Cerebellar and subcortical blood flow abnormalities in children with partial epilepsy.

Cerebellar and cerebral subcortical blood flow in 41 children with partial epilepsy and 6 normal controls was investigated during the interictal state using single photon emission computed tomography with technetium-99m hexamethylpropyleneamineoxime. Seventeen of 41 patients had been treated with antiepileptic drugs (AEDs) for 4.65 +/- 3.80 years (range 0.2-12) and 24 patients were drug-free. Unilateral hypoperfusion of cerebellum and cerebral subcortical gray matter was demonstrated in 11 (28%) and 16 (40%) patients, respectively. Most of them also had focal cerebral cortical perfusion abnormalities, ipsilateral or contralateral to the cerebellar and cerebral subcortical hypoperfusion. The mean asymmetry indices of cerebellar blood flow in the medicated and the unmedicated patients were significantly higher than in the control cases (P < 0.02 and P < 0.04), whereas the differences in the asymmetry indices in cerebral subcortical areas were insignificant. AED therapy did not affect the perfusion of cerebellum and cerebral subcortical regions (P > 0.05 and P > 0.05). Our results suggest that functional alterations on anatomically connected remote areas in patients with partial epilepsy are not related to the drug effect and probably due to primary epileptogenic activity.

The effects of antiepileptic drugs on serum zinc and copper levels in children.

The results of previous studies that examined serum trace metal status of epileptic patients receiving antiepileptic drug (AED) therapy were variable. We measured serum zinc (Zn) and copper (Cu) levels in 52 epileptic children who were treated with either carbamazepine (CBZ) or valproic acid (VPA) or with a combination of CBZ and VPA. Serum Zn levels were significantly lower in the epileptics than in the two control groups which consisted of 7 untreated epileptics and 12 normal children (p < 0.05). Combination therapy and monotherapy with CBZ increased serum Cu levels (p < 0.05). No significant alteration in serum Cu levels was observed with VPA monotherapy. Serum Zn and serum Cu concentrations of the untreated epileptics were not significantly different from those of normal controls. Our results indicate that serum trace metal homeostasis may be affected by AED therapy, but not by the convulsive disorder itself.

Serum lipids in epileptic children treated with carbamazepine and valproate.

UNLABELLED: Serum total cholesterol (TC), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C) and very low-density lipoprotein cholesterol, triglyceride, apolipoproteins A1 and B levels were studied in 57 healthy children and in 39 children with epilepsy who had been receiving carbamazepine (CBZ) (23 children) for 1.58 +/- 1.10 years or valproic acid (VPA) (16 children) for 1.34 +/- 1.11 years. In patients receiving CBZ, mean TC level, mean LDL-C level, mean TC/HDL-C ratio and mean LDL-C/HDL-C ratio-were significantly higher than controls. None of the mean levels of serum lipids evaluated in patients receiving VPA was significantly different from the corresponding control group mean. Changes in serum lipids correlated with neither duration of therapy or plasma antiepileptic levels nor age or gender. CONCLUSION: Our results suggested that CBZ, a hepaticenzyme-inducing drug, affects serum lipid status. Long-term prospective studies are necessary to determine whether chronic CBZ therapy is a risk factor for atherosclerotic disorders.

Efficacy of captopril treatment in children with steroid-resistant nephrotic syndrome.

We studied the efficacy of captopril, an angiotensin-converting enzyme inhibitor in treating persistent moderate or severe proteinuria in children with various glomerular diseases other than minimal-change nephrotic syndrome. Captopril was administered for 3 months to 15 normotensive and nonazotemic or mildly azotemic patients (12 boys, 3 girls) in whom corticosteroid and cytotoxic treatment had failed to induce remission. Urinary protein excretion decreased from 2873.14 +/- 1937.50 (mean +/- s.e.m.) to 1684.71 +/- 1463.13 mg/day (P < 0.05). The reduction in proteinuria was not related to a significant fall in systemic blood pressure or a change in renal function. Serum albumin did not rise and side effects due to captopril were not observed. We concluded that, in the short term, captopril can be used safely and effectively for decreasing the proteinuria of nephrotic children unresponsive to conventional therapy.