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Abstract: The purpose of this study was to evaluate positron emission tomography (PET) findings in patients diagnosed with infantile spasms and autism. This study includes 90 patients who were diagnosed with infantile spasms at the Department of Pediatric Neurology in the Istanbul University Medical Faculty between 1995 and 2007. Of the 90 patients, 15 patients who were diagnosed with autism using the Autism Behaviour Checklist and Childhood Autism Rating Scale and a control group of nine patients without autism but with infantile spasms underwent PET examination. Mean patient age (± standard error, SE) varied between 3years and 16years (7.8±4years), while the mean follow-up time (±SE) varied between 2years and 16years (average: 7.1±4years). Autism was present in 11 patients with symptomatic spasms and in four patients with cryptogenic spasms (p =0.009). On the PET scans of the 15 patients with autism, 13 (86.7%) had significantly decreased metabolic activity in the temporal lobe (p <0.001), nine (60%) had significantly decreased activity in the frontal lobe (p =0.004), and seven (46.7%) had significantly decreased activity in the parietal lobe (p =0.022). In our opinion, hypometabolism in the frontal and parietal lobes, in addition to that previously reported in the temporal lobe, plays a role in the development of autism in patients with infantile spasms. [Copyright &y& Elsevier]

Summary: Behçet''s disease is a systemic vasculitic disease characterized mainly by recurrent oral and genital aphthous ulcers, uveitis and skin findings. Central nervous system involvement is a serious manifestation. A case of acute meningeal syndrome secondary to Behçet''s disease is presented. Behçet''s disease should always be considered in differential diagnosis of acute meningeal syndrome without signs of viral infection, particularly in the context of multisystem manifestations. [Copyright &y& Elsevier]

Objective: We aimed to analyze the development of epilepsy in a patient group with periventricular leukomalacia followed at a tertiary pediatric neurology center. Patients and methods: The study included 108 children aged between 2 and 8 years with radiologically proven periventricular leukomalacia who had been regularly observed at the Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Pediatric Neurology outpatient clinic between January 2006 and December 2011. Results: Neonatal seizures were reported in 22 patients (20.3%), 14 of whom developed epilepsy. A significant correlation was found between neonatal seizures and prematurity and newborn asphyxia (p = 0.013 and p = 0.010, respectively). Epilepsy developed in 35 patients (32.4%), history of neonatal seizures and more severe loss of white matter, periventricular hyperintensity and corpus callosum involvement were found to be correlated with epilepsy (p = 0.001, p = 0.004, p = 0.016, and p = 0.004, respectively). The most common seizure pattern observed was generalized tonic clonic seizures (n = 13) and complex partial seizures (n = 11). Those with focal EEG findings had a significantly better neurodevelopmental and cognitive level than those with multifocal/generalized EEG findings (p = 0.024). Seizures continued with varying frequency in 14 epileptic patients (40%) despite antiepileptic treatment. Conclusion: Almost a third of patients with periventricular leukomalacia develop epilepsy that can be intractable in substantial part. Neonatal seizures and severe MRI findings are important clues that can indicate the development of epilepsy in these patients. [ABSTRACT FROM AUTHOR]

Floppiness in an infant may have a number of different etiologies from disorders of the brain to spinal cord lesions, neuropathies, neuromuscular junction disorders and myopathies.In this study we aimed to investigate the correlation of muscle ultrasonography (US) and electromyography (EMG) in the diagnosis of floppy infants.The study encompassed 41 floppy infants aged 2–24 months. The muscle US and EMG examinations were performed without awareness of the clinical diagnosis. The final diagnosis was established by molecular genetic tests or muscle/nerve biopsy. The neurogenic group consisted of 16 infants according to their US and EMG findings. Fifteen of them had spinal muscular atrophy proven by genetic analysis and one had polyneuropathy diagnosed by nerve biopsy. Six infants were in the myopathic group according to their muscle US and EMG results. All of them underwent muscle biopsy and microscopic examination revealed five congenital muscular dystrophy and one glycogen storage disease. In two infants the US and EMG data conflicted. Their biopsies were also insufficient for the diagnosis. Seventeen infants had normal US and EMG findings but pathologic cranial magnetic resonance imaging or metabolic/genetic tests. They were considered in the group of central hypotonia.Our results suggest a high concordance of US and EMG findings in the diagnostic work-up of neurogenic and myopathic disorders. [Copyright &y& Elsevier]

Abstract: Aim: The aim of this study was to evaluate the application of complementary and alternative medicine (CAM) in pediatric epilepsy patients. Methods: The parents of 202 epilepsy patients being followed at the Pediatric Neurology outpatient clinic of the Istanbul Medical Faculty were interviewed face-to-face between November 2010 and February 2011. Results: At least one CAM method had been used by 95% of interviewed families. Religious practices were used by 94.1% of families. Non-religious spiritual practices were used by 9.9% and other alternative treatment methods by 27.7%. Families had started to use CAM at the suggestion of their doctor in 6.9% of the cases. Compared to the medium and high-income group, religious practices (96.8% vs 64.7%, p: 0.000) and regular prayer (92.4% vs 58.8%, p: 0.000) were significantly more prevalent in the low-income group. Regular prayer was more common in families where patients had moderately frequent or frequent seizures, while families of patients with rare seizures more commonly used religious practices other than regular prayer (p: 0.038, 0.027). The number of antiepileptics used and special education were found to correlate with the use of other alternative treatment methods (p: 0.002, 0.000). Families of patients with rare seizures are more inclined to see benefit in CAM (p =0.043). Conclusion: Religious practices are the most frequently used type of CAM in families with epileptic children. The economic status of the parents and the course of the disease are the main factors that influence the choice between religious, spiritual and other CAM practices and the perception of benefit from them. [Copyright &y& Elsevier]

Abstract: This study evaluated etiologic and risk factors affecting long-term prognoses of neurologic outcomes in newborns with neonatal seizures. We enrolled patients at chronologic ages of 23-44 months, referred to the Department of Pediatric Neurology, Istanbul Medical Faculty, from January 1, 2007-December 31, 2009, after manifesting seizures in their first postnatal 28 days. Of 112 newborns, 41 were female, 71 were male, 33 were preterm, and 79 were full-term. Perinatal asphyxia (28.6%) and intracranial hemorrhage (17%) were the most common causes of neonatal seizures. Cerebral palsy developed in 27.6% of patients during follow-up. The incidence of epilepsy was 35.7%. Almost 50% of patients manifested developmental delay in one or more areas. Global developmental delay was the most common (50.8%) neurologic disorder. The correlation between gestational age or birth weight and adverse outcomes was nonsignificant. Etiology, Apgar score, need for resuscitation at birth, background electroencephalogram, neonatal status epilepticus, cranial imaging findings, type/duration of antiepileptic treatment, and response to acute treatment were all strong prognostic factors in neurologic outcomes. Neonatal seizures pose a threat of neurologic sequelae for preterm and full-term infants. Although the number of recognized etiologic factors in neonatal seizures has increased because of improvements in neonatology and diagnostic methods, perinatal asphyxia remains the most common factor. [Copyright &y& Elsevier]