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ETP023 Effects of anti-epileptic drug therapy on heart rate variability in children with epilepsy
120
Abstracts: Poster Presentations, the Seventh European Paediatric Neurology Society (EPNS) Congress
children receiving antiepileptic drugs and evaluation of these drugs effects on vitamin D and calcium metabolism. Methods: Sixty epileptic children and adolescents of children neurology clinic whom were taking antiepileptic drugs and had inclusion criterions were selected as simple sampling from July 2005 to June 2006. Thirty age and sex matched normal children and adolescent considered as control group. Serum levels of 25OHD3 , calcium and alkaline phosphatase compared between groups. Findings: Serum levels of 25OHD3 (P < 0.001), calcium (P < 0.001) and alkaline phosphatase (P < 0.001) were significantly different between groups. Ten percent of patients had serum 25OHD3 level below lower normal limit. There was a reverse correlation between duration of drug therapy and serum level of 25OHD3 (r = −0.345, P = 0.011). Conclusion: Antiepileptic drug treatment in children results in reducing of serum 25OHD3 and calcium levels and increases bone turnover. With longer duration of treatment serum 25OHD3 level decreases more. Keywords: Antiepileptic drug, Vitamin D, Children ETP023 Effects of anti-epileptic drug therapy on heart rate variability in children with epilepsy ¸ Okuyaz2 *, E. Mert3 , K. Makharoblidze4 . O. Hallıoglu ˘ 1 , C. 1 Mersin University Medical Faculty, Division of Pediatric Cardiology, 2 Mersin University Medical Faculty, Division of Pediatric Neurology, 3 Mersin University Medical Faculty, Department of Family Medicine, 4 Mersin University Medical Faculty, Department of Pediatrics, Turkey Impaired cardiac autonomic function may contribute to the risk of sudden unexpected death in epilepsy. Heart rate variability (HRV) is a useful tool for the detection of sympathetic-parasympathetic balance of autonomic nervous system. The changes of HRV parameters associated with autonomic nerve system dysfunction were; (1) the suppression of time domain parameters including SDNN (standard deviation of all R-R intervals), RMSSD (root-meansquare of successive differences), and HRV triangular index, (2) the deterioration in the balance of the frequency domain parameters including HF (reflects parasympathetic activity) and LF (reflects sympathetic activity). Autonomic nervous system involvement in patients with epilepsy has been studied, but the effects of antiepileptic drugs on HRV in patients with epilepsy have rarely been studied and have shown conflicting results. In the present study, epilepsy patients who had never received antiepileptic medication and those whose seizures have been successfully controlled with antiepileptic drugs were compared with a control group in order to investigate the effects of epilepsy and various antiepileptic drugs on HRV. A short period analysis of HRV was performed for both the frequency and time domain in 92 epilepsy patients and in 83 age and sex matched controls. In the epilepsy patients group, time domain parameters including SDNN (p = 0.000), RMSSD (p = 0.000), and HRV triangular index (p = 0.000) were found to be suppressed and the parasympathetic activity (HF) was found to be decreased. In this group, 73 patients were using antiepileptic drugs including valproic acid (n = 33), oxcarbazepine (n = 19), phenobarbital (n = 11) and combined regimens (n = 10), while 14 patients had never received antiepileptic medication. Comparison of the groups showed that HRV was suppressed (SDNN p = 0.003, RMSSD p = 0.042, HRV triangular index p = 0.002) and parasympathetic activity was decreased (HF p = 0.046) in patients without antiepileptic drug therapy. No significant differences were detected in HRV parameters between the antiepileptic drug using group and control group.
Our results indicate that seizure control with antiepileptic drugs may help to minimize the risk of sudden unexpected deaths resulting from an impairment of cardiac autonomic function. ETP024 Decreased midbrain grey matter after prenatal exposure to antiepileptic drugs C. Ikonomidou1 , I. Scheer2 , T. Wilhelm3 , F. Juengling4 , 2 , U. Lehmkuhl6 , S. Koch7 , J. Kassubek8 . K. Titze5 , B. Stover ¨ 1 Department of Pediatric Neurology, Medical Faculty Carl Gustav Carus Technical University Dresden, Fetscherstrasse 74, 01307 Dresden, Germany, 2 Department of Pediatric Radiology, Charite, Children’s Hospital, Humboldt University, Augustenburger Platz 1, 13353 Berlin, Germany, 3 Department of Pediatric Neurology, Charite, Children’s Hospital, Humboldt University, Augustenburger Platz 1, 13353 Berlin, Germany, 4 Department of Nuclear Medicine, University of Bern, Inselspital, 3010 Bern; 5 Department of Child and Adolescent Psychiatry, University of Zurich; Neumunsterallee, ¨ Switzerland, 6 Department of Child Psychiatry, Charite Children’s Hospital, Humboldt University, Augustenburger Platz 1, 13353 Berlin, Germany, 7 Children’s Hospital, Vivantes Klinikum Neukolln, ¨ Berlin, Germany, 8 Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany Prenatal exposure of humans to antiepileptic drugs may cause cognitive impairment. Ion channels, neurotransmitters and second messenger systems constitute molecular targets of antiepileptic drugs. These same targets regulate brain processes essential for learning, memory and emotional behavior. In addition, it has been shown that antiepileptic drugs trigger apoptotic neurodegeneration in the developing brain when administered to immature rodents. To explore whether prenatal exposure to antiepileptic drugs may result in structural changes in the brain, we subjected a group of 18 healthy young adults exposed prenatally to antiepileptic drugs and a group of 18 age-matched unexposed healthy controls to magnetic resonance imaging (MRI) of the brain. Local differences in cerebral morphology associated with prenatal exposure to antiepileptic drugs were analyzed in volume-rendering MRI data by use of voxelwise comparisons of grey matter images. Contrasts for regional grey matter volume changes, i.e. exposed patients < controls, yielded significant results at a threshold of uncorrected p < 0.05. Regional decreases of grey matter volumes were found in the area of the lentiform nucleus, including both pallidum and putamen bilaterally, and the hypothalamus. We conclude that prenatal exposure to antiepileptic drugs results in lower grey matter volumes in the basal ganglia and the hypothalamus in humans. ETP025 Hematologic side effects of carbamazepine: Is monitoring necessary? M. Mehdizadeh1 *, G. Zamani2 . 1 Shaheed Beheshti Medical University, 2Tehran University of Medical Sciences, Iran Objective: Early case reports of fatal hematologic effects attributed to carbamazepine resulted in extensive monitoring recommendations but rarity of blood dyscrasias led authors to question about guidelines. To investigate frequency and severity of carbamazepine induced cytopenias we conducted a cohort study on patients who started Carbamazepine. Methods: 815 epileptic children aged between 3−18 years on carbamazepine monotherapy who didn’t have any serious hematological disorders entered study. CBC was done first and then 2 weeks, 1 month later and continued with 2−4 months intervals. WBC count and differentiation, Hb level, MCVand platelets count were evaluated. Results: 389 girls and 426 boys entered the study. Mean age was 8.11 years. 38 patients (5%) were iron deficient who
Abstracts: Poster Presentations, the Seventh European Paediatric Neurology Society (EPNS) Congress
children receiving antiepileptic drugs and evaluation of these drugs effects on vitamin D and calcium metabolism. Methods: Sixty epileptic children and adolescents of children neurology clinic whom were taking antiepileptic drugs and had inclusion criterions were selected as simple sampling from July 2005 to June 2006. Thirty age and sex matched normal children and adolescent considered as control group. Serum levels of 25OHD3 , calcium and alkaline phosphatase compared between groups. Findings: Serum levels of 25OHD3 (P < 0.001), calcium (P < 0.001) and alkaline phosphatase (P < 0.001) were significantly different between groups. Ten percent of patients had serum 25OHD3 level below lower normal limit. There was a reverse correlation between duration of drug therapy and serum level of 25OHD3 (r = −0.345, P = 0.011). Conclusion: Antiepileptic drug treatment in children results in reducing of serum 25OHD3 and calcium levels and increases bone turnover. With longer duration of treatment serum 25OHD3 level decreases more. Keywords: Antiepileptic drug, Vitamin D, Children ETP023 Effects of anti-epileptic drug therapy on heart rate variability in children with epilepsy ¸ Okuyaz2 *, E. Mert3 , K. Makharoblidze4 . O. Hallıoglu ˘ 1 , C. 1 Mersin University Medical Faculty, Division of Pediatric Cardiology, 2 Mersin University Medical Faculty, Division of Pediatric Neurology, 3 Mersin University Medical Faculty, Department of Family Medicine, 4 Mersin University Medical Faculty, Department of Pediatrics, Turkey Impaired cardiac autonomic function may contribute to the risk of sudden unexpected death in epilepsy. Heart rate variability (HRV) is a useful tool for the detection of sympathetic-parasympathetic balance of autonomic nervous system. The changes of HRV parameters associated with autonomic nerve system dysfunction were; (1) the suppression of time domain parameters including SDNN (standard deviation of all R-R intervals), RMSSD (root-meansquare of successive differences), and HRV triangular index, (2) the deterioration in the balance of the frequency domain parameters including HF (reflects parasympathetic activity) and LF (reflects sympathetic activity). Autonomic nervous system involvement in patients with epilepsy has been studied, but the effects of antiepileptic drugs on HRV in patients with epilepsy have rarely been studied and have shown conflicting results. In the present study, epilepsy patients who had never received antiepileptic medication and those whose seizures have been successfully controlled with antiepileptic drugs were compared with a control group in order to investigate the effects of epilepsy and various antiepileptic drugs on HRV. A short period analysis of HRV was performed for both the frequency and time domain in 92 epilepsy patients and in 83 age and sex matched controls. In the epilepsy patients group, time domain parameters including SDNN (p = 0.000), RMSSD (p = 0.000), and HRV triangular index (p = 0.000) were found to be suppressed and the parasympathetic activity (HF) was found to be decreased. In this group, 73 patients were using antiepileptic drugs including valproic acid (n = 33), oxcarbazepine (n = 19), phenobarbital (n = 11) and combined regimens (n = 10), while 14 patients had never received antiepileptic medication. Comparison of the groups showed that HRV was suppressed (SDNN p = 0.003, RMSSD p = 0.042, HRV triangular index p = 0.002) and parasympathetic activity was decreased (HF p = 0.046) in patients without antiepileptic drug therapy. No significant differences were detected in HRV parameters between the antiepileptic drug using group and control group.
Our results indicate that seizure control with antiepileptic drugs may help to minimize the risk of sudden unexpected deaths resulting from an impairment of cardiac autonomic function. ETP024 Decreased midbrain grey matter after prenatal exposure to antiepileptic drugs C. Ikonomidou1 , I. Scheer2 , T. Wilhelm3 , F. Juengling4 , 2 , U. Lehmkuhl6 , S. Koch7 , J. Kassubek8 . K. Titze5 , B. Stover ¨ 1 Department of Pediatric Neurology, Medical Faculty Carl Gustav Carus Technical University Dresden, Fetscherstrasse 74, 01307 Dresden, Germany, 2 Department of Pediatric Radiology, Charite, Children’s Hospital, Humboldt University, Augustenburger Platz 1, 13353 Berlin, Germany, 3 Department of Pediatric Neurology, Charite, Children’s Hospital, Humboldt University, Augustenburger Platz 1, 13353 Berlin, Germany, 4 Department of Nuclear Medicine, University of Bern, Inselspital, 3010 Bern; 5 Department of Child and Adolescent Psychiatry, University of Zurich; Neumunsterallee, ¨ Switzerland, 6 Department of Child Psychiatry, Charite Children’s Hospital, Humboldt University, Augustenburger Platz 1, 13353 Berlin, Germany, 7 Children’s Hospital, Vivantes Klinikum Neukolln, ¨ Berlin, Germany, 8 Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany Prenatal exposure of humans to antiepileptic drugs may cause cognitive impairment. Ion channels, neurotransmitters and second messenger systems constitute molecular targets of antiepileptic drugs. These same targets regulate brain processes essential for learning, memory and emotional behavior. In addition, it has been shown that antiepileptic drugs trigger apoptotic neurodegeneration in the developing brain when administered to immature rodents. To explore whether prenatal exposure to antiepileptic drugs may result in structural changes in the brain, we subjected a group of 18 healthy young adults exposed prenatally to antiepileptic drugs and a group of 18 age-matched unexposed healthy controls to magnetic resonance imaging (MRI) of the brain. Local differences in cerebral morphology associated with prenatal exposure to antiepileptic drugs were analyzed in volume-rendering MRI data by use of voxelwise comparisons of grey matter images. Contrasts for regional grey matter volume changes, i.e. exposed patients < controls, yielded significant results at a threshold of uncorrected p < 0.05. Regional decreases of grey matter volumes were found in the area of the lentiform nucleus, including both pallidum and putamen bilaterally, and the hypothalamus. We conclude that prenatal exposure to antiepileptic drugs results in lower grey matter volumes in the basal ganglia and the hypothalamus in humans. ETP025 Hematologic side effects of carbamazepine: Is monitoring necessary? M. Mehdizadeh1 *, G. Zamani2 . 1 Shaheed Beheshti Medical University, 2Tehran University of Medical Sciences, Iran Objective: Early case reports of fatal hematologic effects attributed to carbamazepine resulted in extensive monitoring recommendations but rarity of blood dyscrasias led authors to question about guidelines. To investigate frequency and severity of carbamazepine induced cytopenias we conducted a cohort study on patients who started Carbamazepine. Methods: 815 epileptic children aged between 3−18 years on carbamazepine monotherapy who didn’t have any serious hematological disorders entered study. CBC was done first and then 2 weeks, 1 month later and continued with 2−4 months intervals. WBC count and differentiation, Hb level, MCVand platelets count were evaluated. Results: 389 girls and 426 boys entered the study. Mean age was 8.11 years. 38 patients (5%) were iron deficient who