Recommendations for prescription review of commonly used anti-seizure medications in treatment of children with epilepsy / 中华实用儿科临床杂志

Anti-seizure medications (ASMs) are the main therapy for epilepsy.There are many kinds of ASMs with complex mechanism of action, so it is difficult for pharmacists to examine prescriptions.This paper put forward some suggestions on the indications, dosage forms/routes of administration, appropriateness of usage and dosage, combined medication and drug interaction, long-term prescription review, individual differences in pathophysiology of children, and drug selection when complicated with common epilepsy, for the reference of doctors and pharmacists.

Safety and efficacy of oral Lacosamide as an add-on therapy in Chinese children with partial-onset seizures / 中华实用儿科临床杂志

Objective:To evaluate the long-term safety, tolerability and efficacy of Lacosamide add-on therapy in Chinese children with partial-onset seizures.Methods:SP848 was a global multicenter single-arm study involving 60 Chinese children with partial-onset seizures with the age of 4-17 years who were managed by Lacosamide add-on therapy at seven hospitals across China from April 2018 to May 2019.After treatment with at least two kinds of anti-seizure medications simultaneously or sequentially, partial seizures were still poorly controlled and Lacosamide oral solution (syrup) or tablets were added.The minimum initial oral dose was 2 mg/(kg·d), and the maximum allowable dose was 12 mg/(kg·d)or 600 mg/d during the study period.The dose was adjusted according to the tolerance and seizure control level of partial-onset seizures children.Seizure frequency and the median percentage change in partial-onset seizures per 28 days from baseline to the final visit were recorded, including 50% responder rate and 75% responder rate.Results:A total of 60 Chinese children with the mean age of 9.18 (4.00-15.40) years were included in this interim analysis, involving 39 males and 21 females.The mean course of epilepsy was 5.04 (0.50-15.20) years.A total of 43 patients (71.7%) still have been treated.One patient (1.7%) has completed the 6-12 months of follow-up, and 14 patients (23.3%) have completed the follow-up for less than 6 months.The median change in the frequency of partial seizures every 28 days from baseline to the last visit was -2.91, with its median percentage as -25.46%, and the proportions of ≥50%, while ≥75% responder rate were 40.0% and 28.3%, respectively.A total of 52 patients (86.7%) had 265 treatment emergent adverse events (TEAE), 11 patients (18.3%) had 19 serious TEAE, 37 patients (61.7%) had 127 drug-related TEAE, and 11 patients (18.3%) had 16 TEAE leading to the discontinuation of the trial.The most common TEAE were upper respiratory tract infections (20 cases, 33.3%), followed by drowsiness (16 cases, 26.7%), dizziness (15 cases, 25.0%) and vomiting (13 cases, 21.7%). There were no abnormal changes in the electrocardiographic findings during the treatment.Conclusions:For Chinese patients with partial seizures who are older than the age of 4 years and poorly controlled by other drugs, Lacosamide is effective and well tolerated as an add-on therapy drug.The safety characteristics are consistent with those reported in children and adults.No new safety concerns are identified.

Clinical application of a self-developed bone dust collector in mastoid cavity obliteration following mastoidectomy / 中华耳鼻咽喉头颈外科杂志

Objective@#To introduce a self-developed bone dust collector designed by the authors and evaluate its efficiency in mastoid obliteration following mastoidectomy.@*Methods@#Consecutive patients, from April 2017 to March 2018, who prepared to receive mastoidectomy were randomly divided into two groups, and in each group the bone dust was harvested by self-developed bone dust collector or by conventional used method respectively in mastoidectomy. The amount of the harvested bone dust and the time consumed in the collecting procedure were compared between two groups. The infection of the bone dust after mastoid obliteration was also evaluated during follow up.@*Results@#33 patients were recruited in bone dust collector group, and 31 patients in conventional method group.There is no significance of difference between two groups in sex ratio, age and pneumatization of mastoid cells (P>0.05 for all). The median amount of bone dust harvested by bone dust collector was significantly larger than that collected by conventional method (1.8 g vs 1.1 g, P<0.05). The median time spent in bone dust collector group was significantly shorter than that spent in conventional method group (4 minutes vs 6 minutes, P<0.05). No bone dust infection was found in the follow-up in all patients.@*Conclusion@#The present self-developed bone dust collector is a easy and useful apparatus which can significantly improve the efficiency of collecting bone dust in mastoidectomy.

Acute encephalopathy with biphasic seizures and late reduced diffusion / 中华实用儿科临床杂志

Acute encephalopathy is a common childhood disease,especially in the nervous system of infants and young children. Recently,a new subtype of childhood acute encephalopathy named acute encephalopathy with bi-phasic seizures and late reduced diffusion (AESD)has been reported. The patients present with persistent febrile sei-zures,long - term cognitive impairment and local brain atrophy. Acute infantile encephalopathy predominantly affecting the frontal lobes is a special type of AESD,which mainly impair the frontal lobe the improvement of understanding and early diagnosis of acute encephalopathy in children is particularly important.

Ocular and cervical vestibular evoked myogenic potentials in patients with peripheral vestibular disorders / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To observe the ocular vestibular evoked myogenic potential (oVEMP) and the cervical vestibular evoked myogenic potential (cVEMP) in patients with vestibular diseases.@*METHOD@#From March, 2011 to March, 2012, 13 patients (14 ears) with peripheral vestibular diseases were recruited. Each patient underwent conventional oVEMP and cVEMP examinations elicited by intensive air conducted sound (short tone burst, 500 Hz) in bilateral ears.@*RESULT@#Thirteen cases (14 ears) were included in this study. They were 3 cases (3 ears) with Ramsay Hunt syndrome, 3 cases (4 ears) with acoustic neuroma, 1 case (1 ear) with VII and VIII cranial nerve trauma after head injury, 2 cases (2 ears) with vestibular neuritis, 3 cases (3 ears) with Meniere's disease, and Icase (1 ear) with unilateral hypoplasia of the internal auditory canal. Altogether, oVEMP could be elicited in only 2 ears (14. 3%) and cVEMP were found abnormal in 11 ears (78. 6%).@*CONCLUSION@#The otolithic vestibular end organs and their input pathways could be examined by cVEMP and oVEMP examinations in patients with peripheral vestibular disorders.

Clinical characteristics in four pediatric patients with mild encephalitis/encephalopathy with a reversible splenial lesion of corpus callosum / 中华神经科杂志

Objective To investigate the clinical and imaging features of mild encephalitis/encephalopathy with a reversible splenial lesion of corpus callosum (MERS) in children.Methods Four patients of MERS, who were diagnosed and treated in the First Hospital of Jilin University during 2013-2014, were collected retrospectively.Their clinical, laboratory, radiologic data and the related literatures were reviewed.Results Four patients onsetted as gastrointestinal symptom (3 cases) or respiratory (1 case) symptom, in accompany with disturbance of consciousness (3 cases of drowsiness, 1 case of lethargy), convulsions (4 cases), headache (1 case) as the main symptoms.Abnormal neurological signs included positive cervical resistance (3 cases), positive bilateral Babinski sign (3 cases), bilateral chemosis (2 cases).Laboratory test showed the average blood sodium was 131.6 mmol/L, while the cerebrospinal fluid test only showed abnormality in 1 case.In etiology examination, 2 cases showed human rotavirus antigen positive, and Mycoplasma pneumoniae antibody was found positive in 2 cases.Cranial MRI showed reversible lesion in the splenium of corpus callosum (patchy iso-or hypo-intensity on T1 WI and apparent diffusion coefficient, hyper-intensity on T2WI, FLAIR and DWI, clear boundary).After active treatment, clinical symptoms disappeared within 1 week, and cranial MRI lesions disappeared within 2 weeks.Conclusion The clinical presentations of MERS, which is a clinical-radiological syndrome, are sudden onset and mild, with characteristic changes in brain MRI and good prognosis.

Ultrastructure and study of olfactory cell apoptosis in olfactory mucosa of rats suffering from chronic sinusitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the ultrastructure change and cell apoptosis in the olfactory mucosa of rats suffering from chronic sinusitis, and aim to elucidate the possible mechanism and provide a novel concept of therapy approach to olfactory disease caused by chronic sinusitis.@*METHOD@#Light microscope and transmission electron microscope were used to observe the ultrastructure changes in the olfactory mucosa of 20 rats suffering from chronic sinusitis and that in 20 cases of normal olfactory mucosa. By the method of TUNEL (TdT-mediated dUTP nick end labeling), we studied the apoptosis index (AI) in the olfactory mucosa of 20 rats suffering from chronic sinusitis and that in 20 cases of normal olfactory mucosa.@*RESULT@#(1) Observation by transmission electron microscope: In the olfactory epithelium of the rats group suffering from chronic sinusitis, the ultrastructure of the olfactory epithelium showed some abnormal changes: Olfactory epithelium cells showed a variety of degeneration ornecrosis, the olfactory epithelium were quite disorganized. Supporting cell nuclei were oval, the nuclei of the cell aggregated as the plaque and fringe collection, the density of cytoplasm decreased. Surface microvillus of the olfactory cells reduced and disappeared, part of the karyolemma defected like morphology change about cell apoptosis. Inflammatory cells infiltrated. Basement membrane was exposed and cells were quite disorganized. Olfactory gland cells were prismatic, cell spaces were widen and secretion increased in the cavosurface. In the olfactory mucosa of normal group, the ultrastructure of olfactory epithelium showed some normal changes: Olfactory epithelium were quite regularity, supporting cells and olfactory cells were radial arrangement, basement membrane were integrated, the structure of olfactory gland were completed, microvirus were in richet in cavosurface and slight of serositim were in the cavosurface; (2) The apoptosis index (AI) in the olfactory epithelium of the rats group suffering from chronic sinusitis was higher than that in normal group (P < 0.05).@*CONCLUSION@#There is a ultrastructural change from the surface to the inner of olfactory mucosa in rats suffering from chronic sinusitis. There is notable apoptosis in the olfactory epithelium and propria lamina of rats suffering from chronic sinusitis.