Guillain-Barre syndrome in north eastern Iran; 1999-2005

To study the clinical presentation, hospital course and outcomes of patients admitted with Guillain-Barre Syndrome [CBS] to three tertiary care hospitals in Mashhad, Iran. The records of all patients admitted with flaccid paralysis between April 1999 and January 2005 were reviewed and those with the diagnosis of GBS were included in the study. Standard questionnaires were used to record clinical data on was recorded on a standardized questionnaire, which included patients' age, sex, antecedent infectious history, neurological signs and symptoms and ventilation requirements. The hospital course, including therapy given and the functional status of patients, was analyzed, including therapy given and the functional status of patients. Ninety-one cases of acute flaccid paralysis were admitted to the hospitals during the study period. Eighty-three cases, age range 10 months to 11 years, were later diagnosed as GBS afterwards, with age range of 10 months to 11 years. The mean age for disease onset was 4.2 years; there were 47 boys and 34 girls, male to female ratio 1:0.7. Upper respiratory tract infection [62.6%] was the most common antecedent event, followed by gastrointestinal infections [19%], urinary tract infection [1.2%] and chicken pox [2.4%], while the remaining cases [14.8%] had no other cases [14.8%] did not have any reliable history of any preceding antecedent infections. Most patients developed GBS within one month of the preceding infection. Cranial nerve abnormalities [19.3%], autonomic dysfunction [7.2%] and respiratory failure requiring intubation [10.8%] were also common. The in-patient mortality was 2.4% [2 of 83]. GBS was found to occur slightly more often in male patients, majority of whom had histories of previous infection. Despite persistent disability, in-hospital mortality was low

[ effect of topiramate in treatment of children with intractable epilepsy]

0.5 to 1% of children are epileptic, and 25% of these patients are resistant to therapy. Uncontrolled seizures produce multiple impairments in personal and social life of the patient. Any reduction in seizure number or obviation of them will raise quality of life and can refine educational, occupational and familial situation of the patient. Multiple studies in adults and children have shown efficacy of topiramate as mono or add-on therapy in reduction of seizures. The aim of this study was to evaluate the effects of this drug on intractable epilepsy. This study was done as a clinical trial in Pediatric Neurology Clinic of Ghaem Hospital in the year 2005. 24 drug resistant epileptic patients entered the study. In all of them topiramate administered as add-on therapy in a daily dose of 3 mg/kg and increased up to 9 mg/kg, in a therapy period of at least two months. Any change in seizure number, probable side effects of drug consumption, and patients individual data was evaluated and recorded in a questionnaire and analyzed by descriptive statistics and frequency distribution tables. Mean of seizure number of patients was 119.95 per month, which reduced to 53.41 after recieving topiramate. In 25% of patients seizures resolved completely and in 20.9% of them no improvement was noted. The results of this study implied the efficacy of topiramate in reduction of seizure number. Topiramate and other new antiepileptic drugs due to their effectiveness and lesser adverse effects can be used progressively, and in many cases they can be substituted for older antiepileptic agents

Serum chemistry abnomalities in children with unprovoked seizures

Most children brought to the emergency department [ED] for evaluation of seizures undergo an extensive laboratory workup. Since results are usually negative, the value of such routine laboratory workups has been questioned. A group of children with unprovoked seizures was prospectively studied to determine the diagnostic values of routine serum chemistries and to identify risk factors predictive of abnormal findings. All patients evaluated at the ED of the Ghaem hospital during a consecutive 12 months period between Jan 2004 through Jan 2005 were studied. We collected data for patient's demographics, details of the history of present illness [including vomiting, diarrhea, apnea], medication use, past history of seizures, family history of seizures, metabolic disorders or other chronic medical illnesses, neonatal history and neurological examination as well as nutritional status, imaging and EEG results, type and time of seizure. The role of abnormal serum chemistries as a seizure trigger factor was assessed in patients with a history of seizure. A total of 210 patients [mean age 19.2 months] with unprovoked seizures were evaluated. Twenty- three serum abnormalities were noted in the patients [12 cases of hyponatremia, 7 of hypoglycemia, 4 of hypokalemia, 4 of uremia]. The incidence of abnormal serum biochemical values was higher in patients with a first seizure, younger patients, and those with gastrointestinal symptoms. According to the present study, one can conclude that in children younger than 2 years and having no structural CNS abnormality, electrolyte and glucose screening is recommended only for a first unprovoked seizure, when gastrointestinal symptoms or symptoms suggesting electrolyte disturbances are present

Epilepsy in children with cerebral palsy

Epilepsy occurs in 12% to 90% of children with cerebral palsy [CP]. However its clinical course is not well defined. This investigation was undertaken to study and determine the characteristics and prevalence of epilepsy in children with cerebral palsy. Of 133 children with cerebral palsy, seen between 1998 and 2001, in the pediatric neurology clinic of the Imam Reza hospital, fifty-three had epilepsy. During the same period, a group of 70 epileptic children with normal neurodevelopmental status was studied as the controls. Patients with spastic quadriplegia were the most commonly affected with epilepsy. When compared with the control group, children with CP had a higher incidence of epilepsy with onset within the first year of age [52.8% vs. 18.5%], history of neonatal seizures [20.7% vs. 4.2%], and poly therapy [73.8% vs. 29.1%] respectively. Epilepsy is common in children with CP and can be predicted if seizures occur in the first year of life, in the neonatal period and based on the need for polytherapy

effect of nigella sativa L. on intractable pediatric seizures

Despite availability and administration of numerous antiepileptic drugs [AEDs] nearly 15% of childhood epilepsy cases are resistant to treatment; in traditional medicine however Nigella sativa L. [Black seed] has been known for its anticonvulsant effects. In this double-blind clinical trial conducted on children with refractory epilepsy we administered the aqueous extract of black seed as an adjunct therapy and compared the effects with those of a placebo. The study was performed between Sep 2003 and Nov 2004. The subjects received either extract or placebo for a period of four weeks and between these two periods for two weeks they received only their pre-existing anti-epileptic drugs [AEDs]. The mean frequency of seizures decreased significantly during treatment with extract, [p-value =0/007]. It can be concluded that the water extract of Nigella sativa L. has antiepileptic effects in children with refractory seizures that do not respond to known AEDS

Epilepsy in children with cerebral palsy

Introduction: Although its clinical course is not well defined. This retrospective study reviewed the prevalence, nature and prognosis of epilepsy of cerebral palsy among children

Material and Method: Among 133 children suffering from cerebral palsy and children visited in Neuropediatric clinic of Imam Reza Hospital, during 1997-99, 53 had epilepsy. A control group of 70 epileptic children with normal neurodevelopment status were seen during the same period, Epileptic group, commonly manifest with spastic quadriplegia

Results: When compared with controls, children with cerebral palsy had higher incidence of epilepsy with onset within the first year of age [52.5%VS 18.5%], history of neonatal seizures [20.7% VS 4.2%], polytherapy [76.3% VS 29.1%] and treatment with second line antiepileptic drugs [79.2% VS 23.1%] Thus epilepsy is more common in children with CP