Iranian Journal of Child Neurology (IJCN)
Volume:1 Issue: 1, Summer 2006

Febrile convulsion (FC), an occurrence frequently encountered in everyday practice, is discussed in this article with a review of corresponding literature.Taking into account the extent of debate on the topic, from FC being considered a kind of epileptic seizure to its being viewed as a non-epileptic phenomenon, our aim is not to be judgmental regarding its nature in the present writing. Two distinct groups of children, who convulse with fever are described; one, the group whose neurological status is suboptimal and the other children who one who enjoy good health.In this review, the clinical aspects of management of fever, a forerunner of a seizure are emphasized. The other important aspect of handling a case of febrile convulsion consists of controlling the seizure, which should be done without any delay when it occurs.Nowadays, the drugs of choice are diazepines, used via the rectal, buccal or intranasal routes. The most important area of investigation is lumbar puncture in a child who has had a febrile convulsion, which will be discussed at the end.

Despite availability and administration of numerous antiepileptic drugs (AEDs) nearly 15% of childhood epilepsy cases are resistant to treatment; in traditional medicine however Nigella sativa L. (Black seed) has been known for its anticonvulsant effects.In this double–blind clinical trial conducted on children with refractory epilepsy we administered the aqueous extract of black seed as an adjunct therapy and compared the effects with those of a placebo. The study was performed between Sep 2003 and Nov 2004. The subjects received either extract or placebo for a period of four weeks and between these two periods for two weeks they received only their pre-existing anti-epileptic drugs (AEDs).The mean frequency of seizures decreased significantly during treatment with extract, (p-value =0/007).It can be concluded that the water extract of Nigella sativa L. has antiepileptic effects in children with refractory seizures that do not respond to known AEDS.

Acute inflammatory demyelinating peripheral neuropathy (Guillain-Barre-Syndrome) is by far the most common cause of immune-medicated peripheral nervous system disease in children; with the near disappearance of poliomyelitis, GBS is responsible for the great majority of cases of acute flaccid paralysis. So far, in several controlled studies, corticosteroids, plasmapheresis and IVIG have been utilized in pediatric patients, afflicted with GBS. Regarding IVIG therapy, two methods have been used; the high dose (1 gr/kg/day for 2 days), and the low dose (400mg/kg/day for 5 days). Review of literature shows that a faster rate of recovery can be accomplished in patients who receive total dose of IVIG in 2 days as compared to the dose being given over 5 days. In this study we have compared these two types of treatment in an investigation, conducted in the Mofid Children Hospital on pediatric patients who had sudden onset of acute flaccid paralysis, and were diagnosed as having GBS. Based on histories, physical examination and electrodiagnosis, subjects were divided in two groups, the high dose IVIG treatment, 1gr/kg/day for 2 days (experimental group), and the low dose IVIG treatment, 400 mg/kg/day for 5 days (control group). Statistical analyses were then carried out using the appropriate software. Result of this study showed a faster rate of recovery for patients in the high dose IVIG group; in this group duration of weakness of limbs was shorter and returning of DTR was faster than in controls. In fact, in this type of treatment, the relationship between high dose IVIG therapy and drug side effects was not significant. Base upon the finding in the present study, we conclude that the high dose IVIG therapy is superior to low dose, in view of faster duration of recovery and shorter hospital stay.Also we may infer that shorter hospital stay could be a factor in reducing of more nasocomial infection.In conclusion, we suggest using high dose IVIG treatment of choice in GBS.

Breath holding spells are one of the most frequent and important diagnostic challenges in pediatrics. The aim of this study, conducted on pediatric patients referring to the pediatric neurology clinic in Hormozgan province, was to evaluate therapeutic effects of iron on breath holding spells 35 children (19 males and 16 females), aged between 3 to 60 months, with a history of breath-holding spells, were included in the trial. To obtain all relevant data a specifically designed questionnaire requiring information on sex, age, age of onset of spells, type of spells, frequency of attacks before and after treatment with oral iron supplement, and determinants of body iron stores was completed for all the patients, based on the mother’s statements. The patients were treated by an oral iron preparation for three months. The age of onset of spells ranged between 6 to 24 months. The cyanotic type of spell was detected in 31 children, the pallid type in 3, and the mixed type in one child. There were 14 children with iron deficiency anemia and 20 children with reduced iron stores. Just one child had a normal iron profile. Complete therapeutic response was documented in 24 children, good response in 9, and poor response in one and in one child no change in frequency of spells was seen. Although no significant therapeutic difference was seen in the different response groups, it seems that iron supplement may play an important role in reducing breath holding spells in children.

The physiologic function of carnitine, oxidation of fatty acid and lipid metabolism, is severely affected in carnitine deficiency, secondary forms of which lead to renal tubular disorders and chronic renal failure. Reduction in serum carnitine has been frequently reported in patients and experimental animals treated with antiepileptic drugs, one of which, valproic acid has consistently been found to cause the deficiency; the antiepileptic drugs, valproic acid, has consistently been found to cause the deficiency. Previous results, however, regarding the effects of other antiepileptic drugs have been less consistent. Considering the controversial results available in lterarure, the aim of this study was to determine the effect of Valproic acid, Carbamazepine and Phenobarbital on serum carnitine levels in epileptic children.In the present study, serum carnitine levels were randomly monitored before and six months after therapy in 39 epileptic patients receiving the antiepileptic drugs mentioned. Patient blood samples were taken before and six months after treatment and L-carnitine level was determined using the UV enzymatic test (Rouche Kit) spectronic Genesis 2, 340 nm.Results showed a significant fall in the L-carnitine levels of epileptic children taking these drugs (P< 0.01).Considering the reducing effect of antiepileptic drugs on serum carnitine levels, it is recommended that a carnitine supplement be administered in pediatric epileptic patients to prevent the deficiency and related consequences caused by such therapies.

Febrile Convulsion is the most common convulsive disorder in children, occurring in 2 to 4% of the pediatric population and recurring in 30-50% of cases. Considering the varying recurrence rates reported, this study was conducted at the pediatric ward of the Shahid Beheshti General Hospital, between 2000-2001 to determine the frequency of recurrence and related risk factors in children presenting with their first episode of febrile convulsion A two–year cohort study was performed on 50 children presenting with the first attack of febrile convulsion. Patient demographic data including age, sex, type and duration of seizure, family history of febrile seizure or epilepsy and the interval between fever onset and occurrence of seizure were recorded in questionnaires. Those patients, for whom prophylactic medication was not administered, were followed at three–month intervals for up to one year. Findings were statistically analyzed using Fisher’s exact test. Recurrence was observed in twelve children (24%) out of the fifty, being most common in patients aged less than one year (54.4%). Recurrence rates among children with a positive family history of febrile convulsion, presence of complex febrile seizure and positive family history of epilepsy were 42.1%, 42.8% and 25% respectively. From among those children with a “less than one hour” interval between fever onset and occurrence of seizure, recurrence occurred in 43-7% of cases, while in those with a “more than one hour interval”, 14.7% experienced recurrence. Recurrence rates are increased by certain factors including age-below one year-, positive family history of febrile convulsion, and a “less than one hour” interval between time of fever onset and seizure occurrence.

Non-convulsive status epilepticus (NCSE) may present with several manifestations, many of which may not be obvious. The most important tool for the diagnosis of NCSE is the electroencephalograph (EEG) pattern. This is a case report of a boy 9 years of age presenting with severe and continuous headache. He had received chemotherapy for histiocytosis, diagnosed at the age of 3.5 years. No evidence of central nervous system (CNS) involvement was found. He was diagnosed as having NCSE and following anticonvulsant therapy the headache and EEG anomaly disappeared completely within 24 hours. Headache and seizure disorder may coexist in different situations; to our knowledge this maybe the first report of NCSE with headache as a sole manifestation.