Sodium valproate in the prophylaxis of simple febrile convulsions.

Thirty children with simple febrile convulsions were treated with sodium valproate following their second convulsion. Twenty-two of the 30 (73%) had no further convulsions during the one-year period of observation compared with 17 of 28 in the control group (61%). This was not a statistically significant difference. Side effects attributed to sodium valproate treatment were noted in 7 patients (23%), although 4 of these showed only mild transient gastrointestinal symptoms at high dosage. The study did not confirm any advantage in the use of sodium valproate as a prophylaxis for febrile convulsions, although compliance was good and significant side effects infrequent.     

Sodium valproate versus phenobarbital in the prophylactic treatment of febrile convulsions in childhood

Phenobarbital has been shown to offer effective prophylaxis against childhood febrile convulsions. However, a high percentage of children do not tolerate phenobarbital, mainly due to behavioral changes. Valproate, due to its low toxicity, appears to be an attractive alternative to phenobarbital treatment. Ninety children admitted with their first febrile convulsion were offered prophylactic treatment with either phenobarbital 3–5 mg/kg/day or valproate 20–30 mg /kg/day. Twenty-five children whose parents refused prophylactic treatment make up an untreated control group. Serum levels of the appropriate drug were measured at each follow-up visit. The three groups appear to be comparable. Twenty-one per cent of the phenobarbital treated children required discontinuation of the drug due to side effects. All the children tolerated valproate therapy.Twelve out of 25 untreated children suffered recurrences. Eight out of 33 children treated with phenobarbital suffered recurrences. Four out of 32 children on valproate therapy had recurrences. The difference between valproate treatment and no therapy at all is highly significant (P<0.0001). Phenobarbital did not reduce the risk of recurrence. We now recommend prophylactic treatment with valproate to children with febrile seizures.     

Nafcillin-induced neutropenia in children.

Neutropenia developed in three pediatric patients treated intravenously with nafcillin. This association has not been, to our knowledge, previously reported in children. One of the patients is the youngest reported who had neutropenia associated with any penicillin; another patient had a prolonged recovery. The literature pertaining to marrow suppression by all penicillins is reviewed. This usually occurs 10 to 25 days after the inception of high-dose intravenous therapy and resolves when the penicillin therapy is discontinued. An absolute neutrophil count of less than 1,000/ml is an indication to change to an antibiotic other than a penicillin. Children receiving intravenous penicillins should have WBC counts with differential analysis two to three times a week.     

Infections in patients with neutropenia.

We review published reports and our experience in regard to the causative organisms of infections in patients with neutropenia. The organisms isolated from infected patients were almost exclusively pyogenic and enteric bacteria, and our patients had no history of serious viral or fungal infections, documenting the importance of the neutrophil in normal host defense against extracellular but not intracellular pathogens. Staphylococcus aureus was the single most commonly cultured organism; however, Pseudomonas and Escherichia coli were almost as commonly isolated. Positive cultures were obtained primarily from the blood or cutaneous, subcutaneous, or deep tissue abscesses. In patients with congenital neutropenia, pneumonia, otitis media, and abscesses were the most frequent infections diagnosed clinically. There is a suggestion that recent antibiotic therapy shifted the spectrum of infecting organisms toward enteric bacteria.     

T cell lymphocytosis with neutropenia.

A gross T cell lymphocytosis developed in an otherwise healthy 5 year old girl and has persisted for nearly 3 years. It is associated with neutropenia and seems to be typical of a rare adult disorder that may be a type of T cell chronic lymphocytic leukaemia.     

Monocyte functional capacity in chronic neutropenia.

The bactericidal activity of monocytes from a child with chronic benign granulocytopenia who has had virtual absence of neutrophils yet minimal infections since birth was examined against Escherichia coli and Staphylococcus aureus and compared with that of monocyte and neutrophils from 20 control subjects. Studies on monocyte function in this patient with no neutrophils revealed normal monocyte kill of both organisms when compared with control monocytes. Monocyte and neutrophil killing of both organisms was similar in control subjects at bacteria to phagocyte ratios of 1:1. When ratios of 3:1 were employed, however, control neutrophils were more effective than control and patient monocytes in reducing the number of viable organisms. These findings support the neutrophil as the more effective blood phagocyte but stress the importance of monocyte functional capacity in patients compromised by granulocytopenia or neutrophil functional defects.     

Psychological effects of sodium valproate and carbamazepine in epilepsy.

Information from standardised tests of intelligence, school attainments, attention, memory and visuomotor function, together with parent and teacher questionnaire information about various aspects of behaviour, was obtained for 63 schoolchildren with newly diagnosed epilepsy before treatment with sodium valproate or carbamazepine, and again at intervals for a total period of 12 months. The same information was collected on 47 matched controls. The children with epilepsy represented those under non-specialised paediatric care. The result showed that both drugs were effective in most cases at modest dosage without causing notable psychological effects 12 months into treatment. Modest and temporary adverse cognitive effects seen earlier in treatment could have been the result of uncontrolled seizure discharge. Improved function was the same in children with epilepsy and controls. Some psychological abnormalities in the children with epilepsy were evident before treatment suggesting early unwanted effects of the epileptic process itself.     

Investigating neutropenia

Neutropenia is a reduction in the absolute number of neutrophils in the peripheral blood compared with a healthy subject matched for age, sex, physiological status and ethnic origin. Appropriate reference ranges are necessary to avoid misdiagnosis, as infants and children have lower counts than adults; certain races, particularly Africans, have lower counts than Caucasians. Neutropenia may be an isolated finding or associated with other significant pathology. In its severest forms, it predisposes to recurrent bacterial infection, which may be life-threatening or even fatal. Investigation to determine the cause of neutropenia is important for the identification and treatment of any primary pathology and also for prognosis and appropriate management of any underlying syndrome. Rapid identification of an idiosyncratic drug reaction is essential, as this is a serious disorder with significant mortality. The mainstay of treatment for persistent neutropenia is antibiotics, which should be given promptly at early signs of infection but may also be needed prophylactically. Granulocyte colony-stimulating factor has been used to increase the neutrophil count in a wide variety of neutropenic conditions.