The Efficacy of the Ketogenic Diet in Improving Seizures and EEG Findings in Patients with Refractory Infantile Spasms

Objectives

Infantile spasm is an epileptic disorder of early childhood and infancy and is characterized by cluster epileptic spasms and abnormal EEG findings. Developmental delay is prevalent. Some studies have indicated the significant effect of the Ketogenic Diet (KD) on intractable spasms in children who are unresponsive to first-line treatments. It has been used successfully as a first-line treatment with fewer side effects than ACTH.

Materials & Methods

This was an interventional study in which the effectiveness of KD over a six-month period was evaluated in patients with infantile spasms. Those who fulfilled the inclusion criteria and were willing to use the diet received free cans of the 4:1 ketogenic formula. The diet was prescribed based on the Johns Hopkins protocol in the outpatient setting. All patients used a full formula diet for one month. After a month, the patients were examined by a neurologist and a dietitian, and an EEG was obtained to compare pre- and post-KD findings. In order to compare pre- and post-KD seizures, the maximum number of seizures was multiplied by the longest duration of seizures.

Results

Ten patients were assessed for one month. Using the KD led to significant changes in seizures/clusters and EEG findings. Nine parents reported improvement in their children's social interactions after using the KD.

Conclusion

Based on the findings of this study, the KD can control seizures in patients suffering from infantile spasms by reducing seizure frequency & duration and improving EEG findings.

Patterns of Antiepileptic Drug Reactions in Children: A Multicenter Study

Objectives

Antiepileptic drugs are among the most common triggers of cutaneous adverse reactions. About 5-17% of epileptic patients develop idiosyncratic skin reactions at some point during their treatment course, most of which occur within the first two months of drug initiation. This study aimed to investigate the pattern of cutaneous drug reactions associated with anticonvulsant use among the pediatric population in Iran to identify high-risk individuals.

Materials & Methods

In this retrospective descriptive study, medical records of children aged two months to 14 years, who were diagnosed with drug reactions due to anticonvulsant drugs between April 2007 and March 2018, were reviewed, and relevant information were extracted. This multicenter study was conducted in several provinces of Iran.

Results

A total of 186 cases with a final diagnosis of the antiepileptic drug-induced eruption were evaluated. The median age of participants was 36 months (range: 2-168), and 56% were male. In approximately 70% of the children, the phenobarbital was the culprit. The median time interval between initiation of the causative drug and development of rash and fever was 10 and 7 days, respectively. The most common rash type was maculopapular rashes (69%). Overall, 33% of the patients only received antihistamines after discontinuation of the causative drug.

Conclusion

Similar to previously published studies in Iran, phenobarbital was the main cause of cutaneous drug reactions to antiepileptic drugs, indicating the necessity of paying more attention when prescribing phenobarbital for Iranian pediatrics.

The Impact of Manual Ability Level on Participation of Children with Cerebral Palsy in Life Areas: A Cross-Sectional Study

OBJECTIVES

Participation is a complex and context-dependent concept, which several factors can influence it. The aim of this study was assessing the relationship between the upper extremity function level of children with cerebral palsy (all type of cerebral palsy and severity) and their participation in different life areas.

MATERIALS & METHODS

This cross-sectional study assessed the relationship between the level of upper extremity function of cerebral palsy children and their participation in different life areas. Participants were 274 parents of children with cerebral palsy of the schools of children with special needs and occupational therapy clinics in Tehran, Iran in 2018. They completed the Manual Ability Classification System (MACS) to determine the level of upper extremity function of children with cerebral palsy and Children Participation Assessment Scale-Parent version (CPAS-P) (to determine the participation level of children with cerebral palsy) questionnaires separately.

RESULTS

The mean age of children was 8 yr and 8 months old (at least 6 yr and maximum 12 yr). The correlation between the level of upper extremity function and the overall score of each dimension of participation is significant (P<0.05) and moderate.

CONCLUSION

The upper extremity function of children with cerebral palsy has a moderate and significant relationship with the participation of children with cerebral palsy in different life areas and with different dimensions of participation especially parental satisfaction dimension. Therefore, there is a correlation between upper extremity function and participation in occupations, but this relationship is moderate and is not very strong.

Downward vertical gaze palsy as a prominent manifestation of episodic ataxia type 2: a case report

OBJECTIVE

Episodic ataxia type 2 (EA2) is an inherited autosomal dominant disorder characterized by intermittent ataxia, nausea, vomiting, dysarthria, or nystagmus. We report a case of EA2, which downward gaze palsy exists as a common sign in all her attacks. Responsiveness of EA2 to acetazolamide was observed in this patient.