Παρασκευή, 15 Απριλίου 2011

Acth side effects

The following side effects are associated with ACTH Inj:
Common side effects of ACTH Inj:
Scaly Oily Skin Problem Primarily On Face and ScalpLess Severe
Excessive HairinessLess Severe
Skin DiscolorationLess Severe
Easily Angered or AnnoyedLess Severe
Cushing's SyndromeLess Severe
Infrequent side effects of ACTH Inj:
Bacterial Infection of Blood or Tissues affecting the Whole BodySevere
Enlargement of the Ventricles of the BrainSevere
High Blood PressureSevere
Chronic Heart FailureSevere
High Blood SugarSevere
Insufficiency of the Hypothalamus and Pituitary GlandSevere
Low Amount of Phosphate in the BloodSevere
Low Amount of Calcium in the BloodSevere
High Amount of Sodium in the BloodSevere
Low Amount of Potassium in the BloodSevere
Rare side effects of ACTH Inj:
Lower Seizure ThresholdSevere
Reaction due to an AllergySevere

Treatment with Acth

Children with various types of childhood epilepsy that do not respond to the usual seizure medicines may be candidates for treatment with adrenocorticotropic hormone or ACTH. ACTH is a first-line treatment for infantile spasms, but it is also used in Lennox-Gastaut syndrome, Landau-Kleffner syndrome, and electrical status epilepticus in sleep. Improvement in seizure control can be seen even in the most difficult-to-control epilepsy after treatment with ACTH. The child's developmental status also may improve.
ACTH is a peptide hormone produced in the anterior pituitary gland. It is unclear just how ACTH works to stop seizures. It may work directly on the brain in addition to stimulating the adrenal glands. There is some controversy about whether to use low-dose or high-dose ACTH when treating childhood seizures. No definitive study has yet established one dose as superior.
When used in the gel form (which is given by injection), it is long-acting, so it can be given once or twice a day. Parents are taught how to give the injection so that the child can continue to live at home while receiving treatment. Injections are usually given daily for about 6 weeks.
Potential side effects of ACTH are irritability, increased appetite and weight gain, high blood pressure, low potassium in the blood, and high blood sugar. These side effects will go away once the ACTH is stopped. Other side effects are rare but more serious. These include infections, changes in mental status because of high blood pressure, and bleeding from the gastrointestinal system. The impact of these side effects can be lessened if parents are taught the early signs to look for in the child. Blood pressure should be checked often.


Δευτέρα, 11 Απριλίου 2011

Η εξασθενημένη εμβρυϊκή ανάπτυξη σχετίζεται με την επιληψία

Νέα Υόρκη: 
Τα νεογνά με εξασθενημένη ενδομήτρια ανάπτυξη, που χαρακτηρίζεται από χαμηλό σωματικό βάρος γέννησης ή πρόωρο τοκετό, φαίνεται να διατρέχουν αυξημένο κίνδυνο επιληψίας στα πρώιμα στάδια της παιδικής ηλικίας, σύμφωνα με στοιχεία που δημοσιεύονται στο επιστημονικό έντυπο American Journal of Epidemiology.
Ερευνητές του Πανεπιστημίου του Ααρχους στης Δανίας με επικεφαλής τον Δρ Γουέλιαν Σαν, μελέτησαν 1,4 εκατομμύρια βρέφη που είχαν γεννηθεί στη Δανία την περίοδο 1979- 2002 και είχαν τεθεί υπό ιατρική παρακολούθηση μέχρι και το 24ο έτος της ηλικίας τους. Οι περιπτώσεις επιληψίας εντοπίστηκαν μέσω του Εθνικού Αρχείο Νοσοκομείων της Δανίας. Από την ομάδα αυτή, 14.334 νοσηλεύθηκαν με επιληψία σε κάποιο σημείο της έρευνας.
Το ποσοστό διάγνωσης επιληψίας πάντως αυξήθηκε με την μείωση της ηλικίας κυοφορίας και του σωματικού βάρους γέννησης. Ωστόσο, η σχέση έγινε πιο αδύναμη καθώς η ηλικία διάγνωσης της επιληψίας αυξανόταν. Η επιληψία κατά το πρώτο έτος ζωής ήταν πέντε φορές συχνότερη μεταξύ των βρεφών με ηλικία κυοφορίας μεταξύ 22-32 εβδομάδων συγκριτικά με αυτά που είχαν γεννηθεί μεταξύ 39-41 εβδομάδων.
Ομοίως τα ποσοστά συχνότητας ήταν πέντε φορές υψηλότερα μεταξύ των παιδιών με σωματικό βάρος γέννησης κάτω των 2.000 γραμμαρίων συγκριτικά με αυτά που είχαν γεννηθεί μεταξύ 3.00 και 3.900 γραμμαρίων.Ο συσχετισμός μεταξύ χαμηλού σωματικού βάρους γέννησης και μικρή ηλικίας κυοφορίας και του κινδύνου επιληψίας ήταν ιδιαιτέρως ισχυρός εντός των πρώτων πέντε ετών, ίσως διότι ο ανώριμος εγκέφαλος είναι πιο επιρρεπής σε κρίσεις όταν εκτεθεί σε παράγοντες κινδύνου λειτουργίας κατά το προγεννητικό στάδιο, συγκριτικά με τον ώριμο εγκέφαλο. 

Πηγή: http://www.paidiatros.gr/index.php?cid=1&id=516&st=2

Treatment of West syndrome


PURPOSE: West syndrome (WS) is one of the catastrophic epileptic syndromes in infancy characterized by a triad of infantile spasms, psychomotor deterioration and hypsarrhythmic EEG pattern. WS is commonly associated with poor long-term outcome, especially in symptomatic cases, with development of other seizure types, impaired cognitive and psychosocial functioning. The aim of our study was to evaluate the efficacy of the control of infantile spasms using synthetic ACTH or vigabatrin in newly diagnosed cases and to correlate it with the underlyning causes, outcome and adverse effects.
PATIENTS AND METHODS: The database of children with WS seen at the Neuropediatric Unit and followed at outpatient clinics from January 1, 1994 until December 31, 2003 were reviewed. The diagnosis of WS following the criteria of ILAE was made in 32 patients.
RESULTS: Data were collected for 32 children (9 girls and 23 boys). According to the etiology, 5 (15.6%) were cryptogenic, and 1 (3.1%) was idiopathic. In 26 (81.2%) symptomatic cases, hypoxic-ischemic encephalopathy (69.2%) was the most common etiologic factor, followed by central nervous system anomaly including malformation of cortical development (11.5%), and Sturge Weber syndrome (3.8%), and chromosomal translocation with Down syndrome (11.5%). In 65.1% of symptomatic cases birth occurred prematurely. The mean age at spasm onset was 5.8 months, and mean age at diagnosis and treatment 7.2 months. Between 1994 and 1996 synthetic ACTH was used for treatment of WS in 7 patients (1 cryptogenic and 6 symptomatic), spasm control was achieved in 6, hypsarrhythmia disappeared in 5, and vigabatrin was added after synthetic ACTH in 3 patients. In one child synthetic ACTH was stopped because of arterial hypertension. All children had Cushing syndrome. After 1996, vigabatrin was administrated to 5 children with cryptogenic and 20 children with symptomatic WS. In 22/32 spasm control was achieved within 15 days. Synthetic ACTH was added in 3 children with spasms and hypsarrhythmia disappeared in 1 child. There was no recurrence of WS. The mean follow-up in 27 children was 4.6 (0.5 to 9.9 years) whereas 5 were lost from follow-up. Of 6/27 children with cryptogenic WS, 1 had idiopathic WS, 3 had normal psychomotor development and 2 had psychomotor retardation, without epileptic fits and still receiving AED. Of 21/27 children with symptomatic WS 76.2% had severe psychomotor retardation, 42.8% had epilepsy, 23.8% had intractable epileptic fits, and 2 children with Down syndrome were without epilepsy and without AED. Lennox-Gastaut syndrome developed in 14.2% (3/21 children); 1 of them died at the age of 3.5 years from acute gastric bleeding during the administration of synthetic ACTH, and an other child died at the age of 5.5 years from infection and respiratory insufficiency. The mortality rate was 7.4% (2/27 children).
DISCUSSION AND CONCLUSION: The cryptogenic etiology is associated with a very low risk of poor outcome in WS. In children with normal development and regular school performance an idiopathic etiology can be presumed. The children with Down syndrome had a relatively benign outcome with regard to seizure control compared with symptomatic infantile spasms in the general population. In symptomatic WS caused by hypoxic-ischemic encephalopathy the outcome was linked with coexistence of other forms of epilepsy and neurologic deficit. The poor prognosis concerning intractable nature of the seizures and serious neurologic deficit is recorded in children with malformation of cortical development and Sturge Weber syndrome. The outcome of these children is determined by the brain damage other than by epilepsy itself. Regarding the treatment with synthetic ACTH or vigabatrin, the control of WS was the same for cryptogenic and symptomatic forms, one drug may be effective if the other drug fails. Synthetic ACTH can have many side effects, even death. The visual field defect is associated with vigabatrin, but can be avoided with careful funduscopic follow-up. Vigabatrin can be suggested as the first drug for WS; if spasms persist after 15 days with a dose of 150 mg/kg, synthetic ACTH should be considered.

High-dose corticotropin (ACTH) versus prednisone for infantile spasms: a prospective, randomized, blinded study.

Division of Neurology, Childrens Hospital Los Angeles, USA.


OBJECTIVE: To compare the efficacy of corticotropin (ACTH) (150 U/m2/day) and prednosone (2 mg/kg/day) given for 2 weeks, in suppressing clinical spasms and hypsarrhythmic electroencephalogram (EEG) in infantile spasms (IS). ACTH and prednisone are standard treatments for IS. ACTH at high doses causes severe dose- and duration-dependent side effects, but may be superior to prednisone, based on retrospective or uncontrolled studies. Blinded prospecive studies have shown equal efficacy of prednisone and low-dose ACTH, and low versus high-dose ACTH.
DESIGN: A prospective, randomized, single-blinded study.
SUBJECTS AND METHODS: Patient population consisted of consecutive infants fulfilling entry criteria, including the presence of clinical spasms, hypsarrhythmia (or variants) during a full sleep cycle video-EEG, and no prior steroid/ACTH treatment. Response required both cessation of spasms and elimination of hypsarrhythmia by the end of the 2-week treatment period, as determined by an investigator "blinded" to treatment. Treatment of responders was tapered off over 12 days; those failing one hormone were crossed-over to the other.
RESULTS: OF 34 eligible infants, 29 were enrolled. Median age of patients was 6 months. Twenty-two infants were "symptomatic" with known or suspected cause, and seven were cryptogenic (two normal). Of 15 infants randomized to ACTH, 13 responded by EEG and clinical criteria (86.6%); Seizures stopped in an additional infant, but EEG remained hypsarrhythmic (considered a failure). Four of the 14 patients given prednisone responded (28.6%,, with complete clinical-EEG correlation), significantly less than with ACTH, (chi2 test).
CONCLUSIONS: Using a prospective, randomized approach, a 2-week course of high-dose ACTH is superior to 2 weeks of prednsone for treatment of IS, as assessed by both clinical and EEG criteria.

A World First: The Discovery Of A Common Genetic Cause Of Autism And Epilepsy

A World First: The Discovery Of A Common Genetic Cause Of Autism And Epilepsy

New Direction For Epilepsy Treatment

New Direction For Epilepsy Treatment

Παρασκευή, 8 Απριλίου 2011

Παρασκευή, 1 Απριλίου 2011

Παναγίτσα μου γλυκιά έλα σε τούτη του κόσμου τη γωνιά και κάνε όλα τα παιδιά καλά...