Long-term follow-up study of topiramate in the treatment of symptomatic epilepsy in infants / 中国基层医药

Objective To observe the long-term efficacy and safety of topiramate in the treatment of symptomatic epilepsy in infants.Methods Fifty infants with symptomatic epilepsy were collected.The monotherapy was started with topiramate from April 2012 to April 2013,including 26 males and 24 females.The effective rate,retention rate and adverse effects after using the medication at 1 year,2 years,3 years,4 years were evaluated.Kaplan -Meier and Cox proportional hazards regression model were used to calculate the retention rate and analyze the risk factors for retention rate.Results From the beginning of using the medicine,the effective rate was 66.00％ at 1 year,61.90％ at 2 years,58.33％ at 3 years,and 53.33％ at 4 years,respectively.The rates of complete remission were 44.00％,42.86％,41.67％,36.67％ at 1 year,2 years,3 years,4 years,respectively.The main adverse effects of topiramate were drowsiness,hypodynamia,weight loss,anepithymia,vomit,diarrhea,hypohidrosis,slowly thinking active,attention disorders,etc.The retention rate was 84.00％ at 1 year,72.00％ at 2 years,60.00％ at 3 years,and 48.00％ at 4 years.The main causes of stopping medication were lower curative effect of topiramate monotherapy and side effects.Conclusion Topiramate in the treatment of infants with symptomatic epilepsy has good effect and safety,with higher retention rate in a long-term follow-up.The major factors that affect the retention rate are lower curative effect and adverse reactions.Slowly add quantity and low dose treatment can reduce adverse drug reactions,improve compliance and increase retention rate.

Clinical and imageology follow-up study of acute disseminated encephalomyelitis / 中华实用儿科临床杂志

Objective To explore the clinical manifestations and recovery from neuroimaging abnormalities of acute disseminated encephalomyelitis (ADEM),in order to improve the understanding of ADEM.Methods A total of 47 children with ADEM in Department of Neurology,Children′s Hospital of Soochow University were followed up for 1 year.The clinical manifestations,auxiliary examination (especially neuroimaging),treatment and prognosis were analyzed.The recovery conditions from clinical and neuroimaging abnormalities were summarized.Results Among 47 cases,37 cases (78.72%) had prodromic infection history,and 5 cases (10.64%) had the history of vaccination.The clinical manifestations were varied,including 36 cases (76.60%) with somatic discomfort,30 cases (63.83%) with fever,30 cases (63.83%) with disturbance of consciousness,28 cases (59.57%) with epileptic seizure,24 cases (51.06%) with headache and dizziness,22 cases (46.81%) with nausea and vomiting,15 cases (31.91%) with dyskinesia,15 cases (31.91%) with cranial nerve injury,9 cases (19.14%) with incoordination,and 8 cases (17.02%) with mental and behavior disorders.Abnormal lesions presented multiple,asymmetric patchy and large patchy signal image showed by brain magnetic resonance imaging (MRI),and 7 cases (14.89%) involved the spinal cord.All patients received the treatment of Methylprednisolone [15-20 mg/(kg·d)] combined with intravenous gamma globulin (total 2 g/kg,3 to 5 days).The dose of Methylprednisolone gradually decreased after it had been used for 3 days.In the end,it was replaced by an oral administration of Prednisone [1.0-2.0 mg/(kg·d)],and the total treatment period was for 2-3 months.The follow-ups of 47 children with ADEM showed that the MRI lesions of all the children were reduced and the MRI lesions in 4 (8.51%) of them disappeared completely after 0.5 month of follow-up;the lesions disappeared completely in 13 cases (27.66%) after 1 month of follow-up;the lesions disappeared completely in 23 cases (48.94%) after 3 months of follow-up;the lesions disappeared completely in 32 cases (68.09%) after 6 months of follow-up;the lesions disappeared completely in 43 cases (91.49%) after 1 year of follow-up;and finally there were 4 cases (8.51%) with residual lesions.Conclusion The clinical manifestations of children with ADEM are varied.Most children with ADEM have a favorable prognosis.Imaging lesions of 68.09% of the cases completely disappeared after the onset of 6 months.Imaging lesions in 91.49% of the cases completely disa-ppeared at the onset of 1 year.Only a small fraction of patients present permanent lesions.

Adverse prognostic risk factors for pneumococcal meningitis in children / 中华实用儿科临床杂志

Objective To explore the risk factors for childhood death from pneumococcal meningitis.Methods The data of 32 hospitalized children were retrospectively analyzed,who were diagnosed as pneumococcal meningitis and enrolled in the Affiliated Children′s Hospital of Soochow University from November 201 0 to December 201 5.The subjects were divided into the death group and survival group according to their prognosis.The clinical characteristics and laboratory data were compared between 2 groups.Results Between the death group and survival group,there were significant statistically differences in shock within 24 hours after admission(63.6% vs 1 4.3%,P =0.01 3),as well as endotracheal tube intubation(1 00.0% vs 23.8%,P <0.001 ),the levels of cerebrospinal fluid(CSF)IgG[(491 .27 ± 203.53)mg/L vs (267.24 ±1 88.07)mg/L,P =0.006],IgM[(1 1 5.72 ±79.1 9)mg/L vs (32.80 ±28.52)mg/L, P =0.006],IgA[59.52(1 5.51 ,75.69)mg/L vs 1 8.77(9.33,27.54)mg/L,P =0.023],CSF leukocyte[330.00 (1 50.00,380.00)×1 06 /L vs 870.00 (403.00,6 1 60.00)×1 06 /L,P =0.009 ],CSF protein [(4 047.00 ± 1 942.1 6)mg/L vs (2 470.62 ±1 259.94)mg/L,P =0.009],CSF adenosine deaminase (ADA)[35.20(1 8.90, 87.20)U /L vs 8.80(3.05,23.78)U /L,P =0.001 ],serum sodium[(1 30.21 ±2.85)mmol/L vs (1 32.83 ±3.69) mmol/L,P =0.049],serum lactic acid (LA)[4.40 (2.60,5.70)mmol/L vs 2.40 (1 .75,4.50)mmol/L,P =0.01 3],serum C -reactive protein (CRP)[(95.87 ±65.40)mg/L vs (1 65.61 ±83.05)mg/L,P =0.022],serum lactate dehydrogenase (LDH)[81 3.40(465.20,2 31 0.70)U /L vs 359.20(257.85,405.90)U /L,P =0.001 ], platelet[(1 63.82 ±1 64.86)×1 09 /L vs (295.71 ±1 30.29)×1 09 /L,P =0.01 9]and positive rate of blood culture (90.9% vs 47.6%,P =0.023)between the death group and survival group.Conclusions The risk factors associated with mortality in pediatric SPM include shock within 24 hours after admission,endotracheal intubation,hyponatremia, thrombocytopenia,as well as high serum LA level,high serum LDH level,lower serum CRP level or cultures of blood and CSF double positive.

The neuroprotection effect of vascular endothelial growth factor on epileptic seizure / 中华实用儿科临床杂志

Vascular endothelial growth factor (VEGF) have multiple protective effect on the nervous system which related to angiogenesis,neurogenesis,directly neurotrophic protection and antiapoptotic mechanisms.The study of the nervous system of VEGF focus on tumors,trauma,stroke,autoimmune diseases and neurodegenerative diseases.The study of VEGF related to epileptic seizures is relatively rare.This paper is to make a review about the neuroprotective effect of VEGF on epileptic seizure.

Clinical and imaging characteristics of posterior reversible encephalopathy syndrome in children with acute lymphoblastic leukemia after chemotherapy induction / 中华实用儿科临床杂志

Objective To investigate the clinical features, brain imaging significance and the possible pathogenesis of posterior reversible encephalopathy syndrome (PRES) in childhood acute lymphoblastic leukemia (ALL) followed by chemotherapy induction.Methods The diagnosis and treatment of ALL were performed according to the guidelines of the Pediatric Association of Chinese Medical Association.There were 11 cases of pediatric ALL who developed PRES after chemotherapy induction.The clinical presentations, initial and follow-up radiologic features, and the neurologic outcomes of these 11 cases were investigated for one-year follow-up.All patients were reexamined 1,3,6, and 12 months after first imaging.Results Headache (10/1 1 cases), epileptic seizure (7/11 cases), high blood pressure (4/11 cases) ,visual impairment (6/11 cases) ,disturbance of consciousness (5/11 cases) and walking instability (2/11 cases) were the most common symptoms of these ALL patients with PRES.Magnetic resonance imaging (MRI) scanning revealed that lesions were mainly distributed in occipital lobe (9/11 cases), parietal lobe (8/11 cases), frontal lobe (5/11 cases) ,temporal lobe (3/11 cases), the deep white matter of bilateral periventricular and centrum semiovale (2/11 cases) and hemisphaerium cerebelli (1/11 cases).The radiological findings indicated that lesions had multifocal,symmetrical and posteriorly distributed characteristics in the cerebral hemispheres.After the diagnosis of PRES,patients stopped chemotherapy courses promptly and received symptomatic treatment, and then the clinical and imaging symptoms of most cases gradually disappeared.After 1-year follow-up,9 patients had good prognosis and no sequelae, 1 patient had symptomatic epilepsy (brain magnetic resonance imaging scan showed lesions in the left temporal lobe) ,and 1 patient had slight visual impairment.After the craniocerebral symptoms disappeared clinically ALL chemotherapy continued in all patients and no recurrent PRES was observed.Conclusions Although the clinical and imaging features of PRES may be diverse ,PRES should be recognized as a possible important complication of ALL when neurological symptoms appear.However, PRES is reversible when the patients are diagnosed and treated at an early stage.Thus,the occurrence of PRES should be considered and investigated to optimize the early induction schemes for ALL treatment.

Comparative study on the clinical features of rotavirus gastroenteritis between the children with or without convul-sion / 临床儿科杂志

ObjectiveTo investigate the clinical features and prognosis of children with rotavirus gastroenteritis and convulsion.MethodsClinical data of children with rotavirus gastroenteritis hospitalized from January 2010 to December 2013 were retrospectively analyzed. Subjects were divided into the seizure group and no seizure group according to the presence of seizure in the course and compared between the two groups.ResultsThere were no signiifcant differences in sex, age, and the average duration of hospitalization between two groups (allP>0.05). The family history, history of seizures, the levels of serum sodium, calcium, lactate, standard bicarbonate concentration (SB), actual bicarbonate concentration (AB), carbon dioxide content (TCO2) and pH were statistically signiifcant between two groups (allP>0.05). During the follow-up period (outpatient telephone follow-up), the recurrence of seizure in two groups was signiifcant different (P<0.05) and only one (0.54%) child in seizure group developed epilepsy.ConclusionThis study showed that rotavirus gastroenteritis with convulsion is a benign clinical course.

Effect of Acupuncture on Balance Function of Ataxia Children with Cerebral Palsy / 中国康复理论与实践

@#ObjectiveTo investigate the efficacy of acupuncture in ataxia children with cerebral palsy. Methods40 patients were divided into 2 groups, treatment group and control group. Patients in the control group were treated with routine rehabilitation, while those in the treatment group received acupuncture in addition. All patients were assessed with balance function before and after treatment.ResultsThere was a significant difference (P<0.05) of balance function between the treatment group and the control group after treatment. ConclusionThe acupuncture in addition to the conventional therapy improved significantly balance function of ataxia children with cerebral palsy.

Study on establishment of temporal lobe epilepsy model by administrating drug in brain region / 临床神经病学杂志

Objective To explore a better method to establish temporal lobe epilepsy model by administrating drug in brain region.Methods Kainic acid(KA)4 ?g/kg was injected into rat's hippocampus by stereotactic operation.The rat's behavior,EEG and pathological changes were observed.Results After the rat's hippocampus injected with KA,staring,wet-dog shakes,masticatory movement and clonus of limbs occurred successively.The seizures were paroxysmal with rotation,unsettled state of jump and tic of limbs.The rats' behavior gradually recovered to normal after 10 hours.Then the spontaneous seizure(mostly rating 2～4)occurred 1～3 times every week.Cluster electric discharge,spike waves and sharp waves were recorded in cerebral cortex.KA-treated rats could result in hippocampal CA1 and CA3 fields neuronal degeneration and necrosis,especially significant neuron loss was observed in the CA3 field of KA injected ipsilateral side.Conclusions Injection KA in brain region of rat can establish temporal epilepsy model.The symptom,electrophysiology and pathological changes of temporal lobe epilepsy in the rat model are almost the same as those in human being.The KA induced rat model is an ideal tool to research human temporal lobe epilepsy.

Study on Determinations of the Content of Calcium Dobesilate / 中国药房

OBJECTIVE:To study the methods for determination of the content of ca lcium dobesilate METHODS:The determination was carried out by complexometric t itration,UV-spectrophotometry,precipitation or cerimetric titration RESULTS & CONCLUSION:The cemetric titration is simple in operation,accurate in result and sharp in end point

Expression of GABA_B recepter subunit in hippocampus and effect of its agonist after experimental epileptic rats / 临床神经病学杂志

Objective To explore the expression of Gamma-aminobutyric acid B recepter (GABABR) subunits mRNA and the effects of its agonist Baclofen in hippocampus after KA induced seizures,of experimental epileptic rats.Methods The GABABR subunits GAR1a及GAR2 mRNAs expression were determined in hippocampus of each experimental group after epileptic seizure and Baclofen interference by hybridization in situ. Results In early(6~12 h) time of KA induced epileptic rats, the mRNA levels of both receptor subunits in hippocampal formation were found downregulation widespreadly (all P

Changes and its significance of neuron-specific enolase and myelin basic protein in serum after seizure of rats with temporal epilepsy / 临床神经病学杂志

Objective To explore the dynamic changes of neuron-specific enolase (NSE) and myelin basic protein (MBP) in serum of rats with temporal epilepsy (EP) induced by kainic acid (KA) and to judge the degree of injury of brain neuron and nerve myelin after seizure.Methods KA was injected into rat's hippocampus by stereotactic operation to establish an animal model of temporal EP.The levels of NSE and MBP in serum of rats with temporal EP were measured at the time 3 h,6 h,12 h,24 h,48 h and 72 h after seizure.Results The level of NSE in serum increased gradually and reached its peak at 24 h after seizure, as well as MBP at 72 h.Conclusions There are the nerve cell damage and necrosis after seizure in rats with temporal EP, then brain white matter nerve myelin appear to damage.