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Objectives There is significant scarcity of specialists to provide care for children with epilepsy in many parts of the world. Telemedicine is a potential future option. This study was planned to estimate the diagnostic accuracy of telephone consultation to identify Critical Clinical Events (breakthrough seizures, drug non-compliance, drug adverse events, features of raised intracranial pressure, and other disease-related events),compared to the Face-to-Face consultation (gold standard), in children with Neurocysticercosis (NCC) and symptomatic seizures, following the completion of cysticidal therapy. Methods Children aged 2–15 years attending a tertiary health care facility with a diagnosis of NCC and symptomatic seizures were enrolled after completion of the cysticidal therapy. The parents were contacted by a Pediatric Neurology Resident on Telephone before the scheduled hospital visit. Subsequently, all the children were seen directly in hospital the next day by another Pediatric Neurology Resident. The information was noted on a structured questionnaire. The diagnostic accuracy of telephone consultation for identifying the Critical Clinical Events was estimated using Face-to-Face consultation as the gold standard. Results A total of 1145 potential events were evaluated. Of these, the face-to-face consultation identified 56 events that would need hospital visit for detailed evaluation (breakthrough seizures in 19, drug non-compliance in 15, adverse drug events in 11, features of raised intracranial pressure in 8, and other disease-related events in 3), and 1089 events that did not require hospital consultation. The sensitivity, specificity, positive and negative predictive values of telephone consultation were 89.28% (78.12–95.96), 97.61% (96.52–98.43), 65.79% (54.01–76.30), and 99.43% (98.78–99.79) respectively. The likelihood ratios when telephone consultation was positive and negative were 37.3 and 0.11 respectively. Significance Telephone consultation is an acceptable mode of follow-up for children with mild Neurocysticercosis and symptomatic seizures after completion of cysticidal therapy. [ABSTRACT FROM AUTHOR]

Neurocysticercosis, parasitic infestation of the central nervous system by the Taenia solium larvae, is a major public health problem, primarily in the developing countries. Seizures are the primary clinical manifestation which could be acute (secondary to active lesions) or remote symptomatic (due to calcified lesions). Cysticidal therapy is the standard of care for solitary parenchymal active neurocysticerci. However treatment related side effects and tendency to spontaneous resolution raises concern from time to time whether cysticidal therapy is actually required. This is a retrospective case record analysis of two groups of patients with solitary parenchymal neurocysticerci (group A; 171 patients between 2000 and 2004 who did not receive cysticidal therapy, group B; 512 patients between 2008 and 2013 who received cysticidal therapy). Group B had significantly more radiological resolution of lesions whereas group A reported significantly more seizure recurrences on antiepileptics. There was no significant difference in occurrence of calcification in the two groups. Overall patients with calcified lesions had significantly more breakthrough seizures. Well designed prospective studies should be planned in future to understand the mechanism underlying the epileptogenicity of calcified lesions and how they are linked to host and environment factors. [ABSTRACT FROM AUTHOR]

Summary: Purpose: Autonomic symptoms frequently occur during seizures. There are reports that the adult group of intractable epilepsy patients have different autonomic profile than the well controlled epilepsy, but there is no clear evidence in the children epilepsy group, therefore, we planned to study the autonomic profile in well controlled and refractory epilepsy children by recording the short-term heart rate variability (HRV). Methods: This cross sectional study was conducted in a tertiary care hospital between July 2008 and June 2009. Children with mean age of 9.1±3.3 years were enrolled. Three groups of children, 40 in each group namely, refractory epilepsy, well controlled epilepsy and normal control children were included. Children who had chronic systemic diseases and were on drugs that cause autonomic dysfunction were excluded. All children underwent short term heart rate variability testing. Data was analyzed in time domain and frequency domain. Results: pNN50 was significantly lower in children with refractory epilepsy than the well control as well as healthy controls. Rest of the parameters of time domain and frequency domain were comparable between the groups. Conclusions: Our study showed that parasympathetic activity is lower in refractory epilepsy children. However, autonomic tone is comparable in well control versus healthy controls. [Copyright &y& Elsevier]