1
|
Iai Y, Kashiwagi M, Tanabe T, Oba C, Nomura S, Ashida A. Rhabdomyolysis during ACTH therapy for west syndrome. Pediatr Int 2023; 65:e15583. [PMID: 37551657 DOI: 10.1111/ped.15583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/01/2023] [Accepted: 04/21/2023] [Indexed: 08/09/2023]
Affiliation(s)
- Yuki Iai
- Department of Pediatrics, Hirakata City Hospital, Osaka, Japan
| | | | - Takuya Tanabe
- Department of Child Neurology, Tanabe Children's Clinic, Osaka, Japan
| | - Chizu Oba
- Department of Pediatrics, Hirakata City Hospital, Osaka, Japan
| | - Shouhei Nomura
- Department of Pediatrics, Hirakata City Hospital, Osaka, Japan
| | - Akira Ashida
- Department of Pediatrics, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| |
Collapse
|
2
|
Foster BA, Lane JE, Massey E, Noelck M, Green S, Austin JP. The Impact of Malnutrition on Hospitalized Children With Cerebral Palsy. Hosp Pediatr 2020; 10:1087-1095. [PMID: 33154081 PMCID: PMC7684553 DOI: 10.1542/hpeds.2020-0177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Children with cerebral palsy (CP) and other medical complexity comprise an outsized proportion of health care use. In this review, we describe the current science of assessment of nutritional status for children with CP, outline a systematic approach to assessing their nutritional status, delineate ramifications of malnutrition on hospitalization-associated outcomes, and identify knowledge gaps and means of addressing those gaps using quality improvement and clinical research tools. Methods to accurately assess body composition and adiposity in this population by using skinfolds, age, sex, and activity level are available but are not widely used. There are limitations in our current method of estimating energy needs in children with CP, who are at higher risk of both obesity and micronutrient deficiencies. There is some evidence of an association between malnutrition, defined as either underweight or obesity, and hospitalization-associated outcomes in children generally, although we lack specific data for CP. The gaps in our current understanding of optimal nutritional status and between current science and practice need to be addressed to improve health outcomes for this vulnerable patient population.
Collapse
Affiliation(s)
| | - Jennifer E Lane
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
| | - Elizabeth Massey
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
| | - Michelle Noelck
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
| | - Sarah Green
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
| | - Jared P Austin
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
| |
Collapse
|
3
|
Association Between the Serum Carnitine Level and Ammonia and Valproic Acid Levels in Patients with Bipolar Disorder. Ther Drug Monit 2020; 42:766-770. [DOI: 10.1097/ftd.0000000000000778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
4
|
Klepper J, Akman C, Armeno M, Auvin S, Cervenka M, Cross HJ, De Giorgis V, Della Marina A, Engelstad K, Heussinger N, Kossoff EH, Leen WG, Leiendecker B, Monani UR, Oguni H, Neal E, Pascual JM, Pearson TS, Pons R, Scheffer IE, Veggiotti P, Willemsen M, Zuberi SM, De Vivo DC. Glut1 Deficiency Syndrome (Glut1DS): State of the art in 2020 and recommendations of the international Glut1DS study group. Epilepsia Open 2020; 5:354-365. [PMID: 32913944 PMCID: PMC7469861 DOI: 10.1002/epi4.12414] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 12/14/2022] Open
Abstract
Glut1 deficiency syndrome (Glut1DS) is a brain energy failure syndrome caused by impaired glucose transport across brain tissue barriers. Glucose diffusion across tissue barriers is facilitated by a family of proteins including glucose transporter type 1 (Glut1). Patients are treated effectively with ketogenic diet therapies (KDT) that provide a supplemental fuel, namely ketone bodies, for brain energy metabolism. The increasing complexity of Glut1DS, since its original description in 1991, now demands an international consensus statement regarding diagnosis and treatment. International experts (n = 23) developed a consensus statement utilizing their collective professional experience, responses to a standardized questionnaire, and serial discussions of wide-ranging issues related to Glut1DS. Key clinical features signaling the onset of Glut1DS are eye-head movement abnormalities, seizures, neurodevelopmental impairment, deceleration of head growth, and movement disorders. Diagnosis is confirmed by the presence of these clinical signs, hypoglycorrhachia documented by lumbar puncture, and genetic analysis showing pathogenic SLC2A1 variants. KDT represent standard choices with Glut1DS-specific recommendations regarding duration, composition, and management. Ongoing research has identified future interventions to restore Glut1 protein content and function. Clinical manifestations are influenced by patient age, genetic complexity, and novel therapeutic interventions. All clinical phenotypes will benefit from a better understanding of Glut1DS natural history throughout the life cycle and from improved guidelines facilitating early diagnosis and prompt treatment. Often, the presenting seizures are treated initially with antiseizure drugs before the cause of the epilepsy is ascertained and appropriate KDT are initiated. Initial drug treatment fails to treat the underlying metabolic disturbance during early brain development, contributing to the long-term disease burden. Impaired development of the brain microvasculature is one such complication of delayed Glut1DS treatment in the postnatal period. This international consensus statement should facilitate prompt diagnosis and guide best standard of care for Glut1DS throughout the life cycle.
Collapse
Affiliation(s)
- Joerg Klepper
- Children's Hospital Aschaffenburg‐AlzenauAschaffenburgGermany
| | - Cigdem Akman
- Department of Neurology and PediatricsVagelos College of Physicians and Surgeons at Columbia UniversityNew YorkNYUSA
| | - Marisa Armeno
- Department of NutritionHospital Pediatria JP GarrahanBuenos AiresArgentina
| | - Stéphane Auvin
- Department of Pediatric NeurologyCHU Hôpital Robert DebreAPHPParisFrance
| | - Mackenzie Cervenka
- Department of NeurologyComprehensive Epilepsy CenterJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Helen J. Cross
- UCL NIHR BRC Great Ormond Street Institute of Child HealthLondonUK
| | | | - Adela Della Marina
- Department of Neuropediatrics, Developmental Neurology and Social Pediatrics, Centre for Neuromuscular Disorders in Children, University Hospital EssenUniversity of Duisburg‐EssenEssenGermany
| | - Kristin Engelstad
- Department of Neurology and PediatricsVagelos College of Physicians and Surgeons at Columbia UniversityNew YorkNYUSA
| | - Nicole Heussinger
- Department of Pediatric NeurologyParacelsus Medical Private UniversityNurembergGermany
| | - Eric H. Kossoff
- Departments of Neurology and PediatricsJohns Hopkins UniversityBaltimoreMDUSA
| | - Wilhelmina G. Leen
- Department of NeurologyCanisius Wilhemina HospitalNijmegenThe Netherlands
| | - Baerbel Leiendecker
- Department of Neuropediatrics, Developmental Neurology and Social Pediatrics, Centre for Neuromuscular Disorders in Children, University Hospital EssenUniversity of Duisburg‐EssenEssenGermany
| | - Umrao R. Monani
- Center for Motor Neuron Biology & DiseaseDepartments of Neurology and Pathology & Cell BiologyColumbia University Irving Medical CenterNew YorkNYUSA
| | - Hirokazu Oguni
- Department of PediatricsTokyo Women's Medical UniversityTokyoJapan
| | | | - Juan M. Pascual
- Departments of Neurology and Neurotherapeutics, Physiology and PediatricsEugene McDermott Center for Human Growth and DevelopmentThe University of Texas Southwestern Medical CenterDallasTXUSA
| | - Toni S. Pearson
- Mount Sinai Center for Headache & Pain MedicineNew YorkNYUSA
| | - Roser Pons
- First Department of PediatricsAgia Sofia HospitalUniversity of AthensAthensGreece
| | - Ingrid E. Scheffer
- Florey and Murdoch InstitutesAustin Health and Royal Children's HospitalThe University of MelbourneMelbourneVictoriaAustralia
| | - Pierangelo Veggiotti
- Pediatric Neurology V. Buzzi HospitalChild Neuropsychiatry University of MilanMilanItaly
| | - Michél Willemsen
- Department of Pediatric NeurologyRadboud University Medical CentreAmalia Children's HospitalNijmegenNetherlands
| | - Sameer M. Zuberi
- Royal Hospital for Children & College of Medical Veterinary & Life SciencesUniversity of GlasgowGlasgowUK
| | - Darryl C. De Vivo
- Department of Neurology and PediatricsVagelos College of Physicians and Surgeons at Columbia UniversityNew YorkNYUSA
| |
Collapse
|
5
|
Okumura A, Kurahashi H, Iwayama H, Numoto S. Serum carnitine levels of children with epilepsy: Related factors including valproate. Brain Dev 2019; 41:516-521. [PMID: 30827788 DOI: 10.1016/j.braindev.2019.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 02/17/2019] [Accepted: 02/21/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study measured the serum carnitine levels in patients with epilepsy and determined the factors contributing to low carnitine levels. METHODS We measured the serum carnitine levels in 94 consecutive patients with epilepsy, including the free carnitine (FC) and acylcarnitine fractions, using an enzyme cycling method. We defined a low FC as a serum FC level < 36 μmol/L. Age, body mass index (BMI), standard deviation score of BMI (BMI-SDS), use of valproate, cognitive disorder, and feeding problems differed between patients with low and normal FC. In patients taking valproate, the associations of the serum FC level with the platelet count and serum ammonia and amylase levels were analyzed. RESULTS Univariate analysis showed that a low BMI and BMI-SDS, the use of valproate, and cognitive disorder were more frequent in patients with a low FC. Logistic regression analysis revealed that a low BMI-SDS and cognitive disorders were independently associated with a low FC. Among the patients taking valproate, a low BMI-SDS and age were associated with a low FC. The serum FC and ammonia levels were inversely correlated, whereas no correlation was observed between the serum FC level and platelet count or serum amylase level. CONCLUSION A low BMI and cognitive disorders were related to a low FC in patients with epilepsy and the serum carnitine levels should be monitored in these patients.
Collapse
Affiliation(s)
| | | | | | - Shingo Numoto
- Department of Pediatrics, Aichi Medical University, Japan
| |
Collapse
|
6
|
Chen S, Hu Y, Huang Y, Nan Y, Zhou X, Chen S, Lin J, Lin Z. A newborn with seizures born to a mother diagnosed with primary carnitine deficiency. BMC Pediatr 2019; 19:79. [PMID: 30885166 PMCID: PMC6421665 DOI: 10.1186/s12887-019-1452-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 03/07/2019] [Indexed: 12/31/2022] Open
Abstract
Background Maternofetal carnitine transport through the placenta is the main route of fetal carnitine uptake. Decreased free carnitine levels discovered by newborn screening has identified many asymptomatic adult women with systemic primary carnitine deficiency (PCD). Here, we presented amplitude integrated electroencephalogram (aEEG) and magnetic resonance imaging (MRI) findings from a neonate with epilepsy whose mother was carnitine deficient. Case presentation A one-day-old female newborn was admitted after experiencing seizures for half a day; status epilepticus was found on the continuous normal voltage background pattern with immature sleep-wake cycling during aEEG monitoring. On T1-weighted, T2-weighted, FLAIR, and DWI head MRI, there were various degrees of hyperintense signals and diffusion restrictions in the deep white matter of the right hemisphere. Tandem mass spectrometry discovered carnitine deficiency on the second day, which elevated to normal by the 9th day before L-carnitine supplementation was started. The patient was treated with phenobarbital after admission. No further seizures were noted by day 5. It was confirmed that the patient’s mother had a low level of serum-free carnitine. Gene analyses revealed that the newborn had heterozygote mutations on c.1400C > G of the SLC22A5 gene, and her mother had homozygous mutations on c.1400C > G. The patient had a good outcome at the 8-month follow up. Conclusions Maternal carnitine deficiency that occurs during the perinatal period may manifest as secondary epilepsy with cerebral injury in neonates. The short-term neurodevelopmental outcomes were good. Early diagnosis of asymptomatic PCD in female patients can provide guidance for future pregnancies.
Collapse
Affiliation(s)
- Si Chen
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, 325027, Wenzhou, China
| | - Yingying Hu
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, 325027, Wenzhou, China
| | - Yumei Huang
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, 325027, Wenzhou, China
| | - Yan Nan
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, 325027, Wenzhou, China
| | - Xiaojian Zhou
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, 325027, Wenzhou, China
| | - Shangqin Chen
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, 325027, Wenzhou, China
| | - Jin Lin
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, 325027, Wenzhou, China.,Kravis Children's Hospital and Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Zhenlang Lin
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang, 325027, Wenzhou, China.
| |
Collapse
|
7
|
El Mously S, Abdel Ghaffar H, Magdy R, Hamza S, Mansour M. Carnitine deficiency in epileptic children treated with a diversity of anti-epileptic regimens. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2018; 54:37. [PMID: 30546248 PMCID: PMC6267633 DOI: 10.1186/s41983-018-0033-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 10/19/2018] [Indexed: 12/30/2022] Open
Abstract
Background Carnitine deficiency is relatively common in epileptic patients. The risk factors reported include the combination of valproic acid with other antiepileptic drugs (AEDs), young age, multiple neurologic disabilities, non-ambulatory status, and being underweight. Objectives To study the level of carnitine deficiency and its associated risk factors among a group of children with idiopathic epilepsy treated with different AEDs. Patients and methods Fifty children with idiopathic epilepsy and 40 age-matched controls were enrolled. For all, serum carnitine level was measured by enzyme-linked immune sorbent assay (ELISA). Results The mean carnitine level was lower in cases compared to controls (p = 0.04). Patients receiving monotherapy treatment had a high percentage of carnitine deficiency compared to controls (p = 0.04). Patients receiving valproate with other AEDs had a lower level of carnitine compared to controls (p = 0.03). The age of the patients, the duration of treatment, and the doses of different AEDs were not risk factors for carnitine deficiency. Conclusions Carnitine deficiency is common in our population, and the use of valproate with other AEDs is considered the most important risk factor for it in epileptic children.
Collapse
Affiliation(s)
| | | | - Remon Magdy
- Faculty of Medicine, Fayoum University, Fayoum City, 63611 Egypt
| | - Somaia Hamza
- Faculty of Medicine, Fayoum University, Fayoum City, 63611 Egypt
| | - Mohamed Mansour
- Faculty of Medicine, Fayoum University, Fayoum City, 63611 Egypt
| |
Collapse
|
8
|
|
9
|
Towns M, Rosenbaum P, Palisano R, Wright FV. Should the Gross Motor Function Classification System be used for children who do not have cerebral palsy? Dev Med Child Neurol 2018; 60:147-154. [PMID: 29105760 DOI: 10.1111/dmcn.13602] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 12/11/2022]
Abstract
UNLABELLED This literature review addressed four questions. (1) In which populations other than cerebral palsy (CP) has the Gross Motor Function Classification System (GMFCS) been applied? (2) In what types of study, and why was it used? (3) How was it modified to facilitate these applications? (4) What justifications and evidence of psychometric adequacy were used to support its application? A search of PubMed, MEDLINE, and Embase databases (January 1997 to April 2017) using the terms: 'GMFCS' OR 'Gross Motor Function Classification System' yielded 2499 articles. 118 met inclusion criteria and reported children/adults with 133 health conditions/clinical descriptions other than CP. Three broad GMFCS applications were observed: as a categorization tool, independent variable, or outcome measure. While the GMFCS is widely used for children with health conditions/clinical description other than CP, researchers rarely provided adequate justification for these uses. We offer recommendations for development/validation of other condition-specific classification systems and discuss the potential need for a generic gross motor function classification system. WHAT THIS PAPER ADDS The Gross Motor Function Classification System should not be used outside cerebral palsy or as an outcome measure. The authors provide recommendations for development and validation of condition-specific or generic classification systems.
Collapse
Affiliation(s)
- Megan Towns
- Bloorview Research Institute, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Peter Rosenbaum
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Robert Palisano
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Physical Therapy and Rehabilitation Science Department, Drexel University, Philadelphia, PA, USA
| | - F Virginia Wright
- Bloorview Research Institute, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
10
|
Gezmen-Karadağ M, Çelik E, Kadayifçi FZ, Yeşildemir Ö, Öztürk YE, Ağagündüz D. Role of food-drug interactions in neurological and psychological diseases. Acta Neurobiol Exp (Wars) 2018. [DOI: 10.21307/ane-2018-017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
11
|
Glick NR, Fischer MH. Potential Benefits of Ameliorating Metabolic and Nutritional Abnormalities in People With Profound Developmental Disabilities. Nutr Metab Insights 2017; 10:1178638817716457. [PMID: 35185339 PMCID: PMC8855413 DOI: 10.1177/1178638817716457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 05/21/2017] [Indexed: 11/20/2022] Open
Abstract
Background: People with profound developmental disabilities have some of the most severe neurological impairments seen in society, have accelerated mortality due to huge medical challenges, and yet are often excluded from scientific studies. They actually have at least 2 layers of conditions: (1) the original disability and (2) multiple under-recognized and underexplored metabolic and nutritional imbalances involving minerals (calcium, zinc, and selenium), amino acids (taurine, tryptophan), fatty acids (linoleic acid, docosahexaenoic acid, arachidonic acid, adrenic acid, Mead acid, plasmalogens), carnitine, hormones (insulinlike growth factor 1), measures of oxidative stress, and likely other substances and systems. Summary: This review provides the first list of metabolic and nutritional abnormalities commonly found in people with profound developmental disabilities and, based on the quality of life effects of similar abnormalities in neurotypical people, indicates the potential effects of these abnormalities in this population which often cannot communicate symptoms. Key messages: We propose that improved understanding and management of these disturbed mechanisms would enhance the quality of life of people with profound developmental disabilities. Such insights may also apply to people with other conditions associated with disability, including some diseases requiring stem cell implantation and living in microgravity.
Collapse
Affiliation(s)
- Norris R Glick
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Milton H Fischer
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
12
|
Hagiwara SI, Kubota M, Nambu R, Kagimoto S. Screening of carnitine and biotin deficiencies on tandem mass spectrometry. Pediatr Int 2017; 59:458-461. [PMID: 27634667 DOI: 10.1111/ped.13167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/09/2016] [Accepted: 09/08/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND It is important to assess pediatric patients for nutritional deficiency when they are receiving specific interventions, such as enteral feeding. We focused on measurement of C0 and 3-hydroxyisovalerylcarnitine (C5-OH) with tandem mass spectrometry (MS/MS), which is performed as part of the newborn mass screening. The purpose of this study was to investigate the usefulness of MS/MS for screening carnitine and biotin deficiencies. METHODS Forty-two children (24 boys, 18 girls) were enrolled between December 2013 and December 2015. Blood tests, including measurement of serum free carnitine via the enzyme cycling method, and acylcarnitine analysis on MS/MS of dried blood spot (DBS), were performed for the evaluation of nutrition status. RESULTS Median patient age was 2 years (range, 2 months-14 years). Mean serum free carnitine was 41.8 ± 19.2 μmol/L. In six of the 42 patients, serum free carnitine was <20 μmol/L (range, 4.0-18.7 μmol/L). C0 and C5-OH measured on MS/MS of DBS were 33.8 ± 20.2 nmol/mL and 0.48 ± 0.22 nmol/mL, respectively. There was a strong positive correlation (r = 0.89, P < 0.001) between serum free carnitine and C0 measured on the same day. In one patient on hydrolyzed formula, C5-OH was >1.00 nmol/L. Therapy-resistant eczema was improved by treatment with additional biotin and a non-hydrolyzed formula. CONCLUSION C0 and C5-OH, measured on MS/MS of DBS, were useful for screening carnitine and biotin deficiencies.
Collapse
Affiliation(s)
- Shin-Ichiro Hagiwara
- Division of General Pediatrics, Saitama Children's Medical Center, Saitama, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Ryusuke Nambu
- Division of General Pediatrics, Saitama Children's Medical Center, Saitama, Japan
| | - Seiichi Kagimoto
- Division of General Pediatrics, Saitama Children's Medical Center, Saitama, Japan
| |
Collapse
|
13
|
Ito M, Fukuda M, Suzuki Y, Wakamoto H, Ishii E. Carnitine-related hypoglycemia caused by 3 days of pivalate antibiotic therapy in a patient with severe muscular dystrophy: a case report. BMC Pediatr 2017; 17:73. [PMID: 28292283 PMCID: PMC5351108 DOI: 10.1186/s12887-017-0835-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-term treatment with antibiotics containing pivalic acid may decrease serum carnitine concentration and can sometimes be associated with severe hypoglycemia and encephalopathy in infants. Little has been reported, however, on severe hypocarnitinemia induced by acute administration in older children. CASE PRESENTATION We describe a 6-year-old Japanese girl with Fukuyama-type congenital muscular dystrophy who lost consciousness after 3 days of treatment with an antibiotic containing pivalic acid (cefditoren pivoxil). Investigations at the onset of unconsciousness revealed hypoglycemia (free plasma glucose concentration: 31 mg/dL) and hypocarnitinemia (serum free carnitine concentration: 6.2 μmol/L). Intravenous administration of glucose rapidly improved her symptoms without any complications. Serum free carnitine concentration was 29.0 μmol/L immediately prior to the initiation of cefditoren pivoxil. Computed tomography scanning showed severe peripheral skeletal muscle atrophy, indicating the likelihood of decreased carnitine stores in skeletal muscle. CONCLUSIONS Although serum carnitine concentration can appear deceptively normal, skeletal muscle carnitine stores can be reduced in patients with severe muscular atrophy. Even a short course of a pivalate-containing antibiotic can lead to life-threatening hypocarnitinemia in older children with severe muscular dystrophy.
Collapse
Affiliation(s)
- Masanori Ito
- Department of Pediatrics Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime, 790-0295, Japan.
| | - Mitsumasa Fukuda
- Department of Pediatrics Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime, 790-0295, Japan
| | - Yuka Suzuki
- Ehime Rehabilitation Center for Children, Toon, Ehime, Japan
| | | | - Eiichi Ishii
- Department of Pediatrics Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime, 790-0295, Japan
| |
Collapse
|
14
|
Yamazaki S, Watanabe T, Sato S, Yoshikawa H. Outcome of renal proximal tubular dysfunction with Fanconi syndrome caused by sodium valproate. Pediatr Int 2016; 58:1023-1026. [PMID: 26896192 DOI: 10.1111/ped.12956] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 02/09/2016] [Accepted: 02/16/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although Fanconi syndrome is rare in patients with epilepsy treated with sodium valproate (VPA), the prevalence might be higher in children with severe motor and intellectual disabilities (SMID). VPA-induced Fanconi syndrome usually has a favorable outcome, but the long-term outcome of renal tubular dysfunction in SMID patients remains unknown. The aim of this study was therefore to investigate the long-term outcome of renal proximal dysfunction in SMID children with Fanconi syndrome caused by VPA. METHODS The records of six children with SMID and Fanconi syndrome caused by VPA were retrospectively reviewed to assess long-term proximal renal tubular function after discontinuation of VPA. All six patients had intractable epilepsy and required tube feeding. RESULTS Proximal tubular dysfunction improved in almost all patients after VPA discontinuation, although abnormal uric acid reabsorption persisted in three patients. Five patients had hypocarnitinemia. After carnitine supplementation, one of these three patients with decreased ability to reabsorb uric acid had a normal serum level and improved fractional excretion of uric acid. CONCLUSIONS Secondary carnitine deficiency may cause prolonged tubular dysfunction in some SMID patients with VPA-induced Fanconi syndrome. Fanconi syndrome caused by VPA is a usually reversible dysfunction of the proximal tubules, but can be permanent. Although not effective for all patients, carnitine is recommended for patients with VPA-induced Fanconi syndrome, especially children with SMID.
Collapse
Affiliation(s)
- Sawako Yamazaki
- Department of Pediatrics, Niigata City General Hospital, Niigata, Japan. .,Department of Pediatrics, Nagaoka Institute for Severely Handicapped Children, Nagaoka, Japan.
| | - Toru Watanabe
- Department of Pediatrics, Niigata City General Hospital, Niigata, Japan
| | - Seiichi Sato
- Department of Pediatrics, Niigata City General Hospital, Niigata, Japan
| | - Hideto Yoshikawa
- Department of Pediatrics, Nagaoka Institute for Severely Handicapped Children, Nagaoka, Japan
| |
Collapse
|
15
|
Hamed SA. Markers of bone turnover in patients with epilepsy and their relationship to management of bone diseases induced by antiepileptic drugs. Expert Rev Clin Pharmacol 2015; 9:267-86. [DOI: 10.1586/17512433.2016.1123617] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
16
|
Markers of bone turnover in patients with epilepsy and their relationship to management of bone diseases induced by antiepileptic drugs. Expert Rev Clin Pharmacol 2015. [PMID: 26589104 DOI: org/10.1586/17512433.2016.1123617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Data from cross-sectional and prospective studies revealed that patients with epilepsy and on long-term treatment with antiepileptic drugs (AEDs) are at increased risk for metabolic bone diseases. Bone diseases were reported in about 50% of patients on AEDs. Low bone mineral density, osteopenia/osteoporosis, osteomalacia, rickets, altered concentration of bone turnover markers and fractures were reported with phenobarbital, phenytoin, carbamazepine, valproate, oxcarbazepine and lamotrigine. The mechanisms for AEDs-induced bone diseases are heterogeneous and include hypovitaminosis D, hypocalcemia and direct acceleration of bone loss and/or reduction of bone formation. This article reviews the evidence, predictors and mechanisms of AEDs-induced bone abnormalities and its clinical implications. For patients on AEDs, regular monitoring of bone health is recommended. Prophylactic administration of calcium and vitamin D is recommended for all patients. Treatment doses of calcium and vitamin D and even anti-resorptive drug therapy are reserved for patients at high risk of pathological fracture.
Collapse
|
17
|
Dietary Intakes and Nutritional Issues in Neurologically Impaired Children. Nutrients 2015; 7:9400-15. [PMID: 26580646 PMCID: PMC4663597 DOI: 10.3390/nu7115469] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/28/2015] [Accepted: 11/03/2015] [Indexed: 12/16/2022] Open
Abstract
Neurologically impaired (NI) children are at increased risk of malnutrition due to several nutritional and non-nutritional factors. Among the nutritional factors, insufficient dietary intake as a consequence of feeding difficulties is one of the main issues. Feeding problems are frequently secondary to oropharyngeal dysphagia, which usually correlates with the severity of motor impairment and presents in around 90% of preschool children with cerebral palsy (CP) during the first year of life. Other nutritional factors are represented by excessive nutrient losses, often subsequent to gastroesophageal reflux and altered energy metabolism. Among the non-nutritional factors, the type and severity of neurological impairment, ambulatory status, the degree of cognitive impairment, and use of entiepileptic medication altogether concur to determination of nutritional status. With the present review, the current literature is discussed and a practical approach for nutritional assessment in NI children is proposed. Early identification and intervention of nutritional issues of NI children with a multidisciplinary approach is crucial to improve the overall health and quality of life of these complex children.
Collapse
|
18
|
Yamamoto Y, Takahashi Y, Imai K, Mishima N, Kagawa Y, Inoue Y. Changing incidence of hyperammonemia in Japan from 2006 to 2013: expansion of new antiepileptic drugs reduces the risk of hyperammonemia. Eur J Clin Pharmacol 2015; 71:1517-24. [PMID: 26391520 DOI: 10.1007/s00228-015-1939-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/03/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of the present study was to examine the relationship between the incidence of hyperammonemia and changes in the prescribing of concomitant antiepileptic drugs (AEDs) in patients receiving valproic acid. METHODS We evaluated 40,363 plasma samples from 6009 epilepsy patients obtained from 2006 to 2013. Hyperammonemia was defined as a plasma ammonia level exceeding 100 μg/dL. RESULTS In 2006, 32.6 % of the plasma samples were from patients with concomitant use of phenytoin but this decreased to 16.0 % in 2013. Lamotrigine and levetiracetam were approved in 2008 and 2010, respectively, and were prescribed for patients who provided 27.8 and 14.9 % of the plasma samples in 2013. The incidence rate of hyperammonemia (per 100 person years) decreased markedly from 40.8 (95 % confidence interval (CI), 37.7-43.9) in 2006 to 14.2 (95 % CI, 12.5-15.9) in 2013. In any year reviewed, concomitant use of phenytoin, phenobarbital, carbamazepine, or carbonic anhydrase inhibitors was a risk factor for hyperammonemia. Among enzyme-inducing AEDs, concomitant use of phenytoin was associated with the highest risk of hyperammonemia. CONCLUSION Drug interactions caused by enzyme-inducing AEDs, especially phenytoin, are closely related to the development of hyperammonemia. This study demonstrated that introduction of new AEDs changed the co-prescribing pattern in patients receiving valproic acid, resulting in a marked decrease of hyperammonemia. Although their higher cost may be problematic, new AEDs are beneficial for reducing the risk of drug interactions.
Collapse
Affiliation(s)
- Yoshiaki Yamamoto
- Department of Clinical Research, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, 886, Urushiyama, Shizuoka, 420-8688, Japan. .,Department of Clinical Pharmaceutics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, 52-1, Yada, Shizuoka, 422-8526, Japan.
| | - Yukitoshi Takahashi
- Department of Clinical Research, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, 886, Urushiyama, Shizuoka, 420-8688, Japan.,Department of Clinical Pharmaceutics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, 52-1, Yada, Shizuoka, 422-8526, Japan
| | - Katsumi Imai
- Department of Clinical Research, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, 886, Urushiyama, Shizuoka, 420-8688, Japan
| | - Nobuyuki Mishima
- Department of Clinical Research, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, 886, Urushiyama, Shizuoka, 420-8688, Japan
| | - Yoshiyuki Kagawa
- Department of Clinical Pharmaceutics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, 52-1, Yada, Shizuoka, 422-8526, Japan.,Laboratory of Clinical Pharmacokinetics and Drug Safety, Shizuoka General Hospital, 4-27-1 Kita Ando, Shizuoka, 420-8527, Japan
| | - Yushi Inoue
- Department of Clinical Research, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, 886, Urushiyama, Shizuoka, 420-8688, Japan
| |
Collapse
|
19
|
Al-Mendalawi MD. Re: Sodium Valproate-Induced Myopathy in a Child. Sultan Qaboos Univ Med J 2015; 15:e444. [PMID: 26357567 DOI: 10.18295/squmj.2015.15.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 05/14/2015] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mahmood D Al-Mendalawi
- Department of Paediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad, Iraq, E-mail:
| |
Collapse
|
20
|
Weise S, Syrbe S, Preuss M, Bertsche A, Merkenschlager A, Bernhard MK. Pronounced reversible hyperammonemic encephalopathy associated with combined valproate-topiramate therapy in a 7-year-old girl. SPRINGERPLUS 2015; 4:276. [PMID: 26090323 PMCID: PMC4469596 DOI: 10.1186/s40064-015-1057-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/22/2015] [Indexed: 11/10/2022]
Abstract
Valproate is one of the most frequently used anticonvulsive drugs in children and adults. Valproate is a generally well tolerated medication. However, encephalopathy with or without hyperammonemia is one of its rare adverse events. We present a 7-year-old girl who suffered from epilepsy with generalized tonic-clonic seizures and absence epilepsy. She was initially treated with topiramate. Methylprednisolone pulse therapy and long-term therapy with valproate were initiated due to an increase of seizure frequency. At day 5 of therapy, a further increase of seizure frequency was observed followed by lethargy and somnolence. Liver enzymes remained within normal range, but ammonia serum levels increased to a maximum of 544 mmol/l. Discontinuing valproate and starting potassium-benzoate and sodium-phenylbutyrate improved the clinical condition and ammonia serum levels. Haemodialysis was not required. Cranial magnetic resonance imaging ruled out brain edema. The patient was further on successfully treated with a combination of both, topiramate and levetiracetam. Seizures did not recur and development was normal until now (3 years later). To the best of our knowledge, we observed the highest ammonia serum levels ever reported in valproate-induced hyperammonemia with a complete remission of the subsequent encephalopathy. Topiramate might increase the risk of valproate-induced encephalopathy by carbonic anhydrase inhibition.
Collapse
Affiliation(s)
- Sebastian Weise
- Department of Women and Child Health, University Hospital for Children and Adolescents, Liebigstr. 20a, 04103 Leipzig, Germany
| | - Steffen Syrbe
- Department of Women and Child Health, University Hospital for Children and Adolescents, Liebigstr. 20a, 04103 Leipzig, Germany
| | - Matthias Preuss
- Department of Women and Child Health, University Hospital for Children and Adolescents, Liebigstr. 20a, 04103 Leipzig, Germany ; Department of Neurosurgery, Pediatric Neurosurgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Astrid Bertsche
- Department of Women and Child Health, University Hospital for Children and Adolescents, Liebigstr. 20a, 04103 Leipzig, Germany
| | - Andreas Merkenschlager
- Department of Women and Child Health, University Hospital for Children and Adolescents, Liebigstr. 20a, 04103 Leipzig, Germany
| | - Matthias K Bernhard
- Department of Women and Child Health, University Hospital for Children and Adolescents, Liebigstr. 20a, 04103 Leipzig, Germany
| |
Collapse
|