The Effect of the Ketogenic Diet on Adiponectin, Omentin and Vaspin in Children with Drug-Resistant Epilepsy

Background: Changes in adipokine secretion may be involved in the anti-epileptic effect of a ketogenic diet (KD) in drug-resistant epilepsy (DRE). Objectives: The assessment of the influence of KD on serum adiponectin, omentin-1, and vaspin in children with DRE. Methods: Anthropometric measurements (weight, height, BMI, and waist-to-hip circumference ratio) were performed in 72 children aged 3–9 years, divided into 3 groups: 24 children with DRE treated with KD, 26—treated with valproic acid (VPA), and a control group of 22 children. Biochemical tests included fasting glucose, insulin, beta-hydroxybutyric acid, lipid profile, aminotransferases activities, and blood gasometry. Serum levels of adiponectin, omentin-1 and vaspin were assayed using commercially available ELISA tests. Results: Serum levels of adiponectin and omentin-1 in the KD group were significantly higher and vaspin—lower in comparison to patients receiving VPA and the control group. In all examined children, serum adiponectin and omentin-1 correlated negatively with WHR and serum triglycerides, insulin, fasting glucose, and HOMA-IR. Vaspin levels correlated negatively with serum triglycerides and positively with body weight, BMI, fasting glucose, insulin, and HOMA-IR. Conclusion: One of the potential mechanisms of KD in children with drug-resistant epilepsy may be a modulation of metabolically beneficial and anti-inflammatory adipokine levels

The Role of FDG PET/CT in qualification for neurosurgical treatment children with refractory epilepsy

Cel pracy. Celem pracy była ocena przydatności badania FDG-PET/CT w korelacji z MRI i EEG w kwalifikacji do leczenia operacyjnego dzieci z padaczką oporną na farmakoterapię. Materiał i metody. Analizowano przypadki 24 dzieci w wieku od 2 miesięcy do 16 lat i 11 miesięcy z rozpoznaną padaczką lekooporną, hospitalizowanych na Oddziale Neurologii Dziecięcej Chorzowskiego Centrum Pediatrii i Onkologii im. E. Hankego od 1 stycznia 2012 do 31 grudnia 2013 roku. Na podstawie analizy morfologii napadów, wyników badań MRI (nie starszych niż 6 miesięcy), zapisów wideo EEG i/lub EEG oraz konsultacji neurochirurgicznej dzieci zostały zakwalifikowane do badania PET/CT. U wszystkich pacjentów wykonano badanie PET/CT z wykorzystaniem 18-FDG (znakowanej 18-F-deoksyglukozy) aparatem BIOGRAPH mCT-S (64) 3R firmy Siemens. Wyniki. W badaniu PET/CT nieprawidłową dystrybucję radioznacznika stwierdzono u 21/24 pacjentów (87,50%). W przypadku 8/24 (33,33%) pacjentów zaburzenia miały charakter ogniskowego hipometabolizmu. 6 na 24 (25%) dzieci, u których stwierdzono zgodność lokalizacji zmian patologicznych w badaniach MRI, EEG i FDG-PET/CT zostało zakwalifikowanych do leczenia neurochirurgicznego. Połowę z nich stanowiły dzieci z FCD, 2 ze stwardnieniem guzowatym i 1 ze zmianą rozrostową. Wnioski. Badanie FDG PET/CT jest wartościową metodą neuroobrazowania w procesie kwalifikacji do leczenia neurochirurgicznego. Pozwala w wielu przypadkach zdefiniować ognisko padaczkowe oraz, w znacznie lepszym stopniu niż powszechnie stosowane badania neuroobrazowe, określić jego ewentualną rozległość. 18-FDG PET/CT powinien być stałym elementem diagnostyki dzieci z padaczką lekooporną kwalifikowanych do leczenia neurochirurgicznego.Purpose of the study. The purpose of the study was to evaluate the utility of FDG PET/CT scans in correlation with MR and EEGs in qualifying children with pharmacotherapy resistant epilepsy for neurosurgical treatment. Material and methods. The analysed group consisted of 24 patients diagnosed with refractory epilepsy with the age range from 2 months to 16 years and 11 months. They were admitted at the neurology ward of the Chorzow Centre of Paediatrics and Oncology between 1st January 2012 and 31st December 2013. On the basis of seizure type analyses, MR scan results (not older than 6 months), video EEG recordings and/or EEG transcripts, as well as neurosurgical consultations, the patients were qualified for PET/CT examination. The PET/CT was performed in all patients with the 18-FDG (18F-deoxyglucose), using BIOGRAPH mCT-S (64) 3R Siemens equipment. Results. The PET/CT examinations revealed an incorrect distribution of the radioactive tracer in 21 out of 24 patients (87.5%). In 8 out of 24 patients (33.33%), the disorders consisted of focal hypometabolism. 6 out of 24 children (25%) with the compatibility of location of pathologic lesions in MRI, EEG and FDG-PET/CT examinations wer qualified for neurosurgical treatment. Out of these patients, half suffered from FCD, 2 had tuberous sclerosis and 1 neoplastic lesions. Conclusions. FDG PET/CT examinations are a valuable neuroimaging method during the process to ascertain whether neurosurgical treatment is needed. In numerous cases, it makes possible to identify the epileptic focus and determine its potential extent more precisely than the commonly used neuroimaging techniques. 18-FDG PET/CT should be a constant component in diagnosing children with refractory epileps in qualifying thos in need for neurosurgical treatment

Flaccid paralysis of upper limbs in a 6-year-old as a manifestation of anaplastic spinal cord ependymoma

Wyściółczak anaplastyczny rdzenia kręgowego jest niezwykle rzadkim nowotworem, cechującym się szybką progresją i złym rokowaniem. Cel: Przedstawienie rzadkiego obrazu klinicznego wyściółczaka anaplastycznego rdzenia kręgowego. Materiał i metody: Analiza przebiegu klinicznego i badań dodatkowych u 6. letniego chłopca z bólami kręgosłupa, a następnie zaburzeniami ruchomości kończyn górnych, aż do całkowitego ich porażenia. MRI rdzenia kręgowego i głowy uwidoczniło lokalizujące się wewnątrzoponowo i zewnątrzrdzeniowo masy guza od poziomu komory IV do L1. Na podstawie badania histopatologicznego postawiono rozpoznanie wyściółczaka anaplastycznego. Wnioski: Opis pacjenta zwraca uwagę na konieczność zachowania czujności w procesie diagnostycznym pacjentów z objawami początkowo niespecyficznymi i miernie nasilonymi choć potencjalnie mogącymi sugerować istnienie poważnej patologii w zakresie OUNAnaplastic spinal cord ependymoma is an extremely rare tumour characterized by rapid progression and poor prognosis. Aim: To present a rare clinical picture of the anaplastic spinal cord ependymoma. Material and methods: The analysis of the clinical course and of additional tests in a 6-year-old boy with back pain, followed by impaired mobility of the upper limbs and, ultimately, their complete paralysis. MRI of the spinal cord and head revealed an intrameningeal and extramedullary tumour mass extending from the level of the fourth ventricle to the L1 level of lumbar spinal cord. Histopathological examination led to a diagnosis of anaplastic ependymoma. Conclusions: The description of the patient points to the necessity of being vigilant in the diagnostic process of patients whose symptoms are initially nonspecific and moderately severe, although they potentially suggest the existence of a serious CNS pathology.

The Effect of the Ketogenic Diet on Adiponectin, Omentin and Vaspin in Children with Drug-Resistant Epilepsy

Background: Changes in adipokine secretion may be involved in the anti-epileptic effect of a ketogenic diet (KD) in drug-resistant epilepsy (DRE). Objectives: The assessment of the influence of KD on serum adiponectin, omentin-1, and vaspin in children with DRE. Methods: Anthropometric measurements (weight, height, BMI, and waist-to-hip circumference ratio) were performed in 72 children aged 3–9 years, divided into 3 groups: 24 children with DRE treated with KD, 26—treated with valproic acid (VPA), and a control group of 22 children. Biochemical tests included fasting glucose, insulin, beta-hydroxybutyric acid, lipid profile, aminotransferases activities, and blood gasometry. Serum levels of adiponectin, omentin-1 and vaspin were assayed using commercially available ELISA tests. Results: Serum levels of adiponectin and omentin-1 in the KD group were significantly higher and vaspin—lower in comparison to patients receiving VPA and the control group. In all examined children, serum adiponectin and omentin-1 correlated negatively with WHR and serum triglycerides, insulin, fasting glucose, and HOMA-IR. Vaspin levels correlated negatively with serum triglycerides and positively with body weight, BMI, fasting glucose, insulin, and HOMA-IR. Conclusion: One of the potential mechanisms of KD in children with drug-resistant epilepsy may be a modulation of metabolically beneficial and anti-inflammatory adipokine levels