Onset Of Convulsions Research Articles

Phytochemical Analysis and Evaluation of Anticonvulsant Effect of Chamomile (Matricaria chamomilla L.) Flower Extract in Chicks

This study was carried out to investigate the effect of chamomile flower aqueous extract on different biochemical parameters in pentylenetetrazole (PTZ) induced-convulsive chicks. Parameters included were serum total antioxidant capacity (T-AOC), serum and brain gamma-aminobutyric acid (GABA), serum cholinesterase enzyme activity (ChE), electrolytes (Na+,K+, and Cl-), total calcium (Ca2+), serum glucose and total protein concentration.The dried flowers parts of chamomile (Matricaria chamomilla L.) were subjected to aqueous extraction and given at (200, 400 and 600mg/kg orally), for its anticonvulsant effects and the effect was compared with the standard anticonvulsant drug sodium valproate (200mg/kg). A dose of 200mg/kg showed full protection against PTZ convulsions, whereas doses of 400 and 600 mg/kg reduced the latency and onset of convulsion. The results suggest that the aqueous extract of chamomile flower may produce anticonvulsant effects via biochemical changes including significant increases in serum T-AOC, serum GABA, serum ChE activity and Na+, and a significant reduction in K+ and serum glucose concentration have been observed.

Electrical Stimulation of the Vagus Nerve Modulates the Development of Oxygen Epilepsy in Rabbits

We report here our studies of the effects of electrical stimulation of the vagus nerve on the development of oxygen convulsions and cardiovascular reactions in hyperbaric oxygen (HBO2). The motor signs of the neurotoxic action of HBO2 were identified in conscious rabbits exposed to O2 at 5 atm, along with EEG, ECG, external respiration, and brain blood filling in conditions of stimulation of the cervical component of the vagus nerve. Oxygen convulsions were found to be preceded by increased sympathetic tone, with a specific EEG pattern (synchronization of slow waves), changes in the ECG (tachycardia) and respiration (hyperventilation). Vagal stimulation enhanced the parasympathetic component of the autonomic system and significantly delayed the prodromal signs of oxygen toxicity and the onset of convulsions. Afferent spike activity from the visceral organs is regarded as a new target for countering the neurotoxic effects of hyperbaric oxygen.

SYNTHESIS, CHARACTERIZATION, BIOLOGICAL EVALUATION AND DOCKING OF SOME NOVEL SUBSTITUTED 1, 3-THIAZINE DERIVATIVES

Objective: Chalcones and their heterocyclic analogs represent an important class of small molecules which have a wide range of pharmacological activities. Therefore, in this study, synthesis and anticonvulsant and antimicrobial activities of some new 1, 3-thiazines have been extensively discussed.Methods: The reaction mixture of 4-tert-butylcyclohexanone on Claisen-Schmidt condensation with various aromatic aldehydes in the presence of dilute sodium hydroxide afforded the corresponding chalcones. Further, these compounds were subjected to cocondensation with thiourea, in the presence of isopropanol, catalyzed by aqueous potassium hydroxide to form 4-aryl 8-arylidene-5, 6-dihydro-2-imino-6-methyl-4H, 7H-(1, 3) benzothiazines. The structures of the newly synthesized compounds have been established on the basis of their spectral analysis. The newly synthesized compounds have been tested for their biological screening. Antimicrobial activity by cup plate agar diffusion method and antiepileptic activity by pentylenetetrazole (PTZ) induced seizures model, using diphenyl hydantain as standard, and also they are subjected to molecular properties prediction, toxicity, drug-likeness, lipophilicity and solubility parameters determination were done by using Osiris program, Molsoft, Prototox and ALOGPS 2.1 software. The binding mode of the synthesized compounds with active protein site has been predicted using docking method.Results: Most of the compounds have shown good anticonvulsant as well as antimicrobial activities, but it is less than the standard drugs. 1, 3-thiazines derivatives were more potent, and among them, compounds TB5 andTB7 were the most active compounds in these series; TB5 whichcontains isopropyl phenyl moiety, was shown moderate potent activity with onset of convulsion at 14.1 min and TB7 containing 3, 4, 5-trimethoxyphenyl substituents on the thiazine moiety was more potent as it has prolonged the onset of convulsions by 18.7 min. Whereas in the case of antimicrobial activity of the compounds, from the results we have observed that TB5 have been shown greatest antimicrobial activity in all the bacterial and fungal strains, TB2 also shown superior activity, the others have been shown good antimicrobial activity.Conclusion: According to the activity studies, it is observed that the synthesis and antimicrobial as well as anticonvulsant activities of novel 1, 3-thiazine derivatives have been shown better activity. Moreover molecular docking results give an insight into how further modification of the lead compound can be carried out for higher inhibitory activity. In particular, compounds with electron withdrawing substituents along with lipophilic methoxyl and isopropyl groups were more potent.

Synthesis, molecular modelling, and preliminary anticonvulsant activity evaluation of novel naphthalen-2-yl acetate and 1,6-dithia-4,9-diazaspiro [4.4] nonane-3,8-dione derivatives

The synthesis, pharmacological evaluation and molecular modelling study of novel naphthalen-2-yl acetate and 1,6-dithia-4,9-diazaspiro [4.4]nonane-3,8-dione derivatives as potential anticonvulsant agents are described. The newly synthesized compounds were characterized by both analytical and spectral data. Alkylation of 1H-imidazole or substituted piperazine with 1-(2-naphthyl)-2-bromoethanone (2) gave naphthalen-2-yl 2-(1H-imidazol-1-yl) acetate (3) and naphthalen-2-yl 2-(substituted piperazin-1-yl) acetate (4–8). Moreover, condensation of naphthalen-2-yl 2-bromoacetate or 2-bromo-1-(naphthalen-2-yl) ethanone with hydrazine hydrate and acetylacetone resulted in the formation of the cyclic pyrazole products 9 and 13. Sonication of naphthalen-2-yl acetate (1) with 2-chloropyridine, 2-chloropyrimidine and 2-(chloromethyl) oxirane gave naphthalen-2-yl 2-(pyridin-2-yl) acetate (10), naphthalen-2-yl 2-(pyrimidin-2-yl) acetate (11) and naphthalen-2-yl-3-(oxiran-2-yl) propanoate (12) respectively. Cyclocondensation reaction of 2-iminothiazolidin-4-one (14) with thioglycolic acid, thiolactic acid and thiomalic acid gave 1,6-dithia-4,9-diazaspiro [4.4]nonane-3,8-dione derivatives (15–17). The compounds were testedin vivofor the anticonvulsant activity by delaying strychnine-induced seizures. The diazaspirononane (17) and 1-(2-naphthyl)-2-bromoethanone (2) showed a high significant delay in the onset of convulsion and prolongation of survival time compared to phenobarbital. The molecular modelling study of anticonvulsant activity of synthesized compounds showed a CNS depressant activity via modulation of benzodiazepine allosteric site in GABA-A receptors.

Antimuscarinic-induced convulsions in fasted mice after food intake: no evidence of spontaneous seizures, behavioral changes or neuronal damage

Prolonged or repeated seizures have been shown to cause spontaneous recurrent seizures, increased anxiety‑related behavior, locomotor hyperactivity, impaired functions of learning and memory, and neuronal damage in the hippocampus and other brain regions in animals. Mice and rats treated with antimuscarinic drugs after fasting for twodays or less develop convulsions after being allowed to eat ad libitum. To address whether such behavioral and neuroanatomic changes occur following these convulsions, mice treated i.p. with saline (control) or 2.4mg/kg atropine and given food after 24 h of fasting were grouped according to seizure scores for behavioral and histological analysis. Following convulsions, the occurrence of spontaneous recurrent seizures was observed for 30days. Motor activity and grooming behavior were assessed in the open field, and memory was assessed using the novel object recognition test 4 and 7days after onset of convulsions, respectively. Animals allocated for the histological analysis were decapitated 7days after onset of convulsions and hippocampal slices were evaluated for the percentage of degenerating neurons stained with Fluoro‑Jade C. Spontaneous recurrent seizures, locomotor alterations, anxiety‑related behavior, memory impairment, and neuronal loss in the granular layer of the dentate gyrus were not detected in the animals with seizure score 1-2 or 3-5. These results are in accordance with those related to the absence of behavioral changes, cognitive deficits, and hippocampal neuronal damage after single brief seizures in animals and patients with epilepsy.

Assessment of State of Convulsive Child in Hospital National Children Albert Royer, Dakar

Introduction: The state of epilepticus in children is considered as a medical emergency which involves the vital and functional prognosis of the patient. The difficulties of this support in our country are linked to the lack of pediatric intensive care unit. The aim of our study is to evaluate the clinical, therapeutic, scalable and etiological states of epilepticus in children at Hospital Albert Royer National Children, Dakar. Methods: This is a prospective study which includes all patients aged between 2 months and 16 years who were hospitalized between 1 August, 2014 and 31 May, 2015 for a prolonged convulsion over 5 minutes and/or with at least 3 episodes of successive convulsions. We have not included the newborns and non-convulsive state epilepticus patients. The treatment protocol consists of the use of diazepam as first line, after 60 minutes if the crisis persists; diazepam phenobarbital was associated with the second line. Results: We collected 53 cases of state epilepticus (29 boys and 24 girls), which turned out to be a hospital incidence of 4.2%. The mean age was 48.5 months. Three quarters of our patients (n=40) were received emergency beyond 30 minutes after the onset of convulsions where the generalized seizures (n=42) were more common than partial seizures (n=11). The convulsions occurred in a context of fever in 38 patients. The metabolic balance was in favor of hyponatremia in 13 cases. Twenty-four patients (45.3%) have received only phenobarbital diazepam combination within 60 minutes after the onset of seizures. Conclusions: The state epilepticus cases are frequent in the hospital emergency department especially for infants from 2 months to 3 years. It was observed that the patients unfortunately received emergency in late beyond 30 minutes after the onset of convulsions.

EVALUATION OF ANTIEPILEPTIC ACTIVITY OF ETHANOLIC EXTRACT OF AZIMA TETRACANTHA ROOT IN MICE

Objective: To evaluate the antiepileptic activity of ethanolic extract of Azima tetracantha root (EEATR) against Maximal electroshock (MES) and Pentylene tetrazole (PTZ) induced seizures in mice.Methods: 48 adult male mice were used and 4 groups with six in each were allocated to each model. 4 Groups are divided into control, standard and two test groups. Control group received normal saline, standard group, Sodium valproate-200 mg/kg and the two test groups received ethanolic extract of roots of Azima tetracantha (EEATR) 250 and 500 mg/kg respectively. Antiepileptic activity was assessed based on hind limb tonic extension duration, onset of convulsions and mortality. The results were compared with control and standard.Results: In MES model EEATR reduced the duration of hind limb extension (HLE) and seizure protection was 50% and 66.6% with 250 and 500 mg/kg respectively. In PTZ model both the doses of EEATR delayed the onset of clonic phase and prevented death in 50% of animals in group treated with 500 mg/kg EEATR, similar to sodium valproate. Results were analyzed by ANOVA with p<0.05 considered as significant.Conclusion: EEATR has shown anticonvulsant activity in both MES and PTZ models. 500 mg/kg of EEATR has better protection than 250 mg/kg against seizure in MES model and equally efficacious as sodium valproate standard in PTZ model.

DESIGN, FACILE SYNTHESIS, AND BIOLOGICAL EVALUATION OF NOVEL 1,3-THIAZINE DERIVATIVES AS POTENTIAL ANTICONVULSANT AGENTS

ABSTRACTObjective: Chalcones and their heterocyclic analogs represent an important class of small molecules having anticonvulsant activities. Therefore, inthis study, the synthesis and anticonvulsant activity of some new chalcones and 1,3-thiazines were described.Methods: The reaction of 1-acetylnaphthalene with substituted aromatic aldehydes in the presence of aq. NaOH afforded corresponding chalconeswhich upon further cyclization with thiourea resulted in 1,3-thiazine derivatives. The newly synthesized compounds were tested for anticonvulsantactivity by pentylenetetrazole-induced seizures method using diazepam as standard.Results: Most of the compounds showed good anticonvulsant activity but is less than diazepam. 1,3-thiazines were more potent than chalconesand among them, compound P4 containing 4-fluorophenyl substituents on the thiazine moiety was more potent as it has prolonged the onset ofconvulsions by 155.2 seconds.Conclusion: We described the synthesis and anticonvulsant activity of novel chalcones and 1,3-thiazine derivatives. 1,3-thiazines are more activeanticonvulsant agents than chalcones and in particular compounds with electron withdrawing substituents.Keywords: Chalcone, 1,3-thiazine, Pentylenetetrazole.

Clinical Epidemiology and Treatment of Febrile and Afebrile Convulsions With Mild Gastroenteritis: A Multicenter Study

BackgroundWe investigated features and responses to treatment in patients with febrile and afebrile convulsions with mild gastroenteritis and characterized convulsions with rotavirus and norovirus gastroenteritis. MethodsWe conducted a prospective, observational study to evaluate patients with febrile and afebrile convulsions with mild gastroenteritis who were hospitalized between November 2011 and March 2014 at 13 facilities in the National Hospital Organization. We classified the patients into two groups: presence or absence of fever. We investigated the background, clinical and laboratory characteristics, viral antigen in stool, and efficacy of anticonvulsant drugs. ResultsOf 126 patients enrolled in this study, 50 were febrile (Fc group) and 76 were afebrile (aFc group). A family history of febrile seizures was significantly more frequent in the Fc group than in the aFc group (28.0% vs 9.2%, P = 0.005). Clinical characteristics were similar between the rotavirus and norovirus groups, but fever was significantly more frequent in the rotavirus group (46.2% vs 8.3%, P < 0.001). Serum sodium levels were significantly negatively related to the number of seizures in the aFc group (β = −0.13; 95% confidence interval, −0.24, −0.03; P = 0.01). Carbamazepine was significantly more efficacious than diazepam suppositories in the aFc group (odds ratio = 49.3, 95% confidence interval, 2.35, 1037; P = 0.01). ConclusionFebrile convulsions with mild gastroenteritis show characteristics of both febrile seizures and convulsions with mild gastroenteritis. Carbamazepine is optimal for convulsions with mild gastroenteritis. Clinical features of convulsions with rotavirus and norovirus gastroenteritis are similar, except for fever. Serum sodium levels may play a major role in the onset of convulsions with mild gastroenteritis.

Anticonvulsant effect of Rosa damascena in pentylenetetrazole and maximal electroshock induced convulsions in albino rats

Background: Rosa damascena mill L (Rosa damascena) is an ornamental plant that has several therapeutic (such as sedative and hypnotic) effects. It also heals depression, grief, nervous stress and tension. In the present study we evaluated Anticonvulsant like effect of Rosa damascena in pentylenetetrazole (PTZ) and MES induced convulsions in albino rats. Methods: MES model: rats were divided into 4 groups of 6 rats each. Group-I received 0.5% normal saline, group-II (standard) received phenytoin 25 mg/kg, group-III ,IV received low dose (200 mg/kg) and high dose (400 mg/kg) of rosa damascena respectively orally convulsions were produced in all groups by giving maximum electric shock of 150 mA for 0.2 sec after 1 hour of giving test and standard drugs orally. Tonic clonic seizures were produced after giving electric shock .recovery time was noted. The percentage of inhibition of convulsions by drugs was measured and compared between the control, standard and test. PTZ model: rats were divided and test drugs were given same as above model but standard drug was sodium valporate (200 mg/kg). Convulsions were induced by giving the pentylenetetrazole IP 1hour after giving test and standard drugs intra-peritonelly. The onset of convulsions, duration of action and type of seizures were noted and compared between standard and test groups. Results: In MES Model, aqueous extract of Rosa damascena significantly (p

A case of tuberous sclerosis - presenting as febrile seizures with status epilepticus

Tuberous sclerosis or Tuberous Sclerosis Complex (TSC) is an autosomal dominant disease which comes under a group of diseases known as Neurocutaneous syndromes or phakomas. Incidence of TCS is around 1 in 6000. It is characterized by the growth of numerous hamartomas in several organs including the brain, heart, skin, eyes, kidney, lung and liver. The affected genes are TSC1 and TSC2 encoding hamartin and tuberin respectively. Here, we are presenting a case of 2 year old male child born of a non-consanguineous marriage admitted in the pediatrics emergency ward with the history of fever since one day and continuous convulsions since past one hour GTCS type. Mother also gave history of recurrent attacks of convulsions since 9 months of age. On thorough clinical evaluation and radiological investigation, he was diagnosed as a case of tuberous sclerosis. This case report emphasizes the importance of complete evaluation of a case presenting with seizures and inclusion of TSC (Tuberous Sclerosis Complex) as a differential diagnosis in children presenting with seizures, developmental delay and autism.

Antinociceptive and Antioxidant Activities of the Methanolic Extract of Telfairia occidentalis Seeds.

Context:The seeds of Telfairia occidentalis have been known to possess different biological properties and are used in traditional medicine in Africa and Asia to treat many ailments. The plant is particularly noted traditionally for its healing properties and is usually consumed in the form of herbal decoctions/concoctions as a blood tonic, to treat sudden attacks of convulsions, pain, malaria and anaemia.Aims:In the present study, various phytochemical and pharmacological studies were done on the methanolic extract of the seeds of Telfairia occidentalis to evaluate its antioxidant and antinociceptive properties to substantiate its traditional use.Methods:Phytochemical screening of the extract was done according to standard procedures. Antioxidant potential was ascertained using 2,2-diphenyl-1-picryl hydrazyl (DPPH) scavenging activity, total phenolic content and total flavonoid content assays. Analgesic activity was analyzed using formalin induced paw licking test in albino rats at 100, 200 and 400 mg extract per kg body weight.Statistical Analysis Used:All results extrapolated from the experiments were expressed as mean ± SEM. Data obtained was analyzed statistically using ANOVA (one-way) followed by Dennett's posthoc test.Results:Phytochemicals present in the extract were alkaloids, flavonoids, saponins, terpenoids, steroid and anthraquinones. The extract significantly inhibited DPPH scavenging activity with percentage inhibition of 147.3%. The methanolic seed extract of T. occidentalis significantly reduced (P < 0.05) formalin induced paw licking in both neurogenic and inflammatory phases of formalin induced paw licking test, with 35.59 and 78.51% inhibition at 400 mg/kg, in albino rats in a dose dependent manner.Conclusions:The seed extract in this study significantly reduced formalin induced hind paw licking, and could be used as an analgesic for treatment of pain and also showed marked antioxidant potential.

Effectiveness of Health Teaching Regarding Home Care of Child with Convulsion among Care Givers

Convulsions in children is one of the major health problem,parents also continued to worry about the effects of seizures and treatment in three areas: on their child's brain (brain damage, death and cognitive deficits)on the child's mental health, and on the family. These parents were concerned about how to manage their child's seizures, including worries related to the medical diagnosis, negative responses of others to the epilepsy, lifestyle restrictions, and mental health problems. Peak age of onset around 1 year,90% of the pediatric children have convulsive attacks occurred during the first three years of age.1

Unprecedented bilateral humeral shaft fracture after cesarean section due to epileptic seizure per se

Abstract Despite the fact that spontaneous (non-traumatic) bilateral humeral fractures without trauma are seen as a rare entity, especially grand mal epileptic convulsions may result in these types of fracture in the adult. A 32-year-old early postpartum patient without osteoporosis and with a history of epilepsy is presented here. She had not used anticonvulsant drugs for nearly ten years. After a convulsive epileptic attack on the day of a cesarean section, bilateral humeral shaft fractures were diagnosed on the 5th postpartum day causing bilateral shoulder pain. An earlier chest anteroposterior X-ray including the humerus would be a help in order to perform earlier diagnosis. It should be taken into consideration that humeral bone fractures may happen without any trauma especially in early postpartum patients. A high degree of suspicion should be kept in mind while treating a patient in the post-ictal phase; as, if treated promptly, treatment leads to complete functional recovery.

Forebrain‐independent generation of hyperthermic convulsions in infant rats

SummaryFebrile seizures are the most common type of convulsive events in children. It is generally assumed that the generalization of these seizures is a result of brainstem invasion by the initial limbic seizure activity. Using precollicular transection in 13‐day‐old rats to isolate the forebrain from the brainstem, we demonstrate that the forebrain is not required for generation of tonic–clonic convulsions induced by hyperthermia or kainate. Compared with sham‐operated littermate controls, latency to onset of convulsions in both models was significantly shorter in pups that had undergone precollicular transection, indicating suppression of the brainstem seizure network by the forebrain in the intact animal. We have shown previously that febrile seizures are precipitated by hyperthermia‐induced respiratory alkalosis. Here, we show that triggering of hyperthermia‐induced hyperventilation and consequent convulsions in transected animals are blocked by diazepam. The present data suggest that the role of endogenous brainstem activity in triggering tonic–clonic seizures should be re‐evaluated in standard experimental models of limbic seizures. Our work sheds new light on the mechanisms that generate febrile seizures in children and, therefore, on how they might be treated.

Comparative Anticonvulsant Study of Epoxycarvone Stereoisomers.

Stereoisomers of the monoterpene epoxycarvone (EC), namely (+)-cis-EC, (−)-cis-EC, (+)-trans-EC, and (−)-trans-EC, were comparatively evaluated for anticonvulsant activity in specific methodologies. In the pentylenetetrazole (PTZ)-induced anticonvulsant test, all of the stereoisomers (at 300 mg/kg) increased the latency to seizure onset, and afforded 100% protection against the death of the animals. In the maximal electroshock-induced seizures (MES) test, prevention of tonic seizures was also verified for all of the isomers tested. However, the isomeric forms (+) and (−)-trans-EC showed 25% and 12.5% inhibition of convulsions, respectively. In the pilocarpine-induced seizures test, all stereoisomers demonstrated an anticonvulsant profile, yet the stereoisomers (+) and (−)-trans-EC (at 300 mg/kg) showed a more pronounced effect. A strychnine-induced anticonvulsant test was performed, and none of the stereoisomers significantly increased the latency to onset of convulsions; the stereoisomers probably do not act in this pathway. However, the stereoisomers (+)-cis-EC and (+)-trans-EC greatly increased the latency to death of the animals, thus presenting some protection. The four EC stereoisomers show promise for anticonvulsant activity, an effect emphasized in the isomers (+)-cis-EC, (+)-trans-EC, and (−)-trans-EC for certain parameters of the tested methodologies. These results serve as support for further research and development of antiepileptic drugs from monoterpenes.

Antimuscarinic-induced convulsions in fasted animals after food intake: evaluation of the effects of levetiracetam, topiramate and different doses of atropine.

This study evaluated the effects of different doses of atropine and new antiepileptics, levetiracetam and topiramate, on the development of convulsions triggered by food intake in antimuscarinic-treated fasted animals. Mice deprived of food for 24 h and treated i.p. with atropine at a dose of 2.4 or 24 mg/kg developed convulsions after being allowed to eat ad libitum. No convulsions were observed in fasted animals treated with 0.24 mg/kg atropine. There was no difference in the incidence of convulsions between the two atropine treatments, but latency to convulsions was longer in 24 mg/kg atropine treated animals. The lowest dose of atropine, 0.24 mg/kg, caused stage 1 and stage 2 activity, but did not provide the convulsive endpoint (stage 3, 4, 5 activity). Administration of levetiracetam (50 or 200 mg/kg) or topiramate (50 or 100 mg/kg) to another group of 24-h fasted mice was ineffective in reducing the incidence of convulsions developed in the animals after 2.4 mg/kg atropine treatment and food intake. However, the higher dose of levetiracetam prolonged the onset of convulsions. Present results demonstrated the efficacy of low and high doses of atropine on the development of convulsions in fasted animals and provided additional evidence for the ineffectiveness of antiepileptic treatment in these seizures.

The Effects of Repetitive Transcranial Magnetic Stimulation on Picrotoxin-Induced Convulsions in Mice.

Clinical and experimental results show that repetitive transcranial magnetic stimulation (rTMS) is effective and safe in the treatment of epilepsy. The characteristics of the impulse magnetic field (IMF) are empirical in these studies, making impossible to compare their effectiveness. The article presents the results of a study of the anticonvulsive effects of different modes of IMF on the picrotoxin seizure model, which is important for studying GABAergic brain mechanisms activated by rTMS. The experiments were performed on outbred male mice (n = 597; 450 in the experimental group and 147 in the control group). The picrotoxin was injected in a dose of 2.5 mg/kg subcutaneously after either rTMS or a placebo. The rTMS regimes varied in frequency (0.1, 0.3, 0.5, 1.0 and 10 Hz), intensity (10, 20 and 40% of maximal magnetic induction [MMI] of the big ring coil) and the number of procedures (1, 3, 10). The dependence of the criterial characteristics on the TMS parameters was shown in this convulsive model. The analysis of the data obtained showed that 10 rTMS sessions at an intensity of 20% of MMI in the range of frequencies from 0.5 to 1.0 Hz had the most stable and significant effect in terms of reducing the convulsive readiness of the brain, evaluated by the latent period of the myoclonuses in the picrotoxin test. In all the regimes of exposure, rTMS decreased the number of seizures in the picrotoxin model by 1.5-2 points; the most significant effect was obtained with 10 rTMS sessions in the 0.5-1.0 Hz frequency range and an intensity of 20% of the MMI (р < 0.01). The study results support the use of IMF as therapy for blocking convulsive attacks.

Review of Sodium Valproate Clinical and Biochemical Properties

: Valproic acid is a commonly used anti-epileptic drug (AED) for prescription to control convulsion attacks. The aim of this study was to provide a review of drug management among adult epileptic population. Topic words that searched were “Valproic acid, Pharmacokinetics, Epilepsy and Iran” that search in DOAJ, Google Scholar, PubMed and Web of Science. A total of approximately 1200 articles were found and at the end, 41 articles were reviewed. With an oral dose of 10 - 15 mg/kg/day in three divided doses, target blood level ranges from 50 - 100 mg/L. With a half-life of 9 - 16 hours, it seems that the valproic acid has a variable absorption phase. The pattern of metabolic pathways seems to be through the glucuronide conjugation and mitochondrial β-oxidation. The drug causes delay in carbamazepine elimination and may increase the amount of its metabolites. Valproic acid could decrease the clearance of amitriptyline and nortriptyline. Aspirin increase its’ trough level. The doses of olanzapine suggested to be reduced when co-medicated with valproic acid. To specify the amount and effects of administrated dose an attentive pharmacotherapy- guideline seems to be useful. Due to CYP450 dependent metabolic pathways (inhibition or induction), therapeutic drug monitoring (TDM) in simultaneous prescription of valproic acid with carbamazepine, lamotrigine, phenytoin, topiramate, amitriptyline, nortriptyline, aspirin, meropenem, olanzapine and clonazepam, manifested to be necessary in clinical practice.

An unusual cause for focal convulsions: Menkes kinky hair disease

A 6-month-old male infant was admitted to hospital with the history of repeated attacks of focal convulsions since 1 day prior to admission. He was also suffering from frequent attacks of cough and cold since 5 months of age, which was marked prior to admission. The infant had fair complexion, sparse fuzzy woolly hair with marked trunkal hypotonia. Serum copper and ceruloplasmin levels were low, magnetic resonance imaging showed diffuse cerebral atrophy with ill-defined areas of encephalomalacia. Microscopic examination of hair revealed pili torti. The patient was diagnosed as Menkes disease and treated symptomatically. For lack of facilities, we were not able to do magnetic resonance angiography and genetic study.