Objective To investigate the clinical manifestation of convulsive status epilepticus (CSE) associated with the outcome of children contracted this illness in order to make an effort to prevent and treat those children. Method The patients with CSE admitted from October 1998 to October 2008 were prospectively and consecutively enrolled. All the patients met the diagnostic criteria set by International Anti-epilepsy Union (ILAE) in 1993. The prognosis predictors of outcome were analyzed with the Rank sum test, Chi-square analysis and Logistic regression analysis. Results A total of 169 patients with CSE were enrolled. Of them, 92 patients were from rural areas (54.4% ). The primary cause was central nervous system infection, and the minor ones were a reduction of dose or withdrawal of the antiepileptics, and cerebral hemorrhage. The duration of CSE before treatment was longer in rural patients than in urban residents ( P < 0.01) . The duration of CSE before treatment and the total persistence time of CSE was significantly associated with the mortality 14.2% . The source of patients, the duration before treatment, and respiratory depression were independent prognostic predictor variables of CSE (P < 0.05) .Conclusions The rural patients account for the major ratio of convulsive status epilepticus. Central nervous system infection is the primary cause. The duration before treatment and total persistence time of CSE are highly related to the mortality and morbidity.

Objective To analyze the clinical features,treatment and prognosis of children with post-stroke epilepsy.Methods Sixty-nine children with epilepsy after cerebral stroke who were admitted to Guangdong General Hospital from Jan.2009 to Mar.2013 were retrospectively reviewed,including etiology,clinical features,laboratory examinations,treatment and prognosis.Results Among 260 stroke patients,69 of them (26.5 ％) developed epilepsy,but there was no significant difference between boys and girls(x2 =0.725,P =0.394).The incidence of post-stroke epilepsy differed significantly among different types (x2 =12.000,P =0.02),highest in the children with subarachnoid hemorrhage(47.8％,11/23 cases),followed by those with cerebral hemorrhage (34.6％,27/78 cases),and lastly,those with cerebral ischemia (19.5％,31/159 cases).Among them,53 patients developed seizures in the early stage (76.8％,53/69 cases),others in the late stage(23.2％,16/69 cases),early-onset epilepsy was more common in hemorrhagic stroke and late-onset epilepsy was more common in ischemic stroke,which differed significantly(x2 ＝ 4.778,P =0.029).The electroencephalogram background generally showed slow-wave in the early-onset epilepsy.The composition of seizure types differed significantly among different types of stroke (x2 =8.461,P =0.015).Forty-five of 58 patients (77.6％) suffered from cortical lesions and 13 of 58 patients (22.4％) suffered from subcortical lesions.Those children with post-stroke epilepsy who regularly use of antiepileptic drugs were followed up for 6 months to 4 years,81.2％ (56/69 cases)of clinical seizures were controlled.Conclusions The incidence of epilepsy after stroke is higher in children than in adults,cerebral stroke seizure occurs more commonly in cases with hemorrhagic stroke,especially with subarachnoid hemorrhage.Conventional antiepileptic treatment is effective.

Simvastatin,a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor,is widely prescribed to patients with hypercholesteremia and its muscular toxicity has been widely reported.The metabolism of simvastatin depends on the enzymic activity of cytochrome P450 3A4 (CYP3A4) and inhibitors of CYP3A4 can result in clinical events by interacting with simvastatin.Diltiazem is a moderate inhibitor of CYP3A4,which is known to increase the serum concentration of simvastatin.Here we report a patient with unrecognized hypothyroidism who had been stable for more than one year on low-dose simvastatin therapy of hypercholesteremia and rhabdomyolysis occurred with the addition of diltiazem.This is one of scanty reports of rhabdomyolysis induced by simvastatindiltiazem drug interaction,especially in hypothyroid patient.This case reminds the clinicians that although diltiazem as a moderate CYP3A4 inhibitor can be used cautiously with small doses of CYP3A4-dependent statius (eg,simvastatin),these two commonly used drugs should be avoided in hypothyroid patient.

OBJECTIVETo study the changes in 24-hour video electroencephalogram (EEG) and epileptic attacks after levetiracetam add-on therapy in children with frontal lobe epilepsy and epileptiform discharges.

METHODSA prospective study was carried out in 105 children with the frontal lobe epilepsy who received long-term treatment with 1 or 2 types of antiepileptic drug but still with epileptiform discharges in ECG. Levetiracetam add-on therapy was administered at the initial daily dose of 20 mg/kg (given in 2 doses) for 2 weeks followed by an increase of the dose to 30 mg/kg with a maintenance dose of 30-40 mg/kg. The changes in seizure attacks and 24-hour video-EEG monitoring after a 6-month therapy were observed.

RESULTSLevetiracetam add-on therapy reduced epileptiform discharges in 55 children (52.3%) and resulted in significant changes in EEG (P<0.05). Of the 77 children with clinical seizures, complete seizure control was achieved in 12 cases after the therapy, and the seizure attacks were reduced in 28 cases, showing a total response rate of 51.9%; the reduction in seizure attacks was positively correlated with EEG improvement (P<0.001).

CONCLUSIONLevetiracetam add-on therapy can decrease epileptiform discharges in EEG and reduce clinical seizure attacks in children with frontal lobe epilepsy with only mild adverse reactions.

Adolescent ; Anticonvulsants ; administration & dosage ; therapeutic use ; Child ; Child, Preschool ; Electroencephalography ; Epilepsy, Frontal Lobe ; drug therapy ; physiopathology ; Female ; Humans ; Infant ; Male ; Piracetam ; administration & dosage ; analogs & derivatives ; therapeutic use ; Prospective Studies ; Treatment Outcome

Objective: To explore the factors affecting the prognosis of children with status epilepticus(SE). Methods: A retrospective review was performed on children and the outcomes were measured by Glasgow Outcome Score (GOS). GOS=5 was defined as a good outcome, and GOS<5 as a bad outcome. Results: (1)Two hundred and ninety-eight children (163 girls and 135 boys) with SE were enrolled.The ages of the patients ranged from 2 months and 7 days to 14 years and 5 months, and 106 cases were at 1-3 years old.There were 154 cases (51.68%) with previous history of convulsion, including 98 cases of epilepsy (63.63%) and 241 new onset SE (80.87%). The most common cause of SE in children was febrile seizure (92 cases, accounting for 30.87%), followed by long-term symptom (81 cases, accounting for 27.18%). A total of 109 cases (41.90%) were treated with Diazepam in time after the convulsion, and 151 cases (58.10%) were treated with antiepileptic drugs such as Phenobarbital sodium or Chloral hydrate after the convulsion.Based on GOS scale, the near-term prognosis was as follows: 254 cases(85.23%) of children with GOS=5, and the remaining 44 cases of GOS<5 points.(2) Recent overall prognostic factors: single factor analysis showed that a total of 12 factors were associated with poor prognosis (P<0.05), including age, Pediatric Intensive Care Unit (PICU), tracheal intubation, previous history of convulsions, developmental delay, new onset of SE, fever, comprehensive onset, refractory SE, electroencephalogram (EEG) abnormality, neuroimaging abnormality and etiology.Multiple factor Logistic regression analysis showed that PICU monitoring was required (OR=4.306, 95%CI: 1.554-11.933, P=0.005), developmental delay (OR=3.054, 95%CI: 1.157-8.066, P=0.024), and abnormal cranial image (OR=2.110, 95%CI: 1.121-3.970, P=0.021) was an independent risk factors for short-term poor prognosis.Comprehensive onset (OR=0.330, 95%CI: 0.139-0.782; P=0.012), and the cause of febrile convulsion (OR=0.688, 95%CI: 0.480-0.987, P=0.042) were prognostic non-risk factor.(3)Recent prognostic factors in PICU monitoring group: the hospitalization time of PICU, developmental delay, the atypical attack type, electroencephalogram abnormality, neuroimaging abnormality, and the etiology of these 6 factors were correlated with the prognosis of PICU group, among which prolonged PICU (OR=36.912, 95%CI: 5.165-263.787, P=0.000) and developmental delay (OR=14.403, 95%CI: 1.725-120.273, P=0.014) were independent risk factors for poor outcome of PICU monitoring group. Conclusions PICU monitoring, developmental backwardness and abnormal head image are the independent risk factors for poor prognosis.PICU residence time and developmental delay are the independent risk factors for poor short-term prognosis in PICU enrolled children.