Convulsive Disorders Research Articles

Parental knowledge and practice regarding febrile seizure in their children

Background: Febrile seizure (FS) is a benign convulsive disorder in under 5-year-old children, but at the same time, it is an alarming event in the lives of both child and parents. Lack of parent's knowledge about the nature of FS and how they should deal with it can lead to poor management. Objectives: To assess the knowledge and practice of parents regarding FS in their children and to assess the association of knowledge and practice of parents with certain socio-demographic characteristics. Materials and Methods: A cross-sectional study was performed on 100 parents of children with FS attending emergency department in Babylon Teaching Hospital for Pediatrics and Gynecology and AL-Noor Hospital for Pediatrics during a period of 5 months (from March 1 to August 1, 2018). A questionnaire was administered to parents which included items regarding family characteristics, characteristics of FS, their knowledge, and their first-aid practices with FS. Results: Regarding maternal age and paternal age, they ranged between 15–43 and 20–50 years, respectively. More than half of them live in urban areas, and concerning educational level of mothers, 70% were either illiterate or had a primary level of education. Majority of FS children were presented with first attack who represent a percentage of about 69%. About half of the respondents have good level of knowledge. Fifty-two percent of them considered that FS is equivalent to epilepsy, 69% stated that it is a life-threatening event, and 80% knew that it occurs during febrile occasions. Only 25% of parents took their children to doctor during attack of fit without first aids. Conclusions: Parents' knowledge regarding FS was significantly associated with higher maternal education, urban residence, and mother age. A higher level of practices was shown to have a significant association with increasing in the number of episodes experienced by parents and advancing in maternal age.

Exploring Vitamin D in Children with Febrile Seizure: A Preliminary Study

Background: Febrile seizures are the most common convulsive disorder in children. There is growing evidence that vitamin D can affect gene expression and modulate various cell metabolisms. Also vitamin D may have a role in the etiology of febrile seizures. We aimed to explore vitamin D status in children with febrile seizure. Materials and Methods: This cross-sectional study was conducted on 40 children with first episode of febrile seizure referring to Children's Medical Center in Tehran, Iran. A 5 ml blood sample was taken from the peripheral veins of each participant. Serum levels of vitamin D, calcium, phosphorus, parathyroid hormone (PTH), and alkaline phosphates (ALP) was recorded. Other variables that were recorded from each case were gender, age, parental consanguinity and family history of febrile seizure. Patients’ skin color was categorized based on Fitzpatrick’s scale. We asked the parents to complete a validated food frequency questionnaire including vitamin D sources in children. Results: The mean plasma calcium, phosphorous, PTH and ALP were in normal ranges; the mean vitamin D level was 24.41±11.21 ng/ml) in insufficient range). In 7.5% of patients, vitamin D level was in the deficient, 72.5% was in the insufficient and 20% was in sufficient levels. There was no significant difference in vitamin D level between two sexes (P=0.85). There was no significant correlation between vitamin D level and age (P=0.34). There was no significant correlation between vitamin D level and its metabolites (P>0.05). Conclusion There was a high prevalence of vitamin D insufficiency among ourpatients with febrile seizure. Further analytical studies are recommended to prove the relation between vitamin D deficiency and febrile seizure.

Neuropharmacological Activities of Methanol Extract of Albizia lebbeck (L.) Benth.

Albizia lebbeck (Linn.) Benth. is a deciduous tree which is planted as ornamental and avenue tree almost all over Bangladesh. Leaves of the plant are used in ethnomedicine for the treatment of convulsion and CNS related disorder. This study was aimed to evaluate the neuropharmacological effects of the methanol extract of A. lebbeck leaves in Swiss albino mice. The locomotor effect of crude methanol extract of the plant was investigated by open field and hole cross tests while the anxiolytic activity was determined using elevated plus-maze (EPM) and light/dark box (LDB) tests. Furthermore, the sedative activity of the plant extract was assessed by sodium thiopental-induced sleeping time test. The results demonstrated that the methanol extract significantly (p < 0.001) reduced locomotion of the animals in both hole cross and open field tests in dose-dependent manner at 200-400 mg/kg b.w. In both EPM and LDB tests, the plant extract produced significant anxiolytic effect (p < 0.05) at the doses of 100-400 mg/kg b.w. In addition, it showed significant (p < 0.001) dose-dependent decrease in the onset of sleep and an increase in duration of sleep in sodium thiopental-induced sleeping time test. Preliminary phytochemical analyses of the plant extract revealed the presence of alkaloid, flavonoid, glycoside, saponin, tannin and resin. In acute toxicity test, the leaf extract did not exhibit any adverse effect in mice during 7 days treatment. The results of the present studies suggest that the crude methanol extract of A. lebbeck leaves possesses significant CNS depressant, anxiolytic and sedative properties and rationalize the traditional uses of the plant.Bangladesh Pharmaceutical Journal 21(2): 80-86, 2018

Early-life hyperthermic seizures upregulate adenosine A2A receptors in the cortex and promote depressive-like behavior in adult rats

Febrile seizures (FS) represent one of the most frequent convulsive disorders in children which can be classified into simple and prolonged depending on the duration. Although simple FS are generally considered as benign, there is controversy about the outcome of prolonged FS. Here, we have used an animal model of prolonged FS to investigate persistent neurochemical and behavioral alterations in adult rats. Hyperthermic seizures were induced in 12-day-old rats using a warmed air stream from a hair dryer. Neonates exhibited arrest of heat-induced hyperkinesis followed by body flexion and rearing and falling over associated with hindlimb clonus seizures (stage 5 on Racine scale criteria) after hyperthermic induction. After 48 days, the animals were assayed on dark–light box and forced swim tests in order to detect if rats will show signs of anxiety or depression. Finally, animals were sacrificed 56 days after hyperthermia-induced seizures (HIS), and their effects on adenosine A2A receptor signaling and 5′-nucleotidase activity were studied in plasma membranes from the cerebral cortex by using radioligand-binding assay and by measuring the activities of adenylate cyclase and 5′-nucleotidase. Results obtained have shown that adult rats submitted to HIS during the neonatal period showed depressive-like behavior. Furthermore, animals exposed to hyperthermic insult showed an increase in A2A receptor level which was also accompanied by an increase in A2A receptor functionality.

Metabolic profile of oxidative stress and trace elements in febrile seizures among children.

Febrile seizures (FS) are frequent convulsive disorders, occurring in infants and young children. The present study aims to assess and compare the serum levels of oxidative stress markers and some essential trace minerals in FS with normal or abnormal EEG and evaluate the effect of antioxidant therapy on the clinical outcome. This study has been carried out on 80 children with FS (40 with simple FS and 40 with complex FS) and 40 febrile children without seizures. Clinical and EEG findings were recorded for the included patients. Biochemical assays of serum nitric oxide (NO), malondialdehyde (MDA), superoxide dismutase (SOD), copper (Cu), zinc (Zn) and selenium (Se), using colorimetric methods, were measured in the studied groups. The overall results showed an increased values of NO, MDA and Cu with decreased values of SOD, Zn and Se in patients with FS (simple and complex) in comparison with febrile children without seizures (p < 0.05 for all). Additionally, NO and MDA was increased in complex FS patients with EEG abnormalities in comparison with complex FS with normal EEG findings (p < 0.05); NO and MDA were also significantly decreased after valproate therapy in complex FS patients (p < 0.05 for all). In conclusions, oxidative stress, decreased Zn and Se with increased Cu may play a role in FS. Valproate improves the oxidative stress status in complex FS.

Experimental Substantiation of Inhalation Administration of Pathogenic Therapy of Toxic Convulsive Disorder for Correction of External Respiration Disorders.

We studied the dynamics of respiratory function in rats during intratracheal poisoning with diisopropyl fluorophosphate and pentylenetetrazole in doses corresponding to the LD50 in humans. The maximum of external respiration impairment was recorded in 30 min after poisoning. Administration of diazepam and atropine both separately and in combination during the development of the first signs of poisoning did not significantly affect the respiration parameters, but reduced the incidence of seizures and contributed to a decrease in the rate of animal death. Intratracheal administration of cholinolytic, β2-adrenomimetic, or glutamate receptors antagonist promoted correction of the respiratory function. It was found that the maximum therapeutic effect in case of diisopropyl fluorophosphates poisoning was achieved after intratracheal administration of ipratropium bromide (0.086 mg/kg), salbutamol (0.086 mg/kg), and MK-801 (0.1 mg/kg), while in case of pentylenetetrazole poisoning, intratracheal administration of ipratropium bromide (0.086 mg/kg) was most effective.

Gastrodia elatoides (Orchidaceae: Epidendroideae: Gastrodieae), a new holomycoheterotrophic orchid from Madagascar

Gastrodia Brown (1810: 330; Gastrodieae, Epidendroideae) is a genus of holomycoheterotrophic orchids distributed from India and eastern Asia through Malaysia to Australia, as well as in tropical Afro-Madagascar (Pearce &amp; Cribb 2002, Kores &amp; Molvray 2005, Chen et al. 2009, Cribb et al. 2010). In this genus, 85 species have been accepted based on the combined information from Govaerts et al. (2018) and recently published new records of Gastrodia species (Jin &amp; Kyaw 2017, Metusala &amp; Supriatna 2017, Suetsugu 2017, Aung &amp; Jin 2018). Consequently, it is now the largest holomycoheterotrophic genus among vascular plants (Hsu et al. 2016, Suetsugu 2017). Gastrodia is characterised by a fleshy tuber or coralloid rhizome, fusion of sepals and petals, a spurless lip and two sectile pollinia (Pearce &amp; Cribb 2002, Kores &amp; Molvray 2005, Chen et al. 2009). One species, G. elata Blume (1856: 174), is a highly valued plant in traditional Chinese medicine (TCM) for the treatment of convulsive disorders such as epilepsy (Cribb et al. 2010, Chen et al. 2009).

Cerebellar oxidative stress and fine motor impairment in adolescent rats exposed to hyperthermia-induced seizures is prevented by maternal caffeine intake during gestation and lactation

Febrile seizures (FS) is one of the most common convulsive disorders in infants and young children that only occurs during the first years of life in humans, when the cerebellum is still developing. Several works have shown that maternal caffeine consumption during gestation and lactation can exert protective effects on developing brain under pathological conditions. Here, we have used an animal model of FS to know whether maternal caffeine consumption during gestation and lactation exhibited protective effects on rat cerebellum.Pregnant rats were allowed to freely drink water or caffeine (1 g/l) during gestation and lactation. At PD13, neonates were submitted to hyperthermia-induced seizures (HIS) whereas pups not subject to hyperthermic stimulus were used as controls. 48 h, 5 and 20 days after HIS, rats were killed and plasma membranes and cytosolic fractions were isolated from cerebella. The enzymatic activities of glutathione reductase, glutathione S-transferase, caspase-3, 5´-nucleotidase and the levels of thiobarbituric acid reacting substances, adenosine A1 and A2A receptors were studied in these preparations. Furthermore, rats were tested in balance beam test and footprint test 20 days after HIS (PD33) in order to investigate the effect on fine motor coordination and gait patterns.Results obtained suggest that maternal caffeine consumption during gestation and lactation exerts two kinds of beneficial effects on cerebellum from rats submitted to HIS: a) at short term, maternal caffeine abolishes hyperthermic seizures induced-oxidative stress and caspase-3 activation and b) in adolescent rats (PD33), maternal caffeine prevents fine motor coordination impairment and gait disturbances.

Afebrile Benign Convulsion Associated With Mild Gastroenteritis: A Cohort Study in a Tertiary Children Hospital.

Background:Benign convulsion with mild gastroenteritis is a new clinical entity that occurs in children who are otherwise healthy.Method:This cohort study held among patients with afebrile convulsion and accompanying gastroenteritis in a tertiary children hospital during a 2-year period. Demographic and clinical data were analyzed. Neurodevelopmental milestones were observed during a follow-up period of 12 to 24 months.Results:Twenty-five patients aged 3 to 48 months with female predominance were enrolled. Ninety-three percent of cases experienced generalized tonic-clonic seizures. One-third of seizures occurred in clusters. Primary laboratory findings and electroencephalography were normal except for 3 with few epileptic waves. During the follow-up period, no seizure recurrence happened. Long-term antiepileptic treatment was unnecessary.Conclusion:Afebrile convulsion accompanying mild gastroenteritis is a convulsive disorder with reassuring prognosis. Due to its benign course, comprehensive neurodiagnostic evaluation and long-term antiepileptic drugs are usually avoidable.

Improper Use of Thrombolytic Agents in Acute Hemiparesis Following Misdiagnosis of Acute Ischemic Stroke.

Objective Acute hemiparesis is often an early presentation of acute ischemic stroke, though it can occur in various disorders. This study aimed to investigate the improper use of thrombolytic agents for patients with acute hemiparesis, following the misdiagnosis of acute ischemic stroke.MethodsWe analyzed the clinical and radiological data of nine patients initially misdiagnosed with cerebral stroke in the emergency room from May 2013 to January 2017. All the patients were treated with tissue plasminogen activator (TPA) owing to the presence of acute hemiparesis. Subsequently, emergent computed tomography scan showed no intracranial hemorrhage. Clinical findings including neurological deficits, clinical course, and related complications were detected and analyzed.ResultsAcute hemiparesis was observed in the following conditions: spontaneous spinal epidural hematoma, Brown-Séquard syndrome caused by cervical disc herniation, cervical epidural abscess, hypoglycemia in the presence of an old stroke, and seizure or convulsion disorder. Although acute hemiparesis was regarded as a contraindication, inappropriate TPA administration did not aggravate the neurological condition in any of the patients who required surgery.ConclusionUpon presentation of acute hemiparesis, various conditions mimicking cerebral stroke should be considered to avoid misdiagnosis. We suggest that physicians should exercise caution when prescribing thrombolytic agents.

Effect of implementing an educational module on improving mothers knowledge, home management and attitude about febrile convulsion

Background/Objective: Febrile convulsions (FCs) are the most common convulsive disorder of childhood, and represent a benign condition in children. FC occurrence can affect negatively on the familial quality of life and the parents may experience anxiety and fear with every time child develops fever. Therefore, parents and care givers should be educated about febrile convulsion and its home management. The aim of this study was to evaluate the effect of implementing an educational module on mother's knowledge, home management and attitude about febrile convulsion.Methods: A quasi experimental research design using one group pre &amp; post-test was used. The study sample included 107 mothers of children with febrile convulsion according to statistical consultant and statistical formula. The inclusion criteria were: all mothers of children with first or recurrent FC and the children age was from 6 months to five years. The study was conducted at the Emergency department, outpatient clinic and medical word affiliated to Mansoura University Children's Hospital, Egypt. Results: It was found that, fifty two percent (52.3%) of studied children were boys with the mean age were Mean ± SD 2.76 ± 1.30 for children and 30.29 ± 6.41 for mothers. Percentage of studied mother with good knowledge at base line was low (11.2%) while, this percentage was improved to 65.4% with a mean knowledge score 3.98 ± 2.18 before module and 9.70 ± 1.56 after module implementation. In addition, sixty four percent (64.4%) of studied mothers had inappropriate practice and home management compared to less than half (44.9%) after module implementation; the difference was statistically significant (p = .005). Only 25.3% of mothers had positive attitude about febrile convulsion before module implementation and this percentage was improved to 57.9% after module implementation with the mean score of attitude 18.42 ± 5.84 before module and 24.71 ± 6.76 post module implementation and the difference was statistically significant (p = .025).Conclusions: The study concluded that, the use of educational intervention programs and mothers support group were influenced positively in improving mothers’ knowledge, home management &amp; attitude about FC and its management; but still some mothers having inappropriate home management and negative attitude. Therefore, it is recommended further education in the pediatric clinic or via mass media.

Intelligence, Functioning, and Related Factors in Children with Cerebral Palsy.

Cerebral palsy (CP) is the most common significant motor impairment in childhood. CP is defined as a primary disorder of posture and movement; however, intellectual impairment is prevalent in children with CP. The purpose of this study was to examine the intelligence level associated with gross motor function and hand function, type of CP, the presence of comorbid disorders such as epilepsy, and other factors. In total, 107 children with CP were included. Age, gender, prenatal/natal/postnatal risk factors, type of CP, and presence of other neurodevelopmental disorders were recorded as demographic findings. Intellectual functions of the patients were determined by clinical assessment, adaptive function of daily life, and individualized, standardized intelligence testing. The gross motor function and hand function of the patients were classified using the "Gross Motor Function Classification System" and "Bimanual Fine Motor Function" measurements, respectively. The mean age of the patients was 8.10±3.43 years (2-16 years). The study included 63 (58.9%) male patients and 44 (41.1%) female patients. During clinical typing, 80.4% of the patients were spastic, 11.2% were mixed, 4.7% were dyskinetic, and 3.7% were ataxic. Intellectual functioning tests found 26.2% of the children within the intellectual norm and that 10% of the children had a borderline intellectual disability, 16% of them had a mild intellectual disability, 17% of them had a moderate intellectual disability, and 30.8% of them had a severe intellectual disability. No significant relationship was determined between the CP type and intellectual functioning (p>0.05). Intellectual functioning was found to be significantly correlated with hand functions and motor levels (p<0.001). Factors related with intellectual functioning were neonatal convulsion, epilepsy, and speech disorders. Intelligence assessment should be an essential part of CP evaluation and research. There is not enough reliable knowledge, unanimity regarding validity data, and population-specific norms in the intelligence assessments of children with CP. Research is required to assess properly intelligence for children with CP.

Intelligence functioning and associated factors in children with cerebral palsy

ObjectivesCerebral palsy (CP) is described as a primary disorder of posture and movement; however, intellectual impairment is prevalent in children with CP.AimThe aim of the present study was to examine the association with intellectual level and gross motor function, hand function, type of CP, and the presence of co-morbid disorders in these children.MethodsA total of 107 children with CP were included in the study. Intellectual functions of the children were determined by clinical assessment, adaptive function of daily life, and individualized standardized intelligence testing. Gross motor function and hand function of the patients were classified using the gross motor function classification system and the bimanual fine motor function measurements.ResultsThe mean age of the patients were 8.10 ± 3.43 years (age: 2–16 years). During clinical typing, we observed that 80.4% of the patients were spastic, 11.2% were mixed, 4.7% were dyskinetic, and 3.7% were ataxic. No significant relationship was determined between the type of CP and intellectual functioning (P &gt; 0.05). Intellectual functioning was found to be significantly correlated negatively with both gross motor function and hand functions level (P &lt; 0.001). The factors related to intellectual functioning were neonatal convulsion (x2 = 12.97, P = 0.002), epilepsy (x2 = 29.221, P &lt; 0.001), and speech disorders (x2 = 23.29, P &lt; 0.001).ConclusionsThere is an association between intellectual functioning in children with CP and the degree of motor impairment, neonatal convulsion, epilepsy, and speech disorders. Intelligence assessment should be an essential part of CP evaluation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A critical incident during marathon competition as a result of metabolic decompensation

A case of polyorganic insufficiency syndrome associated with coma, convulsive disorder, acute hepato-renal and respiratory dysfunction, hypovolemic shock, and hyperthermal syndrome in a 46 year-old participant ofa marathon competition is reported. The clinical picture was dominated by acute hepatic insufficiency treated with remaxol to activate substrate phosphorylation under effect of exogenous succinate for slowing down the development of energy deficit in mitochondria under condition of oxygen deficit. This case can be regarded as a variant of correction of mitochondrial dysfunction with the use of a mitochondria-targeted medication such as succinate-containing remaxol. This medication reduced AST and ALT activities and utilization of endogenous enzymes for succinate synthesis from alanine and aspartate under hypoxic conditions. Prescription of remaxol as a form of direct substitution therapy was dictated by pathogenetic considerations.

Therapeutic effects of cannabinoids in animal models of seizures, epilepsy, epileptogenesis, and epilepsy-related neuroprotection.

The isolation and identification of the discrete plant cannabinoids in marijuana revived interest in analyzing historical therapeutic claims made for cannabis in clinical case studies and anecdotes. In particular, sources as old as the 11th and 15th centuries claimed efficacy for crude marijuana extracts in the treatment of convulsive disorders, prompting a particularly active area of preclinical research into the therapeutic potential of plant cannabinoids in epilepsy. Since that time, a large body of literature has accumulated describing the effects of several of the >100 individual plant cannabinoids in preclinical models of seizures, epilepsy, epileptogenesis, and epilepsy-related neuroprotection. We surveyed the literature for relevant reports of such plant cannabinoid effects and critically reviewed their findings. We found that acute CB1R agonism in simple models of acute seizures in rodents typically produces anti-convulsant effects whereas CB1R antagonists exert converse effects in the same models. However, when the effects of such ligands are examined in more complex models of epilepsy, epileptogenesis and neuroprotection, a less simplistic narrative emerges. Here, the complex interactions between (i) brain regions involved in a given model, (ii) relative contributions of endocannabinoid signaling to modulation of synaptic transmission in such areas, (iii) multi-target effects, (iv) cannabinoid type 1 and type 2 receptor signaling interactions and, (v) timing, (vi) duration and (vii) localization of ligand administration suggest that there is both anti-epileptic therapeutic potential and a pro-epileptic risk in up- and down-regulation of endocannabinoid signaling in the central nervous system. Factors such receptor desensitization and specific pharmacology of ligands used (e.g. full vs partial agonists and neutral antagonists vs inverse agonists) also appear to play an important role in the effects reported. Furthermore, the effects of several plant cannabinoids, most notably cannabidiol (CBD) and cannabidavarin (CBDV), in models of seizures, epilepsy, epileptogenesis, and neuroprotection are less ambiguous, and consistent with reports of therapeutically beneficial effects of these compounds in clinical studies. However, continued paucity of firm information regarding the therapeutic molecular mechanism of CBD/CBDV highlights the continued need for research in this area in order to identify as yet under-exploited targets for drug development and raise our understanding of treatment-resistant epilepsies. The recent reporting of positive results for cannabidiol treatment in two Phase III clinical trials in treatment-resistant epilepsies provides pivotal evidence of clinical efficacy for one plant cannabinoid in epilepsy. Moreover, risks and/or benefits associated with the use of unlicensed Δ9-THC containing marijuana extracts in pediatric epilepsies remain poorly understood. Therefore, in light of these paradigm-changing clinical events, the present review's findings aim to drive future drug development for newly-identified targets and indications, identify important limitations of animal models in the investigation of plant cannabinoid effects in the epilepsies, and focuses future research in this area on specific, unanswered questions regarding the complexities of endocannabinoid signaling in epilepsy. This article is part of a Special Issue titled Cannabinoids and Epilepsy.

Phenytoin: 80years young, from epilepsy to breast cancer, a remarkable molecule with multiple modes of action.

In 1908 phenytoin (5,5-diphenylhydantoin) was first synthesized as a barbiturate derivative in Germany by professor Heinrich Biltz (1865-1943) and subsequently resynthesized by an American chemist of the pharmaceutical company Parke-Davis in 1923 in Detroit. Screening phenytoin did not reveal comparable sedative side effects as barbiturates and, thus, Parke-Davis discarded this compound as a useful drug. In 1936, phenytoin's anticonvulsive properties were identified via a new animal model for convulsive disorders, developed by Putnam and Merritt, who also evaluated its clinical value in a number of patients in the period 1937-1940. For many diseases, mechanism of action of phenytoin remains obscure. The voltage-gated sodium channel was and is generally regarded as the main target to explain phenytoin's activity as an anticonvulsant and an anti-arrhythmic drug. This target, however, does not explain many of the other clinical properties of phenytoin. We will explore a number of original articles on phenytoin published in its 80years history and give extra attention to the various hypothesis and experiments done to elucidate its mechanisms of action. Phenytoin has been explored in over 100 different disorders; the last two promising indications tested in the clinic are breast cancer and optic neuritis. Most probably, there are multiple targets active for these various disorders, and the insight into which targets are relevant is still very incomplete. It is remarkable that many pharmacological studies tested one dose only, mostly 50 or 100μM, doses which most probably are higher than the non-plasma bound phenytoin plasma levels obtained during treatment.

Conversion disorder in a neurological emergency department: Restrospective series

Objective: To observe the conversion disorder in a neurological emergency department. Methods: It is common that the initial approach to this patients include the use of various diagnostic exams. In this series we reviewed 94 patients that arrived a neurological emergency room in a 3 year period. Results: 72 patients were females (76%), and the initial presumptive diagnosis were: neurovascular syndrome in 36 patients (38.3%), convulsive disorder in 20 patients (21.28%), and conversive disorder in 8 patients (8.51%). 82 patients had motor symptoms and 61 sensitive symptoms. 88 patients (93%) required neuroimaging studies, 77 (81%) patients underwent through basic biochemical panels. Other tests performed were: electroencephalogram in 12 patients (12.77%), electromyography in 11 patients (11.7%), lumbar punction in 8 patients (8.04%) and regarding the medical consult in the care of these patients 11 were evaluated by 1 specialists, 35 (37.2%) by 2 different specialties, 42 (44.63%) patients required evaluation by 3, and 6 patients (6.38%) required evaluation by 4 different specialties. Conclusions: Based on this data, we conclude that conversion disorders require a lot of resources in the emergency room and that the similarities with neurological diseases demands a complete workup including expensive diagnostic tools. However, this patients can be discharged safely without requiring hospitalization.

Safety and efficacy of intravenous administration for tranexamic acid-induced emesis in dogs with accidental ingestion of foreign substances.

A prospective observational study was performed in canine clinical medicine to evaluate the emetic action and adverse effects of tranexamic acid. Veterinarians treated 137 dogs with a single dose of tranexamic acid (50 mg/kg, IV) after accidental ingestion of foreign substances. If needed, a second (median, 50 mg/kg; range, 20–50 mg/kg, IV) or third dose (median, 50 mg/kg; range, 25–50 mg/kg, IV) was administered. Tranexamic acid induced emesis in 116 of 137 (84.7%) dogs. Median time to onset of emesis was 116.5 sec (range, 26–370 sec), median duration of emesis was 151.5 sec (range, 30–780 sec), and median number of emesis episodes was 2 (range, 1–8). Second and third administrations of tranexamic acid induced emesis in 64.7 and 66.7% of dogs, respectively. In total, IV administration of tranexamic acid successfully induced emesis in 129 of 137 (94.2%) dogs. Adverse effects included a tonic-clonic convulsion and hemostatic disorder in two different dogs, both of which recovered after receiving medical care. Tranexamic acid induced emesis in most dogs following a single-dose. When a single dose was not sufficient, an additional dosage effectively induced emesis. Overall, adverse effects were considered low and self-limiting.

ACUTE NEUROINFECTIONS AND SYMPTOMATIC EPILEPSY IN CHILDREN: CAUSAL RELATIONSHIP (review)

Convulsions in case of acute neuroinfections can both complicate the disease course and transfer to symptomatic epilepsy which is one of the most important medical and social problems. The review article presents the data on epidemiology of convulsive disorder and symptomatic epilepsy in case of neuroinfections in children. There are considered the current immune and biochemical aspects of epileptogenesis in case of infectious pathology. There is given the information on neurophysiological and radial features of symptomatic epilepsy developed in case of neuroinfections of different etiology. There is underlined the practical significance of timely complex etio-pathogenetic therapy for neuroinfections complicated by convulsion that allows to reduce the frequency of symptomatic epilepsy development. There are presented the data on the results of transcranial magnetic stimulation in case of refractory epilepsy.

Clinical Profile of Convulsive Disorders in Children Admitted to the Pediatric Ward in Al-Gumhouri Teaching Hospital, Sana'a, Yemen

Clinical Profile of Convulsive Disorders in Children Admitted to the Pediatric Ward in Al-Gumhouri Teaching Hospital, Sana'a, Yemen