Safety and efficacy of levetiracetam and carbamazepine monotherapy in the management of pediatric focal epilepsy: a randomized clinical trial.

Due to the limited number of studies in children with focal epilepsy and the importance of choosing the most suitable drug to control seizures in children, the administration of the most effective medication with the most negligible adverse events is vital. This study aimed to evaluate the effectiveness and adverse events of carbamazepine vs. levetiracetam monotherapy in children with focal seizures. A monocentric, randomized, controlled, double-blind, parallel-group clinical trial was designed. This study was approved by the Iranian Registry of Clinical Trials (registration number: IRCT20170216032603N2) on June 19, 2020, and conducted at the neurology department of Imam Ali Hospital, Karaj, Iran, from February 2020 to March 2021. This study assessed 120 patients with recently diagnosed focal seizures aged 2 to 14. Patients were randomly divided into two groups, who received carbamazepine (CBZ) 15 to 20 mg/kg and levetiracetam (LEV) 20 to 40 mg/kg daily, respectively. Patients were evaluated for improvement and complications at weeks 4, 12, and 24. Out of 120 patients included in the study, six patients were excluded due to various complications of CBZ. The mean number of seizures at the end of the fourth, twelfth, and twenty-fourth weeks were 1.09 ± 0.75, 0.62 ± 0.27, and 0.39 ± 0.12 in the carbamazepine group and 1.11 ± 0.63, 0.52 ± 0.21, and 0.37 ± 0.11 in the LEV group, respectively (P > 0.05). Similarly, the number of seizure-free patients was 34, 44, and 48 in the CBZ group compared to 41, 50, and 54 in the LEV group, respectively (P > 0.05). On the other hand, the frequency of somnolence, dermatologic complications, and agitation was considerably higher in the CBZ group (P < 0.05). Although both medicines were equally effective in seizure control, CBZ was associated with considerably more adverse events and less patient compliance. Physicians should be aware of this difference to prevent unwanted consequences.

Neurological Involvements in COVID-19: A hospital-based study.

Objectives: The SARS-CoV-2 pandemic is the most challenging crisis in the contemporary world. Besides severe pulmonary involvement, the disease also has several extrapulmonary manifestations, and new signs and symptoms are associated with it every dayThe present study aimed to inquire about the frequency of neurological manifestations and risk factors of COVID-19. Materials & Methods: This retrospective, descriptive study included patients with neurological involvement admitted to the Alborz University of Medical Sciences academic hospitals from March 2020 to July 2020 with confirmed COVID-19 infection. The data included in the analysis were the patient's demographic information, underlying diseases, neurological manifestations, and laboratory findings. Results: The study included ninety-five patients with a mean age of fifty-nine. Neurological symptoms and signs were observed in 91.6% and 10.5% of the patients, respectively. The most frequently associated neurological symptoms of COVID-19 were fatigue (49.5%), headache (47.4%), and dizziness (45.3%). Furthermore, the most common neurological involvements included gait disorders (6.3%), cerebellar dysfunction (4.2%), and cerebrovascular accidents (3.15%). Positive troponin was shown to be the strongest predictor of neurological signs (OR=21, P=0.017), followed by WBC≥15,000 (OR = 20.75, P=0.018) and a history of respiratory disease (OR=7.42, P=0.007). Conclusion: Neurological symptoms were observed in more than 91% of the patients, while neurological signs were present in 10.5% of the COVID-19 patients. Additionally, positive troponin, WBC≥15,000, and a history of respiratory disease were the strongest predictors of neurological signs.

Levetiracetam for prophylactic treatment of pediatric migraine: A randomized double-blind placebo-controlled trial.

INTRODUCTION: Few drugs are available for migraine prophylaxis in children. Levetiracetam is a broad-spectrum anti-seizure drug that has been suggested to be effective in reducing adult migraine episodes. We assessed the safety and efficacy of levetiracetam in the prevention of pediatric migraine. METHODS: A randomized double-blind placebo-controlled trial was performed. Eligible participants were aged 4-17 years old with at least four migrainous episodes monthly or had severe disabling or intolerable episodes. Primary endpoints were the mean changes in monthly frequency and intensity of headaches from the baseline phase to the last month of the double-blind phase. Safety endpoint was the adverse effects reported. RESULTS: Sixty-one participants (31 taking levetiracetam and 30 taking placebo) completed the study. All had a significant reduction in frequency and intensity of episodes that was significantly greater in the levetiracetam arm. Sixty eight percent of individuals in the treatment group reported more than 50% reduction of episodes at the end of the trial compared with 30% in the placebo group (p-value: 0.007). Irritability, day-time sedation, and mild tic were reported. CONCLUSION: Levetiracetam may be useful in migraine prevention and may decrease migraine episodes and severity. TRIAL REGISTRATION: The study is prospectively registered with Iranian Registry of Clinical Trials; IRCT.ir, number IRCT2017021632603N1.

Age estimation by canines' pulp/tooth ratio in an Iranian population using digital panoramic radiography.

OBJECTIVE: Age estimation in adults is an important issue in forensic science. This study aimed to estimate the chronological age of Iranians by means of pulp/tooth area ratio (AR) of canines in digital panoramic radiographs. MATERIALS AND METHODS: The sample consisted of panoramic radiographs of 271 male and female subjects aged 16-64 years. The pulp/tooth area ratio (AR) of upper and lower canines was calculated by AutoCAD software. Data were subjected to correlation and regression analysis. RESULTS: There was a significant and inverse correlation between age and pulp/tooth area ratio of upper and lower canines (r=-0.794 for upper canine and r=-0.282 for lower canine; p-value<0.001). Linear regression equations were derived separately for upper, lower and both canines. The mean difference between actual and estimated age using upper canine was 6.07±1.7. CONCLUSION: The results showed that the pulp/tooth area ratios of canines are a reliable method for age estimation in Iranians. The pulp/tooth area ratio of upper canine was better correlated with chronological age than that of lower canine.

Diagnostic Value of Conventional and Digital Radiography for Detection of Cavitated and Non-Cavitated Proximal Caries.

OBJECTIVES: This study aimed to assess the diagnostic value of conventional and digital radiography for detection of cavitated and non-cavitated proximal caries. MATERIALS AND METHODS: Fifty extracted human premolars and molars were mounted in a silicone block. Charge-coupled device (CCD) and photostimulable phosphor plate (PSP) receptors and intra-oral films were exposed with 60 and 70 kVp with parallel technique. Two observers interpreted the radiographs twice with a two-week interval using a 5-point scale. Teeth were then serially sectioned in mesiodistal direction and evaluated under a stereomicroscope (gold standard). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated. RESULTS: Sensitivity of all three receptors for detection of enamel lesions was low (5.5-44.4%) but it was higher for dentin lesions (42.8-62.8%); PSP with 70 kVp and 0.03s exposure time had the highest sensitivity for enamel lesions, but the difference among receptors was not statistically significant (P>0.05). Sensitivity of all three receptors for detection of non-cavitated lesions was lower than that for cavitated lesions; PSP with 60 kVp and 0.07s exposure time had higher sensitivity and lower patient radiation dose for detection of cavitated and non-cavitated lesions, but the difference was not significant (P>0.05). CONCLUSIONS: Digital radiography using PSP receptor with 70 kVp is recommended to detect initial enamel caries. For detection of non-cavitated and cavitated dentin caries, PSP with 60 kVp is more appropriate. Change in kVp did not affect the diagnostic accuracy for detection of caries, and type of receptor was a more important factor.

Accuracy of Cone Beam Computed Tomography, Photostimulable Phosphor Plate Digital Radiography and Conventional Radiography for Detection of Artificial Cancellous Bone Defects.

OBJECTIVES: The optimal goal of radiography is to provide high-quality diagnostic images with the least patient radiation dose. The aim of this study was to evaluate the accuracy of cone-beam computed tomography (CBCT) and intraoral photostimulable phosphor plate (PSP) digital and film-based conventional radiography for detection of artificial cancellous bone defects. MATERIALS AND METHODS: Five dry human mandibles were used in this study. The mandibles were placed inside a water bath made of plexiglass plates; then PSP and CBCT scans were obtained. The mandibles were cut by a coping saw in buccolingual dimension and oval defects measuring 6.1×6.1 mm, 3×6.1 mm and 4×4 mm were created by a milling machine in the spongy bone. After fixing the two parts together (buccal and lingual), radiographs were repeated. Presence or absence of defects on images was evaluated and recorded by the two observers. Using SPSS 16, compatibility level, sensitivity, specificity and receiver operating curve (ROC) analysis were determined for each observer. RESULTS: The intraobserver agreement in all three imaging modalities was low to moderate (kappa≤0.613). The inter-observer agreement in all the three imaging modalities was moderate (kappa=0.406). The area under the curve (AUC) of the imaging modalities in each observation was not significantly different. The area under the curve based on defect size for the two observers was not significantly different either. CONCLUSION: Defects confined to spongy bone can be identified on film and PSP radiographs and CBCT scans. However, interpretation of PSP images and CBCT scans needs greater expertise and skills.