Marked efficacy of combined three-drug therapy (Sodium Valproate, Topiramate and Stiripentol) in a patient with Dravet syndrome

WHAT IS KNOWN AND OBJECTIVE

Dravet syndrome (DS) is an intractable epilepsy syndrome. The three-drug combination therapy of sodium valproate (VPA), clobazam (CLB) and stiripentol (STP) is recommended worldwide.

CASE SUMMARY

We present a case of DS, in which treatment with CLB could not be continued because of the appearance of adverse reactions to it. Replacement with topiramate (TPM) proved to be markedly effective.

WHAT IS NEW AND CONCLUSION

It is suggested that combination therapy with VPA, TPM and STP is for DS epilepsy.

[Proton magnetic resonance spectroscopy of the autistic brain]

To evaluate brain dysfunction in autism, proton magnetic resonance spectroscopy (1H-MRS) was performed for 29 autistic patients (5-15 y.o.) and 19 normal children (6-14 y.o.). We obtained magnetic resonance (MR) spectra of the left and right amygdaloid-hippocampal regions and the left cerebellar hemisphere with a STEAM sequence (TR = 5000 ms, TE = 18 ms). In addition to the evaluation of signal intensity ratios, the absolute concentration of three major metabolites (N-acetylaspartate [NAA], creatine/phosphocreatine [Cr] and choline-containing substances [Cho]) was quantified by an internal reference method using unsuppressed tissue water. Although no abnormal MR images were found in the three regions examined, the signal intensity and the concentration of NAA in the left amygdaloid-hippocampal region and the left cerebellar hemisphere were reduced significantly in autistic patients compared to normal children. We speculated that this decrease in NAA reflected neuronal loss, immaturity or hypofunction in these regions. The results of our study were in agreement with those of previous studies on autism, one by neuropathological methods and the other using a single photon emission computed tomography with 99mTc HMPAO. Disorders of the amygdaloid-hippocampal region and cerebellum are considered to play an important role in the characteristic cognitive and emotional dysfunction in autism. 1H-MRS is a valuable tool to clarify the pathophysiology of autism.

Cerebrospinal fluid and serum neuron-specific enolase levels after febrile seizures

PURPOSE

Neuron-specific enolase (NSE) has been established as a reliable marker of neuronal damage in various neurologic disorders. The aim of this study was to evaluate whether febrile seizures (FS) cause brain damage, based on the serum and cerebrospinal fluid (CSF) levels of NSE.

METHODS

Fifty-three patients aged from 6 months to 7 years were enrolled. Among them, 36 patients had generalized seizures, and 17 had partial seizures. The maximal seizure duration was 90 min. Blood and CSF samples for measurement of NSE were obtained immediately after the seizure. NSE was measured using an enzyme immunoassay (EIA).

RESULTS

Serum and CSF levels of NSE ranged up to 10 ng/mL, but very high levels were not observed. In patients with partial seizures, the NSE level in the CSF and the ratio of the CSF to serum NSE levels showed a strong correlation with seizure duration. Conversely, there were no correlations between NSE levels and seizure duration in the patients with generalized seizures.

CONCLUSIONS

These results indicate that FS seldom cause severe neurologic damage, but prolonged partial seizures may cause slight neuronal injury.

[Problems of intravenous lidocaine treatment in status epilepticus or clustering seizures in childhood]

Lidocaine was administered intravenously as a substitute for diazepam, to 12 patients with status epilepticus or clustering seizures aged 26 days to 11 years. The medication was very effective in 3 cases with acute convulsions, which disappeared immediately after infusion of lidocaine without relapse. The medication was effective only temporarily in 4 patients; they experienced relapsing seizures during drip infusion of lidocaine intravenously for maintenance. All the relapsing seizures were secondarily generalized ones with diffuse ictal discharges. In 2 cases of localization-related epilepsy, complex partial seizures evolved to secondarily generalized seizures immediately after administration of lidocaine. It must be noticed that in a relatively large number of cases lidocaine is ineffective or even harmful.

A sulfated chitin, SCM-chitin III, inhibits the clearance of human erythrocytes from the blood circulation in erythrocyte-transfused SCID mice

Recently, we have developed a SCID mouse model in which circulating red blood cells (RBC) are entirely substituted with RBCs from other animals like bovine (Bo) or human (Hu). The relatively short life time, especially of Hu-RBCs, in the SCID mouse, however, is a major obstacle in this model. The present study was performed to examine whether a low-toxic sulfated chitin, carboxymethyl chitin III (SCM-chitin III), which has heparin-like structures in the molecule (heparinoid), could inhibit the Hu-RBC clearance in RBC-transfused SCID mice. When Hu-RBCs were transfused simultaneously with SCM-chitin III, their life time in the blood circulation was prolonged significantly. Sulfated chitosan (S-chitosan) showed only a weak decelerating activity on the clearance of Hu-RBCs. Carboxymethyl chitin (CM-chitin), which was used as an unsulfated control compound, had no effect on the Hu-RBC clearance. Another sulfated polysaccharide, dextran sulfate, though this showed some adverse effects, such as anti-coagulant and anti-platelet aggregation, also exhibited a potent decelerating activity on Hu-RBC clearance. Clearance deceleration by these sulfated polysaccharides was primarily attributable to the inhibition of RBC uptake by cultured macrophages.

Brainstem involvement in high functioning autistic children

To determine involvements of the brainstem and/or cerebellum in autism, we compared midsagittal magnetic resonance images of the brains of high functioning autistic children with those of normal controls. We found that the midbrain and medulla oblongata were significantly smaller in these autistic children than in the control children. The pons area did not differ between the two groups, nor was there any difference in the cerebellar vermis area. The ratio of the brain stem and cerebellum to the posterior fossa area did not differ significantly between the high functioning autistic and the control children. A positive correlation between age and area of the cerebellar vermis was observed in autistic children but not in control children. Thus, it was suggested that significant anatomical changes in the midbrain and medulla oblongata existed in the autistic children and that growth of the cerebellar vermis in autistic children was different from normal children.