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    Early and late neurological complications of liver transplantation in pediatric patients
    (Wiley, 2017) Gungor, Serdal; Kilic, Betul; Arslan, Mujgan; Selimoglu, M. Ayse; Karabiber, Hamza; Yilmaz, Sezai
    NCs occur commonly after solid organ transplantation and affect 15%-30% of liver transplant recipients. The aim of this retrospective study was to evaluate the type and incidence of neurologic events in pediatric patients following LT. Between May 2006 and June 2015, 242 patients (118 females, 124 males) requiring LT for different etiologies at the nonu University Liver Transplantation Institute were included. The incidence, types, and risk factors of NCs that occurred following LT were evaluated retrospectively. Neurologic events occurred in 57 (23.5%) of the patients. Early NCs were encephalopathy (12.4%), seizures (11.5%), and PRES (7%). Of 57 patients, five (8.7%) experienced NCs at least 1 month after LT; these late NCs included tremor, headaches, encephalopathy, ataxia, and neuropathy. The psychiatric symptoms after LT were noted in 42 patients (17.4%). The mortality rate after LT in those with or without neurological events was not significantly different (P=.73). There was a high incidence of serious neurologic events after LT. The major neurologic manifestation in our patients was encephalopathy followed by seizures.
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    Efficacy of Levetiracetam Monotherapy in Childhood Epilepsy
    (Kare Publ, 2017) Arslan, Mujgan; Gungor, Serdal; Kilic, Betul
    Objectives: Levetiracetam (LEV) is an antiepileptic drug approved particularly for treatment of focal seizures. The aim of this study was to investigate efficacy and tolerability of LEV monotherapy in pediatric patients. Methods: In the present study, records of 225 children (aged 1 month-18 years) treated with LEV and with follow-up for at least 1 year were evaluated. Diagnosis of epilepsy included history of 2 or more unprovoked seizures. Demographic characteristics, reason for antiepileptic treatment, dosage of levetiracetam, duration of treatment, antiepileptic drugs used previously, seizure type, seizure duration, cranial magnetic resonance images, electroencephalogram results, seizure etiology, and side effects of the drug were documented. Results: Total of 225 patients, 95 girls and 130 boys, were enrolled in the study. Of those, 125 (55.6%) patients had generalized seizures, 90 (40%) had focal seizures, and 10 (4.4%) had other type of seizures. In treatment, 186 (82.7%) patients remained seizure-free. There was no difference in effectiveness of LEV on partial or generalized epilepsy. Overall, 8 (18%) patients had adverse events. Most common side effects observed were irritability and nervousness. There was no relationship between drug dosage and side effects. Conclusion: LEV monotherapy is effective in childhood epilepsy with focal or generalized seizures. It is well tolerated in spite of mild and transient side effects, which do not require drug discontinuation.
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    Hodgkin's lymphoma associated with paraneoplastic cerebellar degeneration in children: a case report and review of the literature
    (Springer, 2017) Gungor, Serdal; Kilic, Betul; Arslan, Mujgan; Ozgen, Unsal; Dalmau, Josep
    Paraneoplastic cerebellar degeneration (PCD) can occur severely and appear as subacute cerebellar syndrome. PCD may be associated with small cell lung cancer, adenocarcinoma, breast cancer, ovarian carcinoma, and Hodgkin's lymphoma. An 11-year-old male was admitted with acute cerebellar ataxia, dysarthria, and diplopia. Mediastinal conglomerated lymph nodes were depicted in a chest computed tomography (CT) examination, and diagnosis of stage IV Hodgkin's lymphoma was obtained after a lymph node biopsy. The antibodies against Purkinje cells (anti-Tr antibody) were positive immunohistochemically. Thus, paraneoplastic cerebellar degeneration depending on Hodgkin's disease was diagnosed. Despite the completion of chemotherapy, neurological recovery was not observed in the patient and plasmapheresis with immunoadsorption, and intravenous immunoglobulin (IVIG) was performed. Truncal ataxia, gait disturbance, and tremors decreased. Consequently, we thought that plasmapheresis with the immunoadsorption method and IVIG therapy might be a treatment option for cerebellar ataxia caused by a mechanism of immune ancestry.
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    Hodgkin's lymphoma associated with paraneoplastic cerebellar degeneration in children: a case report and review of the literature (vol 33, pg 1025, 2017)
    (Springer, 2017) Gungor, Serdal; Kilic, Betul; Arslan, Mujgan; Ozgen, Unsal; Dalmau, Josep
    [Abstract Not Available]
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    Mask face: Bilateral simultaneous facial palsy in an 11-year-old boy
    (Wiley, 2013) Gungor, Serdal; Raif, Sabiha Gungor; Arslan, Mujgan
    Bilateral facial paralysis is an uncommon clinical entity especially in the pediatric age group and occurs frequently as a manifestation of systemic disease. The most important causes are trauma, infectious diseases, neurological diseases, metabolic, neoplastic, autoimmune diseases and idiopathic disease (Bell's palsy). We report a case of an 11-year-old boy presenting with bilateral simultaneous peripheral facial paralysis. All possible infectious causes were excluded and the patient was diagnosed as having Bell's palsy (idiopathic). The most important approach in these cases is to rule out a life-threatening disease.
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    Seizures in Pediatric Patients With Liver Transplant and Efficacy of Levetiracetam
    (Sage Publications Inc, 2017) Kilic, Betuel; Gungor, Serdal; Arslan, Mujgan; Selimoglu, Mukadder Ayse; Yilmaz, Sezai
    The aim of this study was to evaluate the risk factors, clinical implications, and prognosis of new-onset seizures that occurred after pediatric liver transplantation, and to assess the efficacy of levetiracetam treatment. The clinical and laboratory data of liver transplanted 28 children who had seizures after liver transplantation and specifically of 18 children who received levetiracetam were analyzed retrospectively. Sixteen patients (88.9%) remained seizure-free and in 2 (11.1%), more than 50% reduction in seizures were detected with levetiracetam treatment. In conclusion, seizures are generally the most common complication by a spectrum of seizure types, and sometimes cause symptomatic epilepsy. The most common risk factors for seizures in transplant recipients is immunosuppressant toxicity. Currently, there isn't a specific treatment involving the transplant patient population. Levetiracetam may be preferable in pediatric patients as it's reliable for liver disease and has advantages in the treatment of postoperative seizures due to its intravenous usage.
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    Tricuspid valve perforation in a child with ventriculoatrial shunt
    (Georg Thieme Verlag Kg, 2014) Gungor, Serdal; Arslan, Mujgan; Karakurt, Cemsit; Raif, Sabiha Gungor
    Ventriculoperitoneal and ventriculoatrial shunting methods are used for the surgical treatment of hydrocephalus. However, many years or months after the treatment, complications can develop. In this article, we report on a patient with perforation of the tricuspid valve and tricuspid insufficiency, which developed as a complication of the ventriculoatrial shunt. This is a previously unreported complication in pediatric patients with a ventriculoatrial shunt. Because of fairly common and life-threatening cardiac complications, ventriculoatrial shunted patients should be monitored closely by echocardiography.