[Drug-induced hypersensitivity due to phenytoin].

This study aimed to clarify factors associated with intravenous administered phenytoin-induced hypersensitivity reaction. The incidence of hypersensitivity was significantly more frequent in boys than in girls (P < 0.05). Patients with hypersensitivity were relatively younger than those without hypersensitivity, although the difference was not statistically significant. There was no relation between the initial dose or maximum blood level of phenytoin and the occurrence of hypersensitivity. The initial serum level of phenytoin was significantly lower in patients with hypersensitivity than in those without hypersensitivity (P < 0.05), whereas the total dose of phenytoin was relatively larger in patients with hypersensitivity than those without. Reactivation of human herpes virus-6 was not recognized in all 3 patients in whom virological examination was performed using real-time polymerase chain reaction.

Transient splenial lesions in children with "benign convulsions with gastroenteritis".

"Benign convulsions with mild gastroenteritis (CwG)" is recognized as a benign situation-related seizure. Neuroimaging studies usually do not reveal any abnormalities. We report MRI diffusion-weighted image (DWI) findings of two patients who were clinically diagnosed with CwG. DWI demonstrated a transient abnormality in the splenium of the corpus callosum. Although viral encephalitis or encephalopathy should be carefully differentiated in patients clinically diagnosed with CwG, frequent seizures might cause transient splenial abnormality in patients with CwG.

Micturition induced seizures: ictal EEG and subtraction ictal SPECT findings.

We report an 8-year-old girl with seizures induced by micturition. Her seizures were characterized by extension of upper extremities with preserved consciousness. Magnetic resonance imaging and interictal electroencephalograms were normal. Ictal electroencephalogram showed low voltage fast waves without clear focal features followed by frontal dominant rhythmic multiple spikes. Subtraction ictal single photon emission computed tomography revealed a significant increase in blood flow in the mesial frontal area.

Phenytoin desensitization in a child with symptomatic localization-related epilepsy.

We reported a child with refractory partial seizures successfully managed by clinical desensitization to phenytoin. The patient had ischemic brain lesions due to cardiopulmonary arrest at 39 weeks of corrected age. He had complex partial seizures refractory to several antiepileptic drugs since 4 years of age. At 8 years 1 month of age, phenytoin was first administered. Fever and maculopapular rashes appeared at 10 days after phenytoin initiation, and then the drug was discontinued. At 8 years 8 months of age, desensitization was attempted because of refractoriness of seizures to drugs other than phenytoin. Desensitization was started at 1mg daily, and then the dose was doubled every week. His seizures were controlled by 150mg/day of phenytoin in combination with primidone. No problems have been observed during desensitization.

Diffusion tensor imaging in frontal lobe epilepsy.

We report a 13-year-old female with refractory frontal lobe epilepsy in whom diffusion tensor imaging was useful for exploring subtle cortical malformation. She had frequent simple partial seizures characterized by clonic movement of the right upper extremity. Conventional magnetic resonance imaging was not conclusive. A diffusion tensor imaging revealed an increased apparent diffusion coefficient and reduced anisotropy in the left frontal lobe. Positron emission tomography disclosed hypermetabolism in the adjacent area. We could identify the relatively thick cortex with an indistinct gray-white matter junction in a thin-slice T(1)-weighted image.