[Show abstract][Hide abstract] ABSTRACT: Aim. Convulsive status epilepticus is the most common childhood neurological emergency in developing countries, where poor healthcare organisation could play a negative role in the management of the condition. Unavailability of second-line injectable anticonvulsants is an additional hindering factor in Georgia. This report reflects the results of the first study aimed at evaluating the epidemiological features of convulsive status epilepticus, as well as identifying obstacles influencing the management of patients with convulsive status epilepticus in Georgia. Methods. A prospective, hospital-based study was performed. Paediatric patients with convulsive status epilepticus, admitted to the emergency department of a referral academic hospital from 2007 to 2012, were included in the study. Results. Forty-eight paediatric patients admitted to hospital met the criteria for convulsive status epilepticus. Seizure duration was significantly shorter among the group with adequate and timely pre-hospital intervention. Moreover, patients with appropriate pre-hospital treatment less frequently required mechanical ventilation (p=0.039). Four deaths were detected during the follow-up period, thus the case fatality rate was 8%. Only 31% of patients received treatment with intravenous phenytoin. Conclusion. The study results show that adequate and timely intervention could improve outcome of convulsive status epilepticus and decrease the need for mechanical ventilation. Mortality parameters were comparable to the results from other resource-limited countries. More than one third of patients did not receive appropriate treatment due to unavailability of phenytoin.
No preview · Article · May 2015 · Epileptic disorders: international epilepsy journal with videotape
[Show abstract][Hide abstract] ABSTRACT: CSE is the most common childhood neurological emergency in developed countries, which can lead to neuro cognitive sequel and death with different hazards and outcome. The majority of authors'agreed that etiology is the main determinant of morbidity, but different studies reported different etiology groups as predictors of the poor outcome. Present study was conducted to evaluate predictive value of etiology in post CSE morbidity. Prospective, hospital-based study was performed in Tbilisi. Patients, aged from one month to18 years with CSE, admitted to the emergency department of M. Iashvili Children's Central Hospital from March 2007 to March 2012 were included. The short-term outcome of CSE was evaluated after 30 days from admission and it was classified into three categories: unchanged neurologic status, neurological consequences (new neurologic deficit compared to the condition before CSE), and lethal outcome. 48 children aged one month- 18 years were analyzed. In our study acute symptomatic, remote symptomatic and progressive encephalopathy were associated with higher morbidity. Progressive encephalopathy is the most frequent etiology group which led to develop new neurological sequel after CSE and long duration of CSE. According to our data we conclude that children with idiopathic or febrile CSE have a favorable outcome. While acute symptomatic etiology group mostly was associated and statistical significant association were found with progressive encephalopathy and development morbidity after CSE. According to our data we conclude that children with idiopathic or febrile CSE have a favorable outcome. While progressive encephalopathy lead to develop morbidity after CSE.
No preview · Article · Jun 2014 · Georgian medical news
[Show abstract][Hide abstract] ABSTRACT: Convulsive Status Epilepticus (CSE) is most common neurological emergency in childhood. Condition has been defined as a convulsion lasting at least 30 min or recurrent convulsions occurring over a 30-min period without recovery of consciousness. It is generally accepted that early intervention for terminating seizures is beneficial for outcome. The aim of our study was to evaluate influences of pre-hospital and hospital treatment strategies on the outcome of CSE. Our prospective, hospital-based study was performed in Tbilisi and included 48 Patients with CSE, admitted to the emergency department of M. Iashvili Children's Central Hospital from March 2007 to March 2012. The cases were reviewed according to pre-hospital and hospital treatment strategies and outcome. "North Central London Epilepsy Network for Children & Young People" Guideline-"The Management of Convulsive Status Epilepticus" was adapted for the Georgian reality. Our study identified statistically significant increase of incidence of artificial ventilation in patients receiving more than one dose of BZD in pre hospital as in hospital setting; additionally we found a statistically strong relationship between timely initiation of treatment and appropriate pre-hospital treatment with a short duration of CSE. From our data the number of doses of benzodiazepine and a long period before admission are the main determinants of seizure prolongation. Lack of Standardized pre hospital treatment of pediatric CSE had statistically significant negative influence on outcome of CSE.
No preview · Article · Jun 2014 · Georgian medical news
[Show abstract][Hide abstract] ABSTRACT: Prematurity represents one of the risk factors of newborns' mortality, morbidity and derangements of long-term neurological development. With the increase of number of preterm newborns, problems with subsequent neurological development have also increased. Preterm population deserves great interest and a lot of investigations have been carried out in order to study their development dynamically. The goal of our study is evaluation of the preterm newborn, with gestation age <=37 weeks, estimation of their neurological developmet at the later age (6-7) and comparing them with full-term born infants of the same age. Objects of our investigation are preterm newborns, with gestation age <=37 weeks. 94 preterm newborns and 50 full-term newborns were estimated in the neonatal period and then later at the age of 6-7; methods of evaluation at the age of 6 years there were used: Standard full neurological investigation, GMFM scale (gross motor functional measure), Towen Scale for evaluation of minor motor activity, Raven Color Matrix for estimation of non-verbal cognitive functions, Coners Questionnaire for parents - for revelation of dysadaptation;. Cerebral palsy among preterm infants was observed in 15 cases-16%; in control group- 1 case-2%; Dyspraxia syndrome was observed in 32 cases-34%, in control group 9 cases-18%. The results of evaluation gross motor function with GMFM score for term group is higher,than for preterm group: 95,86 vs 83,52, p<0,001. The results of the evaluation nonverbal cognitive function with Color matrix of Raven test is higher in term group:20,20 vs 16,6; p<0,001 Syndromes of behavioral disadaptation have been observed more often among preterm newborns Score for each parts(problem of control; impulsivity, index of hyperactivity) are higher in preterm children, p<0,001. Low birth gestation can be a real risk factor for the later neurological development.. Cerebral palsy and dyspraxial syndrome is probably more among newborns with low gestation than among control group contingent;The results of the evaluation nonverbal cognitive function with Color matrix of Raven test is higher in term group. Syndromes of behavioral disadaptation have been observed more often among preterm newborns. Because of frequent//high percent of neurolodevelopmental problems preterm contingent require continuing monitoring,evaluation in dynamicaly for early distincting mild problems.
No preview · Article · Jan 2007 · Georgian medical news