Childhood Epilepsy; Prognostic Factors in Predicting the Treatment Failure

How to Cite This Article: Taghdiri MM, Omidbeigi M, Asaadi S, Mohebbi M, Azarghashb E, Ghofrani M. Childhood Epilepsy; Prognostic Factors in Predicting the Treatment Failure. Iran J Child Neurol. Winter 2017; 11(1):21-28.AbstractObjectiveWe aimed to find the prognostic factors to detect the patients who fail the treatment of epilepsy, in the early stages of the disease.Materials & MethodsThis study was done on the epileptic patients attending the Neurology Clinic of Mofid Children’s Hospital, Tehran, Iran from September 2013 to October 2014. After defining the criteria for exclusion and inclusion, the patients were divided to two groups based on responding to the medical treatment for their epilepsy and indices were recorded for all the patients to be used in the statistical analyses.ResultsThe patients’ age ranged from 1 to 15 yr. There was 188 patients with refractory seizure in group 1 (experimental group) and 178 patient with well controlled seizure in group 2(control group).There was a significant different between serum drug level in both groups and patients with refractory seizure group had a lower serum drug level than control group. In both groups tonic-clonic was the most common type of seizure. Also the prevalence of brain imaging Abnormalityand other neurologic disorders was significantly higher in patients with refractory seizure in compare with control group.ConclusionChildren with seizure who suffer from refractory epilepsy need more attention and exact observation by the medical staff. References 1. Kozyrskyj AL, Prasad AN. The burden of seizures in Manitoba children: a population-based study. Can J Neurol Sci 2004;31:48-52. 2. Camfield PR, Camfield CS, Gordon Kandet al. If a first antiepileptic drug fails to control a child’s epilepsy, what are the chances of success with the next drug? J Pediatr 1997; 131:821-4.3. Arts WF, Brouwer OF, Peters ACet al. Course and prognosis of childhood epilepsy: 5-year follow-up of the Dutch study of epilepsy in childhood. Brain 2004;127:1774–84.4. Berg AT, Shinnar S, Levy SR, et al. Early Development of intractable epilepsy in children: a prospective study. Neurology 2001;56:1445–52.5. Berg AT, Vickrey BG, Testa FM, et al. How long does it take for epilepsy to become intractable? A prospective investigation. Ann Neurol 2006;60:73–9. 6. Kwan P, Brodie M. Early identification of refractory epilepsy. N Eng J Med2000;342:314–9.7. Mohanraj R, Brodie MJ. Diagnosing refractory epilepsy: response to sequential treatment schedules. Eur J Neurol 2006;13:277–82.8. Berg A. Identification of Pharmacoresistant Epilepsy. Neurol Clin 2009;27(4):1003-1013.9. Luciano AL, Shorvon SD. Results of treatment changes in patients with apparently drug-resistant chronic epilepsy. Ann Neurol 2007;62:375–381. 10. Carpay HA, Arts WF, GeertsAT, et al. Epilepsy in childhood: An audit of clinical practice. Arch Neurol 1998;55:668–73.11. Dudley RW, Penney SJ, Buckley DJ. First-drug treatment failures in children newly diagnosed with epilepsy. Pediatr Neurol 2009;40:71–7.12. Berg AT, Vickrey BG, Testa FM, et al. How long does it take epilepsy to become intractable? A prospective investigation. Ann Neurol 2006;60:73–79.13. Spooner CG, Berkovic SF, Mitchell LA, et al. New onset temporal lobe epilepsy in children: lesion on MRI predicts poor seizure outcome. Neurology 2006;67:2147–2153. 14. Robinson RO, Baird G, Robinson Get al. Landau– Kleffner syndrome: course and correlates with outcome. Dev Med Child Neurol2001;43:243-7.15. Berg AT, Shinnar S, Levy SR, et al. Defining early seizure outcomesin pediatric epilepsy: the good, the bad and the in-between. Epilepsy Res 2001;43:75-84.16. Shinnar S, Berg AT. Does antiepileptic drug therapy prevent the development of ‘‘chronic’’ epilepsy? Epilepsia 1996;37:701-8.Neurol Clin 2009;27(4):1003-1013.17. Engel J. The goal of epilepsy therapy: no seizures, no side effects,as soon as possible. CNS Spectrums 2004;9:95–97.18. Mathern GW, Pretorius JK, Babb TL. Influence of the type ofinitial precipitating injury and at what age it occurs on courseand outcome in patients with temporal lobe seizures. J Neurosurg1995;82:220 –227.19. Cross JH, Jaykar P, Nordli D and et al. Propose criteria for referraland evaluation of children for epilepsy surgery: recommendations of the Subcomission for Pediatric Epilepsy Surgery. Epilepsia2006;47:953–959.20. Weiner HL, Carlson C, Ridgway EBet al. Epilepsy surgery inyoung children with tuberous sclerosis: results of a novel approach. Pediatrics 2006;117:1494 –1502.21. Del Felice A, Beghi E, Boero G, La Neve A, Bogliun G, De Palo A, et al. Early versus late remission in a cohort of patients with newly diagnosed epilepsy. Epilepsia 2010;51(1):37-42.22. Levy SR, Novotny EJ, Shinnar S. Predictors of intractable epilepsy in childhood: a case–control study. Epilepsia 1996;37:24–30.23. Berg AT, Shinnar S, Levy SR and et al. Smith- Rappaport S, Beckerman B. Early development of intractable epilepsy in children: a prospective study. Neurology2001;56:1445–52.24. Casetta I, Granieri E, Monetti VC et al. Early predictors of intractability in childhood epilepsy: a community-basedcase–control study in Copparo, Italy. Acta Neurologica Scandinavica 1999;99:329–33.25. Chawla S, Aneja S, Kashyap Ret al. Etiology and clinical predictors ofintractable epilepsy. Pediatric Neurology 2002;27:186–91.26. Ko TS, Holmes GL. EEG and clinical predictors of medically intractable childhood epilepsy. Clin Neurophysiol 1999;110:1245–51. 27. Kwong KL, Sung WY, Wong SN, et al. Early predictors of medical intractability in childhood epilepsy. Pediatr Neurol2003;29:46–52.28. Oskoui M, Webster RI, Zhang X and et al. Factors predictive of outcome inchildhood epilepsy. J Child Neurol 2005;20:898–904.29. Seker Yilmaz B, Okuyaz C, Komur M. Predictors of Intractable Childhood Epilepsy. Pediatr Neurol 2013;48(1):52-55.30. Kim S, Park K, Kim S, Kwon O, No S. Presence of epileptiform discharges on initial EEGs are associated with failure of retention on first antiepileptic drug in newly diagnosed cryptogenic partial epilepsy: A 2-year observational study. Seizure 2010;19(9):536-539.31. Callaghan B, Anand K, Hesdorffer D, Hauser W, French J. Likelihood of seizure remission in an adult population with refractory epilepsy. Ann Neurol 2007;62(4):382- 389.32. Arhan E, Serdaroglu A, Kurt A, Aslanyavrusu M. Drug treatment failures and effectivity in children with newly diagnosed epilepsy. Seizure 2010;19(9):553-557

The comparison of LC50 of clove essence and MS222 in Acipenser persicus, Oncorhynchus mykiss and Cyprinus carpio

The LC50 of two anaesthetic agents, clove essence and MS222, on the cultivated fish species, Acipenser persicus, Oncorhynchus mykiss, Cyprinus curpio were estimated. 640 samples of above mentioned species were used exposing anaesthetic agents for 2 minutes.LC50 of clove essence and MS222 for sturgeon estimated 297 and 291 ppm, for common carp was 271 and 272 ppm; and for rainbow trout Was 199 and 207 pmm, respectively. Significant difference was found only between LC50 of MS222 in rainbow trout with LC50 of both agents in two other species. Also, the results showed that there is no significant difference on poisoning of two applied drugs in all above mentioned species; with comparing different species, rainbow trout had lower tolerance to both anesthetics

Volume Changes After Traumatic Spinal Cord Injury in Animal Studies - A Systematic Review

There are limited data on the lesion volume changes following spinal cord injury (SCI). In this study, a meta-analysis was performed to evaluate the volume size changes of the injured spinal cord over time among animal studies in traumatic SCI. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive electronic search of English literature of PubMed and EMBASE databases from 1946 to 2015 concerning the time-dependent changes in the volume of the spinal cord following mechanical traumatic SCI. A hand-search was also performed for non-interventional, non-molecular, and non-review studies. Quality appraisal, data extraction, qualitative and quantitative analyses were performed afterward. Of 11,561 articles yielded from electronic search, 49 articles were assessed for eligibility after reviewing of titles, abstracts, and references. Ultimately, 11 articles were eligible for quantitative synthesis. The ratio of lesion volume to spinal cord total volume increased over time. Avascularity appeared in spinal cord 4 hours after injury. During the first week, the spinal subarachnoid space decreased. The hemorrhagic lesion size peaked in 1 week and decreased thereafter. Significant loss of gray and white matter occurred from day 3 with a slower progression of white matter damage. Changes of lesion extent over time is critical in pathophysiologic processes after SCI. Early avascularity, rapid loss of gray matter, slow progression of white matter damage, and late cavitation are the pathophysiologic key points of SCI, which could be helpful in choosing the proper intervention on a timely basis

Evaluation of Anti-CCP Positive in Patients with Systemic Lupus Erythematosus Referred to Loghman Hakim Hospital between 2007-2017; A Descriptive Study

Background: It has been found that some patients with Systemic lupus erythematosus (SLE) may have anti-cyclic citrullinated peptide antibodies (anti-CCP), although the clinical significance of such finding is not well established. SLE patients may have joint complaints that are very similar to those observed in rheumatoid arthritis (RA). In early stages of disease, this form of arthritis can be difficult to differentiate from RA, so it is not rare that some SLE patients are initially misdiagnosed to have this disease. This study aims to investigate the prevalence of anti-CCP in SLE patients in Loghman Hakim hospital, Tehran, Iran.Method and Materials: One hundred fourteen SLE patients were studied for anti-CCP. Demographic features and prevalence serum positive Anti-CCP were measured in studied patient.Results: In this study we evaluate 11 men and 103 women. The mean age of patients was 40.26±14.54 y/o. Anti-CCP was positive in 20 of 114 SLE patients. In Anti-CCP positive group also there was 3 men and 17 women with mean age of 45.7±13.Conclusion: We found that 17.5 % of Iranian patients with SLE have positive anti-CCP. Only a careful and prolonged follow-up will reveal the real clinical value of these markers in each patient individually. Key Words: Anti-CCP, Rheumatoid arthritis, Systemic lupus erythematosu

Association between ultra-processed foods intake with lipid profile: a cross-sectional study

Abstract The purpose of this cross-sectional study was to examine the association between ultra-processed foods (UPFs) intake and lipid profile in Iranian people. The study was performed on 236 individuals with the age range of 20–50 years in Shiraz, Iran. Food intakes of the participants were evaluated using a 168-item food frequency questionnaire (FFQ) which was previously validated in Iranian populations. In order to estimate the ultra-processed foods intake, classification of NOVA food group was used. Serum lipids including total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were measured. The results showed that mean of age and body mass index (BMI) of the participants were 45.98 years and 28.28 kg/m2, respectively. Logistic regression was used to evaluation the relation between UPFs intake and lipid profile. Higher UPFs intake was associated with increased OR of TG and HDL abnormality in both crude (OR 3.41; 95% CI 1.58, 7.34; P-trend = 0.001 and OR 2.99; 95% CI 1.31, 6.82; P-trend = 0.010) and adjusted models (OR 3.69; 95% CI 1.67, 8.16; P-trend = 0.001 and OR 3.38 95% CI 1.42, 8.07; P-trend = 0.009). But, there were no association between UPFs intake and other indices of lipid profile. Also, we found significant associations between UPFs intake and dietary nutrient profiles. In conclusion, UPFs consumption could worsen the nutritional profile of the diet and lead to negative changes in some indices of the lipid profile

Congenital Absence of the Posterior Element of C1, C2, and C3 Along with Bilateral Absence of C4 Pedicles: Case Report and Review of the Literature

Background: Abnormalities of the posterior arch of vertebrae are rare conditions that may incidentally be found on neck radiographs. We report a case and present a comprehensive review of the literature. Case Description: A 10-year-old boy presented with intermittent paresthesia in the lower extremities, mild neck pain, and episodes of drop attacks following neck flexion. Radiologic investigations depicted a complete absence of the posterior element of C1, C2, and C3 along with bilateral absence of C4 pedicles. Conclusions: The diagnosis of posterior arch abnormalities is of high-level of importance because of resultant neurologic defects. To the best of our knowledge, no case of this type has been reported in literature thus far. © 2017 Elsevier Inc

Congenital Absence of the Posterior Element of C1, C2, and C3 Along with Bilateral Absence of C4 Pedicles: Case Report and Review of the Literature

Background: Abnormalities of the posterior arch of vertebrae are rare conditions that may incidentally be found on neck radiographs. We report a case and present a comprehensive review of the literature. Case Description: A 10-year-old boy presented with intermittent paresthesia in the lower extremities, mild neck pain, and episodes of drop attacks following neck flexion. Radiologic investigations depicted a complete absence of the posterior element of C1, C2, and C3 along with bilateral absence of C4 pedicles. Conclusions: The diagnosis of posterior arch abnormalities is of high-level of importance because of resultant neurologic defects. To the best of our knowledge, no case of this type has been reported in literature thus far. © 2017 Elsevier Inc

Connectivity-based parcellation of the amygdala and identification of its main white matter connections

The amygdala plays a role in emotion, learning, and memory and has been implicated in behavioral disorders. Better understanding of the amygdala circuitry is crucial to develop new therapies for these disorders. We used data from 200 healthy-subjects from the human connectome project. Using probabilistic tractography, we created population statistical maps of amygdala connectivity to brain regions involved in limbic, associative, memory, and reward circuits. Based on the amygdala connectivity with these regions, we applied k-means clustering to parcellate the amygdala into three clusters. The resultant clusters were averaged across all subjects and the main white-matter pathways of the amygdala from each averaged cluster were generated. Amygdala parcellation into three clusters showed a medial-to-lateral pattern. The medial cluster corresponded with the centromedial and cortical nuclei, the basal cluster with the basal nuclei and the lateral cluster with the lateral nuclei. The connectivity analysis revealed different white-matter pathways consistent with the anatomy of the amygdala circuit. This in vivo connectivity-based parcellation of the amygdala delineates three clusters of the amygdala in a mediolateral pattern based on its connectivity with brain areas involved in cognition, memory, emotion, and reward. The human amygdala circuit presented in this work provides the first step for personalized amygdala circuit mapping for patients with behavioral disorders