Predictors of anti-convulsant treatment failure in children presenting with malaria and prolonged seizures in Kampala, Uganda

BACKGROUND: In endemic areas, falciparum malaria remains the leading cause of seizures in children presenting to emergency departments. In addition, seizures in malaria have been shown to increase morbidity and mortality in these patients. The management of seizures in malaria is sometimes complicated by the refractory nature of these seizures to readily available anti-convulsants. The objective of this study was to determine predictors of anti-convulsant treatment failure and seizure recurrence after initial control among children with malaria. METHODS: In a previous study, the efficacy and safety of buccal midazolam was compared to that of rectal diazepam in the treatment of prolonged seizures in children aged three months to 12 years in Kampala, Uganda. For this study, predictive models were used to determine risk factors for anti-convulsant treatment failure and seizure recurrence among the 221 of these children with malaria. RESULTS: Using predictive models, focal seizures (OR 3.21; 95% CI 1.42-7.25, p = 0.005), cerebral malaria (OR 2.43; 95% CI 1.20-4.91, p = 0.01) and a blood sugar >or=200 mg/dl at presentation (OR 2.84; 95% CI 1.11-7.20, p = 0.02) were independent predictors of treatment failure (seizure persistence beyond 10 minutes or recurrence within one hour of treatment). Predictors of seizure recurrence included: 1) cerebral malaria (HR 3.32; 95% CI 1.94-5.66, p < 0.001), 2) presenting with multiple seizures (HR 2.45; 95% CI 1.42-4.23, p = 0.001), 3) focal seizures (HR 2.86; 95% CI 1.49-5.49, p = 0.002), 4) recent use of diazepam (HR 2.43; 95% CI 1.19-4.95, p = 0.01) and 5) initial control of the seizure with diazepam (HR 1.96; 95% CI 1.16-3.33, p = 0.01). CONCLUSION: Specific predictors, including cerebral malaria, can identify patients with malaria at risk of anti-convulsant treatment failure and seizure recurrence

Capuchin monkeys (Cebus apella) respond to video images of themselves

Many studies have used mirror-image stimulation in attempts to find self-recognition in monkeys. However, very few studies have presented monkeys with video images of themselves; the present study is the first to do so with capuchin monkeys. Six tufted capuchin monkeys were individually exposed to live face-on and side-on video images of themselves (experimental Phase 1). Both video screens initially elicited considerable interest. Two adult males looked preferentially at their face-on image, whereas two adult females looked preferentially at their side-on image; the latter elicited lateral movements and head-cocking. Only males showed communicative facial expressions, which were directed towards the face-on screen. In Phase 2 monkeys discriminated between real-time, face-on images and identical images delayed by 1 s, with the adult females especially preferring real-time images. In this phase both screens elicited facial expressions, shown by all monkeys. In Phase 3 there was no evidence of discrimination between previously recorded video images of self and similar images of a familiar conspecific. Although they showed no signs of explicit self-recognition, the monkeys’ behaviour strongly suggests recognition of the correspondence between kinaesthetic information and external visual effects. In species such as humans and great apes, this type of self-awareness feeds into a system that gives rise to explicit self-recognition

Chapter 143 - Intraoperative neurophysiology during intracranial surgery in children

Over the past 15 years, intraoperative neurophysiological monitoring (IONM) has established itself as an important clinical discipline. It aims, first, to prevent neurological deficits induced by surgery and, second, to predict functional outcome. IONM also documents the moment when injury to the neural pathways, if any, occurs. This last aspect, besides its medicolegal implications, retains educational value for young neurosurgeons. Nowadays, IONM is considered of great value during neurosurgical procedures in functionally eloquent areas of the nervous system, especially in pediatric neurosurgery

Origins of temporal lobe epilepsy: febrile seizures and febrile status epilepticus.

Temporal lobe epilepsy (TLE) and hippocampal sclerosis (HS) commonly arise following early-life long seizures, and especially febrile status epilepticus (FSE). However, there are major gaps in our knowledge regarding the causal relationships of FSE, TLE, HS and cognitive disturbances that hamper diagnosis, biomarker development and prevention. The critical questions include: What is the true probability of developing TLE after FSE? Are there predictive markers for those at risk? A fundamental question is whether FSE is simply a marker of individuals who are destined to develop TLE, or if FSE contributes to the risk of developing TLE. If FSE does contribute to epileptogenesis, then does this happen only in the setting of a predisposed brain? These questions are addressed within this review, using information gleaned over the past two decades from clinical studies as well as animal models