Alborz University

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Introduction: Traumatic brain injury (TBI) is one of the most common causes of seizure and about 10% of patients with severe and moderate trauma develop seizure. Phenytoin is an anti-seizure medicine which is widely prescribed to prevent seizure in TBI patients. Even it has non-linear pharmacokinetics in therapeutic concentrations, the prescription of which necessitates continuous evaluation of plasmatic level of medicine and regulating the dosage. Objective: This study aimed at surveying the variability of Phenytoin serum level in TBI patients in Poursina Teaching Hospital to determine the dosage of medicine more precisely to reach the Prophylactic level. Materials & Methods: In a descriptive longitudinal study, 90 patients of Trauma Ward of Poursina Hospital were studied. Phenytoin serum level was estimated in first, second, and seventh day after hospitalization by using RAN DOX kits, the results were then analyzed by SPSS software (ver16). Exact Test, Fisher, and Pearson T-test were utilized to analyze the data. Results: Out of 90 studied patients, 79 (87.7%) were men and 11(12.3%) women. Mean age was estimated 36.3±15.6 for men and 41.7±16 for women. There was no significant difference between the Phenytoin level in first and third day in two groups. The Phenytoin serum level in 24 first hrs didn’t reach therapeutic level in 75.6% of patients. The average of Phenytoin serum level was in therapeutic level in third day and Phenytoin serum level didn’t reach therapeutic level only in 5% of patients (p≥0.05). This average figure was 20-30 mg/dl in more than half of the patients on seventh day, during which all patients reached therapeutic level (p≥0.05). A significant relationship was observed between age and Phenytoin serum level in all three levels (p<0.05). Conclusion: Phenytoin is considered as an anti-seizure medicine which is vastly used in TBI victims. Using Phenytion requires exact monitoring due to its limited therapeutic range and linear pharmacokinetics. Since the changes of medicine dosage can lead to blood poisoning and make the medicine ineffective, its prescription needs much more attention regarding its gender, age, and needed dosage.

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Introduction: Febrile seizure is one the most common pediatric disease. Diagnosis of this disease is usually based on the history and clinical signs and symptoms. Various factors have been suggested as pathogenesis of febrile seizure but the main cause is still unknown. Recent studies recommended a relationship between oxidative stress and febrile seizure. This study aimed to examine the relationship between febrile seizure and Malondialdehyde (MDA) serum level as an oxidant determinant and Superoxide dismutase (SOD) serum level as an antioxidant determinant.
Methods: In this case-control study, two groups of people including 46 patients with simple and complex febrile seizure, and 44 normal children were studied. There was no history of febrile seizures, afebrile seizures, epilepsy or any types of neurologic and metabolic disorders in patients. Thus, serum levels of MAD and SOD in the two groups of study were evaluated, separately.
Results: The findings of this study showed a significant increase in malondialdehyde enzymes compared with healthy subjects. Also, the results of the measurement of the superoxide dismutase enzyme indicated a significant increase compared to the healthy group.
Conclusion: Significant increase in SOD and also a significant increase in MDA may be due to the stimulation of compensatory responses in the brain and subsequent the antioxidant system counteracting the oxidant system. These results also indicate the importance of time for enzyme measurements.

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Complex partial seizures are known as focal seizures with impaired awareness. Excluding the first year of life, complex partial seizures are the most frequent type of seizures in patients with epilepsy. A detailed history of the patient and family members is a vital element in diagnosing seizures. Although rare, psychotic and anxiety symptoms in individuals may be the result of the seizure.
A 7-year-old boy referred to our hospital emergency room complaining of fear, crying, screaming, and the imminent death sensation and decreased consciousness. The patient's symptoms started two years ago. He was treated with Risperidone and with the impression of ADHD and anxiety disorder.
The patient's laboratory tests were unremarkable. A brain MRI was performed with a seizure protocol, with no pathological findings. EEG was then performed for the patient, which confirmed focal seizures with impaired awareness. The patient was prescribed carbamazepine and phenytoin, and Risperidone was stopped.

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Introduction: Despite the development of new drugs over the past 20 years, the proportion of drug-resistant epilepsy has not changed. In this study, the effect of vitamin B6 and carbamazepine cotreatment was investigated on the duration of the tonic response, the malondialdehyde (MDA) and tumor necrosis factor alpha (TNF-α) levels in the brain of neonate rats in the maximal electroshock (MES) model.

Methods: Seventy neonatal Wistar rats were divided into seven groups: (1) control, (2) saline and MES, (3) carbamazepine (40 mg/kg), (4 and 5) vitamin B-6 (300 and 600 mg/kg), and (6 and 7) vitamin B-6 + carbamazepine (300 + 40 mg/kg) and (600 + 40 mg/kg). All drugs were injected intraperitoneally 1 hour before applying MES. The duration of hind leg extension (HLE), and the level MDA and TNF-α in brain homogenate of rats were measured.

Results: The treatments did not affect the number of deaths of rats. Administration of carbamazepine (40mg/kg, i.p.) and vitamin B6 (300 mg/kg, i.p.) significantly (p <0.01) reduced the HLE duration. Vitamin B-6 (600 mg/kg) only enhanced the reducing effect of carbamazepine on the duration of HLE compared to the carbamazepine alone group. Treatment with vitamin B-6 and carbamazepine alone reduced the level of MDA and TNF-α in the brain of convulsive rats, but their combined administration did not have a synergistic effect on the suppression of these factors.

Conclusion: The mechanism underlying the enhancement of the anticonvulsant response of carbamazepine administration with vitamin B-6 is independent of the modulation of MDA and TNF-a in the brain.