Treatment of absentias epileptica (if it they)

[AnB]

I observe at a daughter of 10 months the following:

1. pereodicheski *quot; ?ao??aNO*quot; - a view absent, movements proceed i.e. at this time can eat, etc. if potormoshit responds

2. Does or makes *quot; frightened or scared o?u?nn*quot; pupils can extend and can and are not present happens series on neskolku short-term *quot; o?U?N*quot; successively

3. *quot; nNOua??n*quot; the handle, happens that to deviations or rejections of a trunk back, a view after that frightened or scared

That from listed falls under concept *quot; ai?a??*quot; or what is it such basically



The basic treatment now (7 months on end) is Depakinum - a syrup, the dose has risen for this time with 30 up to 45 mg/kg though frequency of attacks more likely even has grown... What to do or make? To increase or enlarge a dose? To change a preparation?

[vesta 999]

It is necessary for your daughter to make -videomonitoring - record EEG and videoimages of the daughter. By result of this research it will be possible to answer your question more precisely.

What kinds of inspection are made your daughter, from what age the diagnosis, on the basis of what is exposed.

In the report you have specified not enough information to give you any advice or council.

Yours faithfully

[pstptt]

It is necessary for your daughter to make -videomonitoring - record EEG and videoimages of the daughter. By result of this research it will be possible to answer your question more precisely.

Whether I shall try to learn or find out probably it from us to make... While about such opportunity did not hear

What kinds of inspection are made your daughter, from what age the diagnosis, on the basis of what is exposed.

So brief history... During sorts or labors a daughter at the wife *quot; ?a?OOn?a*quot;, though it was in advance known that a basin narrow and such could occur or happen, doctors cesarean did not plan though as a result after 6 hours of excruciatings cesarean have made... The daughter normal (a high estimation on Apgar what precisely I do not remember) was born... In the age of 1 month a spontaneous hemorrhage in a thalamus at the left with break of a blood in ventricular system... As a result reanimation and 3 months of treatment... Like *quot; O?N??*quot;... Have written out with the diagnosis a hydrocephalus... Now compensated... Till 6 months any *quot; epileptic O???ao*quot; did not observe, but probably as the cyst on a place of a hemorrhage has started to be formed (according to KTG and US) *quot; YO*quot; also has begun (affairs EEG 2 times, pathological activity once at the left other time already on the right was observed), have now diagnosed Episindrom...

It is treated:

1. Diacarbum (now 2 through 2)

2. Depakinum (have begun about 30 mg/kg)

3. Courses: Phenibutum, korteksin, Pantogamum, kudesan, a lecithine + a homeopathy for protection of a liver, etc.



P.S. On February, 5th were at the neuropathologist, a dose of Depakinum have lifted up to 50 mg/kg, for today kakogoto appreciable effect from it or this I do not notice... Attacks can be before reception of Depakinum, can after, 3-4 times for a day can, can up to 10, happen single, happen series from 3 up to 8 times successively.



P.P.S. Were at manualnogo the therapist so he has found out shifts of vertebra or vertebrae in a cervical department... Speaks consequences of sorts or labors as consider or count it can cause a hemorrhage (peredavilsja then he has not sustained a vessel and has bursted) and whether it can influence a situation with *quot; ai?a??a??*quot;?



In the report you have specified not enough information to give you any advice or council. What particularly the information is necessary?

I write *quot; on O?O?O*quot; I hope you understand about what I speak? Thankful in advance

[nastya 2]

It is necessary to see your last *quot; aOO???*quot; KT. You can scan and send them to me on a N-mail. If KT it has been made prior to the beginning of history with attacks, it is extremely desirable to repeat

[ViSHn]

If also absentias epileptica atypical, and can be avtomatizmy, dialepticheskie attacks, etc. If are not present video-YYu of monitoring then already write down attacks on usual video can to help or assist diagnostics essentially. The inefficiency of Depakinum in such doses demands revision of treatment. EEG I can look or see (jpg a file up to 500 KB)



V.J.Nogovitsyn, Morozovskaja DGKB

drwn@mail.ru

[inna-004]

It is necessary to see your last *quot; aOO???*quot; KT. You can scan and send them to me on a N-mail. If KT it has been made prior to the beginning of history with attacks, it is extremely desirable to repeat



nakonetsto could scan KT with the greatest possible quality...

I spread links:

1. A picture from April, 30th, 2003 next day after a hemorrhage (http: // www.phk.perm.ru/old/ktg300403.jpg) the size 405

2. A picture from May, 6th, 2003 in a week after a hemorrhage (http: // www.phk.perm.ru/old/ktg060503.jpg) the size 372

3. A picture from May, 12th, 2003 in two weeks after a hemorrhage (http: // www.phk.perm.ru/old/ktg120503.jpg) the size 230

4. A picture from May, 20th, 2003 in three weeks after a hemorrhage (http: // www.phk.perm.ru/old/ktg200503.jpg) the size 358



Attacks yet was not



5. A picture from December, 2nd, 2003 (http: // www.phk.perm.ru/old/ktg021203.jpg) the size 443



Attacks have already appeared



If it will not turn out to open a photo shall send on a N-mail.

[Light]

1) As to attacks - in this question Dr. Nogovitsyn has absolutely correctly written All of you and has explained. It is possible to recommend once again only internal consultation/observation/monitoring at children's epileptologa

2) In occasion of pictures - nakakoj *quot; ??OU*quot;, causing the *quot; O?O?*quot; attacks at the child are not present. The edema really is, but she obviously became better concerning the acute period. Nevertheless, inform, please, a circle of a head and a status of the big fontanel (in a prone position and sitting/costing or standing or at passive vertikalizatsii). Also interests, whether you tried to cancel Diacarbum and what occurs or happens thus to the child???

Yours faithfully,

[Taras]

1) As to attacks - in this question Dr. Nogovitsyn has absolutely correctly written All of you and has explained. It is possible to recommend once again only internal consultation/observation/monitoring at children's epileptologa

When I shall scan EEG then Dr. Nogovitsyn chtoto more kontretnoe can can tell or say, and about internal consultation this business of the future as consider or count it is possible to transport a daughter by train with such *quot; iONO?*quot;, to go up to Moscow day?

2) In occasion of pictures - nakakoj *quot; ??OU*quot;, causing the *quot; O?O?*quot; attacks at the child are not present. The edema really is, but she obviously became better concerning the acute period. Nevertheless, inform, please, a circle of a head and a status of the big fontanel (in a prone position and sitting/costing or standing or at passive vertikalizatsii). Also interests, whether you tried to cancel Diacarbum and what occurs or happens thus to the child???

Yours faithfully,

- You consider or count that consequences of a hemorrhage in a thalamus except for a hydrocephalus any are not present? Quality insufficiently good can? On *quot; pictures oce*quot; it or him it is visible is better, I shall scan them at the same time

- About a fontanel now I shall tell or say nothing since a question has not understood, rodnichek *quot; ?aO?*quot; 2 months ago the US already through it or him could not be made already

- The circle of a head now 45 grows on the average on 3-4 mm a month

- Diacarbum accepts under the scheme or plan 2 in 2 last week, what scheme or plan will be then I do not know, to cancel did not try or taste, and what is it can give?

[bumer]

Dear moschino!

In norm or rate the circle of a head for the first year grows on 12 sm, for the first half-year on 9 sm and for the second half-year on 3 see

If at a birth a circle of a head she made about 35 sm that in a year should be 47 see

So your child does not have obvious hydrocephalus.

[tank42]

45 sm in 10 mes for the girl - the norm or rate is absolute. Time a fontanel zaros and through it or him cannot be done or made US is too against a hydrocephalus.



In occasion of Diacarbum - I asked, because happen so-called *quot; compensated oO?U*quot; vodjaki at which the progression on a background of Diacarbum is, but so implicit, that parents of years till 10-12 notice nothing, and then already there is late something essentially to change.



It is possible to go by train. T.o. Neurosurgical problems at the child are not present, treatment at epileptologa is necessary.



Quality sent KT sufficient.

[Alexandra]

Dear moschino!

In norm or rate the circle of a head for the first year grows on 12 sm, for the first half-year on 9 sm and for the second half-year on 3 see

If at a birth a circle of a head she made about 35 sm that in a year should be 47 see

So your child does not have obvious hydrocephalus.

If on the size of a head to judge that certainly the norm or rate, but the sizes of ventricles on US 16-18 on KTG 30 turns out, neznaju what method is more exact, now it is more than me *quot; o?nOau?oa??n*quot; excite... Depakinum have lifted up to 60?u/kg like on couple of days quantity or amount *quot; o?nOau?oa??*quot; has decreased up to 2-3 in day, and today has again grown...

Have appointed or nominated still TANAKANUM though same earlier the doctor himself spoke that gingko-i??ia to accept it is impossible, it is possible to provoke a new hemorrhage...

[Ellina]

In the previous letters you did not write the sizes of ventricles,

Therefore I and have responded.

On US and KT what sizes of ventricles, distance a bone-brain, size of a cerebral raincoat?

If there is no external hydrocephalus, and there is internal without body height of a head, more often it postgipoksicheskoe a lesion of a brain with the phenomenon of a subatrophy of a brain. In this case - Diacarbum is not a preparation of a choice.

In occasion of a hydrocephalus and its or her treatment address

To doctor Kushelju J.V.

What at your child on the Electroencephalogram?

[ALAN1979]

Dear colleagues I shall risk to express the opinion. At treatment of neurologic clinic at the child about one year, as a rule neuropathologists and some pediatrists are uniform a-hypoxia, a birth trauma. However hemorrhages, lejkomaljatsija, cysts can be and at TORCH in particular TSMV. On different data at TSMV infections up to 70-80 % of children has a neurologic symptomatology and accordingly characteristic changes at NSG and KT.

That is characteristic for a lesion of nervous system of an infectious genesis is a fastness to dehydrational, metabolic and vascular therapy. Effect temporary. Tactics of the neuropathologist in these cases consists in escalating a dose and a spectrum of preparations. In practice of our faculty such children meet.

Specific proposal:

1. Research wet on DNA CMV, DNA HSV, Mycoplasmae

2. A blood analysis on DNA CMV, DNA HSV

3. IFA bloods of the child on IgM CMV, IEA-CMV, IgG CMV the same for herpes

4. IgG Mycoplasmae

5. Basically in some cases it is possible to make PCR a liquor on CMV, HSV

Whether mum of the child on these infections during pregnancy was investigated or researched?

[Alexey of M.]

It is grateful YuriTop for interesting opening. And still we wait EEG and whenever possible for a diary of attacks.

[Lelik]

Dear colleagues, for other reaction also did not wait.:cool:

If there is a desire podiskutirovat ask in ordinatorskuju, for now prochtite here it:

Data SHabalova of N.P.neonatolog in 2 t. I (quote)-is considered, that intraventricular hemorrhages (VZHK) and paraventrikuljarnye hemorrhages (PVK) are especially typical for not full-term children with mass of a body less than 1500 gr., where frequency of their diagnostics reaches 50 %, at mass of a body less than 1000 gr.--65-70 %, whereas among full-term 1:1000.

Now an etiology of intracraneal hemorrhages, principal causes:

1. A patrimonial traumatism

2. a hypoxia

3. perinatalnye features of a homeostasis

4. Small gestatsonnyj age of the child

5. Fetal virus and mikoplazmennye the infections causing both a lesion of a wall sosoudov and a liver, a brain.

6. Irrational leaving or care and iatrogenic interventions



So for clearing conscience even exclude TORCH.

P.S. And more we have not enough information on the child: we do not know a state of health of mother as pregnancy (gestoz proceeded, FPN..), we do not know the given extracts from a maternity home (as the child felt the first day, the diagnosis at an extract), NSG in a maternity home, soputsvujushchaja a pathology-icterus, a coloenteritis i.td. And it is very important at statement of the diagnosis.

P.P.S. Esteem V.A.Tsinzerlinga about lesion TSNS at a fetal infection at children - morphologists do not say lies:p

[shura_zd]

And Volga runs into Caspian sea... The child ALREADY HAS attacks, remind. It is a question of replacement of an antiepileptic preparation and the control of a status over the core over gravity to the diagnosis.

[Alex1982d]

Dear colleagues, without physical survey you cannot objectively judge character of a neurologic symptomatology at the child. In what a difference between a true epilepsy and episindromom at TSMV?



Here two citations:

1. Pediatrics, 2000, 5 V.F.Uchajkin, the Role of an infection in a pathology of children.

- The popular belief in the leading part of a fetal asphyxia, a birth trauma, genovariations, chromosomal anomalies is wide, etc. should be reconsidered. According to MDKB, up to 90 % from number died from perinatalnyh the reasons the infectious pathology where cytomegaloviruses dominate, makes enteroviruses and mikstovaja an infection.

2. Pediatrics, 2003, 3. O.V.Sharapova, A.A.Korsunsky. A XXI-century infectious diseases at children recede but do not surrender

In structure or frame of a pathology of children a specific gravity or relative density of infectious agents is very high, in 90 % slechaev the infection underlies illnesses or diseases of organs of respiration, 75 % of nervous system, 70 % of organs of digestion.



Colleagues, I do not call to cancel preparations, I suggest to exclude an infection as one of factors causing neurologic changes at the child.

[LarisaKartashova]

For the decision on necessity offered for exception of a possible or probable congenital infection of analyses it is necessary to respond to some questions:



1) whether It is possible to diagnose in the age of 10 months *quot; congenital TSMV ??oN?n*quot; on the basis of the offered analyses?

No, for this purpose to us only 2 weeks after sorts or labors, unfortunately, are allocated or removed.

2) whether To be spent in the age of 10 months spetseficheskoe treatment congenital TSMV infections (gantsiklovir, valgantsiklovir)?

No.

________

That's all.

[Snezhanna]

Well, my business to offer researches by way of y diagnostics, on the basis of own experience and experience a moss of colleagues.

For you moschino if the subsequent treatment will not satisfy, I advise to address to us on faculty UGMA to professor S.N.Kozlovoj or its or her employees (the academic medical center) ph. (343) 371-80-40. By the way, in Perm it or her well know, can inquire. And is closer up to Ekaterinburg than up to Moscow.

P.S. I Bet, after reception of results EEG will appoint or nominate Suxilepum or similar.

[-Victoria]

And more we have not enough information on the child: we do not know a state of health of mother as pregnancy (gestoz proceeded, FPN..), we do not know the given extracts from a maternity home (as the child felt the first day, the diagnosis at an extract), NSG in a maternity home, soputsvujushchaja a pathology-icterus, a coloenteritis i.td. And it is very important at statement of the diagnosis.

Mother carrier or bearer TSMV, but during pregnancy of exacerbations (rise in temperature, augmentation limfauzlov, eruptions, etc.) were not.

Current of pregnancy: in 13 weeks was faringotraheit lungs (without rise in temperature, it was treated without medicines), toxicoses were not, on US, KTG a fetus - without pathologies, on dopplere - a funic blood flow in norm or rate.

Labors on April, 3rd in term of 40 (41) weeks, clinical disharmony of 2 degrees (the head stood in attempts about 2 hours), emergency cesarean section.

Estimation of the child on APGAR 8/8 points. A status of the child in the first and the subsequent sutkiv a maternity home - satisfactory. It is imparted or vaccinated BTSZH, against VGV. It is written out on 7 day on a status of mother with the diagnosis: the period novorozhdennosti. A skin pure or clean (without eruptions), subikterichnaja, icteruses (especially fixing or lingering) were not. According to pediatrists the healthy child, a liver it is not increased, a chair in norm or rate (constipations with 3 weeks).

The hemorrhage has occured or happened at night with 29 for April, 30th. On US of organs of an abdominal cavity for April, 30th - reactive changes (gipoksicheskie?) in a liver and kidneys. Eruptions was not. In analyses: on a background krovozlijanie in/O the analysis of a blood rising of the general or common bilirubin, ALT and nuclear heating plant vernjaja border of norm or rate. The analysis on TSMV in the age of 2,5 months IgM - it is negative, IgG - 1/40 (sharply positively) Analysis of a blood on a clamidiosis, a herpes - negative. During a finding in hospital prenesla a purulent meningitis. Treatment - tseftiakson.

Now - objectively (without a neurology) a status well skin and visible mucous physiological painting. In lungs puerile respiration. Systolic hum by a left edge of a breast bone (the accompanying diagnosis - the open oval window). The lien and a liver are not increased. It is wetted - freely. A chair - predilection to constipations.



Has not understood that such DNA?

Whether it is possible to consider or count in this case that at the child proceeds TSMVI?

If it TSMVI, whether that can be such massed in/cerebral a hemorrhage unique clinical display of this infection?

[kmp]

Wishing to take part or participate in discussion of a subject *quot; Congenital and perinatalnaja TSMV ??oN?n*quot; we with YuriTop invite in section *quot; the Intensive care ?oO?nN??UO*quot; http: // forums./showthread.php? t=8253

[LUCKY]

DNA-it DNA of a cytomegalovirus.

As I have understood TSMV, at mother was. So, research rebknka in PTSR I consider or count correct.

It is now difficult to tell or say retrospektivno, that was in 1 month. But such clinic can be and at TSMV.

[trollebus]

The request to not withdraw conversation from a subject. Nobody argues about an etiology, differential diagnostics, etc., all this is quite possible or probable. Now a problem - not scientific researches (useless for the patient since you do not change already anything by way of an infection), and a cupping of attacks. Further, for the information: is not present *quot; true Y??N???*quot; and *quot; Y????nO?a*quot; (for discussion by DOCTORS of these questions in the GIVEN conference I advise to study or investigate classification of an epilepsy even 1989). The epilepsy or is or not, in this case she symptomatic. Suxilepum particularly at the given (prospective) form (usually) is not applied. To treat epileptic attacks something except for antiepileptic preparations it is impossible (we do not take surgery). I suggest discussion of infections to finish on it or this (at desire - in privat, to infektsionistam - the address above) and easy to wait for results NEUROLOGIC doobsledovanija. For moschino: I shall repeat the opinion on necessity of correction of treatment with replacement or a combination of antiepileptic preparations. As concrete purposes or appointments on the Internet are impossible, the purpose of continuation of discussion - the control of a status over a diary of attacks, EEG, laboratory parameters) and possible or probable correction (doses, combinations of preparations, a regimen of reception). Other problems or tasks within the limits of the given conference to consider or examine;survey it is problematic. P.S. In ordinatorskuju in occasion of this topic I shall not go, I do not see a subject for conversation.

[Ghost]

Thanks all for participation in discussion, various views on the given problem and ways of its or her decision it is always good, but wished to return dear doctors to that that me most of all worries at present i.e. *quot; O??OOa?*quot;

That now I see at the child: attacks about which wrote in the beginning within day now practically I do not see but there was other version - right after awakenings allocates or removes a head and a view aside, pupils thus are expanded then back i.e. *quot; drives u?a?a??*quot; some seconds successively... What is it can be? Habit spasms?

Accepts Depakinum of 60?u/kg... At transition about 50 week was *quot; ?aO??yN*quot; now here *quot; YO*quot;

Have handed over analyses on thrombocytes 180 000 (norm or rate 150-300 or 220-300? At all different opinion), it already an occasion for refusal of Depakinum and to the reference or manipulation to a hematologist?

Doctors speak that time a dose in 60?u/kg high enough that for efficiency it is necessary to add a preparation or Radedormum or lamiktal (lamotridzhin), how much or as far as it opravdanno at such early age? What at them collateral consequences?



Unfortunately while in any way it is not possible to take away data EEG, categorically do not wish to give out even for a while, to swear at them nekostruktivno for other doctors at us here is not present... Suggest to start to make out to the child physical inability.

[enoise]

Probably (and it is probable), what is it too attacks. Describe them more in detail - through what time after awakening, in what party or side allocates or removes, that else thus occurs or happens, as reacts to references or manipulations that else is in the afternoon. Habit spasms here cannot be. Low, but 1) at absence of bleedings it yet an occasion for refusal of Depakinum, 2) it is necessary to look or see thrombocytes, as they will themselves a message during treatment, including at change of doses AEP. Conservation of attacks at a high dosage of Depakinum demands revision of treatment, probably, for the beginning it will be necessary to hand over a blood on concentration of Depakinum. From additional preparations it is more preferable lamiktal, probably, topamaks (without taking into account cost of medicines!), Probably to consider or examine an opportunity of application of Finlepsinum. Radedormum (while) in no event since he and other preparations of this or thus groups (benzodiazepines) 1) possesses obchen the expressed by-effects, 2) causes accustoming which demands rising a dose, further again accustoming and so it is infinite. It is a preparation of the latest turn of a choice. That I would make: would lower a dose of Depakinum (thrombocytes!) and in view of a diary of attacks (which messages it is strictly obligatory) and EEG would enter the second preparation.