PROFILE OF HISTORY OF FEBRILE SEIZURE IN PATIENTS WITH EPILEPSY

Background: Febrile seizure is convulsions with fever (temperature ³38°C) with no central nervous system infection that commonly found in children (6-60 months). Febrile seizures do not always mean the child has epilepsy. However, febrile seizures can be a possible long-term risk factor for epilepsy. Objective: The objective of this study is to know the profile of febrile seizure in patients with epilepsy. Methods: A retrospective descriptive study on 23 patients with epilepsy in the EEG Department of Neurology, Dr. Soetomo General Hospital, Surabaya, Indonesia in the period 2018-2019 based on inclusion and exclusion criteria. The total number of epilepsy patients is 849 patients, 216 of whom had a history of febrile seizure. Among 216 epilepsy patients who had a history of febrile seizures, 23 of them were qualified as the sample. The sampling technique used was total population sampling. The instrument of this research is the patients’ medical record. Data analysis is carried out descriptively. Results: The characteristics of the history of febrile seizures that found in patients with epilepsy are more patients are male, have the age of onset on less than 2 years old, have the body temperature more than 38.3°C, have the seizure duration less than 15 minutes, have focal seizures, have recurrent seizures in 24 hours, have a history of more than one febrile seizure, have accompanying neurological disorders, and have no family history of epilepsy. Conclusion: Febrile seizure is still becoming a concern because there is a possibility that it may develop into epilepsy. Even though, not all children who experience febrile seizure will generate epilepsy.

Lamotrigine Induced DRESS Syndrome in a Child: A Case Report and Literature Review

Lamotrigine is an important anticonvulsant drug. Its use, however, has been limited by the risk of potentially life-threatening dermatological reactions, such as a drug reaction with eosinophilia and systemic symptoms (DRESS). Here, we report the case of a 7-year-6-month-old girl with a history of epilepsy who developed a skin rash with dyspnoea after 2 weeks of lamotrigine treatment, with DRESS ultimately being diagnosed. After discontinuation of the offending drug and the initiation of systemic glucocorticosteroids, the DRESS symptoms were relieved and the patient was discharged in a stable condition. Anticonvulsant drugs such as lamotrigine are among the factors that induce DRESS in children. When a patient displays skin rash and systemic organ involvement following the initiation of an anticonvulsant drug, DRESS should not be overlooked as a diagnosis, and immunosuppressant drugs should be considered as an option for treating DRESS patients.

Historical Sources on Epilepsy Surgery: From Antiquity Through the End 20th Century

The history of epilepsy is an associate of humanity, and the reports date back to antiquity. Almost all ancient cultures, including the Babylonians, Egyptians, Greeks, Indians in pre-Buddhist period, Iranians, Chinese, and Byzantine epoch, bear witness to epilepsy. Therefore, the earliest beginnings of surgical treatment and epilepsy surgery can be traced back to antiquity. Trepanation as an attempt to treat the disease has often been found in prehistorical tombs (Neolithicum). In antiquity, fasting, a healthy diet, regulation of excretions, medical gymnastics and a decent lifestyle were used as treatment for epilepsy as a non-surgical solution. In the Middle Ages, the basis for treatment fell into three main categories: Conventional (diet and botanical remedies), magical (phases of the moon, trephining of the skull) and religious beliefs (fasting, prayer, exorcisms, and social marginalization). The first neurosurgical operations on epileptic patients with focal semiology were performed during the early 19th century, and began with Godlee, Sommer, Macewen and later Horsley. From that time on, discoveries on epilepsy surgery progressed at a faster pace that started in a historical journey from ancient times until the end of the 20th century.

Risk and outcomes of diabetes in patients with epilepsy

The risk and outcomes of diabetes in patients with epilepsy remains unclear. We evaluated these risks using an epilepsy cohort analysis and a diabetes admission analysis. In the epilepsy cohort analysis, we identified 2854 patients with newly diagnosed epilepsy in 2000–2008 from the research data of National Health Insurance in Taiwan. Using Propensity-score matching by sociodemographic factors and medical conditions, we selected 22,832 people without epilepsy as a non-exposed cohort for comparison. Follow-up events of diabetes from January 1, 2000 until December 31, 2013 were ascertained from medical claims. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of diabetes associated with epilepsy were calculated using multiple Cox proportional hazard models. In the diabetes admission analysis, we identified 92,438 hospitalized diabetes patients, 930 of whom had a history of epilepsy. Adjusted odds ratios (ORs) and 95% CIs of adverse events after diabetes associated with previous epilepsy were calculated using multiple logistic regressions. The adjusted HR of diabetes in the cohort with epilepsy was 1.31 (95% CI 1.14–1.50) compared to the non-epilepsy cohort. Previous epilepsy was associated with post-diabetes adverse events, such as pneumonia (OR 1.68, 95% CI 1.37–2.07), urinary tract infection (OR 1.83, 95% CI 1.55–2.16), and septicemia (OR 1.34, 95% CI 1.09–1.65). In conclusion, epilepsy was associated with higher risk of diabetes and adverse post-diabetes outcomes. Diabetes prevention and attention to post-diabetes adverse events are needed for this susceptible population.

Risk factors for developing epilepsy in children with cerebral pals

Aim. To identify the most important risk factors affecting the development of epilepsy in children with cerebral palsy. Methods. The study included 160 cerebral palsy patients with and without epilepsy who received treatment at the Baku Children's Neurological Hospital. The patients were divided into 2 groups. The first group consisted of 110 (68.7%) patients with cerebral palsy and epilepsy, and the second group consisted of 50 (31.3%) patients with cerebral palsy. The age of children ranged from 1 to 14 years. Statistical data processing was performed by using the SPSS software version 16.0. The Chi-square test was used to compare categorical measurements. T-test for independent groups was used for comparison between groups of continuous measurements. Binary logistic regression was used for determining the risk factors. In all tests, the level of statistical significance was set at p 0.05. Results. There was no significant difference in age and gender distribution between groups (p=0.492 and p=0.818, respectively). 10 (9.1%) children in the main group had a positive family history of epilepsy (odds ratio 8.08, p=0.028). Neonatal seizures were observed in 25 (22.7%) children in the main group and 3 (6%) children in the control group (odds ratio 4.4, p=0.010). The presence of infection during pregnancy in the mother was found in both the main (39.1%) and control (20%) groups (odds ratio 2.6, p=0.018). Level IV of the Gross Motor Function Classification System (GMFCS) was the most frequent among patients with epilepsy (odds ratio 12.8; p=0.035). The incidence rate of epilepsy among cerebral palsy patients was 68.7%. The mean age of onset of seizures was 19.226.6 months. The most frequent epileptic seizures (55.5%) occurred in spastic quadriplegic cerebral palsy. Conclusion. The presence of a positive family history of epilepsy, neonatal seizures, maternal infection during pregnancy and severe GMFCS level were identified as factors for the development of epilepsy in patients with cerebral palsy; premature birth, presence of hypoxic-ischemic injury, low birth weight, consanguineous marriage, multiple pregnancies, or gender were not identified as risk factors for the development of epilepsy in children.

Metabolic Seizures

Metabolic diseases should always be considered when evaluating children presenting with seizures. This is because many metabolic disorders are potentially treatable and seizure control can be achieved when these diseases are appropriately treated. Seizures caused by underlying metabolic diseases (metabolic seizures) should be particularly considered in unexplained neonatal seizures, refractory seizures, seizures related to fasting or food intake, seizures associated with other systemic or neurologic features, parental consanguinity, and family history of epilepsy. Metabolic seizures can be caused by various amino acids metabolic disorders, disorders of energy metabolism, cofactor-related metabolic diseases, purine and pyrimidine metabolic diseases, congenital disorders of glycosylation, and lysosomal and peroxisomal disorders. Diagnosing metabolic seizures without delay is essential because the immediate initiation of appropriate therapy for many metabolic diseases can prevent or minimize complications.

Status Epilepticus During Recovery from General Anesthesia

Propofol is an anesthetic agent commonly used for sedation and induction and/or maintenance of general anesthesia and presents an inhibitory effect on the excitatory neurotransmitters through GABA receptors. Although propofol is an agent that can be used to treat status epilepticus because of its anticonvulsant property, it may cause epileptiform convulsions, as reported in the literature. In this case report, a young patient’s epileptiform convulsions after administering a single dose of propofol injection for general anesthesia are presented. Due to uncontrolled epilepsy episodes following extubation, the patient was taken to intensive care. The patient regained consciousness, and epileptic attacks were controlled on the 4th day of intensive, was taken to the neurology service. We consider that this case is noteworthy concerning the association between propofol and epilepsy in anesthesia. Thus, this study aimed to draw attention to propofol in patients with a history of epilepsy.

Spurious electroencephalographic activity due to pulsation artifact in the depth of anesthesia monitor

Background The depth of anesthesia (DOA) is estimated based on the anesthesia-induced electroencephalogram (EEG) changes. However, the surgical environment, as well as the patient him/herself, generates electrical interferences that cause EEG waveform distortion. Case presentation A 52-year-old patient required general anesthesia due to the right femur necrotizing fasciitis. He had no history of epilepsy or head injury. His cardiovascular status was stable without arrhythmia under propofol and remifentanil anesthesia. The DOA was evaluated with Root® with SedLine® Brain Function Monitoring (Masimo Inc, Irvine, CA). The EEG showed a rhythmic, heart rate time-locked pulsation artifact, which diminished after electrode repositioning. Offline analysis revealed that the pulse wave-like interference in EEG was observed at the heart rate frequency. Conclusions We experienced an anesthesia case that involves a pulsation artifact generated by the superficial temporal artery contaminating the EEG signal. Numerous clinical conditions, including pulsation artifact, disturb anesthesia EEG.

Approaches to teaching children with epilepsy and/or past status epilepticus (within the prin- ciples of inclusive education)

This article discusses the problem of school education as one of the aspects of social adaptation of children diagnosed with epilepsy and / or children with a history of status epilepticus. The authors provide statistical data on the prevalence of epilepsy among children of different ages and information on disease control. We collected the data of patients followed-up in Mytishchi Children’s Polyclinic No. 4. Using our own experience and publications of other authors, we have developed a number of recommendations that can potentially make the presence of a child with a history of epilepsy and / or status epilepticus in an educational institution more comfortable and safe. In particular, we have suggested creating an emergency plan for each child in case of seizures. This plan should be given to a healthcare professional working in the educational institution, as well as to teachers who are responsible for the life and health of the child during classes.