Microseizures Induced by Topiramate.

A 22-year-old Japanese male with trisomy 21 was diagnosed with West syndrome at 4 months old. After the suppression of epileptic spasms using adrenocorticotropic hormone therapy, he had complex partial seizures and bilateral frontal epileptic discharges on EEG. Although the introduction of topiramate (TPM) decreased the seizures during wakefulness, frequent episodes of brief eye-opening appeared during sleep while the patient was taking TPM (400 mg/day). EEG showed fast activity at the times of eye-opening. The episodes of eye-opening during sleep and the fast activities disappeared upon TPM discontinuation. This is the first report of TPM-induced microseizures similar to benzodiazepine-induced microseizures.

Onset of polyarticular juvenile idiopathic arthritis with both anti-cyclic citrullinated peptide antibodies and rheumatoid factor in a 3-year-old girl.

This report describes 3 year old girl with the unusual presentation of polyarticular juvenile idiopathic arthritis (JIA) with anti-cyclic citrullinated peptide (anti-CCP) antibodies and a positive rheumatoid factor (RF). She was initially treated with a nonsteroidal anti-inflammatory drug (NSAID; ibuprofen) followed by methotrexate (MTX, 10 mg/m2/week) and prednisolone (0.25 mg/kg/day), but these treatments were ineffective. Administration of tocilizumab, a humanized antihuman interleukin-6 receptor monoclonal antibody, promptly improved her clinical manifestations, and she has been in complete remission (DAS28 <2.6) without bone erosion and/or destruction. Positivity for both antibodies (anti-CCP and RF) can forecast the severity of JIA (radiographic bone destruction). In such cases the administration of biologic remissive therapy may be prudent early in the disease course.