Refractory seizures in children

Epilepsy is described as a heterogeneous clinical syndrome results from various cerebral destructions. It is categorized to partial and generalized forms. Degree of neural system impairment and affected area determine the severity and pattern of symptoms. Patients might experience sensory, motor, or both signs and symptoms. About 60% of epileptic patients suffer from partial type. It is estimated that up to 30% of epilepsy cases would not be controlled adequately despite sufficient and proper management. Anacyclus pyrethrum, Citrus aurantium var. amara, Paeonia officinalis, Rosa Damascena and Nigella Sativa are some of herbal drugs which have antiepileptic effect. Natural agents are valuable sources to treat chronic diseases and a huge number of world's population believe herbs are effective and safe for daily primary health care needs. There is not enough evidence about their efficacy and safety obtained from randomized control trials

treatable refractory epilepsy: a case report

Biotinidase deficiency is a life threatening inborn error of metabolism specially when delayed in diagnosis. We report a 2-month-old male infant that presented with refractory infantile spasm, alopecia and seborrheic dermatitis. With a high suspicion of the biotinidase deficiency we started biotin 10 mg daily orally before definite diagnosis was made. Rapid treatment was life-saving and all complications disappeared rapidly. With this report we tried to explain the clinical manifestations of biotinidase deficiency and show the importance of early diagnosis and treatment in resolving the complications

Intractable epilepsy in children

Epilepsy is a common disorder affecting approximately 1% of the population. It is estimated that about 20- 30% of the patients become refractory to proper medical therapies. Such cases are often termed intractable. Intractable epilepsy [IE] is a serious condition in children, leading to significant impairment in quality of life, as well as behavioral and psychiatric problems. In this review, we tried to define intractability, mention the causes of intractable epilepsy and its predictive factors in children, and outline the management and various treatments of intractable epilepsy

Evidence based medicine in pediatric practice: brief review

Practicing medicine according to the best evidence is gaining popularity in the medical societies. Although this concept, which is usually called Evidence Based Medicine [EBM] has been explained in many resources, it has not been addressed enough in pediatrics. In this review, we briefly explained Evidence Based Medicine approach and its applications in pediatrics in order to help the pediatricians to efficiently integrate EBM into their daily practice

[Children sedation during gastrointestinal endoscopy comparison of two methods]

Endoscopy is an invasive and painful procedure in children. Since children can not tolerate pain and stress, sedation is necessary in pediatric endoscopy. The aim of this study was comparison of propofol versus intravenous midazolam for reducing anxiety in children. In this study, 103 patients [2-14 years old] in whom endoscopy was indicated were divided into three groups. In the first group, patients received propofol, in the second group, intravenous midazolam was given and patients in the third group received no sedation. Procedures were performed in the endoscopy room. Heart rate, respiratory rate and oxygen saturation were recorded before and during endoscopy in 1 minute intervals. Tremor, sweating and pain scores were recorded by using Visual Analogue Scale [VAS]. A significant increase in heart rate was documented in all groups [p=0.038]. Respiratory rate also increased in all groups. Too Oxygen saturation decreased in the propofol group, but it was not statistically significant [p=0.17]. Pain score in propofol group was significantly lower than those receiving midazolam [20 +/- 22 vs 50 +/- 27, p<0.001]. No noticeable side effect was seen in the propofol group. It seems that propofol is a very useful and effective drug for reducing pain and stress in children and its administration leads to a safe sedation in pediatric endoscopy

Predictive factors of pediatric intractable seizures

This study was performed in children aged <15 years, at the Pediatric Neurology Clinic of Imam Reza Hospital affiliated to Mashhad University of Medical Sciences. The objective of this study was to recognize the main predisposing factors that result in uncontrolled seizures in patients so that we can start the treatment accurately. There were two groups of patients; group I, consisted of 51 patients, with minimum refractory seizures of one episode per month while taking at least two antieplieptic drugs, and group II, comprised of 80 well-controlled patients chosen at random, who had no fit within 6 months after starting the treatment. Factors affecting the occurrence of refractory seizures included age <1 year, multiple seizures before starting the treatment, male gender, myoclonic seizures, neurologic defects, neonatal and daily seizures, and first abnormal electroencephalogram and brain computerized tomo-graphy scan. There are several factors that can predict development of uncontrolled seizures. Knowledge of these factors helps us to discriminate our patients and pay more attention to those at risk of developing uncontrolled seizures

Similarity between first seizure and recurrent seizures in children

The efficacy of anticonvulsants after a first seizure is uncertain; the more predictable the time and the type of recurrent seizure, the more preventable the probable events. This study was conducted to evaluate similarity of type and time of a first seizure and its recurrence in children.174 children with at least two separate seizures were taken into account.Overall in 90.5% the sleep-wake state at the second seizure was the same as the first one, while the seizure type was consistent from the first seizure to the second with 95.9% being the same.This information should be helpful in 1] counseling parents after their child has had a first seizure, and 2] in answering the question whether treatment should be started in a child presenting with a first epileptic seizure