First, Do No Harm: The Risks Of Overtreating Children With Epilepsy

Background: Although overtreatment with antiepileptic drugs contributes to the morbidity associated with epilepsy, many children still are overtreated. Objective: To evaluate if the withdrawal of at least one antiepileptic drug (AED) in children with refractory epilepsy using polytherapy enable a better seizure control. Method: This was a prospective study. Children with refractory epilepsy using at least two AEDs were included. Once the patient, or guardian, agreed to participate in the study, one or more AED were slowly tapered off. The remaining AEDs dosages could be adjusted as needed, but a new AED could not be introduced. Results: Fifteen patients were evaluated, three girls; ages ranging from 3 to 18 (mean=8.7 years). After at least one AED withdrawal, two (13.5%) patients became seizure free, seizures improved >50% in 5 (33.5%) patients, did not change in 5 (33.5%), and seizure frequency became worse in 3 (20%). Adverse events improved in 12 patients (80%). Conclusion: The withdrawal of at least one AED is a valuable option in the treatment of selected children with refractory epilepsy.65114Camfield, C.S., Camfield, P., Gordon, K., Smith, B., Dooley, J., Outcome of childhood epilepsy: A population-based study with a simple scoring system for those treated with medication (1993) J Pediatr, 122, pp. 861-868Silva, M., MacArdle, B., MaGowan, M., Randomised comparative monotherapy trial of phenobarbitone, phenytoin, carbamazepine, or sodium valproate for newly diagnosed childhood epilepsy (1996) Lancet, 347, pp. 709-713Baulac, M., Rational conversion from antiepileptic polytherapy to monotherapy (2003) Epileptic Disord, 5, pp. 125-132Holmes, G.L., Overtreatment in children with epilepsy (2002) Epilepsy Res, 52, pp. 35-42Fischbacher, E., Effect of reduction of anticonvulsants on wellbeing (1982) Br Med J (Clin Res Ed), 285, pp. 423-424Schmidt, D., Reduction of two-drug therapy in intractable epilepsy (1983) Epilepsia, 24, pp. 368-376Alvarez, N., Discontinuance of antiepileptic medications in patients with developmental disability and diagnosis of epilepsy (1989) Am J Ment Retard, 93, pp. 593-595Guerrini, R., Belmonte, A., Genton, P., Antiepileptic drug-induced worsening of seizures in children (1998) Epilepsia, 39 (SUPPL. 3), pp. S2-S10TS, K., Holmes, G.L., EEG and clinical predictors of medically intractable childhood epilepsy (1999) Clin Neurophysiol, 110, pp. 1245-1251Huttenlocker, P.R., Hapke, R.J., A follow-up study of intractable seizures in childhood (1990) Ann Neurol, 28, pp. 699-705Ferngren, H., Akerstrom, I., Rane, A., Mono or polypharmacotherapy in institutionalized epileptic children with severe mental retardation? A team approach for optimizing antiepileptic therapy (1991) Acta Paediatr Scand, 80, pp. 458-465Dooley, J., Gordon, K., Camfield, C., Smith, E., Discontinuation of anticonvulsant therapy in children free of seizures for 1 year: A prospective study (1996) Neurology, 46, pp. 969-974Shinnar, S., Berg, A.T., Moshé, S.L., Discontinuing antiepileptic drugs in children with epilepsy:a prospective study (1994) Ann Neurol, 35, pp. 534-545Shorvon, S.D., Reynolds, E.H., Unnecessary polypharmacy for epilepsy (1977) Br Med J, 1, pp. 1635-1637Vickery, B.G., Hay, R., Engel, J., Outcome assessment for epilepsy surgery: The impact of measuring health-related quality of life (1995) Ann Neurol, 37, pp. 158-16

Síndrome De Transfusão Feto-fetal: Neurodesenvolvimento De Lactentes Tratados Com Cirurgia A Laser

To assess the neurodevelopmental functions of survivors of twin-twin transfusion syndrome (TTTS) treated by fetoscopic laser coagulation (FLC), during the first year of life, comparing them to a control group; and to verify the influence of specific variables on neurodevelopment. Method: This was a prospective, longitudinal study. The sample comprised 33 monochorionic diamniotic twins who underwent FLC for treatment of TTTS and 22 full-term infants of single-fetus pregnancies. Bayley Scales of Infant and Toddler Development Screening Test were used for evaluation. Prenatal, perinatal and postnatal information were obtained. Results: There was an increased frequency of infants in the TTTS group with inadequate performance compared to the control group. The identified variables (fetal donor, low economic income and cardiorespiratory disease) negatively impacted expressive communication and fine motor skills. Conclusion: Although through follow-up is recommended in all TTTS survivors, particular attention is required for the high-risk group as defined in this study. © 2016, Associacao Arquivos de Neuro-Psiquiatria. All rights reserved.74430731

Role of a family 11 carbohydrate-binding module in the function of a recombinant cellulase used to supplement a barley based diet for broiler chickens

Cellulases and xylanases display a modular architecture that comprises a catalytic module linked to one or more non-catalytic carbohydrate-binding modules (CBMs). CBMs have been classified into 52 different families, based on primary structure similarity. These non-catalytic modules mediate a prolonged and intimate contact of the enzyme with the target substrate eliciting efficient hydrolysis of the target polysaccharides. 2. A study was undertaken to investigate the importance of a family 11 CBM, displaying high affinities for barley -glucans, in the function of recombinant derivatives of cellulase CtLic26A-Cel5E of Clostridium thermocellum used to supplement a barley-based diet for broiler chicken. 3. The results showed that birds fed on diets containing the recombinant CtLic26A-Cel5E modular derivatives or the commercial enzyme mixture RovabioTM Excel AP displayed improved performance when compared with birds fed on diets not supplemented with exogenous enzymes. 4. It is suggested that the enzyme dosage used in this study (30 U/kg of basal diet), was probably too high for the efficacy of the family 11 CBM to be noticed. It remains to be established if the targeting effect resulting from the incorporation of CBMs in plant cell wall hydrolases may be effective at lower exogenous enzyme dosages

Crop -glucanase activity limits the effectiveness of a recombinant cellulase used to supplement a barley-based feed for free-range broilers

1. The supplementation of diets rich in soluble polysaccharides with microbial cellulases and hemicellulases decreases digesta viscosity and promotes broiler performance. 2. In contrast, recent experiments suggest that polysaccharidases are ineffective for improving the nutritive value of pasture biomass used by free-range broilers. However, the feasibility of using cellulases and hemicellulases to improve the utilisation of cereal-based feeds by pastured poultry remains to be established. 3. A study was undertaken to investigate the capacity of a recombinant cellulase from Clostridium thermocellum to improve the nutritive value of a barley-based feed for free-range pastured broilers of the RedBro Cou Nu RedBro M genotype. 4. The results show that supplementation of a barley-based diet with a recombinant -glucanase had no effect on the performance of free-range broilers, foraging in legume-based diets from d 28 to 56. In addition, the results confirm that the lack of effect of the recombinant enzyme in improving the nutritive value of the barley-based feed does not result from enzyme proteolysis or inhibition in the gastrointestinal tract. 5. Significantly, -glucanase activity was identified in the crop of non-supplemented animals. The data suggest that endogenous cellulases originated both from the barley-based feed and from the crop microflora. 6. The results presented here suggest that in older birds of slow-growing genotypes associated with free-range production systems, previously unknown sources of -glucanases, such as the feed and microbial symbiotic microflora, can affect the effectiveness of exogenous enzymes added to the feed

Clinical And Neuropsychological Correlation In Patients With Rolandic Epilepsy [correlação Entre Achados Clínicos E Neuropsicológicos Em Pacientes Com Epilepsia Rolândica]

Objectives: To evaluate the presence of neurological soft signs (NSS) and to correlate them with the Wechsler Intelligence Scale for Children (WISC III) in patients with rolandic epilepsy (RE). Methods: Forty children and adolescents aged between 9 and 15 years were studied. They were divided into two groups: G1 - patients with RE (n=20) - and G2 - healthy controls without epilepsy (n=20). They were assessed with the Quick Neurological Screening Test (QNST II) - clinical trial to search for NSS -, and the WISC III - neuropsychological test. Results: No statistical difference between groups was found in WISC III and QNST II. However, children with poorer motor skills had worse performance in the QNST II and also in the execution intelligence quotient - IQ (p=0.001) and in total IQ (p=0.004), thus showing a positive correlation between them. Conclusions: The QNST II is a good screening tool for the neurologist to detect abnormalities in fine motor skills.709691693Berg, A.T., Berkovic, S.F., Brodie, M.J., Revised terminology and concepts for organization of seizures and epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005-2009 (2010) Epilepsia, 51, pp. 676-685Lerman, P., Kivity, S., Benign focal epilepsy of childhood. A follow-up study of 100 recovered patients (1975) Arch Neurol, 32, pp. 261-264Bouma, P.A., Bovenkerk, A.C., Westendorp, R.G., Brouwer, O.F., The course of benign partial epilepsy of childhood with centrotemporal spikes: A meta-analysis (1997) Neurology, 48 (2), pp. 430-437Hommet, C., Billard, C., Motte, J., Cognitive function in adolescents and young adults in complete remission from benign childhood epilepsy with centro-temporal spikes (2001) Epileptic Disord, 3, pp. 207-216D'Alessandro, P., Piccirilli, M., Tiacci, C., Neuropsychological features of benign partial epilepsy in children (1990) Ital J Neurol Sci, 11, pp. 265-269Binnie, C.D., Marston, D., Cognitive correlates of interictal discharges (1992) Epilepsia, 33 (SUPPL. 6), pp. S11-S17Fonseca, L.C., Tedrus, G.M., Pacheco, E.M., Epileptiform EEG discharges in benign childhood epilepsy with centrotemporal spikes: Reactivity and transitory cognitive impairment (2007) Epilepsy Behav, 11, pp. 65-70Baglietto, M.G., Battaglia, F.M., Nobili, N., Neuropsychological disorders related to interictal epileptic discharges during sleep in benign epilepsy of childhood with centrotemporal or rolandic spikes (2001) Dev Med Child Neurol, 43, pp. 407-412Hermann, B.P., Jones, J., Sheth, R., Seidenberg, M., Cognitive and magnetic resonance volumetric abnormalities in new-onset pediatric epilepsy (2007) Semin Pediatri Neurol, 14, pp. 173-180Panayiotopoulos, C.P., Benign childhood partial epilepsies: Benign childhood seizures susceptibility syndromes (1993) J Neurol Neurosurg Psychiatry, 56, pp. 2-5Lindgren, A., Kihlgren, M., Melin, L., Croona, C., Development of cognitive functions in children with rolandic epilepsy (2004) Epilepsy Behav, 5, pp. 903-910Weglage, J., Demsky, A., Pietsh, M., Kurlemann, G., Neuropsychological, intellectual, and behavioral findings in patients with centrotemporal spikes with and without seizure (1997) Dev Med Child Neurol, 39, pp. 645-651Deonna, T., Rolandic epilepsy: Neuropsychology of the active epilepsy phase (2000) Epileptic Disord, 2 (SUPPL. 1), pp. S59-S61Deonna, T., Zesiger, P., Davidoff, V., Benign partial epilepsy of childhood: A longitudinal neuropsychological and EEG study of cognitive function (2000) Dev Med Child Neurol, 42, pp. 595-60

Diskitis in children: study of eight cases

The authors report the study of eight children with diskitis diagnosed through clinical, neurogical and orthopedic evaluation. The evidence of self limiting inflammation or infection of the intervertebral disk space and of soft tissue were avaliable by image studies. Findings with routine roentgenograms, computed tomography and magnetic resonance imaging are discussed.Os autores apresentam o estudo de oito crianças com diagnóstico de discite estabelecido através da avaliação clínica, neurológica e ortopédica. A comprovação de alterações inflamatórias em um espaço discal, vertebral e em tecidos moles foi possível em estudos por imagem, sendo discutidos aqueles obtidos por radiologia convencional, tomografia computadorizada e ressonância magnética.53553