الفهرس 
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Abstract
Epilepsy was defined as two or more unprovoked seizures at least 24 h apart or where a single seizure occurred in the presence of well-defined electroclinical syndrome. Epilepsy presenting in childhood is heterogenous, with diverse underlying aetiologias, clinical presentations, severity and prognosis. Neurobehavioral and psychiatric comorbidities occur in up to 80% of children and are frequently under recognized.
Homocysteine is a thiol metabolite derived from the demethylation of methionine. It is eliminated by two different pathways that both involve folate as cofactor. It is well known that folate deficiency occurs in some epileptic patients taking antiepileptic drugs, causing reduced demethylation or transculturation of Homocysteine.
Interleukin-6 (IL-6), is a pleiotropic cytokine with a spectrum of biologic action son various cell types and tissues. The expression of IL-6 is increased in the setting of various neurological disorders such as multiple sclerosis, Alzheimer’s disease, trauma and meningitis Interestingly, previous studies have reported that activated glial cells secrete Matrix Metalloproteinase-9, MMP-9 resulting in an increased secretion of interleukin-6 (IL-6) when seizures occur or neurons sustained discharge.
The current study aimed to measure serum levels of homocysteine and interleukin 6 in children with idiopathic epilepsy in relation to their clinical findings. This case-control study was conducted on an adequate number of children of both gender and aged from 2 to 15 years with idiopathic epilepsy recruited from Pediatric outpatient Neurology Clinics and inpatients admitted to Neurology Department, Menoufia University Hospitals.
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All children included in this study were divided in to three groups as
follow:
group I: (epileptic children): included epileptic children with idiopathic
epilepsy diagnosed according to the criteria of International League against
Epilepsy ILAE, (2010). This group was sub grouped into:
Group1A: Include children recently diagnosed with idiopathic epilepsy at
most 1 month of presentation and start of antiepileptic drug. Group1B:
include children with idiopathic epilepsy on AEDs for more than 1 year
whether mono or polytherapy.
group II: (Control Group): include children of matched age and sex as
a control group.
All patients were selected according to the inclusion and exclusion
criteria:
Inclusion criteria: Age from 2to 15 years, both sex, children with
idiopathic epilepsy recently diagnosed for less than 1 month of
presentation and children with idiopathic epilepsy on AEDs for more than
1 year whether mono or polytherapy. Exclusion criteria: Patients with
poor compliance with AEDs, patients with severe mental or psychiatric
illness, patients with special epileptic syndrome, and patients receiving
epileptogenic drugs. e.g., theophylline, children with chronic diseases
which could influence the cytokines system i.e., hematological diseases,
chronic inflammatory processes, neoplastic diseases and patients with
systemic illness (uncontrolled diabetes mellitus, hypertension, renal, liver,
neoplastic, connective tissue disorders, morbid obesity, and anemia) to
exclude causes that may lead to increased il-6 serum levels.
For every patient the following was done: Detailed history taking
including: Clinical examination” general, systemic and neurological” to
exclude any diseases that increase IL-6 level such as anemia, liver diseases,
obesity, and autoimmune disorders. Laboratory investigations: Routine
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investigations including: Complete blood count (CBC), Kidney function tests (serum urea & creatinine) by CX9 Beckman coulter auto analyze. Hepatic function tests (ALT &AST) byCX9 Beckman coulter auto analyzer. Serum electrolytes (Na & Ka) by CX9 Beckman coulter auto analyzer. - Specific investigations: Serum homocysteine level was detected by ELISA method and Serum interleukin 6 level: was detected by enzyme-linked immunosorbent assay.
Results of the current study could be summarized as follows:
There was a significant difference between patients’ group and control group regarding child older (p=0.038). While there was non-significant difference between patients’ group and control group regarding age, gender, mode of delivery, consanguinity and family history (P> 0.5).
There were a significant differences among the studied groups regarding ALT, sodium, potassium, urea, LYM, hematocrit, MCV and platelets (P<0.05), while, there were no significant differences regarding other investigations among the studied groups (p˃0.05).
Serum homocysteine level and serum interleukin 6 levels were significantly higher among patients’ groups (1A and 1B) than control group (p˂0.001). Serum homocysteine level was higher in group 1B than group 1A but serum interleukin 6 was higher in group 1A than group 1B.
No significant differences between group 1A and 1B regarding MRI, CT and EEG findings.
There was significant positive correlation between serum homocysteine level ALT (r=0.471, p=0.012), AST (r=0.543, p=0.004), urea level (r=0.384, p=0.039), MPV (r=0.620, p=0.032) and PCT (r=0.448, p=0.019), it was negative correlation with Sodium level (r=-0.447, p=0.014). Regarding, serum inteuloleion-6 level was
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significantly negative correlation with RBCs (r=-0.271, p=0.030), RDW (r=-0.271, p=0.037), and PCT (r=-0.240, p=0.04). There was no significant correlation between serum IL-6 and homocysteine levels with other investigations (p˃0.05).
Sensitivity of serum IL -6 level was 87.5%, specificity (87.5%). PPV (63.12%), NPV (80.1%) while accuracy was 85.21% of a cutoff point of >50 ng/ml for diagnosis of epilepsy. Also, sensitivity of serum homocysteine level was 86%, specificity (91.9%). PPV (71.94%), NPV (81.39%) while accuracy was 90.35% of a cutoff point of >12 ng/ml for diagnosis of epilepsy.