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Carman KB, Aydın K, Kilic Aydin B, Cansu A, Direk MC, Durmus S, Dündar NO, Gencpinar P, Gungor S, Gurkas E, Hur O, Karadag M, Karademir CN, Ozkan Kart P, Okuyaz C, Oz NA, Peduk Y, Per H, Serin MH, Tekgul H, Unay B, Yarar C, Yildirim GK. Evaluation of micronutrient levels in children with cerebral palsy. Pediatr Int 2022; 64:e15005. [PMID: 34585809 DOI: 10.1111/ped.15005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/08/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many studies evaluating the nutritional status of children with cerebral palsy (CP) have focused on energy requirements and protein intake. The present work aimed to assess nutritional status and micronutrient levels of children with (CP). METHODS This multicenter, cross-sectional and observational study was conducted in 10 different cities in Turkey. Data were available for 398 participants. Anthropometric measurements, feeding mode, nutritional status, and micronutrient levels were evaluated. RESULTS The study was conducted with 398 participants (303 patients and 95 healthy controls). Statistical analysis showed that according to the Gomez Classification, weight-for-age (WFA) revealed malnutrition in 92.6% of children with CP, based on Centers for Disease Control and Prevention percentiles. Measurements of micronutrient levels showed that zinc levels were low in patients, whereas vitamin A levels were low in controls. Phosphorous and manganese levels were significantly lower in malnourished children than in typical children. The results revealed that children consuming enteral nutrition solutions had higher selenium and lower zinc levels than non-consumers. CONCLUSIONS Malnutrition is not only a protein- or calorie-based problem; micronutrient deficiencies might cause severe health problems. Children with chronic neurological disabilities must be carefully evaluated for these issues. Therefore, nutritional interventions should be adapted to nutrition.
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Affiliation(s)
- Kursat Bora Carman
- Departments of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Kursad Aydın
- Department of Pediatric Neurology, Medipol University, Istanbul, Turkey
| | - Betul Kilic Aydin
- Department of Pediatric Neurology, Medipol University, Istanbul, Turkey
| | - Ali Cansu
- Department of Pediatric Neurology, Karadeniz Technical University, Trabzon, Turkey
| | | | - Selver Durmus
- Department of Pediatric Neurology, Erciyes University, Kayseri, Turkey
| | - Nihal Olgaç Dündar
- Department of Pediatric Neurology, Katip Celebi University, Izmir, Turkey
| | - Pinar Gencpinar
- Department of Pediatric Neurology, Katip Celebi University, Izmir, Turkey
| | - Serdal Gungor
- Department of Pediatric Neurology, Inonu University, Malatya, Turkey
| | - Esra Gurkas
- Departments of Pediatric Neurology, Saglik Bilimleri University Gulhane Faculty of Medicine, Ankara, Turkey
| | - Ozgen Hur
- Pediatric Neurology, Saglik Bilimleri University Gulhane Faculty of Medicine, Ankara, Turkey
| | - Meral Karadag
- Department of Pediatric Neurology, Inonu University, Malatya, Turkey
| | - Cefa Nil Karademir
- Departments of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Pinar Ozkan Kart
- Departments of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Cetin Okuyaz
- Department of Pediatric Neurology, Mersin University, Mersin, Turkey
| | - Nefise Arıbas Oz
- Departments of Pediatric Neurology, Saglik Bilimleri University Gulhane Faculty of Medicine, Ankara, Turkey
| | - Yakup Peduk
- Department of Pediatric Neurology, Erciyes University, Kayseri, Turkey
| | - Huseyin Per
- Department of Pediatric Neurology, Erciyes University, Kayseri, Turkey
| | | | - Hasan Tekgul
- Department of Pediatric Neurology, Ege University, Izmir, Turkey
| | - Bulent Unay
- Pediatric Neurology, Saglik Bilimleri University Gulhane Faculty of Medicine, Ankara, Turkey
| | - Coskun Yarar
- Departments of Pediatric Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Gonca Kilic Yildirim
- Pediatric Metabolic Diseases and Nutrition, Eskisehir Osmangazi University, Eskisehir, Turkey
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Ipek R, Bozdogan ST, Kömür M, Okuyaz C. A Novel Mutation Diagnosing in Allan–Herndon–Dudley's Syndrome. J Pediatr Genet 2021. [DOI: 10.1055/s-0041-1740457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractAllan–Herndon–Dudley's syndrome (AHDS) is a rare X-linked recessive disease that causes abnormal serum thyroid function tests, severe hypotonia, intellectual disability, and motor deficit due to a mutation in the monocarboxylate transporter 8, which is a thyroid hormone transporter. A 6-month-old male patient presented to our outpatient clinic with a serious hypotonia complaint. With a preliminary diagnosis of AHDS, a molecular genetic examination was performed. The molecular genetic analysis detected a new previously unidentified variant in the SLC16A2 gene. This case has been presented to report the AHDS, which is a rare cause of hypotonia in patients presenting/consulting with severe hypotonia, global developmental delay, and abnormal thyroid function test results. Besides, a novel pathogenic mutation in the SLC16A2 gene has been described in the present article.
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Affiliation(s)
- Rojan Ipek
- Department of Pediatrics, Division of Neurology, Training and Research Hospital, Adıyaman University, Adıyaman, Turkey
| | - Sevcan Tug Bozdogan
- Department of Medical Genetics, Medical Faculty, Çukurova University, Adana, Turkey
| | - Mustafa Kömür
- Department of Pediatrics, Division of Neurology, Medical Faculty, Mersin University, Mersin, Turkey
| | - Cetin Okuyaz
- Department of Pediatrics, Division of Neurology, Medical Faculty, Mersin University, Mersin, Turkey
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Sarigecili E, Makharoblidze K, Çobanogullari MD, Yildirim DD, Komur M, Okuyaz C. Neurodevelopmental risk evaluation of premature closure of the anterior fontanelle. Childs Nerv Syst 2021; 37:561-566. [PMID: 32737565 DOI: 10.1007/s00381-020-04846-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/28/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate neurological development of completely healthy children with anterior fontanelle premature closure via Denver Developmental Screening Test II and to compare the results with control group. METHOD AND RESULTS The records of 140 patients applied to Mersin University Pediatric Neurology Outpatient Clinic between 2011 and 2019 with the complaint of premature closure of the anterior fontanelle were retrospectively reviewed. Patients with microcephaly, craniosynostosis, infection, sequelae of hypoxia-ischemia, metabolic disorders, intracranial hemorrhage, epilepsy, endocrine problems, and dysmorphic features were excluded from the study. Sixty-six completely healthy children with anterior fontanelle premature closure were included in the study. Denver Developmental Screening Test II was performed by the same developmental specialist to the children with premature closure of the anterior fontanelle as well as to the healthy control group. For each child included in the case and the control group, 90% of the values for each development area were calculated and recorded. Then, the results were compared. Denver II Developmental Screening Test (p < 0.001) and gross motor subtest (p < 0.001) results showed statistically significant retardation in the case group compared with the control group. CONCLUSIONS The study was the first study in the literature on the gross motor development of children with premature closure of anterior fontanelle, and it has been found significantly undeveloped compared with the control group, and it has been concluded that similar patients should be evaluated from this view point in pediatric neurology department.
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Affiliation(s)
- Esra Sarigecili
- Faculty of Medicine, Department of Pediatric Neurology, Mersin University, Mersin, Turkey.
| | - Khatuna Makharoblidze
- Faculty of Medicine, Department of Pediatric Neurology, Mersin University, Mersin, Turkey
| | | | | | - Mustafa Komur
- Faculty of Medicine, Department of Pediatric Neurology, Mersin University, Mersin, Turkey
| | - Cetin Okuyaz
- Faculty of Medicine, Department of Pediatric Neurology, Mersin University, Mersin, Turkey
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Direk M, Epcacan S, Epcacan Z, Yildirim DD, Okuyaz C. Efficacy of levetiracetam in the treatment of Sydenham chorea. Pediatr Int 2020; 62:1264-1268. [PMID: 32445412 DOI: 10.1111/ped.14318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/02/2020] [Accepted: 05/18/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND To study the effect of levetiracetam in treating Sydenham chorea. METHODS We retrospectively collected the data of 140 patients diagnosed with Sydenham chorea in the pediatric neurology and pediatric cardiology outpatient clinics of Van Training and Research Hospital between January 2010 and December 2018. RESULTS There were 140 patients, 102 (70%) of whom were girls, with mean age of onset 11.8 ± 2.7 years. Symptomatic treatment was initiated in all patients at the time of diagnosis; this medication was changed during follow up in 15 patients. The most frequently prescribed drugs were haloperidol and sodium (Na) valproate, and the most frequently discontinued one was haloperidol, due to side effects. The second-choice drug was most often levetiracetam. Clinical response often began within the first 2 weeks, with Na valproate (P = 0.002), within 4 weeks with carbamazepine (P = 0.037) but 1-6 months with haloperidol (P = 0.018) and levetiracetam (P = 0.008). Time to full remission was similar with Na valproate, carbamazepine, haloperidol, and levetiracetam (P = 0.276). Our study indicated that levetiracetam was as effective as the other commonly used drugs in the symptomatic treatment of Sydenham chorea. CONCLUSION Levetiracetam might be an option in the treatment of Sydenham chorea because of its acceptable effect and safety profile. This observation needs further support with evidence obtained through controlled and blinded trials.
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Affiliation(s)
- Meltem Direk
- Division of Pediatric Neurology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Serdar Epcacan
- Department of Pediatrics, Van Training and Research Hospital, University of Health Sciences, Van, Turkey
| | - Zerrin Epcacan
- Division of Pediatric Cardiology, Van Training and Research Hospital, University of Health Sciences, Van, Turkey
| | | | - Cetin Okuyaz
- Division of Pediatric Neurology, Faculty of Medicine, Mersin University, Mersin, Turkey
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Sarigecili E, Direk MC, Komur M, Bozdogan ST, Okuyaz C. Identification of a Novel Mutation in GRIN2A Gene with Global Developmental Delay and Refractory Epilepsy. Ann Indian Acad Neurol 2020; 23:696-699. [PMID: 33623275 PMCID: PMC7887506 DOI: 10.4103/aian.aian_365_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 10/03/2018] [Indexed: 11/04/2022] Open
Abstract
We report a 2.5-year-old Turkish boy who first presented with nystagmus, lack of eye contact, and hypotonia at 2 months of age and developed refractory seizures when 6 months old. Extensive metabolic tests and imaging being noncontributory, whole-exome sequencing was carried out which revealed a heterozygote NM_001134407.2:C.3299A>G (p.Glu1100Gly) novel mutation in GRIN2A gene. Topiramate was started and seizures were rapidly brought under control. GRIN2A mutations may result in altered GluN2A membrane trafficking and response to glutamate. This report illustrates the clinical variability of GRIN2A mutations according to the age of onset of symptoms and suggests considering mutations in this gene in cases of global developmental delay, refractory epilepsy, and nystagmus.
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Affiliation(s)
- Esra Sarigecili
- Department of Pediatric Neurology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | | | - Mustafa Komur
- Department of Pediatric Neurology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Sevcan Tug Bozdogan
- Department of Medical Genetics, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Cetin Okuyaz
- Department of Pediatric Neurology, Faculty of Medicine, Mersin University, Mersin, Turkey
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Sarigecili E, Caglar E, Yildiz A, Okuyaz C. A rare concurrence: gelastic seizures in a patient with right temporal nongalenic pial arteriovenous fistula. Childs Nerv Syst 2019; 35:1055-1058. [PMID: 30783755 DOI: 10.1007/s00381-019-04068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/20/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Gelastic seizures are the type of seizures that are most commonly seen in childhood and should be excluded definitely in the differential diagnosis of hypothalamic hamartomas. This seizure type may be accompanied by refractory seizures, cognitive decline, and early puberty. However, etiology may also include other causes different than hypothalamic hamartomas. The seizure may also arise from temporal and frontal region, in addition to hypothalamus. Different clinical findings may be observed based on origin and areas of spread. CONCLUSIONS In this article, we report a case of gelastic seizure that has been observed by a different cause other than hypothalamic hamartoma which was reported for the first time in the literature.
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Affiliation(s)
- Esra Sarigecili
- Department of Pediatric Neurology, Mersin Üniversitesi Tıp Fakültesi, 33343, Mersin, Turkey.
| | - Ezgi Caglar
- Department of Pediatry, Mersin Üniversitesi Tıp Fakültesi, 33343, Mersin, Turkey
| | - Altan Yildiz
- Department of Interventional Radiology, Mersin Üniversitesi Tıp Fakültesi, 33343, Mersin, Turkey
| | - Cetin Okuyaz
- Department of Pediatric Neurology, Mersin Üniversitesi Tıp Fakültesi, 33343, Mersin, Turkey
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Gurgul S, Buyukakilli B, Komur M, Okuyaz C, Balli E, Ozcan T. Does Levetiracetam Administration Prevent Cardiac Damage in Adulthood Rats Following Neonatal Hypoxia/Ischemia-Induced Brain Injury? ACTA ACUST UNITED AC 2018; 54:medicina54020012. [PMID: 30344243 PMCID: PMC6037241 DOI: 10.3390/medicina54020012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/04/2018] [Accepted: 04/06/2018] [Indexed: 12/12/2022]
Abstract
Cardiovascular abnormalities are widespread when a newborn is exposed to a hypoxic-ischemic injury in the neonatal period. Although the neuroprotective effects of levetiracetam (LEV) have been reported after hypoxia, the cardioprotective effects of LEV have not been documented. Therefore, we aimed to investigate whether levetiracetam (LEV) has a protective effect on cardiac-contractility and ultrastructure of heart muscle in rats exposed to hypoxia-ischemia (HI) during the neonatal period. A total of 49 seven-day-old rat pups were separated into four groups. For HI induction, a combination of right common carotid artery ligation with 8% oxygen in seven-day-old rat pups for 2 h was performed for saline, LEV100, and LEV200 groups. Just after hypoxia, LEV100 and LEV200 groups were administered with 100 mg/kg and 200 mg/kg of LEV, respectively. The arteries of rats in the control group were only detected; no ligation or hypoxia was performed. At the end of the 16th week after HI, cardiac mechanograms were recorded, and samples of tissue were explored by electronmicroscopy.While ventricular contractility in the control group was similar to LEV100, there were significant decreases in both saline and LEV200 groups (p < 0.05). Although ventricular contractile duration of the control and saline groups was found to be similar, durations in the LEV100 and LEV200 groups were significantly higher (p < 0.05). After HI, mitochondrial damage and ultrastructural deteriorative alterations in ventricles and atriums of the LEV-administered groups were significantly less severe than the saline group. The present study showed that neonatal HI caused long-term cardiac dysfunction and ultrastructural deteriorations in cardiac muscles. LEV administration just after HI might possess some protective effects against myocardial damage and contractility.
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Affiliation(s)
- Serkan Gurgul
- Department of Biophysics, Faculty of Medicine, Gaziantep University, TR-27310 Gaziantep, Turkey.
| | - Belgin Buyukakilli
- Department of Biophysics, Faculty of Medicine, Mersin University, TR-33343 Mersin, Turkey.
| | - Mustafa Komur
- Department of Child Health and Disease, Faculty of Medicine, Mersin University, TR-33343 Mersin, Turkey.
| | - Cetin Okuyaz
- Department of Child Health and Disease, Faculty of Medicine, Mersin University, TR-33343 Mersin, Turkey.
| | - Ebru Balli
- Department of Histology and Embryology, Faculty of Medicine, Mersin University, TR-33343 Mersin, Turkey.
| | - Tuba Ozcan
- Department of Histology and Embryology, Faculty of Medicine, K. Sütcü Imam University, TR-46040 Kahramanmaraş, Turkey.
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Direk M, Komur M, Ozgur A, Okuyaz C. A rare cause of refractory epilepsy: Posterior periventricular nodular heterotopia. J Pediatr Neurosci 2018; 13:340-342. [PMID: 30271470 PMCID: PMC6144599 DOI: 10.4103/jpn.jpn_178_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 15-year-old male patient presented to our outpatient clinic with drug-resistant seizures. Magnetic resonance imaging of the brain showed bilateral posterior nodular heterotopia and left cerebellar dysgenesis. The patient was diagnosed with cortical developmental malformation and medically refractory epilepsy. The filamin A gene mutation was negative. Posterior periventricular nodular heterotopia is a rarer and a more different entity from classical periventricular nodular heterotopia with no gender difference and negative filamin A gene mutation. There is a limited number of case studies on posterior periventricular heterotopia. Therefore, this patient was presented to emphasize that epilepsy may be more refractory to treatment, and central congenital abnormalities including posterior fossa abnormalities are more frequent in patients with posterior periventricular nodular heterotopia.
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Celik Y, Resitoglu B, Komur M, Polat A, Arslankoylu AE, Okuyaz C, Erdogan S, Beydagi H. Is levetiracetam neuroprotective in neonatal rats with hypoxic ischemic brain injury? ACTA ACUST UNITED AC 2017; 117:730-733. [PMID: 28127971 DOI: 10.4149/bll_2016_140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to determine if levetiracetam (LEV) is neuroprotective in neonatal rats with hypoxic-ischemic brain injury (HIBI). METHODS The study included 7-d-old male Wistar rats that were randomly divided into the LEV400, LEV800, control, and sham groups. All the rats, except those in the sham group, underwent ligation of the carotid artery and were then kept in a hypoxic chamber containing 8% oxygen for 2 h. At the end of the hypoxic period the rats in the control group were administered saline solution 0.5 mL, the rats in the LEV400 group were administered LEV 400 mg.kg-1, and rats in the LEV800 group were administered LEV 800 mg.kg-1 via the intraperitoneal route. The terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling (TUNEL) method was used to evaluate neuronal apoptosis in the rats. The Morris Water Maze (MWM) test was performed at age 14 weeks in order to evaluate cognitive function. RESULTS The number of apoptotic neurons in the right hemispheres was significantly lower in the sham, LEV400, and LEV800 groups than in the control group (p < 0.001, p < 0.001, and p < 0.001, respectively). In addition, the number of apoptotic neurons in the right hemispheres was significantly lower in the LEV800 group than in the LEV400 group (p = 0.001). Platform finding time (PFT) during MWM testing was significantly shorter in the sham and LEV800 groups on d 4 than on d 1 (p = 0.001 and p = 0.006, respectively); however, PFT did not significantly change between d 1 and d 4 in the control or LEV400 groups (p = 0.91 and p = 0.096, respectively). CONCLUSION Based on the present findings, LEV exhibited a dose-dependent neuroprotective effect in neonatal rats with HIBI (Ref. 27).
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Celik Y, Okuyaz C, Arslankoylu AE, Ceylaner S. Lethal neonatal rigidity and multifocal seizure syndrome with a new mutation in BRAT1. Epilepsy Behav Case Rep 2017; 8:31-32. [PMID: 28752061 PMCID: PMC5516089 DOI: 10.1016/j.ebcr.2017.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 05/17/2017] [Accepted: 05/22/2017] [Indexed: 11/08/2022]
Abstract
Rigidity and Multifocal Seizure Syndrome, Lethal Neonatal (RMFSL) (OMIM# 614498) is a rare and recently characterized epileptic encephalopathy that is related to variants in the BRAT1 gene (Breast Cancer 1-associated ataxia telangiectasia mutated activation-1 protein). In this report, an RMFSL case, who died in the 10th month of the life, with rigidity, drug-resistant myoclonic seizures in the face and extremities, with, significant motor delays is presented. The exon sequence was determined and a new homozygous variant (C.2230_2237dupAACATGC) was detected. This RMFSL case with a homozygous variant in the BRAT1 gene, is the fourth one in the literature and the first one being reported from a Turkish family.
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Affiliation(s)
- Yalcin Celik
- Mersin University School of Medicine, Department of Neonatology, 33343 Mersin, Turkey
| | - Cetin Okuyaz
- Mersin University School of Medicine, Department of Pediatric Neurology, 33343 Mersin, Turkey
| | - Ali Ertug Arslankoylu
- Mersin University School of Medicine, Department of Pediatric Intensive Care, 33343 Mersin, Turkey
| | - Serdar Ceylaner
- Intergen Genetic Diagnosis Center, Iran Caddesi, No:13/25, Cankaya, Ankara, Turkey
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Ekinci O, Direk MÇ, Ekinci N, Okuyaz C. Manic Symptoms Due to Methylphenidate Use in an Adolescent with Traumatic Brain Injury. Clin Psychopharmacol Neurosci 2016; 14:314-7. [PMID: 27489389 PMCID: PMC4977809 DOI: 10.9758/cpn.2016.14.3.314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/03/2015] [Accepted: 12/07/2015] [Indexed: 11/18/2022]
Abstract
Almost one-fifth of children who sustain a traumatic brain injury (TBI) are under the risk of attention problems after injury. The efficacy and tolerability of methylphenidate (MPH) in children with a history of TBI have not been completely identified. In this case report, MPH-induced manic symptoms in an adolescent with TBI will be summarized. A male patient aged 17 years was admitted with the complaints of attention difficulties on schoolwork and forgetfullness which became evident after TBI. Long-acting MPH was administered with the dose of 18 mg/day for attention problems. After one week, patient presented with the complaints of talking to himself, delusional thoughts, irritability and sleeplessness. This case highlights the fact that therapeutic dose of MPH may cause mania-like symptoms in children with TBI. Close monitarization and slow dose titration are crucial when considering MPH in children with TBI.
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Affiliation(s)
- Ozalp Ekinci
- Department of Child and Adolescent Psychiatry, Mersin University Medical Faculty, Mersin, Turkey
| | | | - Nuran Ekinci
- Department of Child and Adolescent Psychiatry, Mersin University Medical Faculty, Mersin, Turkey
| | - Cetin Okuyaz
- Department of Pediatric Neurology, Mersin University Medical Faculty, Mersin, Turkey
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Celik Y, Atıcı A, Gulası S, Okuyaz C, Makharoblıdze K, Sungur MA. Comparison of selective head cooling versus whole-body cooling. Pediatr Int 2016; 58:27-33. [PMID: 26189647 DOI: 10.1111/ped.12747] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 05/11/2015] [Accepted: 06/09/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND This study compared selective head cooling (SHC) and whole-body cooling (WBC) in newborns with hypoxic-ischemic encephalopathy (HIE). METHODS We conducted a prospective randomized small-scale pilot study in newborns with HIE, born after >35 weeks of gestation. The patients were randomly assigned to receive SHC or WBC. RESULTS The SHC group consisted of 17 patients, and the WBC group, 12 patients. There was no significant difference in adverse effects related to cooling therapy between the two groups. During the 12 month study period, seven patients in the SHC group and four in the WBC group died, but the difference was not significant (P = 0.667). Among the patients alive at 12 months after treatment, six in the SHC group and four in the WBC group had severe disabilities; the difference was not significant (P = 0.671). When the composite outcome of death or severe disability was evaluated, the difference between the SHC group (77%, n = 13) and the WBC group (67%, n = 8) was not significant (P = 0.562). Moreover, the number of survivors without disability at 12 months after treatment did not differ significantly between the SHC group (n = 3) and the WBC group (n = 4; P = 0.614). CONCLUSIONS There were no significant differences in adverse effects, 12 month neuromotor development, or mortality rate between SHC and WBC in newborns with HIE, born after >35 weeks of gestation.
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Affiliation(s)
- Yalcın Celik
- Division of Neonatology, Department of Pediatrics, School of Medicine, Mersin University, Mersin, Turkey
| | - Aytug Atıcı
- Division of Neonatology, Department of Pediatrics, School of Medicine, Mersin University, Mersin, Turkey
| | - Selvi Gulası
- Division of Neonatology, Department of Pediatrics, School of Medicine, Mersin University, Mersin, Turkey
| | - Cetin Okuyaz
- Department of Pediatric Neurology, School of Medicine, Mersin University, Mersin, Turkey
| | - Khatuna Makharoblıdze
- Department of Pediatric Neurology, School of Medicine, Mersin University, Mersin, Turkey
| | - Mehmet Ali Sungur
- Department of Biostatistics, School of Medicine, Mersin University, Mersin, Turkey
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Bozlu G, Cobanogullari Direk M, Okuyaz C. Subacute sclerosing panencephalitis with parkinsonian features in a child: A case report. Brain Dev 2015; 37:901-3. [PMID: 25736973 DOI: 10.1016/j.braindev.2015.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 02/13/2015] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Subacute sclerosing panencephalitis (SSPE) can present with atypical clinical signs which may result in delayed diagnosis and treatment. We present a child with SSPE whose initial manifestation was parkinsonism. PATIENT This 12-year-old boy presented with the complaint of difficulty in standing up and walking for 2 months. Neurological examination revealed generalized rigidity, bradykinesia, impaired postural reflexes, and a mask-like facies. The initial diagnosis of Juvenile Parkinson Disease was made. He had no improvement with levodopa, trihexyphenidyl, tetrabenazine and clonazepam. The EEG showed irregular background activity with generalized slow waves which were not suppressed with diazepam injection. SSPE was considered and the diagnosis was confirmed with the identification of measles antibodies in cerebrospinal fluid. CONCLUSION SSPE should be considered in children and adolescents with parkinsonian symptoms, particularly in the absence of a history of vaccination against measles.
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Affiliation(s)
- Gulcin Bozlu
- Department of Pediatrics, University of Mersin, Faculty of Medicine, Mersin, Turkey; Division of Pediatric Neurology, University of Mersin, Faculty of Medicine, Mersin, Turkey.
| | - Meltem Cobanogullari Direk
- Department of Pediatrics, University of Mersin, Faculty of Medicine, Mersin, Turkey; Division of Pediatric Neurology, University of Mersin, Faculty of Medicine, Mersin, Turkey
| | - Cetin Okuyaz
- Department of Pediatrics, University of Mersin, Faculty of Medicine, Mersin, Turkey; Division of Pediatric Neurology, University of Mersin, Faculty of Medicine, Mersin, Turkey
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Hallioglu O, Gurer G, Bozlu G, Karpuz D, Makharoblidze K, Okuyaz C. Evaluation of Neurodevelopment Using Bayley-III in Children with Cyanotic or Hemodynamically Impaired Congenital Heart Disease. CONGENIT HEART DIS 2015; 10:537-41. [DOI: 10.1111/chd.12269] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Olgu Hallioglu
- Department of Pediatrics; University of Mersin Faculty of Medicine; Mersin Turkey
- Division of Pediatric Cardiology; University of Mersin Faculty of Medicine; Mersin Turkey
| | - Guliz Gurer
- Department of Pediatrics; University of Mersin Faculty of Medicine; Mersin Turkey
| | - Gulcin Bozlu
- Department of Pediatrics; University of Mersin Faculty of Medicine; Mersin Turkey
| | - Derya Karpuz
- Department of Pediatrics; University of Mersin Faculty of Medicine; Mersin Turkey
- Division of Pediatric Cardiology; University of Mersin Faculty of Medicine; Mersin Turkey
| | | | - Cetin Okuyaz
- Department of Pediatrics; University of Mersin Faculty of Medicine; Mersin Turkey
- Division of Pediatric Neurology; University of Mersin Faculty of Medicine; Mersin Turkey
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15
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Abstract
Moyamoya syndrome is a chronic, progressive occlusion of cerebrovascular arteries that leads to the development of characteristic collateral vessels. It is usually accompanied with sickle cell disease and other hemoglobinopathies. We report a 7-year-old boy, who admitted to our clinic with headache, diagnosed as moyamoya syndrome associated with sickle cell trait. To date, two such cases have been reported in the literature. As far as we know, this patient is the first child reported.
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Affiliation(s)
- Mustafa Komur
- Mersin University School of Medicine, Department of Pediatric Neurology, Turkey.
| | - Selma Unal
- Mersin University School of Medicine, Department of Pediatric Hematology, Turkey
| | - Cetin Okuyaz
- Mersin University School of Medicine, Department of Pediatric Neurology, Turkey
| | - Anil Ozgur
- Mersin University School of Medicine, Department of Radiology, Turkey
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16
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Komur M, Okuyaz C, Makharoblidze K. Consistency between referral diagnosis and post-ENMG diagnosis in children. J PAK MED ASSOC 2014; 64:179-183. [PMID: 24640809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the degree of consistency between the referral diagnosis and that based on electroneuromyography. METHODS The retrospective study was conducted at the Paediatric Neurology Laboratory of Mersin University School of Medicine, Turkey, and comprised all electroneuromyographies carried out between January 2005 and December 2010. Demographic data, referral diagnosis and post-procedure diagnosis were recorded for each patient, and were classified into groups. Consistency between the two groups was compared using SPSS 13. RESULTS Of the total 294 patients, polyneuropathy was the reason for referral in 104 (35.4%), peripheral nerve injury in 54 (18.4%), brachial plexus injury in 52 (17.7%), myopathy in 52 (17.7%), hypotonia in 23 (7.8%), and facial paralysis in 9 (3.0%) patients. There was consistency between the two diagnoses in 179 (60.9%) patients. CONCLUSION Electroneuromyography is an uneasy, painful and stressfull procedure for children, and, therefore, it should be recommended only in cases where the result may be beneficial in the diagnosis treatment and follow-up of a patient.
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Gündoğdu G, Kömür M, Avlan D, Sarı FB, Delibaş A, Taşdelen B, Naycı A, Okuyaz C. Relationship of bladder dysfunction with upper urinary tract deterioration in cerebral palsy. J Pediatr Urol 2013; 9:659-64. [PMID: 22921013 DOI: 10.1016/j.jpurol.2012.07.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 07/23/2012] [Indexed: 10/28/2022]
Abstract
Although lower urinary tract dysfunction (LUTD) in patients with cerebral palsy (CP) has been previously documented by clinical observations and urodynamic tests, its correlation with upper urinary tract deterioration (UUTD) has not been demonstrated. This paper documents symptoms and urodynamic findings of LUTD and their relationship with UUTD in 33 children with CP. By sonography, 4 of these children were found to have UUTD. Age was found to correlate with UUTD, but gender difference and mental or motor functions did not. When comparing urinary symptoms with UUTD, incontinence (n = 31) did not correlate, but on the other hand symptoms of detrusor sphincter dyssynergia (interrupted voiding, urinary retention, hesitancy; n = 5) and culture proven febrile urinary tract infections (n = 4) did. Abnormal urodynamics findings were not diagnostic. We conclude that, apart from incontinence, dysfunctional voiding symptoms and febrile urinary tract infections are valuable indicators of UUTD.
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Affiliation(s)
- Gökhan Gündoğdu
- Pediatric Surgery, Bezmialem Vakif University, Medical Faculty, Department of Pediatric Surgery, Division of Pediatric Urology, Istanbul 34093, Turkey.
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18
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Komur M, Ozen S, Okuyaz C, Makharoblıdze K, Erdogan S. Neurodevelopment evaluation in children with congenital hypothyroidism by Bayley-III. Brain Dev 2013; 35:392-7. [PMID: 22858380 DOI: 10.1016/j.braindev.2012.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 06/01/2012] [Accepted: 07/05/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Congenital hypothyroidism is the most common reason of mental retardation, and normal neurological development can be provided by early and effective treatment. In this present study, it is aimed to compare neurological developments of patients in 6-42 months of age with congenital hypothyroidism and healthy controls of the same age group prospectively by Bayley III test. METHODS In this present study, neurological developments of 41 congenital hypothyroidism cases and 39 healthy controls, who applied to Pediatric Endocrinology Section of Mersin Children Hospital and Pediatric Neurology Outpatient Clinic of the Medical School at Mersin University between years 2009 and 2011, were evaluated by Bayley III test. RESULTS Cognitive, language and global motor scores in addition to receptive communication, expressive communication, fine motor and gross motor subscores in children with congenital hypothyroidism were statistically significantly lower than those in the control group (p<0.05). It is detected that initiation dose and day of treatments, severity of hypothyroidism and time to normalization thyroid stimulating hormone had no statistically significant effects on neurological development of the study group (p>0.05). In both groups, as the education levels of mothers are increased, language development scores are also increased (p<0.05). Additionally, statistically significant increases in Bayley III scores except cognitive scores have been observed in both groups as the level of income is increased (p<0.05). CONCLUSIONS Despite early and effective treatment in newborns with congenital hypothyroidism, retardation in neurological developmental has been detected. This situation can be related to influences on neurodevelopment in intrauterine period. According to our present knowledge, this study is the first case-control study in the literature that neurological developments of congenital hypothyroidism patients are evaluated with Bayley-III score.
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Affiliation(s)
- Mustafa Komur
- Department of Pediatric Neurology, Mersin University School of Medicine, Mersin, Turkey.
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19
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Komur M, Ozen S, Okuyaz C, Makharoblıdze K, Erdogan S. Neurodevelopment evaluation in children with congenital hypothyroidism by Bayley-III. Brain Dev 2013; 35:392-397. [PMID: 22858380 DOI: 10.1016/j.braindev.2012.07003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 06/01/2012] [Accepted: 07/05/2012] [Indexed: 05/24/2023]
Abstract
BACKGROUND Congenital hypothyroidism is the most common reason of mental retardation, and normal neurological development can be provided by early and effective treatment. In this present study, it is aimed to compare neurological developments of patients in 6-42 months of age with congenital hypothyroidism and healthy controls of the same age group prospectively by Bayley III test. METHODS In this present study, neurological developments of 41 congenital hypothyroidism cases and 39 healthy controls, who applied to Pediatric Endocrinology Section of Mersin Children Hospital and Pediatric Neurology Outpatient Clinic of the Medical School at Mersin University between years 2009 and 2011, were evaluated by Bayley III test. RESULTS Cognitive, language and global motor scores in addition to receptive communication, expressive communication, fine motor and gross motor subscores in children with congenital hypothyroidism were statistically significantly lower than those in the control group (p<0.05). It is detected that initiation dose and day of treatments, severity of hypothyroidism and time to normalization thyroid stimulating hormone had no statistically significant effects on neurological development of the study group (p>0.05). In both groups, as the education levels of mothers are increased, language development scores are also increased (p<0.05). Additionally, statistically significant increases in Bayley III scores except cognitive scores have been observed in both groups as the level of income is increased (p<0.05). CONCLUSIONS Despite early and effective treatment in newborns with congenital hypothyroidism, retardation in neurological developmental has been detected. This situation can be related to influences on neurodevelopment in intrauterine period. According to our present knowledge, this study is the first case-control study in the literature that neurological developments of congenital hypothyroidism patients are evaluated with Bayley-III score.
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Affiliation(s)
- Mustafa Komur
- Department of Pediatric Neurology, Mersin University School of Medicine, Mersin, Turkey.
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20
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Komur M, Arslankoylu A, Okuyaz C. Authors′ reply. J Anaesthesiol Clin Pharmacol 2013. [DOI: 10.4103/0970-9185.111733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Our study sought to identify early predictive factors of medically intractable childhood epilepsy. A cohort of epileptic children from the city of Mersin was retrospectively investigated. All patients received care from the same Department of Pediatric Neurology. The epileptic cohort was divided into a drug-responsive epilepsy group and an intractable epilepsy group. Intractable epilepsy is defined as continued seizures in children despite adequate therapy with two or more antiepileptic drugs for more than 18 months. Strong univariate association was observed between intractability and several factors: age of onset, high initial seizure frequency, symptomatic etiology, mixed seizure types, previous history of status epilepticus, febrile and neonatal seizures, mental and motor developmental delay, multiple seizures in 1 day, electroencephalogram abnormalities, magnetic resonance imaging findings, and specific epileptic syndromes. Logistic regression analysis revealed that a previous history of epilepticus status, abnormal electroencephalogram results, and multiple seizures in 1 day comprise independent predictors of medically intractable childhood epilepsy. We suggest that medical intractability in childhood epilepsy can be predicted by monitoring these factors. Along with early prediction, alternative therapies may be designed to provide patients better seizure control and quality of life.
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Okuyaz C, Kursel O, Komur M, Tamer L. Evaluation of appetite-stimulating hormones in prepubertal children with epilepsy during topiramate treatment. Pediatr Neurol 2012; 47:423-6. [PMID: 23127262 DOI: 10.1016/j.pediatrneurol.2012.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 08/01/2012] [Indexed: 10/27/2022]
Abstract
We investigated the mechanism of topiramate-related appetite loss and exposed its relationship to body weight, body mass index, body fat index, and serum insulin, lipid, leptin, neuropeptide-Y, cortisol, ghrelin, and adiponectin levels. Twenty children with epilepsy were evaluated at baseline and months 3 and 6 of treatment. Their body fat index, leptin, and neuropeptide-Y levels significantly decreased at month 3, whereas significant decreases occurred in body weight, body mass index, body fat index, neuropeptide-Y, cholesterol, and cortisol levels of patients at month 6 compared with baseline. Weight loss during topiramate treatment was attributed to loss of appetite and reduced food intake caused by reductions in neuropeptide-Y. To the best of our knowledge, this study is the first to describe reductions in neuropeptide-Y with topiramate use in humans.
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Affiliation(s)
- Cetin Okuyaz
- Division of Pediatric Neurology, Department of Pediatrics, Mersin University School of Medicine, Mersin, Turkey
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23
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Komur M, Delibas A, Arslankoylu AE, Okuyaz C, Kara E. Recurrent and atypical posterior reversible encephalopathy syndrome in a child with hypertension. Ann Indian Acad Neurol 2012; 15:208-10. [PMID: 22919196 PMCID: PMC3424801 DOI: 10.4103/0972-2327.99721] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 12/04/2011] [Accepted: 12/30/2011] [Indexed: 11/05/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiologic entity with typical symptoms including headache, seizures, visual disturbance, altered mental status, vomiting, nausea and focal neurologic signs. In this article, we report recurrent and atypical PRES in a child with hypertension due to end-stage renal disease (ESRD) who was on a peritoneal dialysis program for 6 months. After the second hypertension attack, PRES findings did not recover and persisted as encephalomalacia. As far as we know, this case is the first child with ESRD who developed encephalomalacia after recurrent episodes of PRES. When a patient with a history of PRES presented with new clinical and neuroradiological findings, recurrent PRES should be considered.
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Affiliation(s)
- Mustafa Komur
- Department of Pediatric Neurology, Mersin University School of Medicine, Mersin, Turkey
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24
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Abstract
Midazolam can induce acute dystonia in childhood. We report the development of acute dystonia in a 6-year-old girl after receiving midazolam as a sedative. Dystonic contractions persisted despite flumazenil and biperiden lactate injections and the patient was treated with diazepam. Acute dystonia was rapidly abolished after the administration of diazepam intravenously. Diazepam may be an effective treatment option in patients who are unresponsive to flumazenil.
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Affiliation(s)
- Mustafa Komur
- Department of Pediatric Neurology, Mersin University School of Medicine, Mersin, Turkey
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25
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Komur M, Arslankoylu AE, Okuyaz C, Keceli M, Derici D. Management of patients with status epilepticus treated at a pediatric intensive care unit in Turkey. Pediatr Neurol 2012; 46:382-6. [PMID: 22633634 DOI: 10.1016/j.pediatrneurol.2012.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 03/20/2012] [Indexed: 10/28/2022]
Abstract
We investigated the etiology, treatment, and prognosis of patients treated for status epilepticus at a pediatric intensive care unit. Medical records of 89 patients admitted to a pediatric intensive care unit with status epilepticus were reviewed retrospectively. Patients ranged in age from 2 months to 18 years (mean age ± S.D., 4.7 ± 3.8 years). Seizure etiologies comprised remote symptomatic in 47 (52.7%), febrile in 15 (16.9%), acute symptomatic in 12 (13.5%), and unknown in 15 (16.9%). Seizure durations ranged from 30-60 minutes in 58 patients, whereas 31 manifested refractory seizures longer than 60 minutes. Seizure control was achieved within 30 minutes in 55 patients, from 30-60 minutes in 19, and after 60 minutes in 15. Rectal diazepam was administered to 38 (42.7%) patients before admission to the hospital. Length of intensive care unit stay increased with increasing seizure duration (P < 0.05). The total mortality rate was 3.4%. This lower mortality rate may be considered evidence of the effectiveness and reliability of the status epilepticus treatment protocol in our pediatric intensive care unit. Prehospital rectal diazepam administration and the treatment of brain edema in the intensive care unit may be useful in the management of patients with status epilepticus.
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Affiliation(s)
- Mustafa Komur
- Division of Pediatric Neurology, Department of Pediatrics, School of Medicine, Mersin University, Mersin, Turkey
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26
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Abstract
Idiopathic intracranial hypertension is a headache syndrome characterized by elevated intracranial pressure with normal cerebrospinal fluid content, normal cranial imaging, and elevated appearance of the optic disc. We report on a 6.5-year-old boy with complaints of headache and right esotropia causing diplopia. A lumbar puncture indicated an opening cerebrospinal fluid pressure of 28 cm H(2)O. The headache, diplopia, and esodeviation resolved after the lumbar puncture. However, at 2-week follow-up, the elevated appearance of the optic disc continued despite normal cerebrospinal fluid pressure. A second ophthalmologic consultation revealed optic disc drusen, as also demonstrated by ocular ultrasonography. To date, two such cases have been reported in the literature. To our knowledge, this patient is the youngest with coexisting optic disc drusen and idiopathic intracranial hypertension.
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Affiliation(s)
- Mustafa Komur
- Department of Pediatric Neurology, School of Medicine, Mersin University, Mersin, Turkey.
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Abstract
We report a 14-year-old boy who presented with loss of consciousness and gait instability. The electroencephalogram (EEG) showed generalized slowing with irregular activity and cerebral magnetic imaging revealed asymmetrical nonspecific signals on basal ganglia. His second electroencephalogram revealed periodical generalized high-voltage slow wave complexes which did not disappear with diazepam induction. Subacute sclerosing panencephalitis (SSPE) was considered and the diagnosis was confirmed with the identification of measles antibodies in cerebrospinal fluid. Our findings show that SSPE should be in mind in the differential diagnosis of meningoencephalitis and acute disseminated encephalomyelitis and highlight the significance of EEG in the diagnosis of unidentified cases.
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Affiliation(s)
- Mustafa Komur
- Department of Pediatric Neurology, Mersin University School of Medicine, Mersin, Turkey,Address for correspondence: Dr. Mustafa Komur, Department of Pediatric Neurology, Mersin University School of Medicine, Zeytinlibahce, Mersin 33060, Turkey. E-mail:
| | - Ali E Arslankoylu
- Department of Pediatric Intensive Care, Mersin University School of Medicine, Mersin, Turkey
| | - Cetin Okuyaz
- Department of Pediatric Neurology, Mersin University School of Medicine, Mersin, Turkey
| | - Necdet Kuyucu
- Department of Pediatric Infection, Mersin University School of Medicine, Mersin, Turkey
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Komur M, Okuyaz C, Arslankoylu AE, Kara E, Atici A. Acute necrotizing encephalopathy associated with novel influenza A (H1N1) virus in Turkey. J PAK MED ASSOC 2011; 61:1237-1239. [PMID: 22355976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Influenza-associated acute necrotizing encephalopathy has been well recognized but not yet been reported with novel influenza A in Turkey. We report a 6-year-old boy infected with novel influenza A who displayed the typically characteristic clinical features and neuroimaging findings of acute necrotizing encephalopathy. Physicians who care for children should be aware of acute necrotizing encephalopathy in any child presenting with acute mental status changes during influenza infection. We would like to remind of this entity, because early diagnosis and treatment may reduce mortality and morbidity.
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Affiliation(s)
- Mustafa Komur
- Department of Pediatric Neurology, Mersin University School of Medicine, Mersin, Turkey
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Komur M, Okuyaz C, Ezgu F, Atici A. A girl with spastic tetraparesis associated with biotinidase deficiency. Eur J Paediatr Neurol 2011; 15:551-3. [PMID: 21571559 DOI: 10.1016/j.ejpn.2011.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 02/22/2011] [Accepted: 04/17/2011] [Indexed: 10/18/2022]
Abstract
Biotinidase deficiency is a disorder of biotin metabolism that manifests with cutaneous, ophthalmological and neurologyical symptoms in childhood. Spinal cord involvement has rarely been reported and all of the reported cases are spastic paraparesis. A 3 year-old girl with biotinidase deficiency was admitted to our clinic with hyperventilation, hair loss and spastic tetraparesis. To our knowledge, our case is the first reported tetraparesis associated with biotinidase deficiency. She was treated with oral biotin and benefited significantly from this therapy.
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Affiliation(s)
- Mustafa Komur
- Department of Pediatric Neurology, Mersin University School of Medicine, Mersin, Turkey
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Arslankoylu AE, Kutuk MO, Okuyaz C, Toros F. Neuroleptic malignant syndrome due to risperidone misdiagnosed as status epilepticus. Pediatr Rep 2011; 3:e19. [PMID: 22053263 PMCID: PMC3207307 DOI: 10.4081/pr.2011.e19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 06/21/2011] [Indexed: 11/23/2022] Open
Abstract
Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal disease characterized by fever, muscle rigidity, delirium and autonomic instability. Here we report a child, with NMS due to the risperidone misdiagnosed as status epilepticus. Nine year old boy, who had been under high dose risperidone treatment for 8 weeks, admitted to the emergency room because of the contractions (evaluated as status epilepticus) persisting for 7 hours. Since there was neuroleptic treatment in the past medical history and, unconsciousness, muscular rigidity, diaphoresis, hypertermi and, hypotension in physical examination, leucocytosis and elevated creatininphosphokinase levels in laboratory tests, the patient was evaluated as NMS and discharged without any complications. We reported this case to point out that; NMS may be misdiagnosed as status epilepticus in children when EEG monitoring is unavailable. When a child admitted to the emergency room because of suspicious convulsion neuroleptic drug use must surely be asked.
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Affiliation(s)
- Ali Ertug Arslankoylu
- Mersin University Faculty of Medicine, Department of Pediatrics, Pediatric Intensive Care Unit, Mersin, Turkey
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Abstract
BACKGROUND Children with congenital heart disease are under risk of delayed growth and development. We evaluated physical growth parameters and neurodevelopment in these patients in comparison with normal children and examined the effect of hemodynamic status. METHODS Patients with congenital heart disease (n= 76) and healthy children (n= 51) aged 1-72 months applied to Mersin University Hospital, Mersin, Turkey were included. Patients with heart failure and those requiring intervention or surgery were classified as hemodynamically impaired (HI group, n= 30), and the others, hemodynamically normal (HN group, n= 46). Growth parameters including weight, height, body mass index (BMI), mid-arm circumference (MAC), and triceps skin fold thickness (TSF) were measured and standard deviations (SD) were determined. Functional development was assessed by Denver Developmental Screening Test-II (DDST II). RESULTS MAC and BMI values of the group with impaired hemodynamic status were significantly lower than the hemodynamically normal and control groups (MAC P < 0.05 and BMI P < 0.01). In the DDST II, the group with hemodynamic abnormality had more failures in gross motor and fine motor skills than HN group and controls (gross motor P= 0.011, P < 0.001 and fine motor P= 0.028, P= 0.001, respectively) and more failures in language development than the control group (P= 0.001). CONCLUSION The results showed the importance of hemodynamic status in growth and neurodevelopment of children with congenital heart disease. Besides routine growth parameters, more detailed examinations such as BMI, MAC, TSF, and developmental screening tests appear useful in identifying children with cardiac disease who are under risk for delayed growth and development.
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Affiliation(s)
- Selda Polat
- Department of Pediatrics, Mersin University Faculty of Medicine, Mersin, Turkey.
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Turhan AH, Atici A, Okuyaz C, Uysal S. Single enteral loading dose of phenobarbital for achieving its therapeutic serum levels in neonates. Croat Med J 2010; 51:215-8. [PMID: 20564764 DOI: 10.3325/cmj.2010.51.215] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To investigate whether therapeutic serum drug levels may be achieved with a single enteral loading dose of phenobarbital. METHODS The study was performed at the Mersin University Hospital in Turkey between April 2004 and August 2006, and included 29 newborn babies with seizure. After the acute treatment of the seizure with midazolam at a dose of 0.1 mg/kg, phenobarbital was administered by orogastric route at a loading dose of 20 mg/kg. Serum phenobarbital concentrations were measured at 0.5, 3, 6, and 12 hours after the loading. Serum phenobarbital levels between 10-30 microg/mL were considered as the therapeutic range. RESULTS The serum phenobarbital levels reached therapeutic values in 9 (31%), 19 (66%), 21 (72%), and 23 (79%) patients at 0.5, 3, 6, and 12 hours after loading, respectively, while they did not reach therapeutic values in 6 patients (21%) after 12 hours. Four of the patients in whom there was no increase in serum phenobarbital levels had hypoxic-ischemic encephalopathy. CONCLUSION Enteral loading of phenobarbital can achieve therapeutic serum levels in the large majority of newborn babies with seizure and may be safely used in babies with the intact gastrointestinal tract.
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Affiliation(s)
- Ali H Turhan
- Hospital of Mersin University School of Medicine, Department of Pediatrics, 33079 Mersin, Turkey.
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Serdaroğlu A, Gücüyener K, Dursun I, Aydin K, Okuyaz C, Subaşi M, Or M, Ozkan B. Macular Retinitis as a First Sign of Subacute Sclerosing Panencephalitis: The Importance of Early Diagnosis. Ocul Immunol Inflamm 2009; 13:405-10. [PMID: 16419428 DOI: 10.1080/09273940490912335] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Subacute sclerosing panencephalitis (SSPE) is a subacute inflammatory and neurodegenerative encephalitis related to the measles (rubeola) virus and usually affecting children and young adults. The overwhelming majority of cases follow a progressive downhill course leading to death, although there have been a few case reports of patients who have apparently gone into remission. Ocular changes occur in up to 50% of SSPE cases. Visual complaints, if present, generally antedate the onset of neurological symptoms by a few weeks or months. Here, we report two cases of SSPE presenting with ocular findings and their prognoses. METHODS Case reports. In the first case, a 17-year-old male presenting with macular retinitis, the macular findings were mistaken for a heredodegenerative disorder and diagnosis was postponed until neurological findings took place. He died six months after the appearance of his first ophthalmic symptoms despite intravenous immune globulin and isoprinosine therapy. The second case was a 14-year-old male, who presented with only ophthalmological complaints. His diagnosis was based on both ophthalmological findings and high doses of measles IgG in the cerebrospinal fluid (CSF); isoprinosine and intramuscular beta-interferon therapy was started before the onset of neurological findings and in the follow-up time of about 18 months, neurological findings consistent with SSPE did not develop. RESULTS The characteristic finding of macular retinitis in SSPE patients is rapid recovery in about one month without therapy. After improvement, neurological findings take place. Once suspected, the diagnosis of SSPE is easily established by the demonstration of high levels of measles antibody in the serum and CSF. Early diagnosis can be made with typical ocular findings and high IgG titers for rubeola in CSF. CONCLUSION We suppose that ophthalmic manifestations, especially macular retinitis, may be useful in the diagnosis and management of SSPE cases with elevated IgG titers for rubeola in CSF. The typical clinical findings must be familiar to every ophthalmologist so that diagnostic pitfalls can be prevented and early therapy started. It may be discussed if early diagnosis and therapy will be possible before neurological signs appear, the prognosis of this relentless disease may show a more favorable course.
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Affiliation(s)
- A Serdaroğlu
- Department of Pediatrics, Faculty of Medicine, Gazi University, Ankara, Turkey
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Abstract
Ataxia-telangiectasia (A-T) is an autosomal recessive condition presented by progressive cerebellar ataxia, oculocutaneous telangiectasia, humoral and cellular immunodeficiencies and a predisposition to malignancy. We report on a 13 years old male patient with the diagnosis of A-T associated with uncommon clinical features; optic disc drusen and vitiligo. To our knowledge, this is the first report of A-T associated with these findings.
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Affiliation(s)
- Ayça Sari
- Department of Ophthalmology, Mersin University Medical School, Mersin, Turkey.
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Abstract
An 8-month-old girl was admitted to an outpatient clinic with significant hypotonia and weakness. Organic acid analysis in urine revealed a significant increase in ethylmalonic acid. A deoxyribonucleic analysis revealed the presence of a 625G>A (G-to-A substitution at nucleotide 625) variant short-chain acyl-coenzyme A dehydrogenase gene polymorphism. With the clinical, biochemical and molecular findings, short-chain acyl-coenzyme A dehydrogenase deficiency was suspected. Because 625G>A and 511C>T (C-to-T substitution at nucleotide 511) genetic variations are also present in 14% of the general population, these are considered to be genetic sensitivity variations rather than causing a disease themselves and to result in possible short-chain acyl-coenzyme A dehydrogenase deficiency in the presence of environmental factors such as fever and hunger as well as cellular, biochemical, and other genetic factors. It was stressed that severe infantile hypotonia could also be the only manifestation of ethylmalonic aciduria spectrum disorders.
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Affiliation(s)
- Cetin Okuyaz
- Department of Pediatrics, Division of the Pediatric Neurology, Mersin University Medical Faculty, Mersin, Turkey.
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Atici A, Bozlu G, Turhan AH, Polat A, Nayci A, Okuyaz C, Taskinlar H. The role of trapidil on neuronal apoptosis in neonatal rat model of hypoxic ischemic brain injury. Early Hum Dev 2008; 84:243-7. [PMID: 17693042 DOI: 10.1016/j.earlhumdev.2007.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Revised: 06/18/2007] [Accepted: 06/26/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hypoxic ischemic brain injury (HIBI) is a common cause of neonatal mortality and morbidity. Trapidil is an antiplatelet agent and several studies demonstrate the beneficial effect of trapidil in various forms of tissue injury. The effects of trapidil on neuronal apoptosis in HIBI have not been reported previously. AIMS The aim of this study is to evaluate the effect of trapidil on neuronal apoptosis in neonatal rat model of HIBI. STUDY DESIGN Seven-day-old Wistar rat pups were subjected to right common carotid artery ligation and hypoxia (92% nitrogen and 8% oxygen) for 2h. They were treated with trapidil or saline either immediately before or after hypoxia. In sham group animals, neither ligation, nor hypoxia were performed. Neuronal apoptosis was evaluated by the terminal deoxynucleotidyltransferase-mediated dUTP nick-end labeling (TUNEL) and caspase-3 staining methods. RESULTS Trapidil treatment either before or after hypoxia results in significant reduction of the numbers of apoptotic cells in both hemispheres, when it is compared with saline treatment group. The numbers of apoptotic cells in right hemispheres in all groups are significantly higher than that in the left hemispheres. CONCLUSIONS These results show that trapidil administration either before or after hypoxia reduces neuronal apoptosis and we propose that trapidil may be a novel approach for the therapy of HIBI.
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Affiliation(s)
- Aytug Atici
- Department of Pediatrics, Division of Neonatology, University of Mersin School of Medicine, Mersin, Turkey.
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Hallioglu O, Okuyaz C, Mert E, Makharoblidze K. Effects of antiepileptic drug therapy on heart rate variability in children with epilepsy. Epilepsy Res 2008; 79:49-54. [DOI: 10.1016/j.eplepsyres.2007.12.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 08/30/2007] [Accepted: 12/29/2007] [Indexed: 11/25/2022]
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Olmez A, Yilmaz D, Tan H, Duman O, Güngör S, Okuyaz C, Anlar B. Cerebrospinal fluid pressures in subacute sclerosing panencephalitis. Brain Dev 2007; 29:409-12. [PMID: 17258414 DOI: 10.1016/j.braindev.2006.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Revised: 11/26/2006] [Accepted: 11/28/2006] [Indexed: 10/23/2022]
Abstract
Increased intracranial pressure can rarely be the initial symptom in subacute sclerosing panencephalitis (SSPE). We examined cerebrospinal fluid (CSF) pressures and their correlation with clinical features in 58 patients with SSPE. CSF pressure varied between 50 and 500 mmH2O, mean 210.9+/-103.7 mmH2O. Twenty-five (42%) patients had pressures above 200 mmH2O and 15/58 (25%), above 250 mmH2O. There was no correlation between CSF pressure and neurological disability, spasticity, or clinical stage. Frequent myoclonia and shorter interval between measles and onset of SSPE were associated with CSF pressure >200 mmH2O (p=0.035). The causes of high pressure in certain SSPE patients is unknown but may include the effect of myoclonic jerks or inflammatory reaction. Because these patients may be unable to express symptoms, increased intracranial pressure should be considered in the presence of irritability or frequent myoclonia.
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Affiliation(s)
- Akgün Olmez
- Hacettepe University, Department of Pediatric Neurology, Ankara, Turkey.
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Bozlu G, Atici A, Turhan AH, Polat A, Nayci A, Okuyaz C, Taskinlar H. Platelet-activating factor antagonist (ABT-491) decreases neuronal apoptosis in neonatal rat model of hypoxic ischemic brain injury. Brain Res 2007; 1143:193-8. [PMID: 17320823 DOI: 10.1016/j.brainres.2007.01.094] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Revised: 01/16/2007] [Accepted: 01/17/2007] [Indexed: 02/05/2023]
Abstract
Hypoxic ischemic brain injury (HIBI) is a common cause of neonatal mortality and morbidity. To date, no study has investigated the role of platelet-activating factor (PAF) antagonists on neuronal apoptosis in neonatal rat model of HIBI. In the present study, we evaluated the effect of a highly potent and selective PAF antagonist (ABT-491) on neuronal apoptosis in neonatal rat model of HIBI. Seven-day-old Wistar rat pups were subjected to right common carotid artery ligation and hypoxia (92% nitrogen and 8% oxygen) for 2 h. They were treated with ABT-491 or saline either immediately before or after hypoxia. In sham group animals, neither ligation, nor hypoxia was performed. Neuronal apoptosis was evaluated by the terminal-transferase mediated dUTP biotin nick-end-labeling (TUNEL) and caspase-3 staining methods. Administration of ABT-491 either before or after hypoxia resulted in significant reduction of the numbers of apoptotic cells in both hemispheres, when compared to saline treatment group. The numbers of apoptotic cells in right hemispheres in all groups were significantly higher than that in the left hemispheres. These results suggested that ABT-491, a highly potent and selective PAF antagonist, administration either before or after hypoxia reduces apoptosis and we propose that ABT-491 may be a novel approach in the treatment of HIBI.
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Affiliation(s)
- Gulcin Bozlu
- Department of Pediatrics, Tarsus Devlet Hastanesi, Mersin, Turkey
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40
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Abstract
Although the guidelines for the diagnosis of brain death in children are well established, the diagnosis is still under debate, and further confirmatory tests are required. Performing these confirmatory tests presents some drawbacks, such as high costs, the need for specialized personnel and technology, transportation of patients out of the intensive care unit, and the use of contrast media. Bispectral index monitoring can provide real-time, objective, continuous monitoring of the consciousness level in critically ill children. The aim of this prospective study was to define the role of bispectral index monitoring in the confirmation and diagnosis of brain death. Eight children who had fulfilled the diagnostic criteria of brain death were included in the study. The age of patients ranged from 3 months to 15 years. All patients had electrocerebral silence on their electroencephalographic recordings. After the diagnosis of brain death, at least 2-hour monitoring was performed, and all patients expressed a score of 0, indicating brain death. According to our study, the decrease in bispectral index score to 0 in patients with suspected brain death can support and confirm brain death diagnosis in children and can enable scheduling of expensive tests, such as cerebral angiography, in the appropriate time. Nevertheless, further studies are needed to determine the role of the bispectral index in the diagnosis and confirmation of brain death in children. In this article, we review clinical utility, application time, and interpretation of bispectral index monitoring in confirmation of brain death diagnosis in children.
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Affiliation(s)
- Cetin Okuyaz
- Department of Pediatrics, Mersin University Medical Faculty, Mersin, Turkey.
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Abstract
Weight gain is a common side effect of valproate treatment. The potential mechanisms of valproate-associated weight gain are not yet clear. Decreased blood glucose level, impairment of beta-oxidation of fatty acids, and increased insulin levels are some of the possible mechanisms. The aim of the present study is to evaluate the role of insulin, leptin, and neuropeptide Y in valproate-related weight gain in epileptic children. In 20 epileptic children treated with valproate before treatment and after a follow-up period of 3 and 6 months, body mass index and fasting insulin glucose ratio were calculated and serum glucose, insulin, cortisol, leptin, and neuropeptide Y levels were measured. At the end of 3 months, the mean body mass index values and the mean serum insulin, fasting insulin glucose ratio, and neuropeptide Y levels increased, whereas the serum glucose levels decreased. After 6 months of treatment, the mean serum cortisol and leptin levels were high, in addition to the body mass index, neuropeptide Y, and fasting insulin glucose ratio. These results suggest that weight gain during valproate treatment might be related to low glucose and high insulin, cortisol, leptin, and neuropeptide Y levels.
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Affiliation(s)
- Kursad Aydin
- Department of Pediatric Neurology, Selcuk Univeristy Meram Medical Faculty, Meram, Konya, Turkey.
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Okuyaz C, Aydin K, Gücüyener K, Serdaroğlu A. Treatment of electrical status epilepticus during slow-wave sleep with high-dose corticosteroid. Pediatr Neurol 2005; 32:64-7. [PMID: 15607609 DOI: 10.1016/j.pediatrneurol.2004.06.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2004] [Accepted: 06/15/2004] [Indexed: 11/26/2022]
Abstract
A 4-year-old female patient with epilepsy with continuous spike-and-waves during slow-wave sleep not classified as Landau-Klefner syndrome, refractory to antiepileptic drugs including valproate, benzodiazepines, and lamotrigine, was treated successfully with high-dose intravenous methylprednisolone therapy. Valproate, clobazam, and lamotrigine were continued at the same dose during and after high-dose intravenous corticosteroid therapy. During corticosteroid therapy, awake and sleep electroencephalogram was recorded every day. On day 7, a dramatic clinical and electroencephalographic response was observed. After high-dose intravenous methylprednisolone, prednisolone was administered orally (2 mg/kg daily) for 2 months, then gradually withdrawn. After the withdrawal of corticosteroid therapy, the patient maintained the clinical improvement in behavior, and no continuous spike-and-wave electrical status epilepticus during slow-wave sleep occurred on routine monthly sleep electroencephalogram performed for the last 6 months. In the present case, an add-on high-dose intravenous corticosteroid seems to be effective in the treatment of patients with electrical status epilepticus during slow-wave sleep syndrome, especially when antiepileptic drugs fail.
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Affiliation(s)
- Cetin Okuyaz
- Department of Pediatric Neurology, Mersin University Medical Faculty, Ankara, Turkey
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43
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Abstract
BACKGROUND The diagnosis of brain death is based on both clinical and laboratory findings. However, diagnosis of brain death is still contentious and reliable tests are required. Early recognition and declaration of the diagnosis is the main goal, which is important for discontinuation of life support and organ donation for transplantation. In order to achieve this goal, competent diagnostic procedures should be performed. In this paper the authors review the diagnosis of brain death in eight children from different age groups, with an emphasis on factors concerning the reliability, use and appropriate application time of Tc-99m-HMPAO single photon emission computed tomography (SPECT) in early diagnosis in infants and newborns. METHODS Eight patients who fulfilled the clinical criteria of brain death underwent Tc-99m HMPAO SPECT and electroencephalogram (EEG) monitoring. RESULTS All patients had electrocerebral silence on EEG recordings. Six patients showed lack of perfusion in cerebrum in their first SPECT, however, newborns needed a second image for a confirmed diagnosis. CONCLUSION In infants, SPECT has a high reliability for confirmed diagnosis of brain death; however, in newborns the application time is important for an accurate diagnosis.
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Affiliation(s)
- Cetin Okuyaz
- Department of Pediatric Neurology, Faculty of Medicine, Mersin University, Mersin, Turkey.
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44
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Abstract
Group A streptococcal infections cause a wide range of neuropsychiatric disorders, such as Sydenham's chorea, tics, obsessive-compulsive disorders, and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Structural (computed tomography and magnetic resonance imaging) and functional (positron emission tomography, single-photon emission computed tomography) imaging studies in patients with Sydenham's chorea have suggested reversible striatal abnormalities. The objective of this study was to investigate the cerebral perfusion patterns of the subcortical structures by using hexamethylpropylenamine oxime single-photon emission computed tomography (HMPAO-SPECT) in seven cases of Sydenham's chorea and two cases of streptococcal tic disorder. HMPAO-SPECT studies revealed a hyperperfusion pattern in two and a hypoperfusion pattern in five of the chorea patients and in two patients with tic disorder. The results are discussed in relation to the duration and severity of the symptoms and the response to therapy. Functional imaging findings can be variable in Sydenham's chorea, and hyperperfusion of the striatum and thalamus could be an indicator of the response to therapy and the severity of symptoms. However, the number of cases so far investigated by either SPECT or positron emission tomography is still too limited to draw any firm conclusions.
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Affiliation(s)
- Elvan Caglar Citak
- Department of Pediatric Neurology, Gazi University Medical Faculty, Ankara, Turkey
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45
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Abstract
This study was performed to determine the utility of 99mTc-hexamethylpropylenamine oxime (HMPAO) brain single photon emission computed tomography (SPECT) in evaluating patients with childhood absence epilepsy. Twenty-three patients (13 female, 10 male), aged 7 to 15 years (mean age 10.3 +/- 2.2), were studied. All patients underwent a detailed neurologic examination, interictal and ictal electroencephalography (EEG), computed tomography, and/or magnetic resonance imaging, and SPECT. The baseline study was performed during the interictal period and the activation study was performed on a separate day while the patients were having seizures provoked by hyperventilation. Their EEGs were monitored at the same time. Transaxial, sagittal, and coronal slices were obtained for both studies. The mean counts per pixel were calculated on 11 regions of interest on three representative transaxial slices. Count density was calculated for each region. Region-to-occipital cortex ratios were obtained. For each region, normalized ratios were used to obtain a side-to-side percent asymmetry index between baseline and activation studies. Visual interpretation of the baseline study showed that 10 of the 23 patients had a detectable abnormality in regional cerebral blood flow during the interictal period. These abnormalities consisted of relative hypoperfusion in the frontal lobes that could involve neighboring parietal and temporal regions. The activation study revealed that 13 of 23 patients had relative hyperperfusion in these brain regions that were relatively hypoperfused in the baseline study. These hyperperfused regions occupied larger areas than baseline hypoperfused regions. All patients had global increased perfusion in the ictal study. The side-to-side asymmetry indexes for these visually interpreted regional cerebral blood flow abnormalities ranged from 2 to 6%. The relatively consistent pattern of frontal regional cerebral blood flow alterations suggests that altered frontal lobe functions can be implicated in patients with childhood absence epilepsy.
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Affiliation(s)
- L Ozlem Kapucu
- Department of Nuclear Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
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46
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Abstract
The objective of this study was to assess the utility of electroencephalography (EEG) in the evaluation of common neurologic conditions in children. The EEG recordings of 534 consecutive children (aged < 20 years) were prospectively read by a certified pediatric neurologist. Common diagnostic indications included the following: clinical seizures (33.8%), definite epilepsy (31.2%), attention-deficit hyperactivity disorder (ADHD) (9.1%), headache (8%), syncope (3.5%), learning disabilities (2%), tic disorders (1.4%), and sleep disorders (1.1%). Overall, 63.8% of EEG records were normal, slowing background activity was noted in 6.1%, ADHD was noted in 35.3% (definite epilepsy), and epileptiform activity was noted in 37.1% of the cases of definite epilepsy and 13.2% of the clinically suspected cases. Epileptiform activity was rarely found in the patients without epilepsy. All EEG records of children with syncope (n = 19) and headache (n = 43) were normal. These findings indicate that although EEG plays an important diagnostic role in epilepsy, interictal EEG is being overused during evaluation of various neurologic disorders in children, and a normal EEG is highly predictable in children with nonepileptic conditions.
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Affiliation(s)
- Kürşad Aydin
- Department of Pediatric Neurology, Gazi University Medical Faculty, Ankara, Turkey.
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Abstract
A 4-year-old girl was admitted to our department with the complaints of severe headache, nausea, vomiting, and photophobia. She had a 1-year history of migrainelike headache that occurred every 1 to 2 months. Her neurologic examination was normal, but T-weighted axial magnetic resonance imaging (MRI) of the brain showed flow void within the basal ganglia owing to parenchymal vascular collaterals. Magnetic resonance angiography and digital substraction carotid angiography showed both occlusion of the internal carotid artery in the supraclinoid portion and extensive parenchymal vascular collaterals. Because there was no evidence of risk factors for cerebral arterial occlusion and cerebral infarct or hemorrhage, she was diagnosed as having moyamoya disease. In any case of atypical migrainelike headache, a detailed investigation should be kept in mind to detect an underlying vascular disease such as moyamoya.
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Affiliation(s)
- Kürşad Aydin
- Department of Pediatric Neurology, Selçuk University Faculty of Medicine, Konya, Turkey
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Fişgin T, Gurer Y, Teziç T, Senbil N, Zorlu P, Okuyaz C, Akgün D. Effects of intranasal midazolam and rectal diazepam on acute convulsions in children: prospective randomized study. J Child Neurol 2002; 17:123-6. [PMID: 11952072 DOI: 10.1177/088307380201700206] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this study, the effects and side effects of rectal diazepam and intranasal midazolam were compared in the treatment of acute convulsions in children to develop a practical and safe treatment protocol. In the diazepam group, the seizures of 13 (60%) patients terminated in 10 minutes; however, 9 (40%) patients did not respond. In the midazolam group, 20 (87%) patients responded in 10 minutes, but 3 (13%) patients did not respond. Regarding the anticonvulsant effect, midazolam was found to be more effective than diazepam, and the difference was statistically significant (P < .05). The necessity of a second drug for the seizures that did not stop with the first drug was higher in the diazepam group than the midazolam group, and the difference was statistically significant (P < .05). We conclude that as an antiepileptic agent, intranasal midazolam is more effective than rectal diazepam. After administration, we did not observe any serious complications. Further investigations are necessary; however, intranasal administration is easy, so if the nasal drop and spray forms used in some European countries and the United States are available worldwide, it will be very useful for physicians in the emergency room.
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Affiliation(s)
- Tunç Fişgin
- Pediatric Neurology Department, Dr Sami Ulus Child Health and Disease Centre, Telsizler-Ankara, Turkey.
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Abstract
We investigated the presence of apoptosis in muscle tissues from 24 patients (average age 5.44 +/- 1.81 years) with Duchenne's muscular dystrophy by in situ tailing of nuclear fragmentation. Muscle tissue from 4 children without histologic evidence of myopathy served as normal controls. Muscle fibers positive for nuclear DNA fragmentation were determined quantitatively by counting an area of at least 400 muscle fibers. Eleven of 24 specimens showed no nuclei with DNA fragmentation. On the other hand, 0.37 +/- 0.48% of fibers in patients with Duchenne's muscular dystrophy and none in controls had DNA fragmentation (P > .05). In this study, the percentage of apoptotic nuclei was higher in Duchenne's muscular dystrophy muscle than in normal controls. However, the difference did not reach a statistically significant level, and further studies with larger control groups are warranted.
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Affiliation(s)
- Ayse Serdaroglu
- Department of Pediatric Neurology, Gazi University Faculty of Medicine, Ankara, Turkey.
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50
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Abstract
Sixteen children, aged from 2 months to 14 years, with a diagnosis of acute seizures and seen at Dr. Sami Ulus Child Health and Disease Center, were included in this study. Midazolam (5 mg/mL) 0.2 mg/kg was administered intranasally in 30 seconds by an injector. The heart rate, respiratory rate, blood pressure, and oxygen saturation were recorded at 0, 5, and 10 minutes after administration. The seizures of three (18.7%) patients terminated within 1 minute, of seven (43.7%) patients in 1 to 2 minutes, and of three (18.7%) patients in 2 to 5 minutes. However, three (18.7%) patients did not respond to treatment. As a result, it was concluded that intranasal midazolam administration is easy and effective. The half-life of midazolam is shorter than diazepam, and midazolam has fewer complications when compared with diazepam. It is easier to use in nasal drop and spray forms.
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Affiliation(s)
- T Fişgin
- Department of Pediatric Hematology, Dr. Sami Ulus Child Health and Disease Center, Ankara, Turkey.
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