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reduction >75% with LTG. The subjects from the LTG-grouphad cryptogenic focal epilepsy and became seizure free(n=2) or had seizure reduction >90% (n=1) after switchingto LEV monotherapy; 1 subject became seizure free withdexamethasone. There was no recurrence of seizures duringfollow up for 11−39 (median 21) months.Conclusion:We identified increased seizure activity with LEVor LTG in 9 children with idiopathic or cryptogenic epilepsies.Subsequently 7 of these 9 subjects became seizure free.We hypothesize that different treatment effects of LEV andLTG may disclose subgroups of non-lesional epilepsies withspecific underlying functional properties. Theses findingsmay be used for further clinical and (pharmaco)geneticstudies.

P14.11 May Topiramate Lead to puberte precox inchildren

S. Vurucu1 *, A. Karaoglu2, O. Yesilyurt3, O. Babacan1,E. Yesilkaya4, T. Cayci5, B. Unay1, R. Akin1. 1Gulhane MilitaryMedical Academy, Department of pediatric neurology, Ankara,Turkey, 2Gulhane Military Medical Academy, Department ofpediatric, Ankara, Turkey, 3Gulhane Military Medical Academy,Department of pharmacology, Ankara, Turkey, 4Gulhane MilitaryMedical Academy, Department of pediatric endocrinology, Ankara,Turkey, 5Gulhane Military Medical Academy, Department ofbiochemistry, Ankara, Turkey

The aim of this study was to evaluate vitamin B12,folate levels, thyroid function tests and sex hormonelevels in idiopathic epileptic patients taking topiramateas monotherapy. Newly diagnosed pediatric patients withidiopathic partial epilepsy receiving topiramate were enrolledin this study.The pre-treatment and 6months post-treatmentvalues of vitamin B12, folate, throid functions and sexhormones were obtained from all patients. A total of 26patients [16 (61.5%) males and 10 (38.4%) females] wereenrolled in the study. There were no significant differencesbetween the pre-treatment and 6 months post-treatmentvalues of vitamin B12, folate, thyroid functions and sexhormones. However, the 6 month post-treatment luteinizinghormone values were significantly higher than the pre-treatment values (p=0.046). It is not fully understood whetherthe increase in LH levels, first raising hormone in puberty, isdue to topiramate treatment or the puberty itself. Therefore,further studies are needed to clarify this situation for earlypuberty.

P14.12 Effects of epilepsy and antiepileptic drugs on nitricoxide, lipid peroxidation and xanthine oxidasesystem in children with idiopathic epilepsy

E. Arhan1 *, A. Serdaroglu1, B. Ozturk2, S. Ozturk3, A. Ozcelik1,N. Kurt1, E. Kutsal1, N. Sevinc3. 1Gazi University School ofMedicine, Department of Pediatric Neurology, Turkey, 2SelcukluUniversity School of Medicine, Department of Biochemistry,Turkey, 3Ankara University School of Medicine, Department ofBiochemistry, Turkey

The aim of this study is to investigate the effects ofepilepsy, valproic acid and oxcarbazepine on nitric oxidelevels, lipid peroxidation and xanthine oxidase levels innewly diagnosed epileptic children and healthy controls. Atotal of 49 patients with newly diagnosed idiopathic epilepsyand 15 healthy children were enrolled in this study. Of these49 patients, 16 children were treated with valproate and 16treated with oxcarbazepine. Nitric oxide, malondialdehydeand xanthine oxidase levels prior to antiepileptic drugtherapy were measured in the serum. Blood samples weredrawn before antiepileptic drug therapy and after 3 and6months of the antiepileptic drug treatment. Nitric oxidelevels were statistically higher in the newly diagnosedepileptic patients. In oxcarbazepine group, the nitric oxide

and malondialdehyde levels were found to be decreased. Nostatistically significant differences were noted in nitric oxide,malondialdehyde and xanthine oxidase levels in valproic acidtreated group. Oxcarbazepine which is a frequently usednew antiepileptic drug in childhood epilepsy may modifynitric oxide levels and lipid peroxidation. These resultssuggest that decreased lipid peroxidation would play a rolein the mechanism of antiepileptic effects by oxcarbazepinetreatment.

P14.13 ACTH for refractory childhood seizures: a 24-weektrial

H.H. Abdeldayem1 *. 1Faculty of Medicine, Alexandria University,Egypt

Childhood seizures that are refractory to conventionalantiepileptic drugs (polytherapy) including infantile spasms(IS) or myoclonic epilepsy are distressing to physiciansand parents. Adrenocorticotropic hormone (ACTH) has beensuggested for these cases.Objective: The present study will assess the efficacy andtolerability of ACTH IM for the treatment of IS in our newsuggested dosage.Methods: 6-week treatment with 6 months follow upthereafter. The study will enroll male and female childrenup to age of 4 years old with refractory epilepsy. Patientswill receive ACTH (IM) in dosage of 1mg every alternatedaily for 4 doses then 0.5mg every alternate daily dosagefor 4 doses then gradual decrease by 0.1mg on alternatedaily dosage for 4 doses per each dose (0.4mg, 0.3mg, 0.2mg,0.1mg respectively).

P15. Epilepsy: Imaging and therapy (II)

P15.1 Interictal cerebral cortical hypermetabolism inSturge-Weber syndrome: time for surgery?

L. De Waele1 *. 1University Hospital Gasthuisberg, Leuven,Belgium

Background: Sturge-Weber Syndrome (SWS) is a congenitalneurocutaneous syndrome characterized by facial andleptomeningeal angiomas, often associated with severeepilepsy. Most studies of cerebral glucose metabolism onFDG-PET in SWS describe cortical hypometabolism in theaffected hemisphere, reflecting decreased cerebral blood flowdue to venous hypertension in vascular malformations. Wereport paradoxical interictal hypermetabolism in an infantwith SWS.Clinical case: The patient was born with a facial naevusflammeus. At the age of 3 months he developed seizuresand left hemiparesis. Brain MRI showed right leptomeningealangiomatosis, confirming the suspected diagnosis of SWS.At the age of 6 months he already had refractory epilepsy.Brain MRI showed rapidly progressive right cerebral atrophy.The decision for right cerebral hemispherotomy was madeto promote further psychomotor development. In thepresurgical evaluation FDG-PET showed hypermetabolism inthe right frontotemporoparietal cortex, and crossed cerebellarhypermetabolism on the left side, suggesting activation ofthe cortico-ponto-cerebellar circuitry. This hypermetabolismin the affected side reflects rapidly progressive disease(Chugani et al., J Pediatr. 1989), probably preceding laterhypometabolism. A right cerebral hemispherotomy wasperformed at the age of 8 months, resulting in a left-sidedhemiparesis, but complete seizure freedom.Conclusion: In SWS aggressive treatment consisting ofhemispherotomy or more limited focal cortical resection ofepileptogenic tissue is justified in refractory cases, to preventclinical deterioration. Paradoxical cerebral hypermetabolism

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is accompanied by an increased cerebral blood flow. Themechanisms underlying this transient finding on FDG-PETare still unclear, but may play an important role in thepathophysiological progression of SWS. It indicates rapidprogression of brain damage and should be considered as anurgent indication for surgery.

P15.2 Ketogenic diet in infants and toddlers: efficacy andtolerability in 15 consecutive children

Z. Rener-Primec1 *, A. Trojar1, M. Rogac1, D. Neubauer1.1Dept.of Child Neurology, University Children Hospital Ljubljana,Slovenia

Aim: to asses the efficacy and tolerance of ketogenic diet (KD)in infants and toddlers with refractory epilepsy.Patients and Methods: 15 children, younger than 3 y, weretreated with KD from 2007 to 2010. Data on epilepsy aetiology,age at introduction of KD, seizure frequency before and afterKD and tolerance were analysed retrospectively. All childrenwere closely monitored. The ratio of KD was from 2, 5 to 1to 4. 1 (fat to combined protein-carbohydrate), the ratio wasregulated with regard to ketone bodies.Results: Seven infants started with KD before the age of12 months (age from 4 to 9 month) and 8 children between 12and 31 months of age. In the younger group, only 3 infantstolerated KD, but it was inefficient; 2 had to stop KD after3 weeks due to: repetitive vomiting, one developed allergy tonutrients, one had nephrolithiasis. Aetiology of epilepsy wassevere symptomatic due to perinatal hypoxic brain damage,neonatal meningitis, PEHO, mitochondrial and unknown. Inthe older group tolerability was much better: the averageduration of KD was 13 months (4−16 months) and KD wasdiscontinued after a minimum 3 months, if it proved to beeither inefficient or intolerable. Two children became seizurefree (one with infantile spasms, other with symptomaticpartial epilepsy). In others seizure reduction from 15 to 40%was observed.Conclusion: KDmay be efficient therapy of refractory epilepsyin small children. Tolerability in infants could be improvedwith now available commercial preparations.

P15.3 VNS therapy in children with tuberous sclerosis andrefractory epilepsy

K. Jansen1 *, L. Lagae1. 1University Hospitals Leuven, Belgium

Background: Tuberous sclerosis (TS) is an autosomal dom-inant multisystem disorder. Central nervous system mani-festations include refractory epilepsy, cognitive impairmentand autism spectrum disorder in most cases. In patientswith refractory epilepsy where epilepsy surgery is not anoption, vagus nerve stimulation (VNS) can be a therapeuticalternative.Methods: We present 3 young TS children with refractoryepilepsy who were treated with VNS. Two of them hadcomplex partial seizures at the time of onset of epilepsy, onepresented with infantile spasms. All three of them developedrefractory epilepsy before the age of 12 months. They wereconsidered but no optimal candidates for epilepsy surgery.VNS was implanted at the age of 2.5, 3.5 and 4 years withoutcomplications. Background AEDS remained stable; the VNSsettings were standard duty cycles (5min off, 30 sec on, with2.0mA output).Results: One patient became seizure free after 2 months, theother two after 5 months. All three were remarkably morealert after implementation of the VNS. The VNS was welltolerated; no side effects were mentioned by the parents. Allpatients are now still seizure free after 6, 7, 12 months offollow up.Conclusion:These cases show that VNS therapy can be safelyused in young children with TS and refractory epilepsy and

can be a valuable therapeutic option. Besides unexpectedtotal seizure control, marked behavioral improvementoccurred in all patients. The impact on further developmentaland cognitive outcome needs further investigation.

P15.4 Epilepsy surgery in childhood is possible in aEuropean country with limited resources

P. Stefanova Dimova1 *, K. Minkin2,V. Bojinova1, A. Bussarsky2,M. Penkov3, L. Penev3, H. Tzekov2, M. Marinov2, K. Romansky2,V. Bussarsky2. 1Clinic of Child Neurology, St. Naum UniversityHospital of Neurology and Psychiatry, Bulgaria, 2Clinic ofNeurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria,3Department of Neuroimaging, St. Ivan Rilski University Hospital,Sofia, Bulgaria

Background: Epilepsy surgery is efficacious, safe and cost-effective, but in countries of South-Eastern Europe the vastmajority of refractory epilepsy patients cannot benefit fromthis treatment option due to limited resources. Attempts tostart an epilepsy surgery program, including for childhoodepilepsies, are in progress in this region.Aim of the study: To present the experience of Bulgarianepilepsy surgery team in drug resistant epilepsies ofchildhood for the period 2006 2010.Methods: Forty six children with refractory symptomaticepilepsies were considered epilepsy surgery candidates. Afteran appropriate presurgical work-up 38 were operated on andfollowed up for 3 months up to 4 years.Results: The examinations included standard electroen-cephalography (EEG) andmagnetic resonance imaging (MRI) −in all patients, video-EEG monitoring with ictal registration −in 26 (56.5%), interictal SPECT in 20 (43.5%), intraoperativeelectrocorticography in 4 (8.7%), functional MRI in 3 (6.5%),andWada test in 2 (4.3%). The surgical intervention consistedin resection of the lesional/epileptogenic zone (n=32) andcorpus callosotomy (n=6). The postoperative outcome wasclassified as Engel class I in 26 children (68.4%), class II in 3(7.9%), class III in 6 (15.8%), and class IV in 3 patients (7.9%).No surgery related complications were observed. Etiology wasestablished in all operated patients.Conclusions: Our results demonstrate that even in thisdifficult population, epilepsy surgery is possible withthe available technologies. If candidates are appropriatelyselected and investigated, the results are very good and provethat narrowing the epilepsy surgery treatment gap in Europeis a realistic goal.

P15.5 Therapy with intravenous immunoglobulins and lowdoses of corticosteroids at resistant epilepsies inchildren

S. Yevtushenko1 *, A. Omelyanenko1. 1Donetsk National MedicalUniversity, Ukraine

The significant amount of data, such as accompanyingautoimmune disorders, efficiency of corticosteroids andintravenous immunoglobulins (IVG), suggests possible par-ticipation of autoimmune mechanisms in pathogenesis ofseparate forms of epilepsies. From 2003 for 2010 in ourclinic have applied combined therapy IVG and low dosesof corticosteroids at treatment of resistant epilepsies ofvarious aetiology at 68 children aged from 2 months till 14years (boys − 38, girls − 30). From them were patients withinfantile spasms − 10; with idiopathic or cryptogenic focalepilepsies − 19; with symptomatic focal epilepsies − 24; withDravet syndrome − 6; with Lennox-Gastaut syndrome − 5;with Doose syndrome − 4. Therapy in these patients hasbeen presented by infusions of IVG in a single dose of0.4 g/kg every other day 3−5 times. Intramuscular injections ofcorticosteroids in dose of 1mg/kg into Prednisone equivalentwere performed in day of IGV infusion only. We considered