A volumetric magnetic resonance imaging study of brain structures in children with Down syndrome.

BACKGROUND AND PURPOSE: Down syndrome (DS) is the most common genetic cause of mental retardation with deficits in language and memory. Mental retardation of varying degrees is the most consistent feature of DS. The objective of this study was to use high-resolution magnetic resonance imaging (MRI) techniques to investigate the volumes of the hippocampus, amygdala, and temporal and frontal lobes in children with DS compared with healthy children. MATERIAL AND METHODS: MRI of 49 patients was reviewed prospectively. The study included 23 children with DS (9 girls and 14 boys, mean age 6.7 ± 3.7 years) and 26 healthy children (11 girls and 15 boys, mean age 8.3 ± 2.4 years). Volumes of the right and left hippocampus, the right and left amygdala, temporal and frontal lobes and the total brain volume were measured by a radiologist who was unaware of the diagnosis. RESULTS: Total brain volume in children with DS was significantly lower compared with controls. It was associated with significantly lower volume of the frontal and temporal lobes. Children with DS had a significantly smaller right and left hippocampus volume and a significantly smaller right and left amygdala volume than did the control group. We also found a negative correlation between mental retardation and volume of the right hippocampus. CONCLUSIONS: The presence of these abnormalities from an early age contributes to the specific cognitive and developmental deficits seen in children with DS.

Somatosensory evoked potentials in children with migraine with aura and without aura.

BACKGROUND: The Interictal abnormalities of cerebral information processing in migraine were found by studying different modality-specific evoked and event related potentials, mostly visual and auditory. In this study we focused on short-latency somatosensory evoked potentials (SEP) in children and adolescents suffering from migraine with and without aura. MATERIAL AND METHODS: The study group consisted 111 of children and adolescents at the age of 7-18 years: 27 of them suffered from migraine with aura, 36 of them suffered from migraine without aura, 48 subjects have episodic tension-type headache. SEPs was performed interictally at least two days after the last headache attack. RESULTS: There were no significant differences in the latency averages of SEP components between all migraneurs and tension-type headache subjects. However, N9 and N13 latency averages were significantly shorter in migraine without aura group compared with migraine with aura and tensiom type headaches. We did not find any significant correlations for either headache type between evoked potentials parametrs and illness duration, unilateral localisation of pain, migraine in family and aura. CONCLUSIONS: In concert with similar studies in adult migraineurs, our findings showed no disturbances of somatosensory information processing in children with migraine with aura and without aura. The diagnosis of migraine in children actually remains predominantly based on medical history. However, electrophysiological techniques allow the study of some of the structures in vivo and enlarge our knowledge on controversial aspects of migraine pathophysiology.

Ultrastructural features of astrocytes in the cortex of the hippocampal gyrus and in the neocortex of the temporal lobe in an experimental model of febrile seizures and with the use of topiramate.

The objective of the current study was ultrastructural assessment of astroglia in specimens of the hippocampal cortex and neocortex of the temporal lobe in our own experimental model of febrile seizures (FS) in rats, as well as the analysis of the influence of a structurally novel broad spectrum anticonvulsant, topiramate (TPM), upon these cells in the CNS regions studied. The current study was inspired by some interesting literature reports on the in vitro investigation into the biological effects of TPM in primary cultures of rat cortical astrocytes and by the lack of data concerning astroglial morphology in vivo in an experimental model with this antiepileptic. In the FS group, the most pronounced changes in the study cell population referred to protoplasmic astroglia and were observed in approximately 3/4 of these cells. The abnormalities were similarly expressed in the two CNS regions studied, in terms of both quantity and quality. They were characterized by considerable swelling and degenerative changes, both in astrocytic perikarya and their processes. Changes were visible in the elements of the granular endoplasmic reticulum and mitochondria, which had a condensed configuration. In the group receiving topiramate directly after the induction of FS, submicroscopic changes in protoplasmic astrocytes were similarly expressed as in the FS group. However, in the group receiving the drug prior to the induction of FS its protective action was observed on the morphology of approximately 1/3 of the population of the protoplasmic astroglial cells. The remaining protoplasmic astrocytes still showed features of considerable or moderately pronounced injury. The beneficial effect of TPM on the ultrastructure of part of the population of the protoplasmic astroglia in the group in which the drug was applied prior to the induction of FS can be explained, among others, by a protective effect of the blood-brain barrier enhanced by the drug administration, as indicated by our earlier findings.

Ultrastructure of the blood-brain barrier of the gyrus hippocampal cortex in an experimental model of febrile seizures and with the use of a new generation antiepileptic drug--topiramate.

The ultrastructure of the blood-brain barrier (BBB) of the gyrus hippocampal cortex in an experimental model of febrile seizures in rats and the effect of a new generation antiepileptic drug, topiramate, on the morphological status of this barrier were investigated. Advanced changes indicating a substantial increase in BBB permeability were observed in the animals with induced febrile seizures (FS), with approximately 2/3 of capillaries and perivascular astroglial processes being affected. Almost total occlusion of the capillary lumen was frequently seen, caused by damaged endothelial lining and by external pressure from markedly swollen perivascular astrocytic processes. Mitochondrial changes predominated among the abnormalities found in endoplasmic organelles of endothelial cells. Lesions in the BBB coexisted with damage to pyramidal neurons, mainly with features of aponecrosis ("dark neurons"). The study on topiramate seems to demonstrate its protective action on the BBB components of the ammonal cortex in the group receiving the drug as prevention, i.e. against febrile seizures. It was found to prevent marked BBB damage in over half of the capillaries. However, the application of topiramate directly after FS induction had no distinct beneficial effect on the structural BBB components.

Serum and intraerythrocyte antioxidant enzymes and lipid peroxides in children with migraine.

The oxidant-antioxidant balance disorders underlie a number of acute and chronic diseases of the central nervous system (CNS). It is believed that oxidative stress plays a role in the pathogenesis of migraine. The study objective was to assess the processes of lipid peroxidation with malondialdehyde (MDA) as its major indicator and to determine the activities of antioxidant enzymes: superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and glutathione reductase (GSSG-R) in the serum and erythrocytes of patients at developmental age with migraine with and without aura. The study group consisted of 34 patients at the age of 10-18 years (mean +/- standard deviation: 14.04 +/- 2.29 years), suffering from migraine. The control group included 38 patients, aged 4-17 years (mean age 12.11 +/- 3.46). MDA concentration and activities of SOD, GSH-Px and GSSG-R were determined in serum and erythrocytes of all the patients. In the migraine group, the MDA levels in serum and erythrocytes were statistically significantly lower than in control subjects (p < 0.001). In the migraine group, serum GSH-Px activity was significantly higher (p < 0.05). The GSSG-R activity in the erythrocytes of migraine children was significantly higher compared to controls (p < 0.001). SOD activity was decreased and GSH-Px was increased (non-significantly) in erythrocytes of migraineurs. Our results confirm the disturbances of lipid peroxidation processes in migraine and suggest the activation of antioxidant mechanisms. Its important indicator seems to be the increase in the GSSG-R activity in the erythrocytes and the GSH-Px activity in serum between migraine attacks. Further studies are necessary.

Corpus callosum size in children with spastic cerebral palsy: relationship to clinical outcome.

This study examines corpus callosum pathology in children with spastic cerebral palsy aged 7 to 15 years and to investigates the relation between corpus callosum areas and clinical picture. Magnetic resonance images of 46 patients were reviewed prospectively. Twenty-two patients with cerebral palsy were age and gender matched with the control patients. The cerebral palsy group had a significantly smaller mean corpus callosum surface area than did the control group. The cerebral palsy group also had a significantly smaller mean internal skull surface area measurement than did the control group. The corpus callosum/internal skull surface area ratio was also smaller for those with cerebral palsy. Wechsler Intelligence Scale Verbal IQ scores were associated with the surface area of the corpus callosum in cerebral palsy patients. A significant relationship between corpus callosum surface area and IQ scores in children with cerebral palsy was found. A positive correlation between internal skull surface area and IQ scores in children with cerebral palsy was noted. A significant correlation between Apgar score and corpus callosum surface area in the cerebral palsy group was found. A negative correlation between corpus callosum surface area and the Gross Motor Function Classification System in patients with cerebral palsy was noted.

Spastic cerebral palsy: clinical magnetic resonance imaging correlation of 129 children.

A prospective study was undertaken of 129 children with spastic cerebral palsy to clarify the relationship between magnetic resonance imaging (MRI) findings and clinical features of cerebral palsy. Low birth weight, asphyxia, prematurity, seizures, mental development, Gross Motor Function Classification System, and MRI findings were analyzed. Significant abnormalities relevant to the cerebral palsy were evident on imaging in 123 (95.3%). A similar percentage of MRI abnormalities were detected in the groups, 45 (100%) in patients with tetraplegic cerebral palsy, 37 (92.5%) in children with diplegic cerebral palsy, and 42 (95.4%) with hemiplegic cerebral palsy. Periventricular leukomalacia was detected more frequently in the children with spastic diplegia than in the patients with tetraplegia or hemiplegia. Cerebral atrophy was found more often in the tetraplegic group compared to the diplegic patients. Porencephalic cysts were detected more frequently in children with spastic hemiplegia. Congenital brain anomalies were found in a higher proportion in tetraplegic children. Significant correlations between the MRI findings and Gross Motor Function Classification System in the diplegic and tetraplegic patients were found. No correlations between the MRI results and risk factors for cerebral palsy in the tetraplegic patients were noted. Early detection of brain abnormalities in children with cerebral palsy may help in the prognosis and in the initiation of appropriate therapy

Unfavorable effect of levetiracetam on cultured hippocampal neurons after hyperthermic injury.

BACKGROUND: The aim of this study was to examine the viability of neurons and the putative neuroprotective effects of second-generation antiepileptic drug, levetiracetam (LEV), on cultured hippocampal neurons injured by hyperthermia. METHODS: Primary cultures of rat's hippocampal neurons at 7day in vitro (DIV) were incubated in the presence or absence of LEV in varied concentrations under hyperthermic conditions. Cultures were heated in a temperature of 40°C for 24h or in a temperature of 41°C for 6h. Flow cytometry with Annexin V/PI staining as well as fluorescent microscopy assay were used for counting and establishing neurons as viable, necrotic or apoptotic. Additionally, the release of lactate dehydrogenase (LDH) to the culture medium, as a marker of cell death, was evaluated. Assessment was performed after 9DIV and 10 DIV. RESULTS: Incubation of hippocampal cultures in hyperthermic conditions resulted in statistically significant increase in the number of injured neurons when compared with non-heated control cultures. Intensity of neuronal destruction was dependent on temperature-value. When incubation temperature 40°C was used, over 80% of the population of neurons remained viable after 10 DIV. Under higher temperature 41°C, only less than 60% of neurons were viable after 10 DIV. Both apoptotic and necrotic pathways of neuronal death induced by hyperthermia were confirmed by Annexin V/PI staining. CONCLUSIONS: LEV showed no neuroprotective effects in the current model of hyperthermia in vitro. Moreover, drug, especially when used in higher concentrations, exerted unfavorable intensification of aponecrosis of cultured hippocampal neurons.

Evaluation of the influence of antiepileptic therapy on antioxidant enzyme activity and lipid peroxidation in erythrocytes of children with epilepsy.

The aim of this study was to evaluate the influence of antiepileptic therapy on antioxidant enzyme activity and lipid peroxidation in the erythrocytes of children with epilepsy. For this purpose, the activity of superoxide dismutase, glutathione peroxidase, and glutathione reductase and the malondialdehyde concentration in 61 healthy children and 90 children with epilepsy were measured. The activities of all of these enzymes were insignificantly higher, whereas the malondialdehyde concentration was significantly lower in the patients treated with carbamazepine monotherapy. In patients treated with valproate monotherapy, the activities of all enzymes were insignificantly lower, whereas the malondialdehyde concentration was insignificantly higher. In patients treated with polytherapy, the activity of superoxide dismutase was insignificantly lower, whereas the activity of glutathione peroxidase and glutathione reductase was insignificantly higher and the malondialdehyde concentration was lower. There were differences in glutathione reductase activity between the valproate monotherapy group and both the carbamazepine monotherapy and polytherapy groups and in malondialdehyde concentrations between the carbamazepine and valproate groups. The results indicate that the oxidant-antioxidant balance in children with epilepsy is modified by antiepileptic therapy.

Antioxidant enzymes and lipid peroxides in children with cerebral palsy.

Impaired antioxidant mechanisms are unable to inactivate free radicals that may induce a number of pathophysiological processes and result in cell injury. Thus, any abnormality in antioxidant defense systems could affect neurodevelopmental processes and could have an important role in the etiology of cerebral palsy (CP). The plasma levels of lipid peroxidation as plasma levels of malondialdehyde (MDA), activities of superoxide dismutase (SOD), glutathione peroxidase (GPx), and glutathione reductase (GR) in plasma and erythrocytes were investigated in 34 CP children and compared with 61 normal controls. SOD, GPx and GR activities were spectrophotometrically assayed. Activities of SOD, GPx and GR in plasma did not differ significantly between CP children and the control group. Activities of erythrocyte GR in the CP patients were significantly lower compared with controls. MDA concentration did not differ statistically between the CP children and healthy subjects. In conclusion our results suggest that increased activities of erythrocyte GPx and decreased erythrocyte GR activities might be due to lesser physical activity of children with CP.

Seasonal variations of cerebral palsy births in northeastern Poland.

BACKGROUND: The objective of this report was to examine the seasonal variations on the incidence of cerebral palsy (CP) in Podlasie province, Poland in a retrospective case-control study. METHODS: Data were obtained from the Department of Pediatric Neurology and Rehabilitation. Selected babies were all born between January 1, 1990 and December 31, 1999; 212 children (116 boys, 96 girls) with CP were included in the study. We applied Cosinor analysis to examine the seasonality of CP births. RESULTS: The highest number of CP births occurred in spring and the lowest in winter, with intermediate values in summer and autumn. This seasonal pattern was significant for spring vs. winter. The peaks in CP births occurred in May and August. The lowest number of CP births occurred in February and December. We also demonstrated seasonal variation in CP births in girls and boys and Apgar score. Peaks in CP births in boys were noted in May and October and Apgar score in May and December, respectively. No significant relationship between mean temperature and Apgar score, low birthweight and asphyxia was found. CONCLUSIONS: These data suggest the seasonal patterns of CP births. Further studies should be performed with larger numbers of patients.

A comparison of spastic diplegic and tetraplegic cerebral palsy.

The aim of this study was to compare spastic diplegic and tetraplegic cerebral palsy. Thirty-eight children had spastic diplegic cerebral palsy and 48 spastic tetraplegic cerebral palsy. Risk factors of cerebral palsy, seizures, severity of cerebral palsy, electroencephalogram, and magnetic resonance imaging findings were analyzed. Gestational history, low birth weight, and perinatal pathologies were present in similar percentages in both groups. Lower values of the Apgar score were recorded more often in the tetraplegic cerebral palsy group than the diplegic group. The children with spastic diplegia were classified more frequently into levels I and II of the Gross Motor Function Classification System, but patients with spastic tetraplegia were classified more frequently into levels IV and V. Similarly, mental retardation was observed more frequently in the patients with spastic tetraplegia. In magnetic resonance imaging, periventricular leukomalacia was detected in a higher proportion of children with spastic diplegia than in patients with tetraplegia. Cerebral atrophy occurred more frequently in the tetraplegic group compared with diplegic patients. Twenty-four (50.0%) children with spastic tetraplegia had epilepsy compared with six children with spastic diplegia. The incidence of intractable epilepsy was higher in the tetraplegic patients than in the children with spastic diplegia.

Quantitative EEG analysis in children with hemiparetic cerebral palsy.

Clinical assessment and imaging studies of twenty-six children with hemiparetic cerebral palsy (HCP) were conducted. For each child 20 artifact-free EEG epochs, each of 2 s duration were selected for spectral analysis to calculate spectral power and coherence functions. A fast Fourier transformation alogorithm of signal processing was used to obtain the power spectrum of each lead. The objective of this study was to estimate EEG spectral power as well as the interhemispheric (ICoh) and intrahemispheric (Hcoh) coherence in children with hemiparetic cerebral palsy (HCP) as compared with healthy children. Significant differences between the HCP and control children were noted in the distribution of the alpha, theta and delta rhythms over the left and right hemispheres. In this study we found significant differences between the HCP and control children in the distribution of alpha, theta, delta and beta rhythm over the left and right hemispheres. Significant differences between the HCP and control children were in the distribution of the theta rhythm over the right and left hemispheres. The lower ICoh at the temporal, parietal and occipital derivations in the alpha band implies hypoconnectivity between the right and left hemispheres. The HCoh asymmetry, which implies relative hypoconnectivity within the right and left hemispheres, suggests the functional hemispheric differentiation may be diminished in comparison with the controls.

A comparative study of vigabatrin vs. carbamazepine in monotherapy of newly diagnosed partial seizures in children.

Carbamazepine (CBZ) is a drug of choice for the treatment of simple or complex partial seizures and secondary generalized seizures in adults and children. Vigabatrin (VGB) is a relatively new second line antiepileptic drug and was first registered for use in Poland more than ten years ago. Few reports have been published on the comparison of efficacy of VGB in children with epilepsy. The objective of this study is to evaluate the safety, efficacy and EEG effects of initial VGB monotherapy compared with initial CBZ monotherapy in children with newly diagnosed epilepsy. We present results of a prospective, outpatient and open study carried out in the University Hospital Center in Bialystok. Twenty-six children with partial epilepsy treated with VGB and 28 patients treated with CBZ were studied. The evaluation of the efficacy of the two drugs did not reveal any significant differences. Very good (reduction > 75%) seizure control was achieved in 22 out of 26 patients (84.6%) in the VGB group. One patient had a 50-75% decrease of seizures (good effect), similarly one child had a 25-50% reduction of seizures (mild effect). In two patients, we observed increased seizures (myoclonic jerks). Very good seizure control was achieved in 17 out of 28 patients (60.7%) in the CBZ group. Good seizure control was achieved in 5 out of 28 patients (17.8%) and mild control was seen in two children. No improvement was observed in 4 (14%) of the patients. The EEG background activity was improved in VGB-treated patients. No effect on the EEG background activity was observed in CBZ-treated children. VGB seems to be a safe and effective antiepileptic drug as primary monotherapy for epilepsy in children with similar proportion of side effects as CBZ.

Study of the protective effects of nootropic agents against neuronal damage induced by amyloid-beta (fragment 25-35) in cultured hippocampal neurons.

BACKGROUND: Alzheimer's disease (AD) is a common neurodegenerative disorder, in which progressive neuron loss, mainly in the hippocampus, is observed. The critical events in the pathogenesis of AD are associated with accumulation of ß-amyloid (Aß) peptides in the brain. Deposits of Aß initiate a neurotoxic "cascade" leading to apoptotic death of neurons. Aim of this study was to assess a putative neuroprotective effects of two nootropic drugs: piracetam (PIR) and levetiracetam (LEV) on Aß-injured hippocampal neurons in culture. METHODS: Primary cultures of rat's hippocampal neurons at 7 day in vitro were exposed to Aß(25-35) in the presence or absence of nootropics in varied concentrations. Flow cytometry with Annexin V/PI staining was used for counting and establishing neurons as viable, necrotic or apoptotic. Additionally, release of lactate dehydrogenase (LDH) to the culture medium, as a marker of cell death, was evaluated. RESULTS: Aß(25-35) caused concentration-dependent death of about one third number of hippocampal neurons, mainly through an apoptotic pathway. In drugs-containing cultures, number of neurons injured with 20 µM Aß(25-35) was about one-third lesser for PIR and almost two-fold lesser for LEV. When 40 µM Aß(25-35) was used, only LEV exerted beneficial neuroprotective action, while PIR was ineffective. CONCLUSIONS: Our results suggest the protective potential of both studied nootropics against Aß-induced death of cultured hippocampal neurons with more powerful neuroprotective effects of LEV.

Decrease of interleukin (IL)17A gene expression in leucocytes and in the amount of IL-17A protein in CD4+ T cells in children with Down Syndrome.

BACKGROUND: Down Syndrome is by far the most common and best known chromosomal disorder in humans. It expresses multiple systemic complications with both structural and functional defects as part of the clinical manifestation. The mechanisms of immune changes occurring in Down Syndrome are complex and include an extra gene copy of chromosome 21 and secondary dysregulation of numerous intercellular interactions. Recent studies suggest a role of interleukin 17A (IL-17A), a pro-inflammatory cytokine located on 6p12 chromosome, in the pathogenesis of inflammatory and autoimmune diseases. We aimed to analyze IL17A gene expression in peripheral white cells and IL-17A intracellular expression on CD4+ T-cells. METHODS: The research was carried out on a group of 58 children aged 6-12 years including a group of 30 children with Down Syndrome (simple trisomy of chromosome 21 only) and a reference group of 28 healthy children. We evaluated gene IL17A expression using real-time PCR and intracellular IL-17A analyzed by flow cytometry. RESULTS: We found significantly decreased gene expression in white cells and significantly decreased expression of IL-17A levels on CD4+ T-cells in Down Syndrome. CONCLUSIONS: Our data indicate that decreased IL-17A expression may play a significant role in the etiology of infections in Down Syndrome. Moreover, we demonstrated that in Down Syndrome the other gene located outside the extra chromosome 21 is also affected.

Proton magnetic resonance spectroscopy in children with spastic diplegia.

The objective of this prospective study was the application of proton magnetic resonance spectroscopy in children with spastic diplegia (SD) to determine the metabolite profile of SD children in the left basal ganglia, and to assess the relationship of this profile with motor and mental development. Patients with SD showed reduced ratios of N-acetylaspartate (NAA)/creatine (Cr), NAA/choline (Cho), NAA/myo-inositol (mI), Cho/NAA, Cho/Cr and Cho/mI in the basal ganglia compared to a well-matched control group. On the other hand, we noted increased Cr/NAA, Cr/Cho and mI/NAA ratios in the SD patients as compared with controls. NAA/mI ratios were positively correlated with the severity scale of cerebral palsy in SD children. There was also a significant correlation between Cr/NAA and mental retardation. Increased Cr/NAA, Cr/Cho and mI/NAA ratios in SD children may suggest the existence of the compensatory mechanisms in these patients. The NAA/mI ratio could be used as an additional marker of SD severity and Cr/NAA as a marker of the mental retardation.

Risk factors and prognosis of epilepsy in children with cerebral palsy in north-eastern Poland.

Though epilepsy occurs in 15-90% of children with cerebral palsy (CP) its clinical course is not well defined. We therefore conducted studies of 198 children with CP seen in Pediatric Neurology Department of the Medical Academy in Bialystok between 1994 and, 2001. The aim was to evaluate the risk factors, incidence and prognosis of epilepsy in CP. The overall epilepsy incidence was 41.4%. Epilepsy most commonly affected children with spastic tetraplegia 65.6%. Low birth weight, neonatal seizures, seizures during the first year of life, family history of epilepsy, severity of CP and computer tomography findings were found to be related to significantly increased risk of epilepsy in children with CP in the logistic regression analysis. Intractable epilepsy occurred in 51.2%, while in spastic tetraplegia it was even higher (60%). Controlled epilepsy was observed in 83.3% of spastic diplegia and in 72.7% of spastic hemiplegia. Polytherapy was commonly used in children with spastic tetraplegia 59.5%. Partial seizures secondarily generalized, infantile spasms and Lennox-Gastaut syndrome were the most frequently observed seizures in epileptic children with CP. Epilepsy is common in children with CP and has poor prognosis.

Comparisons of right and left hemiparetic cerebral palsy.

The purpose of this study was to compare right and left hemiparetic cerebral palsy. Sixty children (34 males, 26 females) with hemiparetic cerebral palsy were recruited. Thirty-two children manifested left hemiparetic cerebral palsy and 28 right hemiparetic cerebral palsy. Low birth weight, seizures, a family history of epilepsy, severity of cerebral palsy, and computed tomographic findings were analyzed. No significant differences were found between the clinical patterns of hemiparesis in both groups. Gestational history, low birth weight, and perinatal pathologies were present in similar percentages in the left and the right hemiparetic cerebral palsy children. Significantly greater numbers of pregnancies (P = 0.003) and deliveries (P = 0.01) were observed in the left hemiparetic cerebral palsy group as compared with the right hemiparetic cerebral palsy group. Similarly, significantly (P = 0.03) lower values of the Apgar score were recorded in the left hemiparetic cerebral palsy group than the right hemiparetic cerebral palsy group. A similar percentage of neuroradiologic abnormalities was detected in both groups. Twenty-six (43.3%) children with hemiparetic cerebral palsy had epilepsy. The incidence of intractable epilepsy was similar in both groups. The results of this study are comparable with earlier reports on hemiparetic cerebral palsy.

[The effect of antiepileptic drug therapy on antioxidant enzyme activity and serum lipid peroxidation in young patients with epilepsy]. / Ocena wplywu CBZ i VPA na aktywnosc enzymów antyoksydacyjnych oraz procesy peroksydacji lipidów w surowicy mlodych pacjentów z padaczka.

Changes in antioxidant defense mechanisms and the resulting increased lipid peroxidation are involved in the pathogenesis of epilepsy. Research findings concerning the effect of antiepileptic therapies on these processes are discordant. The aim of our study was to estimate, firstly, the activity of the following antioxidant enzymes: superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and glutathione reductase (GSSG-R), and secondly, malondialdehyde (MDA) serum concentration in children and adolescents newly diagnosed with epilepsy and receiving either carbamazepine (CBZ) or valproate (VPA) monotherapy, or polytherapy. The study group included 90 young patients with epilepsy, aged 6 months to 20 years. In 22 patients epilepsy was newly diagnosed; CBZ monotherapy was administered to 16 patients, VPA monotherapy--to 25, and polytherapy--in 27 cases. The control group consisted of 61 non-epileptic patients aged 4-17 years. SOD, GSH-Px and GSSG-R activities and MDA concentration were measured using spectrophotometry. SOD activity was decreased in newly diagnosed epileptic children receiving VPA or CBZ monotherapy (p < 0.05), or polytherapy (p < 0.01) in comparison to relevant levels in non-epileptic patients. GSH-Px activity was increased in all the patients, but significantly in those receiving polytherapy (p < 0.05). While in patients newly diagnosed with epilepsy no change in GSSG-R activity was found, its level was slightly lower both in those receiving VPA monotherapy and polytherapy, but increased in those with CBZ monotherapy. MDA concentration was elevated in all the epileptic patients, significantly (p < 0.05) both in VPA monotherapy and in polytherapy, while insignificantly--in newly diagnosed epilepsy and in CBZ monotherapy. Our results indicate that in the serum of children and adolescents with epilepsy the oxidants-antioxidants balance is modified by antiepileptic therapy.