Childhood Seizures

New nanocarried phenobarbital formulation: Maintains better control of pentylenetetrazole-Induced seizures

•

For the first time, phenobarbital was intercalated in the layered double hydroxide.

•

This study evaluated the slow release efficacy of intercalated phenobarbital.

•

The time of the anticonvulsant effect was verified by electroencephalographic records.

This study aims to evaluate the efficacy of slow release phenobarbital in the control of convulsions triggered by pentylenetetrazole (PTZ), verifying the time of permanence in the anticonvulsant effect through behavior and electroencephalographic records. A total of 162 male Wistar rats weighing between 100 and 120 g were divided into two groups, one for behavior analysis (n = 90) and biochemistry, and another for the acquisition of electrocorticographic record (n = 72). Hepatic enzymes were measured by obtaining a blood sample from the animals studied by means of a biochemical analysis. The procedures for electrode implant and electrocorticographic recordings were performed. The intercalation of phenobarbital in layered double hydroxide (LDH) nanocarrier allowed us to evaluate a new slow release pharmaceutical formulation based on methodologies that have proven longer residence time and lower side effects. This study demonstrates that phenobarbital can be a new perspective pharmaceutical formulation.

Pediatric seizures

Seizures are a commonly encountered condition within the emergency department and, because of this, can engender complacency on the part of the physicians and staff. Unfortunately, there is significant associated morbidity and mortality with seizures, and they should never be regarded as routine. This point is particularly important with respect to seizures in pediatric patients. The aim of this review is to provide a current view of the various issues that make pediatric seizures unique and to help elucidate emergent evaluation and management strategies.

Role of head computed tomography in the evaluation of children admitted to the paediatric intensive care unit with new-onset seizure

OBJECTIVE

The role of neuroimaging in children presenting with new-onset seizure is poorly defined. This study evaluates the incidence of abnormal CT findings in children admitted to the paediatric intensive care unit (PICU) with new-onset seizure and examines potential clinical variables associated with abnormal head CT findings.

METHODS

A retrospective analysis of 89 previously asymptomatic children admitted to Sydney Children's Hospital (Sydney, Australia) PICU between November 2005 and September 2009 with new-onset seizure was undertaken. Demographic data, clinical details and head CT findings were abstracted from medical records. The clinical significance and the impact of CT findings on acute management decisions was analysed. Clinical variables associated with abnormal clinically significant CT results were examined.

RESULTS

A total of 71/89 patients underwent head CT. Of the children who underwent head CT (n= 71), clinically significant CT results were found in 19.7% of patients and head CT findings resulted in a change in acute management in 7% of patients. Children without fever were more than twice as likely to have a positive CT scan (P= 0.049); however, a substantial proportion (6/45) of febrile children also had abnormal scans. Focal seizures were not predictive of abnormal CT results. There was a significant relationship between abnormal CT and multiple seizures (P < 0.02), and age less than 24 months (P < 0.049).

CONCLUSION

In this highly selected group head CT findings are frequently abnormal and might change acute management. Children admitted to the PICU with first presentation of seizure who have multiple seizures and/or are aged <2 years should have immediate CT or MRI scanning.

New-onset seizures in pediatric emergency

BACKGROUND

Seizures account for 1% of all pediatric emergency department (ED) visits. The aim of this study was to analyze the clinical spectrum and prevalence rates of various etiologies in children with a first attack of acute seizure disorder in the ED.

METHODS

We evaluated 319 children who presented to the ED at the Changhua Children's Hospital with a first attack of seizure disorder from 2005 to 2007. Variables including demographics, clinical presentations, laboratory tests, brain imaging studies, electroencephalography, diagnoses and hospital course were compared between patients with seizures and fever, and patients with seizures without fever. These variables were also compared between patients with simple and complex febrile seizures and among different age groups.

RESULTS

Among these 319 patients, 218 (68%) presented with seizures and fever and 299 (94%) children were younger than 6 years of age. Generalized tonic-clonic seizures were the most common type (71.2%). Febrile seizures (62.1%) were the main etiology of the first seizure (p < 0.001). Seizures caused by severe electrolyte imbalance or hypoglycemia were noted in three patients. Abnormal brain images were noted in 16 (26%) of 61 patients, most (12/16, 75%) of whom had abnormal histories and physical or neurologic examinations.

CONCLUSION

Primary care pediatricians should evaluate children presenting to the ED with a first seizure for age, coexistence of fever, seizure type, associated symptoms and history of head injury. We suggest that electrolytes, blood sugar and emergent brain imaging studies should be arranged based on detailed history-taking and thorough physical examinations, but should not be performed routinely.