Seizure treatment with olfactory training: a preliminary trial.

OBJECTIVE: Epilepsy is a chronic condition characterized by recurrent seizures. Despite miscellaneous antiseizure medications, resistance to treatment is still approximately 30%. This resistance brings forward the multidisciplinary approach and complementary treatments. In this study, we aimed to investigate the effect of olfactory training on epileptic seizures with special aromas having antiseizure effects in patients diagnosed with drug-resistant epilepsy. METHODS: A total of 24 patients (14 pediatric and 10 adults) with drug-resistant epilepsy were recruited for the study. Participants were asked to inhale the standardized bottle filled with lavender aroma (Lavandula Angustifolia) twice a day (morning and evening) for 30-45 s (2 cm in front of nose; 10-15 s to right and left nostril and 10-15 s to both nostrils) for 3 months. The type, frequency, duration of seizures, the quality of life (SF-36 and PedsQL 4.0), and olfactory functions (Sniffin' Sticks Test and Pediatric Smell Wheel) were re-assessed. RESULTS: Statistical analysis showed that olfactory training decreased the seizure frequency (p < 0.001) and the seizure duration (p = 0.02). A global 50% seizure reduction was seen among patients. Moreover, olfactory training increased the quality of life (p = 0.003) and improved the olfactory function in both the pediatric and adult groups (p = 0.017, p = 0.05, respectively). There was no adverse reaction and no increase in seizure frequency. SIGNIFICANCE: The observations of the present investigation suggest that olfactory training is a successful complementary therapy with no adverse reaction in patients with drug-resistant epilepsy. Large cohort studies and longer follow-up periods are needed for providing olfactory training as a therapy modality in patients with epilepsy.

Hypomelanosis of Ito presenting with unilateral dilation of Virchow-Robin spaces: a case report.

Hypomelanosis of Ito is a rare heterogeneous neurocutaneous disorder often associated with central nervous and musculoskeletal system involvement. Herein, we report the first case of hypomelanosis of Ito in the literature presenting with unilateral dilation of Virchow-Robin spaces (VRS). A girl aged 16 years old presented with a 1-year history of headache. Her physical and neurological examinations were normal, except for the presence of unilateral cutaneous macular hypopigmented whorls and streaks on lower side of the right trunk and lower limb, termed as Blaschko's lines. She had mild deficits in cognitive and adaptive functioning. Hearing, renal, dental, ophthalmologic, metabolic, and cardiac assessments were normal. Brain magnetic resonance imaging (MRI) showed markedly unilateral hemispheric enlarged VRS without contrast enhancement and diffusion restriction. To the best of our knowledge, our case is the first report describing the unilateral hemispheric enlarged VRS in a patient with hypomelanosis of Ito. Our report suggested that hypomelanosis of Ito may have unilateral dilation of VRS in brain MRI.

Clinical and Imaging Clues of Arteriopathy-Related Pediatric Arterial Ischemic Stroke: A Single Center Experience.

Background and Purpose: Arteriopathy is a common etiology for childhood arterial ischemic stroke (AIS). In this study, we aimed to address clinical, demographic, and neuroimaging characteristics and the reversibility of vasculopathy in patients with childhood stroke due to arteriopathy by classifying them according to Childhood AIS Standardized Classification and Diagnostic Evaluation (CASCADE) criteria. Methods: We included 15 patients with AIS due to arteriopathy presented between 2013 and 2018. All patients were diagnosed and followed up using magnetic resonance imaging (MRI) studies. All acute AIS patients were classified by acute CASCADE criteria (1-4). Moreover, each group was categorized according to the chronic CASCADE criteria, including progressive, stable, reversible, and indeterminate courses. Results: In the study population, CASCADE 2 patients were the most common group, and basal ganglia involvement was the most common involvement in CASCADE 2 patients. Of CASCADE 2 patients, 71.4% received steroids, which was compatible with a favorable outcome. In the study, trauma was present in 33.3% of patients, 60% of which was related to CASCADE 4. In the control visit on month 24, there were neuromotor sequelae of 60%, including hemiparesis, facial paralysis, and decreased fine motor skills; furthermore, the recurrence rate was 20%. Conclusion: We strongly emphasize that arteriopathy should be kept in mind in school-age children presenting with hemiparesis and headache. Moyamoya disease must be considered in the differential diagnosis with anterior circulation involvement, while focal cerebral arteriopathy (FCA) in patients with basal ganglia involvement was detected on MRI and dissection in the patients with a history of head-neck injury. We think that steroids have positive influences on neurologic prognosis in patients with FCA.

Motor functions, quality of life and maternal anxiety and depression in children with cerebral palsy of different intelligence levels.

BACKGROUND: Cerebral palsy (CP) is the most common motor disability in childhood. In addition to motor impairment, it is frequently accompanied by intellectual disability (ID). We aimed to investigate the associations between motor functions, quality of life (QoL) and maternal psychopathology in children with CP of different intelligence levels. METHODS: In total, 37 children and adolescents (16 females and 21 males) between 4 and 18 years of age diagnosed with CP were recruited from a Pediatric Neurology Outpatient Clinic. Gross Motor Function Classification System (GMFCS) and Bimanual Fine Motor Function (BFMF) were used for the children`s motor functions assessment. Quality of life was determined by the caregivers with Pediatric Quality Of Life Inventory-Parent version (PedsQL-P). Maternal anxiety and depression levels were assessed using Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). RESULTS: Moderate-severe ID (n=19)(13.5%, 37.8%) and normal IQ-mild ID (n=18) (32.4 %,16.2%) groups were evaluated in this study. GMFCS level 2 was more frequent in both groups. The majority of the severe-moderate ID group was at BFMF level 4, while the normal IQ-mild ID group was at BFMF level 2. PedsQL-P scores of children with CP, maternal BAI scores, and maternal BDI scores did not differ between the two groups (p > 0.05). Psychosocial PedsQL scores had a moderate negative correlation with the maternal BAI scores (r=- 0.41, p < 0.05). There was also a moderate positive correlations between the ages of children and maternal BDI scores (r=0.34, p < 0.05). CONCLUSIONS: Our results demonstrated that maternal anxiety was correlated with psychosocial QoL in children with CP. Maternal depression scores increasing with the ages of the children with CP may also indicate the social support needs for mothers with children of chronic diseases. Further studies may reveal the associations with other biopsychosocial factors in children with CP of different intelligence levels by using longitudinal study designs with larger sample sizes.