Tehran University Medical Journal

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Background: Poisoning is one of the major causes of seizure in emergency medicine. Because of the varying availability of drugs in different areas and insufficient control of the sale of some dangerous industrial substances, the causes of seizure in poisoned patients may be differ in our society. In this study, we examine the causes of seizures in poisoned patients in Iran, and their outcomes.
Methods: This retrospective and analytical-descriptive study investigated the sex, age, type of poison, presence and type of seizure, seizure treatment and outcome from the records of 2,220 hospitalized poison victims from 2001 to 2003 in poison emergency departments in Noor Hospital. Data was analyzed by one-way analysis of variance and chi square tests using SPSS.
Results: Of the 2,220 patient records examined, 66 patients developed seizure. Seizure was more common in men (33 patients), and most common in the 15-40 year age group (28 patients). The most common causes of seizure were tricyclic antidepressants (TCA) (39.7%), organophosphates (17.5%), carbamazepine (7.9%) and organochlorines (6.3%). However, status epilepticus was more common in organochlorine (25%), organophosphate, TCA (18.75%), and carbamazepine (12.5%) poisoning. There was a negative relationship between age and type of seizures. Seizure was not related to previous history of seizure. Midazolam alone (25%) was the most effective drug for controlling seizures. Death occurred in six patients with or without renal complication. The mortality rate among poisoned patients with seizure was 37.5%.
Conclusion: The incidence of seizure in our study reflects the availability of certain drugs and toxins that require more steadfast control. Midazolam, with its low side effects, may be the drug of choice for the treatment of status epilepticus in poisoning.

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Background: Epilepsy is a common disease in the pediatric neurology. There are frequent anti-epileptic drugs which are used in management of epilepsy. Anti-epileptic drugs may have some complications on bone and vitamin-D metabolism. In this study we aimed to evaluate vitamin-D metabolism in epileptic children.
Methods: The study was a prospective and cross sectional one. A total 89 epileptic children who were taking anti-epileptic drugs for longer than six months with no underlying disorder in Imam Khomeini and Bahrami Hospitals in Tehran, Iran were enrolled in our study
Results: Forty nine boys and 40 girls were enrolled in this study mean age of the patients was 7.8±2.1 years. Mean duration of anti-epileptic drug therapy was 2.3 years (SD=0.4), 70 of patients were under monotherapy and 19 were under polytherapy. None of the patients had signs of rickets. Serum calcium and phosphor levels were within normal ranges. Serum alkaline phosphates levels were increased more than two times in 43%. 42% had vitamin-D deficiency (25-OH Vit D<10 ng/ml) and another 33% had vitamin-D insufficiency (10<25-oh Vit D<20 ng/ml). 29 patients (32%) were taking prophylactic supplemental Vit D (200-400 IU/day). There was significant difference between patients taking supplemental vitamin-D as prophylaxis and patients who did not (p=0.04). There was no significant difference in vitamin-D levels between patients according to age, gender or different drugs.
Conclusion: Periodic measurement of 25-hydroxy vitamin-D is recommended in epileptic children taking anti-epileptic dugs. Supplemental vitamin-D administration in such patients may be helpful.