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P175 – 2737: Effect of biperiden treatment in acute orofacial and extremity dyskinesia with methylphenidate theraphy
EUROPEAN JOURNAL O F PAEDIATRIC NEUROLOGY
autistic group (p=0.000). Conclusion: The finding of significantly higher serum MEHP, DEHP and BPA levels in autistic group compared to controls suggests that endocrine disruptors may have role in the pathogenesis of ASDs.
P175 - 2737 Effect of biperiden treatment in acute orofacial and extremity dyskinesia with methylphenidate theraphy E. Acar Arslan 1 , E. Arslan 2 , A. Kilinc 3 , O. Göksu 4 . 1 Clinic of Pediatric Neurology, Giresun Prof. Dr. Ilhan Ozdemir Hospital, Giresun, Turkey; 2 Department of Neurosurgery, Giresun University School of Medicine, Giresun, Turkey; 3 Emergency Clinic, Kent Hospital, Giresun, Turkey; 4 Clinic of Psychology, Giresun Objective: Methylphenidate is a short-acting stimulant drug commonly prescribed to individuals with attention deficit hyperactivity disorder. The suggested underlying mechanism of acute dyskinesias is dopaminergic transmission increase. This case report highlights the importance for physicians of awareness of dyskinesia as a potential side-effect of methylphenidate therapy and indicates benefit of biperiden theraphy. The parenteral form of biperiden is an effective and reliable agent for the treatment of acute episodes of extrapyramidal disturbances that may be seen during treatment with neuroleptic agents. Akathisia, akinesia, dyskinetic tremors, rigor, oculogyric crisis, spasmodic torticollis and profuse sweating are markedly reduced or eliminated. Methods: We describe a 9-year-old male patient diagnosed with attention deficit hyperactivity disorder admitting to emergency clinic with primarily orofacial and extremity dyskinesia after the administration of a first dose of 18 mg methylphenidate. Methylphenidate was discontinued, and we injected biperiden with dosage of 0.04 mg/kg intravenously. Results: The patient’s symptoms resolved within 20 minutes after injection of biperiden (0.04 mg/kg). Conclusion: We wish to emphasize that acute orofacial dyskinesia and extremity dyskinesia can be observed during methylphenidate therapy and that biperiden can be successfully used in the treatment of this unpleasant condition. So long as the mechanism involved in acute dyskinesia with methylphenidate therapy is based solely on hypothesis, however, the exact role of methylphenidate in preventing dyskinesia will remain unknown. To the best of our knowledge, this is the first report of the use of biperiden therapy in this condition.
P176 - 2905 Neurological manifestations and clinical outcomes of Hashimoto thyroiditis in children A.K. Bayram, Ü. Gül, S. Kumanda¸s, L. Akin, M. Canpolat, H. Gümü¸s, M. Kendirci, H. Per. Department of Pediatrics, Division of Pediatric Neurology, Erciyes University, School of Medicine, Kayseri, Turkey Objective: Hashimoto thyroiditis (HT) is an autoimmune thyroid disease, characterized by different clinical courses and presentation. The purpose of this study was to identify the neurological manifestations of Hashimoto thyroiditis in children and evaluate their clinical outcome. Methods: Fifteen patients under monitoring with a diagnosis of HT and also presenting with neurological manifestations were enrolled in the study. Patients presenting with change of consciousness was considered as Hashimoto’s encephalopathy. Clinical outcomes were assessed by most recent neurological examinations during their visit at our pediatric neurology department. Results: The study patients consisted of 2 boys and 13 girls. The mean age at diagnosis of patients was 12.8±2.83 years (age range, 6–17 years). The mean duration of follow-up was 25.8±12.7 months, and ranged from 6–48 months. At the time of presentation; 5 patients were euthyroid, and 10 was hypothyroid. Neurological findings at presentation included:
19s (2015) S1 – S152
S143
headache in 10 patients, epileptic seizures in 5 patients, focal paresis in 4 patients, speech abnormalities in 3 patients, decreased school performance in 2 patients, ataxia in 2 patients, Hashimoto’s encephalopathy in 2 patients, diplopia in 1 patients, status epilepticus in 1 patients, and coma in 1 patients. Abnormal electroencephalographic recordings revealed in 8 patients. All hypothyroid patients received thyroxine replacement therapy. Two patients received intravenous methylprednisolone, and 1 patient took intravenous immunoglobulin treatment. Four children received antiepileptic therapy for control of epileptic seizures. Four children improved spontaneously without any treatment. In contrast, Hashimoto’s encephalopathy relapsed 6 times despite all the treatments in 1 patient during follow up period. Conclusion: Hashimoto thyroiditis should be considered in any patient presenting with unexplained neuropsychiatric signs and symptoms.
P177 - 2918 Toxic leukoencephalopathy in synthetic cannabinoid abuse M. Topçu, E. Serdaroglu, S.V. Okar, H. Bektas, B.M. Bekler, R. Gocmen. Hacettepe University Faculty of Medicine, Department of Pediatric Neurology Objective: Synthetic cannabinoids are a new class of abused drugs which are rapidly spreading. They have similar psychoactive effects to classical cannabinoid groups. Cannabinoid receptors are predominantly found in nervous system and mediate inhibition of transmitters. Patients presenting with synthetic cannabinoid abuse typically have altered mental status, seizures, central nervous system depression, hallucinations or vivid dreams. Here we present two adolescent cases presenting to emergency room after synthetic cannabinoid abuse. Cases: First patient aged 17 years, a known addict of opium for 2 years, lost consciousness after taking synthetic cannabinoids. On admission he was unconscious, hypotensive, hypoactive and esophageally intubated during transit time. He needed mechanical ventilation and inotropes in addition to antibiotherapy for aspiration pneumonia. He was discharged with normal systolic functions without neurologic deficits. On follow-up his cranial MRI was found to be normal. Second patient aged 17 years presented after synthetic cannabinoid use with altered mental status and impaired systolic function. He had a history of alcohol abuse for 4 years, opium and synthetic cannabinoid abuse for 1.5 years. He needed mechanical ventilation for a week, he received quetiapin, lorazepam and vitamin replacement. After extubation he suffered from ophtalmoparesis and dystonia resolving over time. His systolic functions improved. Cranial MRI showed diffuse T2 hyperintensity and diffusion restriction of corpus callosum and cerebral white matter. Basal ganglia were also mildly effected. During follow-up these non-hemorrhagic lesions evolved into liquefaction necrosis. Conclusion: Synthetic cannabinoids are potentially dangerous health hazards presenting with cardiac dysfunction and encephalopathy which may lead to severe central nervous system injury. They are a new threat resulting in toxic leukoencephalopathy.
Neurorehabilitation P178 - 2253 The effect of age on the improvement in motor function in patients with cerebral palsy after undergoing robotic-assisted locomotor therapy S. Klobucka, E. Ziakova, R. Klobucky. Rehabilitation Centre Harmony, Bratislava, Slovakia Objective: Cerebral palsy (CP) is a neurodevelopmental disorder
autistic group (p=0.000). Conclusion: The finding of significantly higher serum MEHP, DEHP and BPA levels in autistic group compared to controls suggests that endocrine disruptors may have role in the pathogenesis of ASDs.
P175 - 2737 Effect of biperiden treatment in acute orofacial and extremity dyskinesia with methylphenidate theraphy E. Acar Arslan 1 , E. Arslan 2 , A. Kilinc 3 , O. Göksu 4 . 1 Clinic of Pediatric Neurology, Giresun Prof. Dr. Ilhan Ozdemir Hospital, Giresun, Turkey; 2 Department of Neurosurgery, Giresun University School of Medicine, Giresun, Turkey; 3 Emergency Clinic, Kent Hospital, Giresun, Turkey; 4 Clinic of Psychology, Giresun Objective: Methylphenidate is a short-acting stimulant drug commonly prescribed to individuals with attention deficit hyperactivity disorder. The suggested underlying mechanism of acute dyskinesias is dopaminergic transmission increase. This case report highlights the importance for physicians of awareness of dyskinesia as a potential side-effect of methylphenidate therapy and indicates benefit of biperiden theraphy. The parenteral form of biperiden is an effective and reliable agent for the treatment of acute episodes of extrapyramidal disturbances that may be seen during treatment with neuroleptic agents. Akathisia, akinesia, dyskinetic tremors, rigor, oculogyric crisis, spasmodic torticollis and profuse sweating are markedly reduced or eliminated. Methods: We describe a 9-year-old male patient diagnosed with attention deficit hyperactivity disorder admitting to emergency clinic with primarily orofacial and extremity dyskinesia after the administration of a first dose of 18 mg methylphenidate. Methylphenidate was discontinued, and we injected biperiden with dosage of 0.04 mg/kg intravenously. Results: The patient’s symptoms resolved within 20 minutes after injection of biperiden (0.04 mg/kg). Conclusion: We wish to emphasize that acute orofacial dyskinesia and extremity dyskinesia can be observed during methylphenidate therapy and that biperiden can be successfully used in the treatment of this unpleasant condition. So long as the mechanism involved in acute dyskinesia with methylphenidate therapy is based solely on hypothesis, however, the exact role of methylphenidate in preventing dyskinesia will remain unknown. To the best of our knowledge, this is the first report of the use of biperiden therapy in this condition.
P176 - 2905 Neurological manifestations and clinical outcomes of Hashimoto thyroiditis in children A.K. Bayram, Ü. Gül, S. Kumanda¸s, L. Akin, M. Canpolat, H. Gümü¸s, M. Kendirci, H. Per. Department of Pediatrics, Division of Pediatric Neurology, Erciyes University, School of Medicine, Kayseri, Turkey Objective: Hashimoto thyroiditis (HT) is an autoimmune thyroid disease, characterized by different clinical courses and presentation. The purpose of this study was to identify the neurological manifestations of Hashimoto thyroiditis in children and evaluate their clinical outcome. Methods: Fifteen patients under monitoring with a diagnosis of HT and also presenting with neurological manifestations were enrolled in the study. Patients presenting with change of consciousness was considered as Hashimoto’s encephalopathy. Clinical outcomes were assessed by most recent neurological examinations during their visit at our pediatric neurology department. Results: The study patients consisted of 2 boys and 13 girls. The mean age at diagnosis of patients was 12.8±2.83 years (age range, 6–17 years). The mean duration of follow-up was 25.8±12.7 months, and ranged from 6–48 months. At the time of presentation; 5 patients were euthyroid, and 10 was hypothyroid. Neurological findings at presentation included:
19s (2015) S1 – S152
S143
headache in 10 patients, epileptic seizures in 5 patients, focal paresis in 4 patients, speech abnormalities in 3 patients, decreased school performance in 2 patients, ataxia in 2 patients, Hashimoto’s encephalopathy in 2 patients, diplopia in 1 patients, status epilepticus in 1 patients, and coma in 1 patients. Abnormal electroencephalographic recordings revealed in 8 patients. All hypothyroid patients received thyroxine replacement therapy. Two patients received intravenous methylprednisolone, and 1 patient took intravenous immunoglobulin treatment. Four children received antiepileptic therapy for control of epileptic seizures. Four children improved spontaneously without any treatment. In contrast, Hashimoto’s encephalopathy relapsed 6 times despite all the treatments in 1 patient during follow up period. Conclusion: Hashimoto thyroiditis should be considered in any patient presenting with unexplained neuropsychiatric signs and symptoms.
P177 - 2918 Toxic leukoencephalopathy in synthetic cannabinoid abuse M. Topçu, E. Serdaroglu, S.V. Okar, H. Bektas, B.M. Bekler, R. Gocmen. Hacettepe University Faculty of Medicine, Department of Pediatric Neurology Objective: Synthetic cannabinoids are a new class of abused drugs which are rapidly spreading. They have similar psychoactive effects to classical cannabinoid groups. Cannabinoid receptors are predominantly found in nervous system and mediate inhibition of transmitters. Patients presenting with synthetic cannabinoid abuse typically have altered mental status, seizures, central nervous system depression, hallucinations or vivid dreams. Here we present two adolescent cases presenting to emergency room after synthetic cannabinoid abuse. Cases: First patient aged 17 years, a known addict of opium for 2 years, lost consciousness after taking synthetic cannabinoids. On admission he was unconscious, hypotensive, hypoactive and esophageally intubated during transit time. He needed mechanical ventilation and inotropes in addition to antibiotherapy for aspiration pneumonia. He was discharged with normal systolic functions without neurologic deficits. On follow-up his cranial MRI was found to be normal. Second patient aged 17 years presented after synthetic cannabinoid use with altered mental status and impaired systolic function. He had a history of alcohol abuse for 4 years, opium and synthetic cannabinoid abuse for 1.5 years. He needed mechanical ventilation for a week, he received quetiapin, lorazepam and vitamin replacement. After extubation he suffered from ophtalmoparesis and dystonia resolving over time. His systolic functions improved. Cranial MRI showed diffuse T2 hyperintensity and diffusion restriction of corpus callosum and cerebral white matter. Basal ganglia were also mildly effected. During follow-up these non-hemorrhagic lesions evolved into liquefaction necrosis. Conclusion: Synthetic cannabinoids are potentially dangerous health hazards presenting with cardiac dysfunction and encephalopathy which may lead to severe central nervous system injury. They are a new threat resulting in toxic leukoencephalopathy.
Neurorehabilitation P178 - 2253 The effect of age on the improvement in motor function in patients with cerebral palsy after undergoing robotic-assisted locomotor therapy S. Klobucka, E. Ziakova, R. Klobucky. Rehabilitation Centre Harmony, Bratislava, Slovakia Objective: Cerebral palsy (CP) is a neurodevelopmental disorder