Article Antiepileptic Drug-induced Osteopenia in Ambulatory Epileptic Children Receiving a Standard Vitamin D3 Supplement was published on June 1, 2005 in the journal Journal of Pediatric Endocrinology and Metabolism (volume 18, issue 6).
Out-toeing is one of the most common gait disturbances in children that cause parents to seek medical advice from their doctor. Spinal muscular atrophy (SMA) type III usually presents with an abnormal gait like waddling. The key to an accurate diagnosis of SMA type III is a careful history including subtle motor milestones. We report a 10 year-old-girl with SMA type IIIa presenting with abnormal gait. Past medical history revealed that the patient had been admitted to the department of orthopedic surgery for out-toeing and delayed walking at the age of 6. She had been diagnosed as flat foot and treated with modified shoes for 4 years. On admission, she had waddling gait, Gowers sign and fasciculation in her tongue. The creatine kinase was 462 U/L (N: 5-130 U/L). The electromyogram showed signs of anterior horn cell disease. She had had deletion of exon 7 of SMN gene. Any information about delayed walking obtained from the medical history of a patient with out-toeing related flat foot should alert the physician to diagnose a neuromuscular disease like SMA type IIIa.
A defective cell-mediated immunity and inflammatory cytokines are suggested in the pathogenesis of subacute sclerosing panencephalitis. In this study we analyzed lymphocyte subsets in peripheral blood and concentrations of interleukin-1α (IL-1α), interleukin-2 (IL-2α), tumor necrosis factor-α (TNF-α), and platelet activating factor in plasma and cerebrospinal fluid before and after immunomodulatory therapy (interferon-α plus isoprinosine) in three patients with subacute sclerosing panencephalitis. Increased percentage of CD8 + cells (T-suppressor/cytotoxic cell) and CD16 + CD56 + cells (NK cell) and reduced percentage of CD3 + /HLA-DR + (active T-cell) and CD3 + (total T-cell) cells were found before therapy. After immunomodulatory therapy, CD3 + /HLA-DR + (active T-cell) cells were markedly increased and there was a slight increase in the percentages of all lymphocyte subsets in the patients. The concentrations of platelet activating factor in plasma and cerebrospinal fluid were higher than the mean value in controls. Cerebrospinal fluid and plasma TNF-α and IL-2 levels were nondetectable in two patients who had a stationary course of disease and were markedly elevated in patient 3, who displayed a rapidly progressive course. (J Child Neurol 1999;14:418-421).
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