Search

Background: Encephalitis presents with seizures in the acute phase and increases the risk of late unprovoked seizures and epilepsy. This study aimed to evaluate the effect of antiepileptic drugs in pediatric patients with acute seizures due to encephalitis and epilepsy. Patients and Methods: Cases of acute pediatric encephalitis between January 2000 and December 2010 were reviewed. Clinical data, including onset at age, seizure type, seizure frequency, effects of antiepileptic drugs, and prognosis were analyzed. Results: During the study period, 1038 patients (450 girls, 588 boys) were enrolled. Among them, 44.6% (463) had seizures in the acute phase, 33% had status epilepticus, and 26% (251) developed postencephalitic epilepsy. At one year of follow-up, 205 of the 251 patients with postencephalitic epilepsy were receiving antiepileptic drugs while 18% were seizure free even after discontinuing the antiepileptic drugs. Among those with postencephalitic epilepsy, 67% had favorable outcomes and were using <2 anti-epileptic drugs while 15% had intractable seizures and were using ≥ 2 antiepileptic drugs. After benzodiazepines, intravenous phenobarbital was preferred over phenytoin as treatment of postencephalitic seizures in the acute phase. For refractory status epilepticus, high-dose topiramate combined with intravenous high-dose phenobarbital or high-dose lidocaine had less side effects. Conclusions: Children with encephalitis have a high rate of postencephalitic epilepsy. Phenobarbital and clonazepam are the most common drugs used, alone or in combination, for postencephalitic epilepsy. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To delineate the relationship between neurological severity and neuroimage of lesion load including specific topography of supratentorial cortical tubers and white matter lesions in tuberous sclerosis complex (TSC). Methods: Twenty-five TSC patients more than 2 years of age who underwent conventional and fluid-attenuated inversion recovery sequence (FLAIR) magnetic resonance imaging (MRI) were retrospectively studied. Neurological severity score was designated for three items: seizure, developmental delay and/or mental retardation, and autism. A neuroimaging scoring system was designed to evaluate the load of the cerebrum lesions with respect to location and size of cortical tubers and white matter lesions based on FLAIR MRI. Results: A linear trend was observed between MRI lesion score and neurological severity score (r=0.511; p=0.009). The lesion score in the left temporal lobe has positive correlation to neurological severity score (r=0.609; p=0.001). Conclusions: The brain lesion load was positively correlated with neurological prognosis in TSC patients. Patients with larger lesion load in the left temporal lobe may be correlated with increased neurological severity in right-handed patients with TSC. [Copyright &y& Elsevier]

Purpose: Valproate has been widely used in controlling various kinds of seizures. Intravenous forms of valproate control seizures in a more rapid and efficacious pattern than oral forms. We evaluated the effectiveness and adverse effects of intravenous valproate for controlling seizures in Taiwanese children under 18 years old., Methods: Retrospective chart reviews were performed on 137 pediatric patients receiving valproate infusion from January 2003 to December 2006. Patients were divided into 4 groups as follows: (1) previous use of other antiepileptic drugs (AEDs) (n=59), (2) previous use of oral valproate (n=8), (3) previous use of other AEDs and valproate (n=32), (4) first time use of valproate (n=38). The indications for using intravenous valproate include status epilepticus, repetitive seizures, prophylactic use for brain operations or in cases where oral administration was not feasible due to medical problems., Results: The mean age was 8±6.22 years old and the average dose was 31.2±26.45 mg/kg/day. The mean duration of usage was 7.8±6.99 days. Eight patients failed to respond to intravenous valproate and the AED was shifted to other drugs. Thirty-two patients achieved successful seizure control after adding other AEDs following intravenous valproate. The seizure control rate in our study was 71%, and six patients died of complications associated with an underlying disorder. An allergic reaction (skin rash) was found in 1 patient, while no serious adverse effects were noted in our patients., Conclusion: Intravenous valproate is effective and safe in controlling seizures in children who are either valproate naive or not.

Background: Management of infantile spasms is difficult because current treatment regimens, including many anticonvulsants and hormones, are often ineffective. We conducted this study to determine the effective dose of topiramate (TPM) in Taiwanese children with infantile spasms., Methods: Fourteen patients with infantile spasms were given TPM at an initial dose of 12.5 mg/d, and the dose was raised by 12.5 mg every 2 approximately 3 days. If the seizure frequency did not decrease during the initial 2 weeks, the dose was raised more rapidly. Titration continued for < or = 12 weeks. Subjects were monitored by weekly visits to undergo titration., Results: The etiology of the infantile spasms included a cryptogenic group (n = 3) and a symptomatic group (n = 11). Overall, spasms in 5 patients (38%) were completely controlled. A > or = 50% reduction in spasms was observed in 11 (85%) of 13 subjects during stabilization, while one patient quit the treatment. The mean dose of TPM during stabilization was 7.35 +/- 4.9 mg/kg/d. Among these, 6 patients achieved seizure control and 3 were free of seizures at TPM doses of lower than 6 mg/kg/d., Conclusions: Seizure control was achieved with lower doses of TPM therapy than suggested in previous studies.