Evaluation of Patients With Febrile Seizure: Risk Factors, Reccurence, Treatment and Prognosis.

INTRODUCTION: Febrile convulsion (FC) is the most common neurological disorder in childhood. The aim of this study was to determine the risk factors for recurrence and the development of epilepsy from the demographic data of these patients. METHODS: A retrospective study was made of 680 patients with FC who presented to our hospital. Patients with only FC were defined as group 1 and those who developed epilepsy after FC as group 2. Comparisons were made between the 2 groups of the demographic parameters, parental consanguinity, familial history of FCs or epilepsy, criteria for starting prophylactic treatment, response to treatment, risk factors for recurrence, and results of electroencephalogram. RESULTS: The study included a total of 680 patients comprising 399 males (59%) and 281 females (41%). A diagnosis of FC was made in 652 cases (95.8%, group 1), and epilepsy was diagnosed in 28 (4.2%, group 2). A positive familial history of FCs was determined statistically significantly higher in group 1. On the other hand, a history of pathological birth and parental consanguinity was found higher in group 2. Prophylactic treatment was administered to 89.3% of group 2 and 40.3% of group 1. CONCLUSIONS: Febrile convulsions create fear and panic in the family and are a significant health problem in Turkey. The conclusion that has been reached is that the unnecessary administration of prophylactic treatment could be prevented with education of the families on the subject of fever and correct identification of patients at risk of developing epilepsy.

A rare cause of mental motor retardation: recessive congenital methemoglobinemia type II.

Recessive congenital methemoglobinemia (RCM) is a very rare disorder caused by NADH- cytochrome b5 reductase (cytb5r) deficiency. It has been classified into four types. Type I presents with mild cyanosis due to a significant deficiency of cytb5r in erythrocytes only. In type II, the deficiency occurs in all tissues and causes growth and mental retardation and other neurological impairments. RCM types I and II are caused by a defect in a single gene, which is located on chromosome 22 (locus DIA 1: q 13.31-qter). Prenatal diagnosis is possible. Cyanosis can be well treated by 200-500 mg of ascorbic acid daily; there is no effective therapy for the progressive neurological impairments. This report presents two siblings with central cyanosis, growth retardation, mental retardation, microcephaly, dystonia and hypertonia diagnosed as RCM type II.

Attitudes of parents and physicians toward febrile seizures.

OBJECTIVES: Although febrile seizures are common in children, attitudes may change among parents. The management of a child may differ depending on the specialty of the attending physician. This study was carried out to analyze attitudes of Turkish parents and physicians toward febrile seizures. MATERIAL AND METHODS: 308 children with febrile seizure who were admitted to the Department of Pediatric Neurology at Dr Sami Ulus Children's Hospital and Gazi University in Turkey between January 2006 and March 2007 were enrolled. RESULTS: Prior to seizure, approximately half of the parents took appropriate steps in reducing fever. The data also showed that there was a wide variation of treatment practice depending on the specialty of the attending physician. DISCUSSION: Educational level and economic status are important variables affecting attitudes of parents toward fever and febrile seizure. The management of the child with a febrile seizure differs even within the same specialty in Turkish physicians.

Sinusitis in children and adolescents with chronic or recurrent headache: a case-control study.

The aim of this study was to determine the frequency of misdiagnosis of sinus headache in migraine and other primary headache types in the children and adolescents with chronic or recurrent headaches. Children with chronic or recurrent headaches (n = 310) were prospectively evaluated. Data collection for each patient included history of previously diagnosed sinusitis due to headache, and additional sinusitis complaints (such as fever, cough, nasal discharge, postnasal discharge) at the time of sinusitis diagnosis, and improvement of the headache following treatment of sinusitis. If sinus radiographs existed they were recorded. The study included 214 patients with complete data. One hundred and sixteen (54.2%) patients have been diagnosed as sinusitis previously and 25% of them had at least one additional complaint, while 75% of them had none. Sinusitis treatment had no effect on the headaches in 60.3% of the patients. Sinus graphy had been performed in 52.8%, and 50.4% of them were normal. The prevalence of sinus headache concomitant with primary headache, and only sinus headache was detected in 7 and 1%, respectively, in our study. Approximately 40% of the patients with migraine and 60% of the patients with tension-type headache had been misdiagnosed as "sinus headache". Children with chronic or recurrent headaches are frequently misdiagnosed as sinus headache and receive unnecessary sinusitis treatment and sinus graphy.

Devic's neuromyelitis optica in an infant case.

Devic's neuromyelitis optica was orginally described as an acute severe monophasic syndrome characterised by myelitis and optic neuritis. The mean age at onset was reported to be around 40 years, with a wide range. However, Devic's neuromyelitis optica has also been seen in children. Prognosis of the syndrome was poor, and no satisfactory treatment was known. This article reports a 23-month-old boy with acute myelitis and optic neuritis who was diagnosed with Devic's neuromyelitis optica. The response of the patient to therapy was poor, and he developed severe sequelae.

Prothrombotic risk factors in children with hemiplegic cerebral palsy.

BACKGROUND: The purpose of the present paper was to investigate the prevalence of prothrombotic risk factors associated with hemiplegic cerebral palsy (CP). METHODS: Twenty-three hemiplegic CP patients were tested for inherited and acquired prothrombotic risk factors, except methylene tetrahydrofolate reductase (MTFR) polymorphism. RESULTS: A total of 56.5% of patients had at least one coagulation abnormality and 13% of them had two. Four patients (8.7%) had infection and congenital heart disease, who also had additional coagulopathy risk factors. Obstetric problems were detected in 56.5%. Coagulopathy risk factors were factor V Leiden mutation (21.7%), protein C deficiency (21.7%), elevated lipoprotein-a (13%), G20210A mutation of prothrombin (8.7%), and protein S deficiency (4.3%). CONCLUSION: Children with hemiplegic CP need to be evaluated for coagulopathic abnormalities.

Bilateral basal ganglia lesions after hypoglycemic coma in a 6-year-old child.

Imaging findings of brain damage due to neonatal hypoglycemia are known; however, the effect of childhood hypoglycemia on the brain has not been described well. The authors present the case of a 6-year-old girl who had seizures secondary to hypoglycemia followed up for 1 year as epilepsy. The patient had experienced a hypoglycemic coma attack about 1 year before. Brain magnetic resonance imaging showed atrophy of the cerebrum and cerebellum and bilateral symmetrically hyperintense lesions in the putamina. The patient was diagnosed with hypoglycemia due to hyperinsulinism.

Progressive vacuolar myelopathy and leukoencephalopathy in childhood acute lymphoblastic leukemia and transient improvement with vitamin B12.

Vacuolar myelopathy (VM) in leukemia is rare. We report a boy with leukemia who developed isolated central nervous system (CNS) relapse during reinduction therapy. 5 months after cranial radiotherapy, he gradually developed quadriparesis. Magnetic resonance imaging revealed an intramedullary lesion which extended through the cervical spine. Serum vitamin B12, folic acid, cerebrospinal fluid methyl malonic acid were normal. Viral screening by ELISA was negative. He had lymphopenia, and reduced immunoglobulins, from a cardiac arrest. Biopsy revealed VM. He responded to weekly vitamin B12 treatment but on the 6th week of the therapy he died after developing periventricular, gliotic, hyperintense lesions in the brain.

Fixation-off sensitivity and generalized epileptic EEG induced by eyes closed.

This report describes a female with eyelid fluttering with absence seizures, infrequent generalized tonic-clonic seizures, and mild mental retardation. Interictal and video-electroencephalography evaluations revealed normal activity while eyes were open but continuous generalized discharges with eyes closed (eyes closed induced abnormality), as well as fixation-off sensitivity. This patient is in the group of a pure and distinct clinical form of fixation-off sensitivity cryptogenic generalized epilepsy.