Magnetic resonance angiography evidence of vasospasm in children with suspected acute hemiplegic migraine.

Hemiplegic migraine is a rare subtype of migraine that is differentiated by motor weakness in the aura phase. The purpose of this case series was to examine the magnetic resonance angiogram findings of patients suffering from suspected acute hemiplegic migraine. This was a retrospective institutional board review protocol study of 8 patients. All patients received full brain magnetic resonance imaging under a 1.5-T magnet. The scans were subsequently evaluated by a neuroradiologist and 2 neurologists who were blinded to the study. The magnetic resonance angiogram findings of this study showed the presence of vasospasm within the intracranial vasculature during suspected acute hemiplegic migraine. This case series suggests that routine use of magnetic resonance angiography might be beneficial in both managing patients with acute hemiplegic migraine and helping to further understand the pathophysiology of this complicated disease process.

Overnight transition from carbamazepine to oxcarbazepine in children and adolescents.

STUDY OBJECTIVE: To evaluate our clinical experience in pediatric patients who were rapidly switched from carbamazepine to oxcarbazepine at full therapeutic doses. DESIGN: Retrospective medical record review. SETTING: Children's hospital. PATIENTS: Twenty six patients (mean age 9.8 yrs, range 5-21 yrs) with childhood epilepsy who were converted from carbamazepine to oxcarbazepine overnight between January 2003 and December 2005. MEASUREMENTS AND MAIN RESULTS: Data collection included patient demographics, seizure type, epilepsy syndrome, seizure frequency, and adverse events. Dose conversion ratios for switching from carbamazepine to oxcarbazepine ranged from 1:1-1.5. The transition was well tolerated, with only three patients experiencing an adverse event (rash). Among the other 23 patients, seizure frequency decreased in 12 (52%), increased in two (9%), and remained unchanged in nine (39%). CONCLUSION: Overnight switching from carbamazepine to oxcarbazepine may be a useful option for pediatric patients who cannot tolerate or whose condition is unresponsive to carbamazepine.

Rapid dosage titration of levetiracetam in children.

STUDY OBJECTIVE: To report our experience with rapid titration of levetiracetam regimens in children and adolescents who were unresponsive to or intolerant of other antiepileptic drugs. METHODS: A retrospective chart review was performed to identify patients with childhood epilepsy who underwent a rapid titration to full doses of levetiracetam in 2 weeks or less. Data regarding demographics, disease characteristics, previous use of antiepileptics, levetiracetam dosage titration schedule, and clinical outcomes were collected and analyzed. RESULTS: Eight children (seven girls, one boy) aged 19 months-17 years were identified. The levetiracetam dosage was titrated to full maintenance doses over 2-14 days (mean 10 days). All patients demonstrated greater than 50% reduction in seizure frequency, with six patients (75%) becoming seizure free. Only one patient experienced a clinically significant adverse event. CONCLUSION: Rapid dosage titration of levetiracetam is feasible and well tolerated in children who require rapid escalation to therapeutic doses.

Ketogenic diet: outpatient initiation, without fluid, or caloric restrictions.

Although the ketogenic diet has been used for more than 80 years, the optimal methods of initiating the diet and its maintenance have not been clearly defined. This retrospective study was performed to review our experience with initiation of the ketogenic diet in the outpatient and inpatient settings and maintenance of the diet without fluid or caloric restriction. We analyzed 54 patients who had medically intractable epilepsy of whom 44% manifested some degree of mental retardation, 80% had multiple seizure types, and failed on average 4.8 antiepileptic drugs. Forty-four patients underwent induction of the ketogenic diet on an outpatient basis and 21 as inpatients. Three patients in each group were fasted at the initiation of the diet. No significant differences were observed with regard to seizure control in that 62% and 71% had greater than 50% improvement in the outpatient and inpatient groups, respectively. Both groups manifested improvement in alertness and social interaction. The efficacy of a ketogenic diet in the symptomatic epilepsies was confirmed, and benefit for medically refractory childhood absence epilepsy was documented. We conclude that a prospective, randomized trial is necessary to compare outpatient vs inpatient initiation of the ketogenic diet and the utility of fluid and caloric restriction.