Translation_sidorin-

/Translated from Russian to English/ /Stamp: DEPARTMENT OF HEALTH OF MOSCOW CITY SCIENTIFIC & PRACTICAL CENTER OF MEDICAL CARE FOR CHILDREN WITH CONGENITAL ABNORMALITY OF CRANIOFACIAL AREA AND INHERENT DISEASES CASE RECORD Nr. 622/10
Full name: Sidorin Georgy Vasilievich
Age: 2 years old 7 month
Date of birth: 09.07.2007
Settlement: Moscow city
He stayed at Psychoneurology Department of Scientific & Practical Center from 18.02.10 till
23.04.10
Current hospitalization is the first one.
Clinical diagnosis: Cryptogenic localizes (sinistral, frontal) epilepsy, drug-resistant
course. Infantile spasms syndrome.
Secondary diagnosis: Minor cardiovascular development abnormalities (abnormal heart
chorda). First degree hypertrophy of palatine tonsils.
Complaints at admission: of attacks
Attack type
Frequency
Duration
Time of the day
Registered
Type 1: nods with 6-11 series a day
Treatment at admission: Clonazepam 1,5 mg/d, Suxilep 750 mg/d, Luminal 12, 5 mg/d,
Diphenylhydantoin 30 mg/d.
Anamnesis and medical history:
A child was born in normal pregnancy, in time. Pace of development before the attack debut
according to age.
13.10.2009 he had an operation - resection of fibrous baby hamartoma of the left hand.
Disease debut: at the age of 2 against the background of absolute health there appeared
above mentioned attacks within the waking time, with the frequency of 1-2 per day, duration
5-10 minutes, with gradual acceleration. Since 06.01.10 there have been attacks at night.
Pharmacological anamnesis:
Medicine
Doses mg/d Terms
Concentration
(mcg/ml)
Results of previous examinations:
MRT (10.10.09): in the paraventricle parts of the alba of the parietal lobes of both hemispheres
– there are unclear areas of myelination retention.
EEG (27.10.09): epileptiform activity with high grade of performance in terms of sets of “acute
slow wave” with bitemporal amplitude maximum. Some signals are of regional origin from right
posttemporal and left central temporal parts. Separate sets morphological y coincide with
DEND.
EEG (1.15.10): there is teta- and delta deceleration registered in frontal – central temporal parts
of both spheres. Epiactivity is noticed in terms of several independent foci.
At admission: As to somatic status the condition is satisfactory. Child’s weight is 15,5
kg. Skin and muculent is clear and pink. Heart and lung activity is satisfactory. Physiological functions are normal. As to neurological status: There are no brain and meningeal symptoms. SN is without focal symptoms, kinesis of limbs is ful , tone and power is sufficient. Brisk tendon reflexes, D – S, there are pathological reflexes registered. Coordinational probes are performed satisfactory, sensitivity is not disturbed. Psychic sphere: the child is cooperative, adequate. Speech – separate words, simple phrases. Examination results:
Indices of blood and urine analysis are within the age norm.
Pharmacomonitoring dd. 31.03.10:
Denakin chronosphere in doses of 500 mg/d: 1 probe: 68 mg/ml, 2 probe: 89 mg/ml.
Video-EEG – monitoring during 12 hours with a record of night sleep dd. 22.02.10:
 Significant diffuse changes of brain electrobiological activity. Hypsarrhythmia pattern.  The sleep is not differentiated in stages. Physiological patterns are not traced. Charact
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State
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Clinical performance:
Attack features
Localization
Flexor epileptical spasms of different manifestation rate, It’s difficult to determine the area Video-EEG- monitoring within 6 hours with a record of night sleep dd. 6.04.10:
 Significant diffuse changes of brain electrobiological activity. Hypsarrhythmia pattern. Episodical y registered main rhythm corresponds to the age.  The sleep is not differentiated in stages. Physiological patterns are not traced.
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State
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Clinical performance:
Attack features
Localization
QTY
Flexor epileptical spasms of different manifestation rate, It’s difficult to determine the area In comparison with the previous examination dd. 22.02.10 there is some improvement in frequency characteristics seen and indices of basic rhythm abundance growth.
• Brain MRT dd. 23.03.10: there are no pathological processes in the brain.
• Psychologist’s consultation: Higher mental functions development is slightly
lower the age norm.
• Speech therapist consultation: speech development delay
• Ophthalmologist consultation: OU-development according to the age
• Geneticist consultation, Candidate of medical sciences Zhilina S.S.: in the first
place one should exclude the group of genetic leukodystrophy (TMC)-Crabbe, met achromatic leukodystrophies, Tay-Sacks disease.
Treatment applied:
In respect of ineffectiveness, Difenin, Luminal and Clonazepam are canceled. Depakin
chronosphere 500 mg/d is introduced, on the back of which the number and duration of attacks
has decreased. There also has been Tonamax max 6,5 mg/kg/d introduced, secondary to
which the attacks modificated – the start with rhythmic low amplitude twitching of the right leg
with posterior nod and shoulders uplift, the number of attacks hasn’t changed greatly. Sarbil is
introduced with the doses increase up to 2000 mg/d (130 mg/kg/d), in this connection there has
been a significant decrease in the number of attacks up to 3-4 times per 24-hours. He bears the
treatment satisfactory.
Release condition: satisfactory
Dynamics in somatic and neurological statuses: is overal positive in terms of frequency
characteristics improvement and indices of basic rhythm abundance growth, significant
decrease of attack number, positive psycho verbal development of the child.
Efficiency of antiepileptic therapy (%): decrease of attacks > 75%.
There has been no contact with contagious patients.
Recommendations:
Denakin chronosphere 250 mg twice per 24-hours with a 12-hour interval,
Sabril 0,5 2 pills twice per 24hours with a 12-hour interval
There is a future Sabril doses increase up to 150 mg/kg/d possible, provided that there
are still attacks but with no side effects.
Antiepileptic medicine should be taken permanently, durably and at the same time
without skipping the medicine taking!
Doctor in charge
/Ananjeva T.V./
Chief of the Department
/Yavorskaya M.M./
Head of Epileptology Department
/Ayvazyan S.O./
OF THE DEPARTMENT OF HEALTH OF MOSCOW CITY * PSRN 102776210237 SCIENTIFIC & PRACTICAL CENTER OF MEDICAL CARE FOR CHILDREN WITH CONGENITAL ABNORMALITY OF CRANIOFACIAL AREA AND INHERENT DISEASES OF NERVOUS SYSTEM

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