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P59 – 1708 Parental education predicts IQ change after epilepsy surgery in children
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E U R O P E A N JO U R N A L O F PAEDIATRIC N E U R O L O G Y
multiple influences, mainly by friends and relatives (52%), and visiting internet portals (38%). Compliance with regime of AED therapy was in 70% of cases assessed as good. Most frequent modality of alternative treatments were various diets and vitamins, some form of exorcism and talismans (usually connected with visiting clergypersons of different denominations), herbal medicines. Satisfaction with simultaneous AED and alternative therapy was described as good in 26% cases, fair in 43% cases. Common explanation for starting such combined treatment was “it can not hurt” and fear of side-effects of AED therapy was stated as a main reason in cases of poor compliance. We conclude that combination of AED and alternative treatment is quite common, in children of different socioeconomic and educational backgrounds, but sincerity of answers in questionnaires has to be scrutinized for better understanding of this problem.
P59 - 1708 Parental education predicts IQ change after epilepsy surgery in children Meekes J, van Schooneveld MMJ, Braams OB, Braun K, Jennekens-Schinkel A, van Nieuwenhuizen O. University Medical Center Utrecht, The Netherlands – [email protected] Objective: To determine whether IQ change after epilepsy surgery in children is associated with environmental factors, specifically parental education (PE) or socio- economic status (SES). We focused on change (rather than pre- or post-surgical IQ per se) because cognitive effects of surgery are increasingly considered in the decision to operate. Methods: Retrospective cohort study of children (<18 years) who underwent epilepsy surgery between January 1996 and September 2010. Multiple regression analysis was used to identify predictors of change in IQ after surgery. To enhance interpretation of the results, we applied the same analysis to pre-surgical and post-surgical IQ. Results: The sample included 118 children (median age at surgery 9.73 years [range 0.47–17.70 years]). IQ change after surgery was significantly predicted by a model only including PE. Although there was large variation between children with equal PE, the average difference between lowest and highest levels of PE amounted to 12.18 IQ points (95% CI: 1.20–23.16). SES was also significantly associated with IQ change after surgery, but inclusion of SES in the model already containing PE yielded no further contribution to prediction of IQ change. A model including age at surgery, duration of epilepsy, etiology, and type of surgery significantly predicted pre-surgical IQ. The only significant predictors of post-surgical IQ, however, were pre-surgical IQ and PE, confirming the results concerning IQ change. Conclusions: For the first time, we demonstrate that, after paediatric epilepsy surgery, IQ increases most in children with highest PE or SES, whereas children with low PE or SES had smaller IQ increases or even decreases. Further study is required to determine whether this is due to differences in medical management, pre-existing disposition of the child or heterogeneity in post-surgical environments.
P60 - 1698 Survey on infantile spasm management and treatment outcomes in a tertiary hospital in Hong Kong Yau MLY, Yam K-M, Fung ELW. Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong – [email protected] Infantile spasm is usually refractory to conventional anticonvulsants. This study aims to study the management of patients with infantile spasm, their outcome and possible contributing factors. Methods: All newly diagnosed patients with infantile spasm from June, 2006 till December 2012 in Price of Wales Hospital Hong Kong were reviewed. Their underlying eti-
17s (2013) S1 – S149
ology, choice of treatment and seizure outcome were studied. Results: Total 12 patients were diagnosed with infantile spasm. The age of diagnosis ranged from two months to three years old (median: seven months). Majority (67%) of patients have underlying primary neurological disorders. Two of them have delayed treatment (five and six months) due to parental concerns on possible significant side effects. For initial treatment choice, four chose prednisolone, while seven chose vigabatrin and one chose conventional anti-convulsants. No patient was required to discontinue treatment due to side effects experienced. Four patients have achieved remission after one month of treatment (One in steroid group and three in vigabatrin group). Three with refractory seizure required ACTH treatment (not readily available in Hong Kong) with good response, achieving seizure remission on day four and day nine of treatment. Depending on etiology, three in idiopathic group (75%) remained seizure free (ranging from seven months to 47 months; median 25 months). However in those with primary neurological disorder, four remained seizure free (50%) (ranging from 17 months to four years; median 17 months). One who was refractory to anti-epileptic achieved remission after surgery was performed for removal of primary etiology. Conclusion: Idiopathic infantile spasm is a good prognostic indicator for outcome. In Hong Kong steroid phobia and ACTH availability remains an important issue towards the choice of treatment, which may have significant impact on seizure outcome.
P61 - 1697 Postictal psychosis: a rare entity in childhood epilepsy Iqbal M, Prasad M, Baxter P. Sheffield Childrens Hospital, Sheffield, UK – [email protected] Objective: To describe clinical presentation of Postictal Psychosis in a child who presented with a change in behaviour, hallucinations and confusion following cluster of seizures. Material (case description): 15 years old boy, known epileptic on Levetiracetam, presented with hallucination and confusion after having cluster of seizures. Interestingly there was a clear history of him remaining well for nearly 24 hour followed by onset of hallucination where he was complaining of seeing “red blood on arm” and seeing flashing lights and at times shouting. On examination his GCS was 15/15, looked confused, not answering questions but following commands. Rest of neurological examination was unremarkable. Initial investigations including ammonia, CSF and blood lactate, CSF/plasma glucose ratio, plasma aminoacids were all normal. EEG didn’t show any epileptic discharges or evidence of subclinical status and background EEG showed rhythmic slow waves mostly in posterior region. Levetiracetam level came back as nearly 2 times the normal range. However he was on the same dose (2 gm) for nearly 3 months with no reported side effects. He remained in-patient for 2 days; his psychotic symptoms slowly improved and didn’t need any specific treatment. His dose of Levetiracetam was subsequently reduced in view of the high levels. Results: Postictal psychosis is well known in adults but only sparsely reported in paediatric population. It usually occurs after prolonged partial complex seizure clusters with or without secondary generalisation. The psychosis commonly appears following a lucid interval, ranging from a few hours to days after seizure termination. Early recognition is important as suicidal tendencies have also been reported in adults. Discussion: We believe that the Paediatric Neurologist should be aware of this rare but distinct entity as early diagnosis helps in treating the patient effectively and alleviating patient and parents anxiety and also prevent unnecessary investigations.
E U R O P E A N JO U R N A L O F PAEDIATRIC N E U R O L O G Y
multiple influences, mainly by friends and relatives (52%), and visiting internet portals (38%). Compliance with regime of AED therapy was in 70% of cases assessed as good. Most frequent modality of alternative treatments were various diets and vitamins, some form of exorcism and talismans (usually connected with visiting clergypersons of different denominations), herbal medicines. Satisfaction with simultaneous AED and alternative therapy was described as good in 26% cases, fair in 43% cases. Common explanation for starting such combined treatment was “it can not hurt” and fear of side-effects of AED therapy was stated as a main reason in cases of poor compliance. We conclude that combination of AED and alternative treatment is quite common, in children of different socioeconomic and educational backgrounds, but sincerity of answers in questionnaires has to be scrutinized for better understanding of this problem.
P59 - 1708 Parental education predicts IQ change after epilepsy surgery in children Meekes J, van Schooneveld MMJ, Braams OB, Braun K, Jennekens-Schinkel A, van Nieuwenhuizen O. University Medical Center Utrecht, The Netherlands – [email protected] Objective: To determine whether IQ change after epilepsy surgery in children is associated with environmental factors, specifically parental education (PE) or socio- economic status (SES). We focused on change (rather than pre- or post-surgical IQ per se) because cognitive effects of surgery are increasingly considered in the decision to operate. Methods: Retrospective cohort study of children (<18 years) who underwent epilepsy surgery between January 1996 and September 2010. Multiple regression analysis was used to identify predictors of change in IQ after surgery. To enhance interpretation of the results, we applied the same analysis to pre-surgical and post-surgical IQ. Results: The sample included 118 children (median age at surgery 9.73 years [range 0.47–17.70 years]). IQ change after surgery was significantly predicted by a model only including PE. Although there was large variation between children with equal PE, the average difference between lowest and highest levels of PE amounted to 12.18 IQ points (95% CI: 1.20–23.16). SES was also significantly associated with IQ change after surgery, but inclusion of SES in the model already containing PE yielded no further contribution to prediction of IQ change. A model including age at surgery, duration of epilepsy, etiology, and type of surgery significantly predicted pre-surgical IQ. The only significant predictors of post-surgical IQ, however, were pre-surgical IQ and PE, confirming the results concerning IQ change. Conclusions: For the first time, we demonstrate that, after paediatric epilepsy surgery, IQ increases most in children with highest PE or SES, whereas children with low PE or SES had smaller IQ increases or even decreases. Further study is required to determine whether this is due to differences in medical management, pre-existing disposition of the child or heterogeneity in post-surgical environments.
P60 - 1698 Survey on infantile spasm management and treatment outcomes in a tertiary hospital in Hong Kong Yau MLY, Yam K-M, Fung ELW. Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong – [email protected] Infantile spasm is usually refractory to conventional anticonvulsants. This study aims to study the management of patients with infantile spasm, their outcome and possible contributing factors. Methods: All newly diagnosed patients with infantile spasm from June, 2006 till December 2012 in Price of Wales Hospital Hong Kong were reviewed. Their underlying eti-
17s (2013) S1 – S149
ology, choice of treatment and seizure outcome were studied. Results: Total 12 patients were diagnosed with infantile spasm. The age of diagnosis ranged from two months to three years old (median: seven months). Majority (67%) of patients have underlying primary neurological disorders. Two of them have delayed treatment (five and six months) due to parental concerns on possible significant side effects. For initial treatment choice, four chose prednisolone, while seven chose vigabatrin and one chose conventional anti-convulsants. No patient was required to discontinue treatment due to side effects experienced. Four patients have achieved remission after one month of treatment (One in steroid group and three in vigabatrin group). Three with refractory seizure required ACTH treatment (not readily available in Hong Kong) with good response, achieving seizure remission on day four and day nine of treatment. Depending on etiology, three in idiopathic group (75%) remained seizure free (ranging from seven months to 47 months; median 25 months). However in those with primary neurological disorder, four remained seizure free (50%) (ranging from 17 months to four years; median 17 months). One who was refractory to anti-epileptic achieved remission after surgery was performed for removal of primary etiology. Conclusion: Idiopathic infantile spasm is a good prognostic indicator for outcome. In Hong Kong steroid phobia and ACTH availability remains an important issue towards the choice of treatment, which may have significant impact on seizure outcome.
P61 - 1697 Postictal psychosis: a rare entity in childhood epilepsy Iqbal M, Prasad M, Baxter P. Sheffield Childrens Hospital, Sheffield, UK – [email protected] Objective: To describe clinical presentation of Postictal Psychosis in a child who presented with a change in behaviour, hallucinations and confusion following cluster of seizures. Material (case description): 15 years old boy, known epileptic on Levetiracetam, presented with hallucination and confusion after having cluster of seizures. Interestingly there was a clear history of him remaining well for nearly 24 hour followed by onset of hallucination where he was complaining of seeing “red blood on arm” and seeing flashing lights and at times shouting. On examination his GCS was 15/15, looked confused, not answering questions but following commands. Rest of neurological examination was unremarkable. Initial investigations including ammonia, CSF and blood lactate, CSF/plasma glucose ratio, plasma aminoacids were all normal. EEG didn’t show any epileptic discharges or evidence of subclinical status and background EEG showed rhythmic slow waves mostly in posterior region. Levetiracetam level came back as nearly 2 times the normal range. However he was on the same dose (2 gm) for nearly 3 months with no reported side effects. He remained in-patient for 2 days; his psychotic symptoms slowly improved and didn’t need any specific treatment. His dose of Levetiracetam was subsequently reduced in view of the high levels. Results: Postictal psychosis is well known in adults but only sparsely reported in paediatric population. It usually occurs after prolonged partial complex seizure clusters with or without secondary generalisation. The psychosis commonly appears following a lucid interval, ranging from a few hours to days after seizure termination. Early recognition is important as suicidal tendencies have also been reported in adults. Discussion: We believe that the Paediatric Neurologist should be aware of this rare but distinct entity as early diagnosis helps in treating the patient effectively and alleviating patient and parents anxiety and also prevent unnecessary investigations.