Low plasma antioxidant status in patients with epilepsy and the role of antiepileptic drugs on oxidative stress

Background:

Oxidative stress has been implicated in various disorders including epilepsy. We studied the antioxidant status in patients with epilepsy and aimed at determining whether there was any difference in the antioxidant levels between patients and controls, patients who are not on antiepileptic drugs (AEDs), and on treatment, between individual AEDs and patients on monotherapy and polytherapy.

Materials and Methods:

Antioxidant levels like catalase, glutathione peroxidase (GPx), vitamin E, glutathione (GSH), thiol group (SH), uric acid, and total antioxidant capacity (TAC) were compared between 100 patients with epilepsy and equal number of controls. Twenty-five patients who were not on AEDs were compared with patients on AEDs and the control group. Patients were divided into monotherapy and polytherapy group and antioxidant status was compared between the two groups and between individual drugs.

Results:

Catalase, SH, vitamin E, and TAC were significantly low in patients with epilepsy than those in the control group (P < 0.001). GSH and uric acid did not show any difference; GPx in patients was significantly higher than those in the control group There were no differences in the antioxidant levels between the treated and the untreated groups; however, it was lower in untreated patients than controls (P < 0.001), suggesting that AEDs do not modify the oxidative stress. Patients on Valproate (VPA) showed higher catalase and GPx levels. Catalase was higher in the monotherapy than polytherapy group (P < 0.04).

Conclusion:

Our study found significantly low levels of antioxidant in patients as compared to controls. AED did not influence the antioxidant status suggesting that seizures induce oxidative stress.     

The development of pediatric fluid resuscitation: an interview with Dr. Frederic A. ‘Fritz’ Berry

Dr. Frederic A. ‘Fritz’ Berry (1935), Professor Emeritus of Anesthesiology and Pediatrics at the University of Virginia, has played a pioneering role in the development of pediatric anesthesiology through training generations of anesthesiologists. He identifies his early advocacy of balanced electrolyte solution for perioperative fluid resuscitation as his defining contribution. Based on his clinical experiences, he pushed to extend the advances in adult fluid resuscitation into pediatric practice. He imparted these and other insights to his colleagues although textbooks, book chapters, original journal publications, and decades of Refresher Course Lectures at the American Society of Anesthesiologists' annual meetings. A model educator, clinician, and researcher, he shaped the careers of hundreds of physicians‐in‐training while advancing the field of pediatric anesthesiology.     

延续性护理对GTCS癫痫患儿遵医行为及生活质量的影响

目的探讨延续性护理对强直．阵挛性发作（GTCS）癫痫患儿遵医行为及生活质量的影响。方法将60例符合标准的患儿随机分为观察组和对照组各30r0,对照组给予常规护理,观察组实施延续性护理,比较护理前后两组患儿的遵医行为及生活质量。结果观察组患儿遵医行为明显优于对照组,差异有统计学意义（P〈0．05）。入组时,两组患儿生活质量各项评分比较,差异无统计学意义（P〉0．05）;入组后6个月两组患者生活质量各项评分较入组时均明显提高,差异有统计学意义（P〈0．05）,但是观察组患儿改善更显著（P〈0．05）。结论延续性护理有助于GTCS癫痫患儿建立良好的健康行为,提高遵医行为和生活质量,值得临床推广应用。     

Overexpression of C-terminal fragment of glutamate receptor 6 prevents neuronal injury in kainate-induced seizure via disassembly of GluR6-PSD95-MLK3 signaling module

Our previous study showed that when glutamate receptor （GluR）6 C terminus-containing peptide conjugated with the human immunodeficiency virus Tat protein （GluR6）-9c is delivered into hippocampal neurons in a brain ischemic model, the activation of mixed lineage kinase 3 （MLK3） and c-Jun NH2-terminal kinase （JNK） is inhibited via GluR6-postsynaptic density protein 95 （PSD95）. In the present study, we investigated whether the recombinant adenovirus （Ad） carrying GluR6c could suppress the assembly of the GluR6-PSD95-MLK3 signaling module and decrease neuronal cell death induced by kainate in hippocampal CA1 subregion. A seizure model in Sprague-Dawley rats was induced by intraperitoneal injections of kainate. The effect of Ad- Glur6-9c on the phosphorylation of INK, MLK3 and mitogen-activated ldnase kinase 7 （MKK7） was observed with western immunoblots and immunohistochemistry. Our findings revealed that overexpression of GluR6c inhibited the interaction of GluR6 with PSD95 and prevented the kainate-induced activation of INK, MLK3 and MKK7. Furthermore, kainate-mediated neuronal cell death was significantly suppressed by GluR6c. Taken together, GluR6 may play a pivotal role in neuronal cell death.     

合并癫痫的病人心跳骤停复苏后亚低温治疗对预后的影响

目的：评价癫痫病人对于心跳骤停复苏后接受亚低温治疗对预后的影响。方法：回顾首都医科大学大兴医院重症医学科于2012年1月～2014年1月收治的心脏骤停复苏成功后给予亚低温治疗并进行连续脑电监测的成年患者42例。其中男性22例（52％）,女性20例（48％）,年龄31～62岁,平均47岁。既往有癫痫病史的4例（10％）。通过医院电子病历信息系统查阅病历资料收集所需数据信息。结果：在纳入的42例患者中,有15例（36％,95％置信区间为21％～50％）发生了癫痫,其中7例（17％）发生在亚低温治疗过程中;34例（81％）死亡,其中26例死于医院内,8例存活出院但仍在心脏骤停发生后的28d内死亡。15例发生癫痫的患者均死亡,其中13例（87％）死于院内,2例（13％）存活出院但28d内死亡;未发生癫痫的27例患者中有11例（41％）死亡,16例（59％）存活超过28d。发生癫痫组的患者死亡率显著高于未发生癫痫者（P〈0．001）。结论：提示有癫痫发作症状的患者心肺复苏后接受亚低温治疗预后不良。应用连续脑电监测技术可能有利于早期发现癫痫并采取有效的措施改善患者预后。     

Gender difference in acquired seizure susceptibility in adult rats after early complex febrile seizures

Gender differences are involved in many neurological disorders including epilepsy. However, little is known about the effect of gender difference on the risk of epilepsy in adults with a specific early pathological state such as complex febrile seizures（FSs） in infancy. Here we used a well-established complex FS model in rats and showed that：（1） the susceptibility to seizures induced by hyperthermia, pentylenetetrazol（PTZ）, and maximal electroshock（MES） was similar in male and female rat pups, while males were more susceptible to PTZ- and MES-induced seizures than age-matched females in normal adult rats;（2） adult rats with complex FSs in infancy acquired higher seizure susceptibility than normal rats; importantly, female FS rats were more susceptible to PTZ and MES than male FS rats; and（3） the protein expression of interleukin-1β, an infl ammatory factor associated with seizure susceptibility, was higher in adult FS females than in males, which may reflect a gender-difference phenomenon of seizure susceptibility. Our results provide direct evidence that the acquired seizure susceptibility after complex FSs is gender-dependent.     

Risk Factors and Scoring System as a Prognostic Tool for Epilepsy After Neonatal Seizures

BackgroundNeonatal seizures may cause irreversible changes to the immature brain and. A scoring system for early prognostic information could be a useful clinical tool. The aim of the study was to analyze risk factors for epilepsy after neonatal seizures, to validate Garfinkle's scoring system, and to analyze whether a new scoring system is feasible.MethodsA retrospective study of 176 newborns (59.1% boys, 40.9% girls, 70.5% term, 29.5% preterm; mean birth weight 2820 g), admitted to the Department of Neonatology, Division of Pediatrics, University Medical Centre, Ljubljana, because of neonatal seizures (clinical and/or neurophysiological), was performed. Epilepsy rate between 2 and 12 years of follow-up was 18.1%. Five independent predictors from Garfinkle's study and other known predictors were entered into hierarchical binary logistic regression models and analyzed through four steps to identify independent predictors of epilepsy. We tested whether any of the predictors was an effect modifier.ResultsOf five potential predictors from Garfinkle's score, electroencephalograph background findings and etiology were predictive. Etiologies, gestation, mode of delivery, duration of seizures, and other risk factors at birth were found to be independent predictors. Duration of seizures has a different effect on prognosis depending on the gestational age.ConclusionGestational age determines the association between duration of seizures and epilepsy. Scoring systems to predict development of epilepsy after neonatal seizures need to limit interaction between important predictor variables.     

Occipital seizures induced by Intermittent Photic Stimulation in Dravet syndrome

PurposeDravet syndrome (DS) is a rare disorder with seizure onset in the first year of life, typically beginning with prolonged febrile hemiclonic seizures or generalized tonic–clonic seizures. Photosensitivity is reported in more than 40% of patients. We present two cases of DS in which we had the chance to record occipital seizures induced by Intermittent Photic Stimulation (IPS).MethodWe retrospectively reviewed the medical records of 32 children affected by DS. All clinical notes were reviewed in order to evaluate the occurrence of seizures induced by IPS.ResultsAmong the 32 reviewed clinical records, two patients with IPS-induced seizures were found. In both patients seizures originated from the occipital-temporal region. Clinical history was characterized by generalized tonic–clonic seizures, and myoclonia. At the age respectively of 11 months and 20 months they presented a prolonged focal seizure induced by IPS at a frequency of 10 Hz. During the follow-up they additionally presented with hypomotor seizures, also induced by IPS during laboratory EEG examinations. The semiology of hypomotor seizures resembled what is described as “complex partial status”, a type of non-convulsive status with ictal discharges arising unilaterally from the occipito-temporal region.ConclusionBased on available literature, IPS induced occipital seizures have not been reported during the first year of life. Although pathophysiological features are not yet completely understood, both photosensitivity and occipital seizures should be considered in the diagnostic evaluation in DS. The documentation of IPS induced occipital seizures might contribute to widen the clinical and neurophysiological spectra of DS.     

Neonatal eating epilepsy: 50-year follow-up

PurposeWe present a case of neonatal eating epilepsy.MethodCase report.ResultsAn otherwise healthy female newborn started having epileptic seizures lasting up to 5 minutes induced by breastfeeding at age of 2 weeks. The convulsive seizure started with crying and coughing followed by opisthotonus, flexion of upper extremities, extension of lower extremities, and generalized jerks in extremities. The patient had fairly often postictal vomitings which could not be relieved by upright positioning. At baseline clinical examination, no abnormal symptoms or signs were found except for a postictal hoarseness. On the day of admission to the tertiary care hospital, during 1.5 hours, she had 10 attacks. Though some attacks were spontaneous and during sleep, most were induced by feeding or — less often and inconsistently — by manipulating the pharynx. Phenobarbital 15 mg four times a day stopped the attacks. The last seizure was documented 14 days after admission and phenobarbitalwas eventually withdrawn. The patient remained seizure free off AEDs during a prospective follow-up for over 50 years until 2013.ConclusionsNeonatal eating epilepsy may be a suitable diagnosis if convulsive seizures are precipitated by feeding or eating. Polygraphic recording will help ascertain the diagnosis. Antiepileptic therapy is likely to abolish seizures.