ANTIEPILEPTIC DRUG THERAPY AND SERUM CARNITINE LEVELS IN CHILDREN PRIOR TO AND FOLLOWING TREATMENT

Background:The physiologic function of carnitine, oxidation of fatty acid and lipid  metabolism, is severely affected in carnitine deficiency, secondary forms of which lead to renal tubular disorders and chronic renal failure. Reduction in serum carnitine has been frequently reported in patients and experimental animals treated with antiepileptic drugs, one of which, valproic acid has consistently been found to cause the deficiency; the antiepileptic drugs, valproic acid, has consistently been found to cause the deficiency. Previous results, however, regarding the effects of other antiepileptic drugs have been less consistent.  Considering the controversial results available in lterarure, the aim of this study was to determine the effect of Valproic acid, Carbamazepine and Phenobarbital on serum carnitine levels in epileptic children.Methods:In the present study, serum carnitine levels were randomly monitored before and six months after therapy in 39 epileptic patients receiving the antiepileptic drugs mentioned. Patient blood samples were taken before and six months after treatment and L-carnitine level was determined using the UV enzymatic test (Rouche Kit) spectronic Genesis 2, 340 nm.Results:Results showed a significant fall in the L-carnitine levels of epileptic children taking these drugs (P< 0.01).Conclusion:Considering the reducing effect of antiepileptic drugs on serum carnitine levels, it is recommended that a carnitine supplement be administered in pediatric epileptic patients to prevent the deficiency and related consequences caused by such therapies.Keywords:Carnitine ,Epilepsy - in children ,Valproic Acid, Phenobarbital, Carbamazepin

Moyamoya Induced Acute Paraplegia in A Child with Epilepsy

ObjectiveMoyamoya disease (MMD) is a chronic, occlusive, cerebrovascular disorder of unknown  pathogenesis, characterized by progressive stenosis of the bilateral supraclinoid internal carotid arteries, with concomitant formation of tortuous arterial collateral vessels at the base of the brain, which reconstitute distal branches of the cerebral circulation. In Japanese, "Moyamoya" means "hazy puff of smoke" and refers to the angiographic appearance of the abnormal network of vessels that develop at the base of the brain and basal ganglia to supply a collateral route of blood flow. We report here the case of Moyamoya disease in a 5 year-old girl with normal mentality with a one year history of epilepsy, with Todd's paralysis. This condition is rare and most patients are diagnosed in childhood. With this report we aim to underscore the possibility that a usual neurological sign could be associated with unusual neurological disorders.

Effects of an Exercise-Oriented Rehabilitation Program on Mechanical Efficiency and Aerobic Capacity in Children with Spastic Cerebral Palsy

AbstractObjectiveChildren suffering from Cerebral Palsy (CP), exhibit movement limitations and physiological abnormalities as compared to normal individuals.The objective of this study was to assess mechanical efficiency and certain cardiovascular indices before and after an exercise-rehabilitation program in children with dipelegia spastic cerebral palsy (experimental group) in comparison with able-bodied children(controls). Material and MethodsIn this study, 15 spastic cerebral palsy (dipelegic) children participated in an exercise-rehabilitation program, three days a week for three months with an average 144bpm of heart rate. The mechanical efficiency (net, gross), rest and submaximal heart rate and maximal oxygen consumption (VO2max) were measured before (pretest) and after (posttest) exercise program on the cycle ergometer according to the Macmaster ergometer protocol. Then control group, of 18 normal children underwent the exercise program and were assessed, following which results of the 2 groups were compared using SPSS for statistical analysis (P&lt;0.05). ResultsMechanical efficiency (net, gross) increased significantly in CP patients after the exercise-rehabilitation program; reults did not alter significantly for the controls.Rest and submaximal heart rate in CP patients decreased significantly after exercise program. Maximal oxygen consumption, which remained unchanged in patients following the exercise program, was similar in patients and controls after the program. ConclusionCerebral palsy patients, because of their high muscle tone, severe degree of spasticity, and involuntary movements are physically more incapacitated and need more energy than normal able-bodied individuals. Rehabilitation and aerobic exercise can be effective in improving their cardiovascular fitness and muscle function and increasing their mechanical efficiency

COMPARATIVE EFFECTS OF NITRAZEPAM AND ACTH ON THE TREATMENT OF INFANTILE SPASM

ObjectiveInfantile spasms (IS) or West syndrome is a convulsive disease characterized by brief, symmetric axial muscle contractions (neck, trunk, and/or extremities).The therapy universally recognized as most effective in the treatment of IS, is treatment with the adrenocorticotropic hormone (ACTH) or oral corticosteroids. This therapy however has important side effects. Many studies have sought to find alternative therapies with fewer side effects. Nitrazepam, it has been proven, can be as effective as ACTH in controlling infantile spasms. The aim of this study was to evaluate and compare the efficacy of Nitrazepam and ACTH on the treatment of infantile spasms. Materials & MethodsThis randomized controlled clinical trial, enrolled sixty patients with newly diagnosed and previously untreated IS; diagnosis was made based on the criteria of The International Classification of Epilepsies of the International League Against Epilepsy (ILAE). Prior to treatment, all patients underwent Electro encephalo graphs (EEGs) and CT scans. Patients were randomized to receive 0.5-1 mg/kg Nitrazpam (NZP) in three daily doses or 40 IU Depot ACTH in a single morning dose. Complete cessation of spasms was considered to be as optimal response.ResultsOf the sixty patients studied, 24 (40%) were girls and 36(60%) were boys. All patients in the both groups were matched for age and sex.There were no differences between the both groups regarding age and sex (non-significant). Following treatments, at the end of the 6-week duration therapy, optimal response (Cessation of spasms) was obtained in 19 (63%) patients of NZP group and 9 (30%) patients of ACTH group, (

Development of Enzyme Linked Immunosorbent Assay for humoral immuneresponse and infection monitoring of anthrax

ΔΕΝ ΔΙΑΤΙΘΕΤΑΙ ΠΕΡΙΛΗΨΗImmune assays were taken into consideration to diagnose and quantify metabolites such as antigen and antibody. Enzyme-Linked Immunosorbent Assays (ELISAs), which are used to detect antigens and antibodies, generated several periods of infectious and vaccination conditions. There is an extensive range of commercial infectious disease ELISA kits useful for the detection of human and animal IgG, IgA, IgM antibodies and microorganism antigens. Anthrax is one of the serious infectious diseases caused by rod-shaped, gram-positive bacteria known as Bacillus anthracis. Subunit or attenuated vaccines applied against anthrax disease increase the antibody against the Protective Antigen (PA) which has a critical role as a toxin of B. anthracis. Herein, the ELISA was developed using PA domain 4 and anthrax Lethal Factor to detect IgG antibody in serum. Besides, the level of anti-LF antibodies were determined as a complementary test to measure variance in antibody titers associated with vaccination or infection that leads to detection of anthrax in livestock. The results show that we developed high-quality ELISA kit that can be used to test immunogenicity of vaccines and infections in mice. We tried to develop the Anti- PA4 ELISA kit and conduct the validation studies to evaluate the fluctuation level of the antibody in the anthrax vaccine and distinction between disease and vaccination in mice

Functional brain activity constrained by structural connectivity reveals cohort-specific features for serum neurofilament light chain

Background: Neuro-axonal brain damage releases neurofilament light chain (NfL) proteins, which enter the blood. Serum NfL has recently emerged as a promising biomarker for grading axonal damage, monitoring treatment responses, and prognosis in neurological diseases. Importantly, serum NfL levels also increase with aging, and the interpretation of serum NfL levels in neurological diseases is incomplete due to lack of a reliable model for age-related variation in serum NfL levels in healthy subjects. Methods: Graph signal processing (GSP) provides analytical tools, such as graph Fourier transform (GFT), to produce measures from functional dynamics of brain activity constrained by white matter anatomy. Here, we leveraged a set of features using GFT that quantified the coupling between blood oxygen level dependent signals and structural connectome to investigate their associations with serum NfL levels collected from healthy subjects and former athletes with history of concussions. Results: Here we show that GSP feature from isthmus cingulate in the right hemisphere (r-iCg) is strongly linked with serum NfL in healthy controls. In contrast, GSP features from temporal lobe and lingual areas in the left hemisphere and posterior cingulate in the right hemisphere are the most associated with serum NfL in former athletes. Additional analysis reveals that the GSP feature from r-iCg is associated with behavioral and structural measures that predict aggressive behavior in healthy controls and former athletes. Conclusions: Our results suggest that GSP-derived brain features may be included in models of baseline variance when evaluating NfL as a biomarker of neurological diseases and studying their impact on personality traits

Evaluation of lymphocyte transformation test results in patients with delayed hypersensitivity reactions following the use of anticonvulsant drugs

Background/Aim: Administration of the anticonvulsant drugs phenobarbital, phenytoin, carbamazepine and lamotrigine can be associated with severe hypersensitivity reactions. The lymphocyte transformation test (LTT) is a method to determine which drug has caused the hypersensitivity reaction. This study was done to evaluate the results of LTT in patients with delayed hypersensitivity reactions following the administration of anticonvulsants. Methods: Twenty-four patients with hypersensitivity reactions, e.g. drug-induced hypersensitivity syndrome/drug rash and eosinophilia with systemic symptoms (DIHS/DRESS), Stevens-Johnson syndrome (SJS) and toxic epidermal necrosis (TEN), following the administration of anticonvulsant drugs, and 24 patients who had used anticonvulsant drugs but did not have hypersensitivity reactions (the control group) were included in this study. Peripheral blood mononuclear cells were isolated. The cells were stimulated with the drugs, phytohemagglutinin as a mitogen and Candida as an antigen (positive controls). Lymphocyte proliferation was measured using the BrdU proliferation assay kit (Roche, Germany). The stimulation index was calculated as the mean ratio of the OD of stimulated cells divided by the OD of unstimulated cells. The results in the case and control groups were compared. Results: Of 24 patients in the test group, 14 (58.3) had positive LTT results and 10 (41.7) had negative results. Among patients in the control group, 1 (4.2) had a positive LTT result and 23 (95.8) had negative results. Among the patients who had received carbamazepine and phenytoin, there was a significant difference between the results of LTT in the case and control groups (p = 0.002 and p = 0.028, respectively). Although patients receiving lamotrigine and phenobarbital had more positive LTT results in the case group than in the control group, these differences were not statistically significant. The sensitivity, specificity, positive predictive value and negative predictive value of LTT were 58.4, 95.8, 93.3 and 69.9, respectively. Conclusions: Considering the significant difference in LTT results between the case and control groups in patients receiving carbamazepine and phenytoin, and not observing such a difference in patients receiving phenobarbital and lamotrigine, LTT results are more valuable for the diagnosis of hypersensitivity reactions following the administration of carbamazepine and phenytoin. The LTT has good specificity but low sensitivity for the diagnosis of drug hypersensitivity reactions. © 2016 S. Karger AG, Basel