Thyroid Function Test Imbalance in Epileptic Children Under Anticonvulsive Therapy

How to Cite this Article: Ravi Torkaman M, Amirsalari S, Saburi A. Thyroid Function Test Imbalance in Epileptic ChildrenUnder Anticonvulsive Therapy. Iranian Journal of Child Neurology 2012;6(1):43-44. Dear Editor,There have been many studies regarding the impact of antiepileptic drugs(AEDs) on thyroid function. There are some challenging scopes which must beconsidered for conducting the study adressing the focused question. “Which oneof the thyroid hormones is related to the AEDs consumption?”. Some studiesdemonstrated that there may be alterations in all thyroid function tests (T3, T4 andTSH) after antiepileptic therapy in children (1). Some studies concluded that longtermprescription of anticonvulsive medications resulted in a decline in serum T4levels, although it had no effect on serum TSH levels. However, changes in serumT3 level was challenging and it must be investigated further (2).There were some confounding factors which may interfere with the conclusion.One of them is the type of the study. There are various study plans for this purposesuch as cross-sectional, case-control, experimental, self-controlled cohort anddouble-blind randomized clinical trial studies. It seems that the proper protocol ofstudy for this propose is a double-blind randomized clinical trial study. By usingother designs, the authors cannot interpret the effect of AEDs on thyroid function;however, they can discuss the prevalence of thyroid hormone imbalance and thecoordination among T3, T4 and TSH.Moreover, one of the confounding factors is the thyroid binding globulin (TBG)effect. It has appeared that some of the AEDs may change the amount of TBGand in this way may affect the amount of thyroid hormones (3). Clonazepamand valproic acid do not have any enzyme inducing effects, but phenobarbital,carbamazepine, phenytoin and primidone may induce the hepatic enzyme (4-6). Therefore, it seems necessary to analyze each group of patients based on thetype of drug which is prescribed and also by using the free amount of thyroidhormones, the researcher will be able to exclude the TBG effect. In addition, ageis an important factor which should be considered. The epileptic patients showextra-thyroid adverse effects such as vitamin D and bone metabolism disordersdue to antiepileptic drugs (7). Other secondary clinical disorders which interactwith the thyroid metabolism should be considered and overruled in the study withthe mentioned proposal, especially in the older population.It appears that the confounding effect of the duration of AED intake mustbe adjusted regarding the children’s age using multivariate analysis such asregression model or partial correlation test. The etiological mechanism of serumconcentrations of thyroid hormone change by AEDs has not been clarified clearlyand besides, patients with a personal or family history of thyroid disorders mayprogress to overt thyroid hormone imbalance secondary to AED consumption (6). Therefore, it is suggested that the pure etiologicalmechanism of thyroid disorders due to AEDs shouldbe studied in such cases. Previous reports suggestedthat return to normal of all parameters was observedafter withdrawal of anticonvulsive therapy and thisreversibility of the thyroid hormone imbalance may bea clue for further investigations in order to study thepatho-physiologic mechanism of this disorder (6).Recently, new pharmaceutical drugs have beensuccessfully used for epileptic patients. It is expectedthat the therapeutic role of these new medications willbecome more prominent in these patients in the futureand future studies should be focused on their adverseeffects.Disclosures: None. References: 1. Talebian A, Eslamian MR, Shiasi K, Moravveji A,Khodayari M, Abedi AR. Changing in thyroid functiontest in children underwent antiepileptic therapy. Iran JChild Neurol 2010;4(1):17-22.2. Mahyar A, Ayazi P, Dalirani R, Hosseini SM, DaneshiKohan MM. Serum thyroid hormone levels in epilepticchildren receiving ant-convulsive drugs. Iran J ChildNeurol 2011;5(4):21-4.3. Eirís-Puñal J, Del Río-Garma M, Del Río-Garma MC,Lojo-Rocamonde S, Novo-Rodríguez I, Castro-GagoM. Long-term treatment of children with epilepsy withvalproate or carbamazepine may cause subclinicalhypothyroidism. Epilepsia 1999;40(12):1761-6.4. Kirimi E, Karasalihoglu S, Boz A. Thyroid functions inchildren under long-term administration of antiepilepticdrugs. Eastern J Med 1999;4(1):23-6.5. Amirsalari S, Kayhanidost ZT, Kavemanesh Z, Torkman M, Beiraghdar F, Teimoori M, et al. Thyroid functionin epileptic children who receive carbamazepine,primidone, phenobarbital and valproic acid. Iranian JChild Neurol 2011;5(2):15-20.6. Verrotti A, Di corcia G, Trotta D, Chiarelli F. Thyroidfunction in children treated with antiepilepticdrugs: effects of treatment withdrawal. Ital J Pediatr 2003;29:242-6.7. Pack AM, Morrell MJ, McMahon DJ, Shane E. Normal vitamin D and low free estradiol levels in women onenzyme-inducing antiepileptic drugs. Epilepsy Behav 2011;21(4):453-8

Effect of Low Intensity Cathodal Direct Current on Rate of Healing and Quality Of Life in Diabetic Patients with Ischemic Foot Ulcer

Introduction: Adjunctive treatment using electrical stimulation has recently been shown to promote healing in patients with diabetic foot ulcer. The aim of the present study was to evaluate whether low intensity cathodal direct current electrical stimulation improves healing rate of foot ulcers and health related quality of life in diabetic patients. Materials and methods: A total of 30 type 2 diabetic patients with ischemic foot ulcer were included in the present randomized, single-blind, placebo controlled trial. Participants were randomly assigned to receive either electrical stimulation therapy (direct current with low intensity, ES group, n=15) or sham treatment (placebo group, n=15) for 1 h/day, 3 days/week, for 4 weeks (12 sessions). Improvement ratio of wound and quality of life was evaluated at the 1st and 12th sessions. The quality of life was assessed using SF-36 questionnaire. Results: The mean of improvement ratio was significantly higher in the electrical stimulation group (59.4%) compared with that of the placebo group (27.07%) at the 12th session (P=0.02). Overall score of quality of life significantly increased in the electrical stimulation group as compared with that for the placebo group (0.01). Conclusion: By promotion of wound healing, applied low intensity cathodal direct current may increase the health-related quality of life in diabetic patients with ischemic foot ulcer.Key words: Diabetics, Ischemic foot ulcers, Low intensity direct current, Wound improvement rate, Quality of lif

Neurobrucellosis Presenting with Unilateral Abducens Nerve Palsy

How to Cite This Article: Andisheh M, Amirsalari S, Torkaman M, Sabzechian M, Afsharpaiman Sh. Neurobrucellosis Presenting with Unilateral Abducens Nerve Palsy. Iran J Child Neurol. Spring 2017; 11(2):61-64. AbstractOne of the rare complications of brucellosis is neurobrucellosis. There have been numerous reports showing clinical forms of brucellosis affecting CNS, such as cranial nerve involvement, myelitis, vascular disease, radiculoneuritis, meningitis, meningoencephalitis, and demyelinating disease. In this case report, we introduce a 2.5 yr old girl with unilateral abducens nerve palsy referred to Baghiyatallah Hospital Outpatient Clinic, Tehran, Iran in June 2015. References 1. Pappas G, Akritidis N, Bosilkovski M, Tsianos E. Brucellosis. N Engl J Med 2005; 352:2325–2336.2. Al-Sous MW, Bohlega S, Al-Kawi MZ, Alwatban J, McLean DR. Neurobrucellosis: clinical and neuroimaging correlation. AJNR Am J Neuroradiol 2004; 25:395–4013.Bingöl A, TogayIsikay C. Neurobrucellosis as an exceptional cause of transient ischemic attacks. Eur J Neurol 2006; 13:544–548.4.Adaletli I, Albayram S, Gurses B, et al. Vasculopathic changes in the cerebral arterial system with neurobrucellosis. Am J Neuroradiol 2006; 27:384–386.5.Shakir RA, Al-Din AS, Araj GF, Lulu AR, Mousa AR, Saadah MA. Clinical categories of neurobrucellosis. A report on 19 cases. Brain 1987; 110:213–223.6.Esra Özkavukcu, Zeynep Tuncay, Ferda Selçuk, İlhan Erden: An unusual case of neurobrucellosis presenting with unilateral abducens nerve palsy: clinical and MRI findings; Turkish Society of Radiology 20097. Tena D, Gonzáles-Praetorius A, LópezAlonso A, Peña JL, Pérez-Pomata MT, Bisquert J. Acute meningitis due to Brucella spp. Eur J Pediatr 2006; 165:726–727.8. Rangel Guerra R, Martinez HR, Leon Flores L. Neurobrucellosis. Report of five cases and literature review. Rev Inwest Clin 1982;34:62–8.9. Mugerwa RD, D’Arbela PG. Brucella meningitis; a case report and review of the literature. East African Med J 1976;53:266–9.10. Bashir R, Al-Kawi MZ, Harder EJ, Jinkins J. Nervous system brucellosis: diagnosis and treatment. Neurology 1985; 35:1576–1581.11. Al Deeb SM, Yaqub BA, Sharif HS, Phadge JG. Neurobrucellosis: clinical characteristics, diagnosis, and outcome. Neurology 1989; 39:498–501.12. Lubani MM, Dudin KI, Araj GF, Manandhar DS, Rashid FY. Neurobrucellosis in children. Pediatr Infect Dis J 1989;8:79–82.13. Santini C, Baiocchi P, Berardelli A, Venditti M, Serra P. A case of brain abscess due to Brucella melitensis. Clin Infect Dis 1994;19:977–8.14. Koussa S, Chemaly R. Neurobrucellosis presenting with diffuse cerebral white matter lesions. Eur Neurol 2003; 50:121–123.15. Fincham RW, Sahs AL, Joynt RJ. Protean manifestation of nervous system brucellosis. Case histories and a wide variety of clinical forms. JAMA 1963; 184:269–27516. Marconi G. Su un caso di sclerosis multipla acuta insorta dopo un’infezione da Brucella abortus. Riv Patol Nerv Ment 1966; 87:548–565.17. Bussone G, La Mantia L, Grazzi L, Lamperti E, Salmaggi A, Strada L. Neurobrucellosis mimicking multiple sclerosis: a case report. Eur Neurol 1989; 29:238–240.18. KarakurumGöksel B, Yerdelen D, Karataş M, et al. Abducens nerve palsy and optic neuritis as initial manifestation in brucellosis. Scand J Infect Dis 2006; 38:721–725.19. Yilmaz M, Ozaras R, Mert A, Ozturk R, Tabak F. Abducent nerve palsy during treatment of brucellosis. Clin Neurol Neurosurg 2003; 105:218–220

Comparing the Efficacy of NCPAP and NIPPV in Infants with RDS after Extubation; A Randomized Clinical Trial

peer reviewe

Comparison of Intravenous Dexamethasone and Budesonide Nebulizer in the Treatment of Infantile Respiratory Distress Syndrome; A Randomized Clinical Trial

peer reviewe

The effect of probiotics on reducing hospitalization duration in infants with hyperbilirubinemia

peer reviewedBackground: Approximately 60% of term and 80% of premature infants are hospitalized for hyperbilirubinemia in the first week of life. Hyperbilirubinemia is the most common cause of infant hospitalization and readmission. Due to the high frequency of hyperbilirubinemia in infants and the high costs of treatment, it is necessary to find a way to decrease hospitalization duration. Objectives: The aim of this study is to assess the adjunctive effect of probiotics on decreasing hospitalization time for infants with hyperbilirubinemia. Methods: In this randomized, controlled clinical trial, 92 term infants with hyperbilirubinemia who met the inclusion criteria were randomly assigned to either the probiotic or control group. Patients in both groups underwent common phototherapy. Once a day, those in the probiotic group were also given half of a capsule of Prokid probiotic, while those in the control group received half of a placebo capsule. The duration of phototherapy and hospitalization, the blood groups of mothers and infants, and each patient’s bilirubin levels before and after phototherapy, direct Coombs test results, and levels of hemoglobin, G6PD, and reticulocytes were recorded. Results: Data from 92 patients with a mean age of 5.25 ± 2.35 days underwent analysis. The control group had 47 (51.1%) patients with a mean age of 5.19 ± 2.51 days and the probiotic group had 45 (48.9%) patients with a mean age of 5.31 ± 2.19 days (P = 0.81). The 92 patients had a mean bilirubin level of 16.70 ± 3.07 mg/dL, with a mean of 16.42 ± 3.53 mg/dL in the control group and 17.00 2.49 mg/dL in the probiotic group (P = 0.37). The duration of hospitalization averaged 3.34 ± 0.70 days overall, with an average of 3.55 ± 0.74 days for the control group and 3.13 ± 0.70 days for the probiotic group. The probiotic group had a significantly lower hospitalization stay in comparison to the control group (P = 0.004). Conclusions: Our findings suggest that probiotics may be beneficial as an adjunct treatment for infants with hyperbilirubinemia by reducing the duration of hospitalization

Relationship between Iron Deficiency Anemia and Febrile Seizures

ObjectiveFebrile seizure is the most common convulsive disorder in childhood. The role of iron in metabolism of neurotransmitters and carrying oxygen to the brain suggests the possibility of a relationship between iron deficiency anemia and febrile seizures.The aim of this study was to investigate the relationship between iron deficiency anemia and febrile seizures.Materials & MethodsThis case - control study was performed on 132 cases and 88 controls, aged 9 months to 5 years, from July 2007 to June 2009 in Baqyiatallah Hospital. Patients were selected using simple random sampling. The case group included children with first febrile seizure (core temperature over 38.5˚C during  seizure) without a central nervous system infection or an acute brain insult. The control group included children suffering from a febrile illness without seizure. Iron deficiency anemia was defined with one of these laboratory indexes: 1) Hemoglobin (Hb) <10.5mg/dl 2) Plasma ferritin <12ng/dl 3) Mean corpuscular volume (MCV) <70  fl. The data collected from patients were analyzed with SPSS.13 software.ResultsLow plasma ferritin was found in 35 cases (26.5%) compared to 26 controls (29.5%), low Hb level was found in 4 cases (3%) compared to 6 controls (6.8%) and low MCV was found in 5 cases (3.8%) compared to 6 controls (6.8%).There was no significant difference in plasma ferritin , Hb level and MCV indices between the two group.ConclusionConsidering the above-mentioned results, there is no relationship between iron deficiency anemia and febrile seizures

Assessment of Toxoplasma Seropositivity in Children Suffering from Anxiety Disorders.

peer reviewed[en] OBJECTIVE: This study aimed to assess the seroprevalence of Toxoplasma gondii in children with anxiety disorders. MATERIALS & METHODS: This cross-sectional study was conducted between Sep 2012 and May 2013 in Pediatrics Clinic of Baqiyatallah Hospital, Tehran, Iran. Children were assessed clinically. Diagnosis of patients with anxiety disorders was based on DSM-4 system, performed by child psychiatrist. Then their anti-Toxoplasma antibodies were measured. A questionnaire was verbally administered to all individuals' parents including demographic information and questions about life style, family history, medical history, economic situation, residence, nutritional patterns and contact with animals. RESULTS: Ninety-six male and female cases with a mean age of 8.56±2.5 and 8.42±1.9 yr underwent analysis. Anti- T. gondii IgG antibody was found in one case of each group. There was no significant difference between case and control groups for serum Toxoplasma IgG antibody (P=0.14). No case individuals had Anti- T. gondii IgM antibody, while it was found in one control individual. No significant difference was seen between case and control groups for Toxoplasma IgM antibody (P=0.27). CONCLUSION: Toxoplasmosis has no direct effect on the incidence of anxiety disorders. More studies are needed with a larger volume of individuals in future

Assessment of Toxoplasma Seropositivity in Children Suffering from Attention Deficit Hyperactivity Disorder

peer reviewedBackground: Toxoplasmosis, a protozoan infection caused by Toxoplasma gondii, is suggested to be a risk factor for many psychological disorders such as schizophrenia and depression. Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders among children. Previous studies have assessed the correlation between ADHD and infectious diseases like toxoplasmosis. So we aimed to investigate the possible correlation between Toxoplasma seropositivity and ADHD in children. Materials and Methods: In this cross-sectional study children with signs of ADHD were regarded as patients and underwent clinical assessments. Diagnosis of these patients was based on DSM-IV-TR system which was performed by a pediatric psychiatrist. Forty-eight Children without signs of ADHD or other psychic disorders were considered as control, and 48 patients were considered as case group. Parents were asked to answer a questionnaire including demographic, pregnancy and habitual questions. Blood samples were taken from all individuals and assessed for anti-Toxoplasma IgM and IgG antibodies. Results: Ninety-six male and female patients with a mean age of 8.12 years underwent analysis. Seropositivity rate for anti-T.gondii IgG antibody was 4.2% in the case and 2.1% in control individuals (P=0.92). Anti-T.gondii IgM antibodies were not found in control individuals while it was found in 2.1% of case individuals (P=0.74). There was no statistically significant association between seroprevalence of IgM (P=0.74) and IgG (P=0.92) antibodies and ADHD in study individuals. Conclusion: Our findings showed that the toxoplasmosis seropositivity has no significant difference between children with and without ADHD. Further studies are needed with a larger amount of individuals. [GMJ. 2016;5(4):188-93

Thyroid Function in Epileptic Children who Receive Carbamazepine, Primidone, Phenobarbital and Valproic Acid

ObjectiveIn this study, we investigated the changes of the serum levels of thyroidhormones including Thyroxine (T4), Triiodothyronine (T3), T3 resin uptake andThyroid stimulating hormone (TSH) in epileptic children during treatment withanti-epileptic drugs (AEDs) including carbamazepine (CBZ), primidone (PRM),phenobarbital and valproic acid (VPA).Materials and MethodsThis study consisted of four case-series comparisons, was conducted on 115epileptic children (37 girls and 78 boys with an age range between 2 monthsand 15 years, mean: 62.06 ± 44.97 months). These children were divided into4 groups who took either phenobarbital (n=29), PRM (n=28), CBZ (n=29), orVPA (n=29) for 3 months. Thyroid hormone levels (T3, T3 resin uptake, T4 andTSH) were measured at the beginning and three months after starting the study.ResultsAt first, all patients were euthyroid and there were no clinical or laboratoryfindings suggestive of hypothyroidism. Regarding thyroid hormones before andafter the administration of phenobarbital, carbamazepine, valproic acid andprimidone, there were no significant changes in serum T3, T4, T3 resin uptakeand TSH levels.ConclusionOur findings showed that short term therapy with phenobarbital, carbamazepine,valproic acid and primidone had no effect on thyroid function etsts.Key words: Anti-epileptic drugs; Thyroid hormones; Epileptic children.