Epilepsy surgery should be aggressively considered for the cases of drug-resistant intractable epilepsy, especially earlier in infant and child because persistent epileptic seizures adversely affect on their psychomotor development. To achieve postoperative seizure free, it is required to identify epileptogenic zone and resect epileptic focus completely. Although radical resection of epileptic focus located on eloquent area possibly cause severe neurological complications, relatively good neurological outcomes can be expected because of neural plasticity of childhood brain. Furthermore, it is another reason for deciding surgical indication that long-term administration of anti-epileptic drug causes unfavorable effects on cognitive function of children. On the other hand, the surgical impacts on post-surgical intelligent quotient or coexisting neuropsychiatric disorders are still controversial. Here, we present the most appropriate timing for performing pediatric epilepsy surgery, showing our own clinical examples and literature considerations.
Several peculiar aspects of neurological examination of children with neurological disorders have been described. Neurological examination of children with neurological disorders should be performed in a short time while ensuring patient safety. Standardization of the routine sequence of physical and neurological examination in children is essential. The decision about whether a child has normal findings or abnormal findings in a single neurological examination is challenging owing to the limited time available. It is also difficult to accurately describe the neurological findings in children. Obtaining a video recording of the neurological examination can offer a distinct leverage in this setting. Video recordings can be viewed repeatedly for discerning the presence of a certain neurological finding and the degree of the finding. Moreover, they can be used to obtain the opinion of other doctors. In addition, video records obtained at different time-points can be useful for assessing the temporal changes in neurological signs. Lastly, video records of real children with certain neurological disorders can be an invaluable tool for training of young doctors in pediatric neurological examination.
Monotherapy and combination therapy of valproic acid (VPA) may cause hyperammonemia. Several anti-epileptic drugs used in combination with VPA have reportedly been associated with the development of hyperammonemia. However, whether or not combination therapy with VPA and gabapentin (GBP) induces hyperammonemia remains unclear. We herein report a patient who developed hyperammonemia due to GBP in addition to VPA, phenytoin, phenobarbital, potassium bromide, clonazepam, lamotrigine, lacosamide and perampanel showing a need for awareness for hyperammonemia of the combination therapy.
Acute flaccid myelitis (AFM) is a recently defined clinical disease of acute flaccid paralysis with spinal cord gray matter lesions on MRI. Although enterovirus D68 (EV-D68) has been strongly suspected to be an etiological agent of AFM, EV-D68 is detected mainly from respiratory specimens. Since EV-D68 has been rarely detected in cerebrospinal fluid samples, it remains unclear whether EV-D68 is a major cause of AFM. We experienced a pediatric case of acute flaccid myelitis with enterovirus D68 detected in the cerebrospinal fluid. It is suggested that the direct invasion of EV-D68 into the spinal cord could be a pathomechanism of AFM.