Background: The large proportion of coronavirus disease 2019 (COVID-19) patients has been associated with a large number of neuropsychiatric manifestations. Despite the high prevalence of COVID-19, few studies have examined such manifestations, especially in children and adolescents. Objectives: This study investigated neuropsychiatric manifestations in hospitalized children and adolescents admitted for COVID-19 infection in Iran. Methods: This prospective observational study included admitted children and adolescents (4 - 18 years old) diagnosed with COVID-19 infection, pediatric neurologists, child and adolescent psychiatrists, and infectious disease specialists, and assessed 375 infected patients during August and December 2021. Results: Of the 375 patients, 176 (47%) were female, with a mean age of 9.0 ± 3.39 years. Psychiatric and neurological manifestations were reported in 58 (15.5%) and 58 (15.5%) patients, respectively. The most prevalent psychiatric disorders were separation anxiety disorder (SAD) (5.1%), major depressive disorder (MDD) (3.5%), generalized anxiety disorder (GAD) (2.7%), insomnia (2.4%), and oppositional defiant disorder (ODD) (2.4%). Regarding neurological complications, seizures were the most prevalent (13.1%), followed by encephalitis (1.9%), transverse myelitis (0.3%), acute ischemic stroke (0.3%), and Guillain-Barre syndrome (0.3%). There was no significant relationship between the duration of COVID-19 infection (P = 0.54) and ICU admission (P = 0.44) with the emergence of psychiatric symptoms. Conclusions: The most prevalent neurologic and psychiatric complications among children and adolescents with COVID-19 infection were seizures and the symptoms of anxiety/mood disorders, respectively.
Background: Renal disorders have been observed with the long-term treatment of some antiepileptic drugs (AEDs). We aimed to compare the effects of carbamazepine (CBZ) and valproate (VPA) on renal function in children with epilepsy. Methods: This quasi-experimental study included children with epilepsy aged 2 months to 14 years who had persistently been receiving CBZ or VLP monotherapy for more than 6 months and were referred to Bandar Abbas Children’s Hospital, Bandar Abbas, Iran, 2019-2020. Demographic features, including age and sex, as well as family history of epilepsy, disease duration, and duration of treatment were recorded for each patient. Random blood and urine samples, along with 24-hour urine samples were collected from all the participants. Blood urea nitrogen (BUN), sodium, alkaline phosphatase (ALP), and pH were measured in blood samples. Glucose, protein, sodium, potassium, phosphorus, and creatinine were estimated in 24-hour urine samples. N-acetyl-beta-D-glucosaminidase (NAG) and pH were assessed in random urine samples. Results: Of the 80 children in this study with a mean age of 7.43±3.22 years, 58 (72.5%) were males. Children in both groups were comparable in terms of age, sex, family history of epilepsy, and disease and treatment duration. The urine NAG level was significantly higher in the VPA group compared to the CBZ group (P=0.010). Further, 24-hour urine protein and glucose levels were significantly higher in the VPA group. As for blood parameters, except for sodium (P=0.034), ALP (P<0.001), and pH (P=0.006) which were significantly higher in the CBZ group, other parameters were significantly higher in the VPA group. Conclusion: Overall, CBZ appears to be safer than VPA regarding its effects on renal function in children treated for epilepsy.
Background: Alterations in hematological and renal parameters have been reported with antiepileptic drugs (AEDs). This study aimed to evaluate the effects of lamotrigine (LTG) and levetiracetam (LEV) on these parameters in children with epilepsy. Materials and Methods: This randomized clinical trial included children with a first-time diagnosis of epilepsy referred to Bandar Abbas Children’s Hospital, Bandar Abbas, Iran, from 2017 to 2018. Participants’ age, gender, and family history of epilepsy were recorded at the time of admission. Patients in the LTG group received 0.6 mg/kg of oral LTG in two divided doses for two weeks which continued with 1.2 mg/kg for another two weeks and then with a maintenance dose of 5-15 mg/kg daily. Patients in the LEV group received 10 mg/kg of oral LEV twice a day. When necessary, the dosage was increased to a maximum of 30 mg/kg twice a day. Treatment continued until seizures were controlled. Hematological and renal parameters were measured at baseline and 3 months after treatment. The total duration of treatment with each drug was noted as well. Results: Of the 66 children evaluated in this study with a mean age of 8.51±2.11 years, 31 (47%) were males. Age, gender, family history of epilepsy, treatment duration, and baseline hematological and renal parameters did not differ between the LTG (n=26) and LEV (n=40) groups. Patients in both groups were comparable regarding all the parameters after treatment. Finally, no significant change was observed after treatment compared to baseline in either group. Conclusion: Overall, LTG and LEV appear to have no significant effect on the hematological and renal parameters of children with epilepsy.
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