Cerebrovascular Events in Pediatric Inflammatory Bowel Disease: A Review of Published Cases / 대한소아소화기영양학회지

Pediatric inflammatory bowel disease (PIBD) is a multisystem disorder characterized by intestinal and extraintestinal manifestations and complications. Cerebrovascular events (CVE) are rare extraintestinal complications in patients with PIBD. Statistics show that 3.3% patients with PIBD and 1.3–6.4% adult patients with inflammatory bowel disease (IBD) experience CVE during the course of the disease. Therefore, this study aimed to review the records of children with IBD who developed CVE during the course of the disease. We retrospectively reviewed 62 cases of PIBD complicated by CVE. The mean patient age at the time of thrombotic events was 12.48±4.13 years. The incidence of ulcerative colitis was significantly higher than that of Crohn’s disease (43 [70.5%] vs. 13 [21.3%] patients). Most patients (87.93%) were in the active phase of IBD at the time of CVE. The mean time interval between the onset of IBD and CVE was 20.84 weeks. Overall, 11 (26.83%) patients showed neurological symptoms of CVE at disease onset. The most frequent symptom on admission was persistent and severe headaches (67.85%). The most common site of cerebral venous thrombosis was the transverse sinuses (n=23, 53.48%). The right middle cerebral artery (n=3, 33.34%) was the predominant site of cerebral arterial infarction. Overall, 41 (69.49%) patients who were mostly administered unfractionated heparin or low-molecular-weight heparin (56.09%) recovered completely. Patients with IBD are at a risk of thromboembolism.CVE may be the most common type of thromboembolism. Based on these findings, the most common risk factor for CVE is IBD flares. In patients with CVE, anticoagulant therapy with heparin, followed by warfarin, is necessary.

Assessment of cognitive and motor development in 150 children with refractory epilepsy

Neuropsychological impairment is an important co-morbidity of chronic epilepsy. The aim of this study was to determine the state of the cognitive and motor development of patients with refractory epilepsy. We studied 150 consecutive children with epilepsy who were referred to Mofid Children Hospital, a third level public referral University Hospital in Tehran, Iran from October 2007 to October 2008. Refractory epilepsy was defined as therapeutic failure of three antiepileptic drugs which were used appropriately. Data regarding sex, age, at which the first seizure occurred, microcphaly, muscle tonicity, EEG findings, kind of treatment for controlling seizures and cognitive and motor development delay were collected from medical records. Development delay was defined as delay in acquiring cognitive ability and motor skills for age according to the Denver Scale II. Of 150 patients 72% were younger than 2 years old and 56.7% were male. About 35.3% were microcephalic while 76% had normal muscular tonicity. Only 2.7% had normal EEGs. About 37.3% showed a good response to anticonvulsive drugs and became seizure free, 13.3% showed a relative response to anticonvulsants but 49.3% did not respond. In the present study, 68% had cognitive developmental delay and 60.7% suffering motor delay. There was a significant difference in response to treatment between patients with cognitive and motor development delay. Cognitive developmental delay was more frequent in patients with refractory epilepsy, suggesting that early cognitive screening and introduction of rehabilitation programs are necessary for patients with refractory epilepsy

[ survey of anti-inflammatory effect of bisphosphonates]

Bisphosphonates are currently used in metabolic disorder of bone; however, there have been few studies that reviewed the role of anti-inflammatory and immune modulatory effect of this agent in in-vivo. Bisphosphonates were divided in two classes regarding the structure and mechanism, including amino and non-amino bisphosphonates. The effect of bisphosphonates on cytokine related to in-vitro was complex and related to type and dose of bisphosphonates, examination of cell type and cell culture evaluation system. However, amino bisphosphonates activated inflammatory cytokine regarding to in-vivo and chronic usage of this agent, can stop the production of these cytokines. Present study surveyed the anti -inflammatory and immune modulatory effect of bisphosphonates and clinical trial, along with recent knowledge about potential mechanism of this component