Epileptic Children Research Articles

Exploring the Psychological Risk Factors in Children with Epilepsy

There are many factors that aggravate the clinical picture of children diagnosed with epilepsy. Through this study we will explore risk factors related to disease characteristics, cognitive impairments, intelligence and behavioral problems in children with epilepsy. Methods: Based on the medical data of children diagnosed with epilepsy being treated at the Pediatric Neurology Unit, University Hospital of Pristina, and the “Hope” Psychological Outpatient Center in Kosovo, about 100 epileptic children, 55 female and 45 male, aged between 6 and 11 years of school age were administered the Montreal Cognitive Assessment scale (MoCA), Raven’s Standard Progressive Matrices (IQ), and Child Behavior Checklist (CBCL) tests. Results: Children participating in the study reveals a predomination of the generalized epilepsy, which continue to be treated with anti-epileptics for more than 3 years. From them 67% did not show the presence of another co-neurological deficit. Neurological tests show evidences of moderate EEG changes in some children and MRI registrations in 65% of children are unchanged and continue to be treated with 1 or 2 antiepileptic drugs for being under control. Intelligence, cognitive and behavioral problems in cases where they were associated with a number of neuropsychological characteristics increase the risk of a disease aggravation and compromise their overall development. Discussion: We can imply that based on the severity of these concomitant factors of the epileptic conditions, they will constitute a high-risk factor for cognitive problems, low intelligence and the emergence of a number of internalizing and externalizing problems of the child with epilepsy. Conclusions: As a risk factor that increases the level of difficulty of epileptic children in some contexts, including general functioning, school, family and social context, the presence of neurobiological and neuropsychological factors such as issues in internalizing and externalizing behaviors, problems in the cognitive field and the IQ are seen, which is also expected to affect the overall development of children’s quality of life.

Gut microbiota modulation by both Lactobacillus fermentum MSK 408 and ketogenic diet in a murine model of pentylenetetrazole-induced acute seizure

PurposeSeizures are a threat to the host brain and body and can even cause death in epileptic children. Ketogenic diet (KD) is suggested for children suffering from epileptic seizures and has been investigated for its anti-seizure effect. However, the relationships between KD and gut microbiota (GM) is not yet been deeply understood. Herein, we investigated the anti-seizure effect by administering KD and a lactic acid bacteria (LAB) in murine model of chemically induced seizures. We hypothesized that a single Lactobacillus fermentum MSK 408 (MSK 408) strain with or without KD may exert a neuroprotection by modulating host gut microbiota. MethodWe performed animal study using pentylenetetrazole (PTZ) to induce seizure. Thirty 3-week-old male Institute of Cancer research (ICR) mice were divided in six groups, Normal diet (ND), ND + PTZ, ND + PTZ + LAB, KD, KD + PTZ, and KD + PTZ. Based on our previous study, 4:1 KD and selected MSK 408 strain was orally gavaged (4 × 109 CFU/mL) with both diets for 4 weeks. PTZ (40 mg/kg) was injected intraperitoneally 30 min before euthanization. ResultsCompared to ND, KD significantly reduced the seizure frequency. Administration of MSK 408 with both ND and KD for 4 weeks restored serum lipid profile and tight junction protein mRNA expression of the gut and brain. Additionally, PCoA revealed that MSK 408 independently affected fecal short chain fatty acid (SCFA) content via gut microbiota (GM) modulation. PICRUSt suggested that the modulation of microbiota by KD and MSK 408 led to increased GABA (gamma-aminobutyric acid) metabolism. SignificanceOur findings suggest that MSK 408 strain can be consumed with KD as supplement without interfering the anti-seizure action of KD, and may improve the serum lipid profile, and brain barrier function via gut microbiota and SCFA modulation.

Disrupted topological properties of functional networks in epileptic children with generalized tonic-clonic seizures.

IntroductionGeneralized tonic‐clonic seizure (GTCS) is a condition that is characterized by generalized spike‐wave discharge in bilateral cerebral hemispheres during the seizure. Although previous neuroimaging studies revealed functional abnormalities in the brain activities of children with GTCS, the topological alterations in whole‐brain networks remain poorly understood.MethodsThe present study used graph theory to investigate the topological organization of functional networks in 13 GTCS children and 30 age‐matched healthy controls.ResultsWe found that both groups exhibited a small‐world topology of the functional network. However, children with GTCS showed a significant decrease in nodal local efficiency and clustering coefficient in some key nodes compared with the controls. The connections within the default mode network (DMN) were decreased significantly, and the internetwork connections were increased significantly. The altered topological properties may be an effect of chronic epilepsy. As a result, the optimal topological organization of the functional network was disrupted in the patient group. Notably, clustering coefficient and nodal local efficiency in the bilateral temporal pole of the middle temporal gyrus negatively correlated with the epilepsy duration.ConclusionThese results suggest that the bilateral temporal pole plays an important role in reflecting the effect of chronic epilepsy on the topological properties in GTCS children. The present study demonstrated a disrupted topological organization in children with GTCS. These findings provide new insight into our understanding of this disorder.

Electroencephalography source localization analysis in epileptic children during a visual working-memory task.

We localize the sources of brain activity of children with epilepsy based on electroencephalograph (EEG) recordings acquired during a visual discrimination working memory task. For the numerical solution of the inverse problem, with the aid of age-specific MRI scans processed from a publicly available database, we use and compare three regularization numerical methods, namely the standardized low resolution brain electromagnetic tomography (sLORETA), the weighted minimum norm estimation (wMNE) and the dynamic statistical parametric mapping (dSPM). We show that all three methods provide the same spatio-temporal patterns of differences between the groups of epileptic and control children. In particular, our analysis reveals statistically significant differences between the two groups in regions of the parietal cortex indicating that these may serve as "biomarkers" for diagnostic purposes and ultimately localized treatment.

Faecal Incontinence: An Uncommon Manifestation of Panayiotopoulos Syndrome

Panayiotopoulos Syndrome (PS) is a benign, common, age-dependent syndrome, with susceptibility to idiopathic vegetative seizures and autonomic status epilepticus. It is formally recognized by the International League against Epilepsy (ILAE). It is one of the three focal epileptic child benign syndromes next to rolandic epilepsy and idiopathic occipital epilepsy in children. It is characterized by its relative mildness and confusing manifestations. It is frequently misdiagnosed as non-epileptic disorders.

Effects of SCN1A and SCN2A polymorphisms on responsiveness to valproic acid monotherapy in epileptic children

PurposeThis study was conducted to explore the influence of genetic variations on responsiveness to valproic acid (VPA) monotherapy among Chinese children with epilepsy. MethodsOne hundred and forty epileptic children taking VPA as monotherapy were enrolled, and at least one-year follow-up was obtained to assess the therapeutic outcome. Twenty-seven single nucleotide polymorphisms (SNPs) within twelve candidate genes correlated with the metabolic enzymes, transporters and targets of VPA were genotyped. The effects of selected polymorphisms on VPA efficacy were identified by binary logistic regression analysis adjusting for potential confounders. ResultsSCN2A rs2304016 (A > G) AG genotype was more common among the VPA-resistant patients in comparison with the VPA-responsive patients (OR = 3.18, 95 % CI = 1.10−9.14, P = 0.032), and in subgroup of focal seizure, lower frequency of VPA resistance was found in epileptic children with SCN1A rs2298771 AG genotype than those with AA genotype (OR = 0.11, 95 % CI = 0.01−0.91, P = 0.040). ConclusionsOur study indicated that SCN2A rs2304016 and SCN1A rs2298771 polymorphisms might be associated with the response to VPA monotherapy in Chinese epileptic children. Further and larger researches are required to validate these results.

EDUCATIONAL IMPACT OF EPILEPSY IN CHILDREN

Introduction: Epilepsy can interfere with a child's cognitive development and may result in academic difficulty. Our objective is to identify and estimate the link between epilepsy and academic difficulties. 
 Methods: This is a prospective descriptive and analytical case-control study carried out at the Antsakaviro Laboratory of Neurosciences and Mental Health for the cases and in the four Public Primary Schools of the rural commune of Anjepy for the controls from 1st October 2014 to 31st January 2015. The frequency of school difficulties in epileptic and non-epileptic children, the relationship between epilepsy and school difficulties were evaluated. 
 Results: The frequency of school difficulty in children with epilepsy was 49.13% compared to 25% in non-epileptic children with an Odds Ratio of 2.90 with 95% specificity and a confidence interval of 1.87 to 4.43. Among the cases, 52.94% of the children had their first seizure before the age of 2 years with a predominance of generalized tonic-clonic seizures at 57.65%, the majority of which were of the idiopathic type (67.06%). The majority of children with epilepsy had a lack of concentration in 43.53% of cases and memory impairment in 31.76%, while memory impairment (38%), lack of concentration in 20% and repetition in 20% of non-epileptic children. 
 Conclusion: Epilepsy is a serious illness for the child that can lead to a learning disability. 
 Therefore, prevention of seizures and early detection are essential.

Temporal and Spatial Dynamics of Different Interictal Epileptic Discharges: A Time-Frequency EEG Approach in Pediatric Focal Refractory Epilepsy

Objective: Characterization of the spatial and temporal dynamics of interictal epileptic discharges (IED) using time-frequency analysis (TFA) and electrical-source localization (ESL).Methods: TFA was performed on IED (spikes, spike waves, and polyspike waves) recorded by high-density-EEG (HD-EEG) in 19 refractory focal epileptic children. Temporal modulations related to IEDs were analyzed in a time window around the IED peaks [−1,000 to 1,000 ms]. Spatial modulations were analyzed by ESL in the time-frequency and time domains.Results: IED were associated with complex power spectral modulations. We observed increases in power spectrum (IPS) patterns specific to IED type. For spikes, the TFA pattern consisted of an IPS (−100 to +100 ms, 4–50 Hz). For spike waves, the IPS was followed by a second IPS (+100 to +400 ms, 4–10 Hz), corresponding to the slow wave. IPS patterns were preceded (−400 to −100 ms, 4–40 Hz), and followed (+100 to +400 ms) by a decrease in the power spectrum (DPS) (n = 8). For 14 out of 19 patients, at least one ESL method was concordant with the epileptogenic area. For the remaining five patients, all of them had temporal epilepsies. ESL in the time-frequency domain (DPS/IPS) provided concordant (n = 6) or complementary (n = 4) information to the ESL in the time domain concerning the epileptogenic zone. ESL in time-frequency domain (DPS/IPS) was the only method to provide concordant information concerning the epileptogenic zone in three patients.Significance: TFA demonstrates complex time-frequency modulations of the neuronal networks around IED, suggesting that the pathological mechanisms are initiated well before onset of the classical hyper-synchronization of the IED. Combining time and time-frequency analysis of the ESL provides complementary information to define the epileptogenic zone in refractory focal epilepsy.

Quality of life of epileptic children in Minia Governorate: a cross-sectional study

Background Quality of life of childhood epilepsy (QOLCE) is the main outcome that is increasingly being recognized as an essential element in the assessment of the epilepsy effects on life function and also treatment of epilepsy. This study aimed to assess the QOL among the epileptic children. Patients and Methods A cross sectional study design was carried out on 100 children. The study has been held in the Neurology and Psychiatry outpatient clinic of Minia university hospital; In addition to Minia Psychiatry hospital, the official psychiatry hospital in Minia governorate. The total sample included 100 children. Fifty epileptic children aged between 4–18 yrs and 50 apparently healthy children with no chronic illness, of matched age, sex, and social class were included as the control group. Results There was no significant difference between the two groups regarding sociodemographics, except for birth order and number of sibling, as well as for positive family history of epilepsy. Regarding the electroencephalography changes, there was a significant difference between the two groups. There was a statistically significant difference between the two groups regarding the low QOLCE score. Polytherapy had low score on QOLCE, especially in emotional, social, physical, and total score. Conclusions Childhood epilepsy affects the QOL of the epileptic children, especially cognitive, social, emotional, and physical functions. Polytherapy was associated with more impairment of QOL. On the contrary, epileptic patients who were compliant to treatment had good QOL.

Assessment of Parents' Knowledge, Practices and Attitude Toward Care for Their Epileptic Children

Background Epilepsy is the commonest serious neurological condition of childhood. It is a group of chronic disorders in which the indispensable feature is recurrence of seizure. Parents play the most significant role in caring for their children and helping them adapt to their conditions ,especially mothers. The aim of the present study was to assess parents` knowledge, practice and attitude toward care for their epileptic children at Helwan General Hospital, and Helwan fever Hospital. A descriptive design was conducted on a sample of 100 parents of children with epilepsy at the pediatric neurology outpatient clinic and in-patient units at Helwan General Hospital, Helwan Fever Hospital in Elkahera Governorate, Egypt .Three tools were used in this study, the first was a questionnaire interview sheet to collect data about studied parents and their children, and to assess parents` knowledge about epilepsy .The Second was seizure severity scale. The Third tool was a questionnaire sheet about parents`s knowledge regarding practices in caring for their epileptic children. Results indicated that the majority of the studied parents` (mothers) had a poor knowledge score about epilepsy while ,75/ had moderate knowledge score (Satisfactory level). Most of the studied parents` total care practices score was incompetent. More over there was a positive correlation between parents` total knowledge score and their total knowledge about care practices score with person`s correlation coefficient (r= 0.43, p= 0.001). Based n the result of the present study.it could be recommended that the educational programs for parents of epileptic children about epilepsy and its care should be conducted and establishing a standard of care for children with epilepsy in hospital and clinics is essential.

Effect of Carbamazepine and Sodium Valproate on Liver Enzymes of Epileptic Children

Carbamazepine and sodium valproate are one of the most common antiepileptic medications used in clinical practice. The period of treatment is commonly associated with benign alternation of the liver enzymes due to drug metabolism. Evaluation of asymptomatic enzymatic changes could be challenging to the expert clinician and may expose patients to unnecessary procedures or expenses. Thus, this article aims to focus on the frequency of liver enzyme abnormalities among epileptic children. For this, an analytic cross-sectional study was conducted in 100 epileptic patients who received carbamazepine or sodium valproate for 1 year. Those with healthy pretreatment liver enzymes were recruited for the study. The results showed an elevation of Aspartate Aminotransferase (AST) in 24% of the patients treated with sodium valproate (p = 0.01) and 20% of the patients treated with carbamazepine. Alanine Aminotransferase (ALT) was elevated in both groups to a similar extent, 6% (p = 0.01). In conclusion, the study showed a lower proportion of liver enzyme abnormalities, since AST is a less sensitive biomarker when compared to ALT. No measurement exceeds twice the average value, nor are there any clinical abnormalities. There is no proven value of routine liver enzyme measurement in asymptomatic patients in our study. However, baseline enzyme tests are recommended. Further controlled studies on a larger sample size are required.

The Recommendations for the Management of Chinese Children With Epilepsy During the COVID-19 Outbreak.

The coronavirus disease (COVID-19) is the most severe public health problem facing the world currently. Social distancing and avoidance of unnecessary movements are preventive strategies that are being advocated to prevent the spread of the causative virus [severe acute respiratory syndrome (SARS)-CoV2]. It is known that epileptic children need long term treatments (antiepileptic drugs and/or immunosuppressive agents) as well as close follow up due to the nature of the disease. In addition, it is clear that epilepsy can concur with other chronic illnesses which can lower body immunity. As a result, epileptic children have high risk of acquiring this novel disease due to weak/immature immune system. Of concern, the management of children with epilepsy has become more challenging during this outbreak due to the prevention measures that are being taken. Although children with controlled seizures can be managed at home, it is challenging for pediatricians when it comes to cases with uncontrolled seizures/severe cases. To this end, we provide recommendations for the management of epileptic children at home, outpatient and inpatient settings.

Assessment of quality of life in parents of epileptic children and its associated factors

Background: Aim of the study was to assess quality of life (QOL) of parents of epileptic child and its association with various factors like demographic, clinical, therapeutic and behavioral factors.Methods: Consenting parents of 160 epileptic children were enrolled after finishing child’s visit to the pediatrician. Parents were enquired on baseline demographic variables like age, gender, socio-economic status, parental education; clinical details like type of epilepsy, duration of seizure, seizure frequency and co-morbidity and therapeutic factors like treatment of epilepsy and adverse drug reactions. QOL was evaluated using QOLCE questionnaire and Childhood Illness-related Parenting Stress Inventory and analysed.Results: Out of 160 parents, 85% belong to 30-40 years of age and 62.5% were male. Deteriorated quality of life was reported by parents as mean score 63.46±7.69. QOL was significantly poor (p<0.05) in parents of younger child (<6 yrs), education status (upto primary school only), employment status of parent (unemployed) and lower socioeconomic status. Assessment of disease related parameters revealed that type of seizure, seizure frequency, duration and co-morbidity were factors significantly affecting quality of life of parents with lower QOL scores(p<0.05). QOL of parents of child with epilepsy undergoing polytherapy with multiple AEDs treatment, particle seizure control and having adverse drug reaction were associated with poor scores of health and well being (p<0.05). It was found that parents of epileptic child had deteriorated QOL score with respect to behaviour patterns irrespective to conditions of epilepsy due to constant stress and anxiety and poor state of mind.Conclusions: QOL of parents was compromised in Indian children with epilepsy. Demographic factors like age of child, parental education, socio-economic status and clinical factors like type of seizure, frequency & duration of seizure and co-morbid conditions significantly affect the QOL of parents. Significantly poor QOL scores was also due to therapeutic factors like treatment with polytherapy and adverse drug reactions with poor behavioral patterns which was observed in parents that should be taken care and should not be overlooked.

Prognostic Factors of Patients with Postinfantile Epilepsy and Multiple Independent Spike Foci on Electroencephalography

Purpose Multiple independent spike foci (MISF) have been reported to be associated with hypsarrhythmia and slow spikes and waves. However, some patients with MISF demonstrate a good prognosis, such as benign focal epilepsy. This study aimed to elucidate the prognosis of epileptic children with MISF and to analyze the prognostic factors. Methods The subjects were 115 epileptic children aged 1 to 18 years who visited Pusan National University Children’s Hospital between November 2008 and July 2016 and in whom MISF were noted on electroencephalography. We excluded patients with infantile spasms, congenital metabolic diseases, neurodegenerative diseases, or post-encephalitic epilepsy. We retrospectively reviewed participants’ clinical information. Seizure control was defined as no seizures over 6 months at the last visit. Prognostic factors were analyzed in the seizure control (group A; 84 [73%]) and no seizure control (group B; 31 [27%]) groups. Results Generalized seizure (P=0.033), intellectual disability (P<0.001), cerebral palsy (P=0.046), and abnormal background activity and electrodecrements on electroencephalography (P<0.001) were significantly more common in group B. No clinically significant abnormalities were noted on magnetic resonance imaging of the brain. The MISF improved on follow-up electroencephalography in 58 (71.6%) patients in group A versus 10 (35.7%) in group B (P=0.002). Conclusion Despite MISF on electroencephalography, two-thirds of patients had a benign clinical course, particularly those with post-infantile epilepsy and no infantile spasms. The prognostic factors of poor outcomes were generalized seizures, intellectual disability, and abnormal background activity on electroencephalography. Keywords: Child; Electroencephalography; Epilepsy; Prognosis

Serum zinc and copper levels in a sample of Egyptian epileptic children

BackgroundEpilepsy is among the most common disabling neurological disorders among children. Altered serum levels of zinc and copper may facilitate seizure occurrence and repetition, and antiepileptic drugs may disturb their serum levels affecting disease control and outcome.ObjectiveTo investigate the association between serum levels of zinc and copper and epilepsy and antiepileptic treatment in a group of Egyptian epileptic children.MethodsCase-control study on 100 epileptic patients, aged from 2 to 16 years, from neurology outpatient clinic and 50 apparently healthy children with matched age and sex. Venous samples were withdrawn from patients and controls then serum levels of zinc and copper were measured with graphite furnace atomic absorption spectrometer-A Analyst 800.ResultsSerum zinc level of patients’ group was significantly lower than that of controls with a mean of 59.1 μ/dL ± 22.7 and 85 μ/dL ± 22.2, respectively (P < 0.01). Serum zinc level of patients with history of febrile seizures was significantly decreased compared to patients without history of febrile seizures with a mean of 41.5 μ/dL ± 20.1 and 67.9 μ/dL ± 19.3, respectively (P < 0.01). Patient on carbamazepine intake showed significantly lower zinc serum level than patients without carbamazepine intake, with a mean of 49.0 μ/dL ± 17 and 61.8 μ/dL ± 23.4, respectively (P < 0.01). A significant negative correlation was noted between the duration of illness of epilepsy and the mean copper serum level (P < 0.05).ConclusionZinc and copper altered homeostasis have mounting evidence about their role in the pathogenesis of epilepsy. Designing treatment plans that selectively restore zinc and copper normal levels may be a beneficial strategy in the future.

High Blood Ammonia Levels Associated with Long-term Valproic Acids Therapy in Epileptic Children

Background: Valproic acid is an effective drug for controlling seizure in children with epilepsy and it is usually used for treatment as long as two years or more. Blood ammonia level often increased in epileptic children who were treated with long-term valproic acid. The study was conducted to determine the relationship between blood ammonia level with valproic acid therapy in epileptic children.Materials and Methods: This is an observational study with cross-sectional approach. The subjects were 64 children with epilepsy, average age of 6.2 years old. Subjects were 33 boys and 31 girls. Blood ammonia level was examined using enzymatic glutamate dehydrogenase. Subjects were divided into 2 therapeutic groups based on the duration, doses and combination therapy of valproic acid. Subjects were recruited from Pediatric Neurology Clinic, Sanglah General Hospital, Bali, Indonesia, from May to December 2017. Comparison of blood ammonia level between groups were analyzed using an Independent t-test with significances if the p&lt;0.05. Results: A significant difference of blood ammonia level was found between subjects who were treated with valproic acid less than 2 years and more than 2 years (45.7±16.4 mmol/L vs. 70.9±43.6 mmol/L; p=0.032). However, significant difference was not found between the groups according to the doses and combination therapy (p=0.450 and p=0.647, respectively).Conclusion: Blood ammonia level was significantly higher in epileptic children who used long-term valproic acid, hence it was recommended to check the blood ammonia level routinely.Keywords: ammonia, epilepsy, valproic, children

Level of Parental Education and Physical Activity in the Pediatric Epileptic Population

Level of Parental Education and Physical Activity in the Pediatric Epileptic Population Andrew Payomo*, Kelly Nguyen*, Helen Rynor*, Grettel Castro, MPH, Juan Ruiz, MD, MMEDSCI, Marcia Varella, MD, PhD, MHS, Florida International University Herbert Wertheim College of Medicine *Authors contributed equally to the study Background: Epilepsy in the pediatric population has a noticeable impact on the quality of life of the afflicted. Physical activity positively benefits epileptic children; however, epileptic …

Burden and Its Predictors among Caregivers of Patient with Epilepsy.

Background and PurposeEpilepsy is a chronic unpredictable debilitating condition. Epilepsy has great impacts not only on patients with epilepsies but also the persons around them. Burden among caregivers is understudied area. In view of the dearth of literature or studies focused on caregivers of children with epilepsy in Nepalese context, this study is expected to assess burden and its predictors among caregivers of children with epilepsy.MethodsA total of 106 caregivers were interviewed using purposive sampling technique. The Zarit Burden Interview Scale short version was used to assess burden and Hospital Anxiety Depression Scale was used to assess anxiety and depression. Data were analysed using SPSS ver. 16.0. Chi-square test, multinomial logistic regression and linear regression analysis were done for analysis of inferential statistics to find out the predictors of burden.ResultsMajority of the caregivers (71.7%) were females and 64.2% of caregivers were mothers of children. Majority of responders (77.4%) were Hindus. Mild to moderate burden was found in 27.4% and high burden was found in 14.2% of the caregivers. Borderline anxiety, borderline depression, anxiety and depression were present in 7.5%, 8.5%, 6.6%, and 6.6% caregivers respectively. Burden was significantly higher in caregivers of epileptic children with poorly controlled seizure (p=0.003) and with co-morbidities (p=0.009). Similarly, burden score had significant positive correlation (p=0.001) with depression and significant negative correlation (p=0.005) with age of onset of epilepsy in children.ConclusionsBurden, anxiety and depression are common problems in caregivers of children with epilepsy. Poorly controlled seizure, presence of associated comorbidities, younger age of onset of seizure in children and presence of depression in caregivers are the important factors that predict burden among caregivers of children with epilepsy.

An observational study to determine the status of serum and RBC folate in drug resistant epileptic children at a tertiary care centre in Western Rajasthan, India

Background: Drug resistant epilepsies constitute about 10-20% of childhood epilepsies and treated with higher doses and multiple AEDs. AEDs increases folate metabolism by enzyme induction thus causes deficiency of folic acid.Objective was to evaluate the effect on serum and RBC folate in children having drug resistant epilepsy.Methods: In a prospective observational study 83 drug resistant epileptic children of age 6months to 180 months fulfilled the inclusion criteria enrolled in study, from Oct 2014 to Nov 2016 for a period of two years. Serum and RBC folate levels were done in these children. Epileptic children already receiving folic acid supplementation/treatment were excluded from the study. Children with serum folate level &lt;5ng/ml and RBC folate &lt;280ng/ml was considered as folate deficiency.Results: Total 83 children had drug resistant epilepsy (defined by ILAE). Mean age of children with drug resistant epilepsy was 71.39±49.76 months. 71.08 % were male and 28.91% were female. Mean serum folate in these children was 7.75±2.77 ng/ml and RBC folate 381.63±164.54 ng/ml which was significantly lower as compared to healthy children or epileptic not receiving AEDs. 14.45 % children in drug resistant epilepsy had serum folate &lt;5ng/ml while 20.89% were found to be RBC folate deficient (RBC level &lt;280ng/ml).Conclusions: Antiepileptic drugs are associated with lower blood folate status which deteriorates further with increasing number and doses of AEDs in drug resistant patients. Therefore blood folate monitoring should be done in all children on AEDs on regular intervals and should be considered in the etiologic differentials of drug resistant epilepsy.

ASSESSMENT OF SERUM ZINC LEVEL IN CHILDHOOD EPILEPSY TREATED WITH LONG-TERM ANTI EPILEPTIC DRUG (AED

Almost 85% of epilepsy patients which is a common neurolotical disease lives in developing world. Mostly the disease start in childhoold in more than half o the cases. Long term use of antiepileptic drugs may alter serum zinc level. The purpose of the present study was to assess the serum zinc level in childhood epilepsy treated with long-term Anti Epileptic Drug (AED). This cross-sectional study was carried out in the outdoor and indoor patient department of Pediatric neurology, BSMMU during the period from March 2013 to August 2013. Sample size was one hundred, among these fifty were case e.g. epileptic child who had received anti epileptic drugs (Carbamazepine and/or Valproic acid) for more than three months and fifty werecontrol e.g. newly diagnosed epileptic child, who have not yet received antiepileptic drugs. In this study, among100 epileptic child, mean serum zinc level in case group was 0.36(±0.20)(µg/ml)and incontrol group was 0.52(±0.26) (µg/ml),which was statistically significant (p&lt;0.05). The use of one drug or multiple drugs in the treatment of epileptic patients has made the significant low serum zinc level.