Effects of a Formula-Based Ketogenic Diet on Refractory Epilepsy in 1 to 3 Year-Old Patientsunder Classic Ketogenic Diet

AbstractObjectives: The classic ketogenic diet (CKD) as a potential epilepsy treatment with high-fat has not a good tolerability in some patients, and so many families refuse to use this diet for long term especially in children younger than 2 years of age.  In the present study, the efficacy and tolerability of the only CKD was compared with CKD combined a formula-based powder in children between 1 and 3 years of age with intractable epilepsy.Material and Methods: We prospectively enrolled 45 children with refractory epilepsy for CKD (control group), and CKD combined with a formula-based powder (experimental group) treatment. Subjects were followed up for at least six months.Results: Most of the patients in control group did not tolerate the diet and were reluctant to eat homemade foods with high fat, as all the families of the patients younger than 2 years old in this group chose to discontinue the CKD and pursued other options.  33% of the families of patients younger than 2 years old and totally 41.6% patients between 1-3 years old in experimental group stayed to the end of the trial, and all of them showed more than 90% reduction in seizure  frequency after 6 months. Also, regardless of the other variables, the formula increased the chance of responding to treatment 7.32 times.Conclusions: A ketogenic diet using a formula-based powder is effective, safe, and tolerable in infants and children with refractory seizure especially for younger patients who are reluctant to eat homemade foods. 

Recurrent stroke in a child with TRMA syndrome and SLC19A2 gene mutation

Here we report a 5-month-old boy with thiamine Responsive Megaloblastic Anemia syndrome (TRMA syndrome) with several attacks of stroke. In addition to the cardinal clinical manifestations of the syndrome (thiamine-responsive megaloblastic anemia, diabetes mellitus, and sensor neural hearing loss), the patient showed the ischemic attack of stroke. Megaloblastic anemia and Diabetes were diagnosed at 8 months and was successfully treated with vitamin and insulin prescription. After treatment of thiamine diabetes was controlled and insulin was discontinued. In spite of the thiamine administration, the second stroke as hemorrhagic stroke was occurred in the patient after a few months. TRAMA is inherited in an autosomal recessive manner. TRMA was confirmed by mutation in SLC19A2. A homozygous splice site variant was detected in SLC19A2 gene. According to our knowledge stroke was not reported in this syndrome (only in one report about one attack in an adult patient) but in this patient several attacks of stroke was report before and after thiamin administration

Spinal subdural hematomas in a normal child without trauma history: a case report

Acute Spinal Subdural Hematoma (ASSH) is a rarely recognized condition that may result in severe irreversible neurologic complication. We presented a 7-year old girl was transferred to our hospital with limping and pain in lower extremities and acute paraplegia without history of direct trauma. The patient's lower limbs weakened. She was unable to bear weight. Deep Tendon Reflexes(DTR) in lower extremities had increased. Her MRI showed spinal subdural hematoma we reextended from T2 to T6. We performed laminectomy from T2 to T5 and about 70 cc of subdural hematoma was evacuated. After a month after the operation, the patient's neurological deficit resolved completely. The case illustrates the need of attention to clinical manifestation of acute spinal subdural hematoma and early diagnosis to prevent irreversible neurologic complication

Pattern Generation for Walking on Slippery Terrains

In this paper, we extend state of the art Model Predictive Control (MPC) approaches to generate safe bipedal walking on slippery surfaces. In this setting, we formulate walking as a trade off between realizing a desired walking velocity and preserving robust foot-ground contact. Exploiting this formulation inside MPC, we show that safe walking on various flat terrains can be achieved by compromising three main attributes, i. e. walking velocity tracking, the Zero Moment Point (ZMP) modulation, and the Required Coefficient of Friction (RCoF) regulation. Simulation results show that increasing the walking velocity increases the possibility of slippage, while reducing the slippage possibility conflicts with reducing the tip-over possibility of the contact and vice versa.Comment: 6 pages, 7 figure