDonald criteria and Brain Magnetic Resonance Imaging. Dietary intake was assessed by using a validated semi-quantitative food frequency questionnaire. Odds ratio and 95% confidence interval of MS was calculated in different food item groups using multiple logistic regression models adjusted for potentially confounding variables and compared between the two groups. Results: There was no significant difference between age (34.62 ±9.68vs. 33.96±8.75) and BMI (23.96 ±4.07 vs. 24.47 ±4.07) of MS and control group respectively. Higher intake of processed meat (OR (95% CI)) = (2.07(1.18-3.63) and non-processed meat (1.38(1.13-1.68)) was found in the MS group compared with the control. Conclusion: Higher intake of processed meat and non-processed meat is associated with increased risk of MS. Further studies on the probable role of these nutritional factors in the pathogenesis of MS are suggested.

Relationship between Iron Deficiency Anemia and Febrile Seizures

ObjectiveFebrile seizure is the most common convulsive disorder in childhood. The role of iron in metabolism of neurotransmitters and carrying oxygen to the brain suggests the possibility of a relationship between iron deficiency anemia and febrile seizures.The aim of this study was to investigate the relationship between iron deficiency anemia and febrile seizures.Materials & MethodsThis case - control study was performed on 132 cases and 88 controls, aged 9 months to 5 years, from July 2007 to June 2009 in Baqyiatallah Hospital. Patients were selected using simple random sampling. The case group included children with first febrile seizure (core temperature over 38.5˚C during  seizure) without a central nervous system infection or an acute brain insult. The control group included children suffering from a febrile illness without seizure. Iron deficiency anemia was defined with one of these laboratory indexes: 1) Hemoglobin (Hb) <10.5mg/dl 2) Plasma ferritin <12ng/dl 3) Mean corpuscular volume (MCV) <70  fl. The data collected from patients were analyzed with SPSS.13 software.ResultsLow plasma ferritin was found in 35 cases (26.5%) compared to 26 controls (29.5%), low Hb level was found in 4 cases (3%) compared to 6 controls (6.8%) and low MCV was found in 5 cases (3.8%) compared to 6 controls (6.8%).There was no significant difference in plasma ferritin , Hb level and MCV indices between the two group.ConclusionConsidering the above-mentioned results, there is no relationship between iron deficiency anemia and febrile seizures

Prevalence of Epileptiform Discharges in Children with Sensori-Neural Hearing Loss and Behavioral Problems Compared to Their Normal Hearing Peers

How to Cite This Article: Amirsalari S, Radfar Sh, Ajallouyean M, Saburi A, Yousefi J, Noohi S, Tavallaie SA, Hassanalifard M, Ghazavi Y. Prevalence of Epileptiform Discharges in Children with Sensori-Neural Hearing Loss and Behavioral Problems Compared to Their Normal Hearing Peers. Iran J Child Neurol. 2014 Spring 8(2):29-33.ObjectiveOveractivity and behavioral problems are common problems in children with prelingually profound sensorineural hearing loss (SNHL). Data on epileptiform electroencephalography (EEG) discharges in deaf children with psychologicaldisorders are so limited. The primary focus of this study was to determine the prevalence of epileptiform discharges (EDs) in children with SNHL and overactivity or behavioral problems.Materials & MethodsA total of 262 patients with prelingually profound SNHL who were referred to our cochlear implantation center between 2008 and 2010 were enrolled in this study. Children with SNHL who had diagnosis of overactivity and/or behavioralproblems by a pediatric psychiatrist, underwent electroencephalography (EEG).EEG analysis was carried out by a board-certified pediatric neurologist. The control group consisted of 45 cases with overactivity or behavioral problems and normal hearing.ResultsOne hundred thirty-eight children with mean age of 3.5±1.23 year were enrolled in the case group, of whom 88 cases (63.7%) were boy. The control group consisted of 45 cases with mean age of 3.2±1.53 years, of whom 30 (66.6%)cases were male. EDs were detected in 28 (20.02%) children of the case group (with SNHL) in comparison with 4 (8.88%) in the control group (without SNHL), which was statistically significantly different.ConclusionIn this study, we obtained higher frequency of EDs in deaf children with overactivity and/or behavioral problem compared to the children without SNHL. Further studies are required to evaluate the possible association of SNHL withEDs in overactive children.References1. Matsuura M, Okubo Y, Toru M, Kojima T, He Y, Hou Y, et al. A cross-national EEG study of children with emotional and behavioral problems: a WHO collaborative study in the Western Pacific Region. Biol Psychiatry 1993;34(1-2):59-65.2. Hindley P, Kroll L. Theoretical and epidemiological aspects of attention deficit and overactivity in deaf children. J Deaf Stud Deaf Educ 1998;3(1):64-72.3. [No author listed] . Clinical practice guideline: diagnosis and evaluation of the child with attentiondeficit/ hyperactivity disorder. American Academy of Pediatrics. Pediatrics 2000;105(5):1158-70.4. Klinkerfuss GH, Lange PH, Weinberg WA, O’Leary JL. Electroencephalographic abnormalities of children with hyperkinetic behavior. Neurology 1965;15(10):883-91.5. Millichap JJ, Stack CV, Millichap JG. Frequency of epileptiform discharges in the sleep-deprived electroencephalogram in children evaluated for attention-deficit disorders. J Child Neurol 2011;26(1):6-11.6. Fonseca LC, Tedrus GM, Moraes C, Vicente Machado A, Almeida MP, Oliveira DO. Epileptiform abnormalities and quantitative EEG in children with attentiondeficit/ hyperactivity disorder. Arq Neuropsiquiatr 2008;66(3A):462-7.7. Venkatesh C, Ravikumar T, Andal A, Virudhagirinathan BS. Attention - deficit/Hyperactivity Disorder in Children: Clinical Profile and Co-morbidity. Indian J Psychol Med 2012 ;34(1):34-8.8. Monastra VJ, Lubar JF, Linden M. The development of a quantitative electroencephalographic scanning process for attention deficit-hyperactivity disorder: reliability and validity studies. Neuropsychology 2001;15(1):136-44.9. Monastra VJ, Lubar JF, Linden M, VanDeusen P, Green G, Wing W, et al. Assessing attention deficit hyperactivity disorder via quantitative electroencephalography: an initial validation study. Neuropsychology 1999; 13(3):424-33.10. Barry RJ, Johnstone SJ, Clarke AR. A review of electrophysiology in attention-deficit/hyperactivity disorder: II. Event-related potentials. Clin Neurophysiol 2003;114(2):184-98.11. Magee CA, Clarke AR, Barry RJ, McCarthy R, Selikowitz M. Examining the diagnostic utility of EEG power measures in children with attention deficit/hyperactivity disorder. Clin Neurophysiol 2005;116(5):1033-40.12. Loo SK, Barkley RA. Clinical utility of EEG in attention deficit hyperactivity disorder. Appl Neuropsychol 2005;12(2):64-76.13. Venkateswaran S, Shevell M. The case against routine electroencephalography in specific language impairment. Pediatrics 2008;122(4):e911-6.14. Amirsalari S, Ajallouyean M, Saburi A, Haddadi Fard A, Abed M, Ghazavi Y. Cochlear implantation outcomes in children with Waardenburg syndrome. Eur Arch Otorhinolaryngol 2012; 269(10):2179-83.15. Amirsalari S, Yousefi J, Radfar S, Saburi A, Tavallaie SA, Hosseini MJ, et al. Cochlear implant outcomes in children with motor developmental delay. Int J Pediatr Otorhinolaryngol 2012;76(1):100-3.16. Holtmann M, Becker K, Kentner-Figura B, Schmidt MH. Increased frequency of rolandic spikes in ADHD children. Epilepsia 2003;44(9):1241-4.17. Richer LP, Shevell MI, Rosenblatt BR. Epileptiform abnormalities in children with attention-deficithyperactivity disorder. Pediatr Neurol 2002;26(2):125-9.18. Socanski D, Herigstad A, Thomsen PH, Dag A, Larsen TK. Epileptiform abnormalities in children diagnosed with attention deficit/hyperactivity disorder. Epilepsy Behav 2010;19(3):483-6.19. Fonseca LC, Tedrus GM. [Somatosensory evoked spikes and epileptiform activity in “normal” children]. Arq Neuropsiquiatr 2003;61(3B):793-5. [Article in Portuguese]20. Borusiak P, Zilbauer M, Jenke AC. Prevalence of epileptiform discharges in healthy children--new data from a prospective study using digital EEG. Epilepsia 2010;51(7):1185-8.21. Daneshi A, Hassanzadeh S. Cochlear implantation in prelingually deaf persons with additional disability. J Laryngol Otol 2007;121(7):635-8.22. Dye MW, Bavelier D. Attentional enhancements and deficits in deaf populations: an integrative review. Restor Neurol Neurosci 2010;28(2):181-92.

Thyroid Function in Epileptic Children who Receive Carbamazepine, Primidone, Phenobarbital and Valproic Acid

ObjectiveIn this study, we investigated the changes of the serum levels of thyroidhormones including Thyroxine (T4), Triiodothyronine (T3), T3 resin uptake andThyroid stimulating hormone (TSH) in epileptic children during treatment withanti-epileptic drugs (AEDs) including carbamazepine (CBZ), primidone (PRM),phenobarbital and valproic acid (VPA).Materials and MethodsThis study consisted of four case-series comparisons, was conducted on 115epileptic children (37 girls and 78 boys with an age range between 2 monthsand 15 years, mean: 62.06 ± 44.97 months). These children were divided into4 groups who took either phenobarbital (n=29), PRM (n=28), CBZ (n=29), orVPA (n=29) for 3 months. Thyroid hormone levels (T3, T3 resin uptake, T4 andTSH) were measured at the beginning and three months after starting the study.ResultsAt first, all patients were euthyroid and there were no clinical or laboratoryfindings suggestive of hypothyroidism. Regarding thyroid hormones before andafter the administration of phenobarbital, carbamazepine, valproic acid andprimidone, there were no significant changes in serum T3, T4, T3 resin uptakeand TSH levels.ConclusionOur findings showed that short term therapy with phenobarbital, carbamazepine,valproic acid and primidone had no effect on thyroid function etsts.Key words: Anti-epileptic drugs; Thyroid hormones; Epileptic children.  

Magnetic Resonance Imaging Findings in Epileptic Children and Its Relation to Clinical and Demographic Findings

Epilepsy is an important disease with a cumulative incidence of 3% all over the life and more than half of them are started from childhood. In this study we surveyed magnetic resonance imaging (MRI) findings in epileptic children and its relation with clinical and demographic findings in order to find better diagnostic and treatment modalities for these children in the future. In this cross sectional study, we investigated consecutively all 1 to 15-year-old epileptic children who referred to the pediatric neurology outpatient clinic from 2004 to 2010. Two hundred children were enrolled for investigation. There were 85 (42.5%) girls and 115 (57.7%) boys, aged 1 to 15-year-old (7.7±4). 196 (98%) of the children had abnormal electroencephalography (EEG). Abnormal MRI was seen in 57 (28.5%) patients and consisted of brain atrophy (10%), increasing white matter signal intensity in T2-weighted images (8%), benign cysts (5%), brain tumors (4%) and vascular abnormalities (1.5%). Abnormal MRI findings had significant relation with abnormal EEG, age, positive family history for epilepsy, dysmorphic appearance, and abnormal physical exam. Considering 98% EEG abnormalities in these epileptic children, benign nature of MRI findings in most of our cases, the high price of MRI and the small minority of patients who benefit from active intervention as a result of MRI, we suggest to use EEG for confirmation of epilepsy and perform MRI for patient with abnormal physical exams, focal neurologic deficits or focal EEG abnormalities