Objective: About one third of partial seizures are refractory to treatment. Several anticonvulsant drugs have entered the market in recent decades but concerns about intolerance, drug interactions, and the safety of the drug are notable. One of these new anticonvulsants is pregabalin, a safe drug with almost no interaction with other antiepileptic drugs.Methods: In this open label clinical trial study, pregabalin was used for evaluation of its efficacy on reducing seizure frequency in 29 children suffering from refractory partial seizures. Average daily and weekly seizure frequency of the patients was recorded during a 6-week period (baseline period). Then, during a period of 2 weeks (titration period), pregabalin was started with a dose of 25-75 mg/d, using method of flexible dose, and was brought to maximum dose of drug that was intended in this study (450 mg/d) based on clinical response of the patients and seizure frequency. Then the patients were given the drug for 12 weeks and the average frequency of daily and weekly seizures were recorded again (treatment period).Findings: Reduction in seizure frequency in this study was 36% and the responder rate or number of patients who gained more than 50% reduction in seizure frequency was 51.7%.Conclusion: This study showed that pregabalin can be used with safety and an acceptable efficacy in treatment of childhood refractory partial seizures.

We present a 7 yr old boy afflicted with super-refractory seizure that responded poorly to antiepileptic drugs and sustained a long course of hospitalization and complications of high doses of medications as well as longstanding stay in hospital. The differential diagnoses were, fever-induced refractory epileptic encephalopathy (FIRES), and infectious and autoimmune encephalitis.However, work-ups had not revealed any evidence of any specific diagnosis, so we assumed that he was afflicted by viral infectious encephalitis as he had, fever, vomiting, and prodromal symptoms of infectious (most probably viral) disease prior to onset of the seizure attacks.

Background and Objective: Refractory seizure is a rare manifestation of INH poisoning. We report a case INH poisoning with refractory seizure.Case presentation: A 17-year old male referred to our emergency room with seizure. Antiepileptic treatment with diazepam was ordered and repeated doses were prescribed. His family reported that he ingested 4.5 gram INH about 2 hours ago. He was admitted to ICU. Despite frequent doses of diazepam, he went into status epilepticus. Pridoxine was administered intravenously 200 mg/qid for 3 days Status epilepticus was terminated after pyridoxine administeration. He was discharged from hospital after 4 days without any neurological sequel.Discussion: We reported here a case of INH poisoning with refractory seizure. In this setting pyridoxine helped to terminate status epilepticus.

Background: The main purpose of the current study was to determine the effect of treating helicobacter pylori (HP) infection on seizure frequency in patients with refractory epilepsy.Methods: A small sample of adult patients above 18 years of age with a diagnosis of refractory epilepsy was studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, from January 2009 through June 2011. If and when urea breath test result was positive, an upper endoscopy with multiple gastric biopsies was requested. Rapid urease test and histopathology examination were performed. For patients with confirmed HP infection, treatment with clarithromycin, amoxicillin and omeprazole was ordered for two weeks. Seizure frequency was recorded before and after HP treatment.

Takotsubo cardiomyopathy(TC) is a reversible, yet underdiagnosed cause of mortality and morbidity in the intensive care units. It occurs secondary to sudden catecholamine surge precipitated by any form of emotional or pathological stress. Association between central nervous system disorders and Takotsubo cardiomyopathy is being increasingly reported. Epilepsy is the second most common CNS disorder to trigger TC, SAH being the first. We report a case of TC in an elderly man with prolonged, recurrent seizure episodes refractory to the commonly used antiepileptic drugs (AEDs), who developed unexplained tachycardia, hypotension and elevated cardiac enzymes.

Continuous midazolam infusion was tried as treatment for 15 children with refractory convulsive status epilepticus, at the mofid children hospital over one year period. Ten patients had generalized convulsive status epilepticus and 5 had partial one. All patients had received intravenous diazepam, phenobarbital and phenytion, before midazolam infusion was started (0.15µg/kg bolus, followed by 1-6 µg/kg/min infusion). The siezures were controled in 9 out of 10 (%90) patients with generalized status, and 2 of 5 (40%) cases of partial status. The average required necessary period for complete cessation of seizures in generalized status was about one hour. The mean infusion rate was 3.6µg/kg/min. In two of children with generalized status, decreased oxygen saturation necessitated endotracheal intubation and mechanical ventilation. This modality of therapy did not cause any metabolic derangement in any of our cases. Thus midazolam infusion is an effective and safe therapeutic approach for management of childhood refractory generalized convulsive status epilepticus, although its effect in controlling partial type of convulsive status epilepticus is not remarkable in comparison to the generalized one.

Objective Seizure is the most common signs of nervous system disease in neonates. The first line of treatments in neonatal seizures (after ruling out and emergency treatment of electrolyte imbalance and hypoglycemia) are phenobarbital and phenytoin. We aimed to evaluate drugs that are more effective on neonatal seizure. Materials & Methods Patients admitted to neonatal wards & NICUs (level IIa&IIb) in Qom hospitals (2015-2017), central Iran with presentation of seizure, were enrolled in this clinical trial study. After ruling out electrolyte imbalance and hypoglycemia these neonates were managed by intravenous phenobarbital, then if no response was seen we added intravenous phenytoin and for remaining neonates with refractory seizure we applied oral levetiracetam as add on therapy. The study was registered as code number of IRCT2016051527896N1. Results Initially, 245 neonates were enrolled. According to exclusion criteria, 12 cases were excluded, and phenobarbital was prescribed to the remaining patients. Out of these, 86 patients did not respond, and phenytoin was prescribed for them. Forty two patients who were not responding to phenytoin were finally treated with oral levetiracetam. Finally, 95. 3% of seizures were controlled with oral levetiracetam but 4. 7% were not cured. Conclusion: When the intravenous form of levetiracetam is not available and neonatal seizure does not respond to first line classic drugs, oral levetiracetam as add on therapy maybe effective.

Objectives: Infantile spasm is an epileptic disorder of early childhood and infancy and is characterized by cluster epileptic spasms and abnormal EEG findings. Developmental delay is prevalent. Some studies have indicated the significant effect of the Ketogenic Diet (KD) on intractable spasms in children who are unresponsive to first-line treatments. It has been used successfully as a first-line treatment with fewer side effects than ACTH. Materials & Methods: This was an interventional study in which the effectiveness of KD over a six-month period was evaluated in patients with infantile spasms. Those who fulfilled the inclusion criteria and were willing to use the diet received free cans of the 4: 1 ketogenic formula. The diet was prescribed based on the Johns Hopkins protocol in the outpatient setting. All patients used a full formula diet for one month. After a month, the patients were examined by a neurologist and a dietitian, and an EEG was obtained to compare pre-and post-KD findings. In order to compare pre-and post-KD seizures, the maximum number of seizures was multiplied by the longest duration of seizures. Results: Ten patients were assessed for one month. Using the KD led to significant changes in seizures/clusters and EEG findings. Nine parents reported improvement in their children’, s social interactions after using the KD. Conclusion: Based on the findings of this study, the KD can control seizures in patients suffering from infantile spasms by reducing seizure frequency & duration and improving EEG findings.