Epilepsy and GI Disorders

The gastrointestinal system communicates with the brain by way of vagus nerve fibers and the gut-brain axis. There is a well-known relationship between autoimmune diseases and epileptogenesis, and this may explain the involvement of gut microbiota in the course of epilepsy. Many seizures which are described, depending the severity and/or duration, as benign or epilepsy may be related and based on gastrointestinal origin. Epilepsy and related neurological symptoms may alert the clinician to additional life-threatening conditions and complications during the course of gastrointestinal system-based chronic disease such as inflammatory bowel disease and celiac disease. Since the gut is the only part of inner body exposed to environment, novel therapeutic options that target gut microbiata may be promising in many diseases including epilepsy

Hemlock (Conium Maculatum) Poisoning In A Child

SUMMARYPoison hemlock (Conium maculatum) is a plant that is poisonous for humans and animals. Accidental ingestion of the plant may result in central nervous system depression, respiratory failure, acute rhabdomyolysis, acute renal failure and even death. The main treatment of hemlock poisoning is supportive care. The case of a 6-year-old girl who was admitted to the emergency department with complaints of burning sensation in mouth, hypersalivation, tremor in hands and ataxia after ingestion of poison hemlock is presented here with clinical and laboratory features. In this case, we aim to report that accidental ingestion of plants resembling vegetables that are consumed daily can lead to serious complications and even death

Celiac Disease Presenting with Immune Thrombocytopenic Purpura

Celiac disease (CD) is an immunological disorder. Clinical manifestations occur as a result of intestinal mucosa damage and malabsorption. CD is also associated with extraintestinal manifestations and autoimmune disorders. The coexistence of CD and autoimmune diseases has been described before. In this article, a patient with CD presenting with thrombocytopenia is discussed

Neonatal tetanus in Turkey; what has changed in the last decade?

dikici, bunyamin/0000-0001-7572-6525WOS: 000259222800001PubMed: 18713452Background: Neonatal tetanus (NT) is still considered as one of the major causes of neonatal death in many developing countries. The aim of the present study was to assess the characteristics of sixty-seven infants with the diagnosis of neonatal tetanus followed-up in the Pediatric Infectious Diseases Ward of Dicle University Hospital, Diyarbakir, between 1991 and 2006, and to draw attention to factors that may contribute (or may have contributed) to the elimination of the disease in Diyarbakir. Methods: The data of sixty-seven infants whose epidemiological and clinical findings were compatible with neonatal tetanus were reviewed. Patients were stratified into two groups according to whether they survived or not to assess the effect of certain factors in the prognosis. Factors having a contribution to the higher rate of tetanus among newborn infants were discussed. Results: A total of 55 cases of NT had been hospitalized between 1991 and 1996 whereas only 12 patients admitted in the last decade. All of the infants had been delivered at home by untrained traditional birth attendants (TBA), and none of the mothers had been immunized with tetanus toxoid during her pregnancy. Twenty-eight (41.8%) of the infants died during their follow-up. Lower birth weight, younger age at onset of symptoms and at the time admission, the presence of opisthotonus, risus sardonicus and were associated with a higher mortality rate. Conclusion: Although the number of neonatal tetanus cases admitted to our clinic in recent years is lower than in the last decade efforts including appropriate health education of the masses, ensurement of access to antenatal sevices and increasing the rate of tetanus immunization among mothers still should be made in our region to achieve the goal of neonatal tetanus elimination

The frequency of Duchenne muscular dystrophy/Becker muscular dystrophy and Pompe disease in children with isolated transaminase elevation: results from the observational VICTORIA study

IntroductionElevated transaminases and/or creatine phosphokinase can indicate underlying muscle disease. Therefore, this study aims to determine the frequency of Duchenne muscular dystrophy/Becker muscular dystrophy (DMD/BMD) in male children and Pompe disease (PD) in male and female children with isolated hypertransaminasemia.MethodsThis multi-center, prospective study enrolled patients aged 3–216 months with serum alanine transaminase (ALT) and/or aspartate transaminase (AST) levels >2× the upper limit of normal (ULN) for ≥3 months. Patients with a known history of liver or muscle disease or physical examination findings suggestive of liver disease were excluded. Patients were screened for creatinine phosphokinase (CPK) levels, and molecular genetic tests for DMD/BMD in male patients and enzyme analysis for PD in male and female patients with elevated CPK levels were performed. Genetic analyses confirmed PD. Demographic, clinical, and laboratory characteristics of the patients were analyzed.ResultsOverall, 589 patients [66.8% male, mean age of 63.4 months (standard deviation: 60.5)] were included. In total, 251 patients (188 male and 63 female) had CPK levels above the ULN. Of the patients assessed, 47% (85/182) of male patients were diagnosed with DMD/BMD and 1% (3/228) of male and female patients were diagnosed with PD. The median ALT, AST, and CPK levels were statistically significantly higher, and the questioned neurological symptoms and previously unnoticed examination findings were more common in DMD/BMD patients than those without DMD/BMD or PD (p < 0.001).DiscussionQuestioning neurological symptoms, conducting a complete physical examination, and testing for CPK levels in patients with isolated hypertransaminasemia will prevent costly and time-consuming investigations for liver diseases and will lead to the diagnosis of occult neuromuscular diseases. Trial RegistrationClinicaltrials.gov NCT04120168

THE NEUROLOGICAL FACE OF CELIAC DISEASE

BackgroundSeveral neurological disorders have also been widely described in celiac disease patients.ObjectiveThe aim of this study was to determine the incidence of accompanying different neurologic manifestations in children with celiac disease at the time of diagnosis and to discuss these manifestations in the light of the recent literature.MethodsThis prospective cross sectional study included 297 children diagnosed with celiac disease. The medical records of all patients were reviewed.ResultsIn neurological evaluation, totally 40 (13. 5%) of the 297 celiac patients had a neurological finding including headache, epilepsy, migraine, mental retardation, breath holding spells, ataxia, cerebral palsy, attention deficit hyperactivity disorder, Down syndrome and Turner syndrome in order of frequency. There was not any significant difference between the laboratory data of the patients with and without neurological manifestations. However; type 3a biopsy was statistically significantly more common among patients without neurological manifestations, while type 3b biopsy was statistically significantly more common among patients with neurological manifestations.ConclusionIt is important to keep in mind that in clinical course of celiac disease different neurological manifestations may be reported

Gastrointestinal findings in children with Down syndrome: Is there an early sign for celiac disease?

Aim: To investigate the prevalence of celiac disease (CD) among children with Down’s syndrome (DS) and its association with gastrointestinal symptoms and other accompanying diseases. Methods: The study was consisted of regular trisomy 21 patients who were under follow-up in our department. The age, gender, gastrointestinal symptoms (abdominal pain, constipation, diarrhea, abdominal distension, vomiting, flatulence, and unsatisfactory weight gain/weight loss) and accompanying diseases were recorded. Anti-tissue transglutaminase (anti-tTG) immunoglobulin A (Ig A) levels were analyzed in all cases. Serologically positive patients were referred to a pediatric gastroenterologist for intestinal biopsy. Results: Totally 98 children with a mean age of 3.2±2.81 years (range: 2-13 years) diagnosed with the DS were included in this study. Among study participants, 46 (46.9%) were female. Among study participants, 3 (3.1%) had positive anti-tTG IgA results and endoscopic biopsies revealed the diagnosis of Marsh type 3b CD in all of them. In correlation analysis, hypothyroidism (p=0.03) and presence of diarrhea (p=0.04) significantly correlated with the CD presence among children with the DS. Diarrhea increased the risk for 1.50 times (0.67-3.34) while hypothyroidism increased the risk for 2.75 times (0.55-13.67) among patients with DS. Conclusion: Clinicians should be aware of an increased prevalence of CD among patients with DS especially in children with diarrhea and/or hypothyroidism

Katılma nöbeti, febril konvülziyon ve anemi bir yap-bozun parçaları mı? Çölyak hastalığı

Çölyak hastalığı epilepsi, ataksi, nöropati, miyopati ve baş ağrısı gibi birçok nörolojik hastalık ile ilişkili olup, febril konvülziyon ile birlikteliği enderdir. Bununla birlikte, demir eksikliği anemisi olan olgularda febril konvülziyon ve çölyak hastalığı sıklığı artmıştır. Demir eksikliğinin katılma nöbetinin sıklığını da artırdığı bilin- mektedir. Öncesinde katılma nöbeti ve demir eksikliği anemisi öyküsü olan 4,5 yaşında febril konvulziyon ile başvuran kız olgu- nun çölyak tanısına uzanan öyküsünü irdeledik. Çocuk hekimleri- nin sık karşılaştığı çeşitli hastalıklara eşlik eden çölyak hastalığını, hastanın öyküsü, muayenesi ve laboratuvar test sonuçlarını bir yap-bozun parçaları gibi birleştirerek nasıl ortaya çıkarılabilece- ğini göstermeyi amaçladık.Celiac disease is related to many neurologic disorder such as epi- lepsy, ataxia, neuropathy, myopathy and headache. The coexis- tence of celiac disease and febrile convulsion is unusual. However the incidence of celiac disease, and febrile convulsion is increased in cases with iron deficiency anemia. Iron deficiency is known to increase breath-holding spells. We’ve discussed clinical progress of a 4.5 year-old female patient with a history of breath-holding spell and iron deficiency anemia who applied with a febrile con- vulsion and diagnosed as celiac disease. We aimed to show how pediatricians could reveal celiac disease accompanying different type common disorders just like by way of combining data gat- hered from patient’s history, physical examination findings and laboratory results as parts of a puzzle

Katılma nöbeti, febril konvülziyon ve anemi bir yap-bozun parçaları mı? Çölyak hastalığı

Çölyak hastalığı epilepsi, ataksi, nöropati, miyopati ve baş ağrısı gibi birçok nörolojik hastalık ile ilişkili olup, febril konvülziyon ile birlikteliği enderdir. Bununla birlikte, demir eksikliği anemisi olan olgularda febril konvülziyon ve çölyak hastalığı sıklığı artmıştır. Demir eksikliğinin katılma nöbetinin sıklığını da artırdığı bilin- mektedir. Öncesinde katılma nöbeti ve demir eksikliği anemisi öyküsü olan 4,5 yaşında febril konvulziyon ile başvuran kız olgu- nun çölyak tanısına uzanan öyküsünü irdeledik. Çocuk hekimleri- nin sık karşılaştığı çeşitli hastalıklara eşlik eden çölyak hastalığını, hastanın öyküsü, muayenesi ve laboratuvar test sonuçlarını bir yap-bozun parçaları gibi birleştirerek nasıl ortaya çıkarılabilece- ğini göstermeyi amaçladık.Celiac disease is related to many neurologic disorder such as epi- lepsy, ataxia, neuropathy, myopathy and headache. The coexis- tence of celiac disease and febrile convulsion is unusual. However the incidence of celiac disease, and febrile convulsion is increased in cases with iron deficiency anemia. Iron deficiency is known to increase breath-holding spells. We’ve discussed clinical progress of a 4.5 year-old female patient with a history of breath-holding spell and iron deficiency anemia who applied with a febrile con- vulsion and diagnosed as celiac disease. We aimed to show how pediatricians could reveal celiac disease accompanying different type common disorders just like by way of combining data gat- hered from patient’s history, physical examination findings and laboratory results as parts of a puzzle