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Background and objectives: Recurrent seizures are a consequence of uremia due to chronic kidney disease (CKD). This study was aimed to determine types, frequencies, causes and treatments of uremic seizures and their independent predictors. Methods: Seventy adults (male = 33; female = 37) were included. They had mean age of 45.87 ± 3.36 years and duration of kidney failure (stage 3-5) of 5.53 ± 1.53 years. They underwent clinical and laboratory investigations and electroencephalography (EEG) and brain neuroimaging.Results: Eleven patients (15.7%; on dialysis = 6, not on dialysis = 5) developed recurrent seizures after the development of CKD. Six had (54.55%) generalized tonic-clonic (GTC) seizures, of them 4 (66.67%) had tetany, hypocalcemia (< 6 mg/dl), hyperparathyroidism and brain calcifications. Five (45.45%) had focal to bilateral GTC seizures, focal electroencephalography (EEG) epileptic discharges and white matter ischemic hyperintensities in their brain magnetic resonance imaging. Epileptic EEG discharges (spikes and spike-wave complexes) were found in 24.3% (n = 17) in absence of seizures. Compared to those without seizures, the majority of patients with seizures had end stage kidney disease (ESKD), metabolic derangements and neuroimaging abnormalities. Multiple regression analysis showed that the presence of uremic seizures was independently correlated to the severity of kidney failure (OR = 1.25, 95% Cl = 1.08-1.30, P = 0.01) and metabolic derangements (OR = 2.44; 95% CI = 1.25-2.80, P = 0.01). Conclusion:Recurrent seizures are common with uremia. The progression of uremia and its acute manifestations (as uremic encephalopathy with/of without metabolic derangements) were the most common precipitating factors for uremic seizures. Improvements of seizures occurred with hemodialysis and correction of metabolic derangements.

<b><i>Background:</i></b> Vestibular system is critical for maintaining balance and learning complex tasks. This study aimed to determine the frequencies, types, and predictors of vestibular dysfunctions (VDs) in children with type 1 diabetes (T1D) using videonystagmography (VNG). <b><i>Patients and Methods:</i></b> This study included 65 patients (children with T1D = 40; controls = 25). The patients underwent VNG. <b><i>Results:</i></b> Patients (boys = 15; girls = 25) had a mean age of 14.05 ± 1.82 years and duration of illness of 6.30 ± 2.84 years. The majority had frequent attacks of diabetic ketoacidosis (DKA) (65%) and hypoglycemia (40%). Dizziness was reported in 20%. VNG abnormalities were reported in 70% (<i>n</i> = 28), of them 71.43 and 28.57% had central and peripheral VDs, respectively. Dizziness was associated with peripheral VD. Compared to patients without VDs, those with VDs were older and had earlier age at onset and longer duration of diabetes (&#x3e;5 years), higher levels of HbA1c (&#x3e;7%), higher frequencies of DKA and hypoglycemic attacks, comorbid medical conditions, and diabetic complications. Multiple logistic regression analysis showed that presence of VNG abnormalities (VDs) was independently correlated with diabetes duration &#x3e;5 years (odds ratio [OR] = 4.52 [95% confidence interval [CI] = 3.55–7.04], <i>p</i> = 0.001), HbA1c% levels &#x3e;7% (OR = 3.42 [95% CI = 2.84–5.75], <i>p</i> = 0.001), and presence of hypoglycemic attacks (OR = 4.65 [95% CI = 2.85–7.55]). <b><i>Conclusions:</i></b> -VDs are prevalent in children with T1D and correlated with the duration and severity of diabetes and the occurrence of hypoglycemic attacks. Therefore, optimizing glycemic control and prevention and treatment of diabetic complications and comorbidities are important. Multidisciplinary follow-ups are required for early detection and management of diabetic VDs.

Objectives: Iron deficiency (ID) and its anemia (IDA) are the most prevalent nutritional deficiency worldwide. Dysfunction of the autonomic nervous system (ANS) is a consequence of anemia regardless to its type. Many studies found ANS dysfunction in adults with ID/IDA. This study evaluated ANS function in children and adolescents with IDA as related studies are scare.Patients and Methods: This prospective study included 60 children with IDA (boys = 20; girls = 40; age: 14.50 ± 2.04 yrs.). Blood concentrations of hemoglobin, ferritin and iron were determined. ANS function testing were carried twice (at baseline and 3 months after iron therapy). They included measuring of heart rate at rest and its variation (HRV) in response to standing and breathing and blood pressure (BP) changes in response to standing, sustained handgrip and cold.Results: Manifestations of IDA included excessive fatigue, dizziness, palpitation at rest and headache. Children with IDA had significant changes in resting heart rate, blood pressure and HRV parameters compared to healthy mates indicating sympathetic hyperactivity and reduction in parasympathetic activity. Early, definite and severe ANS dysfunctions were found in 20%, 36.67% and 3.33%, respectively. For children with IDA, significant correlations were found between ferritin levels and HB and iron levels (P = 0.001), HRV to active standing, deep breathing and Valsalva maneuver (P = 0.001) and systolic and diastolic (P = 0.001) and diastolic BPs in response to sustained handgrip and cold (P = 0.001). Ferrous sulfate therapy (6 mg/kg/day) for 3 months resulted in improvement of ANS manifestations with IDA. Conclusion:ANS dysfunctions are common consequences of IDA in children and can be attributed to the increased need of tissues for oxygen, resulting in sympathetic hyperactivity. Optimal iron therapy can improve ANS consequences of IDA.

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