Value of combining targeted emergency nursing with psychological nursing in children with febrile convulsions

BACKGROUND Febrile convulsions are a common pediatric emergency that imposes significant psychological stress on children and their families.Targeted emergency care and psychological nursing are widely applied in clinical practice,but their value and impact on the management of pediatric febrile convulsions are unclear.AIM To determine the impact of targeted emergency nursing combined with psychological nursing on satisfaction in children with febrile convulsions.METHODS Data from 111 children with febrile convulsions who received treatment at Nantong Maternal and Child Health Care Hospital between June 2021 and October 2022 were analyzed.The control group consisted of 44 children who received conventional nursing care and the research group consisted of 67 children who received targeted emergency and psychological nursing.The time to fever resolution,time to resolution of convulsions,length of hospital stays,Pittsburgh Sleep Quality Index,patient compliance,nursing satisfaction of the parents,occurrence of complications during the nursing process,and parental anxiety and depression were compared between the control and research groups.Parental anxiety and depression were assessed using the Hamilton Rating Scale for Depression(HAMD)and the Hamilton Rating Scale for Anxiety(HAMA).RESULTS The fever resolution,convulsion disappearance,and hospitalization times were longer in the control group compared with the research group(P<0.0001).The time to falling asleep,sleep time,sleep quality,sleep disturbance,sleep efficiency,and daytime status scores were significantly better in the research group compared with the control group(P<0.0001).The HAMD and HAMA scores for parents of children in the research group were lower than the scores in the control group after nursing(P<0.05).Compliance with treatment of children in the research group was higher than in the control group(P<0.05).Parental satisfaction with nursing in the research group was higher than in the control group(P<0.05).The total complication rate of children in the control group was higher than in the research group(P<0.05).CONCLUSION Combining psychological nursing with targeted emergency nursing improved the satisfaction of children’s families and compliance with treatment and promoted early recovery of clinical symptoms and improvement of sleep quality.

Repeated febrile convulsions impair hippocampal neurons and cause synaptic damage in immature rats: neuroprotective effect of fructose-1,6-diphosphate

Fructose-1,6-diphosphate is a metabolic intermediate that promotes cell metabolism. We hypothesize that fructose-1,6-diphosphate can protect against neuronal damage induced by febrile convulsions. Hot-water bathing was used to establish a repetitive febrile convulsion model in rats aged 21 days, equivalent to 3–5 years in humans. Ninety minutes before each seizure induction, rats received an intraperitoneal injection of low- or high-dose fructose-1,6-diphosphate（500 or 1,000 mg/kg, respectively）. Low- and high-dose fructose-1,6-diphosphate prolonged the latency and shortened the duration of seizures. Furthermore, high-dose fructose-1,6-diphosphate effectively reduced seizure severity. Transmission electron microscopy revealed that 24 hours after the last seizure, high-dose fructose-1,6-diphosphate reduced mitochondrial swelling, rough endoplasmic reticulum degranulation, Golgi dilation and synaptic cleft size, and increased synaptic active zone length, postsynaptic density thickness, and synaptic interface curvature in the hippocampal CA1 area. The present findings suggest that fructose-1,6-diphosphate is a neuroprotectant against hippocampal neuron and synapse damage induced by repeated febrile convulsion in immature rats.

A case of dissociative convulsions presented as frequent epilepsylike seizures

Dissociative convulsions, a prominent form of dissociative (conversion) disorder formerly known as hysteria, are a common and elusive differential diagnosis from epilepsy. However, the treatment of such patients is always challenging and frustrating due to poor response to the routinely used interventions in most situations. Here, we present a case with dissociative convulsions in order to catch the eye of the clinicians and researchers on the recognition of clinical manifestation and exploration of therapeutic strategies.

Changes of Immunoreactive β-Endorphin in Plasma, Pituitary and Hypothalamus of Rats during Oxygen-Induced Convulsions

We observed for the first time the differences of immunoreactive β-endorphin(IR -β- EP) content in plasma, pituitary and hypothalamus of rats under various conditionsusing radioimmunoassay (RIA) and the effects of naloxone and β - endorphin (β- EP) antiserumon initial time of convulsions (ITC), severity of convulsions(SOC) and mortality on surface(MOS) of rats to hyperbaric oxygen(HBO). The results suggest thatβ- EP may partici-pate in the course of oxygen - induced convulsions and be one of endogenous convulsion - causingagents.

Primary intestinal lymphangiectasia presenting as limb convulsions:A case report

BACKGROUND Primary intestinal lymphangiectasia(PIL)is a rare protein-losing enteropathy characterized by abnormally dilated lymphatic structures,resulting in leakage of lymph(rich in protein,lymphocytes,and fat)from the intestinal mucosal and submucosal layers and thus hypoproteinemia,lymphopenia,hypolipidemia,and pleural effusion.CASE SUMMARY A 19-year-old Chinese male patient complained of recurrent limb convulsions for the last 1 year.Laboratory investigations revealed low levels of calcium and magnesium along with hypoproteinemia and high parathyroid hormone levels,whereas gastroscopy exhibited chronic non-atrophic gastritis and duodenal lymphatic dilatation.Subsequent gastric biopsy showed moderate chronic inflammatory cell infiltration distributed around a small mucosal patch in the descending duodenum followed by lymphatic dilatation in the mucosal lamina propria,which was later diagnosed as PIL.The following appropriate mediumchain triglycerides nutritional support significantly improved the patient’s symptoms.CONCLUSION Since several diseases mimic the clinical symptoms displayed by PIL,like limb convulsions,low calcium and magnesium,and loss of plasma proteins,it is imperative to conduct a detailed analysis to avoid any misdiagnosis while pinpointing the correct clinical diagnosis and simultaneously ruling out other clinical aspects in the reported cases without any past disease history.A careful assessment should always be made to ensure an accurate diagnosis in a timely manner so that the patient can be delivered quality health services for a positive health outcome.

PROPHYLAXIS OF INTERMITTENT DIAZEPAM IN CHILDREN WITH FEBRILE CONVULSIONS（FC）

The purpose of this study was to limit intermittent diazcpam prophyiaxis of children with FC to the patients who haye the second recurrence.A series of 156 children with FC received prophylactic treatment.During 1￣5 years for Follow-up (average,2 years and 10 months),28 cases of prophylactic group suffered recurrence of FC 48 times. 54 of 126 cases in control group suffered it 108 times. The difference in case number and recurrent rate between the prophylactic and control groups was highly significant (P<0. 01). Diazepam was found tO be considerably effective in reducing the risk of recurrence of FC.

The Role of Human Herpesvirus Type-6 (HHV-6) in Convulsions Seen in Children at Korle-Bu Teaching Hospital, Accra

Background: Since the isolation of HHV-6 in 1986, extensive investigation has revealed it to be ubiquitous and responsible for the majority of cases of a common febrile rash illness of infants known as roseola. Other clinical associations including seizure disorders, encephalitis and meningitis have also been stated in various publications. Objective: The aim of the study is to find out if there is any association between HHV-6 infection and the convulsions prevailing at the Child Health Department of the Korle-Bu Teaching Hospital, Accra-Ghana. Methods and Results: Children admitted into the Department of Child Health with episode of convulsions were recruited after informed consent had been sought from subjects. Cerebrospinal fluid (CSF) and Plasma were obtained from patients. PCR directed at the detection of the large tegument protein (LTP) gene in the SIE strain of the HHV-6 in Plasma and CSF from patients was done. The mean age of study subjects was 37.44 months with 53 (64.6%) being males. There was a significant relationship between the convulsions and fever (P < 0.05). Based on CSF characteristics gathered, viral infections may be the probable cause of the observed convulsions but not malaria or bacterial infections. None of the samples from the patients had evidence of HHV-6. Conclusion: The study was unable to establish HHV-6 infection in the CSF and Plasma of patients. What role if any HHV-6 has in convulsions seen in children or neurological diseases at large merits further studies. Other neurotropic viruses need to be investigated as possible causes for the convulsions.

Prevalence of recent immunisation in children with febrile convulsions

AIM:To determine the prevalence of recent immunisation amongst children under 7 years of age presenting for febrile convulsions.METHODS:This is a retrospective study of all children under the age of seven presenting with febrile convulsions to a tertiary referral hospital in Sydney.A total of 78 cases occurred in the period January 2011 to July 2012 and were included in the study.Data was extracted from medical records to provide a retrospective review of the convulsions.RESULTS:Of the 78 total cases,there were five medical records which contained information on whether or not immunisation had been administered in the preceding 48 h to presentation to the emergency department.Of these five patients only one patient(1.28%of the study population) was confirmed to have received a vaccination with Infanrix,Prevnar and Rotavirus.The majority of cases reported a current infection as a likely precipitant to the febrile convulsion.CONCLUSION:This study found a very low prevalence of recent immunisation amongst children with febrile convulsions presenting to an emergency department at a tertiary referral hospital in Sydney.This finding,however,may have been distorted by underreporting of vaccination history.

The Limits of Etiological Diagnosis of Convulsions in Children at the Bangui Pediatric Hospital

Introduction: Convulsions are a frequent cause of admission to paediatric wards in countries with limited resources, and a major cause of neurological and cognitive sequelae. In sub-Saharan Africa, the aetiology of febrile convulsions is dominated by infections of the central nervous system. A detailed clinical examination and laboratory and imaging tests are carried out to identify the cause of the disease. Computed tomography is reserved for emergency situations or as a second line of defence, after Magnetic Resonance Imaging (MRI) to look for calcifications. Imaging thus helps to establish the nature of the epileptogenic lesion, specify its extent and guide its therapeutic management. The aim of this study is to clarify the contribution of MRI in the etiological investigation of convulsions in children at the paediatric university hospital, in addition to the usual means of exploration. Patient and Method: This was a cross-sectional, descriptive study from January 2022 to December 2023. We carried out an exhaustive sampling of all children aged between 1 and 59 months admitted for convulsion with fever or not who had undergone complementary examinations for aetiological purposes in relation to our technical platform during the study period. Results: Thirty patients were recruited. Children aged 12 to 59 months were the most represented (69.7%). The sex ratio was 1.30. The mean age was 36 months (range 30 days to 59 months). Of the 30 patients, 21.8% had a history of febrile convulsions. Most of our patients were from Bangui (73.3%). On admission, the majority of patients presented with an elevated temperature ranging from 38.5 degrees Celsius to 39.4 degrees Celsius in 33.1% of cases. The dominant clinical manifestations were tonic-clonic convulsions (53.2%), tonic convulsions (35.3%) and clonic convulsions (11.5%). According to their characteristics, convulsions were complex in 53.7% of cases and simple in 46.3%. Examinations for infectious diseases, tumors or malformation has been ruled out. The anticonvulsants most commonly used were diazepam, phenobarbital and phenytoin. We recorded a 73.3% cure rate and 4 (13.3%) cases of death. Conclusion: The investigation of seizures in search of aetiology outside the usual means in our context still presents difficulties. MRI is the examination of choice for exploring the posterior fossa and midline lesions. Combined with CT, it is better for exploring hemispheric tumours.

Specific convulsions and brain damage in children hospitalized for Omicron BA.5 infection:an observational study using two cohorts

Background SARS-CoV-2 continues to mutate over time,and reports on children infected with Omicron BA.5 are limited.We aimed to analyze the specific symptoms of Omicron-infected children and to improve patient care.Methods We selected 315 consecutively hospitalized children with Omicron BA.5 and 16,744 non-Omicron-infected febrile children visiting the fever clinic at our hospital between December 8 and 30,2022.Specific convulsions and body temperatures were compared between the two cohorts.We analyzed potential associations between convulsions and vaccination,and additionally evaluated the brain damage among severe Omicron-infected children.Results Convulsion rates(97.5%vs.4.3%,P<0.001)and frequencies(median:2.0 vs.1.6,P<0.001)significantly differed between Omicron-infected and non-Omicron-infected febrile children.The body temperatures of Omicron-infected children were significantly higher during convulsions than when they were not convulsing and those of non-Omicron-infected febrile children during convulsions(median:39.5 vs.38.2 and 38.6℃,both P<0.001).In the three Omicron-subgroups,the temperature during convulsions was proportional to the percentage of patients and significantly differed(P<0.001),while not in the three non-Omicron-subgroups(P=0.244).The convulsion frequency was lower in the 55 vaccinated children compared to the 260 non-vaccinated children(average:1.8 vs.2.1,P<0.001).The vaccination dose and convulsion frequency in Omicron-infected children were significantly correlated(P<0.001).Fifteen of the 112 severe Omicron cases had brain damage.Conclusions Omicron-infected children experience higher body temperatures and frequencies during convulsions than those of non-Omicron-infected febrile children.We additionally found evidence of brain damage caused by infection with omicron BA.5.Vaccination and prompt fever reduction may relieve symptoms.

A Delicate Diagnostic of Posterior Reversible Encephalopathy Syndrome (PRES) Revealed by Repetitive Convulsions in a 14-Year-Old Child: A Case Report and Review of the Literature

Background: Rare pathological conditions are frequently a diagnostic challenge in intensive care. Posterior-reversible encephalopathy syndrome (PRES) is a clinical and imaging diagnosis recently individualized. It occurs in various conditions such as collagenosis or vasculitis of the central nervous system, electrolytic disorders and the use of cytotoxics or immunosuppressive treatment. It is responsible for non-specific neurological manifestations such as confusion, coma, convulsions or visual disturbances. The diagnosis is suggested by brain magnetic resonance imaging (MRI). The lesions correspond to vasogenic edema and are therefore generally reversible after etiologic treatment and control of blood pressure. Aim: This clinical case aims to show the diagnostic complexity of rare pathologies in the intensive care unit. Case presentation: We present a case of a 14-year-old child received in the pediatrics department for generalized tonic-clonic convulsions with tongue biting in a febrile context. Malaria was negative, with hyperleukocytosis, slightly elevated C-reactive protein, anemia and hypokliemia, lumbar puncture was performed and all cerebrospinal fluid examinations revealed nothing. The seizures were controlled by titrated cumulative doses of diazepam with a total of 12mg, antibiotic therapy with ceftriaxone, corticotherapy with dexamethasone 12mg and blood transfusion without any improvement in his condition. He was then transferred to intensive care where the clinical and paraclinical assessment highlighted a neurological deficit Glasgow coma scale of 12/15 and biological hyponatremia. Brain CT-scan was normal. Hydroelectrolytic equilibration was undertaken, antibiotics continued, anti-comital prophylaxis and general resuscitation measures were provided. He regained consciousness on the 3rd day. On the 4th day, he presented high blood pressure and on the 5th, a resumption of convulsions without any obvious biological disorder, cerebrospinal fluid control was once more non-pathological. An MRI was performed and revealed Posterior-reversible encephalopathy syndrome. Conclusion: Posterior-reversible encephalopathy syndrome is a rare disease. It is necessary to keep rare diseases in mind.

Penetrance estimation of PRRT2 variants in paroxysmal kinesigenic dyskinesia and infantile convulsions

Proline-rich transmembrane protein 2(PRRT2)is the leading cause of paroxysmal kinesigenic dyskinesia(PKD),benign familial infantile epilepsy(BFIE),and infantile convulsions with choreoathetosis(ICCA).Reduced penetrance of PRRT2 has been observed in previous studies,whereas the exact penetrance has not been evaluated well.The objective of this study was to estimate the penetrance of PRRT2 and determine its influencing factors.We screened 222 PKD index patients and their available relatives,identified 39 families with pathogenic or likely pathogenic(P/LP)PRRT2 variants via Sanger sequencing,and obtained 184 PKD/BFIE/ICCA families with P/LP PRRT2 variants from the literature.Penetrance was estimated as the proportion of affected variant carriers.PRRT2 penetrance estimate was 77.6%(95%confidence interval(CI)74.5%–80.7%)in relatives and 74.5%(95%CI 70.2%–78.8%)in obligate carriers.In addition,we first observed that penetrance was higher in truncated than in non-truncated variants(75.8%versus 50.0%,P=0.01),higher in Asian than in Caucasian carriers(81.5%versus 68.5%,P=0.004),and exhibited no difference in gender or parental transmission.Our results are meaningful for genetic counseling,implying that approximately three-quarters of PRRT2 variant carriers will develop PRRT2-related disorders,with patients from Asia or carrying truncated variants at a higher risk.

Clinical analysis between serum 25-hydroxyvitamin D3, interleukin-6 levels and febrile convulsion in children

Objective:To investigate the relation between febrile convulsions and 25hydroxy-vitamin D_(3)[25-(OH)D_(3)]and interleukin-6(IL-6)levels in children.Methods:241 children(divided into simple febrile convulsions and complex febrile convulsions),who were diagnosed with febrile convulsions at the Women and Children's Medical Center of Hainan Province from January 2017 to October 2022,were selected into the febrile convulsions group;100 healthy children,who had no uncomfortable symptoms and attended the outpatient clinic of the Women and Children's Medical Center of Hainan Province for physical examination,for the control group.All the subjects measured the serum 25-(OH)D_(3) and IL-6 levels,and clinical information,such as age,gender and season,was recorded.Results:1)Serum 25-(OH)D_(3) levels in the febrile convulsion group were significantly lower than in the healthy control group(78.77±20.37 nmol/L versus 96.55±29.74 nmol/L,respectively),and there was a statistically significant between the two groups(t value-6.359,P<0.001).Serum IL-6 levels in the febrile convulsion group were significantly higher than in the healthy control group,and there was a statistically significant between the two groups(Z value of-14.291,P<0.001).2)Serum 25-(OH)D_(3) levels in children with complex febrile convulsions were significantly lower than those in children with simple febrile convulsions,and the difference between the two groups was statistically significant(t-value of 6.612,P<0.05).IL-6 levels were higher in children with complex febrile convulsions than in children with simple febrile convulsions,and the difference between the two groups was statistically significant(Z value-10.151,P<0.001).The difference in the severity of febrile convulsions was statistically significant in serum 25-(OH)D_(3) levels(x^(2)=29.83,P<0.001).3)The results of correlation analysis showed that serum 25-(OH)D_(3) level was negatively correlated with febrile convulsion(γ=-0.393,P<0.05);serum 25-(OH)D_(3) level was positively correlated with that(γs=0.328,P<0.05).4)The correlation analysis results showed that the serum 25-(OH)D_(3) level was negatively correlated with the clinical characteristics of febrile convulsion(γ=-0.393,P<0.05).However,serum IL-6 water is positively correlated with it(γs=0.328,P<0.05).4)In contrast,there was no statistically significant difference in serum 25-(OH)D_(3) levels among children with febrile convulsions in different seasons(P>0.05).Conclusions:There is a correlation between febrile convulsion and serum levels of 25-(OH)D_(3) and IL-6.25-(OH)D_(3) and IL-6 may participate in the pathogenesis of febrile convulsion.

Etiology and Short Term Outcome of Neonatal Convulsion in NICU at Benghazi Children Hospital

Background: Neonatal seizures are the most prominent feature of neurological dysfunction during neonatal period, which are abnormal electrical discharges in the central nervous system of neonates, usually manifest as stereotyped muscular activity or autonomic changes, occurring in approximately 1.8 - 3.5/1000 live birth. Objective: The aims of study are to determine prevalence rate, natural history, time of onset, etiological factors, clinical types and the short term outcome of neonatal convulsion. Settings: This study conducted in Neonatal Department at Benghazi Children Hospital—Libya. Patients and Methods: Descriptive cross sectional study, included all neonates who developing clinically identifiable seizures, admitted from 1st of March 2013 to 1st of March 2014. The data collected by using a designed perform including;gender, nationality, residence, place of transfer, gestational age, time of onset, mode of delivery, and history of maternal diseases, family history of neonatal seizures in previous siblings or death, jaundice and exchange transfusion were taken. Details examination include dysmorphic features, weight, head circumference were recorded. Types of seizures were diagnosed by clinical observations, and the etiology of neonatal seizures had been identified from imaging study and from initial relevant investigations which include blood glucose levels, arterial blood gases, serum calcium, electrolytes, phosphate and cerebrospinal fluid examination for evidence of infection. In addition to treatments received, as well as causes of deaths. Results: A total of 2842 neonates were admitted to NNW, out of which 150 had seizures. 86 (57%) were male with M:F ratio of 1.3:1. (97%) were Libyan and (76%) from Benghazi, (42%) admitted directly from home. 131 (87%) were term and 15 (10%) preterm. Most of neonatal seizures (76%) were seen in the 1st week of life, and during initial 72 hours of life (63%), with 24% presented in 1st 24 hours of life. Vaginal delivery conducted in 101 (67%), C/S 49 (33%). Among babies with birth asphyxia, 76% delivered vaginally. 43/150 mothers presented with different medical problems, 32% of them had preeclampsia followed by diabetes in 28%. 127 (85%) babies had normal birth weight and 128 (86%) lie within normal range of head circumference. The most common type of seizure was subtle (48%) followed by clonic (36%). Cranial ultrasound performed to 110 (73%), among them, 16 babies MRI or CT scan were done. The most common cause of seizure was birth asphyxia (30%) followed by infection (16%), hypocalcemia (14%). Phenobarbitone was the most common drug used in treatment (60%), followed by phenytoin (40%) and resistant cases for treatment received pyridoxine (2%). 77 (52%) improved and discharged home without treatment. Mortality rate was 15%;among them 44% from IEM, followed by birth asphyxia 22%. There is strong association between main causes and the outcome with p = 0.005. Conclusion: The majority of neonates in our study were full term and male. The most common etiology of seizures is birth asphyxia. Hypocalcemia is the most common biochemical abnormality. Subtle represents the commonest type of seizure. Phenobarbitone is still the most commonly prescribed anticonvulsant. Inborn error of metabolism carries a higher mortality rate. Statically analysis showed there is significant association between main causes of neonatal convulsions and the outcome with p = 0.005.

Prevalence and CT-Scan Presentations of Brain Malformations in Children at a University-Affiliated Mother and Child Hospital (Cameroon)

Background: Brain malformations (BMs) are congenital abnormalities of the shape or structure of the brain, with corpus callosum agenesis known as the most frequent. Diagnosis of most BMs can be prenatal with ultrasound and fetal magnetic resonance imaging (MRI);post-natal diagnosis is based on transfontanellar ultrasound, CT-scan, and head MRI which is the imaging gold standard technique. MRI has been recently introduced and the CT-scan was previously the reference technique for the diagnosis of BMs in our context. Almost no publication has been made in sub-Saharan Africa on the clinical and CT scan characteristics of Brain malformations in children. Objective: The aim of this study was, in the absence of MRI, to describe the clinical and CT-scan presentations of brain malformations in children at the Yaounde Gynaeco-Obstetric and Pediatric Hospital (YGOPH). Patients and method: This was a cross-sectional descriptive study conducted from February to May 2016 at the YGOPH, including all children of 15-year-old and less with BM diagnosed on CT-scan at YGOPH between April 2006 and March 2016. The studied variables were clinical (age at diagnosis, sex, clinical manifestations) and CT findings (type of cerebral malformation). The data was analyzed using the SPSS 20.0 software with the estimation of hospital prevalence of BMs, frequencies and associations. The chi-square test was used to seek for an association between variables. The threshold of significance was p Results: The prevalence of BMs was 0.52%, with 29 cases of BMs identified out of 5590 patients followed up at the pediatric neurology outpatient unit over a period of 10 years. The mean age at diagnosis was 37.2 months (3.1 years) and the most represented age groups were 0 - 1 year (37.9%) and 1 - 5 years (37.9%). The sex ratio was 0.81 (55.2% girls). The clinical presentation was represented by neurological signs (93.1%) with convulsions (65.5%) and psychomotor retardation (58.8%) associated with skin lesions (34.5%) and/or facial dysmorphic features (27.6%). BM was suspected on antenatal ultrasound in 14.3% of cases (4/28). Abnormalities of cortical development accounted for 65.5% of BM followed by abnormalities of brain separation (31%). Tuberous sclerosis complex was the most common BM (31%) followed by agenesis of the corpus callosum (27.6%). The presence of dysmorphic facial features was associated (p = 0.007) with disorders of brain separation (DBS) while the presence of cutaneous lesions was associated (p = 0.013) with anomalies of the cortical development (ACD) especially tuberous sclerosis complex. Conclusion: BMs are infrequent, dominated by tuberous sclerosis complex and agenesis of the corpus callosum. They are mainly revealed by convulsions and psychomotor retardation. Efforts are needed to improve antenatal diagnosis and facilitate access to cerebral MRI.

Evaluation of the anticonvulsant activity of the essential oil of Myrothamnus moschatus in convulsion induced by pentylenetetrazole and picrotoxin

Objective: To evaluate the anticonvulsant effect of the essential oil of Myrothamnus moschatus(M. moschatus) in convulsion induced by pentylenetetrazole and picrotoxin in rodent models.Methods: The essential oil of the aerial parts of M. moschatus was extracted by steam distillation. Thereafter, it was injected subcutaneously to rats and mice at escalating doses(0.1–0.8 m L/kg). Ten minutes after drug injection, pentylenetetrazole was injected intraperitoneally to rats and picrotoxin was administered to mice by the same route.Diazepam served as the positive control. Every single animal was placed into transparent cage and observed for convulsive behavior for 30 min by using ordinary security cameras connected to a video recorder. Death occurring for a period of 24 h was also recorded.Results: The essential oil at 0.8 m L/kg completely arrested the pentylenetetrazole-induced convulsion without any sedative effect and delayed its appearance at lower doses, but showed moderate activities on picrotoxin-induced convulsion. For the rats treated with pentylenetetrazole alone, the mortality was 100% within 1 h, but for the rats pre-treated with the essential oil, the mortality was 0%. For the mice treated with picrotoxin, the mortality rate was also 100%, while 20%–100% died in those that had been pre-treated with the oil.Conclusions: The results confirmed at least partly the traditional uses of the smoke of M. moschatus for the management of convulsion, and implied that the essential oil may inhibit the convulsion by GABAergic neuromodulation.

Frequency of Hypocalcemic Fits in Children 2 Months to 2 Years of Age, Presenting with the First Episode of Afebrile Seizures at Hospital Settings in Urban Pakistan: A Cross-Sectional Study

Introduction: Seizures are common in the pediatric age group, occurring approximately 10% of children. Hypocalcemia is one of the most common metabolic causes of afebrile seizures. The objective of the study was to determine the frequency of hypocalcemic fits in children presenting with the first episode of afebrile seizures from 2 months to 2 years of age. Methods: The study was conducted at the Aga Khan hospital Karachi and its three secondary hospitals including the following sites of Kharadar, Hyderabad, and garden. It was a cross-sectional study. The duration of the study was of 6 months from 18th July 2017 to 18th Jan. 2018. All patients who fulfill the inclusion criteria and visited the Pediatric medicine Department of Aga Khan Hospital, Karachi, and its secondary hospitals were included in the study after ethical approval and informed and written consent. A brief history was taken, clinical examination was done and serum calcium level was sent to the institutional laboratory to reach the outcome i.e. hypocalcemic fits. Result: A total of 85 children presenting with the first episode of afebrile seizures were included. Total of 45 patients (52.98%) were males & 40 patients 2 (47.1%) were females with the mean age were 10.5824 ± 6.84907 months. The hypocalcemic fits were seen in 21 children (24.7%). Discussion: Hypocalcemia is a common cause of afebrile fits in children. Inadequate sun exposure, early age, male gender, low weight, and illiteracy are major risk factors for hypocalcemia.

Insulinoma misdiagnosed as epilepsy

Insulinoma is a rare disease presenting with episodic neuroglycopenic and/or adrenergic symptoms. We describe the clinical case of a female subject, 44 years old, affected with insulinoma, misdiagnosed for two years as epilepsy, threaten with antiepileptics. Insuli-noma was diagnosed based on fasting blood glucose level of 15 mg/dl, high fasting immunoreactive insu-lin/blood glucose ratio (more than 0.3), and a tumor in the pancreas by abdominal CT. After surgical re-moval of the neoplasm, the blood glucose level and insulin level turned normal. A benign insulinoma was also confirmed by histopathological evaluation. The patient remained seizure-free during the 2-year follow up.

Seizures in Children under Five in a Pediatric Ward: Prevalence, Associated Factors and Outcomes

Introduction: convulsion is a frequent cause of neurological and cognitive sequelae and then of epilepsy. The objective of this work was to describe the socio-demographic, clinical, therapeutic, and evolutionary aspects. Methodology: This was a descriptive retrospective study carried out in the general pediatrics department of CHU-Gabriel Touré. It took place over a period of 02 years from January 2017 to December 2018. We included all children aged 1 to 59 months hospitalized in the ward for convulsion. Results: During the study period, 2653 children aged 2 months to 59 months were hospitalized in the general pediatric ward. We included 288 medical records of children who presented with a seizure on admission. Convulsions represented 11% of pediatric hospitalizations from 1 month to 59 months. The average age was 29 months. Fever was present in 86% of patients. The cerebrospinal fluid (CSF) test was positive in 38 patients. Hypoglycemia was present in 14 patients. Serum calcium was low in 3 patients. The most implicated etiologies were malaria 70%, meningitis 20%, and dehydration 13%. Management consisted of airway clearance, oxygen therapy as needed, and administration of diazepam (54%). Antibiotics were prescribed in 77% of cases and antimalarials in 70%. The average length of hospital stay was 8 days with extremes of 1 and 30 days. The outcome was favorable in 95% of cases. Sequelae were observed in 5% of cases and one case of death was observed. Conclusion: Acute convulsions are one of the most common causes of hospitalization in children under 5 years old. The causes were dominated by infectious diseases (malaria, meningitis). The appropriate course of action was the administration of diazepam rectally.

Epidemiological and Clinical Aspects of Abnormal Movements in Children from 2 Months to 15 Years in the Pediatric Department of Gabriel Toure University Hospital Centre of Bamako

Introduction: Abnormal or involuntary movements correspond to a disorder in the programming and/or execution of movement. They have two characteristics;they are hardly or not at all controlled by the will and occur in the absence of any paralysis. Objective: To determine the epidemiological, clinical and etiological characteristics of abnormal (involuntary) movements in children aged 2 months to 15 years. Patients and Methods: This was a prospective, descriptive study from January 2016 to December 2018 of children aged 2 months to 15 years seen in neuropediatric consultations for abnormal movements. Results: During the study period 1920 children were seen in neuropediatric consultations and 57 presented with abnormal movements, i.e. a frequency of 2.96%. Children aged between 6 and 60 months were the most affected (54.4%). The sex ratio was 1.53. Movement abnormality was the most common reason for consultation (45.7%), followed by apyretic convulsions (28%), and laxity (5.3%). The onset was progressive in 68.4% of children. The main types of abnormal movements were chorea (31.6%), dystonia (26.3%), myoclonus (17.5%), tremor in 10.5%. The causes were infectious (73.68%). Conclusion: Abnormal movements are rare in paediatric practice. They have multiple causes and their management is urgent in certain situations that can jeopardise the future of children.