The Relationship between Underlying Diseases and the Patterns of Abnormal MR Image Findings in Childhood White Matter Diseases / 대한소아신경학회지

PURPOSE: In children disorders affecting brain white matter are not uncommon and MRI has high sensitivity to detect white matter lesions. We performed this study to find out the distribution of underlying diseases that show abnormal white matter image findings on brain MRI and the relationship between the underlying diseases and some particular patterns of MR imaging abnormalities. METHODS: Out of 1477 pediatric patients who visited the department of pediatrics of Yeungnam University Medical Hospital and took brain MRIs from January 1995 to June 2001, ninety five patients with white matter abnormalities on T2 MR images were evaluated retrospectively. This study excluded the patients with brain tumor, brain abscess, trauma, secondary white matter abnormalities due to hydrocephalus, cerebral infarct, and those whose main lesions were gray matter. RESULTS: The most common underlying disease was cerebral palsy(50 cases, 52.6%), followed by acute disseminated encephalitis(10 cases, 10.5%), intrauterine CMV infections (9 cases, 9.5%), inherited neurometabolic disorders(7 cases, 7.4%). In 12 patients(12.6%) with some neurological problems such as afebrile seizures and developmental delay, no underlying disease were found. The most common pattern of abnormal image findings was periventricular white matter lesions(45.3%) strongly related with cerebral palsy. The pattern of peritrigonal deep white matter lesions was found in 19 patients(20.0%), in 10 patients of whom no underlying diseases were found. The pattern of multiple round margined scattered lesions was found in all the 10 patients(10.5%) of acute disseminated encephalitis. CONCLUSION: There are diverse underlying diseases showing abnormal white matter image findings on MR in pediatric patients and particular patterns of abnormal image findings may serve to make a specific diagnosis possible. But not in a small group of children no diagnosis was established. Further studies regarding the underlying diseases affecting white matter lesions and more detailed knowledge of abnormal MR image findings are needed.

Effects of Arbiturary Acute Anticonvulsnat Withdrawal in Epileptic Children / 대한소아신경학회지

PURPOSE: The effects of arbiturary acute anticonvulsants withdrawal in epileptic children were studied and relationship between status epilepticus and anticonvulsant withdrawal was analysed. METHODS: Medical records of 88 withdrawal episodes in 72 active epileptic children were analysed retrospectively according to the types of epilepsies, anticonvulsants. RESULTS: 1) When followed up after withdrawal, 42 cases (47.7%) had a recurrence of habitual seizure, 18 cases (20.5%) had no seizure and increased seizure frequency were found in 14 cases (16.0%). Three cases (3.4%) had no change in seizure frequency or severity and in 2 cases (2.3%) the frequency or severity of seizure were decreased after withdrawal. 2) Recurrence of habitual seizure, increased seizure frequency, more intense seizure or status epilepticus were noted in 55 of 71 withdrawal episodes in focal epilepsies (77.5%), in 9 of 17 withdrawal episodes (52.9%) in generalized epilepsies (P=0.041). These changes occurred in 36 of 55 cases (65.5%) in focal epilepsies, 3 of 9 cases (30.0%) in generalized epilepsies within 4 weeks after withdrawal (P=0.137). 3) Recurrence of habitual seizure, increased seizure frequency, development of more intense seizure or status epilepticus were found in 18 of 26 cases (69.2%) in carbamazepine monotherapy, 15 of 16 cases (93.8%) in phenobarbital monotherapy, 24 of 34 cases (70.6%) in polypharmacy (P=0.143). These changes occurred in 14 of 18 cases (77.8%) in carbamazepine monotherapy, 7 of 15 cases (46.7%) in phenobarbital monotherapy and 18 of 24 cases (75.0%) in polypharmacy within 4 weeks after withdrawal (P=0.122). 4) Four cases (4.5%) of status epilepticus occurred in 4 patients with focal epilepsies at 4 months (2 cases), 5 months, 23 months later after acute anticonvulsant withdrawal. CONCLUSION: Arbiturary acute anticonvulsants withdrawal in epileptic children were more common than expectation and councelling to avoid arbiturary anticonvulsant withdrawal must be entensified. Approximately half of the cases with anticonvulsant withdrawal showed a recurrence of habitual seizure and status epilepticus occurred in 4.5% of cases only. Other factors besides acute anticonvulsant withdrawal must be investigated to clarify the underlying mechanism of status epilepticus. A quarter of cases showed no seizure and even decrease in seizure frequency or severity after anticonvulsant withdrawal. These results suggest more considerated prescription of anticonvulsant is needed in practice.