study of risk factors for idiopathic generalized epilepsy among Egyptian children residing at mid delta territory lower Egypt

This study aimed to evaluate the etiopathogenetic role of prenatal, perinatal and postnatal risk factors in the history of epileptic children specially those suffering from idiopathic generalized epilepsy on a community-based case control study. Study population consisted of 60 epileptic children aged 4-16 years. The control sample consisted of 160 randomly selected children matched with the patients for the age and sex. Both patients and control children were residents of the mid-delta territory of the Lower Egypt. The interview for detection of history of presumed risk factors was based on questionnaires proposed and formulated by Pediatrics, Neurology and Public Health Departments of Tanta University, Obstetric, Neurolgic and Neonatal Units charts were also included. The study recorded that the prenatal factors included a family history of epilepsy, febrile seizures and continued physical stress or manual work of the mother during pregnancy specially agriculture, maternal age above 35 years and birth order more than 3 were significantly more common in the patients as compared to the control. Our data agree and support the hypothesis of the genetic propensity for generalized idiopathic epilepsy and febrile seizures, which may represent early expression, of a low seizure threshold that subsequently develops into epilepsy. Also, our study confirmed the importance of EEG and neurologic monitoring in children with first unprovoked seizure if their history was positive as regards to these risk factors

Lead exposure and neurobehavioral development in school children

The vulnerability of young children to lead toxicity has been increasingly recognized in recent years. Central nervous system is one of the most sensitive systems to lead. This study aimed to determine some risk factors associated with lead exposure and to detect the effect of lead exposure on children neurobehavioral development. One hundred school children were studied. They were interviewed and were subjected to estimation of blood and hair lead levels, assessment of intelligence and scholastic achievement, assessment of adjustment and neurological screening. Urban residence, dwelling in old houses and passive smoking were recognized as significant risk factors for lead exposure [p<0.05]. No significant difference between subjects age and their blood and hair lead levels [p>0.05]. A significant negative correlation was recorded between subjects intelligence and scholastic achievement and their blood and hair lead levels [p<0.05]. No significant difference between children with blood or hair levels above or below cutoff points as regards neurological screening [p>0.05]. Maladjusted children were significantly higher among children with elevated blood lead above cutoff point, but no significant difference as regards elevated hair lead [p>0.05]. Urban residence, dwelling in old houses and passive smoking were recorded as significant risk factors for lead exposure. Lead exposure was associated with neurobehavioral deterioration. Lead exposure can be assessed by measuring lead in blood and hair but blood screening method is more sensitive than hair one

Predictors of anticonvulsants-induced osteopathy in epileptic children

Anticonvulsants are known to have many side effects specially is growing epileptic children. Among these side effects are that bad effects on calcium metabolism and bone mineral density. This study was designed to find sensitive predictors of calcium homeostasis and bone mineral status with possible osteopathy in epileptic children. 60 epileptic children aged 4-14 years, admitted at neurology ward of pediatric department of Tanta university were enrolled in the study. They were subdivided into 4 subgroups according to monotherapy given: 15 cases phenytion-treated, 15 cases phenobarbital-treated, 15 cases carbamazepine-treated and 15 cases valproate-treated. 15 healthy children matched for age and sex plotted as control. After establishment of diagnosis and control and after one year of initiation of anticonvalsant therapy they were subjected to full serological surgery of calcium metabolism: serum calcium, serum phosphorus, serum alkaline phosphatase. As indicators of bone resorption, fasting urinary calcium and total urinary hydroxyproline were measured. Bone mineralization was estimated with plain X-ray films of spine and extremities and dual-energy X-ray absroptiometry for estimation of bone mineral density [BMD] at the trabecular and cortical bone of distal third of radius. We found normal calcium and phosphorous levels in the 4 patient groups denoting possibly the successful homeostasis by parathormone. But we found significant increase of urinary fasting excretion of calcium and hydroxyproline in patients receiving phenytion and phenobarbtione denoting bone resorption which is supported by the significant increase of alkaline phosphatase in these patient groups confirming osteoclastic activity found. Serum basal calcitonin was found to be significantly reduced in all patients groups except carbarnazepine treated group [mean 46.00 +/- 0.9 picogram/ml] denoting presented complete homeostasis of calcium in CBZ-treated children in contrast to the other three groups who are prone to osteopenia specially if the tendency to increased osteoclastic activity is aggravated by secondary' hyperparathyroidism. Bone mineral density [BMD] is decreased in the four patients groups, the worst was phenytoin - treated group [Mean 0.284 +/- 0.049 gm/cm[2]] as compared to controls [mean 0.436 +/- 0.047 gm/cm[2]]. The best BMD was in carbamazepine-treated group [mean 0.39 +/- 0.045 gm/cm[2]], denoting nearly no deleterious effect of the drug on both calcium homeostasis and bone mineral density. From this study, we recommend the full radiologic survey of epileptic children before and during anticonvulsant therapy specially if prolonged. We also recommend both high dietary calcium and vitamin D intake in patients treated with phenytion, phenobarbitone and valproate with special emphasis of 1,25 dihydroxy D3 supplement. Also we recommend radiological survey of these patients with attention to measurement of bone mineral density using sensitive non-invasive techniques as dual -energy x-ray absorptiometry