Introduction: Status epilepticus (SE) is a life-threatening neurological emergency requiring immediate medical intervention and is associated with high mortality and morbidity. The aim of this research was evaluation of clinical and etiological profile of refractory status epilepticus (RSE) among children aged between 1 month and 18 years. Material and methods: The study was done between January 1, 2017 and December 24, 2019. All children with the age limits mentioned above, who presented convulsive SE, subsequently with development in refractory status epileptic (RSE), were included in the study. Patients were investigated and evaluated according to a standard protocol. Subsequently, the characteristics of children with RSE and those without an evolution in RSE were compared. Results: 55 children, out of whom 32 boys with SE were enrolled in the study, of which 20 children (36%) developed RSE. Central nervous system (CNS) infections were the most common causes of SE and development of RSE (51% in SE and 53% in RSE, p > 0.05). Noncompliance of antiepileptic medication served as the second cause for evolution of RSE. The overall mortality rate was 10.9%, the chances of death in RSE (20%) being higher than in SE (5.7%). The unfavorable prognosis was seven times higher in children with RSE, compared to children who developed SE. Conclusions: In the management of CNS infections, pediatricians should be aware of the high risk of developing RSE. In addition, the possibility of developing RSE should be considered and promptly managed in an intensive care unit in order to reduce the risk of mortality and morbidity of this severe neurological condition
Introduction. Peripheral biomarkers have numerous uses in the treatment, prognosis, and pharmacovigilance of epilepsy. Unfortunately, no peripheral biomarker has demonstrated proven efficacy, although several options are being investigated. In this article, we want to analyze the main areas in which peripheral biomarkers can present their usefulness, including participation in the processes of inflammation, dysfunction of the blood-brain barrier, changes in metabolism, hormones, and growth factors. Material and methods. Publications on diagnostic biomarkers of epilepsy were reviewed. References were identified by PubMed, MEDLINE and Scopus search until June 2022, with various combinations of the terms – „epilepsy”, „seizures”, „epileptogenesis”, „biomarkers”, „neuroimaging”, „inflammation”, „status epilepticus”, „prognosis”. A qualitative and analytical study was performed focused on primary studies published in 2020-2022. More than 85 sources were identified and 33 were selected for analysis from the PubMed, MEDLINE, and Scopus online databases. 12 articles, 5 clinical trials, 2 meta-analyses, 7 reviews, and 7 systematic reviews were identified. Results. Screening articles from online databases according to the search criteria, we found 258 titles on molecular and cellular biomarkers in epilepsy highlighted. The final bibliography included 33 sources that summarized that biomarkers of epileptogenesis are expensive and difficult to research, but the identification of biomarkers specific to the entire epileptogenic process, in close proximity to neuronal damage, have demonstrated the possibility of predicting the risk of seizures, epilepsy and resistance to treatment. Conclusions. Epilepsy remains a continuous area of research; a special role is occupied by specific biomarkers of great clinical importance, being necessary for the prognosis of the disease, the risk of neurological sequelae, refractory to anti-epileptic drugs. Thus, their identification could have a significant impact on the clinical course of the disease.
Background: Ischemic stroke (IS) in children is a major neuropediatric emergency. The incidence of stroke in children is from 2 to 13 for 100000 children. IS in perinatal period occurs in 1 for 2300 – 5000 live births. Material and methods: In 2010 – 2019 in the Republic of Moldova was carried out a retrospective as well as prospective study on a cohort of 458 children diagnosed with stroke. Were studied possible risk factors related to IS. Out of 458 children, 284 children with IS were selected and diagnosed during the reference period. Results: IS was determined in 284 cases with the diagnosis of stroke (62%, 95CI 59.73-64.27). Among the most common risk factors for the development of neonatal IS are pathologies of amniotic membranes in 113 cases (39.8%, 95CI 36.9-42.7), pathologies of amniotic fluid with meconium in 135 cases (47.5%, 95CI 44.54-50.46), and history of urgent caesarean section in 132 cases (46.5%, 95CI 43.54-49.46). Among the etiological causes of IS in the studied children were: congenital heart anomalies in 52 cases (18.3%, 95CI 16.01-20.59), neonatal encephalopathy in 27 cases (9.5%, 95CI 7.76-11.24), genetic syndromes in 18 cases (6.3%, 95CI 4.85-7.75), sickle cell disease – 5 (1.8%, 95CI 1.06–2.54), MELAS syndrome – 4 (1.4%, 95CI 0.7-2.1). Conclusions: IS risk factors are an important problem in clinical research. Most often, there is not a single risk factor responsible for the development of IS in children
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