Pharmacological management of post-traumatic seizures in a South African paediatric intensive care unit

Background. Traumatic brain injury (TBI) is a common cause of paediatric intensive care unit (PICU) admissions in South Africa. Optimal care of these patients includes the prevention and control of post-traumatic seizures (PTS) in order to minimise secondary brain injury. Objectives. To describe the demographics of children admitted to a South African PICU, to describe the characteristics of PTS, and to describe the prophylactic and therapeutic management of PTS within the unit. Method. A 3-year retrospective chart review was conducted at the PICU of the Chris Hani Baragwanath Academic Hospital (CHBAH) in Soweto, Johannesburg, from 1 July 2015 to 30 June 2018. Results. Seventy-eight patients were admitted to the PICU, all with severe TBI. A total of 66 patient files were available for analysis. The median age of admission was 6 years (interquartile range (IQR) 4 - 9) with the majority of trauma secondary to mechanical injury (89%). Prophylactic anti-epileptic drugs (AEDs) were initiated in 44 (79%) patients. Early PTS occurred in 11 (25%) patients who received prophylaxis and 4 (33%) who did not. Three (5%) patients developed late PTS, resulting in an overall incidence of PTS of 43%. The most common seizure type was generalised tonic clonic (82%). Children diagnosed with PTS were a median of 2 years younger than those without PTS, with increased prevalence of seizures (83% v. 38%) in children below 2 years of age. Maintenance therapy was initiated in all patients consistent with recommended dosages. Of the total 167 anti-epileptic levels taken during maintenance, only 56% were within target range. Of the initial 78 patients, 8 died (10%). The median length of stay was 7 (IQR 5 - 12) and 8 (IQR 8 - 24) days longer in ICU and hospital respectively, in children with PTS. Conclusion. PTS is a frequent complication of severe TBI in children. There was considerable variation in the approach to both prophylaxis and maintenance therapy of PTS in terms of choice of agent, dosage, frequency of drug monitoring and approach to subtherapeutic levels. It is clear that more high-level studies are required in order to better inform these practices

Modeling of post-traumatic epilepsy and experimental research aimed at its prevention

Research on the prevention of post-traumatic epilepsy (PTE) has seen remarkable advances regarding its physiopathology in recent years. From the search for biomarkers that might be used to indicate individual susceptibility to the development of new animal models and the investigation of new drugs, a great deal of knowledge has been amassed. Various groups have concentrated efforts in generating new animal models of traumatic brain injury (TBI) in an attempt to provide the means to further produce knowledge on the subject. Here we forward the hypothesis that restricting the search of biomarkers and of new drugs to prevent PTE by using only a limited set of TBI models might hamper the understanding of this relevant and yet not preventable medical condition.

Progress in Research on Biomarkers of Post-Traumatic Epilepsy / 法医学杂志

Post traumatic epilepsy （PTE） is a serious complication of traumatic brain injury and a difficult problem in forensic justice practice. In recent years, many biomarkers have been applied to the diagnosis, treatment and prognosis of injuries and diseases. There have been many studies on the biomarkers of PTE in the field of epilepsy. This paper reviews the progress in research on biomarkers of PTE in recent years in order to provide reference for the forensic identification of PTE.

Clinical analysis on risk factors and prognosis of early post-traumatic epilepsy / Análise clínica de fatores de risco e prognóstico da epilepsia pós-traumática precoce

ABSTRACT Objective To analyze the risk factors and prognosis related to early post-traumatic epilepsy (EPTE). Methods One hundred and eighty-six patients with traumatic brain injury were enrolled. Their full clinical data were collected. Single factor analysis and logistic regression analysis of risk factors related to EPTE were performed. The prognosis of patients was determined. Results Single factor analysis showed that there were significant differences of age (p = 0.011), epilepsy history (p < 0.001), injury site (p = 0.004), injury type (p < 0.001) and injury degree (p < 0.001) between the EPTE group (40 patients) and non-EPTE group (146 patients). Logistic regression analysis showed that the injury site, injury type and injury degree were the main risk factors for EPTE. The odds ratio values of injury site, injury type and injury degree were 1.977 (1.473-2.679), 2.096 (1.543-2.842) and 2.376 (1.864-3.609), respectively. The logistic regression equation was P = Exp (-1.473 + 0.698 × injury site + 0.717 × injury type + 0.935 × injury degree). The sensitivity and specificity of injury site, injury type and injury degree for predicting EPTE were 79.2% and 80.5%, 78.9% and 85.7% and 84.2% and 81.0%, respectively. The analysis of prognosis showed that the Glasgow Outcome Scale/Activity of Daily Living Scale scores in the EPTE group were significantly lower than those in non-EPTE group (p < 0.05). Conclusions Injury site, injury type and injury degree are the main risk factors for EPTE. The prognosis of patients with traumatic brain injury can be affected by EPTE.

RESUMO Objetivo Analisar os fatores de risco e prognóstico relacionados à epilepsia pós-traumática precoce (EPTE). Métodos Cento e oitenta e seis pacientes com lesão cerebral traumática foram incluídos. Seus dados clínicos completos foram coletados. A análise fatorial única e a análise de regressão logística dos fatores de risco relacionados à EPTE foram realizadas. O prognóstico dos pacientes foi observado. Resultados A análise fatorial única mostrou que houve diferenças significativas de idade (p = 0,011), história de epilepsia (p < 0,001), local da lesão (p = 0,004), tipo de lesão (p < 0,001) e grau de lesão (p < 0,001) entre o grupo EPTE (40 casos) e o grupo não-EPTE (146 casos), respectivamente. A análise de regressão logística mostrou que o local da lesão, tipo de lesão e grau de lesão foram os principais fatores de risco para EPTE. Os valores de razões de chance do local da lesão, tipo de lesão e grau de lesão foram 1.977 (1.473-2.679), 2.096 (1.543-2.842) e 2.376 (1.864-3.609), respectivamente. A equação de regressão logística foi P = Exp (-1,473 + 0,698 × local de lesão + 0,717 × tipo de lesão + 0,935 × grau de lesão). A sensibilidade e especificidade do local da lesão, tipo de lesão e grau de lesão para a predição da EPTE foram de 79,2% e 80,5%, 78,9% e 85,7% e 84,2% e 81,0%, respectivamente. A análise do prognóstico mostrou que o escore da Escala de Desfechos de Glasgow / Atividade de Vida Diária no grupo EPTE foi significativamente menor do que no grupo não-EPTE (P <0,05). Conclusões O local da lesão, tipo de lesão e grau de lesão são os principais fatores de risco para EPTE. A EPTE pode afetar o prognóstico de pacientes com lesão cerebral traumática.

Retrospective Analysis of Forensic Appraisal of Post-traumatic Epilepsy in 30 Cases / 法医学杂志

Objective To summarize the general characteristics and identification considerations of appraisal of post-traumatic epilepsy （PTE） in forensic clinical expertise. Methods Descriptive statistics were made on the general situations （age and sex）, injury sites, PTE grading, clinical manifestations and blood drug concentrations of 30 cases of PTE. Chi-square test was performed on the differences of sex composition, age group incidences, injury sites, clinical manifestations and PTE grading. Fisher's exact probability method was used to test the differences in clinical manifestations and PTE grading of each site and the differences in PTE grading of different clinical manifestations. Results PTE occurred more frequently among 21 to 40 year olds, more in males than in females, and more frequently in the temporal lobe and frontal lobe. The clinical manifestations were mostly partial seizures and the PTE grading was mostly mild PTE. There were no statistical significance in the differences in distribution of clinical manifestations and PTE grading of injury sites （P>0.05）. The difference in the PTE grading of different clinical manifestations had no statistical significance （P>0.05）. The blood drug concentration of the three identified people did not reach the effective concentration, which affected the final identification opinion. Conclusion In the identification of PTE, in addition to strictly grasping the necessary factors of identification, such as the history of craniocerebral trauma, and epileptic seizures, it is also suggested that attention should be paid to the detection of blood drug concentration. Overall analysis and comprehensive evaluation should be made.

Epilepsia postraumática en escolares ingresados en el Hospital Nacional de Niños Benjamín Bloom periodo de enero a diciembre del 2015. Serie de casos / Post-traumatic epilepsy in schoolchildren admitted to the Benjamín Bloom National Children's Hospital from January to December 2015. Case series

En la actualidad, los traumas continúan siendo una causa importante de morbimortalidad en el mundo, y de estos, los traumas craneoencefalicos pueden desencadenar como secuelas epilepsias postraumáticas, de la cual se desconoce su prevalencia. Por lo tanto, el objetivo de este trabajo es identificar el perfil epidemiológico en pacientes escolares quienes consultaron en el hospital nacional de niños Benjamín Bloom. Se realizó un estudio de serie de casos, tomándose como periodo de tiempo de enero a diciembre de 2015. Se tomaron como sujetos de investigación los escolares (6-12 años) cuyo motivo de consulta haya sido un traumatismo craneoencefálico y quienes cumplieron criterios de inclusión, usando un instrumento para identificar sus variables y seguimiento para confirmar diagnostico en consulta externa. Se llenó el instrumento mediante la revisión de expedientes clínicos, en dicho periodo. Finalmente los resultados obtenidos fueron almacenados en una base de datos y analizados estadísticamente mediante el empleo de Microsoft Excel. Para la realización del presente estudio se solicitó la autorización de la institución involucrada (HNNBB), mediante el comité bipartito de Investigación y del Comité de Ética del HNNBB. Se encuentra una prevalencia de 3.91% de escolares con trauma craneoencefálico quienes han presentado diagnóstico de epilepsia postraumática. De los pacientes que presentaron esta condición, las características más frecuentes encontradas el sexo masculino, trauma craneoencefálico severo, con mecanismo de trauma por accidente de tránsito y con un TAC cerebral anormal. Así mismo se corroboró que los pacientes presentaban un seguimiento por médico subespecialista, neurólogo o neurocirujano. Conclusiones: La epilepsia postraumática es una complicación del trauma craneoencefálico, la cual tiene poca prevalencia. Se encontró que las características de un paciente que haya sufrido trauma craneoencefálico es un escolar masculino, con trauma craneoencefálico severo, que haya sufrido un accidente de tránsito, con un TAC cerebral anormal

Progress on Post Traumatic Epilepsy and Its Forensic Evaluation / 法医学杂志

Post traumatic epilepsy （PTE） refers to the epileptic seizures after traumatic brain injury. Organic damage can be found by imaging examination, and abnormal electroencephalogram can be detected via electroencephalogram examination which has the similar location of the brain injury. PTE has the characteristics of low incidence, absence of case reports, and easy to exaggerate the state of illness, which add difficulties to the forensic identification. This paper reviews the status of epidemiology, pathogenesis, clinical treatment and forensic identification for PTE.

Post-Traumatic Ictogenesis and Epileptogenesis / 대한신경손상학회지

For ictogenesis, initial step is intrinsic bursts of pacemaker neurons and, through exaggerated circuits or networks, the involved neurons become hyperexcitable state. Hypersynchrony of hyperexcitable neurons can induce paroxysmal depolarization shift for developing seizure. The mechanism underlying the development of post-traumatic epilepsy still remains to be elucidated. By traumatic brain injury, breakdown of blood-brain barrier (BBB) may lead network changes, long-lasting epileptiform activity and eventual neurodegeneration. Recently the concept of inflammation and epileptogenesis is widely accepted. In the surgically resected brain tissue from refractory partial epilepsy patients, there are hallmarks of a chronic inflammatory state and, also, via animal experiments, we can find the role of inflammation in the genesis of seizure and epilepsy. Inflammatory mediators (IL-1b, TGF-beta1 and COX-2) are associated with the epileptogenic brain. They can reduce seizure threshold, induce neurodegeneration, neurogenesis, and synaptic plasticity, and also disregulate BBB permeability. The increase in knowledge about a role of inflammation in epileptogenesis may support the use of specific anti-inflammatory drugs for developing disease-modifying treatments that can interfere epileptogenesis.

Fractura compuesta de cráneo: reporte de casos y revisión de la literatura / Compound fracture of skull: case report and literature review

Introducción: Las fracturas son generalmente clasificados como simples (cerrada) o compuesta (abierta). En el caso de las fracturas de cráneo, pueden ser fracturas lineales, elevados, o triturado con la depresión. Fractura de cráneo compuesta rara vez se ha reportado en la literatura médica y cursa con una alta morbilidad y mortalidad. Los autores presentan seis casos de fracturas múltiples del cráneo, hablan sobre el tratamiento y pronóstico. Pacientes y métodos: Se analizaron seis casos de fractura compuesta del cráneo. Analizado por sexo, causa, localización, diagnóstico, tratamiento y pronóstico. Resultados: El sexo 5M / 1F. La edad media fue de 22 a. Las causas fueron: tres por agresión física, dos por accidente de coche y uno por explosión de neumático. Todos los pacientes fueron sometidos a TC. GCS medio al ingreso fue de 8. El tratamiento quirúrgico fue instituido en todos los casos. Tres pacientes desarrollaron infecciones (meningitis 2, empiema 1). Las secuelas fueron tres convulsiones, trastornos de la conducta 2. Hubo una muerte. Conclusión: La fractura compuesta del cráneo es rara y depende de la superficie del objeto y energía cinética. Las fracturas compuestas del cráneo con fragmentos de la depresión, son más frecuentes debido a la fuerza que se aplica hacia el cráneo. Su tratamiento inicial es quirúrgico y frecuentemente evoluciona con un mal pronóstico.

Introduction: Fractures are usually classified as simple (closed) or compound (open). In the case of skull fractures, they may be linear, high, or comminuted fracture with subsidence. The compound skull fracture has been rarely reported in medical literature and courses with high morbidity and mortality. The authors present six cases of compound fractures of the skull, discuss the treatment and prognosis. Patients and methods: We reviewed six cases of compound fracture of the skull. Analyzed according to gender, causes, location, diagnostic, treatment and prognosis. Results: The gender 5M / 1F. The mean age was 22 a. The two causes were physical aggression 3, car accident 2 and explosion of a tire 1. All patients underwent CT. Average score on ECG in admission 8. Surgical treatment was instituted all cases. Sequels were seizures 3 and behavioral disorders 2. There is one death. Conclusion: The compound fracture of the skull is rare and depends on the surface of blunt object and kinetic energy. The compound skull fractures with fragments of depression are more common, due to the force that is applied toward the skull. The initial treatment is surgical, and usually evolves with poor prognosis.

Clinical Characteristics of Post-traumatic Seizures in Children / 대한소아신경학회지

PURPOSE: Post-traumatic seizures (PTS) are well-recognized complications from head injuries and children are particularly more vulnerable to them. The aim of this study was to investigate the clinical characteristics of PTS in children and the findings of several diagnostic tools and to determine the role of prophylactic anticonvulsants. METHODS: We retrospectively reviewed the medical records of patient under 18 years of age who presented with seizures after traumatic brain injuries. Data analyzed included patient's demographics, clinical presentations, radiological and electroencephalographic findings, management and outcomes. RESULTS: Thirty one patients with PTS were included in the study and consisted of 13 males and 18 females. A mean age of the accident was 3.2 years (4 months-6.8 years) and a mean duration of follow-up was 26.0 months (12 months-54 months). Twenty one patients (67.7%) developed seizures within 24 hours after injury. Focal radiological findings were observed in 83.8% and described as subdural or epidural hematoma (25.8%), intraparenchymal hemorrhage (19.3%) and intracerebral parenchymal lesions (51.6%). Electroecephalographic findings included background abnormalities in 32.2% and interictal epileptiform discharges in 45.1%. All patients were treated with anticonvulsants for a certain period of time and a mean duration of treatment was 12.5 weeks (4-40 weeks). Eight patients (25.8%) developed subsequent seizures during follow-up period and 2 patients (6.5%) were diagnosed afterward with post-traumatic epilepsy. CONCLUSION: PTS generally take a benign clinical course, but subsequent seizures including epileptic seizures can occur in minor proportion. In these cases, radiological and electroencephalographic findings are helpful in prediction of clinical course of PTS.

Quality of life and its influencing factors in patients with post-traumatic epilepsy / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To observe the quality of life in patients with post-traumatic epilepsy and discuss the influencing factors.</p><p><b>METHODS</b>We assessed 105 patients with post-traumatic epilepsy and 100 healthy people as control using Quality of Life Scale-31 (QOL-31), Self-rating Depressing Scale (SDS) and Self-rating Anxiety Scale (SAS), and conducted retrospective analysis on the depression, anxiety, site of trauma, control of seizure, EEG and therapeutic compliance.</p><p><b>RESULTS</b>Patients with post-traumatic epilepsy scored much lower than the control group on QOL-31 (P less than 0.01), but higher than the control group on SDS and SAS (P less than 0.01). Multiple regression analysis indicated that major influencing factors on the quality of life were anxiety, therapeutic compliance, depression, poor control of epileptic seizure and site of trauma.</p><p><b>CONCLUSIONS</b>The quality of life in patients with post-traumatic epilepsy has significantly declined. Doctors should pay attention to psychological and mental problems of patients with epilepsy, such as depression and anxiety, enhancing therapeutic compliance and controlling epileptic seizure, which are the keys to improving prognosis.</p>

A Case of Gabapentin-induced Myoclonus in a Type 2 Diabetic Patient with End-stage Renal Disease / 임상당뇨병

Development of myoclonus can manifest as a side effect of antiepileptic drugs in subjects with preexisting epilepsy, post-traumatic brain injury, encephalopathy, or focal and multifocal brain lesions. A 69-year-old male showed new onset severe myoclonus and confusion two days after taking 1200 mg gabapentin. The patient had end-stage renal disease secondary to type 2 diabetes and was receiving hemodialysis twice a week. After increasing hemodialysis to three times a week and discontinuing gabapentin, myoclonus spontaneously resolved. Here we report the first case of myoclonus in a Korean subject with diabetic renal failure. We recommend caution in the administration of gabapentin for diabetic subjects with renal disease.

Tratamento homeopático emergencial por traumatismo em Aratinga leucophthalma (Statius Muller, 1776): relato de caso / Homeopathic treatment in emergency trauma in Aratinga leucophthalma (Statius Muller, 1776): case report

O número crescente de aves de estimação tem aumentado o número de atendimentos nas clínicas de pequenos animais. O estudo particular da medicina avíaria se torna necessário para um melhor atendimento do paciente, em especial as emergências, haja vista que, na maioria das vezes a consulta de emergência é a primeira consulta de uma ave. O presente estudo descreve o tratamento homeopático emergencial de uma ave de estimação por trauma e a terapia suporte. discute-se também o tratamento homeopático em casos de emergência. O tratamento homeopático mostrou-se eficaz na emergência, o que permitiu o retorno das atividades normais da ave em período curto de tempo.

Epilepsia decorrente do traumatismo cranioencefálico / Epilepsy after traumatic brain injury

JUSTIFICATIVA E OBJETIVOS: Com a alta prevalência de traumatismo cranioencefálico e suas comorbidades, é imprescindível um melhor conhecimento da sua fisiopatologia. Do ponto de vista prático, a presença de quadro convulsivo de instalação tardia (mais de sete dias após o trauma) é uma condição, em certas situações, bastante incapacitante. O objetivo deste estudo foi rever os conceitos atuais sobre o assunto, bem como explorar a melhor conduta terapêutica. CONTEÚDO: Se, por um lado, o tratamento com anticonvulsivantes precocemente (nos primeiros sete dias) é eficaz em evitar o quadro epiléptico precoce, há razoável acordo de que este tratamento não previne as complicações epilépticas tardias. Ao lado disso, a utilização de medicamentos antiepiléticos traz consigo um importante conjunto de efeitos colaterais. CONCLUSÃO: Até que novas modalidades terapêuticas sejam introduzidas, que são decorrência de um melhor conhecimento fisiopatológico, a utilização de medicamentos anticonvulsivantes deve ser realizada somente nos primeiros sete dias depois do traumatismo cranioencefálico.

BACKGROUND AND OBJECTIVES: In view of the high prevalence of traumatic brain injury (TBI) and its comorbidities, it is quite important a better knowledge of the pathophysiology of this process. Our objective was to review the best way to manage these posttraumatic epilepsy cases. CONTENTS: Under the practical point of view, the seizures occurring after 7 days of the TBI were, in certain cases, a very debilitating condition. If the precocious anticonvulsant therapy is efficacious in avoiding seizures in the first 7 days after TBI, there is good agreement that this kind of treatment is unable to avoid later convulsions. On the other hand, we must remember that anticonvulsant therapy has important and serious side effects. CONCLUSION: Until new treatment modalities are not available, as a consequence of a better pathophysiologic knowledge, the use of anticonvulsant drugs should be limited to the first 7 days after TBI and not beyond.

Disability evaluation of 204 cases of children with brain injury in road traffic accidents / 法医学杂志

OBJECTIVE@#To study the types, characteristics and common complications as well as disability assessment for the children with craniocerebral injury in the road traffic accidents.@*METHODS@#Data from 204 cases of children with cranio-injury in road traffic accidents were collected and were statistically analyzed according to the location injured, complication, the type of complication and the severity of disability.@*RESULTS@#There were 64 cases of simple diffuse primary craniocerebral injury, 80 cases of simple local primary cranio-injury, 24 cases of diffuse secondary craniocerebral injury and 36 cases of local secondary cranio-injury. The main complications included traumatic epilepsy (14, 6.9%), traumatic cerebral infarction (9, 4.4%), traumatic hydrocephalus (7, 3.4%) and traumatic mental disorder (5, 2.5%).@*CONCLUSION@#Among the children with cranio-injury due to road traffic accidents, simple primary cranio-injury was the most common result, whereas the traumatic epilepsy and traumatic cerebral infarction were the major types of complications. The assessment criteria for body impairment of the children with craniocerebral injury in the road traffic accidents should be broadened accordingly, with addition of certain specific items for children.

The quantitative analysis of Ub and UbE1 in focus of traumatic epilepsy / 法医学杂志

OBJECTIVE@#To study the expression of ubiquitin proteasome system (UPS) in the traumatic epilepsy pathogenesis and its value in traumatic epilepsy by quantitative analysis.@*METHODS@#Fifteen specimens from human epileptic temporal cortex from PTE were collected as the PTE group. Fifteen specimens from non-PTE were collected as the non-PTE group. Fifteen normal cerebral cortex specimens died from acute traffic accident were collected as the control group. The expression of mRNA and protein of Ub and UbE1 were detected by RT-PCR and Western blot. Statistical analysis was used to compare the data between three groups.@*RESULTS@#The expression of mRNA and protein of Ub and UbE1 were the following order: PTE group(high), non-PTE group(middle) and control group(low).@*CONCLUSION@#The study confirms that UPS is up-regulated in the epilepsy's focus, especially in traumatic epilepsy. The activation of UPS may be an important pathological change in neurons in pathogenesis of traumatic epilepsy.

Morphology changes of ubiquitin-proteasome system in traumatic epilepsy / 法医学杂志

OBJECTIVE@#To investigate the value of ubiquitin(Ub) and ubiquitin-activating enzymel(UbE1) for the appraisement of post traumatic epilepsy (PTE).@*METHODS@#Fifteen specimens from human epileptic temporal cortex originating from PTE were collected as the PTE group. Fifteen specimens from non-PTE were collected as the non-PTE group. Meanwhile, 15 normal cerebral cortex specimens from people dead from acute traffic accident were collected as the control groups. Observe morphology changes of each group with HE, then with immunohistochemistry of Ub and UbE1.@*RESULTS@#Compared to the control group, morphology changes of neuron quantity reduction, neuron denaturation and so on were observed both in the PTE group and the non-PTE group under HE, especially in the PTE group. Ub and UbE1 mainly expressed in the nucleus and cytoplasm of the neurons in epilepsy spot without extracellular expression. The expression of Ub and UbE1 is PTE group > non-PTE group > control group (P < 0.05).@*CONCLUSIONS@#The neuron denaturation are one of the main pathology changes of epilepsy, and it is more obvious in the PTE group. Immunohistochemistry of Ub and UbE1 may be more helpful to distinguish PTE and non-PTE than HE staining.

Sodium valproate for prevention of early posttraumatic seizures / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To assess the preventive effect of sodium valproate on early posttraumatic seizures in traumatic brain injury (TBI) patients.</p><p><b>METHODS</b>The retrospective study was based on 159 patients with TBI treated at Department of Neurosurgery, Nanjing General Hospital of Nanjing Command enrolled between January 1, 2008 and December 31, 2009. The in-hospital section of the retrospectively collected database includes information on age, sex, initial Glasgow Coma Score (GCS), results of CT scanning, operation, usage of sodium valproate, seizures in the first week after injury and outcome.</p><p><b>RESULTS</b>Seven patients (4.4%) showed early posttraumatic seizures. Although the incidence was zero in patients who received sodium valproate treatment, the difference between the treatment and control groups was not statistically significant. Of the 87 severe TBI patients (GCS 3-8), 6 patients in the control group (6.9%) suffered from early seizures during the first week after TBI and no patient who received preventive therapy suffered from seizures. The difference between the treatment and the control groups was still not statistically significant. Of the 72 mild and moderate TBI patients (GCS 9-15), only 1 patient in the control group suffered from seizures and no patient in the treatment group suffered.</p><p><b>CONCLUSIONS</b>Although the results suggest that the study is not sufficiently powerful to detect a clinically important difference in the seizure rates between the treatment and control groups, sodium valproate is effective in decreasing the risk of early posttraumatic seizures in severe TBI patients. Further prospective studies are recommended.</p>

case of fetal valproate syndrome with new features expanding the phenotype

Fetal valproate syndrome [FVS] is a well-recognized constellation of dysmorphic features, and neurodevelopmental retardation that results from prenatal exposure to the anticonvulsant valproic acid. In this report, we describe a case with typical features of FVS. A 23-year-old lady with post-traumatic epilepsy controlled by sodium valproate [Depakene] 500 mg twice daily throughout pregnancy as monotherapy, gave birth to a female baby with facial features characteristic of FVS, and severe radial ray reduction. She also had wide-spaced nipples and short neck, features not described before. Sodium valproate, a widely used anticonvulsant and mood regulator, is a well-recognized teratogen that can result in severe limb deformities, craniosynostosis, neural tube defects and neurodevelopmental retardation. Therefore, we recommend that valproic acid must be avoided during pregnancy, as new generation of anticonvulsant drugs have emerged into the market