Body mass index [BMI] and some hormonal changes in epileptic children receiving antiepileptic therapy

Epilepsy is a common neurological problem. It's treatment is often for years or even lifelong. The primary treatment of choice is the use of the antiepileptic drugs [AEDs]. Endocrine disorders are of major concern for clinicians who treat patients with epilepsy. This prospective hospital based study was conducted during the period from March 2008 till November 2010 at Assiut Children University Hospital. The aim of the study was to assess the effect of some antiepileptic drugs is Valproic acid, Carbmazepine or Topirmate, either monotherapy in combination on body weight and some endocrine aspects in epileptic children. The study included 62 epileptic children and 25 age and sex matched normal children as control. The cases were divided into 4 groups: [Group 1] included 22 cases on Valproic acid alone, [Group 2] included 19 cases on Valproic acid and Carbmazepine, [Group 3] included 21 cases on Valproic acid and Topirmate and control cases [Group 4]. All children were subjected to detailed medical history, full neurological examination, measurement of height, weight and body mass index [BMI], in addition to estimation of serum levels of leptin, insulin and fasting blood glucose levels. Patients treated with Valproic acid alone [group1] had significantly increased BMI and serum levels of leptin and insulin when compared with either [group3] or [group 4]. Cases on both Valproic acid and Carbmazepine [group 2] had significantly higher serum level of leptin, insulin and BMI when compared with control group [group 4].Cases on both Valproic acid and Topiramate had significantly higher serum level of insulin when compared with control group [group 4].Serum level of leptin in cases treated with Valproic acid had positive correlation with age, BMl,insulin, dose and treatment duration. Cases of obese parents had increased BMI, serum leptin and insulin when compared with cases of non obese parents. The study concluded that children receiving antiepileptic medications especially valoproic acid are at a great risk for development of obesity especially if associated with other risk factors as female sex and obese parents. Leptin and insulin serum levels should be checked regularly during treatment with antiepileptic drug therapy especially Valproic acid

Serum leptin levels in type-I diabetic children and adolescents versus healthy controls: relationship to age, gender, body mass index, gonadal hormones and pubertal stages

Since childhood and puberty are periods of major metabolic and endocrine changes, the present study was conducted to: [I] Evaluate developmental changes of serum leptin levels in children and adolescents with type-1 diabetes mellitus in comparison with matched healthy controls in respect with chronological age and pubertal stages [2] Evaluate if leptin concentration would be related to obesity observed in children and adolescents with type-1 diabetes during puberty. The study included 60 children diagnosed as type-1 diabetes mellitus by the criteria of American Diabetes Association [ADA] as well as 48 healthy children with matchable age and sex with diabetic patients. The patient and control children were grouped according to their chronological age into 4 groups [6-7yr, 8-10yr, 11-13 yr and 14-16yr] and according to stages of puberty into 3 groups: pre puberty P[1] early puberty P[2] and overt puberty P[3]. Serum leptin levels and BMI were measured to all patients and controls. Also, serum testosterone in boys and serum estradiol in girls were measured by ELISA method. Serum leptin levels significantly increased parallel with age and with pubertal stages both in control and diabetic girls. The maximum levels were observed at 14-16yr age group and at overt stage of puberty. Serum leptin levels were significantly higher in diabetic girls than controls at all studied groups. In control boys, leptin levels were significantly higher at 8-10yr and during P[1] stage then a significant decline occurred thereafter. In contrast, the diabetic boys showed no such decline either with age or with pubertal staging. Diabetic boys had significantly higher leptin levels than control boys at all studied groups. Serum leptin levels in girls were significantly higher than boys either in control or diabetic children. Diabetic children [girls and boys] were significantly older than controls during P[2] and P[3] stage. BMI was significantly increased In diabetic children [girls and boys] than controls during P[1], P[2] and P[3] stage whereas serum estradiol in diabetic girls and testosterone in diabetic boys were significantly lower than controls during P[2] and P[3] stages. Significant positive correlations were observed between serum leptin levels versus age, BMI and estradiol hormone in control girls. Also significant positive correlations were found in diabetic girls between serum leptin levels and each of age, BMI and estradiol hormone. In control boys significant negative correlations were observed between serum leptin level and each of age and testosterone hormone whereas non significant with BMI. Significant positive correlations were found in diabetic boys between serum leptin levels and each of age and BMI, while the correlation with testosterone was non significant. In conclusion leptin appears to participate in various endocrinological and physiological process in human body. Among the more notable are obesity and pubertal delay-associated diabetes. Thus, it may be involved in regulation of body weight and signaling the onset of puberty and maintenance of reproductive function thereafter

Adiponectin serum level among children with nephrotic syndrome in relation to right ventricular functions

Adiponectin [ADPN], a protein hormone, is exclusively expressed on and secreted from adipocyte. ADPN is a particularly interesting compound because it may have a protective influence on the cardiovascular system. This study was a prospective hospital based study aiming to evaluate ADPN serum level among children with nephrotic syndrome [NS], right ventricular functions by Echocardiography and finding any correlation between ADPN as a protective hormone and right ventricular function. The study included 47 patients [28 boys and 19 girls] with steroid responsive nephrotic syndrome [SRNS]. Cases included two groups: Group A: Included 25 patients with SRNS in relapse. Group B: Included 22 patients with SRNS in remission for periods ranging from 3-9 months and with no steroid therapy. In addition to control group which included 28 children with matched age and sex. A thorough history and full clinical examinations and echocardiography measuring right and left ventricular wall functions and other abnormalities if present were done. Blood samples were collected for measuring serum levels of total cholesterol, triglycerides, high density lipoprotein [HDL], low density lipoprotein [LDL], very low density lipoprotein [VLDL] by Enzymatic Colorimetric kits, in addition to ADPN by ELISA method. Serum ADPN level was significantly higher in patients with SRNS in relapse [33.4 +/- 15.60 micro g/ml] in comparison with patients with SRNS in remission [12.54 +/- 8.76 micro g/ml] and with control group [10.54 +/- 6.43 micro g/ml] with P value<0.001 for both. Right ventricular end diastolic diameter [RVEDD], right ventricular peak pressure[RVPP] and pulmonary artery pressure [PAP] were significantly higher while right ventricular ejection fraction [RVEF%] was significantly lower among cases in relapse [group A] than in cases in remission [group B] or children in control group. During relapse of SRNS, ADPN serum level is higher than its level in SRNS in remission and also, right ventricular dysfunction occurs in relapsed SRNS reflected by decrease of RVEF% and increase in RVEDD, RVPP and PAP

Pro-inflammatory cytokines, oxidative stress and intelligent quotient [IQ] in malnourished pediatric patients

Protein energy malnutrition [PEM] is one of the most common health problems among children of developing countries. Children with PEM lose their resistance to infection because of a disordered immune system. Protein energy malnutrition produces changes in inflammation related proteins characteristic off a low grade systemic inflammatory response and, thus, can serve as an inflammatory stimulus. Antioxidant status of PEM patients is significantly reduced. An increasing body of evidence indicates a link between malnutrition and poor cognitive ability in children [in particularly in early onset malnutrition]. This study included 28 children having malnutrition [17 patients had marasmus [loss of subcutaneous fat over the thigh or over the abdomen or loss the buccal bad of fat] and 11 patients had kwashiorkor[presented by generalized edema, sparse easily detachable hair, flag sign, cracky paint dermatosis and apathy], 15 males 13 females, their ages ranged from 4 months to 24 months, admitted to Gastroenterology Unit, Assuit University Children Hospital from April 2007 to December 2007 as well as 15 apparently healthy children of matchable ageand sex. All patients subjected to full history, complete clinical examination and the following investigations: serum levels of TNF-alpha, lL-6, nitric oxide [NO], lipid peroxide and zinc as well as Intelligent Quotient [IQ] were done. Serum levels TNF-alpha, lL-6, NO were significantly higher in patients with kwashiorkor and in patients with marasmus than in controls as well as higher in patient with kwashiorkor than in patients with marasmus. Serum levels of peroxide, was only significantly higher in patients with kwashiorkor and in patients with marasmus than in control. Also serum zinc level and I.Q were significantly lower in patients with kwashiorkor and in patients with marasmus than in controls as well as in patients with kwashiothor than in patients with marasmus. There are negative correlations between serum levels of TNF-alpha, lL-6 and lipid peroxide with I.Q in patients with marasums and patients with kwashiorkor. Also there is a positive correlation between serum level of zinc with IQ in patients with marasmus and in patients with kwashiorkor. in conclusion, oxidative stress imbalance and zinc deficiency in children with PEM play an important role in their neurocognitive development

Study of chromosomal abnormalities in childhood epilepsy with dysmorphism

Various chromosomal abnormalities have been found in patients with epilepsy and epileptic syndromes. Genetic linkage and karyotype analysis may provide cytogenetic clues leading to the identification of genes linked to specific types of epilepsy. This study is aimed to evaluate the chromosomal abnormalities and specific chromosomal regions in cases of childhood epilepsy with dysmorphism. The present study included 40 epileptic patients with dysmorphic features, 22 males and 18 females, their ages ranged between 27 months and 9.5 years with mean and standard deviation 4.32 +/- 2.89 years All patients had at least two attacks of unprovoked afebrile seizures greater than 24 hours apart. A thorough history taking about fits, general as well as neurological examination with special emphasis on any associated anomalies. EEG, IQ and CT were carried out in all patients, while MRI brain was done for some cases. Chromosomal study included karyotyping and fluorescence in situ hybridization [FISH] were done for all cases. Our results showed: 22 [55%] patients had normal karyotype [first group] while 18 patients [45%] had chromosomal aberrations [second group]. The frequency of various types of chromosomal aberrations among the studied patients was: Eight patients [44%] had trisomy 21 [Down syndrome], three patients [16.5%] had Turner [45x] syndrome, one patient [5.5%] had trisomy 18 [Edwards syndrome], one patient [5.5%] had deletion of short arm of chromosome 18 one patient [5.5%] had deletion of long arm of chromosome 15 [Angelman syndrome], one patient [5.5%] had deletion of long arm of chromosome 13, one patient [5.5%] had deletion of long arm of chromosome 7 [Williams syndrome], one patient [5.5%] has deletion of long arm of chromosome 4 and one patient [5.5%] had duplication of long arm of chromosome 20. There was significant difference between the two groups in developmental milestones. Consanguineous marriage was found in 22.7% of the first group versus 33% of second group. Cerebral atrophy was found in three patients [13.5%] of the first group and in five patients [27.5%] of the second group. Cerebellar atrophy was found in one patient [5.5%] of the second group. A genesis of corpus callosum was found in one patient [5.5%] of the second group. The present study reinforces the findings of the significant association between some chromosomal aberrations and epilepsy. These include: Trisomy 21, trisomy 18, Turner syndrome and abnormallties of regions 4q, 7q and 15q. Other regions associated with epilepsy were decteded: 13q, 18p and 20q. Further investigation into these regions may lead to discovery of new genes involved in epileptogenesis. The present study directs the attention of the clinicians about the importance of dysmorphic features in the evaluation of epileptic patients. In recommendation, karyotype should be performed in a child with seizures and dysmorphic features. Further advanced molecular studies about genetic basis of epilepsy are recommended

Value of serum prolactin in epileptic and some non-epileptic events

A seizure or convulsion is a common problem in pediatric age group. Other events such as breath holding attacks and syncope may simulate seizures. A thorough history and accurate description by the parents or eye witness is necessary for making diagnosis of seizures. When the description is unreliable, the diagnosis becomes difficult. The adverse effects of long term antiepileptic drugs, cost of therapy as well as social implications make it essential to build a solid diagnosis before the decision of therapy. Electroencephalography [EEG] which is the common tool to confirm the diagnosis of epilepsy, could be normal in up to 40% of patients in the inter-ictal period Twenty-four hours EEG monitoring, ambulatory EEG are used in cases with diagnostic uncertainly. Such modalities are not easily available in our locality as well as our country and so, available cheaper and easily accessible alternatives are required. The aim of the study is to evaluate the diagnostic value of post-ictal serum prolactin in the diagnosis of epilepsy and its specificity to differentiate epileptic from non-epileptic events in our locality where EEG monitoring is not available. The study included sixty eight patients and twenty one healthy controls of matched age and sex. Patients were divided into two groups: 45 epileptic patients and 23 non-epileptic patients [15 patients with breath-holding spells and 8 with syncope]. A thorough history, full neurological examination as well as general examination were done. Conventional EEG was carried out in the awake state. Serum urea, creatinine calcium, sodium and potassium were performed. Serum prolactin was performed by enzyme immunoassay. Two samples for prolactin assay, the first within one hour in attack and the second After 24 hours. Generalized tonic-clonic [G. T.C.] convulsions were the commonest type [57.7%], complex partial type of convulsion were the 2[nd] in frequency [17.8%], generalized tonic [G.T], atonic and partial with secondary generalization were 6.7% for each, and lastly simple partial were 4.4%. The serum level of prolactin of the epileptic patients [21.7 +/- 2.5 ng/ml] was significantly higher than that of each of the non-epileptics group [9.4 +/- 2.3 ng/ml], [p<0.0001], as well as the control group [7.2 +/- 1.6 ng/ml], [p<0.0001]. Furthermore, the serum level of prolactin was significantly higher among the non-epileptics than the control group [p<0.05]. Significant differences were also reported between first and second samples in the epileptic group [p<0.001]; while the difference was insignificant between the first and second samples in non-epileptic group. A significant negative linear correlation [r=-0.8] and [P<0.01] was detected between the serum prolactin and time lapsed after the fit in the first sample. Taking mean +/- 2SD as a cut off value, sensitivity of serum prolactin for diagnosing epileptic fits was 93.3% and specificity was 65.2%. Post-ictal serum prolactin in the first hour after the fit is a sensitive parameter for diagnosis of epileptic patients and highly specific parameter to differentiate between epileptic patients and patients with syndrome that mimic epilepsy and could build a solid diagnosis for doubtful cases of epilepsy

Neurophysiological and intellectual evaluation of patients with beta-thalassemia major

Anemia and its complications represent a major health problem in children. Beta-Thalassemia major [BTM] is a chronic genetically determined hematological disorder characterized by ineffective erythropoiesis, peripheral hemolysis and severe anemia and they require regular blood transfusions. The aim of the present study is to evaluate the neurophysiological and intellectual aspects of patients with BTM who are clinically have no CNS affection. The study included 33 patients with BTM 23 males and 10 females, their mean age was [8.00 +/- 3.02 years], who attended hematology unit of pediatric hospital, Assiut university in the period between January and April 2006. In addition to 30 apparently healthy children of cross matched age and sex as a control. A thorough history full clinical examination and detailed neurological history and examination were carried out. Evaluation of the hemoglobin level, serum Iron and serum ferritin were done as well as EEG and IQ. In the present study, Hb level was significantly lower in patients [6.9 +/- 1.2 gm/dl] than controls [11.4 +/- 0.7 gm/dl] with P<0.001, serum iron was significantly higher in patients [186.3 +/- 60.9 micro g/dl] than controls [91.9 +/- 22.1 micro g/dl] with P<0.001 and serum ferritin was significantly higher in patients [2580.00 +/- 576.9 micro g/dl] than controls [435.6 +/- 112.9 micro g/dl] with P<0.001. Total as well as performance I.Q were significantly lower in patients than controls with p-value <0.001 for each, Mean value of total I.Q were 88.3 +/- 8.1 for patients and 98.7 +/- 6.4 for controls. Performance I.Q were 81.7 +/- 9.1 for patients and 97.8 +/- 6.1 for controls. A significant negative correlations was present between serum iron and total I.Q [r=-0.67 and p<0.001] as well as performance I.Q [r=-0.45 and p<0.01]. There were no significant correlations between serum ferritin and I.Q [total, verbal or performance]. A significant positive correlation between mean Hb level in the last 2 years and total I.Q [r=0.68 and P<0.001], performance I.Q [r=0.47 and p<0.01] and verbal I.Q [r=0.41 and p< 0.05]. EEG background activity was normal in 48.5% and shows different grades of slowing in the rest of cases. There were a significant increase in slow waves as theta waves [39.7 +/- 23.4 and controls 11.8 +/- 6.9 with P-value <0.001] and delta waves [9.6 +/- 8.8 and controls 4.4 +/- 4.6 with p-value <0.05]. While fast waves of EEG were significantly decreased as alpha waves [12.12 +/- 9.28 and controls 19.7 +/- 6.7 with p-value <0.001] and beta waves [38.48 +/- 22.24 and controls 64.1 +/- 12.28 with p-value <0.001]. A significant positive correlation was present between Hb level and alpha waves [r=0.74 and P<0.001], significant-ve correlation between Hb and theta waves [r=0.65 and P<0.001] and a significant positive correlation between Hb and beta waves [r=0.66 and P<0.001]. C.N.S. is one of the important systems affected by repeated blood transfusions in BTM patients leading to lowering of I.Q scores especially performance skills and also affect EEG and these effects starts silently and progress and so, early detection of CNS affection in BTM patients is recommended for early intervention and to maintain good quality of life as well as to reach a satisfactory levels in learning

study of some oxidants/antioxidants and trace elements in children with bronchial asthma

Asthma is a chronic inflammatory disorder of the airways involving variable airflow obstruction and increased airway responsiveness to a variety of stimuli. The rise in prevalence of asthma and allergic diseases among children is a matter of worldwide concern. Epidemiological evidence suggests that changes in diet, in particular reduced antioxidant intake have contributed to the increased asthma prevalence and severity and raises the possibility that dietary interventions may improve asthma. To evaluate the oxidants/antioxidants, and trace elements status in children with bronchial asthma this study was conducted on 39 asthmatic patients [mean age of 8.5 +/- 2.1 years] as well as 20 apparently healthy controls of matched age and sex recruited from Assiut Pediatric University hospital. Beside thorough history-taking, and meticulous clinical examination for all cases and controls, lung function tests and a chest x-ray were done for each asthmatic child. Fifteen patients had mild bronchial asthma, twelve had moderate, and twelve had severe asthma according to the National Asthma Education and Prevention program. The following investigations were done to all studied children: plasma lipid peroxide level expressed in terms of malondialdhyde [MDA]; red blood cell enzyme activity of each of glutathione peroxidase [GSH-Px], and superoxide dismutase [SOD]; plasma levels of vitamins [A, E, and C], zinc [Zn], copper [Cu], selenium [Se] and magnesium [Mg]. Asthmatic children showed significantly higher plasma level of MDA than controls. Red blood cell enzyme activity of each of GSH-Px, and SOD, also, plasma levels of vitamins A, and C, Zn, Se, and Mg showed significantly lower values in asthmatic children than controls. The changes observed in the studied parameters were more apparent in patients with severe asthma than those with mild degree. Significant positive correlations were observed between the values of forced expiratory volume 1 [FEV 1], and each of GSH-Px, SOD, and vitamin A, Zn, and Se, while significant negative correlation was found between FEV 1 and MDA. Also, significant negative correlations were detected between MDA, and each of GSH-Px, SOD, vitamin C and Zn. Oxidative stress and disturbed antioxidants and trace elements status are present in asthmatic children, and may have important consequences for the pathogenesis, and severity of asthma. Special attention must be given to the assessment of dietary intake of vitamins and trace elements. So, good dietetic intakes of high biological value protein, and supplements of vitamins, and trace elements are recommended as an adjuvant therapy. Long term prospective trials are recommended to determine whether modification of dietary intake will be beneficial in prevention, or reduction of the severity and or morbidity of the disease

Transforming growth factor beta and other angiogenic factors in hematologic malignancies of childhood

Angiogenesis, a process of new blood vessels formation from an existing vasculature, has been blamed for growth, dissimination and metastasis of solid tumors. Little is known about angiogenesis and angiogenesis- related molecules in hematologic malignancies. Transforming growth factor-beta [TGF- beta] and platelet-derived growth factor-C [PDGF-C] are considered as indirect angiogenic factors in tumorigenesis. Gangliosides and hyaluronan are components of cell membrane that modulate cell membrane signal transduction of multiple growth factors. The aim of this study is to assess serum levels of TGF- beta, PDGF-C, Gangliosides, and hyaluronan in children with newly diagnosed malignancies including 15 cases with acute lymphoblastic leukemia [ALL], 15 cases with non Hodgkin lymphoma [NHL], and 10 cases with neuroblastoma. Ten matchable apparently healthy children were included as controls. Results of the study showed that cases as a whole had significantly higher levels of TGF-beta, PDGF-C, gangliosides and hyaluronan than controls. Furthermore cases with hematologic malignancies as well as those with neuroblastoma had significantly higher levels of the studied parameters than controls. On comparing the different groups of cases with each other, it was found that cases with ALL and NHL had significantly higher level of TGF-beta than cases with neuroblastoma whereas the latter group had significantly higher level of gangliosides than ALL and NHL groups and higher level of hyaluronan than ALL group. Cases of NHL and neuroblastoma with advanced disease had significantly higher levels of the studied parameters than the rest of cases. In conclusion the angiogeneic factors TGF-beta, PDGF-C, gangliosides, and hyaluronan are raised in children with ALL and NHL as well as in those with neuroblastoma. Their levels are significantly higher in severer cases with advanced stages of malignancy. The estimation of their levels therefore not only points to the severity but also help to predict progress in these cases

Prevalence and risk factors of nocturnal enuresis in a rural area of Assiut governorate

Nocturnal enuresis is a common problem that can be troubling for children and their families. Nocturnal enuresis is the involuntary and undesirable wetting that occurs during sleep beyond the age of anticipated bladder control. Children are not considered enuretic until they have reached five years of age. Although comparison of studies are difficult because of variation in the definition of enuresis and in the age range of population studied, true geographical differences in prevalence and in natural history of enuresis seem to exist, arising from racial, cultural, or environmental factors. The literatures about the prevalence of enuresis in rural areas of Assiut governorate are limited. The aim of the study is to evaluate the prevalence of nocturnal enuresis among children aged 5-12 years old in a rural area of Assiut governorate, this is in addition to study risk factors associated with nocturnal enuresis among enuretic children in this rural area. A cross-sectional community- based study was carried out in mankabad village. A total of 592 houses were visited. All eligible children [5-12 years] in the selected houses were included. The first house was selected randomly, and then every third house of the village was included. A well-designed questionnaire was used for data collection. The questionnaire sheet was developed to assess the prevalence and risk factors of nocturnal enuresis among children. This study included 1148 children distributed in 592 houses in mankabad village. The prevalence of enuresis was found to be 17.8%. diurnal as well as nocturnal enuresis occurs in 19.6% of the enuretic group. The most frequent cause of nocturnal enuresis expected by the mother was deep sleep [24.5%], followed by urinary tract infection [13.7%]. As regards the dealing of the families with problem of nocturnal enuresis, 15.7% mentioned that they consult others and about 29.4% consult a physician, 30.4% punish their children, while 24.4% do nothing. The prevalence of enuresis was insignificantly higher in males [51.9%] than females [48.1%] [p=0.209]. The mean age of enuretic children [5.9 +/- 2.1] years is significantly lower than that of non-enuretic children [8.7 +/- 2.2] years [P<0.001]. Birth order has no significant effect on the prevalence of enuresis. The prevalence of enuresis was significantly higher among children of illiterate fathers than among those of educated fathers [p