[Evaluation of the bone mass by dual-photon absorptiometry in children under prolonged anticonvulsant therapy]. / Valoración de la masa ósea por absorciometría fotónica doble en niños con tratamiento prolongado con anticonvulsivos.

We have evaluated, in a prospective study, the total and per unit area mass, measured in lumbar spine by Dual Photo-absorptiometry, in a group of 62 children on long-term anticonvulsant treatment. A second group of 58 normal children was used as a control. The total and per unit area bone mass increased with age, weight, height and bone maturity in all of the children studied. There were no significant differences found between the two groups. Children on multi-therapy and that were over six years of age showed statistically significantly less bone mass per area when compared th the control group (p less than 0.01). Phenobarbital, Carbamazepine and Valproic acid in monotherapy did not statistically diminish bone mass. Of these anticonvulsants, Phenobarbital was responsible for the most statistically significant decline in bone mass per area (p = 0.027). After six year of treatment, whether on mono-therapy or on poly-therapy, bone mass was lower with respect to the control series, although this was not statistically significant.

[Developmental psycho-neurologic follow up of neonates with high pre-perinatal risk factors]. / Control psico-neuroevolutivo de recién nacidos de riesgo pre-perinatal.

The authors give the results of a horizontal study made in the course of the work carried out during 1988 in the Developmental Follow-up Unit of the University Hospital "Virgen Macarena" of Seville, making emphasis on the psiconeurological pathology detected and its relation to the cause consultation. A total of 443 children were studied, this number being 77% of the cases under control up to that time. 82.2% of the children (N = 364) were normal on neurological examination, with normal I.Q. at the last control. However, 147 of these children (33.2% of the total) had shown some transient neuromotor abnormality over the follow-up period. Of the total, 17.8% (N = 79) showed one more of the following permanent sequelae: Defects of mental development 15% (N = 67), Motor sequelae 8.8% (N = 39), Sensorial deficits 5.6% (N = 25), Convulsions 3.6% (N = 16), Important behaviour disorders 0.5% (N = 2). The presence of motor sequelae had a significant correlation with: CNS defects (p less than 0.001), Metabolic changes in the neonatal period (p less than 0.005), Neonatal convulsions (p less than 0.005), Isquemic-anoxic syndrome (p less than 0.05). Deficits of mental development are associated significantly with: Polimalformative syndromes (p less than 0.001), CNS defects (p less than 0.001) and with neonatal convulsions (p less than 0.001). The neuromotor abnormalities detected (in order of frequency) were: Changes in muscle tone (32%), Motor retardation (31.8%). Changes in prehensive behaviour (22%), Changes in motility (21%). Retarded expressive conduct (14.3%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Phosphorus-calcium metabolism in children under prolonged treatment with anticonvulsants. (II)]. / Metabolismo fosfocálcico en niños con tratamiento prolongado anticonvulsivo. (II).

Comparative assessments were made regarding the effects of prolonged administration of anticonvulsant drugs (phenobarbital, carbamazepine, valproate and polytherapy) on the different biochemical parameters related to phosphocalcium metabolism, in 98 children between 1 and 14 years. The most patent effect was on the levels of 25-Hydroxycholecalciferol which went down significantly (p = 0.0001) in children treated with phenobarbital (34.5 +/- 17 ng/ml) or polytherapy (28.4 +/- 18 ng/ml) in relation to those treated with carbamazepine (49.2 +/- 15 ng/ml) or valproate (43.1 +/- 15 ng/ml) and to control group (45.9 +/- 13 ng/ml). The alkaline phosphatase has been found significantly higher among those treated with phenobarbital, carbamazepine and polytherapy, evidencing significant differences in relation to those treated with valproate and to control group (p less than 0.05). For calcium, parathyroid hormone and osteocalcine levels no differences were found in the different drugs, nor with control group. Depending on the duration of treatment there was a significant reduction (p = 0.02) in the levels of 25-Hydroxycholecalciferol in children treated over 3 years, but no difference for calcium, phosphorous, alkaline phosphatase and PTH under this parameter.

[Phosphorus-calcium metabolism in children under long-term anticonvulsant therapy]. / Metabolismo fosfocálcico en niños con tratamiento prolongado anticonvulsivo.

The effects of prolonged administration of anticonvulsants were analyzed on different biochemical parameters related to phosphocalcium metabolism in 98 children aged 1 to 14, not affected by other chronic pathology, and to whom no Vitamin D nor other vitamin-mineral complexes had been administered. We take as reference a group of normal children studied during the same period. Determinations were accomplished with the usual chemical controls in our laboratory (autoanalysis of continuous flow, radioimmunoassay and colorimetric measurements) and the following mean levels were obtained for treated children: Calcium: 9.2 +/- 0.4 mg/dl, phosphorous: 3.5 +/- 1.9 mg/dl, alkaline phosphatase: 252 +/- 72 U/L, 25-Hydroxycholecalciferol: 35.6 +/- 18 ng/ml, Osteocalcine: 5.4 +/- 3.6 ng/ml, and parathyroid hormone: 0.4 +/- 0.1 ng/ml. These values differed significantly from those found in the control group for phosphorous, lower in children under treatment (p = 0.000), and the 25-Hydroxycholecalciferol was likewise lower (p = 0.000). In other way the mean levels of alkaline phosphatase were higher in treated children (p = 0.000). No significant differences were obtained for mean levels of calcium, parathyroid hormone and osteocalcine. These differences are maintained when distributing patients among different age groups. Solar radiation received by treated children during the months preceding the extraction, did not produce significant differences on 25-Hydroxycholecalciferol, with mean values that were similar at the end of summer (34 +/- 9 ng/ml) and the end of winter (36.6 +/- 18 ng/ml).

[Phenylketonuria. Treatment and developmental control]. / Fenilcetonuria. Tratamiento y control evolutivo.

We evaluated annually the compliance of dietary restriction, weight, height, head circumference EEG and IQ score on 16 children with phenylketonuria comparing the children diagnosed early with those later. The compliance was good in children treated early and bad in the others. Height and head circumference was normal in all children and we found a tendency towards obesity in the older ones. The IQ score was lower than 80 in 77% of the children diagnosed later and in those the EEG showed slow basal activity in 55%.