Efficacy of Pyridoxine in Early-Onset Idiopathic Intractable Seizures in Children
|
|
- Georgia Boone
- 6 years ago
- Views:
Transcription
1 Indian J Pediatr (2010) 77: DOI /s y ORIGINAL ARTICLE Efficacy of Pyridoxine in Early-Onset Idiopathic Intractable Seizures in Children Devendra Mishra & Veena Kalra & Rachna Seth & Sheffali Gulati & Narayan Saha Received: 9 April 2009 / Accepted: 18 August 2010 / Published online: 10 September 2010 # Dr. K C Chaudhuri Foundation 2010 Abstract Objective To identify pyridoxine responsive seizures among children with early onset intractable seizures, and to identify pyridoxine-dependency as a subset in this group. Methods Patients with neonatal onset idiopathic, intractable seizures were identified over a 6-month period and subjected to a pyridoxine trial, at the Pediatric Neurology Clinic of a tertiary-care teaching hospital in New Delhi, India. This consisted of an intravenous infusion of 100 mg of pyridoxine over 10-min with a simultaneous EEG monitoring. This procedure was carried out in the EEG laboratory with all appropriate precautions (including availability of resuscitation equipment and trained personnel). Continuous EEG monitoring was done throughout the infusion and till 20 min later, to look for correction of EEG abnormalities. All patients were then prescribed oral pyridoxine, mg/kg/day divided TDS for 6 weeks, in addition to their current anticonvulsant therapy. Patients were reviewed every 15 days regarding compliance and change in seizure frequency. A reduction in seizure frequency by 50% of the baseline was considered as response (significant change), meriting further continuation of pyridoxine therapy. In patients who remained seizure free on pyridoxine therapy, previous anti-epileptics were gradually tapered one by one. Devendra Mishra, Rachna Seth and Narayan Saha: Enrolled patients and carried out the therapy, under supervision of Sheffali Gulati and Veena Kalra. Veena Kalra: Conceptualized and planned the study. All the authors were involved in the decision to publish and approval of the final manuscript. DM did the literature search and manuscript preparation. Veena Kalra edited the manuscript for important intellectual content and would be the guarantor. D. Mishra (*) : V. Kalra : R. Seth : N. Saha Child Neurology Division, Department of Pediatrics, Ansari Nagar, New Delhi , India drdm@rediffmail.com D. Mishra Pediatric Neurology Division, Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, 2, BSZ Marg, New Delhi , India V. Kalra Pediatric Neurology, Indraprastha Apollo Hospitals, New Delhi, India R. Seth Department of Pediatrics, New Delhi, India S. Gulati Child Neurology Division, Department of Pediatrics, Ansari Nagar, New Delhi , India N. Saha Child Neurology Section, Dhaka Medical College, Dhaka, Bangladesh
2 Indian J Pediatr (2010) 77: Results 621 children with active epilepsy were seen at the PNC, of which 48 had early-onset, medical intractable epilepsy, and 21 children (13 males and 8 females), aged between 11 month and 38 month were enrolled. The median age at onset of seizure was 5.1 months. The major seizure type was focal in 3 and generalized in 18 (including infantile spasm in 11). No patient had normalization of EEG during the trial. Two patients (9.5%) had a response during the 2 weeks of oral treatment and oral therapy was continued. No toxicity or side-effects of pyridoxine were observed in these two patients over a follow-up of more than 18 months. Conclusions Pyridoxine responsive seizures contribute a significant proportion to early-onset idiopathic intractable epilepsy in childhood. Routine use of pyridoxine in the management of early onset resistant seizures would go a long way in identifying these patients early. Keywords Antiepileptic drugs. India. Infantile spasms. Pyridoxine. Resistant epilepsy Introduction Pyridoxine is used for management of seizure disorder in three settings viz., (i) seizures that respond to pyridoxine and require life-long supplementation with therapeutic doses of pyridoxine, pyridoxine dependent seizures (PDS, MIM ); (ii) early-onset seizures responsive to pyridoxine but not requiring life-long pyridoxine supplementation, pyridoxine-responsive seizures (PRS); and, (iii) high-dose pyridoxine for the treatment of major seizure disorders of young children e.g., West syndrome [1]. It has been suggested that pyridoxine dependency is often underdiagnosed, both because of occasional atypical presentation [2], and infrequent use of pyridoxine in intractable seizures of early onset in infants in India [3, 4]. Moreover, occasional reports of initial response to phenobarbitone followed by later intractability [5], suggest that pyridoxine responsive seizures may not be identified in infancy. As this would likely lead to resistant/intractable seizure with or without developmental delay [1], we conducted this study to identify pyridoxine responsiveness in children with early-onset, idiopathic, intractable seizures. Material and Methods This study was conducted over a 6 month period in a tertiary-care teaching hospital in New Delhi, India. Enrollment After informed, written consent of the parents/ caregivers, all children <5 yrs attending the Pediatric Neurology Clinic (PNC) with intractable seizures, who fulfilled the inclusion criteria were enrolled in the study. Inclusion criteria (i) Intractable seizures i.e., seizures had persisted for more than 6 months under regular administration of three or more appropriate antiepileptic drugs (AEDs), except pyridoxine; (ii) the seizure frequency was more than once per day; (iii) onset of epilepsy in the first 18 months of life. Exclusion criteria (i) Those with underlying structural (congenital malformations, tumors, chromosomal disorders, and dysmorphic syndromes), infectious (meningitis, encephalitis and neurocysticercosis), metabolic (inborn errors of metabolism, electrolyte and endocrine disorders) or posttraumatic etiologies; and, (ii) prior pyridoxine trial or use of vitamin B6 for management of seizures (use of multivitamin preparations containing pyridoxine was not an exclusion criteria). MRI of brain, EEG, serum electrolytes, blood lactate and ammonia, blood gases, and urine reducing substance are routinely done for all resistant epilepsy patients at our clinic, and the data was available for all patients. Urine organic acids and serum amino acid were available for those needing the same for management. Other treatment options for epilepsy, including other newer AEDs, ketogenic diet, and epilepsy surgery were available to those patients who were not enrolled or did not respond to the present treatment protocol. At enrollment, a structured proforma was filled with the caregiver, including the age at onset, seizure semiology and frequency, family history, birth and development history, development quotient (DQ) assessment, fundus evaluation, review of previous neuroimaging and EEG, treatment history, and a detailed CNS examination. All enrolled patients were asked to maintain a seizure diary, which was reviewed and the proforma updated at each follow-up visit. Intervention An EEG was recorded for all patients. Those with abnormal EEG were given a pyridoxine trial. This consisted of an intravenous infusion of 100 mg of pyridoxine (Vitneurin, Glaxo Pharma, Mumbai, India; containing (per ml): vitamin B6 25 mg; vitamin B1 50 mg; vitamin B mg; D-panthenol 25 mg), diluted in saline, over 10-min with a simultaneous EEG monitoring [3]. This procedure was carried out in the EEG laboratory with all appropriate precautions (including availability of resuscitation equipment and trained personnel). Continuous EEG monitoring was done throughout the infusion and till 20 min later, to look for correction of EEG abnormalities. All patients were then prescribed oral pyridoxine, mg/kg/day divided TID for 6 wks, in addition to their current anticonvulsant therapy. No changes were made in the anticonvulsants.
3 1254 Indian J Pediatr (2010) 77: Fig. 1 Flow chart of patients in the study 48 Patients with intractable epilepsy evaluated 27 Excluded 7 Post-meningitic 11 Neonatal hypoglycemia 5 Structural cortical lesion 3 Neurocutaneous syndromes 5 Refused consent 21 Given IV pyridoxine 21 No EEG Response 21 Oral pyridoxine for 6 weeks 2 50% seizure reduction 19 No change or <50% seizure reduction 1 Pyridoxine-dependent seizure 1 Pyridoxine-responsive seizures Follow-up Patients were reviewed every 15 days regarding compliance and change in seizure frequency. A reduction in seizure frequency by 50% of the baseline was considered as response (significant change), meriting further continuation of pyridoxine therapy. Those patients who remained seizure-free on pyridoxine therapy, previous AEDs were gradually tapered one by one over the next 3-months. infusion. Two patients (9.5%) had a response during the 2 wks of oral treatment with pyridoxine (and unchanged previous anticonvulsants), and oral therapy was continued. One 19-month old patient with global developmental delay, and generalized tonic-clonic seizures and myoclonic seizures since 6-1/2 months of age, who had previously received phenobarbitone and phenytoin, and was presently Results During the period of this study, 621 children with active epilepsy were seen at the PNC. After appropriate management, 48 had early-onset, medically intractable epilepsy, of which, 27 were excluded (Fig. 1). Twenty-one children (13 males and 8 females), aged between 11 month and 38 month, were defined as having idiopathic intractable epilepsy and were enrolled in the study. The median age at onset of seizure was 5.1 months. The major seizure types were focal in 3 and generalized in 18 (including infantile spasm in 11) (Table 1). No patient had normalization of EEG during the trial, nor was any EEG suppression noted during the pyridoxine Table 1 Characteristics of the study population (n=21) Characteristic Sex, male (%) 13 (61.9%) Type of seizure Focal 3 Generalized 18 (IS at onset) 7 Number of anticonvulsants 3(2 5) used, mode (range) Anticonvulsants used Sodium valproate, phenobarbitone, phenytoin, carbamazepine, clonazepam, clobazam, lamotrigine, topiramate EEG findings Generalized polyspike (7), multifocal (4), generalized spikes (7), focal (3)
4 Indian J Pediatr (2010) 77: receiving valproate, clobazam and lamotrigine, had complete cessation of seizures within 2 wks of pyridoxine. Following which all three anticonvulsants were gradually tapered without recurrence of seizures. Inadvertent discontinuation of pyridoxine by the patients led to breakthrough seizures, which again ceased within a week of restarting oral pyridoxine therapy. A diagnosis of PDS was thus confirmed. In another 3½-yr old patient with myoclonic seizures and developmental delay, seizure frequency decreased to 20% after pyridoxine therapy. A diagnosis of PRS was made. Pyridoxine was continued in addition to the previous anticonvulsants (phenobarbitone, valproate and clonazepam) and the long-term seizure control in the next 18 months was better than before pyridoxine (seizure frequency reduced to 20 30% of baseline). No toxicity or side effects of pyridoxine were observed in these two patients over a follow-up of more than 18 months. Discussion The role of pyridoxine in the treatment of epilepsy is wellrecognized [6] including use of vitamin B6 (both pyridoxine and pyridoxal phosphate) for intractable seizures [7, 8] and high-dose pyridoxine for the management of West syndrome [9]. Despite many reports of late presentation [10], and initial response to other AEDs [5], pyridoxine is still commonly considered only for the management of neonatal seizures by most physicians. Moreover, as previously reported, even that is quite uncommon in Indian patients [3, 4]. Although many authorities feel that trials of B6 for seizure are frequently unrewarding [6], we conducted this trial to determine the proportion of intractable epilepsy in children being contributed by pyridoxineresponsiveness, an eminently treatable condition, with usually a good prognosis. The demonstrated 9.5% prevalence of response to pyridoxine showed that many of these patients are being missed in early life and, thus contributing to the burden of active epilepsy and also, possibly, developmental delay/mental retardation. There exist many reports of vitamin B6 use as an adjuvant therapy for epilepsy. Jiao, et al. [7]. used intravenous pyridoxine for seizure control in Chinese children and found it to be effective and safe for treatment of recurrent seizures. More recently, Wang, et al. [8]. used pyridoxine and/or pyridoxal phosphate (PLP) to achieve good seizure control in 11 of 94 children (11.7%) with idiopathic intractable epilepsy. There were some patients who exclusively responded to pyridoxal phosphate in their study [8]. If a similar situation also exists in India, the proportion of children responding could have been higher, had we also used PLP in our study. We could not do so due to its non-availability. Both the patients responding to pyridoxine did not show any normalization of EEG during pyridoxine trial. This phenomenon has also been reported previously. Delayed clinical response [1] and delayed normalization of EEG [3] are some of the atypical features recognized amongst recent reports. Bass et al. reported a child in whom repeated pyridoxine trials were required to demonstrate pyridoxine dependency, as the initial two pyridoxine trials at 6 day and 3 months age did not result in seizure/eeg response [11]. There are other reports of abnormal EEG persisting up to several weeks after seizure cessation with pyridoxine trial [3, 12]. These cases probably either demonstrate subclinical electrical seizures that later subside with continued pyridoxine use, or the need for a higher initial pyridoxine dose for EEG response. In our study population (those receiving pyridoxine later in life, after uncontrolled epilepsy); this delayed response could also be because of EEG changes secondary to repeated seizures. EEG findings have also been reported to correlate with the long-term prognosis, with those with persistently abnormal EEG backgrounds despite pyridoxine therapy being moderately to severely retarded, and others with normal EEGs having normal/near normal development on long-term follow up [13]. Recently, elevated serum and CSF pipecolic acid levels, and elevated aminoadipic semialdehyde levels in various body fluids have been shown to be associated with PDS [14]. We could also have used elevated levels of these compounds to enable confirmation of the diagnosis without recourse to withdrawal test. However, as these facilities were not available to us, the final diagnosis of pyridoxine-dependent seizures was only possible in the traditional way, as has previously been suggested [15]. We used an injection which contains more vitamins than only pyridoxine. Although, this has been used previously; [3, 15, 16] the possibility of response to some compound other than pyridoxine, and risk of toxicity to other vitamins remain. The high proportion of pyridoxine-responsiveness in this pilot study underscores the need for larger, preferably blinded studies to validate the findings. Till then, the results justify a trial of B6 in all idiopathic, intractable epilepsy with onset in infancy. Acknowledgements DM and RS were working as Senior Research Associate with Human Resource Development Group, Council of Scientific and Industrial Research, Government of India, during the period of the present work. The organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Role of Funding Source Conflict of Interest None. None.
5 1256 Indian J Pediatr (2010) 77: References 1. Baxter P. Pyridoxine-dependent and pyridoxine-responsive seizures. Dev Med Child Neurol. 2001;43: Goutieres F, Aicardi J. Atypical presentation of pyridoxine dependent seizures: a treatable cause of intractable epilepsy in infants. Ann Neurol. 1985;17: Gupta VK, Mishra D, Mathur I, Singh KK. Pyridoxine-dependent seizures: a case-report and a critical review of the literature. J Paediatr Child Health. 2001;37: Ramachandrannair R, Parameswaran M. Prevalence of pyridoxine dependent seizures in south Indian children with early onset intractable epilepsy: a hospital based prospective study. Eur J Paediatr Neurol. 2005;9: Lin J, Lin K, Masruha MR, Vilanova LCP. Pyridoxine-dependent epilepsy initially responsive to phenobarbital. Arq Neuropsiquiatr. 2007;65: Baxter P. Epidemiology of pyridoxine dependent and pyridoxine responsive seizures in the UK. Arch Dis Child. 1999;81: Jiao FY, Gao DY, Takuma Y, et al. Randomized, controlled trial of high-dose intravenous pyridoxine in the treatment of recurrent seizures in children. Pediatr Neurol. 1997;17: Wang HS, Kuo MF, Chou ML, et al. Pyridoxal phosphate is better than pyridoxine for controlling idiopathic intractable epilepsy. Arch Dis Child. 2005;90: Ito M, Seki T, Takuma Y. Current therapy of West syndrome in Japan. J Child Neurol. 2000;15: Bankier A, Turner M, Hopkins IJ. Pyridoxine dependent seizures: a wider clinical spectrum. Arch Dis Child. 1983;58: Bass NE, Wyllie E, Cohen B, Joseph SA. Pyridoxine-dependent epilepsy: the need for repeated pyridoxine trials and the risk of severe electro-cerebral suppression with intravenous pyridoxine infusion. J Child Neurol. 1996;11: Waldinger C, Berg RB. Signs of pyridoxine dependency manifest at birth in siblings. Pediatrics. 1963;32: Mikati MA, Trevathan E, Krishnamoorthy KS, Lombroso CT. Pyridoxine-dependent epilepsy. EEG investigations and long-term follow-up. Electroencephalogr Clin Neurophysiol. 1991;78: Gospe SM. Pyridoxine-dependent seizures: new genetic and biochemical clues to help with diagnosis and treatment. Curr Opin Neurol. 2006;19: Kumar P, Gupta VK, Mishra D. Non-compliance in Pyridoxine dependent seizures and a way out. J Paediatr Child Health. 2007;43(7): Mishra D, Gupta VK. Pyridoxine dependent and pyridoxine responsive seizures. Indian Pediatr. 2005;42:291 2.
Outcome in West Syndrome
Outcome in West Syndrome NATWAR LAL SHARMA AND VENKATARAMAN VISWANATHAN From the Department of Pediatric Neurology, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India. Correspondence to: Dr Natwar Lal
More informationEPILEPSY. Elaine Wirrell
EPILEPSY Elaine Wirrell Seizures are amongst the most common of neurological disorders in the pediatric age range. The incidence of new-onset epilepsy in children is approximately 40 per 100,000 per year
More informationNeuromuscular Disease(2) Epilepsy. Department of Pediatrics Soochow University Affiliated Children s Hospital
Neuromuscular Disease(2) Epilepsy Department of Pediatrics Soochow University Affiliated Children s Hospital Seizures (p130) Main contents: 1) Emphasize the clinical features of epileptic seizure and epilepsy.
More informationNEONATAL SEIZURES-PGPYREXIA REVIEW
NEONATAL SEIZURES-PGPYREXIA REVIEW This is a very important Postgraduate topics will few Q asked in undergraduation also. Lets see them in detail. References: 1.Volpe s Neurology of newborn 2.Nelson s
More informationDr. Dafalla Ahmed Babiker Jazan University
Dr. Dafalla Ahmed Babiker Jazan University change in motor activity and/or behaviour due to abnormal electrical activity in the brain. seizures in children either - provoked by somatic disorders originating
More informationFebrile seizures. Olivier Dulac. Hôpital Necker-Enfants Malades, Université Paris V, INSERM U663
Febrile seizures Olivier Dulac Hôpital Necker-Enfants Malades, Université Paris V, INSERM U663 olivier.dulac@nck.aphp.fr Definition Seizures precipitated by fever that is not due to an intracranial infection
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Absence seizures, 6 in childhood, 95 Adults, seizures and status epilepticus in, management of, 34 35 with first-time seizures. See Seizure(s),
More informationACTH therapy for generalized seizures other than spasms
Seizure (2006) 15, 469 475 www.elsevier.com/locate/yseiz ACTH therapy for generalized seizures other than spasms Akihisa Okumura a,b, *, Takeshi Tsuji b, Toru Kato b, Jun Natsume b, Tamiko Negoro b, Kazuyoshi
More informationUpdate in Pediatric Epilepsy
Update in Pediatric Epilepsy Cherie Herren, MD Assistant Professor OUHSC, Department of Neurology September 20, 2018 Disclosures None Objectives 1. Identify common pediatric epilepsy syndromes 2. Describe
More informationICD-9 to ICD-10 Conversion of Epilepsy
ICD-9-CM 345.00 Generalized nonconvulsive epilepsy, without mention of ICD-10-CM G40.A01 Absence epileptic syndrome, not intractable, with status G40.A09 Absence epileptic syndrome, not intractable, without
More informationDavid Dredge, MD MGH Child Neurology CME Course September 9, 2017
David Dredge, MD MGH Child Neurology CME Course September 9, 2017 } 25-40,000 children experience their first nonfebrile seizure each year } AAN/CNS guidelines developed in early 2000s and subsequently
More informationErnie Somerville Prince of Wales Hospital EPILEPSY
Ernie Somerville Prince of Wales Hospital EPILEPSY Overview Classification New and old anti-epileptic drugs (AEDs) Neuropsychiatric side-effects Limbic encephalitis Non-drug therapies Therapeutic wishlist
More informationEpilepsy in the Primary School Aged Child
Epilepsy in Primary School Aged Child Deepak Gill Department of Neurology and Neurosurgery The Children s Hospital at Westmead CHERI Research Forum 15 July 2005 Overview The School Age Child and Epilepsy
More informationManagement of the Fitting Child. Dr Mergan Naidoo
Management of the Fitting Child Dr Mergan Naidoo Seizures A seizure is a change in movement, attention or level of awareness that is sustained or repetitive and occurs as a result of abnormal neuronal
More informationReview of Anticonvulsant Medications: Traditional and Alternative Uses. Andrea Michel, PharmD, CACP
Review of Anticonvulsant Medications: Traditional and Alternative Uses Andrea Michel, PharmD, CACP Objectives Review epidemiology of epilepsy Classify types of seizures Discuss non-pharmacologic and pharmacologic
More informationThere are several types of epilepsy. Each of them have different causes, symptoms and treatment.
1 EPILEPSY Epilepsy is a group of neurological diseases where the nerve cell activity in the brain is disrupted, causing seizures of unusual sensations, behavior and sometimes loss of consciousness. Epileptic
More informationRisk Factors of Poorly Controlled Childhood Epilepsy - A Study in A Tertiary Care Hospital
44 BANGLADESH J CHILD HEALTH 2010; VOL 34 (2): 44-50 Risk Factors of Poorly Controlled Childhood Epilepsy - A Study in A Tertiary Care Hospital AKM MOINUDDIN 1, MD. MIZANUR RAHMAN 2, SHAHEEN AKHTER 3,
More informationContemporary Developments in Childhood Epilepsy Management. Olivia O Mahony, Cork University Hospital, Cork, and Mercy University Hospital
Contemporary Developments in Childhood Epilepsy Management Olivia O Mahony, Cork University Hospital, Cork, and Mercy University Hospital Developments in Epilepsy Care Standardised epilepsy care using
More informationDrug Utilization and Rationality of Antiepileptic Drugs in Epilepsy in a Tertiary Care Teaching Hospital of Dehradun
Drug Utilization and Rationality of Antiepileptic Drugs in Epilepsy in a Tertiary Care Teaching Hospital of Dehradun Sarita 1, Neeraj Kumar 2, Sudhakar kaushik 3, Preeti Kothiyal 4 Correspondence Author
More informationEvaluation and management of drug-resistant epilepsy
Evaluation and management of drug-resistant epilepsy Fateme Jahanshahifar Supervised by: Professor Najafi INTRODUCTION 20 to 40 % of patients with epilepsy are likely to have refractory epilepsy. a substantive
More informationOn completion of this chapter you should be able to: list the most common types of childhood epilepsies and their symptoms
9 Epilepsy The incidence of epilepsy is highest in the first two decades of life. It falls after that only to rise again in late life. Epilepsy is one of the most common chronic neurological condition
More informationPediatrics. Convulsive Disorders in Childhood
Pediatrics Convulsive Disorders in Childhood Definition Convulsion o A sudden, violent, irregular movement of a limb or of the body o Caused by involuntary contraction of muscles and associated especially
More informationWhen to start, which drugs and when to stop
When to start, which drugs and when to stop Dr. Suthida Yenjun, MD. PMK Epilepsy Annual Meeting 2016 The main factors to consider in making the decision The risk for recurrent seizures, which varies based
More informationEpilepsy management What, when and how?
Epilepsy management What, when and how? J Helen Cross UCL-Institute of Child Health, Great Ormond Street Hospital for Children, London, & National Centre for Young People with Epilepsy, Lingfield, UK What
More informationCHILDHOOD OCCIPITAL EPILEPSY OF GASTAUT: A LONG-TERM PROSPECTIVE STUDY
Acta Medica Mediterranea, 2017, 33: 1175 CHILDHOOD OCCIPITAL EPILEPSY OF GASTAUT: A LONG-TERM PROSPECTIVE STUDY MURAT GÖNEN ¹, EMRAH AYTAǹ, BÜLENT MÜNGEN¹ University of Fırat, Faculty of medicine, Neurology
More informationChildren Are Not Just Small Adults Choosing AEDs in Children
Children Are Not Just Small Adults Choosing AEDs in Children Natrujee Wiwattanadittakun, MD Neurology division, Department of Pediatrics, Chiang Mai University Hospital, Chiang Mai University 20 th July,
More informationEpileptic syndrome in Neonates and Infants. Piradee Suwanpakdee, MD. Division of Neurology Department of Pediatrics Phramongkutklao Hospital
Epileptic syndrome in Neonates and Infants Piradee Suwanpakdee, MD. Division of Neurology Department of Pediatrics Phramongkutklao Hospital AGE SPECIFIC INCIDENCE OF EPILEPSY Hauser WA, et al. Epilepsia.
More informationChildhood epilepsy: the biochemical epilepsies. Dr Colin D Ferrie Consultant Paediatric Neurologist Leeds General Infirmary
Childhood epilepsy: the biochemical epilepsies Dr Colin D Ferrie Consultant Paediatric Neurologist Leeds General Infirmary Definitions Epileptic Seizure Manifestation(s) of epileptic (excessive and/or
More informationof Eectroencephalograms in Paediatrics
Uti~ity ~An of Eectroencephalograms in Paediatrics iatrics Analysis of 66 Records I H M I Hussain, MRCp, A It Mazidah, MD, Neurology Unit, Paediatric Institute, Hospital Kuala Lumpur Discovered by Hans
More informationLow-Dose Topiramate Is Effective in the Treatment of Infantile Spasms
Original Article 291 Low-Dose Topiramate Is Effective in the Treatment of Infantile Spasms Meng-Ying Hsieh, MD; Kuang-Lin Lin, MD; Huei-Shyong Wang, MD; Min-Liang Chou, MD; Po-Cheng Hung, MD; Ming-Yu Chang,
More informationChallenging epilepsy with antiepileptic pharmacotherapy in a tertiary teaching hospital in Sri Lanka
Original Article Challenging epilepsy with antiepileptic pharmacotherapy in a tertiary teaching hospital in Sri Lanka S. H. Kariyawasam, Namal Bandara,* A. Koralagama,** Sunethra Senanayake*** Dept. of
More informationBIBLIOGRAPHIC REFERENCE TABLE FOR SODIUM VALPROATE IN CHILDHOOD EPILEPSY
BIBLIOGRAPHIC REFERENCE TABLE FOR SODIUM VALPROATE IN CHILDHOOD EPILEPSY Bibliographic Marson AG et al. for (Review). The Cochrane 2000 De Silva M et al. Romised or for childhood. Lancet, 1996; 347: 709-713
More informationNeonatal Seizure. Dr.Nawar Yahya. Presented by: Sarah Khalil Zeina Shamil Zainab Waleed Zainab Qahtan. Supervised by:
Neonatal Seizure Supervised by: Dr.Nawar Yahya Presented by: Sarah Khalil Zeina Shamil Zainab Waleed Zainab Qahtan Objectives: What is neonatal seizure Etiology Clinical presentation Differential diagnosis
More informationManagement of Epilepsy in Primary Care and the Community. Carrie Burke, Epilepsy Specialist Nurse
Management of Epilepsy in Primary Care and the Community Carrie Burke, Epilepsy Specialist Nurse Epilepsy & Seizures Epilepsy is a common neurological disorder characterised by recurring seizures (NICE,
More informationEEG in Epileptic Syndrome
EEG in Epileptic Syndrome Surachai Likasitwattanakul, M.D. Division of Neurology, Department of Pediatrics Faculty of Medicine, Siriraj Hospital Mahidol University Epileptic syndrome Electroclinical syndrome
More informationInitial Treatment of Seizures in Childhood
Initial Treatment of Seizures in Childhood Roderic L. Smith, MD, Ph.D. Pediatric Neurology Clinic of Alaska,PC Incidence of Seizures Overall 5% by age 20 yrs. Lifetime risk= 5-10% CNS Infections= 5% TBI=10%
More informationNEONATAL SEIZURES. Introduction
Introduction NEONATAL SEIZURES Definition: Sudden, paroxysmal depolarisation of a group of neurones with transient alteration in neurological state. Possibly abnormal motor, sensory or autonomic activity
More informationDifferent Outcome with Different Aetiologies: The Prognosis Follow-up in 13 Infants with Burst-suppression Pattern
HK J Paediatr (new series) 2016;21:7-13 Different Outcome with Different Aetiologies: The Prognosis Follow-up in 13 Infants with Burst-suppression Pattern J SHEN, SS MAO, ZF YUAN, YL YU, ZZ XIA, F GAO
More informationStatus Epilepticus in Children
PedsCases Podcast Scripts This is a text version of a podcast from Pedscases.com on Status Epilepticus in Children. These podcasts are designed to give medical students an overview of key topics in pediatrics.
More informationFEBRILE SEIZURES. IAP UG Teaching slides
FEBRILE SEIZURES 1 DEFINITION Febrile seizures are seizures that occur between the age of 6 and 60 months with a temperature of 38 C or higher, that are not the result of central nervous system infection
More informationChildhood Epilepsy - Overview & Update
Childhood Epilepsy - Overview & Update Nicholas Allen Dept. Paediatrics Mar 2016 NO DISCLOSURES Videos 1 Outline: Childhood Epilepsy What is it? How do we classify it? How do we diagnose it? How do we
More informationAPPENDIX K Pharmacological Management
1 2 3 4 APPENDIX K Pharmacological Management Table 1 AED options by seizure type Table 1 AED options by seizure type Seizure type First-line AEDs Adjunctive AEDs Generalised tonic clonic Lamotrigine Oxcarbazepine
More informationAnticonvulsants Antiseizure
Anticonvulsants Antiseizure Seizure disorders Head trauma Stroke Drugs (overdose, withdrawal) Brain tumor Encephalitis/ Meningitis High fever Hypoglycemia Hypocalcemia Hypoxia genetic factors Epileptic
More informationEpilepsy 7/28/09! Definitions. Classification of epilepsy. Epidemiology of Seizures and Epilepsy. International classification of epilepsies
Definitions Epilepsy Dr.Yotin Chinvarun M.D., Ph.D. Seizure: the clinical manifestation of an abnormal and excessive excitation of a population of cortical neurons Epilepsy: a tendency toward recurrent
More informationp ผศ.นพ.ร งสรรค ช ยเสว ก ล คณะแพทยศาสตร ศ ร ราชพยาบาล
Natural Course and Prognosis of Epilepsy p ผศ.นพ.ร งสรรค ช ยเสว ก ล คณะแพทยศาสตร ศ ร ราชพยาบาล Introduction Prognosis of epilepsy generally means probability of being seizure-free after starting treatment
More informationUpdated advice for nurses who care for patients with epilepsy
NICE BULLETIN Updated advice for nurses who care for patients with epilepsy NICE provided the content for this booklet which is independent of any company or product advertised NICE BULLETIN Updated advice
More informationChapter 31-Epilepsy 1. public accountant, and has begun treatment with lamotrigine. In which of the following activities
Chapter 31-Epilepsy 1 Chapter 31. Epilepsy, Self-Assessment Questions 1. BW is a 28-year-old man recently diagnosed with partial seizures. He works as a certified public accountant, and has begun treatment
More informationUse of ACTH and prednisolone in infantile spasms: Experience from a developing country,
Seizure (2005) 14, 552 556 www.elsevier.com/locate/yseiz Use of ACTH and prednisolone in infantile spasms: Experience from a developing country, Matloob Azam *, Nasera Bhatti, Jai Krishin Children s Hospital,
More informationRESEARCH ARTICLE EPILEPSY IN CHILDREN WITH CEREBRAL PALSY
RESEARCH ARTICLE EPILEPSY IN CHILDREN WITH CEREBRAL PALSY S.Pour Ahmadi MD, M.Jafarzadeh MD, M. Abbas MD, J.Akhondian MD. Assistant Professor of Pediatrics, Mashad University of Medical Sciences. Associate
More informationNEONATAL SEIZURE. IAP UG Teaching slides
NEONATAL SEIZURE 1 INTRODUCTION One of the important neonatal neurological emergencies requiring immediate medical care. Contribute to significant morbidity and mortality Incidence is around 0.5 to 0.8%
More informationORIGINAL ARTICLE. Prediction of Response to Treatment in Children with Epilepsy
ORIGINAL ARTICLE How to Cite This Article: Ghofrani M, Nasehi MM, Saket S, Mollamohammadi M, Taghdiri MM, Karimzadeh P, Tonekaboni SH, Javadzadeh M, Jafari N, Zavehzad A, Hasanvand Amouzadeh M, Beshrat
More informationManagement of Neonatal Seizures
Management of Neonatal Seizures Manal E. Moustafa Assistant Professor of Pediatric Neurology and Epilepsy Children s Healthcare of Atlanta/Emory University Disclosures I have none! 1 Objectives Recognition
More informationInvestigation of seizures in infants
Chapter 24 Investigation of seizures in infants RICHARD E. APPLETON The Roald Dahl EEG Unit, Paediatric Neurosciences Foundation, Royal Liverpool Children s Hospital, Alder Hey The investigation of seizures
More informationLevetiracetam in patients with generalised epilepsy and myoclonic seizures: An open label study
Seizure (2006) 15, 214 218 www.elsevier.com/locate/yseiz CASE REPORT Levetiracetam in patients with generalised epilepsy and myoclonic seizures: An open label study Angelo Labate a,b, Eleonora Colosimo
More informationRetrospective study of topiramate in a paediatric population with intractable epilepsy showing promising effects in the West syndrome patients
Acta neurol. belg., 2000, 100, 171-176 Retrospective study of topiramate in a paediatric population with intractable epilepsy showing promising effects in the West syndrome patients J. THIJS, H. VERHELST,
More informationInternational Journal of Pharmaceuticals and Health care Research
5 Research Article Available Online at: www.ijphr.com An African Edge Journal International Journal of Pharmaceuticals and Health care Research SJ Impact Factor (2015) 5.546 ISSN: - 2306 6091 Assessment
More informationKeywords: treatment; epilepsy; population based cohort Institute of Neurology, University College London, London WC1N 3BG, UK
632 Institute of Neurology, University College London, London WC1N 3BG, UK S D Lhatoo JWASSander S D Shorvon Correspondence to: Professor J W Sander, Department of Clinical and Experimental Epilepsy, Institute
More informationOutline. What is a seizure? What is epilepsy? Updates in Seizure Management Terminology, Triage & Treatment
Outline Updates in Seizure Management Terminology, Triage & Treatment Joseph Sullivan, MD! Terminology! Videos of different types of seizures! Diagnostic evaluation! Treatment options! Acute! Maintenance
More informationPaediatric Epilepsy Update N o r e e n Te a h a n canp C o l e t t e H u r l e y C N S E p i l e p s y
Paediatric Epilepsy Update 2018 N o r e e n Te a h a n canp C o l e t t e H u r l e y C N S E p i l e p s y Epilepsy Service CUH ~550 children New diagnosis-education, support, clinic follow up Epilepsy
More informationAMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY, INC. SUBSPECIALTY CERTIFICATION EXAMINATION IN EPILEPSY MEDICINE
SUBSPECIALTY CERTIFICATION EXAMINATION IN EPILEPSY MEDICINE 2014 Content Blueprint (November 26, 2012) Number of questions: 200 I. Classification 7 9% II. Routine EEG 16 20% III. Evaluation 22 26% IV.
More informationClassification of Seizures. Generalized Epilepsies. Classification of Seizures. Classification of Seizures. Bassel F. Shneker
Classification of Seizures Generalized Epilepsies Bassel F. Shneker Traditionally divided into grand mal and petit mal seizures ILAE classification of epileptic seizures in 1981 based on clinical observation
More informationEpilepsy CASE 1 Localization Differential Diagnosis
2 Epilepsy CASE 1 A 32-year-old man was observed to suddenly become unresponsive followed by four episodes of generalized tonic-clonic convulsions of the upper and lower extremities while at work. Each
More informationNo relevant disclosures
No relevant disclosures - Epileptic Encephalopathy (EE): Epileptic activity itself contributes to cognitive and behavioural impairments - Developmental and Epileptic Encephalopathy (DEE): Impairments occur
More informationEpilepsy in children with cerebral palsy
Seizure 2003; 12: 110 114 doi:10.1016/s1059 1311(02)00255-8 Epilepsy in children with cerebral palsy A.K. GURURAJ, L. SZTRIHA, A. BENER,A.DAWODU & V. EAPEN Departments of Paediatrics, Community Medicine
More informationRisk of seizure recurrence after antiepileptic drug withdrawal, an Indian study
Neurology Asia 2006; 11 : 19 23 Risk of seizure recurrence after antiepileptic drug withdrawal, an Indian study Archana VERMA DM (Neurology) MD, Surendra MISRA DM (Neurology) FRCP (Edin) Department of
More informationCase #1. Inter-ictal EEG. Difficult Diagnosis Pediatrics. 15 mos girl with medically refractory infantile spasms 2/13/2010
Difficult Diagnosis Pediatrics Joseph E. Sullivan M.D. Assistant Professor of Clinical Neurology & Pediatrics Director, UCSF Pediatric Epilepsy Center University of California San Francisco Case #1 15
More informationSurveillance report Published: 12 April 2018 nice.org.uk
Surveillance report 2018 Epilepsies: diagnosis and management (2012) NICE guideline CG137 Surveillance report Published: 12 April 2018 nice.org.uk NICE 2018. All rights reserved. Subject to Notice of rights
More informationThe epilepsies: pharmacological treatment by epilepsy syndrome
The epilepsies: pharmacological treatment by epilepsy syndrome This table provides a summary reference guide to pharmacological treatment. Anti-epileptic drug (AED) options by epilepsy syndrome Childhood
More informationTherapeutic strategies in the choice of antiepileptic drugs
Acta neurol. belg., 2002, 102, 6-10 Original articles Therapeutic strategies in the choice of antiepileptic drugs V. DE BORCHGRAVE, V. DELVAUX, M. DE TOURCHANINOFF, J.M. DUBRU, S. GHARIANI, Th. GRISAR,
More informationA study of clinico-biochemical profile of neonatal seizure: A tertiary care hospital study
Original Research Article A study of clinico-biochemical profile of neonatal seizure: A tertiary care hospital study Wakil Paswan 1*, Bankey Behari Singh 2 1 Assistant Professor, 2 Associate Professor
More informationPREVALENCE & TREATMENT OF PATIENTS WITH EPILEPSY ASSOCIATED WITH INTELLECTUAL DISABILITY: A PILOT STUDY IN PALESTINE
Vol.4, No., P.83-89, 006, ISSN 76-6807, http//www.iugzaza.edu.ps/ara/research/ PREVALENCE & TREATMENT OF PATIENTS WITH EPILEPSY ASSOCIATED WITH INTELLECTUAL DISABILITY: A PILOT STUDY IN PALESTINE Waleed
More informationClassification of Epilepsy: What s new? A/Professor Annie Bye
Classification of Epilepsy: What s new? A/Professor Annie Bye The following material on the new epilepsy classification is based on the following 3 papers: Scheffer et al. ILAE classification of the epilepsies:
More information2018 American Academy of Neurology
Practice Guideline Update Efficacy and Tolerability of the New Antiepileptic Drugs I: Treatment of New-Onset Epilepsy Report by: Guideline Development, Dissemination, and Implementation Subcommittee of
More informationEpilepsy and Epileptic Seizures
Epilepsy and Epileptic Seizures Petr Marusič Dpt. of Neurology Charles University, Second Faculty of Medicine Motol University Hospital Diagnosis Steps Differentiation of nonepileptic events Seizure classification
More informationEpilepsy. Annual Incidence. Adult Epilepsy Update
Adult Epilepsy Update Annual Incidence J. Layne Moore, MD, MPH Associate Professor Department of Neurology and Pharmacy Director, Division of Epilepsy The Ohio State University Used by permission Health
More informationEpilepsies of Childhood: An Over-view of Treatment 2 nd October 2018
Epilepsies of Childhood: An Over-view of Treatment 2 nd October 2018 Dr Sophia Varadkar MRCPI, PhD Consultant Paediatric Neurologist and Honorary Senior Lecturer Great Ormond Street Hospital for Children
More informationEpilepsy 101. Russell P. Saneto, DO, PhD. Seattle Children s Hospital/University of Washington November 2011
Epilepsy 101 Russell P. Saneto, DO, PhD Seattle Children s Hospital/University of Washington November 2011 Specific Aims How do we define epilepsy? Do seizures equal epilepsy? What are seizures? Seizure
More informationEpilepsy. Presented By: Stan Andrisse
Epilepsy Presented By: Stan Andrisse What Is Epilepsy Chronic Neurological Disorder Characterized by seizures Young children or elderly Developing countries Famous Cases Socrates Muhammad Aristotle Joan
More informationWest syndrome is an intractable epileptic syndrome, characterized by epileptic spasms and hypsarrhythmia. It is
Developmental Outcomes of Cryptogenic West Syndrome SHIN-ICHIRO HAMANO, MD, PHD, SATOSHI YOSHINARI, MD, NORIMICHI HIGURASHI, MD, MANABU TANAKA, MD, MOTOYUKI MINAMITANI, MD, PHD, AND YOSHIKATSU ETO, MD,
More informationSuccessful treatment of super-refractory tonic status epilepticus with rufinamide: first clinical report
*Manuscript Click here to view linked References Successful treatment of super-refractory tonic status epilepticus with rufinamide: first clinical report Thompson AGB 1, Cock HR 1,2. 1 St George s University
More informationEpilepsy and EEG in Clinical Practice
Mayo School of Professional Development Epilepsy and EEG in Clinical Practice November 10-12, 2016 Hard Rock Hotel at Universal Orlando Orlando, FL Course Directors Jeffrey Britton, MD and William Tatum,
More informationThe Fitting Child. A/Prof Alex Tang
The Fitting Child A/Prof Alex Tang Objective Define relevant history taking and physical examination Classify the types of epilepsy in children Demonstrate the usefulness of investigations Define treatment
More informationQ9. In adults and children with convulsive epilepsy in remission, when should treatment be discontinued?
updated 2012 When to discontinue antiepileptic drug treatment in adults and children Q9. In adults and children with convulsive epilepsy in remission, when should treatment be discontinued? Background
More informationKetogenic Diet therapy in Myoclonic-Atonic Epilepsy (MAE)
KD therapy in epilepsy syndromes Ketogenic Diet therapy in Myoclonic-Atonic Epilepsy (MAE) Hirokazu Oguni, MD Department of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan Epilepsy Center, TMG
More informationBackground. Correlation between epilepsy and attention deficit hyperactivity disorder. Background. Epidemiology of ADHD among children with epilepsy
Correlation between epilepsy and attention deficit hyperactivity disorder I-Ching Chou M.D. Director, Department of Pediatric Neurology China Medical University Hospital Taiwan Background Attention deficit/hyperactivity
More informationIs it epilepsy? Does the patient need long-term therapy?
Is it a seizure? Definition Transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain Is it provoked or unprovoked? Is it epilepsy? Does the
More informationLamotrigine in children with refractory epilepsy
The Turkish Journal of Pediatrics 2008; 50: 426-431 Original Lamotrigine in children with refractory epilepsy Aslı Çelebi, Dilek Yalnızoğlu, Güzide Turanlı, Haluk Topaloğlu Sabiha Aysun, Meral Topçu Pediatric
More informationRefractory Status Epilepticus in Children: What are the Options?
Refractory Status Epilepticus in Children: What are the Options? Weng Man Lam, PharmD, BCPS, BCPPS PICU Clinical Pharmacy Specialist Memorial Hermann Texas Medical Center November 11, 2017 Objectives 1.
More informationEEG in the Evaluation of Epilepsy. Douglas R. Nordli, Jr., MD
EEG in the Evaluation of Epilepsy Douglas R. Nordli, Jr., MD Contents Epidemiology First seizure Positive predictive value Risk of recurrence Identifying epilepsy Type of epilepsy (background and IEDs)
More informationObjectives. Amanda Diamond, MD
Amanda Diamond, MD Objectives Recognize symptoms suggestive of seizure and what those clinical symptoms represent Understand classification of epilepsy and why this is important Identify the appropriate
More informationWest syndrome is an age-dependent epileptic encephalopathy. PET in Infancy Predicts Long-Term Outcome during Adolescence in Cryptogenic West Syndrome
ORIGINAL RESEARCH PEDIATRICS PET in Infancy Predicts Long-Term Outcome during Adolescence in Cryptogenic West Syndrome J. Natsume, N. Maeda, K. Itomi, H. Kidokoro, N. Ishihara, H. Takada, A. Okumura, T.
More informationCONVULSIONS - AFEBRILE
Incidence All Children require Management Recurrence Risk Indications for starting therapy Starting Anticonvulsant medication Criteria for Referral to Paediatric Neurology Useful links References Appendix
More informationEpilepsy the Essentials
INSTITUTE OF NEUROLOGY DCEE / NSE Epilepsy the Essentials Fergus Rugg-Gunn Consultant Neurologist Dept of Clinical and Experimental Epilepsy Institute of Neurology, University College London Epilepsy Society
More informationQUIZ ON CHILDHOOD EPILEPSIES
QUIZ ON CHILDHOOD EPILEPSIES Q.1 2 month old boy with uneventful birth history started having very frequent focal seizures arising from different regions of the brain. Prolonged VEEG showed migration of
More informationMeasures have been taken, by the Utah Department of Health, Bureau of Health Promotions, to ensure no conflict of interest in this activity
Measures have been taken, by the Utah Department of Health, Bureau of Health Promotions, to ensure no conflict of interest in this activity Seizures in the School Setting Meghan Candee, MD MS Assistant
More informationDiagnostic Approach to Developmental Delay. Dr Kang Ying Qi Consultant Developmental Pediatrician 20 May 2017
Diagnostic Approach to Developmental Delay Dr Kang Ying Qi Consultant Developmental Pediatrician 20 May 2017 What is development? Young Baby Adulthood Wide variation between children Variation between
More informationNonConvulsive Seizure
Sample Protocol #5: Management of status epilepticus and seizures in hospitalized patients nconvulsive Seizure Patient presents with alteration of consciousness unexplained by other etiologies AND suspicious
More informationIntroduction. Clinical manifestations. Historical note and terminology
Epilepsy with myoclonic absences Douglas R Nordli Jr MD ( Dr. Nordli of University of Southern California, Keck School of Medicine has no relevant financial relationships to disclose. ) Jerome Engel Jr
More informationElectroclinical Syndromes Epilepsy Syndromes. Angel W. Hernandez, MD Division Chief, Neurosciences Helen DeVos Children s Hospital Grand Rapids, MI
Electroclinical Syndromes Epilepsy Syndromes Angel W. Hernandez, MD Division Chief, Neurosciences Helen DeVos Children s Hospital Grand Rapids, MI Disclosures Research Grants: NIH (NINDS) Lundbeck GW Pharma
More informationDoes a diagnosis of epilepsy commit patients to lifelong therapy? Not always. Here s how to taper AEDs safely and avoid relapse.
Does a diagnosis of epilepsy commit patients to lifelong therapy? Not always. Here s how to taper AEDs safely and avoid relapse. T he epilepsy specialist always has two equally important endpoints in mind
More information