Katılma Nöbetlerinde Demir ve Pirasetam ile Anoksik Epileptik Nöbetlerde Levetirasetamın Etkinliği

Yıl 2023, Cilt: 3 Sayı: 1, 18 - 23, 12.04.2023

Nezir Özgün , Osman Akdeniz , Muhittin Çelik , Hakan Sarbay , İzzettin Toktaş

https://doi.org/10.58252/artukluder.1227442

Öz

Giriş: Bu çalışmada, katılma nöbeti veya anoksik epileptik nöbet tanısı alan ve demir, pirasetam veya levetirasetam tedavilerinden en az biri başlanan hastalarda, ilaçların nöbetleri azaltma etkinliği değerlendirilmiştir.
Materyal and Metot: Çalışma kriterlerini karşılayan 194 hastanın dosyaları geriye dönük olarak incelenmiştir. Demir eksikliği anemisi olan veya anemi olmasa bile ferritin değeri 12 ng/dl altında olan hastalara demir tedavisi başlanmıştı. Anemi, düşük ferritin ve anoksik epileptik nöbeti olmayan hastalara pirasetam, anoksik epileptik nöbeti olanlara levetirasetam başlanmıştı.
Bulgular: Hastaların 108’i (% 55.7) erkekti. Ortalama yaş 21.39±12.78 aydı. 87 hastaya demir tedavisi, 96 hastaya pirasetam ve 11 hastaya levetirasetam başlanmıştı. Tedavi başlandıktan bir ay sonraki değerlendirmede tüm gruplarda nöbet sayısı belirgin azalmıştı (p<0.05).
Sonuç: Tüm gruplarda nöbet sayısının azaldığını veya tam durduğunu saptadık. Levetirasetam katılma nöbeti sonrası gelişen anoksik epileptik nöbetlerde oldukça etkili gibi görünmektedir.

Anahtar Kelimeler

Katılma nöbeti, Anoksik epileptik nöbet, Tedavi

Destekleyen Kurum

Yok

Proje Numarası

Yok

Teşekkür

Yok

The Efficacy of Iron and Piracetam in Breath Holding Spells and Levetiracetam in Anoxic Epileptic Seizures

Öz

Introduction: In this study, the patients diagnosed with breath holding spell (BHS) or anoxic epileptic seizures and initiated at least one out of iron or piracetam or levetiracetam therapies were evaluated.
Material and Methods: We retrospectively evaluated 194 BHS patients. Iron therapy was initiated in case of iron deficiency anemia or case of ferritin values under 12 ng/dl even if there was no anemia. The patients having no iron deficiency anemia, low ferritin and anoxic epileptic seizures were administered piracetam and the patients diagnosed with anoxic epileptic seizures were administered levetiracetam.
Results: One hundred and eight patients (55.7%) were male. The mean age was 21.39±12.78 months. Iron therapy was initiated in 87 patients, piracetam to 96, and levetiracetam in 11 patients. Seizure numbers were manifestly decreased in all groups by the end of the first month after treatment concerning pretreatment levels (p<0.05).
Conclusions: We determined that the spells were reduced or completely stopped in all groups. Levetiracetam seems to be considerably effective in patients developing anoxic epileptic seizures after BHS.

Anahtar Kelimeler

Breath holding spell, Anoxic epileptic seizure, Treatment

Proje Numarası

Yok

Kaynakça

• Leung AKC, Leung AAM, Wong AHC, Hon KL. Breath-Holding Spells in Pediatrics: A Narrative Review of the Current Evidence. Curr Pediatr Rev. 2019;15(1):22-29.
• Abbaskhanian A, Ehteshami S, Sajjadi S, Rezai MS. Effects of Piracetam on Pediatric Breath Holding Spells: A Randomized Double Blind Controlled Trial. Iran J Child Neurol. 2012;6(4):9–15.
• DiMario FJ Jr SM. Family pedigree analysis of children with severe breath-holding spells. J Pediatr. 1997;130(4):647–51.
• Azab SFA, Siam AG, Saleh SH, Elshafei MM, Elsaeed WF, Arafa MA, et al. Novel findings in breath-holding spells: A cross-sectional study. Med (United States). 2015;94(28):1–7.
• Vurucu S, Paksu MS, Karaoglu A, Oz O, Yaman H, Gulgun M, et al. Breath-holding spells may be associated with maturational delay in myelination of brain stem. J Clin Neurophysiol. 2014;19(1):99-101.
• Saad K, Farghaly HS, Badry R, Othman HAK. Selenium and antioxidant levels decreased in blood of children with breath-holding spells. J Child Neurol. 2014;29(10):1339–43.
• Sawires H, Botrous O. Double-blind, placebo-controlled trial on the effect of piracetam on breath-holding spells. Eur J Pediatr. 2012;171(7):1063–7.
• Leung AKC, Leung AAM, Wong AHC, Hon KL. Breath-Holding Spells in Pediatrics: A Narrative Review of the Current Evidence. Curr Pediatr Rev. 2018;15(1):22–9.
• Stephenson JBP. Febrile convulsions and reflex anoxic seizures. 4th Edition, Rose FC. London, UK: Pitman. 1998:244-52.
• Kuhle S, Tiefenthaler M, Seidl R, Hauser E. Prolonged generalized epileptic seizures triggered by breath-holding spells. Pediatr Neurol. 2000;23(3):271–3.
• Jain R, Omanakuttan D, Singh A, Jajoo M. Effect of iron supplementation in children with breath holding spells. J Paediatr Child Health. 2017;53(8):749–53.
• Azam M, Bhatti N, Shahab N. Piracetam in severe breath holding spells. Int J Psychiatry Med. 2008;38(2):195–201.
• Mattie-Luksic M, Javornisky G DF. Assessment of Stress in Mothers of Children with Severe Breath-Holding Spells. Pediatrics. 2000;106(1):1–5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=Assessment+of+stress+in+mothers+of+children+with+severe+breath-holding+spells
• Stephenson JBP, Breningstall G, Steer C, Kirkpatrick M, Horrocks I, Nechay A, et al. Anoxic-epileptic seizures: Home video recordings of epileptic seizures induced by syncopes. Epileptic Disord. 2004;6(1):15–9.
• Francis J. DiMario. Prospective study of children with cyanotic and pallid breath-holding spells. Pediatrics. 2001;107(2):265-9.
• Khurana D, Valencia I, Kruthiventi S, Gracely E, Melvin J, Legido A, et al. Correspondence on “electroencephalography (EEG) with ocular compression in the diagnosis of breath-holding spells or syncope.” J Child Neurol. 2008;23(6):716–7.
• Gouliaev AH, Senning A. Piracetam and other structurally related nootropics. Brain Res Rev. 1994;19(2):180–222.
• Lukkarinen H, Virtanen I, Arikka H, Arola A, Peltola M, Ekblad H. Recurrent sinus arrest and asystole due to breath-holding spell in a toddler; recovery with levetiracetam-therapy. Circulation. 2010;122(25):986992.
• Garg M, Goraya JS. Treatment of cyanotic breath-holding spells with oral theophylline in a 10-year-old boy. J Child Neurol. 2015;30(7):919–21.
• Walsh M, Knilans TK, Anderson JB, Czosek RJ. Successful treatment of pallid breath-holding spells with fluoxetine. Pediatrics. 2012 Sep;130(3):e685-9.
• Carano N, Bo I, Zanetti E, Tchana B, Barbato G, Agnetti A. Glycopyrrolate and theophylline for the treatment of severe pallid breath-holding spells. Pediatrics. 2013;131(4):e1280-3.
• Gonzalez Corcia MC, Bottosso A, Loeckx I, Mascart F, Dembour G, François G. Efficacy of treatment with belladonna in children with severe pallid breath-holding spells. Cardiol Young. 2018;28(7):922–7.
• Kelly AM, Porter CJ, McGoon MD, Espinosa RE, Osborn MJ HD. Breath-holding spells associated with significant bradycardia: successful treatment with permanent pacemaker implantation. Pediatrics. 2001;108(3):698–702. Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=Breath-holding+spells+associated+with+significant+bradycardia%3A+successful+treatment+with+permanent+pacemaker+implantation
• Kolkiran A, Tutar E, Atalay S, Deda G, Cin Ş. Autonomic nervous system functions in children with breath-holding spells and effects of iron deficiency. Acta Paediatr Int J Paediatr. 2005;94(9):1227–31.
• Mocan H, Yildiran A, Orhan F, Erduran E. Breath holding spells in 91 children and response to treatment with iron. Arch Dis Child. 1999;81(3):261–2.
• Orii KE, Kato Z, Osamu F, Funato M, Kubodera K, Inoue R, et al. Changes of autonomic nervous system function in patients with breath-holding spells treated with iron. J Child Neurol. 2002;17(5):337–40.
• Gürbüz G, Perk P, Çokyaman T, Gürbüz ÖB. Iron supplementation should be given in breath-holding spells regardless of anemia. Turkish J Med Sci. 2019;49(1):230–7.
• Donma MM. Clinical efficacy of piracetam in treatment of breath-holding spells. Pediatr Neurol. 1998;18(1):41–5.
• Dai AI, Demiryürek AT. Effectiveness Oral Theophylline, Piracetam, and Iron Treatments in Children with Simple Breath-Holding Spells. J Child Neurol. 2019;088307381987185.
• Lukkarinen H, Virtanen I, Arikka H, Arola A, Peltola M, Ekblad H. Recurrent sinus arrest and asystole due to breath-holding spell in a toddler; Recovery with levetiracetam-therapy. Circulation. 2010;122(25):e637.
• Weijenberg A, Brouwer OF, Callenbach PMC. Levetiracetam Monotherapy in Children with Epilepsy: A Systematic Review. CNS Drugs. 2015;29(5):371–82.
• Rathore G, Larsen P, Fernandez C, Parakh M. Diverse Presentation of Breath Holding Spells: Two Case Reports with Literature Review. Case Rep Neurol Med. 2013;2013:1–3.
• Horrocks IA, Nechay A, Stephenson JBP, Zuberi SM. Anoxic-epileptic seizures: Observational study of epileptic seizures induced by syncopes. Arch Dis Child. 2005;90(12):1283–7.
• Sartori S, Nosadini M, Leoni L, de Palma L, Toldo I, Milanesi O, et al. Pacemaker in complicated and refractory breath-holding spells: When to think about it? Brain Dev. 2015;37(1):2–12. Available from: http://dx.doi.org/10.1016/j.braindev.2014.02.004