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Background: The discovery of anti-myelin oligodendrocyte glycoprotein (MOG)-IgG and anti-aquaporin 4 (AQP4)-IgG and the observation on certain patients previously diagnosed with multiple sclerosis (MS) actually have an antibody-mediated disease mandated re-evaluation of pediatric MS series. Aim: To describe the characteristics of recent pediatric MS cases by age groups and compare with the cohort established before 2015. Method: Data of pediatric MS patients diagnosed between 2015 and 2021 were collected from 44 pediatric neurology centers across Türkiye. Clinical and paraclinical features were compared between patients with disease onset before 12 years (earlier onset) and ≥12 years (later onset) as well as between our current (2015–2021) and previous (

Amaç: Katılma nöbeti çocukluk yaş grubunda görülen epileptik olmayan paroksismal bir olaydır. Patofizyolojisi tam olarak aydınlatılamamıştır. Hipoksi neden ya da sonuç olsa da hipoksinin çocukta yaptığı hasar önemlidir ve maruziyeti azaltılmalıdır. Bizim çalışmamız katılma nöbeti olan çocuklarda palatintonsil hipertrofisinin ve yumuşak doku evrelemesinin katılma nöbeti üzerine etkisini ve ilişkisini göstermeyi amaçlayan ilk çalışmadır.Gereç ve Yöntemler: 2012-2016 yılları arasında en az bir senedir takipli demir eksikliği anemisi olmayan ve sık enfeksiyon geçirmeyen 8-56 ay arasında toplam 90 çocuk (katılma nöbeti olan/kontrol: 45/45) retrospektif olarak tarandı ve çalışmaya dahil edildi. Katılma nöbeti tanısı hikaye ve klinik gözlemlerinden ve videolardan konuldu. Katılma nöbeti olan hastaların yaşa ve cinsiyete göre atak süreleri, atak tipleri palatotonsil ve yumuşak damak evreleri kendi arasında ve kontrol grubu ile karşılaştırıldı.Bulgular: Hastaların ortalama yaşları 28.9±12.9 (8-56) aydı. Katılma nöbeti olan çocukların palatotonsil evre 1-2 (toplam %81.8) iken yumuşak damak evrelemeleri evre 2-3 (%78.9)’di ve kontrol grubu ile anlamlı farklılık vardı (p: 0.000). Siyanotik tipte katılma nöbeti olan çocuklarda tonsil büyüklüğü evre 2-3’di ve tonsil büyüklüğü ile katılma nöbeti sıklığı arasında pozitif korelasyon vardı (r: 0.315, p: 0.032). Katılma nöbeti süresi ortalama 3.5±1.3 dakikaydı. Palatotonsil büyüklüğü ve yumuşak damak evrelemesi ile atak süresi arasında da sırasıyla pozitif korelasyon mevcuttu (r: 0.459, p: 0.000; r: 0.734, p: 0,000).Sonuç: Biz bu çalışmada; demir eksikliği anemisi olmayan ve sık enfeksiyon geçirmeyen katılma nöbeti olan çocuklarda kontrol grubuna oranla palatotonsil hipertrofinin belirgin olduğunu, ancak yumuşak damağın daha ileri evrelerde olduğunu gösterdik. Sonuç olarak katılma nöbeti etyolojisinde ve nöbet süresinin uzamasında bu hastalarda ileri evre yumuşak damak hipertrofisi olması riski 1.5 kat artırır ve erken müdahele ile akip gerektirir., Objective: Breath-holding spells (BHS) are common paroxysmal events in earlychildhood with unknown pathophysiology. Hypoxia can be the cause or result of BHS and the damage caused by hypoxia is of paramount importance. Therefore, exposure to hypoxia should be minimized in children with BHS. The present study, for the first time in the literature, investigated the staging of palatinetonsil and soft palate hypertrophy in children with BHS and their relationship with BHS.Material and Methods: The retrospective study included 45 children with BHS with no iron deficiency and no complaints of frequent infections and had been followed up for a minimum of one year over between 2012 and 2016. A control group of 45 age-matched subjects. BHS was diagnosed based on patient history, clinical observations, and video records. Duration of spell, spell type, and the staging of palatinetonsil and soft palate hypertrophy were compared among the patients and with the control subjects in terms of age groups and genders.Results: Mean age was 28.9±12.9 (range, 8-56) months in the BHS group. In the same group, the patients had stage 1-2 palatinetonsil hypertrophy (total 81.8%) and stage 2-3 soft palate hypertrophy (78.9%) and a significant difference was found between the BHS and control groups (p=0.000). In patients with cyanotic BHS, tonsillar hypertrophy was grade 2-3 and a positive correlation was found between cyanotic BHS and tonsillar hypertrophy (r: 0.315, p=0.032). Mean duration of spell was 3.5±1.3 minand tonsillar hypertrophy established a stronger correlation with spell duration and soft palatinetonsil hypertrophy (r: 0.459, p=0.000;r: 0.734, p=0.000, respectively).Conclusion: The results indicated that the BHS patients with no iron deficiency and no complaints of frequent infections had greater palatinetonsil hypertrophy and a higher stage of soft palate hypertrophy compared to control subjects. We suggest that the presence of a high-stage soft palate hypertrophy increases the risk of developing BHS and the duration of spell by 1.5 times and thus requires early intervention and clinical follow-up.

Amaç: Otizm spektrum bozuklukları prevalansında son yirmi yıl içerisinde ortaya çıkan artış çevresel koşullardaki değişiklikler ile otizm arasındaki ilişkinin önemini yeniden tartışmaya açmıştır. Bu çalışma ile, çevresel bazı risk faktörlerini otizm hastalarında geriye dönük incelemeyi hedefledik.Gereç ve Yöntemler: Sağlık Bilimleri Üniversitesi Van Eğitim ve Araştırma Hastanesi Çocuk Nöroloji Polikliniği’nde otizm tanısı ile takip edilmekte olan hastalar geriye dönük olarak tarandı. Benzer yaş grubundaki sağlıklı çocuklar kontrol grubu olarak alındı. Bu iki grup; hipoksi ve prematürite varlığı, anne sütü alımı ve süresi, televizyon ile tanışma yaşı, televizyon, akıllı telefon ve tablet kullanım süreleri açısından incelendi.Bulgular: Çalışmaya otizm grubunda 66, kontrol grubunda 60 olmak üzere toplam 126 çocuk alındı. Gruplar arasında prematürite öyküsü ve hipoksik etkilenim açısından fark izlenmedi. Anne sütü hiç almayan çocuklar otizm grubunda daha yüksek sayıdaydı (p=0.018). Otizm tanısı alan hastaların daha kısa süre anne sütü almış oldukları görüldü (otizm:8.489.19 ay, kontrol:13.188.64 ay, p=0.001). Otizm grubunun ve kontrol grubunun televizyon ile tanışma yaşları arasında belirgin bir farklılık gözlenmedi. Otizm tanılı grupta dört saat ve üzeri televizyon izleme oranı belirgin derecede yüksekti (p=0.020). Benzer şekilde tablet ve akıllı telefon ile vakit geçirme süreleri otizm tanılı hastalarda anlamlı derecede yüksekti (p=0.001).Sonuç: Anne sütü almamış olmak ya da kısa süre anne sütü ile beslenme, otizm riski ile ilişkilendirilebilir. Televizyon, tablet ve akıllı telefon gibi ekran maruziyetlerinde artmış süre, otizme yatkınlığı olan çocuklarda kliniğin ortaya çıkmasını kolaylaştıran ya da tetikleyen bir faktör olabilir.

We aimed to determine the morphological and histological effects of zonisamide, sultiam, lacosamide, clobazam, and rufinamide on ovarian folliculogenesis in rats. Sixty female Wistar rats were divided into six experimental groups as control, zonisamide, sultiam, lacosamide, clobazam, and rufinamide groups; control solution and drugs were administered by gavage for 90 days. The number of healthy follicles in the control group was significantly higher than in the anti-medication groups (p 0.001), and the number of corpus luteum was significantly lower (p 0.001). There was a significant difference in the number of TUNEL positive apoptotic follicles between the control and drug groups (p 0.001). With EGF, IGF-1, and GDF-9 staining, a very strong immunoreaction was observed in the ovarian multilaminar primary follicle granulosa cells and oocytes in the control group compared to the drug group (p 0.001). Long-term anti-seizure medication with zonisamide, sultiam, lacosamide, clobazam, and rufinamide from prepubertal to adulthood causes apoptosis and disruption of folliculogenesis in the ovarian follicles of nonepileptic rats.

Objective: To evaluate the effectiveness and tolerability of clobazam therapy in the pediatric population in terms of seizure semiology, epileptic syndromes, and etiological subgroups. Methods: A retrospective cohort study was conducted consisting of 1710 epileptic children from eight centers in seven geographic regions of Turkey. The initial efficacy of clobazam therapy was evaluated after three months of treatment. The long-term effectiveness of the drug, overall seizure outcomes, and overall therapeutic outcomes were evaluated during 12 months of therapy. Results: Analysis of initial efficacy after the first three months of clobazam therapy showed that 320 (18.7 %) patients were seizure-free, 683 (39.9 %) had > 50 % seizure reductions, and 297 (17.4 %) had < 50 % seizure reductions. A positive response (seizure-free and >50 % seizure reduction) was determined for focal-onset (62.3 %) seizures, epileptic spasms (61.5 %), and generalized onset seisures (57.4). The highest positive response rate among the epileptıc syndromes was for self-limited epilepsy with centrotemporal spikes (SeLECTS). The highest negative response rate was for developmental and/or epileptic encephalopathies (DEEs). Magnetic resonance imaging (MRI) revealed a structural etiological diagnosis in 25.8 % of the cohort. A higher positive response rate was observed at MRI in patients with sequelae lesions than in those with congenital lesions. The seizure recurrence rate was higher in the patient group with epilepsy wıth genetic and metabolic causes, in individuals with more than one seizure type, and in those using three or more antiseizure drugs. Conclusions: This cohort study provides additional evidence that clobazam is an effective and well-tolerable drug with a high seizure-free rate (18.7 %), a significant seizure reduction rate (57.3 %), and with excellent overall therapeutic outcomes with a low seizure relapse rate and considerable reversible benefits in the pediatric population.

The purpose of this study was to compare HMGB-1, TLR4, IL-1β, IL-1R1, and TNF-α levels in patients with mild and severe epilepsy with those in a healthy control group. Children aged 4-17 years, diagnosed with epilepsy for at least three years and with no progressive neurological disease, metabolic disease or infection, were selected for the study. The severe epilepsy group consisted of 28 children with at least one episode a week despite receiving three or more antiepileptic drugs. The mild epilepsy group consisted of 29 children with no seizures in the previous year, receiving only one antiepileptic drug, while 27 healthy children were selected as the control group. HMGB-1, TLR4, IL-1R1, TNF-α and IL-1β levels were investigated in these three groups. The MRI findings and clinical characteristics of the patients in the epilepsy group were also compared with these markers. HMGB-1, TLR4, TNF-α, and IL-1β levels in the severe epilepsy group were higher than in the control group and the mild epilepsy group (p

Our aim was to perform the Turkish-language adaptation of a practical ataxia rating scale for children. The Brief Ataxia Rating Scale was subjected to cultural adaptation following receipt of the requisite permissions. Thirty-six children aged 4–18 years followed-up with a diagnosis of ataxia were included in the study. Evaluation of each child was recorded on video. The video recordings were scored independently by nine observers (four physiotherapists, one pediatric neurologist, and four pediatricians). Intra-rater reliability was tested by the same video images being scored twice, at 15-day intervals, by a pediatric neurologist. Intraclass correlation coefficients were used for inter-rater and intra-rater reliability. The Scale for the Assessment and Rating of Ataxia was used for concurrent validity. Good to excellent reliability was determined among the nine observers in terms of total scores with the intraclass correlation coefficient among the nine observers (intraclass correlation coefficient = 0.926; 95% CI: 0.885–0.956). Intra-rater reliability analysis results exhibited strong reliability in terms of scores elicited at two-week intervals (intraclass correlation coefficient = 0.967; 95% CI: 0.890–0.987, r = 0.97, p r = 0.942, p The Turkish-language adaptation of the Brief Ataxia Rating Scale is reliable and valid for application in children.Implications for RehabilitationThis study shows the reliability and validity of the Turkish language adaptation of brief ataxia rating scale in children.The scale being both practical and easily applicable to ataxic children will contribute to broadening its use in the pediatric age group in particular. This study shows the reliability and validity of the Turkish language adaptation of brief ataxia rating scale in children. The scale being both practical and easily applicable to ataxic children will contribute to broadening its use in the pediatric age group in particular.

Purpose To examine the effects of the COVID-19 pandemic on the lifestyle, habits, and behavioral differences in children, and their changing internet use habits. Methods The research was planned as a cross-sectional study involving 4892 children aged 8 to 17 years attending schools in the city center of Trabzon, Turkey. Children’s daily living activities, social habits, mood and temperament changes, and internet use were investigated before and during the pandemic. In terms of problematic internet use, internet addiction rates were evaluated using the validated Turkish-language version of the Parent-Child Internet Addiction Scale (PCIAT-20). Results The children’s mean age was 13 ± 2.45 years, and 17.1% (n = 837) exhibited problematic internet use features on the PCIAT-20. Problematic internet use was higher in boys and in children older than 13 years. The presence of COVID-19 infection among members of the household, quarantine measures, attending private schools, the mother’s occupation, the time spent by the mother and father on their mobile phones, and high parental education levels were associated with a high level of internet addiction. Families also described significant changes in their children’s temperament and character compared with the pre-pandemic period. Conclusion The prevalence of problematic internet use increased during the COVID-19 pandemic compared with previous studies from Turkey. Children were also more introverted, irritable, and pessimistic during the pandemic.

Bu çalışmada masum üfürüm düşünülerek, fizik muayene, elektrokardiyografi, telekardiyografi ve ekokardiyografi ile değerlendirilen hastaların, altta yatan kardiyak patolojiye sahip olma oranlarının görülmesi amaçlanmıştır. Ekokardiyografi kesin tanı yöntemi kabul edilerek pediatri araştırma görevlisi ve pediatrik kardiyoloji uzmanının fizik muayenelerinin sonucunda düşündükleri ön tanılarının doğruluk oranları karşılaştırılmıştır. Pediatrik Kardiyoloji Polikliniği’ne, üfürüm nedeni ile ilk kez başvuran, daha öncesinde bilinen kardiyak bir patolojisi olmayan olgular incelenmiştir. Olguların, birbirinden bağımsız olarak pediatri araştırma görevlisi ve pediatrik kardiyoloji uzmanı tarafından kardiyolojik muayeneleri yapılmış, elektrokardiyografi ve telekardiyografileri değerlendirilmiş, sonuçlar kesin tanı kabul edilen ekokardiyografi sonuçları ile karşılaştırılmıştır. Üfürüm nedeni ile başvuran 308 olgu vardı. Masum üfürüm düşünüldüğü halde kardiyak patoloji saptanan 49 olgunun 20’sinde atriyal septal defekt, 13’ünde ventriküler septal defekt, beşinde mitral yetmezlik, dördünde pulmoner stenoz, üçünde minimal aort yetmezliği, ikisinde atriyoventriküler septal defekt, birinde küçük patent duktus arteriozus ve birinde aort stenozu izlendi. Ekokardiyografik değerlendirme sonuçlarında dilate kardiyomiyopatinin eşlik ettiği üçüncü derece mitral yetmezliği olan bir olgu dışında tüm olguların sistolik ve diastolik fonksiyonları normal bulundu. Pediatri kardiyoloji uzmanının ve pediatri araştırma görevlisinin masum üfürümü tanımadaki duyarlılıkları (sırasıyla; %88, %75), özgüllükleri (sırasıyla; %53, %36), pozitif kestirim oranları (sırasıyla; %90, %86), negatif kestirim oranları (sırasıyla, %31, %21) ve pozitif test sonucu olasılık oranları (sırasıyla; 1.88, 1.19) karşılaştırıldı. Masum üfürümü tanımadaki duyarlılıkları, özgüllükleri ve pozitif kestirim oranları pediatrik kardiyoloji uzmanında belirgin olarak yüksek bulundu. Telekardiyografi ve EKG ‘nin tanıya katkı sağlamadığı görüldü.

Background Amitriptyline ingestion is an important cause of poisoning morbidity and mortality in Turkey and other countries. In contrast to adults, data concerning amitriptyline intoxication in children are limited. The purpose of this study was to investigate amitriptyline intoxication findings in the pediatric population, based on age groups and reported dosages. Methods The medical records of 192 patients admitted to the Karadeniz Technical University Medical Faculty Farabi Hospital Pediatric Emergency Department, Turkey, due to amitriptyline intoxication in 1997-2017 were examined retrospectively. Patients were divided into 6 groups based on amitriptyline doses and 4 groups based on age. Complete blood count, blood glucose, serum electrolytes, renal and liver function tests, coagulation tests (prothrombin time and partial thromboplastin time), and blood gas analysis were studied in all patients. Electrocardiography was performed on all children, and chest radiography and electroencephalography on those with respiratory or central nervous system symptoms. Results Amitriptyline intoxication was most frequently observed between the ages of 1 and 4 years. The most common signs and symptoms observed at time of hospital admission were lethargy and drowsiness (45.3%), sinus tachycardia (19.2%), and nausea and vomiting (13%). The most common laboratory finding was hyperglycemia (17.7). Six patients were intubated because of respiratory failure, and mechanical ventilation was initiated in these cases. One patient with amitriptyline overdose had persistent supraventricular tachycardia. Four children died due to amitriptyline intoxication. Conclusions Tricyclic antidepressant intoxication is a leading cause of mortality and morbidity in children. It is therefore particularly important to identify the clinical and laboratory findings that develop with high-dose consumption.

Stevens–Johnson syndrome and toxic epidermal necrolysis are severe mucocutaneous reactions involving at least two mucosal surfaces and resulting in cutaneous eruption. They are frequently associated with infection and drug use. The best-known infectious cause is Mycoplasma pneumoniae, while antiepileptics are often among the drugs giving rise to these conditions. We describe two patients with suspected Stevens–Johnson syndrome and cutaneous eruption, which were primarily attributed to carbamazepine therapy. Another important shared feature in these two cases is that following an initial improvement in lesions in both patients, an increase in lesions and worsening of clinical picture after initiation of levetiracetam therapy was noted. One of the patients was found to be HLA-B 1502 positive, which is a known risk factor for carbamazepine-induced Stevens–Johnson syndrome. Levetiracetam therapy, which is regarded as safe in terms of cutaneous reactions, if chosen following such reactions due to another antiepilepsy medication, may be capable of reactivating Stevens–Johnson syndrome and toxic epidermal necrolysis as was seen in our patients.

GİRİŞ ve AMAÇ: Çocuklarda, dikkat eksikliği ve hiperaktivite bozukluğu (DEHB) epilepsiyesıklıkla eşlik etmektedir. Bu birlikteliğin nedenleri konusundaki görüşlerfarklıdır. Epilepsiden önce veya sonra gelişen DEHB’de, epilepsi özelliklerininetkisi çalışılmamıştır. Bu çalışmada, DEHB ve epilepsi birlikteliği gösterençocukların verileri, bu ilişkiye yönelik ipuçları elde etmek amacıylaincelenmiştir.YÖNTEM ve GEREÇLER: Çocuk Nörolojisi polikliniğine ardışık olarak başvuran, epilepsi ve DEHBbirlikteliği gösteren 44 hastanın (33 erkek, 11 kız) verileri geriye dönükolarak incelendi. Çeşitli özelliklere göre ikili alt gruplarda istatistikselkarşılaştırma yapıldı.BULGULAR: DEHB 11hastada (%25) epilepsi bulguları öncesinde, 33 hastada (%75) ise epilepsisonrasında tanılanmıştı. Hastaların yaş ortalaması 11,5±2,7, ilk nöbet yaşları5,2±3, son nöbet yaşı 9,5±2,8, antiepileptik başlama yaşı 6,6±3,4, DEHB tanıyaşı 8,4±2 yıldı. Epilepsi sonrasında DEHB tanılananlarda, antiepileptiktedavinin başlangıç yaşı ve ilk nöbet yaşı daha küçüktü (sırasıyla, p=0,004 vep=0,002). İki gruptaki cinsiyet dağılımı, epilepsi tipi, DEHB tanı yaşı,elektroensefalografi ve beyin manyetik rezonans görüntüleme bulguları benzerdi.Epilepsi ve DEHB tanıları arasındaki sürenin anlamlı olarak kısa olduğuhastalar; ilk nöbet yaşı >5 ve antiepileptik başlama yaşı >6,5 yaşolanlardı (sırasıyla, p=0,013, p=0,000). Epilepsi ve DEHB tanıları arasındakisüre 1,5 yıldan uzun olanlarda, EEG anormalliği daha sıktı (p=0,044). Son nöbetve AEİ başlama yaşları; DEHB tanı yaşı ile pozitif korelasyon gösterdi(r=0,389, r=0,434, p, INTRODUCTION: Epilepsy isoften accompanied by attention deficit hyperactivity disorder (ADHD). There aredifferent opinions about reasons. The effect of epilepsy features was notstudied in ADHD before or after epilepsy. We aimed to obtain clues about thiscomorbidity in children.METHODS: Data of forty-four (33males, 11 girls) consecutive epilepsy patients with ADHD were retrospectivelyreviewed. The binary subgroups were statistically compared.RESULTS: ADHD wasdiagnosed before epilepsy in 11 (25%) and after epilepsy in 33 (75%) patients.The mean age was 11.5±2.7, the first and last seizure ages were 5.2±3 and9.5±2.8, antiepileptic drug (AED) starting and ADHD ages were 6.6±3.4 and 8.4±2years respectively. In patients with ADHD after epilepsy, AED and first seizureages were younger (p=0.004 and p=0.002, respectively). Gender, epilepsy type,ADHD age, electroencephalography and brain magnetic resonance imaging findingswere similar. There was a shorter interval time between ADHD and epilepsy inpatients with a first seizure age >5 and AED age >6.5 years (p=0.013 andp=0.000). EEG abnormalities were more frequent in patients with >1.5 yearstime interval between epilepsy and ADHD (p=0.044). The ages of last seizure andAED starting ages were positively correlated with ADHD age (r=0.389, r=0.434,p

Leukoencephalopathy with thalamus and brainstem involvement, and high lactate (LTBL) is a recently identified disease related to mutations in the EARS2 gene encoding glutamyl-tRNA synthetase. We report clinical and radiological findings for two siblings with new pathogenic mutations in the EARS2 gene. Both patients showed symptoms of mild-type disease, but there were clinical differences between the two siblings. While the older brother had hypotonia and delayed developmental milestones, the younger brother had seizures and spasticity in the lower extremities. Brain magnetic resonance imaging (MRI) findings were quite similar for the two siblings. MRI findings were specific to LTBL. MRI lesions of the older sibling had regressed over time. Clinical and radiological improvement, as in the previously reported patients with LTBL, may be an important clue for diagnosis.

Oxymetholone, an androgen analogue, is widely used in the treatment of Fanconi aplastic anemia (FAA). Androgen is known to cause cerebral venous thrombosis (CVT). A 9-year-old girl under monitoring with a diagnosis of FAA presented to our hospital with severe headache. She had been receiving oxymetholone therapy for 1 year. Neurological examination was normal. Superior sagittal sinus thrombosis was detected at magnetic resonance imagining (MRI) of the brain. The thrombosis was thought to be oxymetholone-related, and oxymetholone therapy was discontinued. The patient was started on enoxoparin therapy and the symptoms resolved. Control images 4 months later were normal. We think that the risk of venous thrombosis must be considered with administering oxymetholone therapy in patients with FAA. [Med-Science 2017; 6(3.000): 576-8]

Dyke-Davidoff-Masson syndrome (DDMS) was first described in 1933 as a clinical condition characterized by hemiatrophy, hyperpneumatization of paranasal sinuses, contralateral hemiparesis, facial asymmetry, seizures, and mental retardation.1 DDMS can be of 2 types: congenital and acquired. The congenital type can be caused by various conditions experienced during fetal or early childhood development, including ischemia, infarction, trauma, infections, and hemorrhage. The acquired type is mostly associated with hemorrhage, trauma, and infections experienced after 1 month of age. DDMS can manifest alone or can be accompanied by crossed cerebellar atrophy (CCA) which is a newly discovered radiological marker characterized by prominent cortical sulci and loss of cerebellar parenchyma. The congenital type of DDMS is known to be accompanied by ipsilateral cerebellar atrophy and the acquired type is known to be accompanied by contralateral cerebellar atrophy.2,3 Supratentorial events may lead to destruction in the cortico-ponto-cerebellar pathways, mostly in the contralateral side of the body (80%) due to decussation.4 In this report, we present 2 cases of DDMS accompanied by CCA to emphasize the possibility that the DDMS cases with severe intrauterine hemorrhage can be accompanied by contralateral CCA and migratory abnormalities rather than ipsilateral CCA and clinical survey.

Introduction: Fluid intake was reported to reduce migraine attacks. This may be due to its effect on hemoconcentration. Hemoconcentration may manifest itself by increasing in the hemoglobin and platelet-related values. This study aimed to reveal hemoconcentration by evaluating complete blood cell counts in attack-free periods of pediatric patients with migraine. Materials and Methods: Consecutive children with migraine (n = 70) and tension-type headache (TTH) (n = 65) were compared with the control groups. Control 1 (n = 70) and control 2 (n = 60) groups consisted of age- and gender-matched patients, respectively. Control 2 group patients had gastrointestinal symptoms leading to fluid loss, which may have caused hemoconcentration. To evaluate hemoglobin and platelets together, the M1-value was created by multiplying hemoglobin level by plateletcrit. Results: The M1-value was higher in the migraine group than in control 1 and TTH groups (P = 0.017 and 0.034) and the hemoglobin and hematocrit levels were also higher in the migraine group than in control 2 group (P = 0.013 and 0.012). Female patients with migraine had higher hemoglobin levels as compared to the female patients in control group 1 (P = 0.041). Male patients with migraine had higher M1-values than the male patients in control group 1 (P = 0.034). In the subgroup of migraine with aura (n = 10), folic acid was significantly lower than the other patients with migraine (P = 0.02). Conclusion: This study suggests that migraine may be accompanied with hemoconcentration in children.

Background Wernicke`s encephalopathy (WE) is a coenzyme-induced disease with acute neuropsychiatric symptoms leading to high mortality and morbidity due to thiamine deficiency. WE is mostly caused by alcoholism in adult populations; however, it is often associated with gastrointestinal surgical procedures, recurrent vomiting, chronic diarrhea, cancer and chemotherapy treatment, systemic diseases, drugs, magnesium deficiency, and malnutrition in children. Although these predisposing factors are considered to be uncommon in children, they are actually highly frequent and can be fatal if not treated promptly. Case In this report, we present a patient who developed diplopia during total parenteral nutrition following surgical resection and was diagnosed with WE. The findings of the patient's cranial magnetic resonance imaging (MRI) findings were consistent with those of WE and the ocular findings of the patient resolved completely after thiamine treatment. Conclusion Although WE is rare in children it can be prevented by early diagnosis and treatment and oculomotor findings such as diplopia can be a warning sign.

Objective: Since antiepileptic drug use is long-term, it may be important to know their effects on blood cell counts during the management of these patients. However, these effects have not been adequately evaluated in epileptic children. In our study, the effects of valproate, levetiracetam and carbamazepine on complete blood counts were assessed in children. MaterialandMethods: Material and methods: Consecutive epilepsy patients under monotherapy were reviewed retrospectively. Eighty patients, whose data were available before the treatment and at 2-6 months and 9-16 months after treatment initiation were included in the study. The ages at the start of the treatment were taken into consideration. Hemoglobin, hematocrit, erythrocyte, platelet and leucocyte counts, leukocyte subset percentages and the mean volume and distribution width of the erythrocytes and thrombocytes were recorded.Results:There were no statistically significant differences between the levels at pre-treatment and at 2-6 and 9-16 months after treatment initiation in the patients treated with levetiracetam (n=25) and carbamazepine (n=20). In the valproate group (n=35), there was an increase in mean corpuscular volume and monocyte percentage, and a decrease in platelet counts, in the first six months (p=0.015, p=0.001, p=0.005, respectively). At 9-16 months, the lymphocyte percentage increased while the neutrophil and eosinophil percentages decreased (p=0.016, p=0.014, p=0.01, respectively) in this group.Conclusion: In our study, valproate caused an increase in the percentage of lympho-monocytes and mean corpuscular volume, and a decrease in the platelet count, neutrophil and eosinophil percentages. These effects seem to be related to the fact that valproate is a histone deacetylase inhibitor., Amaç: Antiepileptik ilaçların kan hücreleri üzerine etkilerinin bilinmesi, uzun süreli kullanımları nedeniyle hastaların izleminde önemlidir. Bu etkiler, epilepsili çocuklarda yeterince değerlendirilmemiştir. Çalışmamızda; valproat, levetirasetam ve karbamazepin tedavisi alan epilepsili çocukların tam kan sayım üzerine, tedavinin etkileri incelenmiştir. GereçveYöntemler: Çocuk Nörolojisi polikliniğine ardışık olarak başvuran, idiopatik epilepsi nedeniyle tekli antiepileptik ilaç kullanan hastalar, geriye dönük olarak incelendi. Tedavi öncesi, tedaviden sonraki 2-6 ay ve 9-16 aydaki tam kan sayımı verileri olan 80 hasta çalışmaya alındı. Hastaların tedavi başlangıcındaki yaşları dikkate alındı. Hemoglobin, hematokrit, eritrosit, trombosit, lökosit sayıları, lökosit alt tip (lenfosit, nötrofil, monosit, eozinofil) oranları, eritrosit ve trombositlerin ortalama hacmi ve dağılım genişliği kaydedildi. Bulgular: Levetirasetam (25 hasta) ve karbamazepin (20 hasta) grubundaki hastaların, tedaviden 2-6 ay ve 9-16 ay sonrası değerleri ile tedavi öncesi değerleri arasında istatistiksel fark saptanmadı (p>0.05). Valproat (35 hasta) grubunda ise ilk 6 ayda, ortalama eritrosit hacmi ve monosit yüzdesinde artış, trombosit sayısında azalma saptandı (sırasıyla, p=0.015, p=0.001 ve p=0.005). Tedavinin 9-16 aylık döneminde, ek olarak, lenfosit oranında artış, nötrofil ve eozinofil oranında azalma vardı (sırasıyla, p=0.016, p=0.014 ve p=0.01).Sonuç:Çalışmamızda, valproat tedavisinin, lenfomonositer hücre oranı ve ortalama eritrosit hacminde artışa; trombosit sayısı, nötrofil ve eozinofil oranında azalmaya neden olduğu saptanmıştır. Valproat tedavisiyle ortaya çıkan bu etkiler, histon deasetilaz inhibitörü olmasıyla ilişkili görünmektedir.

WOS: 000456751500018 PubMed: 30584976 Objectives: The hippocampus is susceptible to damage in patients with epilepsy and in animals with seizures caused by excitotoxic agents. The effect of vitamin D on hippocampal apoptosis related with seizures has not been reported. However, epileptic patients have an increased risk of hypovitaminosis D which is most likely due to the effects of antiepileptic drugs. Therefore, in this study, it was aimed to evaluate the effects of vitamin D on hippocampal apoptosis related with seizures by using pentylenetetrazol (PTZ) and kainic acid (KA) in rats. Methods: Male Sprague Dawley rats, aged 5.5 weeks, were randomly divided into six groups: control, vitamin D, PTZ, KA, PTZ + vitamin D and KA + vitamin D groups. The groups that received vitamin D were given 500 IU/kg of vitamin D daily for two weeks in addition to a standard diet. At the end of this period, PTZ and KA were applied to trigger seizures in the rats in the seizure groups. 24 h after the administration of PTZ and KA, the rats were decapitated. In the hippocampal region, apoptosis was assessed by TUNEL and brain-derived neurotrophic factor (BDNF), Bax, caspase-3 and c-fos activation were evaluated by immunohistochemical method. Results: BDNF level increased while c-fos, Bax and caspase-3 levels decreased (p < 0.0001, in all) in the hippocampal neurons of the groups that were pre-treated with vitamin D before the administration of PTZ and KA, in comparison with the PTZ and KA groups. Vitamin D significantly decreased the number of apoptotic cells in these rats in comparison with the PTZ and KA groups (p < 0.0001). Conclusion: This study indicates that vitamin D has neuroprotective effects on hippocampal apoptosis induced by PTZ and KA in rats. With this study it is suggested that keeping vitamin D levels within normal limits may be beneficial for patients with epilepsy, especially children. Research Fund of the Karadeniz Technical University [5384] This study was financially supported by Research Fund of the Karadeniz Technical University (Project Number: 5384).

To investigate the potential toxic effects of levetiracetam monotherapy on ocular tissues in cases of pediatric epilepsy using optical coherence tomography (OCT). Thirty epileptic children (group 1) receiving levetiracetam monotherapy at a dosage of 20–40 mg/kg/day for at least 1 year with a first diagnosis of epilepsy and 30 age- and gender-matched healthy children (group 2) were included in the study. In addition to a detailed eye examination, peripapillary retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) thickness, foveal thickness (FT), and central corneal thickness (CCT) were measured in all children by means of spectral domain OCT. The data obtained from the two groups were then subjected to statistical analysis. The mean age of both groups was 12 ± 3.64 years [1–12]. The mean duration of levetiracetam in group 1 was 24.07 ± 12.82 months. Mean RNFL values in groups 1 and 2 were 106.1 ± 10.42 and 104.98 ± 10.04 μm, mean GCC values were 94.72 ± 6.26 and 94.4 ± 6 μm, mean FT values were 240.73 ± 17.94 and 240.77 ± 15.97 μm, and mean CCT values were 555.1 ± 44.88 and 540.97 ± 32.65 μm, respectively. No significant difference was determined between the two groups in terms of any parameter. Best corrected visual acuity values of the subjects in both groups were 10/10, and no color vision or visual field deficit was determined. Levetiracetam monotherapy causes no significant function or morphological change in ocular tissues in pediatric epilepsies.

Background The goal of this study was to explore the changes in serum antiepileptic drug levels and their relation with sex steroid levels during the menstrual cycles of adolescent girls. In addition, valproate and levetiracetam were compared in terms of their effects on body mass index, ovulation, and sex steroid levels. Methods Adolescent girls using valproate (n = 16) and levetiracetam (n = 9) were included in the study. Serum antiepileptic drug, progesterone, and estradiol levels were analyzed in two periods, when the levels of sex hormones might be the highest (midluteal phase) and the lowest (early follicular phase). Results Serum antiepileptic drug levels were not significantly different between the two periods in both antiepileptic drug groups. Serum antiepileptic drug levels during menstruation increased in 69.2% of the valproate group, whereas they decreased in 88.9% of the levetiracetam group ( P = 0.011). A positive correlation between serum valproate and progesterone levels ( r = 0.767, P = 0.001) and between levetiracetam and estradiol levels ( r = 0.259, P > 0.05) was present in the menstrual phase. Body mass index, body mass index percentile, z score, and ovulation rates were not different between the two groups. Conclusions This study indicates a strong correlation between valproate and progesterone levels in the early follicular phase of the menstrual cycle. The findings of this study also suggest that valproate and levetiracetam have different relationships with sex steroid levels, during menstrual cycle. Especially in catamenial seizures, taking this interaction into account may be beneficial.

Wernicke encephalopathy is an acute neurological problem resulting from thiamine deficiency and manifesting with mental confusion, oculomotor dysfunction, and ataxia. It is associated with alcohol dependence in adults. Preparatory factors include hyperemesis gravidarum, prolonged diarrhea, prolonged parental nutrition without vitamin support, absorption disorders, anorexia, cancer, and chemotherapy. Failure to consider the clinical findings and preparatory factors of this disease, which is rare in children, can delay diagnosis. This report describes a case of Wernicke encephalopathy developing in a patient with brid ileus and receiving total parenteral nutrition after partial ileal bypass surgery. The patient's clinical and cranial magnetic resonance findings were compatible with Wernicke encephalopathy. Although these are not widespread, typical ocular findings for Wernicke encephalopathy were present. Dramatic improvements were observed in clinical, ocular, and cranial magnetic resonance findings after treatment.

WOS: 000436884500017, PubMed ID: 29679911, Purpose: Although some drugs used in the treatment of epilepsy are known to affect body weight, the hormonal factors responsible have not been sufficiently described. The purpose of this study was to compare insulin, leptin, neuropeptide Y and ghrelin levels in children with epilepsy receiving monotherapy with topiramate (TPM) and valproic acid (VPA), the drugs whose effects on body weight have been most discussed, with those of a control group. Method: 48 patients (25 VPA, 23 TPM) aged between 6 and 15.5 years, presenting to the Karadeniz Technical University Medical Faculty Pediatric Neurology Clinic, diagnosed with idiopathic epilepsy or location-related idiopathic epilepsy, and receiving VPA or TPM monotherapy for at least 6 months were included in the study. Twenty-five healthy subjects with similar demographic characteristics were enrolled as the control group. Blood samples were collected from the patient and control groups after fasting for at least 10-12 h and again 1 and 2 h postprandially. Body mass index (BMI) values were calculated for all cases. VPA levels, glucose, insulin, leptin, neuropeptide Y and ghrelin were investigated in all three separate blood samples. Results: Age, height, weight and BMI were similar between the patient and control groups. Significant weight gain was observed throughout treatment in the VPA group compared to the TPM group. High fasting and postprandial insulin levels were observed in the VPA group. VPA group leptin and neuropeptide Y (NPY) levels were also higher than in the TPM and control groups. No significant difference was determined in ghrelin levels in the patient groups compared to the controls. Conclusion: Low blood sugar not being observed, even though insulin levels are high, after fasting and in the postprandial period in epileptic children receiving VPA is indicative of insulin resistance. The elevation in leptin and neuropeptide Y levels observed in the VPA group also suggest this. (C) 2018 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Infections are an important acquired cause of cerebral arteriopathy. Tuberculous (TB) meningitis leading to infectious cerebral vasculopathy is a rare cause of acute hemiparesis.A 14-year-old male patient was examined after acute hemiparesis developing within 1 day. Neurological examination revealed total hemiplegia on the left side. Brain MRI findings showed bilateral focal T2-weighted signal hyperintensity in the subcortical and deep white matter regions. There were also areas of restricted diffusion in the right basal ganglia. Although the father had a history of pulmonary TB, the patient had not been given TB prophylaxis because of PPD negativity. At lumbar puncture, opening cerebrospinal fluid (CSF) pressure was 50 cm/H20, CSF protein 66.9 mg/dL, and glucose 54 mg/dL (concurrent blood glucose 93 mg/dL); 170 polymorphonuclear leukocytes per cubic millimeter were present in CSF. Following tests for TB, treatment was started immediately with four anti-TB drugs. TB PCR of CSF and acid-fast bacteria (AFB) staining in gastric aspirate were positive. At clinical follow-up, the patient was able to walk with support at the end of the first month.Various infectious agents have been reported as causes of cerebral vasculopathy. TB, which affects a significant number of patients worldwide, should be kept in mind in terms of cerebral vascular complications. Lumbar puncture is essential in order to diagnose TB meningitis.

Sag E, Kamasak T, Kaya G, Cakir M. A rare clinical association: Barth syndrome and cystic fibrosis. Turk J Pediatr 2019; 61: 134-138. Barth syndrome (BS) is a rare X-linked recessive metabolic disorder characterized by cardiomyopathy, hypotonia, neutropenia, growth retardation and 3-methylglutaconic aciduria type II. Cystic fibrosis is a common autosomal recessive genetic disorder in Caucasians. Herein, we reported a rare clinical association in an infant diagnosed based on clinical and genetic analysis. A six-month old boy admitted with chronic steatorrhea. The diagnosis of cystic fibrosis was made after clinical and laboratory examinations. Fifteen days later, the patient was presented with restlessness and moaning. He had hypoglycemia and lactic acidosis. The patient died three hours after the admission. Pedigree analysis revealed similar sudden infant deaths in close relatives. Postmortem genetic analysis revealed the diagnosis of Barth syndrome. This is the first case of the association of Barth syndrome with cystic fibrosis. Our case reinforces the importance of pedigree analysis and postmortem examinations.

Purpose Infantile spasm is an age-dependent epileptic syndrome seen in infancy or early childhood. Although studies have investigated the epilepsy–cytokine relationship, there has been insufficient research into the relation between cytokines and infantile spasm. The purpose of this study was to examine the role of cytokines in the pathogenesis of infantile spasm by investigating cytokine levels before and 1month after adrenocorticotropic hormone (ACTH) therapy in patients diagnosed with the condition. Method Twenty patients aged between 1month and 2years and diagnosed with infantile spasm at the Karadeniz Technical University Medical Faculty Department of Child Health and Diseases Pediatric Neurology Clinic, Turkey, and 20 healthy children were included in the study. Patients received 11 doses of ACTH on 2days a week. Levels of TNF-alpha and IL-2, the main cytokines involved in inflammation and recently associated with infantile spasm, and of IL-1beta, IL-6 and IL-17A, associated with epileptic seizures, and serum levels of the IL-17A activator IL-23 were investigated in all patients at the start of treatment and 1month after completion of treatment. Results No statistically significant difference was observed between pre- and post-treatment patient group and control group IL-1beta, IL-2, IL-23 or TNF-alpha levels. Pre-treatment IL-6 and IL-17A levels were significantly higher in the untreated patient group compared to the healthy control group ( p p =0.002). Conclusion Our study supports the recent idea that IL-6 and IL-17A are cytokines involved in the pathogenesis of infantile spasm.

Although drug-related acute dystonic reaction is one of the known side-effects of haloperidol therapy, the number of cases reported, particularly in children, is quite low. This report discusses a case of a male child developing acute dystonic reaction, and nearly drowning, while swimming in the sea following inappropriate use of haloperidol he was taking for tic disorder. The purpose of this report is to draw attention to acute dystonic reaction that may occur, not only at times when this drug, which enjoys wide pediatric use, is started or the dosage is increased, but also due to misuse by families.

Background/aim: In recent years ischemia-modified albumin (IMA) has been suggested as a marker that can be used in differentiating nonconvulsive conditions from epilepsy. The purpose of this study was to investigate changes in IMA levels caused by generalized clonic tonic (GTC) seizures. Materials and methods: A total of 114 children presenting to the Karadeniz Technical Pediatric Emergency Polyclinic with GTC seizures were included in the study. Sixteen cases meeting the inclusion criteria were included in the study and sixteen healthy children were enrolled as the control group. The patients' IMA, albumin, and IMA/albumin values at hours 0 and 1 following the episode were compared with control group values. Results: IMA levels in the patient group were significantly higher at hour 1 compared to hour 0, and were also significantly higher than those of the control group levels at hour 1. In addition, the patient group IMA/albumin index value at hour 1 was significantly higher than the baseline value. IMA levels increased significantly with length of seizure. Conclusion: Although there were no markers of hypoxia in patients undergoing GTC seizures in this study, hypoxia was observed to develop, and this caused serum IMA levels to rise in line with seizure duration.

Background Although bilateral paramedian thalamic infarctions occur more frequently in adults than in children, they are rare entities at any age. The syndrome is thought to result from occlusion of the artery of Percheron, which arises as a common trunk from one of the posterior cerebral arteries to supply both paramedian thalamic regions. We describe two children with acute ischemic infarction involving both paramedian thalami developing after infection. Patients The first patient developed mutism with ataxia after chicken pox infection. The second child developed headache, somnolence, agitation, and speech dysfunction following an upper respiratory tract infection. Bilateral thalamic lesions were documented on magnetic resonance imaging of both children. Conclusion Bilateral infarctions of the paramedian thalamus may result in severe illness and impairment. Common clinical manifestations include disorientation, confusion, hypersomnolence, deep coma and "coma vigil," or akinetic mutism (awake unresponsiveness), as well as severe memory impairment.

Listeria monocytogenes is an uncommon cause of bacterial meningitis beyond the neonatal period. Patients with immunosuppression or neoplastic disease are at increased risk of developing serious invasive disease, particularly meningitis. L. monocytogenes meningitis in two previously healthy, immunocompetent children aged 7 years and 18 months is described. One of them was successfully treated with ampicillin and amikacin. In the other there was resistance to ampicillin, and meropenem, vancomycin and amikacin were given. One patient developed unilateral abducens paralysis and inappropriate antidiuretic hormone secretion. L. monocytogenes should be suspected in children with bacterial meningitis who fail to respond to empirical antibiotic therapy.

Objective Cerebral venous infarction is rare comparing to arterial occlusion. Antithrombin III deficiency can lead to deep vein thrombosis in early adulthood, but is rare as a cause of cerebral infarction. Herein a pediatric case with acute tetraparesis was presented because of improvement within 3 weeks. Methods The case was presented. Results A 15-year-old girl was referred to our hospital with the complaints of tetraparesis and dysarthria developed within 1 day following left hemiparesis. Her vital signs were normal, but drowsiness, tetraparesis and bilateral Babinski's sign were present. His muscle strength was1/5 in the distal and proximal of the extremities. In laboratory examination, except anemia and increased D-dimer, other biochemical, hematological and blood gas analysis were normal. Brain magnetic resonance (MR) imaging showed venous infarction in the bilateral frontal regions. MR venography revealed thrombosis in the superior sagittal sinus and cortical veins. Enoxaparin and acetylsalicylic acid were initiated. Dexamethasone, mannitol and furosemide were added for 5 days. Oral iron supplementation was given for iron deficiency anemia. The consciousness returned to normal in the second day, and dysarthria disappeared in the 4th day. Motor movement began in the hands at the end of the first week, and later muscle strength was 4–5/5 in the whole upper extremities within 1 week. The next week, motor movement began in the lower extremities and reached full recovery within one week. At the end of the 3 weeks, she began walking with assistance and later without assistance in a few days. Antithrombin III levels were decreased in repeated controls. Conclusion Increased intracranial pressure and alteration in vascular supply may lead to the ischemic and hemorrhagic lesions in cerebral sinus-vein thrombosis (CSVT). It may be thought that venous infarction, even with large parenchymal changes, may show good outcome, especially in the patients with well controlled intracranial pressure.