Use of Early Childhood Epilepsy Severity Scale (E-Chess) in Classification and Prognostication of Children with West Syndrome: A Study from Tertiary Care Pediatric Neurology Centre

Objective: To assess the incidence and pattern of potential drug-drug interaction (pDDI) in hospitalized stroke patients.Methods: A retrospective study was carried out in a medical record from a tertiary care teaching hospital for a 4 mo period from November 2015-February 2016. The total of 200 prescriptions was analyzed during the study period.Results: A significant proportion of patients with pDDIs were males (61.5%) followed by females (38.5%). Among the 200 prescriptions, 179(89.5%) were confirmed with minimum one potential drug-drug interaction. Moreover, patients prescribed with more than 5 drugs developed a higher number of interactions. Based on severity scale, there were 125 major, 375 moderate and 128 minor interactions were observed. The pharmacodynamic interactions were 286 while the pharmacokinetic were 342.Conclusion: The study highlighted the pDDIs which were high in stroke patients greater than 40 y. pDDIs in prescriptions contained multi-drug therapy is a major concern as such interaction may lead to increased risk of hospitalization and higher health care cost. The majority of interactions were pharmacokinetic in nature, having moderate severity. In this study pDDIs mainly occurred between antihypertensive, anticoagulants and antiplatelet.

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Benign Localized and Generalized Epilepsies of Early Childhood (Epilepsy Research, Supplement No. 6)

Neurology ◽

10.1212/wnl.43.7.1455-a ◽

1993 ◽

Vol 43 (7) ◽

pp. 1455-1455

Author(s):

E. Wyllie

Keyword(s):

Early Childhood ◽

Childhood Epilepsy ◽

Epilepsy Research

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Clinical and Neuroimaging Changes of Subacute Sclerosing Panencephalitis – Experience 30 Cases in Tertiary Care Center in Bangladesh

European Journal of Clinical Medicine ◽

10.24018/clinicmed.2021.2.3.25 ◽

2021 ◽

Vol 2 (3) ◽

pp. 1-4

Author(s):

Gopen Kumar Kundu ◽

Mohammad Monir Hossain

Keyword(s):

Early Childhood ◽

White Matter ◽

Subacute Sclerosing Panencephalitis ◽

Tertiary Care ◽

Stage Ii ◽

Cortical Atrophy ◽

Periventricular White Matter ◽

History Of ◽

Signal Changes ◽

Intense Signal

Background: Subacute sclersing panencephalitis (SSPE) is a very rare progressive, fatal neurodegenerative disease of the control nervous system of childhood and early adolescence. It is a slow virus disease caused by persistent defective measles virus infection of the brain Objective: To see the clinical andneuro-imaging findings in children with Subacute sclerosing panencephalitis. Methods: This retrospective study was conducted at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, a tertiary care premier Postgraduate Medical Institution in Bangladesh. Thirty (30) Subacute sclerosing panencephalitis (SSPE) children were evaluated at paediatric neurology ward during the period January 2010 to December 2017. Diagnosis was based on typical clinical characteristic features, the presence of periodic discharges on EEG, demonstration of raised antibody titer against measles in the plasma and cerebrospinal fluid Detected by ELISA in all patients. Results: Total number of studied children were 30. Mean age was 10.2±3.1 year and Male female ratio was 5:1. Most of the patient arrived from poor socio-economic (83.33%) background of rural area (66.67%) of Bangladesh. Among them 46.67% had history of measles infection during early childhood. Progressive deterioration of school performance (50%), gait disturbance (70%), myoclonus (83%) dysarthria (43%) and Ocular manifestations like optic atrophy & papilledema (83.33%) were the main presenting feature of our studied children. All of the patients (100%) showed positive measles specific antibody IgG in CSF and On electroencephalographic findings showed periodic burst suppression in 90.90% cases. Most of the children (56.6%) were in stage II category and other 3.3%, 33.3%,6.6%, were stage I, stage III, stage IV category respectively. Neuroimaging study showed abnormalities in 45.83% cases included periventricular white matter hyper intense signal changes, cortical atrophy and ischaemic change. Conclusion: In our study most of the SSPE patient were in stage II.About half of the patient had history of measles infection during early childhood. Neuroimaging abnormalities found in about half of the cases and majority cases were in stage II. Common neuroimaging abnormalities were periventricular white matter hyper intense signal changes and cortical atrophy.

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Parent Perceptions of the Value of Pediatric Neurology Clinic Visits

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100001530 ◽

2001 ◽

Vol 28 (4) ◽

pp. 319-321 ◽

Cited By ~ 2

Author(s):

J.M. Dooley ◽

K.E. Gordon ◽

E.P. Wood

Keyword(s):

Care Delivery ◽

Tertiary Care ◽

Alternative Methods ◽

Pediatric Neurology ◽

Before And After ◽

Neurology Clinic ◽

Potential Alternative ◽

Care Costs ◽

Clinic Visits

Background:There is little data available on the acceptability to parents, of alternate methods of delivering care to their children. This pilot study explored parents'perceptions of conventional clinic visits and their attitudes to potential alternative methods of delivering care.Methods:Questionnaires were completed by the families of 200 consecutive children before and after a visit to a tertiary-care Pediatric Neurology Clinic in Nova Scotia, Canada.Results:Responses were received from 172 (86%) for the first questionnaire and 138 (69%) for the second. There were 59 new referrals, 76 follow-up visits and 39 were seen because of new concerns. Visiting the clinic resulted in school absenteeism for 85% of the children and lost pay for 19% of the parents. Telephone, video conference or replacement of the physician by a nurse practitioner were acceptable alternate methods of assessment for only 10%. The only factor which was associated with willingness to accept telephone as an assessment modality was an initial opinion that the visit was unnecessary.Conclusion:Escalating health care costs and limited specialist availability demand consideration of alternate methods of care delivery. Although adults seem comfortable with care outside the usual clinic setting, there is little data for the pediatric setting. The responses from the parents attending our clinic, indicate that families were happy with services offered in the conventional clinic. In contrast, only 10% found potential alternate methods acceptable. These opinions must be considered in the design of new methods of caring for children.

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A study of clinical, etiological and neurodevelopmental profile of epilepsy in children aged 0-5 years

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20212470 ◽

2021 ◽

Vol 8 (7) ◽

pp. 1189

Author(s):

Vaishali R. Chanpura ◽

Hardev T. Mori

Keyword(s):

Early Childhood ◽

Perinatal Asphyxia ◽

Primary Diagnosis ◽

Idiopathic Epilepsy ◽

Childhood Epilepsy ◽

Perinatal Complications ◽

Acute Seizures ◽

Neurological Problem ◽

One Year ◽

Systemic Examination

Background: Seizures constitute the most common neurological problem in children. Appropriate diagnosis and management of childhood epilepsy is essential to improve quality of life in them. Objectives of the study were to study the clinical and etiological profile of early childhood epilepsy and its effect on neurodevelopment.Methods: This was a time bound study; duration being one year from September, 2018 to September 2019. All new patients with acute seizures or status epilepticus admitted in paediatric emergency ward were evaluated and those meeting inclusion criteria were enrolled. On the basis of history, neurological and systemic examination and available investigations primary diagnosis of epilepsy was reached. Neurodevelopmental parameters like vision, hearing, and DQ were assessed. EEG was done in all patients. Other relevant investigations like neuroimaging were carried out when indicated. Collected data was analysed in form of frequency and percentage.Results: A total of 52 patients were enrolled. 60% patients were younger than 2 years. Maximum patients had generalised convulsions; generalised tonic-clonic being the most prevalent. 38% patients had significant perinatal complications like perinatal asphyxia, pyogenic meningitis and kernicterus. Fifty per cent patients had delayed milestones and half of those had severe delay. 67% had abnormal EEG and 20 patients had abnormal neuro-imaging findings. The most common etiologies for epilepsy were hypoxic ischaemic encephalopathy, idiopathic, epilepsy syndromes, metabolic disorders and CNS infections.Conclusions: Majority of early childhood epilepsy is a result of either genetic conditions or perinatal events. They have neurodevelopmental and behavioural associations. While treating epilepsy all these factors should be considered in order to ensure a near-normal life for these patients.

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Cardiometabolic outcomes in children and adolescents with West syndrome

BMC Pediatrics ◽

10.1186/s12887-021-02871-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Inbar Gilboa ◽

Galit Israeli ◽

Avivit Brener ◽

Michal Yackobovitch-Gavan ◽

Uri Kramer ◽

...

Keyword(s):

Early Childhood ◽

Medical Center ◽

Density Lipoprotein ◽

West Syndrome ◽

Group Differences ◽

Significant Group ◽

Diastolic Hypertension ◽

Z Scores ◽

Obesity Hypertension

Abstract Background West syndrome is a convulsive disorder of infancy with unique seizures and a characteristic background electroencephalograph pattern. Adrenocorticotropic hormone (ACTH) is effective in spasm cessation, yet metabolic consequences of this therapeutic agent in childhood have not been published. Methods In this observational study we explored the cardiometabolic outcomes of 117 children with West syndrome (78 ACTH-treated and 39 non-ACTH-treated) monitored at a single medical center from 1995 to 2019 (median follow-up 7.2 years). Outcomes included the prevalence of cardiometabolic derangements (obesity, hypertension, and dyslipidemia) during infancy (< 2 years), early childhood (2–6 years), and childhood/adolescence (6–18 years). Results The rates of metabolic derangements during infancy in the West syndrome cohort were high compared to childhood/adolescence (obesity 27.3 % vs. 3.3 %, [p = 0.010], diastolic hypertension 48.8 % vs. 5.1 % [p < 0.001], hypertriglyceridemia 71 % vs. 40 % [p = 0.008], low high-density lipoprotein cholesterol [HDL-c] 54.2 % vs. 12.9 % [p = 0.001], and elevated triglycerides/HDL-c ratios 62.5 % vs. 12.9 % [p < 0.001]). The proportion of systolic and/or diastolic blood pressure levels categorized as hypertensive was 58.5 % during infancy, 48.1 % during early childhood, and 26.3 % during childhood/adolescence. ACTH-treated patients had higher weight and weight-to-length z-scores and higher triglyceride levels during infancy compared to non-ACTH-treated patients (p = 0.008, p = 0.001, and p = 0.037, respectively), and higher triglyceride levels during early childhood (p = 0.050), with no significant group differences during childhood/adolescence. Conclusions Children with West syndrome apparently have an increased prevalence of cardiometabolic derangements more pronounced in infants and in ACTH-treated patients. These findings highlight the need to monitor these children for cardiometabolic derangements, even though these cardiometabolic abnormalities are transitory and tend to decrease with time. The health implications of cardiometabolic derangements during critical windows of growth and development warrant further investigation.

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