Tonic-clonic Convulsions Research Articles

6791 Pituitary Apoplexy as Presentation of Atypical Teratoid/Rhabdoid Tumor

Abstract Disclosure: S.I. Babli: None. H. Alkubedan: None. N.M. Ali: None. R. Alqawahmed: None. M.M. Elhassan: None. Introduction: Pituitary apoplexy occurs in a pituitary adenoma; it migh occur in other less common types of tumors. The atypical teratoid/rhabdoid tumor (ATRT) is a very aggressive malignant tumor of the central nervous system and has a poor prognosis. It is rare to occur in adult and in the sellar region. Clinical Case: 32 years old male presented to ER with 4 days history of fever, headache and vomiting. He was conscious but confused. Vital signs Temperature 39 C, BP 120/80, HR 110 beats/min and Saturation of 95 %, Possibility of meningoencephalitis was raised, patient Brain CT showed Sellar and suprasellar mass with compression over the optic chiasma and invasion to the left cavernous sinus. Patient suddenly developed Generalize tonic-clonic convulsion and hypotension. He received IV midazolam, intubated and was started on noradrenaline and hydrocortisone, he was admitted to ICU as a case of meningoencephalitis and started on Ceftriaxone, Vancomycin and Acyclovir. Cerebrospinal fluid analysis showed RBC 175/cumm, WBC 20/cumm with 20% polymorph and 80% mononuclear cells, Protein 1.38 g/l (0.24-0.49) glucose 7.9 mmol/l with plasma glucose of 10 mmol/l. Repeated Brain CT showed Sellar and suprasellar mass with compression over the optic chiasma and invasion to the left cavernous sinus and with minimal heterogenicity and increased density suggestive of hemorrhagic components. Endocrine history revealed weight gain but no history to suggest acromegaly, Cushing’s syndrome or hypogonadism . Examinations: Patient was intubated and sedated BP 90/60 on Maximum inotropic support. Left oculomotor nerve palsy, Bilateral papilledema, he was having acanthosis nigricans with no signs of acromegaly, CS or hypogonadism. Laboratory finding: WBC17 with neutrophilia, Hgb 14.7 g/dl plt 360 Na 140 mmol/l, creatnin 180 mmol/, FT4 6.2 pmol/l, TSH 0.015, PROLACTINE 22, IGF1 29 ng/ml (41-246) Free testosterone index 2.13 (33-106), LH 0.5, FSH 0.3 .Patient had TTS and histopathology showed: SMARCB1 deficient malignant neoplasm, consistent with sellar atypical teratoid rhabdoid tumor. Post OP, patient had Ventilator associated pneumonia and recurrent attacks of seizures despite multiple antiepileptic medications. Patient was evaluated by medical and radiation oncologists but due to his general condition the treatment was postpone. One month after TSS, he developed intractable seizure new Brain CT showed interventricular haemorrhage with hydrocephalus and marked enlargement of hyperdense pituitary lesion which suggests haemorrhage. External ventricular drain was inserted but patient arrested and died. Conclusions: ATRT of the CNS usually affects young children. In the literature review performed in adults, only nine cases have occurred in the sellar or suprasellar region. Survival is variable in the different cases reported in the literature, with a mean of 26 months. Presentation: 6/2/2024

Biochemical Side Effect of Antiepileptic Drugs on Liver Enzymes, Lipid Profile and Haematological Profile in Epileptic Pediatric Patients

Antiepileptic drugs are large group of medications with variable mechanisms of action. There are various effects have been reported with long-term antiepileptic therapy. To assess the effects of the antiepileptic drugs on blood indices, liver function and lipid enzymes in epileptic pediatric age group. A comparative case-control study was performed in which 50 epilepsy cases were matched with 50 controls for age and sex. The mean age of the cases was 9.1(± 3.7) years, 86% from Benghazi. The 68% were primarily generalized seizure, 64% tonic clonic convulsion. The age at diagnosis between 2 months - 13 years. The 74% used Na-valproate as a single or a combined therapy and Carbamazepine was prescribed as a single medication in 18%. No statistical significant differences in the means of CBC indices and liver function profiles (AST and ALT) in the treatment groups compared to the control. Alkaline phosphatise was highly significant difference in the mean between the two groups (P=0.007). Mean of serum Cholesterol level showed higher in the cases than controls with highly statistical significant difference (P<0.001). HDL mean level is higher for cases on carbamazepine and Na-valproate group compared to controls with statistical significant difference (P=0.011). Cases on carbamazepine and Na-valproate group as well showed higher mean LDL level compared to the controls with statistically significant (P=0.006). No any statistical significant difference in means of CBC indices between epileptic patient treated with AED and control. Carbamazepine group expressed higher mean HDL level as compared to Na-valproate group, this difference is highly significant. Key words: Antiepileptic drugs, liver enzymes, lipid profiles.

Susceptibility to Pentylenetetrazole-Induced Seizures in Mice with Distinct Activity of the Endogenous Opioid System.

Currently, pharmacotherapy provides successful seizure control in around 70% of patients with epilepsy; however, around 30% of cases are still resistant to available treatment. Therefore, effective anti-epileptic therapy still remains a challenge. In our study, we utilized two mouse lines selected for low (LA) and high (HA) endogenous opioid system activity to investigate the relationship between down- or upregulation of the opioid system and susceptibility to seizures. Pentylenetetrazole (PTZ) is a compound commonly used for kindling of generalized tonic-clonic convulsions in animal models. Our experiments revealed that in the LA mice, PTZ produced seizures of greater intensity and shorter latency than in HA mice. This observation suggests that proper opioid system tone is crucial for preventing the onset of generalized tonic-clonic seizures. Moreover, a combination of an opioid receptor antagonist-naloxone-and a GABA receptor agonist-diazepam (DZP)-facilitates a significant DZP-sparing effect. This is particularly important for the pharmacotherapy of neurological patients, since benzodiazepines display high addiction risk. In conclusion, our study shows a meaningful, protective role of the endogenous opioid system in the prevention of epileptic seizures and that disturbances in that balance may facilitate seizure occurrence.

Isolated Cortical Vein Thrombosis: A Case Report

Isolated cortical vein thrombosis (ICVT) is a rare entity of cerebral venous thrombosis (CVT) that represents a third leading cause of death during pregnancy and puerperium. IVCT manifests with wide spectrum of symptoms including headache, seizure, focal neurological deficits and changed mental status, makes the diagnosis challenging. Pregnancy, puerperium, lumbar puncture, trauma and infection, genetic predisposing and acquired prothrombotic causes, all are well recognized risk factors for ICVT. Although no established universal consensus for management, IVCT generally treated by anticoagulant. In this paper, a case of IVCT reported in 25 years old postpartum mother, delivered by cesarean using epidural anesthesia. The case presents by persisting non-orthostatic headache in first few days post-delivery that treated as post dural puncture headache but not improved. On day 7 post-delivery developed multiple episodes of focal convulsion progressed to generalized tonic-clonic convulsion associated by left hemi-paresis. MRI gradient echo sequences showed liner hypo-signal lesion with configuration of cortical vein over right high parietal area. The MRV showed multiple small filling defects along the right cortical vein in favor IVCT. The patient treated successfully by enoxaparin (according her body weight) followed by warfarin for 3 months with complete resolution of the neurological deficit.

Hetero pregnancy. A case report

Background: Heterotopic pregnancy is a rare condition that refers to the simultaneous existence of intrauterine pregnancy (IUP) and ectopic pregnancy. It is a life-threatening condition that requires early diagnosis and prompt management. Case Presentation: A 30-year-old African pregnant woman was presented to the emergency department complaining of severe abdominal pain, especially on the right side. She was checked for history and underwent a physical examination and ultrasound which reveals intrauterine pregnancy with right adnexal mass. While undergoing laparotomy for management of the adnexal mass, a small fetus was found; therefore, a right salpingo- oophorectomy for removal of this ectopic pregnancy was done. She was improved and discharged in good condition with a recommendation to follow up on her pregnancy. Five months later, she was admitted again as she experienced an eclamptic fit with tonic-clonic convulsion lasting for 10 minutes. She experienced a deteriorating condition that required medical termination of pregnancy. She did not improve and she was admitted to the intensive care unit and well-managed, then she improved and was shifted to the ward for observation for 10 days and then discharged in good condition. Conclusion: The presence of IUP does not exclude the presence of ectopic pregnancy. Follow-up during pregnancy is necessary, especially if the patient is known to have previous gestational complications. Examination using transvaginal ultrasound is necessary for early diagnosis of heterotropic pregnancy (HP). Surgical treatment of HP and subsequent follow-up can contribute to maintaining IUP and its successful delivery.

Epilepsy Classification (ILAE Classification 2017) in Resource-limited Countries: A Cross-sectional Study on Epilepsy in Pediatric Patients from Sudan

Background: The objective of this study is to utilize the ILAE 2017 to classify epilepsy patients and determine its applicability in Sudan. Methods: This study is a prospective, descriptive, cross-sectional research conducted in two pediatric epilepsy clinics in Khartoum State, Sudan. Results: In this cross-sectional study, 350 pediatric patients with epilepsy were included, with a mean age of 8.4 ± 4.7 years and a mean illness duration of 4.71 ± 3.91 years. The ILAE classification was applied, showing that 71.11% of patients had generalized onset seizures, 27.7% had focal onset seizures, and only 1.1% had unknown onset seizures. Among patients with focal onset seizures, 56.4% had intact awareness, while 43.6% had impaired levels of awareness. The majority of patients who had generalized onset seizures experienced motor onset seizures, with tonic-clonic seizures being the most common (44.2%). Nearly all patients with unknown onset seizures experienced tonic-clonic convulsions. These findings provide insights into the prevalence and types of seizures among pediatric epilepsy patients in Sudan and can guide clinicians in developing appropriate treatment plans. Conclusion: This study highlights the importance of utilizing the latest ILAE classification 2017 in epilepsy classification and its potential utilization in resource-limited areas like Sudan.

Ruptured Intracranial Vascular Aneurysm with Subarachnoid Haemorrhage: Autopsy Case Series and Literature Review

Background: Subarachnoid haemorrhage (SAH) is a severe condition where bleeding occurs in the subarachnoid space surrounding the brain. SAH can be caused by a ruptured aneurysm or head injury leading to a stroke (with associated disability or death). Common symptoms include severe (thunderclap) headache, neck pain, nausea, vomiting, and sensitivity to light. Case Presentations: Firstly, a 58-year-old man presented with a history of severe headaches and inability to use the left side of his body, with a possible hemorrhagic right-sided hemispheric stroke diagnosis. Following death, an autopsy revealed a ruptured intracranial Charcot Bouchard aneurysm, with SAH as the cause. Secondly, a 35-year-old woman presented with a sudden loss of consciousness and three episodes of generalised tonic-clonic convulsion during a coital activity at a guest house. Following death, an autopsy revealed a ruptured middle cerebral artery’s saccular (berry) aneurysm, causing SAH with bilateral tonsillar herniation as the cause. These case series highlight the importance of autopsy in diagnosing SAH.

Enhanced Membrane Incorporation of H289Y Mutant GluK1 Receptors from the Audiogenic Seizure-Prone GASH/Sal Model: Functional and Morphological Impacts on Xenopus Oocytes.

Epilepsy is a neurological disorder characterized by abnormal neuronal excitability, with glutamate playing a key role as the predominant excitatory neurotransmitter involved in seizures. Animal models of epilepsy are crucial in advancing epilepsy research by faithfully replicating the diverse symptoms of this disorder. In particular, the GASH/Sal (genetically audiogenic seizure-prone hamster from Salamanca) model exhibits seizures resembling human generalized tonic-clonic convulsions. A single nucleotide polymorphism (SNP; C9586732T, p.His289Tyr) in the Grik1 gene (which encodes the kainate receptor GluK1) has been previously identified in this strain. The H289Y mutation affects the amino-terminal domain of GluK1, which is related to the subunit assembly and trafficking. We used confocal microscopy in Xenopus oocytes to investigate how the H289Y mutation, compared to the wild type (WT), affects the expression and cell-surface trafficking of GluK1 receptors. Additionally, we employed the two-electrode voltage-clamp technique to examine the functional effects of the H289Y mutation. Our results indicate that this mutation increases the expression and incorporation of GluK1 receptors into an oocyte's membrane, enhancing kainate-evoked currents, without affecting their functional properties. Although further research is needed to fully understand the molecular mechanisms responsible for this epilepsy, the H289Y mutation in GluK1 may be part of the molecular basis underlying the seizure-prone circuitry in the GASH/Sal model.

SURG-15. RIGHT FRONTAL-PARIETAL PILOCYTIC ASTROCYTOMA WHO GRADE I ASSOCIATED WITH HEMORRHAGIC COMPONENT AND ESSENTIAL HYPERTENSION IN AN ADULT

Abstract Pilocytic astrocytoma (PA) is a primary glial neoplasm and low-grade tumor. After total resection, the prognosis is very good. A poor prognosis results from leptomeningeal spreading and bleeding, both of which are extremely uncommon in Pilocytic Astrocytoma patients. Case presentation We report the case of a 43-year-old male that presented with a 4 days’ history of right sided frontal headache, non-radiating and mostly felt in the morning. Not associated with vomiting and fever. In addition, there was a sudden decline in level of consciousness with no associated stool or urine incontinence. The patient also developed three episodes of tonic clonic convulsions, lasting less than 3 minutes associated with urine incontinence and frothing from the mouth. Two days later, there was a sudden onset of left sided weakness involving upper and lower limbs. However, there is no history of trauma or hypertension. He was identified as having a hemorrhagic right frontal-parietal PA evidence on MRI associated with essential hypertension. The patient had an intervention combination of medical treatment and craniotomy via fronto-temporal approach plus excision of lesion. Histopathological examination of specimen determined that it was PA WHO grade I. He was treated with oral anti-epileptic therapy (Phenytoin 300 mg once a day), folic acid supplementation (400 mcg once a day), anti-hypertensive therapy (Amlodipine 10 mg and Losartan 50 mg once daily) and he showed marked improvement and was discharged home after 1 month and followed up by primary neurosurgeon, oncologist and physician. CONCLUSION: This case report raises awareness of Pilocytic Astrocytoma among adults and emphasizes the value of early diagnosis and management of patients with Pilocytic Astrocytoma associated with essential hypertension can prevent complications, reduce morbidity and mortality.

GLIOMA-13 RIGHT FRONTO-PARIETAL PILOCYTIC ASTROCYTOMA WHO GRADE I ASSOCIATED WITH HEMORRHAGIC COMPONENT AND ESSENTIAL HYPERTENSION IN AN ADULT: A CASE REPORT

Abstract Pilocytic astrocytoma (PA) is a primary glial neoplasm and low-grade tumor. After total resection, the prognosis is very good. A poor prognosis results from leptomeningeal spreading and bleeding, both of which are extremely uncommon in Pilocytic Astrocytoma patients. CASE PRESENTATION: We report the case of a 43-year-old male that presented with a 4 days’ history of right sided frontal headache, non-radiating and mostly felt in the morning. Not associated with vomiting and fever. In addition, there was a sudden decline in level of consciousness with no associated stool or urine incontinence. The patient also developed three episodes of tonic clonic convulsions, lasting less than 3 minutes associated with urine incontinence and frothing from the mouth. Two days later, there was a sudden onset of left sided weakness involving upper and lower limbs. However, there is no history of trauma or hypertension. He was identified as having a hemorrhagic right fronto-parietal PA evidence on MRI associated with essential hypertension. The patient had an intervention combination of medical treatment and craniotomy via fronto-temporal approach plus excision of lesion. Histopathological examination of specimen determined that it was PA WHO grade I. He was treated with oral anti-epileptic therapy (Phenytoin 300 mg once a day), folic acid supplementation (400 mcg once a day), anti-hypertensive therapy (Amlodipine 10 mg and Losartan 50 mg once daily) and he showed marked improvement and was discharged home after 1 month and followed up by primary neurosurgeon, oncologist and physician. CONCLUSION: This case report raises awareness of Pilocytic Astrocytoma among adults and emphasizes the value of early diagnosis and management of patients with Pilocytic Astrocytoma associated with essential hypertension can prevent complications, reduce morbidity and mortality.

Audiogenic Seizures and Social Deficits: No Aggravation Found in Krushinsky-Molodkina Rats.

Epilepsy or epileptic syndromes affect more than 70 million people, often comorbid with autism spectrum disorders (ASD). Seizures are concerned as a factor for social regression in ASD. A stepwise experimental approach to this problem requires an animal model to provoke seizures and monitor subsequent behavior. We used rats of the Krushinsky-Molodkina (KM) strain as a validated inbred genetic model for human temporal lobe epilepsy, with recently described social deficiency and hypolocomotion. Generalized tonic-clonic seizures in KM rats are sound-triggered, thus being controlled events in drug-naïve animals. We studied whether seizure experience would aggravate contact deficits in these animals. Locomotor and contact parameters were registered in "the elevated plus maze", "socially enriched open field", and "social novelty/social preference tests" before and after sound-provoked seizures. The triple seizure provocations minimally affected the contact behavior. The lack of social drive in KM rats was not accompanied by a submissive phenotype, as tested in "the tube dominance test", but featured with a poor contact repertoire. Here, we confirmed our previous findings on social deficits in KM rats. The contact deficiency was dissociated from hypolocomotion and anxiety and did not correlate with seizure experience. It was established that experience of rare, generalized tonic-clonic convulsions did not lead to an impending regress in contact motivation, as seen in an animal model of genetic epilepsy and comorbid social deficiency. One of the oldest animal models for epilepsy has a translational potential to study mechanisms of social behavioral deficits in future neurophysiological and pharmacological research.

Familial Case of Porphyria with an Epileptic Seizure in the Moscow Region

Objective a clinical case of a 37-year-old patient with familial acute porphyria is presented (the patient's sister died at the age of 28 during an attack of acute porphyria). Material and methods: we used a qualitative urine test for porphyria with Erdich reagent and quantitative determination of porphyrins (porphobilinogen and delta-aminolevulenic acid on a spectrophotometer “Hitachi 3900”. Results.The attack began with pain in the abdomen and lower back, tachycardia, arterial hypertension during menstruation. After taking ketorol and surgical intervention, tonic-clonic convulsions developed with involuntary release of pink urine. CT of the brain shows signs of ischemic cerebrovascular accident in the parietal region of the right hemisphere. There was a decrease in the level of hemoglobin in the blood and APTT. A urine test for porphyria was positive. Porphobilinogen and delta-aminolevulinic acid in the blood are elevated. After the appointment of glucose at a dose of 300 g of dry matter per day in an oral solution, the condition improved. Conclusion. The presented case demonstrates the difficulties in diagnosing and managing patients with acute porphyria, despite the awareness of the attending physicians about this disease. The patient developed an epileptic seizure and brain damage according to CT, which could be posterior reversible encephalopathy. To improve the efficiency of diagnosis and treatment of porphyria in all laboratories, a simple and cheap qualitative urine test for porphyria with Ehrlich's reagent should be organized and Hitachi 3900 spectrophotometers should be purchased at regional medical centers. Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.

The spectrum of electroencephalographic characteristics in children with autistic spectrum disorder at a tertiary care centre

There are high rates of epileptiform EEGs in children with ASD without a history of seizures or epilepsy. ASD is associated with a higher risk of epilepsy with prevalence ranging from 5%-46%. The study was conducted to detect the prevalence of EEG abnormalities in ASD patients and to evaluate the spectrum of EEG changes in epileptic and nonepileptic patients with their clinical features and severity of ASD. The study was conducted at the tertiary care centre. A total of 140 cases with ASD, who met DSM V criteria for autism were studied. All the cases were screened with history taking, physical, neurological, and neuropsychiatric evaluation. These children were subjected to psychological testing using the ISAA scoring system. All the studied cases were also subjected to EEG testing. The prevalence of EEG changes (epileptic and non-epileptic discharges) in our study was 45%, with EEG changes seen in 28.44% of cases of ASD without seizure. In ASD cases with seizure, the most common seizure type was generalized tonic-clonic convulsion (GTCS), on the contrary, most common EEG changes were focal epileptiform activity. Most of EEG had shown well-formed background, except for few which were slow for age. The most dominant background rhythm was theta intermixed with delta followed by theta and delta intermixed with alpha in those children with seizures. Whereas, in children without a history of seizure, the dominant rhythm was delta theta alpha and theta delta. This may be due the o large number of EEG recordings being sleep EEG. We will like to hypothesize that the predominant EEG changes in the frontal lobe may have some neuronal link in the pathogenesis of behavior pattern in ASD. We also propose that more detailed study with different types of EEG and with a larger sample size should be done in the future.

Local anesthesia toxicity in occipital nerve block: A case of generalized tonic-clonic convulsions

Local anesthesia toxicity in occipital nerve block: A case of generalized tonic-clonic convulsions

A STUDY ON MATERNAL AND PERINATAL OUTCOME IN ECLAMPSIA

Introduction: Eclampsia is still amongst the six major determinants of maternal mortality. It is characterized by sudden onset of generalized tonic-clonic convulsion or coma in pregnancy or postpartum, unrelated to other cerebral conditions,in patients with signs and symptoms of preeclampsia. Eclampsia results in increased maternal morbidity and perinatal morbidity. Materials And Methods: This is a prospective hospital based observational study in which all women with eclampsia admitted in OBG department of tertiary care center over one year period from January 2021 to December 2021. Aims And Objectives: To study the incidence of eclampsia, maternal and fetal outcome in eclampsia, complications of eclampsia. Results: Mean age of study group was 23.9±3.55 SD.Majority of the cases were primigravida- 74 (61.66%). Majority of cases were unbooked- 112 (93.3%). Mean gestational age in study group was 35.11 ± 3.24weeks.Majority of cases were antepartum eclampsia- 110 (91.66%)Caesarean delivery was needed in 74 (61.66%) and 46 (38.33%) delivered vaginally.The perinatal mortality is 29.03%. The maternal mortality is 4.16%. Conclusion: Eclampsia occurred in young unbookedprimigravidas in the antenatal period and its incidence is 1.32%. Women require care in HDU-ICU and need careful evaluation to decide the mode of delivery in the best interest of mother and the, to be born preterm baby.We still have a long way to go to improve the outcome of such mothers and infants by better high-risk assessment at peripheral hospitals, critical care ambulances for transfer of these women from periphery and improvement of critical care at our institution by training of our faculty and residents in critical care obstetrics.

The Protection by Vitamin E Against Tramadol-Induced Proconvulsant Effects and Brain Damage in Pentylenetetrazole-Induced Status Epilepticus in Rats

We investigated the effect of the opioid analgesic tramadol on the development of epileptic seizures and neuronal injury and the possible modulatory effect of vitamin E (Vit E) in rats with pentylenetetrazole (PTZ)-induced status epilepticus. Rats received repeated intraperitoneal (i.p.) injections of PTZ till the development of status epilepticus and were pretreated once with tramadol (30, 60 or 90 mg/kg), vitamin E (Vit E, 70 mg/kg) or both tramadol (90 mg/kg) and Vit E (70 mg/kg) prior to starting PTZ injections. Seizure scores, the latency time and the PTZ dose for each group required to reach status epilepticus were determined and histopathological examination of the brain tissue was done. Results indicated that tramadol produced both anticonvulsant and proconvulsant effects. The anticonvulsant effects of tramadol were observed for facial twitching (stage 1), convulsive body waves (stage 2), and myoclonic jerks and rearing (stage 3) and turn over onto one side position (stage 4) that were significantly inhibited by tramadol. In contrast, tonic-clonic convulsions (stage 5) were significantly increased by 60 or 90 mg/kg of tramadol as compared to PTZ control group. The mean latency and PTZ threshold dose for status epilepticus were markedly decreased after tramadol. The administration of Vit E exerted beneficial effects in decreasing epilepsy scores and increasing both the latency time and threshold dose of PTZ for reaching status epilepticus. Meanwhile, rats treated with both tramadol and Vit E exhibited significant increase in tonic-clonic convulsions and markedly shortened latency time to reach status epilepticus compared to those treated with only Vit E. In cerebral cortex and hippocampus, PTZ resulted in apoptotic cells, darkly stained degenerated and vacuolated neurons and gliosis. These pathological changes increased after tramadol but were markedly reduced by Vit E treatment. Collectively, these results suggest that: (i) tramadol exerts both anticonvulsant and proconvulsant effects; (ii) tramadol shortened the latency time and decreased the threshold dose of PTZ for evoking status epilepticus; (iii) PTZ-induced seizures and brain damage can be inhibited by Vit E; (iv) tramadol at high doses interferes with the effect of Vit E in inhibiting tonic-clonic convulsions and in reducing brain damage.

Microburst Vagus Nerve Stimulation: Safety and Efficacy Outcomes (S44.003)

Microburst Vagus Nerve Stimulation: Safety and Efficacy Outcomes (S44.003)

Neurological Complications in MIS-C: Case Report

COVID-19 has seriously affected children and the whole world. Pediatric multi-system inflammatory syndrome (MIS-C), a new syndrome that has not been known before, has been described. Although MIS-C may progress with different clinical manifestations in children, neurological involvement is reported relatively rarely. A 12-year-old girl with cerebral palsy and motor mental retardation was admitted to the emergency department with complaints of cough, fever, mouth sores and malnutrition. As a result of the evaluation, the patient was hospitalized to investigate the etiology of the fever and empirical antibiotic treatment was started, and she developed a rash on the 3rd day and tonic-clonic convulsions on the 5th day. The patient was hospitalized in the pediatric intensive care unit (PICU), and COVID-19 IgG and IgM were positive. Cerebral imaging of the patient was reported as normal. The patient with fever, rash, convulsions lasting longer than five days, and compatible laboratory results were diagnosed with MIS-C. Intravenous immunoglobulin (IVIG) and methylprednisolone treatments were started, and the patient was discharged on the 14th day of hospitalization, whose condition improved. This case is presented as an example of the rare neurological involvement of MIS-C. Detailed clinical investigation and neurological examination are required to exclude neurological sequelae of COVID-19 during the pandemic. The development of general guidelines that can combine them would be instructive.

Clinical, radiological and electrophysiological predictors for drug-resistant epilepsy

BackgroundEpilepsy is the third chronic brain illness worldwide. About a third of the epileptic patients will be drug resistant. Early identification of these patients is critical for appropriate treatment selection and prevention of the devastating consequences of recurrent seizures. The objective of this study aims to detect clinical, electrophysiological, and radiological predictors for drug-resistant epilepsy patients.ResultsOne hundred fifty-five patients were included in this study, divided into a well-controlled epilepsy group (103 patients) and a drug-resistant group (52 patients). Both groups were compared regarding clinical, electrophysiological, and neuro-radiological data. Younger age at onset, history of delayed milestones, history of perinatal insult (especially hypoxia), mental retardation, neurological deficits, depression, status epilepticus (SE), complex febrile seizures, focal seizure to bilateral tonic–clonic convulsion as well as multiple seizures and high seizure frequency (daily) at onset, poor response to first anti-seizure drug (ASD), structural and metabolic etiology, abnormal brain imaging, and slow background and multifocal epileptiform discharges in EEG were significant risk factors for the development of drug-resistant epilepsy.ConclusionMRI abnormalities are the most significant predictor for drug-resistant epilepsy. Drug-resistant epilepsy is associated with clinical, electrophysiological, and radiological risk factors that can be used to diagnose drug-resistant patients early and choose the best treatment option and time.

Successful treatment of 5‐fluorouracil toxicosis with hemodialysis

To describe the successful treatment of lethal dose 5-fluorouracil (5-FU) toxicosis using hemodialysis. A 4-month-old intact female Golden Retriever was presented to the emergency department after ingesting 20g of 5% 5-FU cream. The puppy developed refractory seizures and became comatose with uncontrolled tonic-clonic convulsions. Because of the low molecular weight and minimal protein binding of 5-FU, a single hemodialysis treatment was employed for detoxification. The puppy improved clinically posttreatment and was successfully discharged 3days after admission. Postingestion leukopenia and neutropenia occurred but were responsive to treatment with filgrastim. The puppy is neurologically normal and has no lasting effects 1 year postingestion. To the authors' knowledge, this is the first reported case in veterinary medicine of a potentially fatal 5-FU ingestion that has been treated with intermittent hemodialysis.