Treatment Of Epilepsy In Children Research Articles

Mediating effects of sleep quality between clinical characteristics and quality of life in children with epilepsy: A cross-sectional study from Southwest China

BackgroundAlthough sleep quality (SQ) reportedly affects the health-related quality of life (QOL) of patients with epilepsy, little is known about the potential association between SQ and QOL, particularly in children with epilepsy (CWE). Our study aimed to investigate the mediating effect of SQ on the QOL of CWE to obtain more information for the prevention and treatment of epilepsy in children. MethodsWe collected general demographic and clinical data of 212 CWE and 79 controls (children who visited the Health Examination Department), and their guardians were instructed to answer the Children’s Sleep Habits Questionnaire (CSHQ) and the optimized Quality of Life in Childhood Epilepsy Questionnaire-16 (QOLCE-16). The t-test, analysis of variance, chi-square test, and Fisher’s exact test were used for between group comparisons. The Pearson correlation was used to analyze the correlation between variables. The direct, indirect, and total effects of predictors on the QOL of CWE were estimated based on an adjusted mediation model. ResultsCWE had significantly smaller long-term urban residence rates, less educated guardians, higher total CSHQ score, higher incidence of poor SQ, higher bedtime resistance, more sleep anxiety, worse sleep-disordered breathing, increased parasomnia, more daytime sleepiness, more frequent night waking, and greater sleep onset delay than controls (P < 0.05 for all). The univariable analysis showed significant differences in total CSHQ scores between CWE with different seizure frequency in the last month, whether or not drug-resistant epilepsy (DRE), and with different video electroencephalogram (VEEG) findings (P < 0.05 for all). Differences in QOLCE-16 scores between CWE with different guardian’s employment status, age at diagnosis, number of anti-seizure medication (ASM) types, seizure frequency in the last month, DRE status, seizure type, VEEG findings, neuropsychological evaluation findings, magnetic resonance imaging (MRI) findings, and etiology were statistically significant (P < 0.05 for all). The correlation study indicated that the total CSHQ score was negatively correlated with the QOLCE-16 score (P < 0.05). The mediation analysis showed that DRE and VEEG abnormalities had a standardized direct effect on the QOL. Seizure frequency in the last month, DRE, and VEEG abnormalities had an indirect effect on the QOL through SQ, and their mediating effect values of SQ were 31.61 %, 13.45 %, and 14.35 %, respectively. ConclusionOur findings uncovered the relationship of some clinical characteristics with SQ and QOL and characterized the nature of factors affecting the QOL of CWE. SQ could be a key factor in the prognosis of CWE experiencing epileptic seizures, and more attention should be paid on the management of SQ in interventions for epilepsy.

Prevalence, incidence, and trends of epilepsy among children and adolescents in Africa: a systematic review and meta-analysis

BackgroundEpilepsy contributes to a significant disease burden in children and adolescents worldwide. The incidence of childhood epilepsy is threefold higher in low and middle income countries compared in high-income countries. Epilepsy is a serious neurological condition associated with stigma and discrimination, an impaired quality of life, and other mental health related problems.ObjectiveThis study is aimed to synthesize existing evidence and estimate the pooled prevalence and incidence of epilepsy in children and adolescents in Africa.MethodsA comprehensive and systematic search of relevant databases was conducted. The quality of each study was assessed using the Newcastle-Ottawa Quality Assessment Scale adapted for meta-analysis. Two reviewers screened retrieved articles, conducted critical appraisals, and extracted the data. Heterogeneity between studies was assessed by visual inspection of forest plots and statistically using Cochran’s Q statistics and the I2 test. Publication bias was checked by visual inspection of funnel plots as well as statistically using Egger’s correlation and Begg’s regression tests. Finally, the pooled prevalence and incidence of childhood epilepsy were computed with 95% confidence intervals.ResultIn this review and meta-analysis 42 studies with 56 findings were included to compute the pooled prevalence of childhood epilepsy. On the other hand, 6 studies were included to estimate the combined incidence. The pooled prevalence of cumulative epilepsy was 17.3 per 1000 children. Whereas the pooled prevalence of active and lifetime epilepsy was 6.8 and 18.6 per 1000 children respectively. The pooled incidence of childhood epilepsy was 2.5 per 1000 children.ConclusionNearly 1 in 50 children are suffering from epilepsy in Africa. However, little attention has been paid to the prevention and treatment of childhood epilepsy. Mass epilepsy screening, scaling up treatment coverage, and designing strict treatment follow up and monitoring mechanisms are recommended.

Middle temporal gyrus approach to mesial temporal lobe tumours in children.

To assess whether the middle temporal gyrus (MTG) approach to mesial temporal lobe (MTL) tumours is an effective procedure for the treatment of epilepsy in children. MTL tumours are a common cause of drug-resistant epilepsy in children. There is as yet no consensus regarding their treatment. One possibility is resection via a MTG approach. We assessed the medical records of patients treated at the Department of Neurosurgery, Children's Memorial Health Institute,Warsaw, Poland between 2002 and 2020. A prospectively maintained database including clinical, laboratory, and radiographic presentation, as well as pre- and post-operative course, was analysed. Patients with at least a one- -year follow-up were included. There were 14 patients aged 4-18 years who underwent a MTG approach for a MTL tumour. All presented with epileptic seizure, and none had neurological deficit on admission to hospital. Median follow-up was 2.5 years. Neuronavigation was used to adjust the approach, localise the temporal horn, and achieve radical resection of the tumour and the hippocampus. Gross total resection was performed in all cases. In most patients, histopathological examination revealed ganglioglioma. One patient had transient aphasia. Two patients developed hemiparesis after surgery, which later improved. One of them also experienced visual disturbances. Acute complications were more frequent in younger patients (p = 0.024). In all cases, MRI confirmed complete resection and there was no tumour recurrence during the follow-up period. 13/14 patients remained seizure-free (Engel class I). The MTG approach to MTL tumours is an effective procedure for the treatment of epilepsy in children. It avoids removal of the lateral temporal lobe and poses only a minor risk of permanent neurological complications.

Pharmaceutical providing of the treatment of children with epilepsy in Ukraine and abroad

The aim: to investigate the pharmaceutical providing for the treatment of epilepsy in children in Ukraine and abroad and to conduct a marketing analysis of the domestic market of antiepileptic drugs.&#x0D; Materials and methods: domestic and foreign Internet sources, medical and technological documents on a specific research topic, the regulatory and legal base of Ukraine, materials of the State Formulary of Medicines, the State Register of Medicines of Ukraine were the objects of the study. The methods of marketing analysis, graphic, documentary and analytical generalization were used.&#x0D; Results: a comparative analysis of clinical protocols (France, Great Britain and Ukraine) for the treatment of epilepsy in children showed that there are only 12 INNs out of 37 INNs in the country. The analysis of the formulary lists of drugs of Great Britain and Ukraine showed that the BNFC has 32 INNs, and the domestic - 10 INNs. As of October 2022, 287 names of antiepileptic drugs are registered in Ukraine, and 164 of them are allowed in children's practice. The main producers of antiepileptic drugs are India and Ukraine. Children's drugs forms are mainly represented by tablets and capsules - more than 90%. A comparison of the lists of drugs for the treatment of epilepsy from the National List of Essential Medicines of Ukraine, BNFC, WHO Model List of Essential Medicines and WHO Model List of Essential Medicines for Children showed that out of 37 INNs, only 11 INNs are listed in all documents.&#x0D; Conclusions: the results prove the need of improvement of pharmaceutical providing of epilepsy treatment in Ukraine. The nomenclature and variety of dosage forms for children's practice need to be expanded. In order to increase the economic availability of epilepsy treatment, it is advisable to update the National List of the main drugs of Ukraine and include new drugs in it, which will make it possible to purchase them at the expense of the State Budget of Ukraine

Effect of mTOR Inhibitors in Epilepsy Treatment in Children with Tuberous Sclerosis Complex Under 2 Years of Age

Mechanistic target of rapamycin (mTOR) inhibitors sirolimus and everolimus are an effective therapy for subependymal giant cell astrocytomas, cardiac rhabdomyomas, renal angiomyolipomas, and lymphangioleiomyomatosis associated with tuberous sclerosis complex (TSC). Everolimus was recently approved in the EU and the USA for the treatment of refractory focal-onset seizures. Despite frequent use of mTOR inhibitors, there are only a few studies on their effect on epilepsy control in children under 2years of age. This study aims to assess the effect of adjunctive mTOR inhibitor treatment on seizure frequency in this age group. We performed retrospective data analysis of medical records of patients with TSC who initiated sirolimus or everolimus under the age of 2years. Participants' antiseizure medication was adjusted according to their epilepsy control independently from mTOR inhibitor administration. The data was assessed separately for patients treated with mTOR inhibitors before and after the onset of seizures. We also compared the treatment group with a matched control group. The follow-up duration was up to 24months. Twenty-one patients with TSC from two clinical centers were included in the study. Nine participants had no history of seizures before mTOR inhibitor initiation. Twelve reported active epilepsy in the month prior to treatment initiation. Most patients treated preventively with mTOR inhibitors did not report active epilepsy at the end of their follow-up. In the second group, the mean frequency of seizures decreased with time. According to the comparative analysis, seizure control was better in the groups treated with mTOR inhibitors. Patients with TSC treated with mTOR inhibitors demonstrated better seizure control than individuals without this treatment. Adjunctive pharmacotherapy with mTOR inhibitors appears to have a beneficial effect on epilepsy outcome in young children. Further prospective clinical trials should be conducted to determine the efficacy of mTOR inhibitors on epilepsy in patients with TSC under the age of 2years.

Can the Gut Microbiota Serve as a Guide to the Diagnosis and Treatment of Childhood Epilepsy?

BackgroundTo investigate the activity of the gut-brain axis in the pathogenesis of childhood epilepsy and to define biomarkers capable of assisting with determining new strategies in that context. MethodsTwenty children with epilepsy of “unknown etiology” and seven healthy controls in the same age group were included in the study. The groups were compared using a questionnaire. Stool samples were stored in tubes containing DNA/RNA Shield (Zymo Research) with a sterile swab. Sequencing was carried out using the MiSeq System (Illumina). The 16S rRNA sequencing of samples using next-generation sequencing involved V4 variable region polymerase chain reaction amplification concluded by 2 × 250-bp paired-end sequencing of amplicons and at least 50,000 reads (>Q30) per sample. DNA sequences were classified at the genus level using the Kraken program. Bioinformatics and statistical analysis were then performed. ResultsIndividuals’ gut microbiota relative abundance values differed between the groups at the genus, order, class, family, and phylum levels. Flavihumibacter, Niabella, Anoxybacillus, Brevundimonas, Devosia, and Delftia were seen only in the control group, whereas Megamonas and Coriobacterium were observed only in the epilepsy group. The linear discriminant analysis effect size method identified 33 taxa as important in differentiating the groups. ConclusionsWe think that bacterial varieties (such as Megamonas and Coriobacterium) that differ between the two groups can be employed as useful biomarkers in the diagnosis and follow-up of epileptic patients. We also predict that, in addition to epilepsy treatment protocols, the restoration of eubiotic microbiota may increase the success of treatment.

Adapted Evidence-Based Clinical Practice Guidelines for Diagnosis and Treatment of Epilepsies in Children: A Tertiary Children's Hospital Update

Hypothesis and/or BackgroundWe recently updated and merged the adapted clinical practice guidelines (CPGs) for the diagnosis and treatment of children with epilepsy of a tertiary-level hospital. Medical knowledge is always evolving. As a result, it is critical to revisit the clinical standards on a frequent basis to ensure that the best services are offered to the target receivers. The purpose of this article was to update and merge the CPGs at Alexandria University Children Hospital (AUCH) for the diagnosis (2014) and treatment (2016) of children with epilepsy to unify and standardize the practice for better care and outcome. MethodsThis review and update CPG project was initiated by assembling a Guideline Review Group (GRG). The GRG conducted focus group discussions and decided to search any published updates of the recommendations of the previously identified high-quality and evidence-based CPG developed by the SIGN (Scottish Intercollegiate Guidelines Network) and to merge the two previous local CPGs under one comprehensive CPG for full management of epilepsy in children. The high quality of the selected source CPG from SIGN was based on quality assessment of CPGs undertaken previously using the Appraisal of Guidelines for Research and Evaluation II Instrument. The GRG followed the Checklist for the Reporting of Updated Guidelines (CheckUp), which is the CPG tool recommended by the Enhancing the Quality and Transparency of health Research Network for reporting of updated CPGs in addition to the RIGHT-Ad@pt Checklist for Adapted CPGs. The finalized updated CPG draft was sent to the external reviewer group topic experts. ResultsThe group updated 10 main categories of recommendations from one source CPG (SIGN). The recommendations included (1) epilepsy diagnosis; (2) recognition, identification, and referral; (3) pharmacological treatment of epilepsy and epilepsy syndromes; (4) nonpharmacological treatment of epilepsy and epilepsy syndromes; (5) managing pharmacoresistant epilepsy; (6) management of epilepsy in special groups; (7) medications; (8) children and caregiver education and support; (9) comorbidities and mortality; and (10) transitional care from pediatric to adult care services. ConclusionsThe finalized CPG provides evidence-based guidance to health care providers in AUCH for the diagnosis and management of epilepsy in children. The study also established the significance of a collaborative clinical and methodological expert group for the update of CPGs, as well as the usability of the “CheckUp” and “RIGHT-Ad@pt” CPG Tools.

Surgical treatment of epilepsy in children with focal cortical dysplasia in central gyri

Assessment of the outcome after epilepsy surgery in children with FCD in central lobules. Nine patients, median age 3.7 ys, IQR=5.7 ys (min 1.8- max 15.7 ys) with FCD in central gyri and DR-epilepsy underwent surgery. Standard preoperative evaluation included MRI and video-EEG. Invasive recordings were used in 2 cases, coupled by fMRI in 2. An ECOG and neuronavigation, as well as stimulation and mapping of primary motor cortex were used routinely during the procedure. Gross total resection was achieved in 7 patients according to postoperative MRI. Six patients with new or worsening of already existing hemiparesis recovered within a year after surgery. At the last FU (med 5 ys) favorable outcome (Engel class IA) has been achieved in 6 cases (66.7%), while two patients with persisting seizures reported seizing less frequently (Engel II-III). Three patients were able to discontinue AED-treatment and four children resumed development with improvement in cognition and behavior.

Anti-seizures therapeutics in patients with epilepsy: an approach to levetiracetam – review

Epilepsy is a chronic condition that consists of a transient disorder of brain function manifested by recurrent and unprovoked seizures affecting approximately 50 million people worldwide. Antiepileptic treatment is aimed at possible improvement the quality of life by reducing epilepsy seizures with the lowest possible side effects. One of the newest broad spectrum antiepileptic drug (AED) for the treatment of wide range of epilepsies – focal, partial, myoclonic, tonic-clonic and primary generalized seizures that can be used in both children and adults is levetiracetam. Levetiracetam is believed to bind to SV2A (synaptic vesicle protein 2A) in the brain, prevent the release of calcium stores from neurons and inhibit GABA and glycine activity. Due to the unique mechanism of action, high bioavailability (in both oral and intravenous administration), rapid absorption, metabolism based on the hydrolysis of acetamide groups in the blood (independent of the liver) and the lack of activity of the resulting metabolites, the drug is considered to be safe and effective in reducing and stopping seizures. In this review, we present the latest reports on the effectiveness of levetiracetam and its potential in the treatment of epilepsy in children and adults.

Efficacy and adverse reactions of perampanel in the treatment of epilepsy in children.

ObjectiveTo observe the clinical effect and adverse reactions of perampanel in the treatment of epilepsy in children.MethodsA retrospective analysis was performed on 83 children with epilepsy who were treated with perampanel in the Department of Pediatric Neurology, Second Affiliated Hospital of Xi'an Jiaotong University from April to August 2021. The treatment status, prognosis and adverse reactions were followed up. The effective rates of different age groups, different seizure types and epilepsy syndromes, and different treatment methods were statistically analyzed. The effective rate and adverse reactions of all patients were statistically analyzed.ResultsThe overall effective rate of perampanel in the treatment of epilepsy was 62.03%, and there was no significant difference in the effective rate of perampanel in the treatment of epilepsy in patients of different ages (P > 0.05). The effective rates of perampanel in the treatment of focal seizures and generalized seizures were 60.38% and 65.38%, and the effective rates of benign childhood epilepsy with centrotemporal spikes (BECT), BECT combined with electrical status epilepticus during sleep (ESES) and frontal lobe epilepsy (FLE) were 88.89, 72.73, and 66.67%. The effective rates of monotherapy and combination therapy were 88.88 and 58.57%, respectively. The above statistical differences were not statistically significant (P > 0.05). In addition, the adverse reaction rate of perampanel treatment was 16.45%, including irritability, drowsiness, dizziness, nausea, vomiting and abnormal liver function.ConclusionPerampanel has a high efficiency and controllable adverse reactions in the treatment of childhood epilepsy. This drug can be used as a reliable choice for long-term use in the treatment of epilepsy in children.

Kainic Acid Epilepsy Model in Wistar Rats: The Comparative Ameliorate Use of Bryophyllum pinnatum, Ketogenic Diet and Carbamazepine on the Frontal Lobe Cortex with Selected Behavioral Parameters

Introduction: Frontal lobe Epilepsy is a neurological disorder characterized by brief, recurrent seizures which arise from the frontal lobes of the brain. Bryophyllum pinnatum, is a natural herb which has been known for its anticonvulsant potential in experimental animals. The ketogenic diet is a form of treatment for epilepsy in children created due to the observation that fasting had anti-seizure properties. This comparative study investigated the potential ameliorative use of Bryophyllum pinnatum, Ketogenic diet and Carbamazepine, on the frontal lobe cortex in kainic acid induced epilepsy wistar rat models.&#x0D; Materials and Methods: Twenty-eight (n=28) adult male Wistar rats with an average weight of 150g were randomly distributed into five groups labelled A, B, C, D &amp; E. Group A served as control; group B was treated with kainic acid only, group C was treated with Kainic acid + Bryophyllum pinnatum, group D was treated with Kainic acid + ketogenic diet and group E was treated with Kainic acid + carbamazepine. Rats were sacrificed after 29 days treatment period and their brains excised. The precentral cortices were cut and phosphate buffer preserved for enzymes and hormonal assay and the rest brain samples were stored in formal saline for histological demonstrations. Neurobehavioral studies which included Elevated Plus Maze and Barnes Maze tests were carried out before the rats were sacrificed.&#x0D; Results: Kainic acid caused extensive damage to cortical structures. Bryophyllum pinnatum stimulated regeneration of damaged cells and restoration of myelination and cellular integrity. &#x0D; Discussion: Although, there was extensive damage done by kainic acid to the cortical structures in group B, group C, group D and group E, Bryophyllum pinnatum stimulated the restoration of neurotransmission and massive production of astrocytes which aided in neuronal regeneration.

Safety &amp; Efficacy of Medical Cannabinoids in Children

Source: Treves N, Mor N, Allegaert K, et al. Efficacy and safety of medical cannabinoids in children: a systematic review and meta-analysis. Sci Rep. 2021;11(1):23462; doi:10.1038/s41598-021-02770-6Investigators from multiple institutions conducted a systematic review and meta-analysis to assess the efficacy and safety of medical cannabinoids (MC) in children. Studies in which the efficacy and safety of MCs and placebo or other pharmacotherapy were compared in patients ≤18 years old were selected for review. Outcomes of interest included seizure reduction in children treated with cannabidiol (CBD) or CBD-containing products, reduction in vomiting and retching events in patients with chemotherapy induced nausea and vomiting treated with nabilone (synthetic D-9-Tetrahydrocannabinol [THC]), and adverse events in children receiving MCs such as decreased appetite, gastrointestinal hyperactivity (eg, vomiting, diarrhea, nausea, upset stomach), serious adverse events, adverse mental events, infections, and pyrexia. Seizure reduction was assessed as a 50% reduction in seizure rate from baseline, reported seizure events, and Caregiver Global Impression of Change (CGIC). A variety of statistical tests applicable to meta-analysis were used to compare outcomes in children treated with MCs or comparison treatment.Data from 8 studies were included in the review. Of these, 5 studies reported outcomes on seizure control: 3 evaluated CBD treatment for children with Dravet syndrome and 2 studies using CBD-THC extracts for other conditions. Overall, MCs were associated with an increase in achieving 50% reduction in seizures (RR, 1.69; 95% CI, 1.20, 2.36), and a significant reduction in seizure events (RR, 0.59; 95% CI, 0.36, 0.97); however, a statistically significant reduction in seizure events was observed only in studies evaluating pure CBD treatment and not in those assessing CBD-THC extracts. A significant improvement in CGIC scores was associated with MCs in these studies. Similarly, in 2 studies with a total of 48 participants, nabilone was found to be superior to conventional treatment (prochlorperazine or domperidone) as an anti-emetic in children receiving chemotherapy (difference in means, -11.5; P <0.001).There were 6 studies, including 513 patients, in which serious adverse events were assessed; a non-significant increase associated with MCs was found (RR, 1.59; 95% CI, 0.85, 2.98). Treatment with CBD in doses of 20 mg/kg was associated with decreased appetite (RR, 2.40; 95% CI, 1.39, 4.15, compared to placebo), but the overall risk associated with predominant CBD treatments was of borderline significance (RR, 2.10; 95% CI, 0.96, 4.62). CBD treatment also was associated with an increased risk of gastrointestinal hyperactivity (RR, 2.30; 95% CI, 1.28, 4.12). A statistically significant increase in adverse mental events was found in 4 of 8 studies. There was no statistically significant increase in risk of infections or pyrexia associated with MC use.The authors conclude that MCs are effective in the treatment of some conditions in children but may be associated with an increased risk of adverse events.Dr Candee has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.The results of the current study build upon a prior systematic review from 2017 that was centered largely around the use of medical cannabinoids for Dravet syndrome, a rare drug-resistant epilepsy, which showed limited and low-quality evidence in support of the use of MC in children and adolescents.1 Beyond the addition of 3 more years of studies from which to choose, the current review is more comprehensive and stringent in its selection criteria, with investigators reaching out to authors for any missing data and combing through the references of any eligible studies to ensure inclusiveness. While the results of more recent studies support the safety and efficacy of long-term use of CBD for the treatment of epilepsy in children, the current study is the first of its kind to focus more broadly on treatment with MCs in the pediatric population.2,3The current study is, however, also thereby limited in its scope, as it includes MCs used for a variety of medical purposes (eg, epilepsy, severe behavioral problems, chemotherapy-induced nausea and vomiting, spasticity, and autism). This reduces the applicability of the findings. Furthermore, the precise outcomes for each data subset (based on pharmacological mechanism or organ system) were not defined during the study design phase but rather during the data extraction process. The observational nature of the study and limited size are weaknesses as well.Medical CBD is effective in reducing seizures in children with Dravet syndrome, and naboline (synthetic THC) decreases vomiting in patients treated with chemotherapy. Safety concerns related to MC use in children include adverse mental events. (See AAP Grand Rounds. 2021;46[4]:40.)4

Does Valproate Treatment in Childhood Epilepsy Affect Nutritional Status and Biochemical Parameters?

Objective: Valproic acid is widely prescribed for the treatment of various neurological and neuropsychiatric disorders. This study aimed to determine the effect of valproic acid therapy, which is thought to have weight gain effect on nutritional status and some biochemical factors in children with epilepsy. Material and Methods: The study included 30 children and adolescents who received valproic acid monotherapy because of the diagnosis of epilepsy. Selected biochemical parameters before and 12 months after treatment were recorded retrospectively from the patient files. Valproic acid doses ranged from 11-40 mg/kg/day and plasma levels were maintained within the therapeutic limits throughout the study. The anthropometric measurements of the patients were recorded in the WHO Anthro program for children aged 1-5 years and the WHO Anthro-Plus program for children aged 5-18 years. Results: The epilepsy age of the patients was determined as 48.85±38.16 months; and they have been receiving valproic acid therapy at a dose of 25.00±10.75 mg/kg/day for 18.95±6.02 months. While no difference was found in terms of hunger VAS scores before and after treatment, VAS scores of appetite increased and satiety decreased (p<0.05). BMI-SDs, fasting insulin, HDL cholesterol and triglyceride levels increased after treatment (p<0.05). Conclusion: For this reason, it was thought that it is important to include a dietitian in multidisiplinary team for growth and weight monitoring in children receiving VPA therapy.

Transcriptomic profile of epileptic children treated with ketogenic therapies.

Background: Ketogenic dietary therapies (KDT) are used as a treatment in childhood epilepsy. However, their mechanism has not yet been established. The main objective of this study was to determine the changes in the transcriptomic profile induced by KDT in children with epilepsy in order to shed light on its possible mechanisms. Methods: Eight children with refractory epilepsy were enrolled in the study. Peripheral blood mononuclear cells were obtained before and after the children were treated with KDT for a minimum of 6 months. RNA was extracted and mRNA and miRNA profiling were performed and analyzed. Results: Our intervention with KDT significantly reduced the seizure number in seven of the eight paediatric patients treated and caused important changes in their gene expression profile. Our study reveals modifications in the transcription of 4630 genes and 230 miRNAs. We found that the genes involved in the protection against epileptic crises were among those mainly changed. These genes collectively encode for ion channels, neurotransmitter receptors, and synapse structural proteins. Conclusions: Together our results explain the possible mechanisms of KDT and reinforce its clinical importance in the treatment of epilepsy.

A Review on the Concept of Avapeedaka Snehapana in the management of Mutravahshroto Dushti

The ketogenic or “keto” diet is a low-carbohydrate, fat-rich eating plan that has been used for centuries to treat specific medical conditions. In the 19thcentury, the ketogenic diet was commonly used to help control diabetes. In 1920 it was introduced as an effective treatment for epilepsy in children in whom medication was ineffective. The ketogenic diet has also been tested and used in closely monitored settings for cancer, diabetes, polycystic ovary syndrome, and Alzheimer’s disease. In the Ancient Science of AyurvedaSneha(lipid) is the essence of an individual and human beings life.Snehana(oleation) has a fundamental role in Ayurvedatreatments in both preventive and curative aspect. It can be widely divided intobahya snehana(external oleation) andabhyantara snehana(internal oleation).Snehapana(internal administration of lipid) comes underabhyantara snehanaand is the internal administration ofSneha dravya(lipid).Sneha dravyacan betaila(oil),ghrita(ghee),majja(bone marrow), andvasa(muscle fat) individually or in combination.Snehapanais the principal treatment to be done prior tosodhana(purificatory procedure) and is one amongpurvakarma(prepurificatory procedure). On the basis of therapeutics,snehapanacan be classified based on their action asbrhmana(nourishing),samana(pacifying), andsodhana(purifying).In the Management of MutravahashrotoDushti(Urinary tract disorder) Avapeedaka snehapanais very helpful

Formulation design of oral lamotrigine suspension for the treatment of epilepsy

Aim: Lamotrigine is a broad-spectrum anticonvulsant drug widely used as mono- or adjunct therapy in adults and children. The aim of this study was to develop a liquid formulation of lamotrigine to fulfil the unmet needs of children and geriatric epileptic patients.Materials and Methods: Suspension formulation was prepared using Carbopol 974P as a suspending agent. It was evaluated for its sedimentation and re-dispersibility, solubility, morphology, particle-size distribution, rheological properties, pH measurement, uniformity of dosage unit, in vitro drug release behaviour and results were compared with marketed formulation Lamictal tablets.Results: The release profile of marketed product Lamictal tablets and developed lamotrigine oral suspension shows a complete release profile throughout physiological pH in all three media (0.1N hydrochloric acid, 4.5 pH acetate buffer and 6.8 pH phosphate buffer) and shows similar release as a marketed product. Microscopic observation clearly indicates the stability of the suspension (no aggregation of suspended particles) during the storage period of 12 months. The content uniformity of suspension was found well within the specified limits.Conclusion: Lamotrigine oral suspension was developed successfully and found a suitable alternative for a commercially available tablet for the treatment of epilepsy in children and geriatric patients.

Dietary therapies for epilepsy in low resource settings: challenges and successes

The Ketogenic Diet (KD) is a high fat, low carbohydrate and restricted protein diet which has been used for the treatment of drug resistant epilepsy in children. It is considered the treatment of choice for refractory nonsurgical epilepsy in children. However, despite this being a very useful and relatively simple treatment, children from developing countries have not been able to benefit as much as their counterparts in more privileged settings. In this article, the challenges faced by pediatric neurologists and parents who wish to use the diet in children with refractory epilepsy are discussed, and also the simple low cost innovations which can be used to overcome these challenges are suggested. The evolution from the use of the classic ketogenic diet to the flexible use of the modified Atkins diet in low resource settings will be discussed.

Особенности применения ламотриджина в современном лечении эпилепсии

Более 70 млн человек во всем мире страдают от эпилепсии — обременительного неврологического заболевания, которое может влиять на продолжительность жизни и приводить к инвалидности. Ламотриджин — это современный противоэпилептический препарат второго поколения. По сравнению с препаратами первого поколения (фенобарбитал, фенитоин, примидон, карбамазепин, вальпроат) он отличается меньшим количеством побочных эффектов и лучшей переносимостью. Основной механизм действия ламотриджина связан с блокированием натриевых каналов. К тому же известно его влияние на кальциевые каналы, ГАМКергические, серотонинергические эффекты. Комплексный механизм действия обусловливает широкий спектр показаний при эпилепсии, то есть возможно купирование как генерализованных, так и фокальных приступов. Ламотриджин отличается линейной фармакокинетикой. Он быстро и хорошо всасывается при приеме внутрь: общая биодоступность при пероральном приеме составляет 98 %, максимальная концентрация в плазме крови достигается через 1–3 ч после приема. На сегодня ламотриджин имеет убедительно доказанную эффективность как противоэпилептический препарат (как в монотерапии, так и в составе комбинированной терапии) при первично-генерализованных тонико-клонических, простых и сложных парциальных, вторично-генерализованных припадках, абсансах и атипичных абсансах, миоклонических приступах, а также при синдроме Леннокса — Гасто у пациентов в возрасте 2 лет и старше. Не менее важно и то, что ламотриджин также эффективен при ассоциированных с эпилепсией психических нарушениях: эпилептической депрессии, эпилептической дисфории, эпилептических психозах, психомоторных и соматовегетативных эквивалентах приступов. Итак, ламотриджин является одним из новейших противоэпилептических препаратов, который эффективно применяется при лечении эпилепсии у детей и взрослых.

Relationship between Ag-NORs and T Lymphocyte Subsets in Children with Epilepsy

With the acceleration of the pace of life, the number of children with epilepsy is increasing. This study was to investigate the relationship between Ag-NORs and T lymphocyte subsets in children with epilepsy. In the morning, 3ml of elbow vein blood was collected from epileptic children on an empty stomach. After standing at room temperature for 0.3-1 hour, the serum was centrifuged (2000 rpm, 4 minutes). 3 ml of mixed venous blood was collected in EDTA-K2 vacuum container. The sample was taken out within 5 hours after staining. 30 n I of Itcite reagentand 30 n I of anticoagulant were put into TruCount tube and mixed evenly. Then flow cytometry was used for detection, and facscomp software was used for automatic inspection and calibration. In the same way, the automatic analysis software muitiset was used to obtain 20000 white blood cells, count 8000-10000 lymphocytes automatically, and calculate CD4 + T lymphocytes, CD8 + T lymphocytes and CD4 + / CD8 + ratio. Ag-NORs detection: under aseptic conditions, 0.5ml anticoagulant blood was added into the medium flask containing rpm-1640 and incubated in the incubator at 37°C for 72 hours. After mixing the cell suspension at room temperature, put it into a 10ml glass tube, heat it and dry it. Wait until the temperature of the water solution tank rises to 80-90 °C, and then put aluminum plate on it. The staining was placed under the microscope on the stage, and the image was adjusted to make the image analysis program effective. The ratio of nuclear area to nuclear silver staining area of 30 lymphocytes was counted. This ratio reflects the content of Ag-NORs in the nucleolar forming region of T lymphocytes. The ratio of Ag-NORs area to nuclear area was 0.32 ± 0.03, 0.38 ± 0.03 and 0.46 ± 0.03, respectively. This study is helpful to provide guidance for the treatment of epilepsy in children.

Cognitive outcomes following frontal lobe resection for treatment of epilepsy in children and adolescents

ObjectiveTo use reliable change indices (RCIs) developed specifically for pediatric patients with epilepsy to examine cognitive outcomes after frontal lobe resection for pharmacoresistant epilepsy. MethodsForty-one pediatric patients (25 male, Mage = 10 years) completed comprehensive neuropsychological evaluations before and an average of 6.5 months after frontal lobe resections for treatment of epilepsy. Evaluations included tests of intelligence, attention/working memory, processing speed, language, visuospatial skills, executive function, and episodic memory. Practice effect-adjusted RCIs were used to determine clinically significant postoperative cognitive change. Demographic, disease, and surgical variables were examined to identify factors associated with postoperative cognitive decline or improvement. ResultsWithin each cognitive domain, there was a large proportion of patients (51–84%) who did not exhibit significant cognitive change. In terms of overall cognitive profile, 44% demonstrated improvement in at least one domain and 69% declined in at least one domain. Postoperative cognitive improvement occurred most commonly in the domain of processing speed, whereas postoperative cognitive decline occurred most frequently in the domain of visuospatial skills. Younger age at surgery was associated with cognitive improvement. Older age at seizure onset and higher baseline cognitive performance were associated with cognitive decline. SignificanceApproximately 6.5 months after frontal lobe resection, only 15% of our sample showed stable performance across all cognitive domains. Seventeen percent of patients showed improvements without declines, 42% showed declines without improvements, and 27% showed a mix of improvements and declines across different cognitive domains. Age and baseline abilities were associated with postoperative cognitive change on multiple measures. With 1 in 8 children demonstrating postoperative decline across three or more domains, further research is needed to identify factors associated with cognitive decline in order to inform clinical decision-making and patient/family counseling.