Medication non-compliance and oxidant-induced adverse effects of antiepileptic drugs in children

Poor compliance with prescribed medications and their side effects are significant health problems in chronic disease states as epilepsy. This work aimed to study medication non compliance of epileptic children and the possible role of free radical injury in antiepileptic drugs side effects. The study was done on eighty-two epileptic children subjected to history taking, clinical examination and they were given antiepileptic drugs with follow-up for one year. Thirty healthy, age and sex matched children were studied as a control group. Complete blood count, liver and renal function tests were performed for all patients at the beginning and the end of study. Therapeutic drug monitoring for antiepileptic drugs given was performed for all patients. Nitric oxide [NO], superoxide dismutase [SOD] and malondialdehyde [MDA] were measured for all patients who developed any drug side effects, thirty patients without drug side effects chosen randomly, and control group. Unsatisfactory compliance was reported in 51% of cases. Serum levels of antiepileptic drugs were not matched with seizure outcome. Complicated regimens were associated with unsatisfactory compliance [P<0.05]. NO, MDA and SOD were significantly higher in both patients groups receiving antiepileptic drugs with or without side effects compared to control group. Also, these parameters were significantly higher in patients who developed side effects compared to patients without side effects to antiepileptic drugs [P<0.05]. It could be concluded that simple antiepileptic drug regimens are needed, focusing on drug compliance is essential by depending not only on drug levels but also on regular follow-up of patients and good physician- patients relation. Role of oxidant injury in producing antiepileptic drugs side effects is suspected and should be confirmed by further studies

Prognostic value of serum S100 protein level in newborn infants with hypoxic ischemic encephalopathy

Hypoxic ischemic encephalopathy [HIE] is the most common cause of neurologic disease during neonatel period and is associated with high mortality and morbidity rate including cerebral palsy, mental retardation and seizures. S100 beta[2] is normally present in serum in very low concentrations, but found in high concentrations in the brain both in glial cells and in neurons. Serum S100 protein peaked in the first day after birth in asphyxiated newborn infants. The aim of this study was to clarify the prognostic value of serum S100 protein level as a marker of cerebral injury in newborn infants with birth asphyxia [HIE]. 20 newborns with HIE were investigated successively in the first 3 days after birth in comparison with 20 healthy newborn infants as a control group. S100 protein levels were detected by a monoclonal two-site immuno-luminometric assay. Follow up of the cases for 6 months after discharge from incubators was done to detect cases that developed cerebral palsy. We found significant increase in serum S100 protein level in newborn infants with birth asphyxia as compared to control group, also we found significant positive correlation between day 1 S100 protein levels and severity of HIE and positive correlation between day 1 S100 protein levels and future development of cerebral palsy. Early determination of serum S100 protein in first day after birth in newborn infants with hypoxic ischemic encephalopathy may be used as a good marker for assessment of severity of HIE and extent of brain damage and to predict the possibility of future development of cerebral palsy in newborn infants with HIE