Seizures In Pediatric Patients Research Articles

Frequency of a Positive Cerebrospinal Fluid Study in Patients Presenting With Febrile Seizures

Background: Febrile seizures are a common neurological condition in pediatric practice, affecting 2-5% of children globally. These seizures occur in the context of fever without evidence of central nervous system infection or metabolic disturbance. While often benign, febrile seizures are associated with significant morbidity and can cause considerable distress for both patients and caregivers. The role of cerebrospinal fluid (CSF) abnormalities in the pathogenesis of febrile seizures is not well understood, but identifying these factors may help predict the risk of seizure occurrence. Objective: To determine the frequency of positive cerebrospinal fluid abnormalities in pediatric patients with febrile seizures and to assess the impact of these abnormalities on the risk of febrile seizures. Methods: This prospective cohort study was conducted from January 2022 to December 2023 at the Department of Paediatrics, Combined Military Hospital, Rawalpindi. A total of 117 pediatric patients aged 1 to 12 years with a history of febrile seizures presenting with a febrile illness were included. Patients with prior febrile seizures, metabolic/electrolyte disorders, or signs of meningeal infection were excluded. Comprehensive data collection included demographic information, clinical history, and CSF analysis for cell count, total protein, glucose, lactate, and electrolyte levels. Patients were monitored for febrile seizure occurrence during hospitalization. Data were analyzed using SPSS version 25, with continuous variables expressed as medians and interquartile ranges (IQR) and categorical variables as frequencies and percentages. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the association between CSF abnormalities and febrile seizures. Results: The median age of the patients was 3.0 years (IQR: 2.0), with 57.3% (n=67) being male. Febrile seizures occurred in 22.2% (n=26) of patients during hospitalization. Elevated CSF total protein (>60 mg/dL) was observed in 28.2% of patients, CSF glucose (>42 mg/dL) in 12.0%, CSF lactate (>2.0 mmol/L) in 13.7%, and CSF calcium (>1.25 mmol/L) in 10.3%. These abnormalities were significantly associated with an increased risk of febrile seizures: CSF total protein (OR: 3.55, 95% CI: 1.42–8.86, p=0.005), CSF glucose (OR: 13.59, 95% CI: 3.79–48.71, p<0.001), CSF lactate (OR: 4.61, 95% CI: 1.53–13.92, p=0.004), and CSF calcium (OR: 15.52, 95% CI: 3.81–63.36, p<0.001). Conclusion: This study identified significant associations between elevated CSF total protein, glucose, lactate, and calcium levels and an increased risk of febrile seizures in pediatric patients. CSF analysis could be a valuable tool in identifying children at higher risk for febrile seizures, potentially guiding preventive strategies and clinical management.

Intranasal Versus Buccal Versus Intramuscular Midazolam for the Home and Emergency Treatment of Acute Seizures in Pediatric Patients: A Randomized Controlled Trial

BackgroundBenzodiazepines are the recommended first-line treatment of acute seizures. We wished to compare the efficacy, side effects, and satisfaction after midazolam administration by the buccal, intranasal, or intramuscular route in the treatment of acute seizures in children at homes and in emergency room (ER). MethodsA prospective, randomized, controlled trial was performed in children aged one month to 17 years with acute seizures lasting longer than five minutes. The primary end point was seizure cessation within 10 minutes of drug administration and no seizure recurrence within 30 minutes. ResultsIn the home group, 67 patients received midazolam via buccal route, 60 via intranasal route, and 69 via intramuscular route, whereas in the ER group, 37 patients received buccal, 34 received intranasal, and 34 received intramuscular midazolam. The primary end point was achieved in 94.2% and 85.3% after intramuscular midazolam in the home and ER groups, respectively. The intranasal midazolam was successful in stopping seizures in 93.3% in the home group and 88.2% in the ER group. The buccal route was effective in 91% in the home group and 78.4% in the ER group. There were no significant differences in efficacy between all groups (P = 0.763 and P = 0.509) among the home and ER groups, respectively. There were no significant cardiorespiratory events in all groups. ConclusionsIntramuscular, intranasal, and buccal doses of midazolam resolved most seizures in prehospital and emergency settings. Our results indicate that there is no statistically significant difference detected between different routes of midazolam. Intranasal route showed the highest satisfaction rate among caregivers.

Does Hyperventilation Increase the Diagnostic Yield of the Routine Electroencephalogram: A Retrospective Analysis of Adult and Pediatric Cohorts.

While hyperventilation (HV) increases the diagnostic yield of EEG in children, there is conflicting evidence to support its application in adults. For the first time in history, a large cohort of patients has undergone EEGs without HV during the COVID-19 pandemic. Utilizing this opportunity, we sought to investigate whether HV increases the diagnostic yield of EEG in children compared with adults. Patients aged six years and above who had routine EEGs at Monash Health between January 2019 and December 2020 were studied. The cohort was divided into two, pediatric (younger than 18 years) and adult (18 years or older). Epileptiform abnormalities (ictal and interictal) were the outcomes investigated. The effect of HV was examined with logistic regression to determine odds ratios with 95% confidence intervals. In total, we studied 3,273 patients (pediatric = 830, adult = 2,443). In the pediatric cohort, HV significantly increased the diagnostic yield of absence seizures (p = 0.01, odds ratios 2.44, 95% confidence intervals 1.21-4.93). In adults, HV did not increase the yield of absence seizures (p = 0.34, odds ratios 0.36, 95% confidence intervals 0.05-2.88). Interictal epileptiform discharges during HV were significantly more frequent in children compared with adults (p < 0.001, odds ratios 3.81, 95% confidence intervals 2.51-5.77). Hyperventilation is useful to increase the yield of interictal epileptiform discharges and absence seizures in pediatric patients but not in adults. Hence, routine EEG may be recorded in adults without HV when it is unsafe to perform.

Intravenous Lacosamide Therapy for Pediatric Patients With Cluster Seizures

BackgroundFew studies have investigated intravenous lacosamide use to treat cluster seizures in pediatric patients. Therefore, we aimed to investigate the efficacy and safety of intravenous lacosamide therapy in pediatric patients with cluster seizures. MethodsWe retrospectively evaluated the efficacy and safety of intravenous lacosamide therapy in 25 pediatric patients with cluster seizures at Saitama Children's Medical Center between March 2019 and June 2023. Cluster seizures were defined as a single seizure of less than five minutes duration, repeated three or more times within 12 hours, with recovery of consciousness between seizures. Response was defined as seizure freedom for at least 12 hours after lacosamide infusion. ResultsThe median age at onset of epilepsy was 1.5 (0.0 to 9.8) years. The median seizure frequency was 5 (3 to 20) times per 12 hours. The etiologies were remote (n = 17), acute (n = 4), and progressive (n = 4). The median age at which intravenous lacosamide therapy was administered was 4.2 (0.0 to 11.3) years. The median lacosamide dose was 2.6 (1.3 to 5.2) mg/kg. In total, 12 of 25 patients (48.0%) responded. Among patients treated with intravenous lacosamide as first-line therapy, nine of 17 (52.9%) had complete seizure remission. The frequency of complete seizure remission in patients with remote etiologies was 58.8% (10 of 17); among them, seven of 12 (58.3%) patients with structural abnormalities showed complete seizure remission. No adverse events were observed. ConclusionsIntravenous lacosamide therapy is a potentially useful treatment option for cluster seizures in pediatric patients.

COMPARISON OF INTRAVENOUS DIAZEPAM AND INTRAVENOUS MIDAZOLAM FOR TREATMENT OF RECURRENT FEBRILE SEIZURES

Background: Recurrent febrile seizures are seizures in children less than 5 years of age which reoccur within 24 hours. Benzodiazepines such as midazolam and diazepam are used to stop and decrease the recurrent rate of febrile seizures. The objective of study was to compare the efficacy of intravenous midazolam with intravenous diazepam for treatment of recurrent febrile seizures in paediatric patients. Methods: This observational cross-sectional study observed 60 children aged 6 to 59 months with recurrent febrile seizures who presented at paediatric clinic in Combined Military Hospital Kharian and THQ Hospital, Kharian from Sep to Nov 2023. The response time was noted for children who received intravenous midazolam 0.2 mg/Kg only and IV diazepam 0.2 mg/Kg only. The children were randomly allocated into group A (midazolam group) and Group B (diazepam group.) Study was done after taking informed consent from the parents. Both drugs were given during the fits. Results: The time interval from drug administration to cessation of febrile seizures was 2.50±0.94 minutes in the midazolam group and 2.4±1.12 minutes in the diazepam group. There was no significant difference between the two groups (p=0.567). Minor dizziness and sedation were the only main effects reported. Conclusion: Both diazepam and midazolam have same efficacy in the treatment of recurrent febrile seizures. Pak J Physiol 2024;20(1):12?4

Etiological Profile of First Episode Seizures in Paediatric Patients at a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction: Seizures are the most common neurological emergency and one of the most common reasons for paediatrics hospital admissions. This study aimed to identify the etiology, clinical profile, and immediate outcome of children with the first episode of seizure in Eastern Nepal. Methods: This was a prospective descriptive study carried out in the Tertiary Care Centre from September 2022 to August 2023. Ethical clearance was taken from the Institutional Review Committee (Ref no:654/2022). Convenience sampling was done to include 170 children presenting with the first episode of seizure at age 6 months to 15 years. Variables collected were demographics, clinical presentations, family history, trauma history, laboratory tests, neuroimaging, EEG, final diagnosis, and immediate outcome.Results: A total of 170 patients were admitted with the first episode of seizure with 123 (72.36%) males and 47 (27.64%) females. The mean age of the patients was 5.13±2.95 years with 104 (61.18%) patients under 5 years of age. The most common seizure was generalized tonic-clonic type in 132 (77.64%) patients. The most common associated symptom was fever in 150 (88.23%) children. Neuroimaging was abnormal in 52 (30.59%) patients, with neurocysticercosis seen in 27 (15.88%). The most common etiology was febrile seizure in 92 (54.17%) patients, neurocysticercosis in 27 (15.88%), and meningitis in 12 (7.05%).Conclusions: Febrile seizures, neurocysticercosis, infection, and trauma were the major causes of seizures in children. When simple febrile seizures were unlikely, lumbar puncture, neuroimaging, and laboratory tests were useful tools for diagnosing etiologies of seizures.

Factors Affecting the Safety Profile of Intravenous Levetiracetam Used for Controlling Seizures in Children: A Literature Review

The administration of intravenous levetiracetam (IV-LEV) serves as a significant therapeutic approach for managing seizures in pediatric patients. The major factors that are involved in the equation determinants contain pharmacokinetic parameters, such as dosage regimen, drug interactions, and patient-specific factors including age, weight, and underlying comorbidities. Furthermore, attention is given to potential adverse effects, including hypersensitivity reactions, renal impairment, and central nervous system manifestations. Clinical trials, observational studies, and pharmacovigilance data contribute to a comprehensive evaluation of the drug’s safety, shedding light on optimal dosing strategies and risk mitigation techniques. Understanding these intricate factors is paramount for healthcare providers to ensure efficacious seizure control while minimizing potential harms associated with IV-LEV administration in children. This abstract examines the multifaceted factors that influence the safety profile of IV-LEV in this vulnerable pediatric population. This literature review explores the various factors influencing the safety profile of intravenous levetiracetam (IV-LEV) in its application for seizure management in pediatric patients. Based upon a comprehensive analysis of peer-reviewed articles, clinical trials, and observational studies, the review synthesizes findings related to pharmacokinetic variables, dosage considerations, and potential drug interactions. Additionally, patient-specific determinants, encompassing age-related variations, weight-based dosing implications, and the impact of comorbid conditions, are critically evaluated.

Safety, tolerability, and efficacy of adjunctive lacosamide in pediatric patients with epilepsy syndromes associated with generalized seizures: Phase 2, open-label exploratory trial.

To evaluate the safety, tolerability, pharmacokinetics, and preliminary efficacy of lacosamide (up to 12 mg/kg/day or 600 mg/day) as adjunctive therapy in pediatric patients with epilepsy syndromes associated with generalized seizures. Phase 2, multicenter, open-label exploratory trial (SP0966; NCT01969851; 2012-001446-18) of oral lacosamide for epilepsy syndromes associated with generalized seizures in pediatric patients ≥1 month to <18 years of age taking one to three concomitant antiseizure medications. The trial comprised a 6-week prospective baseline period, 6-week flexible titration period, and 12-week maintenance period. 55 patients (mean age: 9.2 years; 56.4% male) took at least one dose of lacosamide and had at least one post-baseline efficacy-related assessment. The median treatment duration was 127.0 days. There were no clinically significant mean or median changes or worsening from baseline to end of the titration period in the count of generalized spike-wave discharges per interpretable hour on 24-hour ambulatory electroencephalogram recordings, or from baseline to the maintenance period in mean and median days with any generalized or focal to bilateral tonic-clonic seizures per 28 days. Treatment-emergent adverse events (TEAEs) were reported by 49 (89.1%) patients, and three (5.5%) patients discontinued due to TEAEs. The median change and median percentage change in days with any generalized or focal to bilateral tonic-clonic seizures per 28 days from baseline to the maintenance period were both 0. Trends towards improvement (decrease) were observed in median change and median percentage change in days with each individual seizure type (absence, myoclonic, clonic, tonic, tonic-clonic, atonic, and focal to bilateral tonic-clonic) per 28 days. Safety findings were consistent with the known safety profile of lacosamide and were as expected for the pediatric population. There was no worsening of generalized seizures with lacosamide. Limitations include the inability to correlate spike and wave data with clinical outcomes, and lack of similar studies against which the results can be compared.

New Onset Seizures in a Child Taking 0.01% Atropine Drops

Introduction: Myopia is a refractive disorder commonly diagnosed in childhood that follows a progressive course. It is considered a global epidemic with nearly 23% of the world’s population being diagnosed with this condition. Moreover, myopia is increasing in prevalence worldwide, demonstrated by studies in Asian and Western populations. This has important implications as myopic progression to high myopia is associated with significant morbidity and visual disability if left untreated. Of these treatments, the pharmacologic agent atropine has demonstrated the greatest efficacy in reducing myopia progression. Case report: This is a case report of an 11-year-old male treated with 0.01% atropine drops for myopia progression that developed new-onset seizures. The seizures were characterized as benign epilepsy with central temporal spikes and ceased when drops were discontinued. Discussion: Atropine 1% drops have previously been associated with new or increased seizure activity in a handful of case reports, however, it is our knowledge that this is the first report associated with 0.01% drops. This is important given the growing use of 0.01% drops as well as higher concentrations such as 0.025 % and 0.05% for the treatment of pediatric myopia. Conclusion: While it cannot be proven that the drops were causative in the seizure events, it is important to consider prior seizures as a relative contraindication to the use of these drops. Atropine has the potential to exacerbate seizure activity, so it is possible that the 0.01% atropine drops played a role in the patient’s seizures. Also, any diagnosis of new-onset seizures in pediatric patients should prompt discontinuation of drops at seizure onset.

Characteristics of febrile seizures with SARS-CoV-2 infection in the Omicron era.

While the pandemic of coronavirus disease 2019 (COVID-19) is ongoing, the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been dominant recently. The Omicron variant causes more seizures in pediatric patients compared with previously circulated variants. This study aimed to investigate the incidence and clinical features of febrile seizure (FS) in pediatric patients with COVID-19 during the Omicron era. The medical records of pediatric patients (≤18 years of age) diagnosed with COVID-19, who presented with FS between February 2020 and June 2022, were reviewed retrospectively to analyze clinical characteristics of FS in seven university-affiliated hospitals of Korea. Of 664 pediatric patients with COVID-19 during the study period, 46 during the pre-Omicron period and 589 during the Omicron period were included in the study analysis; 29 patients during the transition period were excluded. Among the included patients, 81 (12.8%) had concomitant FS, and most (76.5%) experienced simple FS. All FS episodes occurred during the Omicron period and none of them during pre-Omicron period (P=0.016). Sixty-five (80.2%) and 16 (19.8%) patients were categorized as FS (patient age ≤60 months) and late-onset FS (patient age >60 months), respectively. Underlying neurologic disease (P=0.013) and focal onset seizure (P=0.012) were more common in the late-onset FS group than in the FS group; however, overall clinical manifestations and outcomes including seizures consistent with characteristics of complex FS and subsequent epilepsy were similar between the two groups. As the COVID-19 pandemic persists, the incidence of FS has increased with the emergence of the Omicron variant. About one-fifth of the patients experiencing FS due to infection by the Omicron variant of SARS-CoV-2 were aged >60 months; however, clinical characteristics and outcomes were favorable. More information and long-term prognoses in patients with FS due to COVID-19 should be acquired.

Anti-epileptic Prophylaxis for Early or Late Post-traumatic Seizures in Children with Traumatic Brain Injury: A Systematic Review (P13-1.009)

<h3>Objective:</h3> We aim to assess the effect of anti-epileptic drug, “AED”, prophylaxis for early or late post traumatic seizures, targeting the pediatric age population with traumatic brain injury, “TBI”. <h3>Background:</h3> Traumatic brain injury is one of the known causes of seizures. There have been several studies investigating the benefit of AED prophylaxis for early and late post traumatic seizures. However, not many discussed that for the pediatric population, exclusively. <h3>Design/Methods:</h3> We systematically searched for studies reporting the incidence of posttraumatic seizures in pediatric patients who suffered from TBI and received AEDs prophylactically following their TBI incident. Studies that included adult patients, adult and pediatric patients but did not report results for the pediatric population separately and patients who did not suffer from a TBI, were excluded. Studies that did not indicate the use of antiepileptic drugs prophylactically following TBI were excluded. <h3>Results:</h3> A total of 10 studies were included involving 4621 post traumatic brain injury patients of the pediatric age population (&lt;18). The majority of the studies included Levetiracetam or Phenytoin as AED prophylaxis for post traumatic seizures. Five studies assessed the effect of prophylaxis on early seizures, 4 on late seizures, and 1 on any seizure. The mean incidence of early post traumatic seizures with AED prophylaxis was 8%. Moreover, one study revealed no benefit of AED prophylaxis for early post traumatic seizures. Regarding late post traumatic seizures, the average incidence with AED prophylaxis was 7.1%. However, no studies demonstrated a benefit of AED prophylaxis. Additionally, one study showed a lower incidence of post traumatic seizures with Levetiracetam prophylaxis (37%) than Phenytoin (41%). <h3>Conclusions:</h3> In conclusion, AED prophylaxis seems to be effective against early post traumatic seizures for the pediatric population, with Levetiracetam possibly being more effective. Also, there is no observed benefit for late post traumatic seizures. <b>Disclosure:</b> Dr. Al Jayyousi has nothing to disclose. Dr. Hazaimeh has nothing to disclose. Mr. Freitekh has nothing to disclose. Ms. Sawan has nothing to disclose. Dr. Jbarah has nothing to disclose.

Use of antiepileptic drugs as prophylaxis against posttraumatic seizures in the pediatric population: a systematic review and meta-analysis.

We aim to assess the effect of anti-epileptic drug (AED) prophylaxis for early or late posttraumatic seizures, targeting the pediatric population with traumatic brain injury (TBI). We systematically searched for studies reporting the incidence of posttraumatic seizures in pediatric patients who suffered from TBI and received AEDs prophylactically following their TBI incident. Studies that included adult patients, adult and pediatric patients but did not report results for the pediatric population separately, and patients who did not suffer from a TBI were excluded. Studies that did not indicate the use of antiepileptic drugs prophylactically following TBI were excluded. A total of 10 studies were included involving 4621 posttraumatic brain injury patients of the pediatric age population (<18). Five studies assessed the effect of prophylaxis on early seizures, four on late seizures and one on any seizure. The mean incidence of posttraumatic seizures with AED prophylaxis was 8% for early seizures and 7.1% for late seizures. Moreover, one study revealed no benefit of AED prophylaxis for early posttraumatic seizures. Meta-analysis revealed a significant difference in the incidence of early posttraumatic seizures with antiepileptic prophylaxis. However, no significant difference for late posttraumatic seizures has been shown. In conclusion, AED prophylaxis seems to be effective against early posttraumatic seizures for the pediatric population, with levetiracetam possibly being more effective. Also, there is no observed benefit for late posttraumatic seizures.

Assessment of the Knowledge Levels and Attitudes of Physicians Regarding the Management of Acute Seizures in Pediatric Patients

Assessment of the Knowledge Levels and Attitudes of Physicians Regarding the Management of Acute Seizures in Pediatric Patients

Analysis of the risk factors of post-operative seizure in pediatric patients with hydrocephalus undergoing endoscopic third ventriculostomy.

The cause and mechanism of epilepsy after endoscopic third ventriculostomy (ETV) have still remained elusive. This single-center study aimed to explore and analyze the risk factors of post-operative seizure in pediatric patients with hydrocephalus undergoing ETV. Data of pediatric patients with hydrocephalus who were treated with ETV from October 1, 2015, to November 31, 2021, were retrospectively analyzed. Basic demographic characteristics, etiology of hydrocephalus, surgical details, and laboratory measurements were collected. An early postoperative seizure was defined as the occurrence of at least one clinical seizure within 24 h of ETV. A total of 50 participants were included in the study, of whom 5 (10.00%) cases were in postoperative epilepsy group and 45 (90.00%) cases were in non-epilepsy group. Epilepsy patients were younger than those without epilepsy, while no statistically significant difference was found (P = 0.0836). In the age subgroup, children with epilepsy were younger than 2 years old. All patients with epilepsy received Ringer's solution intraoperatively. The mean postoperative serum calcium and potassium concentrations were significantly lower in patients with epilepsy than in those without epilepsy (Pcalcium = 0.0429; Ppotassium = 0.0250). Moreover, a faster decrease of serum potassium and calcium levels was found in children with epilepsy compared with those without epilepsy after ETV. The decrease of serum calcium and potassium levels, younger age, and using Ringer's solution as irrigation fluid were risk factors for epilepsy after ETV.

Etiological profile of seizure in children of age group 1 month to 18 years with special reference to neuroimaging in a tertiary care hospital

Background: Seizure is a common cause of childhood hospitalization. Neuroimaging studies help in identifying etiologies, including the rare ones, and planning management. Purpose: The aim of this study is to determine the etiology of seizures in pediatric patients and the utility of neuroimaging in the same. Materials and Methods: A prospective study was carried out on 100 children who were admitted with seizures (including recurrent episodes) in our tertiary care institute. The sociodemographic profile, clinical features, neuroimaging findings, and findings of other investigations were documented and analyzed, to classify the type and etiology of seizures. Results: The male–female ratio among patients was 1.94: 1. Seizures of generalized onset were most common (95%), affecting mostly the age group of 1–5 years (50.53%), followed by the 5–18 years (29.47%) and the 1 month to 1 year (20%) groups. The etiologies were simple febrile seizure (51%), seizure disorder (8%), cerebral palsy (8%), acute viral meningoencephalitis (7%), pyogenic meningitis (6%), and complex febrile seizure (5%). Neuroimaging was carried out in 30 children, in which 14 showed abnormal reports, and abnormal electroencephalogram (EEG) report was found in 6 out of 10 patients. The analysis of the distribution of the types of seizures concerning age, gender, family history of seizure, history of seizure, socioeconomic status, and developmental milestones did not reveal any statistically significant relationships (P &gt; 0.05). Conclusion: Seizure of generalized onset was the most common type, and the most common etiology was a simple febrile seizure. Abnormal neuroimaging/EEG findings were more pronounced in patients with focal seizures.

Bilateral oligodendroglial hamartomas: A rare cause of drug-resistant epilepsy in a pediatric patient.

Intractable or drug-resistant seizures in pediatric patients are often secondary to cortical malformations, hamartomas, or mass lesions. Various subtypes of intracerebral hamartomas, associated with seizure disorders, have been described. In this report, we describe a subtype of intracerebral hamartoma associated with intractable epilepsy in a 10-year-old patient. Initial MR imaging demonstrated a mildly expansile, T2/FLAIR hyperintense, T1 isointense, nonenhancing lesion with blurring of the gray-white junction in the left amygdala. Surgical resection was performed, and pathology confirmed oligodendroglial hamartoma. Patient’s seizures recurred after a two-year interval with imaging demonstrating a similar lesion in the right amygdala which in retrospect was also seen on multiple imaging studies. This case report demonstrates the importance of recognizing oligodendroglial hamartomas as a cause of intractable seizures given the imaging findings, distinguishing it from ganglioglioma, dysembryoplastic neuroepithelial tumor, and oligodendroglioma, and the importance of closely looking/searching for contralateral lesions, which has important therapeutic and prognostic implications.

Febrile seizures in paediatric patients: What is the exact chance of having dengue as the underlying disease?

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

Cost-effectiveness of perampanel as an adjunctive treatment for uncontrolled focal seizures in pediatric patients: a Chinese perspective.

BackgroundThe incidence of epilepsy is 41–187 per 100,000 person-year in children. The health care costs for children with uncontrolled epilepsy is a huge burden. Perampanel (PER) was effective, safety and well-tolerated as add-on therapy in pediatric patients aged 4 to <12 years with uncontrolled focal seizures. However, there is still limited evidence on cost-effectiveness of PER in pediatric patients. We aimed to evaluate the cost-effectiveness of PER as an add-on therapy for pediatric patients with uncontrolled focal seizures.MethodsA Markov model was established to conduct an analysis from the perspective of the Chinese health system and society. The incremental cost-effectiveness ratio (ICER) of patients using PER and conventional therapy versus patients using conventional therapy alone were estimated and compared. The transition probability of the response level, health state utility values, and costs were derived from clinical trials and the literature. Costs, including medical, drug, transportation and indirect costs, were calculated. We performed 1-way sensitivity analyses and probabilistic sensitivity analyses. A subgroup analysis of different ages was also conducted.ResultsThe base-case analysis indicated that compared to maintaining conventional therapy, adding PER as an adjuvant drug therapy had an increased cost of $3,449.85 over 5 years, with an incremental quality-adjusted life years (QALY) value of 0.40, resulting in an ICER of $8,582.58 per additional QALY. The health state utility value had the greatest effect on the ICER. The probabilistic sensitivity analyses showed that the probability of PER being cost-effective was 76.72% at a willingness-to-pay of $11,293/QALY. The ICER of the subgroup ranged from $7,167.95/QALY to $19,710.96/QALY.ConclusionsOur study demonstrated that PER is a cost-effective add-on therapy for pediatric patients.

Predictors of seizure recurrence in emergency department pediatric patients with first-onset afebrile seizure: A retrospective observational study.

The primary goals of emergency department (ED) clinicians when dealing with a pediatric patient experiencing a seizure are to control the seizure and prevent seizure-related complications. After stabilizing the patient, the clinician should determine whether the patient is likely to have recurrent seizures that may need treatment such as antiepileptic drugs (AEDs). The early identification of pediatric seizure patients at high risk for recurrence can be of great help in consulting with their parents. This study aimed to identify predictors of seizure recurrence in pediatric patients who visited the ED for first-onset afebrile seizure. This retrospective study was conducted with pediatric patients aged 1month to 18years who visited our ED for afebrile seizure from January 2016 to March 2020. Children with a known seizure disorder, known underlying genetic or metabolic disorder, or acute trauma history, and those lost to follow-up were excluded. Multivariable logistic regression analysis was performed to identify factors associated with seizure recurrence. A total of 253 pediatric patients were included in the study. Seizure recurrence was observed in 117 patients (46.3%). From the multivariable logistic regression analysis, older age at onset (11-15years, odds ratio [OR] 5.781, p=0.001; 16-18years, OR 6.223, p=0.002), a longer seizure duration (1-5min, OR 3.043, p=0.002; 6-10min, OR 5.629, p=0.002; >10min, OR 8.882, p=0.002), blood pH under 7.2 (OR 8.308, p=0.015), and a glucose level over 144mg/dL (OR 6.408, p=0.030) were significantly associated with seizure recurrence. The area under the receiver operating characteristic curve for the multivariable logistic regression analysis was 0.774. Age at onset ≥11years, a longer seizure duration, acidosis, and hyperglycemia were predictors of seizure recurrence in children who had experienced first-onset afebrile seizure.

Seizures in Children with Cardiac Disease on Extracorporeal Membrane Oxygenation.

Children supported with extracorporeal membrane oxygenation (ECMO) have been shown to be at risk for developing seizures. However, previous studies have consisted of heterogeneous patient populations. We aimed to describe the rate of seizures in pediatric patients receiving ECMO for cardiac indications and to identify risk factors for the occurrence of this complication. This is a retrospective cohort study of consecutive pediatric patients on ECMO for congenital or acquired cardiac disease between 2014 and 2018 at a tertiary care pediatric hospital. We reviewed 110 children, of whom 104 (95%) received continuous electroencephalogram for at least 48h after ECMO initiation. Seizures were observed in 20 (18%) children. Seizures were subclinical only in 13 (65%) patients, and 8 (40%) developed status epilepticus. The median time from ECMO initiation to first seizure was 34h (25%, 75%: 19, 44). Children with seizures were more likely to have suffered pre-ECMO cardiac arrest (odds ratio 5.7, 95% confidence interval 2.0-16.1, p < 0.001), require extracorporeal cardiopulmonary resuscitation (odds ratio 5.2, 95% confidence interval 1.9-14.7, p < 0.001), and have been cannulated via the cervical vessels (p = 0.029). Children with seizures also had lower pH nadir prior to ECMO (p = 0.015) and had higher peak lactate prior to ECMO (p = 0.002). Patients with seizures had significantly a longer median intensive care unit length of stay, (43 versus 32days, p = 0.02), had a significantly worse pediatric cerebral performance score (2 versus 1, p = 0.03), and tended to have worse survival to hospital discharge (50% versus 71%, p = 0.069). Seizures in pediatric patients on ECMO for cardiac indications are common, occurring in nearly one in five patients. Seizures are frequently subclinical only and often progress to status epilepticus. Continuous electroencephalogram is therefore warranted for this patient population, especially in the setting of cardiac arrest, extracorporeal cardiopulmonary resuscitation, or severe metabolic acidosis.