RESUMO
Thirty-two children with refractory partial epilepsy received open-label gabapentin as an additional medication to their antiepileptic drug regimen. Gabapentin was given in a dose ranging from 10 to 50 mg/kg per day (mean dose, 26.7 mg/kg daily). All patients had partial seizures with or without secondary generalization. Compared with baseline, 11 patients (34.4%) had a greater than 50% decrease in seizure frequency, and 4 (12.5%) had a 25% to 50% decrease in seizure frequency. Of the seven children who received the medication for 6 months or longer, two were seizure free and four were almost seizure free (having one seizure every few months). Mean gabapentin concentration was 4.8 micrograms/ml, and mean apparent clearance was 372 ml/kg per hour. The major reported side effects were behavioral. These consisted of hyperactivity, irritability, and agitation that occurred in patients with baseline mental retardation with attention deficit. We conclude that gabapentin can be a useful adjunctive medication in the treatment of refractory partial epilepsy in children.
Assuntos
Acetatos/uso terapêutico , Aminas , Anticonvulsivantes/uso terapêutico , Ácidos Cicloexanocarboxílicos , Epilepsias Parciais/tratamento farmacológico , Ácido gama-Aminobutírico , Acetatos/efeitos adversos , Adolescente , Anticonvulsivantes/efeitos adversos , Criança , Comportamento Infantil/efeitos dos fármacos , Pré-Escolar , Relação Dose-Resposta a Droga , Esquema de Medicação , Quimioterapia Combinada , Eletroencefalografia/efeitos dos fármacos , Epilepsias Parciais/diagnóstico , Feminino , Gabapentina , Humanos , Lactente , Masculino , Resultado do TratamentoRESUMO
Intermittent rhythmic delta activity is reported in various disorders and is classified as a nonspecific abnormal electroencephalographic pattern. We have investigated its clinical and electroencephalographic features in childhood. Intermittent rhythmic delta activity was identified in 54 children over a period of 48 months. Epilepsy was present in 81%, 4% had only a single generalized tonic-clonic seizure, and 15% had no seizures. Generalized seizures were more common than partial seizures (83% versus 13%; 4% were mixed). The largest group of patients had idiopathic epilepsy. Epileptiform features were present in 70%. No patient identified prospectively has had a space-occupying lesion. Intermittent rhythmic delta activity should be considered an epileptiform pattern in children, most commonly occurring as an interictal pattern in primary generalized epilepsy.
Assuntos
Ritmo Delta , Eletroencefalografia , Epilepsia/fisiopatologia , Adolescente , Córtex Cerebral/fisiopatologia , Criança , Pré-Escolar , Epilepsias Mioclônicas/diagnóstico , Epilepsias Mioclônicas/etiologia , Epilepsias Mioclônicas/fisiopatologia , Epilepsias Parciais/classificação , Epilepsias Parciais/etiologia , Epilepsias Parciais/fisiopatologia , Epilepsia/classificação , Epilepsia/etiologia , Epilepsia Tipo Ausência/classificação , Epilepsia Tipo Ausência/etiologia , Epilepsia Tipo Ausência/fisiopatologia , Epilepsia Generalizada/classificação , Epilepsia Generalizada/etiologia , Epilepsia Generalizada/fisiopatologia , Epilepsia Tônico-Clônica/classificação , Epilepsia Tônico-Clônica/etiologia , Epilepsia Tônico-Clônica/fisiopatologia , Feminino , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
Four children with the classic form of maple syrup urine disease (MSUD) died of cerebral edema during an intercurrent infection that caused severe dehydration and acidosis. The diagnosis of MSUD had been established during the neonatal period in all four patients, on day 1 of life in three of them. All were in satisfactory control before the intercurrent illness. Two patients underwent peritoneal dialysis. Signs of brain-stem compression occurred after treatment, when biochemical abnormalities were improving. Computed tomography of the head, which was done in two patients, revealed cerebral edema; one of these patients also had subarachnoid hemorrhage. Autopsy in one case revealed cerebral edema with herniation. Our experience documents that cerebral edema may occur in the older child with MSUD as well as in the neonate. The pathogenesis of cerebral edema in MSUD remains unclear. Early treatment of dehydration and acidosis may prevent the catastrophic consequences that we have observed.