European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society
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Eur. J. Paediatr. Neurol. · Jul 2008
Multicenter Study Clinical TrialAdd-on levetiracetam in children and adolescents with refractory epilepsy: results of an open-label multi-centre study.
To study the efficacy and tolerability of add-on levetiracetam in children and adolescents with refractory epilepsy. ⋯ Levetiracetam proved to be an effective and well-tolerated add-on treatment in this group of children with refractory epilepsy.
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Eur. J. Paediatr. Neurol. · Jul 2008
Increased total-Tau levels in cerebrospinal fluid of pediatric hydrocephalus and brain tumor patients.
Total Tau (t-Tau), hyperphosphorylated Tau (p-Tau(181P)) and beta-amyloid(1-42) in cerebrospinal fluid (CSF) have shown to be markers of neuronal and axonal degeneration in various neurological and neurodegenerative diseases. The aim of this study was to evaluate the influence of the presence of a brain tumor and hydrocephalus on t-Tau, p-Tau(181P) and beta-amyloid(1-42) levels in CSF of pediatric patients. t-Tau, p-Tau(181P) and beta-amyloid(1-42) levels were simultaneously quantified by xMAP technology in 22 lumbar and 15 ventricular CSF samples from newly diagnosed pediatric brain tumor patients and 39 lumbar and 12 ventricular CSF samples from pediatric patients without a brain tumor. t-Tau, p-Tau(181P) and beta-amyloid(1-42) levels in both lumbar and ventricular CSF were not significantly correlated with age. t-Tau levels in lumbar CSF were elevated in brain tumor patients, being especially high in medulloblastoma patients. Lumbar CSF p-Tau(181P) levels were lower in brain tumor patients compared to normal controls. ⋯ Two patients with an infected ventriculo-peritoneal drain also had high CSF t-Tau levels. In conclusion, high t-Tau levels in CSF are found in pediatric patients with a brain tumor, patients with hydrocephalus and patients with a serious CNS infection, reflecting neuronal and axonal damage. Ongoing studies should determine whether these neurodegenerative markers in CSF can be used to monitor neuronal and axonal degeneration in these patients during therapy and long-term follow up.
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Eur. J. Paediatr. Neurol. · May 2008
Nerve growth factor expression correlates with severity and outcome of traumatic brain injury in children.
Secondary brain damage after traumatic brain injury (TBI) involves neuro-inflammatory mechanisms, mainly dependent on the intracerebral production of cytokines. In particular, interleukin 1beta (IL-1beta) is associated with neuronal damage, while interleukin 6 (IL-6) exerts a neuroprotective role due to its ability to modulate neurotrophins biosynthesis. However, the relationship between these cytokines and neurotrophins with the severity and outcome of TBI remains still controversial. ⋯ NGF concentration in CSF is a useful marker of brain damage following severe TBI and its up-regulation, in the first 48 h after head injury together with lower IL-1beta expression, correlates with a favorable neurologic outcome. Clinical and prognostic information may also be obtained from IL-6 expression.
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Eur. J. Paediatr. Neurol. · Mar 2008
Case ReportsAcute hemorrhagic pancreatitis due to the use of valproic acid in a child.
Acute pancreatitis is rarely seen in children, and it is often drug induced. Valproic acid (VPA) is one of the most widely used anticonvulsants for children all over the world. ⋯ The symptoms of pancreatitis subsided within 2 weeks after discontinuation of VPA. It seems that the prognosis of VPA-associated acute pancreatitis depends on early diagnosis, timely withdrawal of the offending agent and the treatment.
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Monitoring with continuous EEG (cEEG) has become a valuable tool in the adult neurointensive care unit. The benefits of cEEG or amplitude-integrated EEG in neonatal intensive care have also been described. The aim of the present study was to describe and evaluate the use of cEEG in a paediatric intensive care unit. ⋯ Four patients had seizure activity on cEEG due to global anoxia; these were not classified as status epilepticus. In conclusion, in the paediatric intensive care unit the most important indication for cEEG monitoring is in patients with suspected refractory status epilepticus where it adds to the diagnosis and choice of treatment. Continuous EEG should therefore be part of the paediatric intensive care unit technical support to select and monitor, among children with critical neurological disorders, those with refractory status epilepticus.