No abstract

Epilepsy is an important component of ME. The higher incidence of complex I defects in patients with epilepsy suggests a possible relationship between mitochondrial oxidative stress dysfunction and epileptogenic process.

No abstract

Presentation of ADEM with delayed development of MRI lesions in deep gray matter and brainstem may herald a prolonged clinical course and lack of response to glucocorticoid therapy. Plasmapheresis might be an effective therapeutic intervention in these patients. The role of plasmapheresis versus corticosteroids and intravenous immunoglobulin as a primary treatment of ADEM needs to be investigated further.

VNS appears to be an effective treatment for children with refractory epilepsy. Development of intractable cough in one patient in spite of device being turned off and recurrent infection-related removal in another are unusual complications. Polysomnography before implantation of VNS should be considered to identify patients with pre-existing OSA.

No abstract

Background:Thrombocytopenia, being among the most common laboratory abnormality, found in Intensive Care Unit (ICU) patients is commonly associated with sepsis and disseminated intravascular coagulation. Declining platelet counts are associated with higher mortality rates. Thus, thrombocytopenia can be used as a prognostic marker in critically ill patients.Methodology:A prospective observational study was conducted on patients fulfilling the inclusion criteria and were evaluated for complete medical history, clinical, and laboratorial examination. Short-term outcome of the patient was correlated with thrombocytopenia.Results:The incidence of thrombocytopenia in ICU patients was 37.57%, and mortality was 44%. Higher mortality rate was found among patients with acute febrile illnesses, respiratory diseases, and sepsis (P = 0.08, 0.22, 0.41 respectively). The mortality was higher in patients with platelet counts <100,000/μl (P = 0.0008) and whose platelet levels declined on day 3 or 5 (P = 0.0001).Conclusions:Low as well as declining platelet counts are markers of severity of critical patients and are directly related to prognosis and mortality of patients in ICU.

Lacosamide is a US Food and Drug Administration (FDA)-approved antiepileptic drug for patients 17 years or older with partial epilepsy. There are sparse data on children. The objective of our study was to evaluate its efficacy/safety in children with refractory epilepsy. Forty children (mean age 14.3 years) were treated with lacosamide at our institution (adjunctive therapy in 36, monotherapy in 4). Fifteen patients had symptomatic focal epilepsy, 2 had cryptogenic focal epilepsy, 20 had symptomatic generalized epilepsy, and 3 had cryptogenic generalized epilepsy. Two had juvenile myoclonic epilepsy and 5 had Lennox-Gastaut syndrome. Forty-two percent had at least >50% reduction in seizure frequency, and 6 became seizure free. Average dose was 7 mg/kg/d and average follow-up was 9.2 months. Responders had a 76.5% mean decrease in seizures. Fifteen children experienced an adverse reaction and 7 discontinued lacosamide (4: Ineffective, I: insurance denial, 1: tremor, 1: behavior). Lacosamide is effective and well-tolerated in children with refractory epilepsy.