Clinical spectrum of hypocalcaemia in children

Background: Hypocalcaemia is a biochemical abnormality commonly seen in paediatric population with a multi-factorial etiology having varied presentation ranging from acute emergency to chronic diagnostic dilemma. We studied the clinical profile of infants and children presenting with hypocalcaemia from 0 to 12 years of age. Methods: Clinical features, risk factors, precipitating factors, feeding/dietary practices of all children (0-12 years) visiting our tertiary care centre, from January 2019 to March 2020, diagnosed with hypocalcaemia were recorded and a correlation with serum calcium levels was studied. Results: Out of 92 patients having hypocalcaemia majority 57 (62%) were males. Majority of participants belonged to age group of 6 months-2 years i.e. 40 (43.48%). The commonest presentation was convulsions present in 39 (42.39%) participants affecting more children less than 2 years of age; whereas majority of children above 2 years of age presented with growth impairment. Risk factors identified were perinatal risk factors, faulty feeding practices in infants, inadequate dietary calcium intake in children, inadequate sun exposure. Amongst the biochemical factors precipitating hypocalcaemia, alkalosis showed significant association (p value 0.016) with degree of hypocalcaemia; most common etiology was vitamin D deficiency and nutritional rickets. Conclusions: Hypocalcemia plays vital role in infants and growing children because of its various implications on growth and development. Exposure to sunlight, vitamin D and calcium supplementation during pregnancy and lactation and infancy with good dietary calcium intake for children during their growth spurts can prevent complications. Health education and awareness of common risk factors for hypocalcaemia can prove helpful.

Predictive value of inflammatory markers for convulsions in children infected with the severe acute respiratory syndrome coronavirus 2 Omicron variant / 中华传染病杂志

Objective:To explore the predictive value of inflammatory markers for convulsions in children infected with the severe acute respiratory syndrome coronavirus 2 Omicron variant.Methods:A total of 263 children infected with the Omicron variant admitted to various wards of Fujian Children′s Hospital from December 2022 to January 2023 were included in this study. Based on the presence or absence of convulsions, the children were divided into convulsions group (93 cases) and non-convulsions group (170 cases). Chi-square test and independent samples t-test were used to compare the clinical characteristics and laboratory indicators of the two groups. Binary logistic regression analysis was conducted to determine the relationship between inflammatory markers and convulsions, and receiver operator characteristic (ROC) curve was used to evaluate the efficacy of serum amyloid A (SAA) and interleukin-6 (IL-6) for predicting convulsions occurrence in children. Results:The convulsions group had proportions of 29.03%(27/93) with underlying medical conditions and 40.86%(38/93) with a history of febrile convulsions, which were both higher than the non-convulsions group′s proportions of 18.24%(31/170) and 5.29%(9/170), respectively. These differences were both statistically significant ( χ2=8.71 and 16.92, respectively, both P<0.05). In the convulsions group, levels of procalcitonin, serum ferritin, IL-6, SAA, aspartate aminotransferase, creatine kinase, creatine kinase-isoenzymes and fibrinogen were all significantly higher than those in the non-convulsions group. These differences were all statistically significant ( t=-2.00, -1.54, -2.71, -5.04, -1.30, -2.03, -1.38 and 1.57, respectively, all P<0.05). Erythrocyte sedimentation rate, C-reactive protein, lymphocyte count, blood urea nitrogen and serum creatinine in the convulsions group were all lower than those in the non-convulsions group, with statistically significant differences ( t=3.31, 2.05, 4.21, 2.37 and 1.85, respectively, all P<0.05). SAA and IL-6 were identified as independent risk factors for convulsions in children infected with Omicron variant (both P<0.01). The ROC curve analysis showed that the area under the curve of predictive value of combined SAA and IL-6 was 0.833 ( P<0.01), with a sensitivity of 0.724 and specificity of 0.843. The optimal cutoff values for SAA and IL-6 in predicting convulsions in children infected with the Omicron variant were 141.40 mg/L and 85.05 ng/L, respectively. Conclusions:The combination of SAA and IL-6 could serve as early predictive indicators for convulsions in children infected with the Omicron variant, which could provide valuable insights for timely clinical diagnosis and treatment.

Correlation between serum zinc and brain injury in infants with mild gastroenteritis complicated with benign infantile convulsion and febrile convulsion / 中华危重病急救医学

Objective:To investigate the association between serum zinc levels and convulsive brain injury in infants with mild gastroenteritis complicated with benign infantile seizures (BICE) and febrile seizures (FC).Methods:A case-control study method was conducted. 120 children with mild gastroenteritis and convulsion admitted to the First Affiliated Hospital of Hebei North University from January 2020 to January 2022 were enrolled as the research subjects. They were divided into BICE group and FC group according to the type of convulsion. The serum zinc level, the frequency and duration of convulsion, and the occurrence of convulsive brain injury in the two groups were recorded. Multivariate Logistic regression analysis was used to screen the risk factors for convulsive brain injury. The Spearman correlation method was used to analyze the association between serum zinc levels, clinical characteristics of convulsion and convulsive brain injury.Results:A total of 120 children were enrolled, of which 81 developed to BICE and 39 developed to FC during hospitalization. The serum zinc level of children in the FC group was significantly lower than that in the BICE group (μmol/L: 39.24±6.50 vs. 48.65±7.21, P < 0.01). In the BICE group and FC group, the serum zinc level in children with more than 2 convulsions was significantly lower than that in the children with one convulsion (μmol/L: 37.65±6.50 vs. 53.17±7.55 in the BICE group, and 30.27±5.58 vs. 44.16±7.57 in the FC group, both P < 0.01). Serum zinc level in children with convulsion duration ≥5 minutes was significantly lower than that in the children with convulsion duration < 5 minutes (μmol/L: 38.75±6.74 vs. 51.21±7.58 in the BICE group, and 31.08±5.46 vs. 45.19±7.25 in the FC group, both P < 0.01). Moreover, the serum zinc level of children with different convulsion frequency and duration in the FC group was significantly lower than that in the BICE group (all P < 0.01). Among the 120 children, 9 cases of convulsive brain injury occurred, and the incidence rate was 7.50%. The incidence of convulsive brain injury in the BICE group was 1.23% (1/81), which was significantly lower than 20.51% in the FC group (8/39, P < 0.01). The serum zinc level of children with convulsive brain injury was significantly lower than that of children with non-brain injury (μmol/L: 28.50±5.00 vs. 60.22±7.31, P < 0.01), and the number of convulsion was significantly higher than that of non-cerebral injury (≥ 2 convulsions: 100.00% vs. 1.80%, P < 0.01), and the duration of convulsion in children with brain injury was significantly longer than that of non-brain-injured children (convulsion duration ≥5 minutes: 100.00% vs. 11.71%, P < 0.01). Multivariate Logistic regression analysis showed that decreased serum zinc level [odds ratio ( OR) = 2.147, 95% confidence interval (95% CI) was 1.354-3.403], increased number of convulsion ( OR = 3.452, 95% CI was 1.266-9.417), and prolonged convulsion duration ( OR = 3.117, 95% CI was 1.326-7.327) were independent risk factor for convulsive brain injury in children with mild gastroenteritis and convulsion (all P < 0.05). Spearman correlation analysis showed that serum zinc level, convulsion ≥2 times, duration of convulsion ≥5 minutes and convulsion ≥2 times + convulsion duration ≥5 minutes were significantly negatively correlated with the occurrence of convulsive brain injury in FC children ( r values were -0.546, -0.517, -0.522, and -0.528, all P < 0.01). There was no significant correlation between serum zinc level, convulsion ≥2 times, convulsion duration ≥5 minutes and convulsion ≥2 times+convulsion duration ≥5 minutes and convulsive brain injury in BICE children ( r values were -0.281, -0.129, -0.201, -0.243, all P > 0.05). Conclusions:Serum zinc level is related to the characteristics of convulsive symptoms in children with mild gastroenteritis complicated with FC, and has a strong negative correlation with the occurrence of convulsive brain injury. Active targeted intervention and treatment may help reduce the incidence of brain injury in children.

Investigations of clinical characteristics and inflammatory markers of febrile seizures induced by coronavirus infection

@#The study of children who experienced with febrile seizures(FS) as a result of COVID-19 infection to gain insight into the clinical characteristics and prognosis of neurological damage, with the aim of improving prevention, diagnosis, and the treatment of neurological complications. This study investigated the clinical features of 53 children with FS who were admitted to Sanya Women and Children’s Hospital from December 1, 2022, to January 31, 2023. The results indicated that the duration of convulsion in the case and control group was 7.90±8.91 and 2.67±1.23 (minutes) respectively. The analysis reveals that convulsions occurred within 24 hours in 39 cases (95.12%) of the case group, and in 8 cases (66.7%) of the control group. The difference was statistically significant (P<0.05). Additionally, the case group presented lower counts of WBC and NEU compared to the control group (p<0.05). The findings indicate that convulsions manifest at earlier stages of COVID-19 in children and the last longer than in the control group. It is therefore crucial for healthcare workers to remain attentive to patients with COVID-19 who report fever within 24 hours, and act promptly to implement preventive measures, particularly in cases of prolonged fever. It is essential to integrate the clinical manifestation, particularly convulsions, and the continuous numerical changes of inflammatory factors to assess COVID-19 linked with febrile seizures. In addition, larger-scale multi-center and systematic research are necessary to aid clinicians in monitoring neuropathological signals and biological targets, enabling more equitable diagnosis and treatment plans.

Persistent neonatal hypoglycemia secondary to hyperinsulinism/hyperammonemia. Case report

Introduction: Hyperinsulinism/hyperammonemia syndrome (HI/HA) is a rare genetic disease caused by the activation of mutations in the GLUD1 gene. It is characterized by recurrent symptomatic hypoglycemic episodes, poor tolerance to fasting, and requirement for high metabolic fluxes of glucose, with an insulin/ glucose ratio ≥0.3. Case presentation: Preterm male newborn (36 2/7 weeks of gestation) who was delivered by caesarean section due to acute fetal distress. At birth, the patient presented with weak cry, hypotonia, mild respiratory distress, and recurrent episodes of hypoglycemia, thus 10% dextrose and hydrocortisone were administered initially. Treatment with octeoctride was started, but due to the patient's poor response, laboratory tests were performed, reporting the following findings: serum ammonia: 137.6, insulin: 39.1 µIU/mL, blood glucose: 26.06 mg/dL, and insulin/blood glucose ratio: 1.5, leading to the diagnosis of HI/HA syndrome. Treatment with diazoxide was initiated, achieving a progressive improvement in blood glucose levels; however, afterwards, he presented seizures, so midazolam, phenobarbital and valproic acid were added to the treatment regimen. When hypoglycemia and seizure episodes resolved, the patient was discharged at 2 months and 5 days of life, and a treatment based on oral administration of diazoxide, phenobarbital and valproic acid was prescribed. Conclusion: HI/HA syndrome is characterized by recurrent episodes of hypoglycemia and hyperammonemia; therefore, the presence of these two conditions in neonates is highly suggestive of the disease. Timely diagnosis and treatment are required to avoid neurological sequelae, and transdisciplinary assessment is of great importance, as it increases the likelihood of early diagnosis and timely administration of diazoxide to restore normal glucose levels.

Introducción. El síndrome hiperinsulinismo/hiperamoniemia (HI/HA) es una enfermedad genética rara causada por la activación de mutaciones en el gen GLUD1. Este síndrome se caracteriza por hipoglucemias sintomáticas recurrentes, poca tolerancia al ayuno y requerimiento de altos flujos metabólicos de glucosa, con un índice insulina/glucosa ≥0.3. Presentación del caso. Recién nacido masculino pretérmino de 36 2/7 semanas de gestación que nació por cesárea debido a sufrimiento fetal agudo. Al nacer, el paciente presentó llanto débil, hipotonia, dificultad respiratoria leve y episodios recurrentes de hipoglicemia, por lo que inicialmente se administró dextrosa 10% e hidrocortisona. Se inició tratamiento con octeoctride, pero ante la pobre respuesta, se realizaron exámenes de laboratorio en los que se reportó lo siguiente: amonio sérico: 137.6 pmol/L, insulina: 39.1 µUl/mL, glucemia: 26.06 mg/dL y relación insulina/glucemia: 1.5, lo que permitió diagnosticarlo con síndrome HI/HA. Se inició tratamiento con diazóxido, lográndose mejora progresiva de la glicemia; pero posteriormente presentó crisis convulsivas, por lo que se agregó midazolam, fenobarbital y ácido valproico al tratamiento. Al resolver la hipoglicemia y las convulsiones, el paciente fue dado de alta a los 2 meses y 5 días de vida, prescribiéndose un tratamiento basado en la administración oral de diazóxido, fenobarbital y ácido valproico. Conclusión. El síndrome HI/HA se caracteriza por hipoglucemias recurrentes e hiperamoniemia; por tanto, la presencia de estas dos condiciones en neonatos es altamente sugestiva de la enfermedad. Su diagnóstico y tratamiento deben ser oportunos para evitar secuelas neurológicas, siendo la valoración transdisciplinaria de gran importancia, pues aumenta las probabilidades de un diagnóstico temprano y administración oportuna de diazóxido para restablecer los niveles normales de glucosa.

Luxofractura posterior bilateral de hombro secundaria a episodio de convulsión: importancia del diagnóstico oportuno. A propósito de un caso / Bilateral posterior glenohumeral fracture-dislocation secondary to a seizure episode: the importance of early diagnosis. A case review

Resumen: Introducción: la luxofractura glenohumeral posterior (LFGHP) es una lesión poco frecuente. Puede ser secundaria a una crisis convulsiva, casos de electrocución, o por traumatismo directo. Su diagnóstico suele ser tardío, lo que aumenta la tasa de complicaciones y secuelas. Caso clínico: paciente de sexo masculino de 52 años, trasladado a centro de alta complejidad por convulsión tónico-clónica y LFGHP derecha. En el estudio inicial con radiografías se confirma lesión de hombro derecho y se diagnostica luxación glenohumeral posterior simple de hombro izquierdo no pesquisada previamente. Se complementa estudio con tomografía computarizada (TC) de ambos hombros, observándose una LFGHP bilateral, lo que demuestra agravamiento intrahospitalario de la lesión del hombro izquierdo. Se realiza reducción abierta y osteosíntesis con placa bloqueada bilateral en un tiempo. El hombro izquierdo requirió dos reintervenciones, una por falla de osteosíntesis y otra para liberación articular. Dos años después del procedimiento el paciente evoluciona satisfactoriamente con 5% en la escala Quick DASH y un puntaje de 72 y 76 en la escala de Constant en el hombro derecho e izquierdo, respectivamente. Conclusión: la LFGHP es una lesión poco frecuente que requiere un alto índice de sospecha para evitar el retraso diagnóstico y la aparición de secuelas. En casos de convulsión se debe sospechar compromiso bilateral. Con un tratamiento quirúrgico oportuno se pueden obtener resultados satisfactorios y reintegración del paciente a sus actividades habituales.

Abstract: Introduction: posterior glenohumeral fracture dislocation (PGHFD) is a rare injury. It may present secondary to a seizure, electrocution or due to direct trauma. It is usually missed, and late diagnosis is common which increases the rate of complications and sequalae. Case report: 52 year old male, transferred to a reference trauma center due to a tonic-clonic seizure and a right PGHFD. Upon admission radiographs are requested and right shoulder injury is confirmed. Additionally, a simple left posterior glenohumeral dislocation (that was missed in the initial assessment of the patient) is observed. A computed tomography (CT) scan is obtained for both shoulders to plan surgery. The CT scan showed a bilateral PGHFD with severe comminution in the left shoulder, showing considerable worsening of the left shoulder since admission. Open reduction and bilateral locked plate osteosynthesis were performed in a one stage surgery. At two years follow up the patient evolved favorably with a Quick DASH score of 5% and a CONSTANT score of 72 and 76 for his right and left shoulder, respectively. Conclusion: PGHFD is an infrequent injury, which requires a high level of suspicion to avoid diagnostic delay and prevent complications and sequelae. Bilateral cases may be seen in cases of seizure. With prompt surgical treatment, satisfactory results can be achieved with a complete return to normal activities.

Tumores encefálicos asociados con epilepsia: una serie de casos / Brain tumors most frequently associated with epilepsy: A case series

RESUMEN INTRODUCCIÓN: Las crisis epilépticas son la manifestación clínica inicial en un 30-50 % de los pacientes con tumores cerebrales. Algunos de los tumores más frecuentes, como los gliomas y los meningiomas se asocian con manifestaciones epilépticas. En el país no hay estudios que especifiquen cuáles son los tumores del encéfalo más frecuentemente relacionados con epilepsia. OBJETIVO: Determinar los tumores del encéfalo más frecuentes relacionados con epilepsia en pacientes del hospital Universitario Erasmo Meoz, en Cúcuta, Colombia entre los años 2015 y 2018. METODOLOGÍA: Estudio retrospectivo. Se recolectaron historias clínicas de pacientes mayores de 18 años que ingresaron al servicio de Neurocirugía del Hospital Universitario Erasmo Meoz, en Cúcuta, Colombia con diagnóstico de tumor del encéfalo entre el año 2015 y el 2018. RESULTADOS: Se incluyeron 220 historias, el 56 % correspondió al sexo femenino y la media de edad fue de 48 años; 98 (45 %) de los casos presentó crisis epilépticas. El tumor del encéfalo más frecuente relacionado con epilepsia fue el glioma (46 casos). El tipo de glioma que más se relacionó con crisis epilépticas fue el glioblastoma (27 casos); 82 % de los gliomas de bajo grado se manifestaron con epilepsia, y 71 % de los de alto grado (70,6 %). En los hombres el tumor más frecuente relacionado con epilepsia fue el glioblastoma y en las mujeres el meningioma. La localización tumoral más frecuente fue la región frontal (27 %). CONCLUSIONES: Los gliomas son el tipo de tumor cerebral más común relacionado con epilepsia, siendo el glioblastoma el tumor más frecuente de este grupo.

ABSTRACT INTRODUCTION: Seizures are the initial clinical symptom in 30 to 50 % of patients with brain tumors. With a high percentage, gliomas and meningiomas have been reported as tumors associated with epilepsy, these also being frequent tumors in Colombia. Currently in the country there are no studies that specify which are the most frequent brain tumors related to epilepsy, an investigation being necessary to clarify these data. OBJECTIVE: To determine the most frequent brain tumors associated with epilepsy in patients at the Erasmo Meoz University Hospital in Cúcuta. METHODS: Medical records were collected from all patients over 18 years of age who were admitted to the Neurosurgery service of the Erasmo Meoz University Hospital in Cúcuta with a diagnosis of brain tumor between 2015 and 2018. RESULTS: 220 patients were included, 56% were female. The mean age was 48 years; 98 cases (45%) presented with epilepsy. The most frequent brain tumor related to epilepsy were gliomas (46 cases). The glioma with the highest frequency of seizures was glioblastoma (27 cases). Low-grade gliomas had a higher percentage of epilepsy (82%) than high-grade gliomas (71%). In men, the most frequent tumor related to epilepsy was glioblastoma and in women, meningioma. The most frequent location was the frontal region (27%). CONCLUSIONS: Gliomas are the most common type of brain tumor associated with epilepsy, with the most common tumor in this group being glioblastoma.

Establishment and analysis of nomogram prediction model for early critical changes in children with febrile convulsion / 中国实用护理杂志

Objective:To establish a nomograph prediction model of early critical changes in children with febrile convulsion, and to provide guidance for the prevention and nursing of children with febrile convulsion.Methods:Convenient sampling method was adopted to select 384 children with febrile convulsion in Anhui Children ′s Hospital from January 2018 to April 2021 as the research objects. Based on pews, the children with febrile convulsion were divided into 334 cases of non risk group and 50 cases of risk group. Binary Logistic regression analysis were used to determine the independent risk factors affecting the early critical changes of children with febrile convulsion. A nomogram was drawn based on the independent risk factors. The discrimination and consistency of the model were verified by model ROC curve and Hosmer Lemeshow goodness of fit.The external validation of model prediction efficiency were verified by validation data. Results:Binary Logistic regression analysis showed that age, respiratory rhythm disorder, unconsciousness, breath rate, heart rate, neutrophil-to-lymphocyte ratio (NLR), red blood cell distribution width (RDW), duration of first convulsion and mean body temperature after first convulsion were influence factors for early critical changes in children with febrile convulsion ( P<0.05). The C-index of the model was 0.974 (95% CI 0.954-0.993), and the C-index of the external validation of the model was 0.922 (95% CI 0.880-0.966). The results of H-L fitting test showed that the difference was not statistically significant( χ2=0.29, P>0.05). Conclusions:The early critical changes of children with febrile convulsion may be affected by respiratory rhythm disorder, confusion of consciousness, breath rate, heart rate, NLR, RDW, duration of the first convulsion, mean temperature after the first convulsion and other factors. Pediatric emergency department should collect corresponding intervention measures for children with febrile convulsion according to the establishment of prediction model to prevent their early deterioration.

Absceso cerebral por Actinomyces sp: una infección infrecuente en niños: a propósito de un casot / Actinomyces sp. brain abscess: a rare infection in children: a case repor

A pesar de los avances en las técnicas de diagnóstico y tratamiento, las infecciones intracraneanas son aún enfermedades graves con una incidencia estimada entre 0,3 y 1,3 casos por cada 100 000 habitantes. Se presenta un paciente previamente sano con un absceso cerebral de diagnóstico intraoperatorio en quien, si bien el cultivo evidenció desarrollo polimicrobiano, se identificó presuntivamente Actinomyces sp. en la anatomía patológica. Dado este hallazgo, se realizó antibioticoterapia combinada prolongada con buena evolución. La presentación de este proceso supurado fue inespecífica y la contribución de la anatomía patológica en el diagnóstico etiológico fue relevante. La identificación de un microorganismo inhabitual definió la necesidad de profundizar en la determinación de factores predisponentes

Despite advances in diagnostic and treatment techniques, intracranial infections remain serious diseases with an estimated incidence of between 0.3 and 1.3 cases/100,000 inhabitants. We present a previously healthy patient with an intraoperative diagnostic of brain abscess, in whom although the culture showed polymicrobial development, Actinomyces sp was presumptively identified in the pathological anatomy. Given this finding, prolonged combined antibiotic therapy was performed with good evolution The presentation of this suppurative process was nonspecific and the contribution of the anatomopathology in the etiological diagnosis was relevant. The identification of an unusual microorganism defined the need to deepen the identification of predisposing factors.

Manifestaciones neurológicas en pacientes pediátricos con COVID-19: reporte de casos / Neurological manifestations in pediatric patients with COVID-19: case report

La pandemia por la COVID-19 afecta actualmente a millones de personas sin exceptuar la población pediátrica. Las manifestaciones clínicas en niños son variables: respiratorias, gastrointestinales, hematológicas, neurológicas y sistémicas. Con el objetivo de describir las diversas presentaciones clínicas y neurológicas durante la evolución de la enfermedad se documentó una serie de casos de pacientes pediátricos con la COVID-19. Se plantean diversos mecanismos a través de los cuales el SARS-CoV-2 causaría daño neurológico (daño directo, secundario a respuesta inmune, entre otras) con características clínicas variables (convulsiones, debilidad muscular, trastorno del sensorio). Los estudios sobre características clínicas y factores pronósticos en niños y adolescentes con SARS-CoV-2 son limitados, por lo cual el presente reporte contribuye con un espectro de manifestaciones neurológicas asociadas al SARS-CoV-2 en población pediátrica.

The COVID-19 pandemic currently affects millions of people including the pediatric population. The clinical manifestations in children are diverse: respiratory, gastrointestinal, hematological, neurological and systemic. In order to describe the various clinical and neurological manifestations during the evolution of the disease, we documented a series of cases of pediatric patients with COVID-19. Various mechanisms are proposed through which SARS-CoV-2 would cause neurological injury (direct injury, secondary to an immune response, among others) with variable clinical characteristics (seizures, muscle weakness, sensorial disorder). Studies on clinical characteristics and prognostic factors in children and adolescents with SARS-CoV-2 are limited, therefore, this report provides a spectrum of neurological manifestations associated with SARS-CoV-2 in pediatric population.

Enfermedad celíaca, epilepsia y calcificaciones cerebrales / Celiac disease, epilepsy and cerebral calcifications

Resumen Varón de 33 años con antecedentes de convulsiones febriles y discapacidad intelectual moderada grave, inició a los 2 años convulsiones tanto focales como generalizadas atónicas diarias, que ocasionaron traumas faciales. Debido a la farmacorresistencia se implantó un estimulador del nervio vago, con respuesta parcial al mismo. Durante su seguimiento, se hizo diagnóstico de enfermedad celíaca. Al realizar una tomografía de encéfalo se evidenciaron calcificaciones piriformes occipitales bilaterales, estableciéndose el diagnostico de enfermedad celiaca, epilepsia y calcificaciones cerebrales. Se le indicó dieta libre de gluten y continuar el tratamiento farmacológico, logrando de esta manera una reducción de las crisis.

Abstract A 33-year-old man with a history of febrile seizures and moderate-severe intellectual disability began, at 2 years, both focal and generalized daily atonic seizures, which caused facial trauma. Due to drug resistance, a vagus nerve stimulator was implanted, with partial response to it. During his follow-up, he was diagnosed with celiac disease. When performing a brain tomography, bilateral occipital pyriform calcifications were evidenced, establishing the diagnosis of celiac disease, epilepsy and cerebral calcifications. A gluten-free diet was indicated and pharmacological treatment continued, thus achieving a reduction in seizures.

A study of serum zinc levels among children with seizures in comparison with febrile children without seizures

Background: Infants and children are more prone to have seizures than adults. This reflects the greater neuronal excitability at certain ages as the excitatory glutamate system and inhibitory GABA system do not always balance each other. Febrile seizures are the most common type of seizures observed in pediatric age group. Febrile seizures occur in young children at a time in their development when seizure threshold is low. Objective of the study was to determine the levels of zinc in children with febrile seizures when compared to children with fever without seizures.Methods: To determine the levels of zinc in children with febrile seizures when compared to children with fever without seizures. A total of 50 Study subjects were selected into each group. Group 1: Children with Febrile Seizures. Group 2: Children with Fever and Without Febrile Seizures.Results: Among the cases with fever and convulsion Zinc level was found to be low among 72% of the subjects, 22 % of them had normal zinc levels and only 6% had high zinc levels. Among the subjects with Fever and no convulsions nearly 80% of them had normal zinc levels, 16 % had low levels of zinc and 4% had high zinc levels. The association of levels of Zinc between both the groups was found to be statistically significant.Conclusions: This study shows that serum zinc levels are decreased in children with febrile convulsions when compared to children with fever alone without convulsions, thus indicating that zinc deprivation plays significant role in the pathogenesis of febrile convulsions.

Risk analysis of vaccination in children with genetic epilepsy combined with febrile seizures plus / 中华神经医学杂志

Objective To assess the risk of vaccination in children with genetic epilepsy combined with febrile seizures plus (GEFS+).Methods Sixty-seven children with GEFS+,admitted to our hospital from May 2016 to May 2019,were enrolled in our study;using targeted second-generation sequencing technology,these patients were divided into positive SCN1A gene mutation group (SCN1A+group,n=l 1) and negative SCN1A gene mutation group (SCN1A-group,n=51) after kicking out 5 patients with other gene mutations.The frequencies of convulsion and changes of body temperature after vaccination were analyzed retrospectively in the two groups from birth to age of 7 years.The levels of interleukin (IL)-2,IL-6,IL-10 and tumor necrosis factor (TNF)-α in peripheral blood were measured by flow cytometry in both groups after seizures.Results Children from SCN1A+ group were vaccinated for 34 times,with incidence of post-vaccine convulsion reaching 47％ (16/34);children from SCN1A-group were vaccinated for 186 times,with incidence of post-vaccine convulsions reaching 6.45％ (12/186);incidence of post-vaccine convulsion was statistically significant between the two groups (P＜0.05).The mean body temperature in children from the SCN1A+ group ([38.06±0.57] ℃C) during convulsion was significantly lower than that in SCN1A-group ([39.49±0.49] ℃,P＜0.05).Expressions of IL-6 and IL-10 in peripheral blood after convulsion in children from SCN1A+ group (96.80±25.05 and 74.90±18.28) were significantly higher than those in SCN1A-group (72.97±4.81 and 43.99±10.63,P＜0.05).Conclusion GEFS+ children in the SCN1A+ group are more prone to convulsion after vaccination than those in the SCN1A-group;cytokines may be involved in the development of convulsion.

Comparison of Conventional and Combined APGAR score in Predicting Adverse Early Neurologic Outcomes in Term and Near Term Babies with Birth Asphyxia

Objective: To compare the Conventional and Combined Apgar scoring systems in predicting adverse early neurologic outcomes in term and near term babies with birth asphyxia. Methods: A retrospective cross sectional study was conducted over a period of 2 years. All the neonates with gestational age more than 35 weeks delivered in this hospital with birth asphyxia requiring admission in NICU were included in the study. Neonates with gestational age less than 35 weeks, those with major congenital anomalies and death in delivery room were excluded from the study. The APGAR and COMBINED APGAR scores were noted. Convulsion, use of anticonvulsant drugs, requirement of mechanical ventilation, and duration of hospital stay were also noted. The data was analysed using fisher exact test. Results: Statistically significant associations were observed between Apgar score less than 3 at 1 minute and occurrence of convulsion (p=0.003) and requirement of ventilation (p<0.001), Apgar score less that 6 at 5 minutes” occurrence of convulsion (p=0.001) and requirement of ventilation (p<0.001), Combined Apgar score less that 7 at 1 minute and occurrence of convulsion (p=0.003) and requirement of ventilation (p=0.002), Combined Apgar score less that 10 at 5 minutes and occurrence of convulsion (p<0.001) and requirement of ventilation (p<0.001), and early neonatal death (within 7 days)” and Combined Apgar score less than 7 at 1 minute (p=0.09) and Combined Apgar score less than 10 at 5 minutes (p=0.09). Conclusion: Though a low combined apgar score was superior to the traditional apgar score in predicting early neonatal mortality, no difference was seen in prognostication of convulsion and mechanical ventilation.

Association Of Febrile Seizure With Hyponatremia- A Prospective Study

Background & Objective-Febrile seizure is the most common seizure disorder in the pediatric age group and often recurs within the rst twenty four hours. It has been observed that children have lower serum sodium levels was a risk factor for recurrence of febrile seizure. The study was conducted to ascertain the role of serum sodium level in the rst episode of febrile seizure and as a predictor of seizure recurrence within the same febrile illness. Material and methods-It was a prospective observational study conducted at Tertiary medical teaching hospital, in Department of Pediatrics. 55 Children of age 6 months to 60 months presenting with rst episode of seizure with fever in our Hospital were selected for the study. Serum sodium levels were evaluated in all the children. Results-Sr. Sodium level reveals that in 72.73% of the children Sr. Sodium Level was ≤ 135 whereas in 27.27% it was >135 and mean level was 133.49±6.02.Conclusion-Measurement of the serum sodium in a child with febrile seizures helps in predicting seizure recurrence within the same febrile illness.

Estado epiléptico refractario en UCIP. Experiencia en un hospital de la Provincia de Buenos Aires / Refractory status epilepticus in the PICU. Experience at a hospital in the Province of Buenos Aires

Introducción: El estado epiléptico (EE) es la emergencia neurológica más frecuente en pediatría. Los pacientes que no responden al tratamiento estándar con dosis adecuadas de benzodiacepinas seguido de una droga antiepiléptica aceptable son definidos como Estado epiléptico Refractario (ER). Objetivo: caracterizar la población de niños con EE que ingresan a UCIP y determinar qué factores son predictores de refractariedad en esta población. Métodos: Estudio de casos y controles, retrospectivo. Población: niños con EE internados en UCIP desde Febrero 2015 a Febrero 2017. Casos: Estado epiléptico Refractario (ER). Controles: Estado epiléptico No Refractario (ENR). Se calculó el Odds Ratio (OR) individual para las distintas variables en Med Calc. Resultados: Se internaron 35 pacientes de los cuales 12 fueron casos y 23 controles. Hubo fiebre en 77% de los pacientes. En el total de niños estudiados hubo 11% con antecedente de convulsión febril, 11% con antecedente de epilepsia y 9% con antecedente de malformación del SNC. Los niños con antecedente de convulsión febril tuvieron 2,5 veces mayor riesgo de ER (OR: 2,58; IC 95%: 1,17-5,68). Los niños con EE que tenían antecedentes de enfermedad neurológica previa presentaron riesgo de ER 2,6 veces mayor que el grupo control (OR 2,60; IC 95%: 1,24-5,42). Discusión: Dado el aumento en la mortalidad de los pacientes con ER sería importante disponer de más herramientas para predecir este desenlace e iniciar tratamiento oportuno. Resultaría útil entrenar a los padres de niños con antecedente de convulsión febril en la aplicación de medicación antiepiléptica prehospitalaria, esto podría prevenir la farmacorresistencia, el daño neurológico y las complicaciones que acarrea el ingreso a UCIP. (AU)

Introduction: Status epilepticus (SE) is the most common neurologic emergency in children. Patients that do not respond to standard treatment with adequate doses of benzodiazepines followed by an acceptable antiepileptic drug are defined as having refractory status epilepticus (RSE). Objective: To characterize the population of children with SE admitted to the PICU and to determine predictive factors for refractoriness in this population. Methods: A retrospective case-control study was conducted. Population: Children with SE admitted to the PICU between February 2015 and February 2017. Cases: Refractory status pilepticus (RSE). Controls: Non-refractory status epilepticus (NRSE). Individual Odds Ratio (OR) was calculated for different variables using Med Calc. Results: 35 patients were admitted of whom 12 were cases and 23 controls. Overall, 77% of the patients had fever. Of all the children, 11% had a history of febrile seizures, 11% had history of epilepsy and 9% had a CNS malformation. Children with a history of febrile seizures had a 2.5-fold higher risk of developing RSE (OR: 2.58; 95% CI: 1.17-5.68). Children with SE that had a history of neurologic disease had a 2.6-fold higher risk of developing RSE than controls (OR 2.60; 95% CI: 1.24-5.42). Discussion: Given the increased mortality in children with RSE, availability of tools to predict this outcome in order to initiate early treatment is important. It would be useful to train the parents of children with a history of febrile seizures in the prehospital administration of antiepileptic drugs as this may prevent pharmaco-resistance, neurologic damage, and complication related to PICU admission (AU)

Síndrome De Sturge-Weber: Reporte De Un Caso Y Revisión De La Literatura / Sturge-Weber Syndrome: A Case Report And Literature Review

Resumen El Síndrome de Sturge-Weber es un trastorno poco común del desarrollo neuroectodérmico, caracterizado por un angioma facial tipo nevus flammeus y una angiomatosis leptomeníngea, con frecuencia ipsilateral al nevus. Este síndrome predispone a calcificaciones, atrofia cerebral y convulsiones refractarias. Propósito: En este artículo se realiza una revisión de la literatura sobre el Síndrome de Sturge-Weber y se reporta el caso de un paciente de 18 meses de edad diagnosticado con esta patología que ingresa a urgencias por presentar cuadro febril de tres días y comienzo de convulsiones tónico clónicas localizadas en hemicuerpo derecho refractarias al tratamiento convencional; en esta revisión se resalta la importancia del diagnóstico y manejo oportuno al igual que un adecuado seguimiento. Desarrollo: se realizaron búsquedas en las bases de datos PubMed, Science Direct y Scielo, confirmando que aún se desconocen algunos aspectos de esta patología, sin embargo, con el descubrimiento de la mutación somática de GNAQ hay un amplio campo para próximas investigaciones. Hallazgos y conclusiones: Es importante en el ejercicio médico no pasar de alto las lesiones angiomatosas que posean una ubicación trigeminal en los recién nacidos, con el fin de establecer un diagnóstico oportuno e intentar conseguir un mejor desarrollo a futuro.

Abstract Sturge-Weber Syndrome is a rare developmental neuroectodermical disorder. It is characterized by a facial port-wine stain and a leptomeningeal angiomata, frequently localized ipsilateral to the facial port-wine stain. This syndrome predisposes either to brain atrophy, calcifications and refractory seizures. In this paper a Sturge-Weber Syndrome literature review was made and a 18 month aged child case with this diagnosis is reported. He was admitted to the emergency department of a local hospital with a history of three days of fever and tonic-clonic seizures localized on the right side and refractory to conventional treatment. This review highlights the importance of an early diagnosis and an appropriate follow up. To carry out this review a search in PubMed, Science Direct and Scielo databases was done, confirming that there are some issues about this disorder that are still unknown. However, with the GNAQ somatic mutation discovery, there is an open field for new researches. It is very important in medical practice not to understimate a facial port-wine stain over trigeminal territory in newborns in order to make an early diagnosis and try to achieve a better future neurodevelopment.

Efficacy of low dose magnesium sulphate regime and Pritchard’s regime in controlling of eclamptic convulsion and prevention of recurrence

Background: Eclampsia is defined as the onset of convulsions or coma during pregnancy or in post-partum period in a patient who has signs and symptoms of pre-eclampsia. It is life threatening emergency that continues to be a major cause of serious maternal morbidity and mortality also along with high perinatal mortality and morbidity. The present study undertaken to determine the efficacy of low dose magnesium sulphate regime and Pritchard’s regime in controlling eclamptic convulsion and prevention of recurrence of convulsion.Methods: Out of total 60 patients enrolled in the study; 30 were given low dose magnesium sulphate regime and remaining 30 with Pritchard’s regime. Selection of patients was done with simple random sampling. Relevant history was obtained from the patient, if conscious, or from the relatives. Through clinical examination was done and blood samples were collected for investigations after securing IV line.Results: There was insignificant difference regarding type of eclampsia in both groups. Recurrence of convulsion in Pritchard’s regime group was 6.67% and in Low dose regime group found to be 10% but this was statistically insignificant. Total dose of magnesium sulphate required in Low dose regime group was less than that required for Pritchard’s regime.Conclusions: Low dose magnesium sulphate Regime proved equally effective as that of Pritchard’s regime in control of convulsion in spite of less amount of drug and comparatively low serum magnesium levels and hence there is hardly any fear of intoxicator.

Fever, unilateral convulsion status, disturbance of consciousness / 中华实用儿科临床杂志

There was a 6-years-old girl who was hospitalized for " four episodes of convulsions within four hours" . On admission, the main manifestations of the patient were unilateral convulsion status, fever and disturbance of consciousness.After improvement of consciousness, physical examination revealed hemiplegia on the convulsive side.Viral encephalitis was considered at admission.However, there were no abnormalities in routine and biochemical examinations of cerebrospinal fluid(CSF), and there were no abnormalities in immune antibodies and pathogen high-throughput sequencing of CSF, which excluded central nervous system infection.According to the craniocerebral magnetic resonance imaging, extensive edema in the right cerebral hemisphere was demonstrated.Diagnosis was considered to be idiopathic hemiconvulsion hemiplegia syndrome(IHHS). The antiepileptic drug was adjusted as phenobarbital, and the seizures were reduced.But one month later, intractable epilepsy occurred, and the final diagnosis was idiopathic hemiconvulsion-hemiplegia-epilepsy syndrome(IHHES). The clinical manifestations were fever, unilateral convulsion status, and disturbance of consciousness.The diagnosis should be combined with CSF examination and imaging characteristics and other considerations.IHHS may develop to IHHES in the later stage.

Fever, unilateral convulsion status, disturbance of consciousness / 中华实用儿科临床杂志

There was a 6-years-old girl who was hospitalized for "four episodes of convulsions within four hours".On admission,the main manifestations of the patient were unilateral convulsion status,fever and disturbance of consciousness.After improvement of consciousness,physical examination revealed hemiplegia on the convulsive side.Viral encephalitis was considered at admission.However,there were no abnormalities in routine and biochemical examinations of cerebrospinal fluid(CSF),and there were no abnormalities in immune antibodies and pathogen high-throughput sequencing of CSF,which excluded central nervous system infection.According to the craniocerebral magnetic resonance imaging,extensive edema in the right cerebral hemisphere was demonstrated.Diagnosis was considered to be idiopathic hemiconvulsion hemiplegia syndrome(IHHS).The antiepileptic drug was adjusted as phenobarbital,and the seizures were reduced.But one month later,intractable epilepsy occurred,and the final diagnosis was idiopathic hemiconvulsion-hemiplegia-epilepsy syndrome (IHHES).The clinical manifestations were fever,unilateral convulsion status,and disturbance of consciousness.The diagnosis should be combined with CSF examination and imaging characteristics and other considerations.IHHS may develop to IHHES in the later stage.