1. Case Series: The Paradox of Epilepsy Surgery and Psychiatric Disorder
Charcrin Nabangchang , Piradee Sanguankiat , Kamornwan Katanyuwong , Siraruj Sakoolnamarka
De novo psychiatric disorder following epilepsy surgery is an infrequent but very interesting phenomenon. The authors described 4 distinct cases with medically intractable epilepsy who had epilepsy surgery and developed postsurgical psychiatric disorder. The onset of psychiatric disorder was during dramatic improvement of their epilepsy after surgery. There was no history of psychiatric disorder in their familial members or in the patients prior to the surgery. Since three patients also had mental retardation, presurgical cognitive impairment may be one of the risk factors for developing postsurgical psychiatric disorder. Potential mechanisms include volume reduction of gray matter in frontal, temporal and parietal cortexes secondary to epilepsy surgery as well as forced normalization. Several other mechanisms may also play important role for this phenomenon and further studies will be required which may reveal the connection between these two aspects.
2.Neuropsychiatric Manifestations in Pediatric Systemic Lupus Erythematosus
Suwanpakdee P , Nabangchang C , Lumpaopong A
Background: The frequency of neuropsychiatric manifestations in systemic lupus erythematosus (NPSLE) is rare.
Objective: To determine the prevalence and clinical features of pediatric NPSLE.
Material and Method: We reviewed the medical records of pediatric SLE patients between January 1988 and August 2009. Sixty-six SLE patients were identified. The patients who had lupus-like symptoms and had NPSLE secondary to other causes were excluded.
Results: NPSLE was identified in 17 patients (25.8%). The median age onset was 13 years. Eight patients (12.1%) had NPSLE on initial diagnosis of SLE. Ten patients (58.8%) developed NP symptoms within the first year of SLE, while seven patients (41.2%) developed these symptoms after one year of SLE diagnosis. The most common symptoms were seizure (52.9%), stroke (29.4%), and movement disorder (17.6%). No laboratory finding was correlated with NPSLE. Brain imaging showed abnormalities in more than 50% of patients including infarction, vasculitis, brain atrophy, and subdural effusion.
Conclusion: The present study demonstrated that most of NPSLE patients developed symptoms within the first year after diagnosis. Interestingly, the prevalence of seizures in Asian pediatric SLE was found to be more significant than non-Asian population. We hypothesized that ethnicity may be one of the potential predictors of NP manifestations.
Keywords: NPSLE, Neuropsychiatric, Pediatric systemic lupus erythematosus
3.Effectiveness and Adverse Effect of Intravenous Lacosamide in Nonconvulsive Status Epilepticus and Acute Repetitive Seizures in Children
Monsicha Ngampoopun,Piradee Suwanpakdee,Nattapon Jaisupa, and Charcrin Nabangchang
Nonconvulsive status epilepticus (NCSE) and acute repetitive seizures (ARS) are associated with significant morbidity and mortality. Due to the lack of randomized-controlled trials of intravenous antiepileptic drugs (AEDs) in these conditions, trials of a new generation of AEDs in this aspect are needed. A prospective interventional study was conducted in children under 18 years of age with NCSE or ARS who either had contraindication to or were refractory to first-line AEDs and received intravenous lacosamide. Demographic data, the efficacy of treatment, and adverse effects were recorded. Eleven patients with a median age of 11 years, predominantly female (72.7%), were enrolled. Average loading dose was 227 mg (8.3 mg/kg/dose) and average daily maintenance dose was 249 mg (4.6 mg/kg/dose). All patients (100%) experienced a reduction in seizure frequency within 24 hours. Eight of eleven patients (72.7%) experienced a reduction in seizure frequency of more than 50% by the end of the study, and one patient became seizure-free. In terms of adverse events, one patient had a bradycardia without prolongation of the PR interval. Interestingly, there was a case of neuronal ceroid lipofuscinosis in which a significant improvement in seizure control was achieved. The results indicate that intravenous lacosamide may be an alternative treatment for NCSE or ARS in children. To our knowledge, this is the first study on the use of intravenous lacosamide in Asian children. This study is registered to Thai Clinical Trials Registry (TCTR) and the trial registration number is TCTR20180508004.