Groups Of Epileptic Children Research Articles

The effect of antiepileptic drugs on thyroid hormonal function: valproic acid and phenobarbital.

The aim of this study was to evaluate the thyroid function alterations in a group of epileptic children taking antiepileptic drugs. The study included a total of 183 pediatric epilepsy patients, aged 15months-16years, comprising 114 patients treated with valproic acid, 69 patients treated with phenobarbital, and 151 age-matched healthy volunteers as the control group. Serum levels of thyroid hormones were measured before the beginning of the antiepileptic therapy and after 12months of treatment. Thyroid-stimulating hormone levels were significantly higher in the 12th month of phenobarbital and valproic acid treatment. The level of free triiodothyronine before treatment was higher in epileptic patients than in the control group. Subclinical hypothyroidism at month 12 was determined in 15.2% of the valproic acid group and in 2.9% of the phenobarbital group. When compared with the pre-treatment values, there was a statistically significant difference in the incidence of subclinical hypothyroid in the valproic acid group and no significant difference in the phenobarbital group. Symptomatic hypothyroidism was not detected. It was concluded that the thyroid functions of patients using valproic acid and phenobarbital for a long time should be regularly monitored.

Does Anticonvulsant Treatment Influence Pain Perception in Epileptic Children?

The aims of our study were to evaluate pain perception in epileptic children and to establish the influence of anticonvulsant drugs on pain perception. The study involved 40 children, 30 with epilepsy and 10 healthy control subjects. In the group of epileptic children, 10 were not treated and 20 assumed a single drug. From all children of each group, one sample of saliva was collected through a noninvasive device 15 minutes before (t0), during (t1), and 15 minutes after (t2) blood withdrawal, and salivary α-amylase activity was then determined. No statistically significant difference was found at t0 and at t1, indicating that in both groups venipuncture equally induced a state of stress. Conversely, at t2 a statistically significant difference (p = 0.0195) was found, suggesting that epileptic children presented a greater sensitization to pain and a slower recovery from stress. Comparing furthermore data obtained in children with epilepsy not treated with those registered in treated ones, we found a statistically significant difference at t0 (p = 0.012), at t1 (p = 0.037), and at t2 (p = 0.011). Anticonvulsant drugs do not seem to influence pain perception and enzymatic activity levels in epileptic patients.

Thyroid Hormones in Children on Antiepileptic Therapy

ABSTRACTThe aim of this study was to evaluate the thyroid function alterations in a group of epileptic children taking antiepileptic drugs (AEDs). Patients demographic data and the free throxine (fT4) and thyroid-stimulating hormone (TSH) levels at the beginning of the treatment and at the third, sixth and ninth months of AED treatment were recorded retrospectively. A total of 106 children, 59 males and 47 females, were enrolled in the study. Mean patient age was 3.7 years, ranging between 3 months and 14 years. In total, 54% of patients were on valproic acid (VPA), 16% phenobarbital (PB), 14% were on carbamazepine (CBZ), 6% were on oxcarbazepine (OXC), 5% were on levetiracetam, and 5% were on topiramate therapy. There were no significant differences in average fT4 values between the drug groups. But the mean fT4 levels of the patients on VPA therapy showed a clear decrease within the observation period. No significant difference in average TSH values between the groups was detected in the beginning and in the third and sixth month. However, in the ninth month, a significant increase in TSH values was found in the VPA group (p = 0.007). In the patients taking VPA, average TSH values rose progressively while staying within normal limits. During follow-up, thyroid dysfunction were found in 21 patients (19.6%). A statistically significant relationship was found between severe electroencephalography (EEG) findings and thyroid dysfunction (p = 0.041). It was concluded that epileptic children with severe EEG findings and using VPA could have thyroid dysfunction. These patients should be followed up closely by thyroid function tests during treatment.

Prevalence of Hypopigmented Maculae and Café-au-Lait Spots in Idiopathic Epileptic and Healthy Children

The cutaneous lesions and findings related to the central nervous system are frequently seen concomitantly in many patients. Neurocutaneous syndromes are the most typical examples supporting this observation. The prevalences of hypopigmented maculae and café-au-lait spots were investigated in 210 idiopathic epileptic children between the ages of 2 and 17 years and 2754 healthy children between the ages of 5 and 15 years. In the group of epileptic children, hypopigmented maculae and café-au-lait spots were observed in 30 (14.3%) and 63 (30%) children, respectively. In the group of healthy children, the prevalence of hypopigmented maculae was 1.6% (44 children) and of café-au-lait spots was 2.83% (78 children). The difference between the two groups was very significant statistically (P < .0001).

Renal tubular function in patients receiving anticonvulsant therapy: a long-term study.

The goal of the study was to evaluate the tubular renal function in children and adolescents who are undergoing monotherapy with sodium valproate (VPA), carbamazepine (CBZ), and phenobarbital (PB). The urinary excretion of N-acetyl-beta-glucosaminidase (NAG), beta-galactosidase (beta-Gal), alanine-amino-peptidase (AAP), and alpha1-microglobulin (alpha1M) was measured in 58 epileptic patients (29 girls and 29 boys), aged 12.6 +/- 3.9 years, who were subdivided into three groups according to their therapy. Fifty healthy sex-and age-matched children served as controls. The measurements were taken before the beginning of therapy and after 6 months, 1 year, and 2 years of therapy. Before the beginning of therapy, there were no significant differences in NAG, beta-Gal, AAP, and alpha1M values between the control group and the three groups of epileptic children. After 6 months of therapy, patients treated with VPA and CBZ showed a significant increase in the urinary excretion of NAG and beta-Gal compared with baseline data and control values. After 1 and 2 years, these patients showed a persistence of the changes found after 6 months of therapy. In patients treated with PB, we did not find any significant variation in NAG, beta-Gal, AAP, and alpha1M urinary excretion. Our study demonstrates that in patients treated with VPA and CBZ, an impairment of tubular function can be present, whereas PB does not cause any significant change.

Effects of antiepileptic drugs on evoked potentials in epileptic children

To evaluate the visual and auditory function in children and adolescents who are undergoing monotherapy with sodium valproate, carbamazepine, and phenobarbital visual-evoked potentials and brainstem auditory-evoked potentials were measured in 58 epileptic patients (30 males and 28 females), ages 13.7 ± 6.9 years. Fifty healthy sex- and age-matched children served as controls. The measurements were performed before the beginning of therapy and after 12 months. Before the beginning of therapy, there were no significant differences in visual- and auditory-evoked potentials between the control group and the three groups of epileptic children. After 12 months of therapy, patients treated with carbamazepine demonstrated a significant ( P < 0.001) increase of P100 latencies when compared with baseline data and control values; moreover, these patients exhibited a significant increase of peak latencies of waves I-III-V and interpeak interval I-V at auditory second evaluation. The patients treated with sodium valproate manifested a significant ( P < 0.05) increase in VEP P100 latencies. On the contrary, children receiving phenobarbital did not manifest any significant abnormality at visual- and auditory-evoked potentials measurements. Our study demonstrates that for patients treated with carbamazepine and sodium valproate, an electrophysiologic dysfunction of visual and auditory sensory pathways can be present after 12 months of treatment.

Hyperhomocysteinemia in children treated with sodium valproate and carbamazepine

Objective: To evaluate plasma homocysteine (Hcy) concentrations in children receiving sodium valproate (VPA) and carbamazepine (CBZ), monotherapy, in comparison with healthy control subjects and to determine the possible relationship between Hcy levels and dosage and plasma concentrations of the antiepileptic drugs. Methods: We measured levels of fasting and post-methionine Hcy, plasma pyridoxal 5′-phosphate (PLP, active vitamin B6), serum folate, erythrocyte folate and serum vitamin B12 in 60 epileptic patients (29 females, 31 males), aged from 14.2 to 17.9 years, subdivided into two groups according to their therapy. Sixty-three healthy sex- and age-matched children served as controls. These measurements have been performed before the beginning of therapy and after 1 year of therapy with VPA or CBZ. Results: Before the beginning of therapy, there were no significant differences in fasting and post-methionine Hcy, plasma PLP, serum folate, erythrocyte folate and serum vitamin B12 values between the control group and the two groups of epileptic children. After 1 year of therapy, patients treated with VPA and CBZ showed a significant increase of the plasma concentrations of Hcy when compared to baseline data and controls values. Moreover, was observed a significant decrease of serum folate and plasma PLP. On the contrary, serum vitamin B12 and erythrocyte folate levels remained in the normal range. Conclusions: Our study demonstrates that prolonged treatment with VPA and CBZ increases plasma concentrations of Hcy.

Auditory/verbal and visual/spatial memory in children with complex partial epilepsy of temporal lobe origin

Two groups of epileptic children and a normal control group were administered a Comprehensive Children's Memory Scale (Experimental Edition) which is presently being developed by this author. The first experimental group consisted of 12 children having complex partial seizures of left temporal origin and the second group consisted of 12 children having partial complex seizures of right temporal lobe origin based upon clinical description and EEG/neuroimaging verification. Results indicated: (a) Children with left temporal lobe epilepsy demonstrated significantly lower performance than controls on auditory/verbal memory testing. (b) Children with right temporal lobe epilepsy demonstrated significantly lower performance than controls on visual/spatial memory testing. (c) For the most part, the right and left temoporal lobe groups did not significantly differ from each other. However, their performance was in the expected direction; i.e., children with left temporal lobe epilepsy scored lower than right temporal lobe epileptics on auditory/verbal memory testing, and children with right temporal lobe epilepsy scored lower than left temporal lobe epileptics on visual/spatial memory testing.

Delayed bone development in epileptic children assessed by microdensitometer.

Bone development of metacarpal bones was assessed by microdensitometer analysis of hand X-rays from 101 epileptic outpatients. Most of the patients were treated with two or three anticonvulsant drugs; however, 27 patients were treated with only one. A significantly larger number of patients showed a delay in bone development of 2 or more years when compared with either handicapped or normal control children. In epileptic children, physical activity and the duration of anticonvulsant therapy were correlated with bone development. Patients with delayed bone development had reduced levels of serum 25-OH-D (p less than 0.005) and elevated levels of 1,25-(OH)2D (p less than 0.01). Microdensitometer analysis of metacarpal bone radiographs is useful for detecting mild impairment of bone in groups of epileptic children.

The development of psychiatric disorder among schoolchildren with epilepsy.

Two groups of epileptic children, one newly diagnosed and one with chronic epilepsy, were compared with two comparable groups of diabetic children and with children in the general population in order to investigate the development of psychiatric disorder. The results confirm previous findings that children with chronic epilepsy are significantly more disturbed than children with chronic physical illness not involving the central nervous system, and than children in the general population. Children with newly diagnosed epilepsy were also significantly more disturbed than those with newly diagnosed diabetes, and than children in the general population. The rate of psychiatric disturbance was similar in the two groups of epileptic children. In both groups of epileptic children, those with focal EEG abnormalities and/or complex partial seizures were particularly vulnerable to psychiatric disturbance.

Does illness foster dependency? A study of epileptic and diabetic children.

The development of inappropriate dependency was investigated among two comparable groups of children, one with newly diagnosed epilepsy or diabetes, the other with chronic epilepsy or diabetes. The two groups of epileptic children were significantly more dependent than the two diabetic groups, and than children in the general population. Psychiatric disturbance was significantly more common among the epileptic children, and possibly is a factor in their inappropriate dependency. Specific advice and counselling for the parents is likely to help promote the children's sense of self-esteem and independence.

Psychiatric disturbance in the families of epileptic children.

The rates of psychiatric disturbance among the parents and school-age siblings of two groups of epileptic children, one newly diagnosed and one with chronic epilepsy, were compared with those of adults and children in the general population. Siblings of children in the newly diagnosed group were no more disturbed than children in the general population, whereas those of children with chronic epilepsy were. The parents of both groups were no more disturbed than adults in the general population, but there was an association between disturbance in the chronically epileptic children and increased psychiatric morbidity among their mothers. Professionals involved in the care of epileptic children should be aware of the effects on the psychological health of other members of the family, and of ways of helping the child and the family to cope with the illness.

Relationship between age and vitamin E level in epileptic and normal children

Plasma vitamin E was assayed in 100 children on anticonvulsants either singly or in combination. Their plasma vitamin E levels were lower than in 100 apparently normal children. The age range of the children was between 2 and 12 years. The plasma vitamin E levels of the control children were lower than published values for adults. In the normal course of development, vitamin E levels increase with age but this developmental pattern does not occur in groups of epileptic children, and this may be related to the metabolic effects of drug therapy in epilepsy.

Epilepsy in childhood: I. A statistical study of clinical types

Summary 1. Some of the difficulties in making the diagnosis of epilepsy have been discussed. The difficulties usually depend upon incomplete history or observation. So-called “febrile convulsions” are sometimes confused with epilepsy. When seizures are of atypical nature rather than true convulsions, it is sometimes difficult to distinguish them from peculiar behaviorisms exhibited by defective children, syncope, hysteria, and breath-holding attacks. 2. The statistical studies reported here are based upon a group of 254 noninstitutionalized children thought to have epilepsy. All cases with questionable diagnosis were excluded from the group. 3. It is impossible at present to divide epilepsies into an “organic” and an “essential” group. It is probable that many epileptics with severe mental defects have organic cerebral lesions. However, since it is frequently impossible to determine whether a severe mental defect points to a preexisting cerebral malformation causing attacks, or is a result of deterioration following epilepsy, it is thought advisable to subdivide the cases into three groups, as follows: Group I. Patients with intelligence quotient above 80 and with no evidence of neurologic lesions (43.7 per cent) Group II. Patients with intelligence quotient below 80 but with no other evidence of neurologic lesions (32.3 per cent) Group III. Patients with definite evidence of neurologic lesions (24 per cent). 4. Fifty-four per cent of all the patients studied had I. Q.'s above 80; 57.5 per cent of the patients without neurologic lesions were standardized above 80, as compared with 41.5 per cent of the patients with neurologic lesions. 5. The character of the seizures in the three groups of epileptic children is discussed. A distinction is made between true petit mal seizures without motor manifestations and minor motor attacks. The convulsive discharge (either general or localized) was the predominant feature in 96.7 per cent of the epileptics with neurologic lesions, 69.5 per cent of those with mental retardation, and 62.2 per cent of the patients with approximately normal mentality. Only 16 patients, or 6.3 per cent of the entire series, had attacks exclusively of the petit mal type, and 15 of these patients were children of normal mentality. The petit mal attack was the predominant feature in 20.7 per cent of the group with normal mentality and in 6.1 per cent of the group of retarded children. The typical petit mal attack was not encountered in any of the patients diagnosed as having neurologic lesions. 6. A study of the frequency of seizures in the different groups of epileptic children does not gire a correct indication of the severity of the disease, due to the fact that petit mal seizures are more common among the children with normal mentality. When the frequency of convulsive attacks is compared in the different groups, it is found that the disease is relatively less severe in the children who have normal mentality. Conversely, mental defects are more often associated with the more severe forms. 7. The age of the onset of epilepsy is discussed. The symptoms are most liable to appear in the first two years of life. There is a decrease in the number of cases commencing between the second and the sixth years and another increase between the sixth and the eighth years. Other workers have shown a third increase in the frequency of onset occurring between the tenth and fifteenth years but this is not indicated by our figures due to the smaller number of children in the older age periods studied by us. The early onset, before the second year, is especially common in children having neurologic lesions since many of these lesions are the result of birth traumas or congenital malformations.