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Clippings
Theme: Pediatric
Neurology
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Jaya Shankar Kaushik
[email protected]
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Early ictal and interictal patterns in FIRES: The sparks before the
blaze. (Epilepsia. May 26, 2017. Doi: 10.1111/epi.13801.
[Epub ahead of print])
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Febrile infection related epilepsy syndrome (FIRES) is a catastrophic
epileptic encephalopathy which presents with explosive onset of
super-refractory status epilepticus in previously healthy children. This
retrospective case series of seven children with FIRES describes their
clinical and electroencephalographic characteristics. Testing for
infectious, autoimmune, paraneoplastic and metabolic etiology was not
contributory. Initial 12 hour EEG recording of all patients revealed
paucity of electrographic seizures that evolve to status epilepticus. It
also revealed delta beta complexes resembling extreme delta brush.
Seizure pattern consisted of focal fast activity >10 Hz evolving to
rhythmic spike wave complexes after 30-45 seconds. In few patients, the
rhythmic discharge shifted from one to other hemisphere. Authors believe
that these EEG findings could facilitate early recognition of FIRES, and
therapeutic decision-making.
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Amplitude integrated EEG compared with conventional video EEG
for neonatal seizures. (J Child Neurol.
2017:32:815-22)
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Amplitude integrated electroencephalography (EEG) has been used
increasingly for detection, monitoring and management of neonatal
seizures. This diagnostic accuracy study compared the accuracy of
seizure detection by amplitude-integrated EEG with conventional video
EEG in term and near-term infants at risk of seizures. Thirty-five
infants were subjected to simultaneous recording. Of the 169 seizure
episodes on video EEG, only 57 were identified by amplitude integrated
EEG. Amplitude integrated EEG had 86% sensitivity and 50% specificity
for detecting a true seizure. This study raises concern of routine use
of amplitude integrated EEG for detection of neonatal seizures.
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Ketogenic diet for pediatric super-refractory status
epilepticus. (Seizure. 2016;41:62-5)
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Ketogenic diet is a high fat, low carbohydrate and sufficient protein
diet that has proven efficacy in management of refractory epilepsy. The
present study explored the possible role of ketogenic diet in children
with super refractory status epilepticus (SRSE). Data of ten children
with SRSE with varied etiology (including Rasmussen encephalitis,
anti-NMDA receptor encephalitis, post-infectious mycoplasma
encephalitis, Lennox Gestaut syndrome and other genetic epilepsy) were
examined. Median duration of status epilepticus was 18 days and number
of antiepileptic drugs was 3.0 prior to initiation of diet. Nine out of
ten patients achieved resolution of SRSE, and were weaned off
anaesthetic support within 7 days and 15 days respectively. Only one
patient required supplementation secondary to side effect of diet.
Authors suggested a possible role of ketogenic diet in SRSE in children.
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Low-dose vs. high-dose corticosteroid therapy in
Bell’s palsy. (J Child Neurol. 2017;32:72-5)
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This retrospective data review compared the therapeutic efficacy of low
dose (1 mg/kg/day) and high dose (2 mg/kg/day) corticosteroids for
Bell’s palsy in children. Severity of idiopathic facial palsy was graded
according to House-Brackman grading. Data revealed no significant
difference in complete recovery in low dose and high dose groups at 1, 3
and 6 months of treatment. Authors proposed low dose steroids to be as
effective as high dose steroids for treatment of Bell’s palsy.
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Operational classification of seizure types by the
International League Against Epilepsy (ILAE). (Epilepsia.
2017;58:522-30)
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Key changes in the revised operational classification of seizure types
include: ‘partial’ seizure becomes ‘focal’; awareness is used as a
classifier of focal seizure (terminology of simple partial seizure is
replaced with focal seizure with preserved awareness); terms like
dyscognitive, simple partial seizure, complex partial seizure and
psychic are eliminated; ‘focal to bilateral tonic clonic seizure’
replaces secondary generalized seizure; new types introduced
(automatism, behavioral arrest, hyperkinetic, autonomic, cognitive and
emotional seizures) – others include myoclonic absence, eyelid myoclonia,
myoclonic atonia and myoclonic-tonic clonic seizures.
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