scholarly journals Comparative efficacy of IV phenytoin, IV valproate and IV levetiracetam in childhood seizures

2019 ◽  
Vol 6 (4) ◽  
pp. 1592
Author(s):  
Sheeraz A. Dar ◽  
Wasim A. Wani ◽  
Mudasir Nazir ◽  
Zul Eidain Hussan
Keyword(s):  
Pediatric Patients ◽  
Seizure Control ◽  
Randomized Study ◽  
P Value ◽  
Age Group ◽  
Seizure Recurrence ◽  
Comparative Efficacy ◽  
Acute Setting ◽  
Neurologic Disorder

Background: Seizures are the most common pediatric neurologic disorder, with 4% to 10% of children suffering at least one seizure in the first 16 years of life objectives to compare efficacy of IV phenytoin, IV valproate, and IV levetiracetam in childhood seizures between 2months to 16 years of age.Methods: This prospective, randomized, study was done on pediatric patients in the age group of 2 months to 16 years who present actively convulsing to the emergency department of pediatrics.Results: At 24 hours seizures were controlled in 44 (88%) patients out of 50 patients in phenytoin group, 39 (78%) out of 50 patients in levetiracetam group and 46 (92%) out of 50 patients in valproate group (p-value 0.115). The relative risk of seizure recurrence for levetiracetam and phenytoin groups when compared to valproate was 2.75 and 1.5, respectively.Conclusions: Present study demonstrates that IV levetiracetam and IV valproate were comparable to IV phenytoin in terms of seizure control in acute setting. All the three are safe and efficacious. Time to regain consciousness was less in valproate group and long-term seizure control too was also better.

scholarly journals Epilepsy surgery related to pediatric brain tumors: Miami Children’s Hospital experience

2015 ◽  
Vol 16 (6) ◽  
pp. 675-680 ◽  
Author(s):  
Aria Fallah ◽  
Alexander G. Weil ◽  
Samir Sur ◽  
Ian Miller ◽  
Prasanna Jayakar ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Brain Tumors ◽  
Epilepsy Surgery ◽  
Pediatric Patients ◽  
Pediatric Brain Tumors ◽  
Seizure Freedom ◽  
Seizure Recurrence ◽  
Children's Hospital ◽  
Pediatric Brain

OBJECT Pediatric brain tumors may be associated with medically intractable epilepsy for which surgery is indicated. The authors sought to evaluate the efficacy of epilepsy surgery for seizure control in pediatric patients with brain tumors. METHODS The authors performed a retrospective review of consecutive patients undergoing resective epilepsy surgery related to pediatric brain tumors at Miami Children’s Hospital between June 1986 and June 2014. Time-to-event analysis for seizure recurrence was performed; an “event” was defined as any seizures that occurred following resective epilepsy surgery, not including seizures and auras in the 1st postoperative week. The authors analyzed several preoperative variables to determine their suitability to predict seizure recurrence following surgery. RESULTS Eighty-four patients (47 males) with a mean age (± standard deviation) of 8.7 ± 5.5 years (range 0.5–21.6 years) were included. The study included 39 (46%) patients with gliomas, 20 (24%) with dysembryoplastic neuroepithelial tumors (DNETs), 14 (17%) with gangliogliomas, and 11 (13%) with other etiologies. Among the patients with gliomas, 18 were classified with low-grade glioma, 5 had oligodendroglioma, 6 had uncategorized astrocytoma, 3 had pilocytic astrocytoma, 3 had pleomorphic xanthoastrocytoma, 3 had glioblastoma, and 1 had gliomatosis cerebri. Seventy-nine (94.0%) resections were guided by intraoperative electrocorticography (ECoG). The mean time (± standard deviation) to seizure recurrence was 81.8 ± 6.3 months. Engel Class I outcome was achieved in 66 (78%) and 63 (75%) patients at 1 and 2 years’ follow-up, respectively. Patients with ganglioglioma demonstrated the highest probability of long-term seizure freedom, followed by patients with DNETs and gliomas. In univariate analyses, temporal location (HR 1.75, 95% CI 0.26–1.27, p = 0.171) and completeness of resection (HR 1.69, 95% CI 0.77–3.74, p = 0.191) demonstrated a trend toward a longer duration of seizure freedom. CONCLUSIONS ECoG-guided epilepsy surgery for pediatric patients with brain tumors is highly effective. Tumors located in the temporal lobe and those in which a complete ECoG-guided resection is performed may result in a greater likelihood of long-term seizure freedom.

scholarly journals Cardiomyopathy Associated with Anti-SARS-CoV-2 Vaccination: What Do We Know?

Viruses ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2493
Author(s):  
Alfredo Parra-Lucares ◽  
Luis Toro ◽  
Sebastián Weitz-Muñoz ◽  
Cristóbal Ramos
Keyword(s):  
Messenger Rna ◽  
Pediatric Patients ◽  
Low Frequency ◽  
The Elderly ◽  
Autoimmune Response ◽  
Age Group ◽  
Medium Term ◽  
Moderate Severity ◽  
Term Evolution

The SARS-CoV-2 pandemic has mobilized many efforts worldwide to curb its impact on morbidity and mortality. Vaccination of the general population has resulted in the administration of more than 6,700,000,000 doses by the end of October 2021, which is the most effective method to prevent hospitalization and death. Among the adverse effects described, myocarditis and pericarditis are low-frequency events (less than 10 per 100,000 people), mainly observed with messenger RNA vaccines. The mechanisms responsible for these effects have not been specified, considering an exacerbated and uncontrolled immune response and an autoimmune response against specific cardiomyocyte proteins. This greater immunogenicity and reactogenicity is clinically manifested in a differential manner in pediatric patients, adults, and the elderly, determining specific characteristics of its presentation for each age group. It generally develops as a condition of mild to moderate severity, whose symptoms and imaging findings are self-limited, resolving favorably in days to weeks and, exceptionally, reporting deaths associated with this complication. The short- and medium-term prognosis is favorable, highlighting the lack of data on long-term evolution, which should be determined in longer follow-ups.

Multilobar Epilepsy Surgery in Childhood and Adolescence: Predictors of Long-Term Seizure Freedom

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. 174-182
Author(s):  
Evangelos Kogias ◽  
Thomas Bast ◽  
Susanne Schubert-Bast ◽  
Gert Wiegand ◽  
Armin Brandt ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Seizure Control ◽  
Focal Cortical Dysplasia ◽  
Benign Tumors ◽  
Seizure Freedom ◽  
Childhood And Adolescence ◽  
Epileptogenic Zone ◽  
Seizure Recurrence ◽  
Eloquent Cortex

Abstract BACKGROUND Although multilobar resections correspond to one-fifth of pediatric epilepsy surgery, there are little data on long-term seizure control. OBJECTIVE To investigate the long-term seizure outcomes of children and adolescents undergoing multilobar epilepsy surgery and identify their predictors. METHODS In this retrospective study, we considered 69 consecutive patients that underwent multilobar epilepsy surgery at the age of 10.0 ± 5.0 yr (mean ± SD). The magnetic resonance imaging revealed a lesion in all but 2 cases. Resections were temporo-parieto(-occipital) in 30%, temporo-occipital in 41%, parieto-occipital in 16%, and fronto-(temporo)-parietal in 13% cases. Etiologies were determined as focal cortical dysplasia in 67%, perinatal or postnatal ischemic lesions in 23%, and benign tumors in 10% of cases. RESULTS At last follow-up of median 9 yr (range 2.8-14.8), 48% patients were seizure free; 33% were off antiepileptic drugs. 10% of patients, all with dysplastic etiology, required reoperations: 4 of 7 achieved seizure freedom. Seizure recurrence occurred mostly (80%) within the first 6 mo. Among presurgical variables, only an epileptogenic zone far from eloquent cortex independently correlated with significantly higher rates of seizure arrest in multivariate analysis. Among postsurgical variables, the absence of residual lesion and of acute postsurgical seizures was independently associated with significantly higher rates of seizure freedom. CONCLUSION Our study demonstrates that multilobar epilepsy surgery is effective regarding long-term seizure freedom and antiepileptic drug withdrawal in selected pediatric candidates. Epileptogenic zones–and lesions–localized distant from eloquent cortex and, thus, fully resectable predispose for seizure control. Acute postsurgical seizures are critical markers of seizure recurrence that should lead to prompt reevaluation.

Sternotomy versus Mini-Sternotomy in Pediatric Patients undergoing Modified Blalock-Taussig Shunt

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Sherif Azab ◽  
Ashraf A El Midany ◽  
Ayman A Doghish ◽  
Abdelfatah E Salah El-din Abugabal
Keyword(s):  
Pediatric Patients ◽  
Randomized Study ◽  
Young Infant ◽  
Cardiac Anomaly ◽  
P Value ◽  
Safe Alternative ◽  
Icu Stay ◽  
Superficial Wound ◽  
Pulmonary Arterial ◽  
Blalock Taussig Shunt

Abstract Background In the present era, primary correction is the preferred approach to the neonate or young infant with a cardiac anomaly who has two ventricles. However, when only one functional ventricle is present or pulmonary blood flow is reduced, an initial palliative systemic-to-pulmonary arterial shunt is mandatory. In this study we compare post-operative short term outcomes of sternotomy versus mini-sternotomy approaches in pediatric patients undergoing Modified Blalock Taussig Shunt. Patients and Methods A prospective randomized study was conducted on 90 patients who were schedueled for MBT shunt due to a group of cyanotic heart disease. They comprised 2 groups G1: sternotomy group (n = 45) and G2: ministernotomy group (n = 45). Results Mean age was 11± 3.39 months and mean weight was 6.75±1.96 kg in the sternotomy group, while for ministernotomy group the mean age was 10.55± 4.65 and mean weight was 7.00±2.03 kg. The change (%) between preoperative and postoperative oxygen saturation was 35.6% for sternotomy group and 43.8% for ministernotomy group. There were seven cases of mortality (15.6%) in sternotomy grouped compared to three cases of mortality (6.7%) in ministernotomy with P value of 0.314. Superficial wound infection occurred in one case (2.2%) in each group. Mean duration of ventilation was 52.53 ± 15.76 h for sternotomy group and 46.93±19.23 h for ministernotomy group with P value of 0.025, mean ICU stay was 7.42 ± 2.94 days for sternotomy group and 5.13± 2.37 days for ministernotomy with P value of < 0.001. Conclusion Upper ministernotomy is a safe alternative approach for MBT shunt in pediatric patients. It provides the advantages of less ventilation time, less post operative bleeding, and ICU stay.

Cumulative Efficacy and Safety of 5-Year Deferasirox (Exjade®) Treatment in Pediatric Patients with Thalassemia Major: A Phase II Multicenter Prospective Trial

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5413-5413 ◽  
Author(s):  
Antonio Piga ◽  
Kamila Kebaili ◽  
Renzo Galanello ◽  
Valentine Jehl ◽  
Corinne Rebischung ◽  
...  
Keyword(s):  
Iron Overload ◽  
Children And Adolescents ◽  
Sexual Development ◽  
Pediatric Patients ◽  
Prospective Trial ◽  
Thalassemia Major ◽  
Age Group ◽  
Iron Intake ◽  
Relative Change

Abstract Background: Pediatric thalassemia major (TM) patients may begin lifelong iron chelation therapy (ICT) as early as 2 years to avoid potential complications of iron overload, such as impaired growth and the later development of cardiac dysfunction. Deferasirox (Exjade®), administered orally once daily, was developed to improve compliance to long-term ICT in patients with transfusion-dependent anemias. We report cumulative efficacy, safety and development data in pediatric patients with transfusion-dependent TM treated with deferasirox for 5 years (study 106). Methods: Pediatric TM patients stratified into two age groups (children 2-≤12 years; adolescents 12–17 years) were enrolled in study 106 and received deferasirox 10 mg/kg/day for 1 year. Patients completing the 1 year study were able to continue deferasirox treatment for an additional 4 years at adjusted doses, to evaluate long term safety and effect on liver iron concentration (LIC). Safety was assessed by the incidence and type of adverse events (AEs), laboratory parameters and growth/sexual development. Efficacy was evaluated by changes in LIC by SQUID. Results: 20 children (mean age 6.7±2.8 years) and 20 adolescents (mean age 14.1±1.6 years) were enrolled. Children had a greater mean iron intake (0.46–0.49 mg/kg/day) than adolescents (0.39–0.41 mg/kg/day). Median exposure to deferasirox was 5.0 years for children, 5.5 years for adolescents; mean dose in children and adolescents was 18.9±5.7 and 20.9±4.5 mg/kg/day, respectively. On average, 30% of children and 10% of adolescents received <15 mg/kg/day. Mean final dose was 26.3 mg/kg/day for children and 27.8 mg/kg/day for adolescents. Relative change in LIC over the treatment period is shown in Figure 1. Figure 1. Boxplot of relative change in LIC during deferasirox treatment, by age group Figure 1. Boxplot of relative change in LIC during deferasirox treatment, by age group Overall, 24 patients (60.0%; 11 children and 13 adolescents) completed the 5-year study. Reasons for discontinuation were AEs (n=8), consent withdrawal (n=7), unsatisfactory therapeutic effect (n=1). Most common AEs were cough, pyrexia (n=34, 85%) and rhinitis (n=30, 75%); the annual frequency of reported AEs did not increase from year to year and generally occurred in similar proportions for children and adolescents. One child had a serious AE (increased transaminases) assessed as drug-related. Two other patients had an ALT increase >10 × ULN on at least one visit; baseline levels were >8 × ULN in one patient, and normal in the other. Both patients were restarted on deferasirox after 2 week interruptions without further incident. No patient had an increase in serum creatinine >33% above baseline and ULN at two consecutive visits. Neutropenia (neutrophil count <1.5×109/L at two consecutive visits), assessed unrelated to treatment, occurred in one child and two adolescents. There were no clinically significant visual defects and one child had a drug-related audiometric abnormality (hypoacusis). Physical development was normal in both groups; growth velocity was higher in children. Sexual development progressed normally in adolescents. Conclusions: Deferasirox dose-dependently reduced iron overload over 5 years of treatment in these heavily transfused pediatric patients with TM. Dose increases over time, with a stable iron intake, were associated with a decrease in LIC for both groups, but the reduction in LIC was greater in adolescents. Despite having a higher transfusional iron intake, more children than adolescents were on a dose <15 mg/kg/day, highlighting that transfusional iron intake should be considered when selecting deferasirox dose. Deferasirox was generally well tolerated. There was no evidence of progressive renal, hepatic or bone marrow dysfunction. Deferasirox treatment had no negative impact on growth and sexual development.

scholarly journals Antiseizure Medication Withdrawal in Seizure-Free Patients: Practice Advisory Update Summary

Neurology ◽  
2021 ◽  
Vol 97 (23) ◽  
pp. 1072-1081
Author(s):  
David Gloss ◽  
Kimberly Pargeon ◽  
Alison Pack ◽  
Jay Varma ◽  
Jacqueline A. French ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Seizure Freedom ◽  
Insufficient Evidence ◽  
Seizure Recurrence ◽  
Medication Withdrawal ◽  
Significant Difference ◽  
Practice Advisory ◽  
American Academy Of Neurology

ObjectiveTo update a 1996 American Academy of Neurology practice parameter.MethodsThe authors systematically reviewed literature published from January 1991 to March 2020.ResultsThe long-term (24–60 months) risk of seizure recurrence is possibly higher among adults who have been seizure-free for 2 years and taper antiseizure medications (ASMs) vs those who do not taper ASMs (15% vs 7% per the 1 Class I article addressing this issue). In pediatric patients, there is probably no significant difference in seizure recurrence between those who begin tapering ASMs after 2 years vs 4 years of seizure freedom, and there is insufficient evidence of significant difference in risk of seizure recurrence between those who taper ASMs after 18 months of seizure freedom and those tapering after 24 months. There is insufficient evidence that the rate of seizure recurrence with ASM withdrawal following epilepsy surgery after 1 year of seizure freedom vs after 4 years is not significantly different than maintaining patients on ASMs. An epileptiform EEG in pediatric patients increases the risk of seizure recurrence. ASM withdrawal possibly does not increase the risk of status epilepticus in adults. In seizure-free adults, ASM weaning possibly does not change quality of life. Withdrawal of ASMs at 25% every 10 days to 2 weeks is probably not significantly different from withdrawal at 25% every 2 months in children who are seizure-free in more than 4 years of follow-up.RecommendationsFourteen recommendations were developed.

scholarly journals Camphor induced status epilepticus: a case report

2018 ◽  
Vol 5 (3) ◽  
pp. 1140
Author(s):  
Rahumath Ajeetha ◽  
Anand Ramakrishnan ◽  
Benjamin Sagayaraj
Keyword(s):  
Status Epilepticus ◽  
Seizure Control ◽  
Lethal Dose ◽  
Age Group ◽  
Seizure Recurrence ◽  
Accidental Ingestion ◽  
Complete Evaluation ◽  
Toxic Compound ◽  
Small Doses ◽  
Author Report

Camphor is very toxic compound, which can be fatal for infants and children even if ingested in very small doses. Around 3-5 ml of 20% camphor oil or >30mg/Kg is a potentially lethal dose. Camphor is used very frequently for house hold purposes. The chances of accidental ingestion by children are high particularly in toddlers. Here author report 2 years old previously well child brought with status epilepticus with no apparent trigger. Child required benzodiazipine, phenytoin and levetiracetam loading for seizure control and was ventilated. Complete evaluation for seizure cause was planned post stabilization, but during intubation camphor odour was noticed and parents accepted a possibility of camphor ingestion. Hence seizure was attributed to camphor toxicity. Further evaluation was withheld. Child had no seizure recurrence and AED was stopped prior to discharge after documenting normal neurological examination and EEG. This case highlights the need for considering camphor poisoning as a cause of status epilepticus in the toddler age group and importance of proper enquiry about possible exposure and complete examination including odour in all cases of unprovoked seizures in children which can help us avoid unnecessary investigations searching for the cause of status epilepticus.

scholarly journals Long-Term Antithyroid Treatment in Pediatric and Juvenile Graves’ Disease

2020 ◽  
Vol 18 (Suppl) ◽  
Author(s):  
Hossein Delshad ◽  
Miralireza Takyar
Keyword(s):  
Pediatric Patients ◽  
Radioactive Iodine ◽  
Remission Rate ◽  
Current Evidence ◽  
Graves Disease ◽  
Age Group ◽  
Pediatric Age ◽  
Pediatric Age Group ◽  
Review Articles

Context: Thyroid hormones can affect the development and function of the central nervous system and various other organs. As such, the pathologic excess of these hormones, known as thyrotoxicosis, can be the source of significant damage during childhood and adolescence. The objective of this study was to review the management of Graves’ disease (GD) in the pediatric age group, especially concerning long-term antithyroid drug (ATD) treatment. Evidence Acquisition: A thorough search of literature published from 1980 to 2019 was performed in PubMed only for English language literature. The following key terms were used: “Graves’ disease, hyperthyroidism, thyrotoxicosis in children, thyrotoxicosis remission, thyrotoxicosis relapse, definite therapy, radioactive iodine, thyroidectomy, anti-thyroid drugs, propylthiouracil, methimazole, and carbimazole”. We also did a thorough search in review articles, observational studies, open-label/controlled randomized/non-randomized trials, and meta-analyses, as well as the articles cited by textbooks, chapters, and review articles, which led us to locate older sources of information on the topic. Results: More than 90% of thyrotoxicosis in the pediatric age group is attributable to GD. A host of strategies, including ATDs, radioiodine therapy, and surgery, are employed to treat this entity. However, there is still significant controversy regarding the most optimal strategy. Current evidence suggests that ATDs are the best initial treatment in pediatric patients with GD. Although ATDs are widely used, the duration of their administration is controversial and varies significantly between protocols. A major problem is the high relapse rate (up to 70%), but extending the duration of such treatment could potentially bring the remission rate up to 88%. Indications for using radioactive iodine treatment include the lack of remission following years of receiving ATDs, poor compliance, and the emergence of a major side effect. In pediatric patients aged five-years-old or younger who suffer from very large goiter, severe ophthalmopathy, and persistent hyperthyroidism, as well as those with the lack of response to or showing adverse effects of ATDs, it is advisable to consider total or near-total thyroidectomy. Conclusions: Antithyroid drugs are the mainstay of treatment of juvenile GD, and long-term methimazole therapy increases the remission rate in pediatric GD.

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