ABSTRACT
Objective: To evaluate the efficacy and tolerability of intravenousfosphenytoin in children with status epilepticus, and resultingserum total phenytoin levels.Methods: In this prospective study, 51 children aged less than 18years received intravenous loading dose of fosphenytoin (18-20mg/kg). Serum total phenytoin levels were estimated at 90 -100minutes. Outcomes studied were (i) seizure control and local and/or systemic adverse effects in next 24 hours and (ii) phenytoinlevels and its correlation with dose received, seizure control andadverse effects.Results: The actual dose of fosphenytoin received varied from15.1 to 25 mg/kg. Seizures were controlled in 45 (88%) childrenand, two required additional dose of 10 mg/kg. None of thechildren showed any local or systemic adverse effects. Serumtotal phenytoin levels were in the therapeutic range (10-20 μg/mL)in 12 (23.5%), sub-therapeutic in 16 (31.3%) and supra-therapeutic in 25 (49%) children. There was weak correlation ofthe phenytoin levels with dose of fosphenytoin received, seizurecontrol, or adverse effects.Conclusion: Intravenous fosphenytoin loading dose of 20 mg/kgis effective in controlling seizures in 88% of children with statusepilepticus, with a good safety profile. Seizure control and adverseeffects appear to be independent of serum total phenytoin levelsachieved.
ABSTRACT
This study was conducted in a tertiary pediatric epilepsy clinic to ascertain the spectrum of development malformations in children, with seizures. Seventy Six Children (0-12 yr) with seizures and CNS malformations based on neuroimaging were included. Observed anomalies included dysgenetic corpus callosum (DCC), lissencephaly, focal cortical dysplasia (FCD), pachygyria, polymicrogyria, heterotopia, schizencephaly, holoprosencephaly, hemimegalencephaly, and phakomatoses like tuberous sclerosis, Sturge Weber syndrome and linear cutaneous nevus syndrome. Seizure semiology varied in all categories. Microcephaly, developmental delay and tone abnormalities were common clinical findings. 60.5 percent cases presented in infancy. The characteristic EEG features provided a clue to the diagnosis of anomalies like lissencephaly, agenesis of corpus callosum and alobar holoprosencephaly.