Neuropsychiatric Disease and Treatment

Abstract: Purpose: Neuron specific enolase (NSE) is considered as a biomarker for the severity of nervous system diseases. We sought to explore whether serum NSE concentration in ischemic stroke patients undergoing mechanical thrombectomy (MT) is related to 3-month functional outcome and symptomatic intracranial hemorrhage (sICH). Patients and Methods: We retrospectively collected the data of acute ischemic stroke patients with anterior circulation infarction receiving MT within 6 h in our stroke center. Favorable outcome and poor outcome at 3 months were defined as modified Rankin Scale (mRS) score 0-2 and 3-6, respectively. sICH was defined according to the Heidelberg bleeding classification. We used multivariate logistic regression model and receiver operating characteristic curves to investigate the correlation between NSE and the clinical outcomes. Results: Among the 426 patients enrolled, 40 (9.4%) patients developed sICH. 3-month favorable outcome in 160 (37.6%) and poor outcome in 266 (62.4%) patients were observed. Serum NSE levels was significantly correlated with 3-month mRS score (R = 0.473, P < 0.001). A cutoff value of 15.29 ng/mL and 23.12 ng/mL for serum NSE was detected in discriminating 3-month poor outcome (area under the curve, 0.724) and sICH (area under the curve, 0.716), respectively. Multivariate analysis showed that high serum NSE levels were independently associated with 3- month poor outcome (odds ratio [OR] 5.049, 95% confidence interval [CI] 2.933-8.689, P＜0.001) and sICH (OR 5.111, 95% CI 2.210-11.820, P < 0.001). Conclusions: Our study demonstrated that high serum NSE levels after receiving MT were independently associated with 3-month poor outcome as well as sICH in acute ischemic stroke patients. Serum NSE levels could be a good predictor of prognosis for patients receiving MT

Efficacy aand Tolerability of Intravenous Paracetamol Compared to Oral Paracetamol for the Treatment of Childhood Fever

ABSTRACT Introduction: Paracetamol is widely used as antipiretic in children and has complete rute. The use of enteral rute is limited because of high variability of bioavailability. Intravenous paracetamol commonly used as accessible analgetic in adult. There are limited data about efficacy and tolerability intravenous paracetamol compares to oral paracetamol as antipiretic in children. The aim of the study is to analyse efficacy and tolerability intravenous paracetamol compared to oral paracetamol for treating fever in children. Methods: A randomized, controlled, and open labelled clinical trial was conducted at pediatric ward Soetomo hospital Surabaya. Eligible patients received either intravenous paracetamol or oral paracetamol 10 mg/kgBW and were examined for temperature at 15, 30, 45, 60, 120, 180 and 240 minutes. Tolerability evaluations included adverse event (AE), physical exam and laboratory assessments. Results: Of 104 patients, 52 received intravenous paracetamol intravena and 52 received oral paracetamol. Mean temperature intravenous group were lower than oral groups, with higher degree of decrease. The difference were achieved at 30, 45, and 60 minutes with p=0.005, 0.002, and 0.006 respectively. Maximum decrease from baseline were achieved at 120-minute for intravenous grup and 180-minute for oral groups. Normal temperature achievement were higher in intravenous group than oral. The adverse event were comparable between the intravenous and oral groups. Conclusion: Intravenous paracetamol is more effective and as safe as oral paracetamol in reducing fever in children. Key words: Accessible, Efficacy, Fever, Intravenous paracetamol, Tolerabilit

Clinical Outcome of Intraventricular Implantation Autologous Adipose Derived Neural Progenitor Cells in Parkinson

Parkinson’s disease (PD) involves the malfunction and death of vital nerve cells in the brain, is a chronic and progressive movement disorder. Supportive medications and surgery may conduct, but no optimal results have been obtained. The main goal of this study was to investigate the effectiveness of the intraventricular implantation of adipose derived neural progenitor stem cells in post-Parkinson’s disease patients. 12 patients were included in this study. Small adipose tissue was isolated by small lipopectomy under local anesthesia, cultured and derived become neural progenitor cells. Intraventricular implantation was performed in the operating room. The evaluation was carried out using the Unified Parkinson’s Disease Rating Scale (UPDRS), include non-motor experiences and motor experiences of daily living, motor examination, and motor complications. The primary target was the UPDRS over the time period of 12 months after treatment as the end point. Descriptive statistics are provided. 10 of 12 patients (83.33%) had a significant improvement in mentation, behavior and mood, activity of daily living, and motor examination after treatment. There were no serious adverse events reported, limited to mild headaches, fever or vomiting, and all side effects resolved within few days. Because of the small sample size and non-randomised trial performed, we could not reach a definitive conclusion regarding the potential of intraventricular implantation. However, this study shows that repeated intraventricular implantation of autologous stem cells is advantageous

Stem Cell Research In Cerebral Palsy Option of treatment in Future?

Childhood cerebral palsy is a non-progressive brain disease that results from various cerebral insults that can occur before birth and 1 month after birth. Patient primarily present with motor developmental delay or motor dysfunction and possible mental retardation, epilepsy, behavioural disorders and sensory and perceptual disturbances. Conventional therapies for treating cerebral palsy include physical therapy, motor function training, language training, surgery and instramuscular injections of botulinum toxin. However these methods have not improved cerebral injuries in patients with moderate-to-severe cerebral palsy

Clinical Features of Childhood Brain Tumor in Dr. Soetomo Hospital, Surabaya

Brain and central nervous system (CNS) tumors are the most common solid tumor and the second leading cause of cancer related death in individuals 0 to 19 years of age in the United States and Canada. There are >100 different histologic subtypes of CNS tumors with the incidence of each varying by age and histologic subtype. Childhood CNS tumor incidence varies by country from 1.12 to 5.14 cases per 100,000 persons. CBTs are more common in males, though this varies by histologic type. In the United States, whites and AAsians Pacific Islanders have a higher CBT incidence than blacks and American Indians/Alaska Natives, whereas nonHispanics have higher incidence thans Hispanics. Subtype incidence and survival rates are reviewe. here we report a 3 years experience of managing Childhood Brain Tumors (CBTs) in Soetomo Hospital, Surabaya

A case of juvenile dermatomyositis responding to methotrexate and steroid

A 4-year-old patient presented with skin rash and muscle weakness. She was diagnosed with juvenile dermatomyositis based on Bohan and Peter criteria as well as laboratory testing. She received steroid and combined with methotrexate. The treatment resulted in a good response

Acanthamoeba Infection in a Drowning Child

BACKGROUND: Acanthamoeba infection is a potential life-threatening complication of drowning. The management of drowning-associated Acanthamoeba infection remains controversial. Survival reports on Acanthamoeba infection have been on case reports only.CASE DETAILS: A 2-year-old, previously healthy Indonesian boy presented with decreased consciousness and inadequate breathing, followingdrowning. The event was unsupervised with unknown estimated time of submersion. Resuscitation was commenced and mechanical ventilated was applied. Sputum specimen revealed alive Acanthamoeba with pseudopods and cysts. Sputum culture resulted in Pseudomonas aeruginosa and cerebrospinal fluid was supportive for Acanthamoeba with 1-3 trophozoites and cyst. Imaging of the head showed cerebral edema and encephalitis. The patient received intravenous ceftazidime, metronidazole, fluconazole and rifampicin. The patient’s consciousness was unsatisfactory regained resulting in an altered mental status.CONCLUSION: No treatment so far has given a succesful outcome for Acanthamoeba. In this case, management with metronidazole, rifampicin and fluconazole showed regain of consciousness resulting in altered mental status.KEYWORDS: Acanthamoeba, Pneumonia, Encephaliti

Hemispherectomy Procedure in Proteus Syndrome

How to Cite This Article: Gunawan PI, Lusiana L, Saharso D. Hemispherectomy Procedure in Proteus Syndrome. Iran J Child Neurol.Summer 2016; 10(3):86-90 ObjectiveProteus syndrome is a rare overgrowth disorder including bone, soft tissue, and skin. Central nervous system manifestations were reported in about 40% of the patients including hemimegalencephaly and the resultant hemicranial hyperplasia, convulsions and mental deficiency. We report a 1-month-old male baby referred to Pediatric Neurology Clinic Soetomo Hospital, Surabaya, Indonesia in 2014 presented recurrent seizures since birth with asymmetric dysmorphic face with the right side larger than the left, subcutaneous mass and linear nevi. Craniocervical MRI revealed hemimegalencephaly right cerebral hemisphere. Triple antiepileptic drugs were already given as well as the ketogenic diet, but the seizures persisted. The seizure then was resolved after hemispherectomy procedure.ReferencesBeachkofsky TM, Sapp JC, Biesecker LG, Darling TN. Progressive overgrowth of the cerebriform connective tissue nevus in patients with Proteus syndrome. J Am Acad Dermatol 2010;63:799-804.Biesecker L. The challenges of Proteus syndrome: diagnosis and management. Eur J Hum Genet 2006;14:1151-7.Yamatogi Y, Ohtahara S. Early-infantile epileptic encephalopathy with suppression-bursts, Ohtahara syndrome; its overview referring to our 16 cases. Brain Dev 2002;24:13-23.Bastos H, da Silva PFS, de Albuquerque MAE, Mattos A, Riesgo RS, Ohlweiler L, et al. Proteus syndrome associated with hemimegalecephaly and Ohtahara syndrome: Report of two cases. Seizure 17(4):2008.Turner JT, Cohen MM, Jr., Biesecker LG. Reassessment of the Proteus syndrome literature: application of diagnostic criteria to published cases. Am J Med Genet A 2004;130A:111-22.Cohen MM, Jr. Proteus syndrome: clinical evidence for somatic mosaicism and selective review. Am J Med Genet 1993;47:645-52.Bilkay U, Tokat C, Ozek C, Gundogan H, Erdem O, Gurler T, et al. Proteus syndrome. Scand J Plast Reconstr Surg Hand Surg 2003;37:307-10.Biesecker LG, Happle R, Mulliken JB, Weksberg R, Graham JM, Jr., Viljoen DL, et al. Proteus syndrome: diagnostic criteria, differential diagnosis, and patient evaluation. Am J Med Genet 1999;84:389-95.Caraballo R, Bartuluchi M, Cersosimo R, Soraru A, Pomata H. Hemispherectomy in pediatric patients with epilepsy: a study of 45 cases with special emphasis on epileptic syndromes. Childs Nerv Syst 2011;27:2131-6.Moosa AN, Gupta A, Jehi L, Marashly A, Cosmo G, Lachhwani D, et al. Longitudinal seizure outcome and prognostic predictors after hemispherectomy in 170 children. Neurology 2013;80:253-60.