SYNOPSI

S
STUDY OF HEMATOLOGICAL AND BI
OCHEMI
CAL CHANGES I
N PAEDI
ATRI
CS
PATI
ENTSONANTI EPI
LEPTICDRUG.

FORTHETHESI
S

MD(
PAEDI
ATRI
CS)

SESSI
ON:
JULY2020-
JULY2023

UTTARPRADESHUNI
VERSI
TYOFMEDI
CALSCI
ENCE (
UPUMS) SAI
FAI
ETAWAH.

BY

DR.RAM LALI
TCHAUDHARY
(
JUNI
ORRESI
DENT)
DEPARTMENTOFPAEDI
ATRI
CS
UPUMS,
SAI
FAI
,ETAWAH,
U.P
To,
TheDean

UPUMS,
Sai
fai
,

Et
awah

Respect
edsi
r,
Iam her
ewi
thsubmi
tt
ingf
oll
owi
ngpar
ti
cul
arsf
orr
egi
str
ati
onoft
hesi
s
f
orDOCTRATE OF MEDI
CINE (
Paedi
atr
ics)exami
nat
ion ofUTTAR PRADESH
UNI
VERSI
TY OF MEDI
CAL SCI
ENCES,ETAWAH t
o be hel
din 2023 al
ong wi
th
Per
for
maf
orf
avourofconsi
der
ati
on.

NameofCandi
dat
e :
RAM LALI
TCHAUDHARY

YearandMont
hofgr
aduat
ion :
APRI
L2019.

Uni
ver
sit
yfr
om whi
chGr
aduat
e :
G.S.
V.M. Medi
cal Col
l
ege KANPUR UTTAR
PRADESH.

Per
manentRegi
str
ati
onNumber:
84195

Pr
oposedt
it
leoft
hesi
s :STUDYOFHEMATOLOGI
CALANDBI
OCHEMI
CAL
CHANGESI
NPAEDI
ATRI
CPATI
ENTSONANTI
EPI
LEPTI
CDRUGS.

Pl
aceofwor
k : UTTARPRADESHUNI
VERSI
TYOFMEDI
CAL
SCI
ENCES,
SAI
FAI,
ETAWAH

PROTOCOLOFTHESI
S :
FORDOCTRATEOFMEDI
CINE(
PAEDI
ATRI
CS)

NAMEOFTHESTUDENT :
DR.
RAM LALI
TCHAUDHARY

PGSESSI
ON :JULY2020-
JULY2023

THESI
SSTUDYDURATI
ON :JANUARY2021–JUNE2022
 RECOMMENDATI
ONOFTHEHEADOFTHEDEPARTMENT

DR.RAJESHKUMARYADAV

(
MD,
PAEDI
ATRI
CS)

Pr
ofessorandheadofDepar
tmentofPaedi
atr
icsUPUMS,Sai
fai
,Et
awah

RECOMMENDATI
ON OFGUI
DE

DR.
DINESHKUMAR

(
MD,
PAEDI
ATRI
CS)

Associ
atePr
ofessor
,Depar
tmentofPaedi
atr
icsUPUMS,
Sai
fai
,Et
awah
 RECOMMENDATI
ONOFCO-
GUI
DE

DR.
GANESHKUMARVERMA
(
M.D.
PAEDI
ATRI
CS)
ASSI
STANTPROFESSOR,
Depar
tmentofPaedi
atr
icsUPUMS,
Sai
fai
,Et
awah.

RECOMMENDATI
ONOFCO-
GUI
DE

DR.
AJAYKUMAR
(
M.D.
BIOCHEMI
STRY)
ASSI
STANTPROFESSOR,
Depar
tmentofBi
ochemi
str
y,UPUMS,
SAI
FAI
,ETAWAH
 PROTOCOLOFTHESI
S
FORDOCTRATEOFMEDI
CINE

(
PAEDI
ATRI
CS)

TOPI
COFTHESI
S:STUDYOFHEMATOLOGI
CALANDBI
OCHEMI
CALCHANGESI
N
PAEDI
ATRI
CPATI
ENTSONANTI
EPI
LEPTI
CDRUG.

NAMEOFTHESTUDENT:Dr
.RAM LALI
TCHAUDHARY

Depar
tmentofPaedi
atr
ics

(
SESSI
ON:
Jul
y2020-
Jul
y2023)
 I
NDEX:

1.I
NTRODUCTI
ON

2.AI
MSANDOBJECTI
VESS

3.REVI
EW OFLI
TERATURE

4.MATERI
ALSANDMETHODS

5.REFERENCES

6.STUDYPRFORMA
 I
NTRODUCTI
ON
“
Sei
zur
eisat
ransi
entoccur
renceofsi
gnsorsy
mpt
omsr
esul
ti
ngf
rom abnor
mal
1
excessi
veorsy
nchr
onousneur
onalact
ivi
tyi
nthebr
ain”.Epi
l
epsyi
sadi
sor
derof
t
hebr
ainchar
act
eri
zedbyanendur
ingpr
edi
sposi
ti
ont
ogener
atessei
zur
esandby
t
heneur
obi
ologi
c,cogni
ti
ve,
psy
chol
ogi
cal
,
andsoci
alconsequencesoft
hiscondi
ton1.
i
Forepi
demi
ologi
candcl
i
nicalpur
poses,
epi
l
epsyi
sconsi
der
edpr
esentwhent
woor
mor
e unpr
ovoked sei
zur
e occer i
n a t
ime f
rame of l
onger t
han 24
hour
s.Appr
oxi
mat
ely 4-
10% of chi
l
dren exper
ience at l
east one sei
zur
e
(f
ebr
il
e/af
ebr
il
e)i
nthef
ir
st16y
earofl
i
fe.
Thecumul
ati
vel
i
fet
imei
nci
denceof
epi
l
epsyi
s3%andmor
ethanhal
fofdi
sor
derst
arti dhood1.I
nchi
l nIndi
a,90%oft
he
est
imat
ed5.
5mi
l
li
onpeopl
ewi
thepi
l
epsyar
efr
om r
uralpopul
ati
onandt
hree-
f
our
thsoft
hem maybedepr
ivedofspeci
fi
ctr
eat
mentaspert
hepr
esentst
andar
d.
Newcasesar
ecl
oset
ohal
fami
l
li
oneachy
earandt
hei
nci
dencer
atesf
arexceed
pr
eval
ence f
i es2 . I
gur ndi
a,t
reat
mentgap i
s gr
adual
l
y get
ti
ng nar
rowed as
communi
ty based appr
oaches ar
e of
fer
ing ef
fect
ivet
reat
mentst
rat es3,
egi 4
.
Et
iol
ogi
cal
l
ySei
zur
esar
ecausedandassoci
atedwi
thnumberofcauses.Oft
hose
5.
who hav
easei
zur
e,about25% hav
e epi
l
epsy Dehy
drat
ion 
can t
ri
ggerepi
l
ept
ic
sei
zur
es i
fiti
s sev
ere enough6 .
 A numberofdi
sor
der
sincl
udi
ng:
 
low bl
ood
sugar
, 
low bl
ood sodi
um,
 
hyper
osmol
ar nonket
oti
c hy
per
gly
cemi
a,
 hi
gh bl
ood
sodi
um,
 
low bl
ood cal
cium 
and 
high bl
ood ur
ea 
l
evel
s may cause sei
zur
es as
may
 hepat
icencephal
opat
hy 
andt
hegenet
icdi
sor
der
 por
phy
ria7.I
nfect
ionwi
tht
he
por
ktapewor
m,whi
chcancausesneur
ocy
sti
cer
cosi
s,i
sthecauseofupt
ohal
fof
epi
l
epsycasesi
nar
easoft
hewor
ld8.
Par
asi
ti
cinf
ect
ionssuchascer
ebr
al 
mal
ari
a
ar
eassoci
ated i
th sei
zur
es.I
n Ni
ger
ia neur
ocy
sti
cer
cosi
sisoneoft
hemost
commoncausesofsei
zur
esamongchi
l
drenunder5y sofage9.I
ear nfect
ionsuchas
meni
ngi
ti
s,encephal
i
tisar
eassoci
atedwi
thsei e10.Space-
zur occupy
ingl
esi
onsi
n
t
he br
ain(
abscesses,
 
tumour
s).I
n peopl
e wi
th 
brai
ntumour
s,t
he f
requencyof
epi
l
epsydependsont
hel
ocat
ionoft
het
umori
nthe 
cor
ti
calr on11.Anumberof
egi
medi
cat
ionsar
ecur
rent
lyusedi
nthet
reat
mentofepi
l
epsy
.Theol
derAED'
sar
e
Phenobar
bit
al(
PB)
,Pheny
toi
n(PHT)
,Car
bamazepi
ne(
CBZ)
,Pr
imi
done(
PRM)
,Sodi
um
v
alpr
oat
e(VPA)and Cl
onazepam (
CZP)
.NewerAED'
s ar
e Lamot
ri
gine (
LTG)
,
Topi
ramat
e(TPM)
,Cl
obazam (
CLB)
,Oxcar
bazepi
ne(
OXC)andLev
eter
ici
tam (
LEV)
.
UseofAED'
shasacut
eandchr
oni
csi
deef
fect
s.Chr
oni
cuseofAEDcanaf
fectbone
heal
th.Mai
ntenanceofboneheal
thandbonedensi
tyi
sady
nami
cpr
ocess.Repor
ts
ofAEDi
nducedbi
ochemi
calabnor
mal
i
tiessuggest
iveofost
eomal
aci
ahav
ebeen
r
epor
tedi
ntheear
ly70s12-15.
Theseshor
tter
m ant
iepi
l
ept
icdr
ugsmi
ghtcauseal
ter
ati
onsi
nli
pidpr
ofes16,
i
l 17
,
ki
dneyf
unct
iont s18 andmi
est l
dincr
easei
nli
verf
unct
iont
est
ssuchasGGT,AST,
ALT 19.Long t
erm t
reat
mentwi
th ant
iepi
l
ept
ic agent
s al
so has been f
ound
associ
atedwi
thal
ower
ingofbonemi
ner
aldensi
ty20 .I
nvi
ewoft
heabov
efact
s,a
pat
ientonant
iepi
l
ept
icdr
ugt
reat
mentneedsr
egul
arcl
i
nicalexami
nat
ionaswel
las
moni
tor
ingofv
ari
ousbi
ochemi
calt
est
s.Al
argenumberofr
epor
tsar
eav
ail
abl
eto
i
ndi
cat
e cl
i
nicaland met
abol
i
c al
ter
ati
ons f
oll
owi
ng ant
iepi
l
ept
ict
reat
menti
n
dev
elopi
ngcount
ri
esi
ncl
udi
ngI a21-23.Si
ndi deef
fectcommonl
yusedant
iepi
l
ept
ic
dr
ugsar
ePheny
toi
n(Cosmet
icchanges(
gum ov
ergr
owt
h,coar
seni
ngoff
aci
es,
hi
rsui
ti
sm)
, per
ipher
al neur
opat
hy, hy
per
sensi
ti
vi
ty r
eact
ions) . Bar
bit
urat
es
(
Behav
ior
alchanges and cogni
ti
ve ef
fect
s,Dupy
tren’
s cont
ract
ures,per
ipher
al
neur
opat
hy)
. Suxi
mides(Hi
ccups,gast
roi
ntest
inalpr
obl
ems,v
isualchanges)
Car
bamazepi
ne (
Hyponat
remi
a Leukopeni
a,dr
ug er
upt
ions)
,Benzodi
azepi
nes
(
Sedat
ion,
hyper
sal
i
vat
ion),
Val
proat
e(Wei
ghtgai
n,endocr
inechanges,
tremor
,hai
r
l
oss,
thr
ombocy
topeni
a,hy
per
ammonemi
a,hepat
otoxi
cit
y,pancr
eat
it
is),
Fel
bamat
e
(Anor
exi
aandwei
ghtl
oss,i
nsomni
a,apl
ast
icanemi
a,l
i
verf
ail
ure),Gabapent
in
(Hy
per
act
ivi
tyoraggr
essi
vebehav
iori
nchi
l
dren,wei
ghtgai
n),Lamot
ri
gine(ski
n
r
ash) Topi
ramat
e (
Cogni
ti
ve pr
obl
ems (
speech di
stur
bance)
, behav
ior
al
abnor
mal
i
ties,ki
dney st
ones,par
est
hesi
as,anor
exi
a,wei
ght l
oss)
,Ti
agabi
ne
(
Tremorandner
vousness,
emot
ional
),
Vi
gabat
ri
n (
Behav
ior
al and psy
chi
atr
ic di
stur
bances: i
rr
it
abi
l
ity
,insomni
a,
hy
per
act
ivi
ty,psy
chosi
s and depr
essi
on,v
isualf
iel
d def
ect
s and bl
i
ndness ),
24
Zoni
sami
de(
Kidneyst
ones) .
)
I
nci
denceofsei
zur
ear
ecommoni
ndev
elopi
ngcount
ri
esi
ncl
udi
ngI
ndi
aandmost
oft
hepat
ient
sbel
ongi
ngt
olowsoci
oeconomi
cst
atusandnotwi
l
li
ngt
ofol
l
owup.
Cl
i
nicalst
udi
esar
ever
yli
mit
edt
ochar
act
eri
set
heseant
iepi
l
ept
icdr
ugi
nduced
changesi
nepi
l
ept
icchi
l
dreni
nIndi
a.Hencewear
econduct
ingast
udyt
olook
v
ari
ous haemat
ologi
caland bi
ochemi
calchanges t
hatar
e seen i
n pat
ient
s on
ant
iepi
l
ept
icdr
ugs

AI
MSANDOBJECTI
VES

1.St
udyofhaemat
ologi
caland bi
ochemi
calchanges i
n paedi
atr
icpat
ient
s on
ant
iepi
l
ept
icdr
ugs.

2.Compar
isonofhaemat
ologi
calandbi
ochemi
calchangesi
npaedi
atr
icspat
ient
s
onsi
ngl
eant
iepi
l
ept
icdr
ugwi
thcombi
neant
iepi
l
ept
icdr
ugt
her
apy.

3.Toknow t
hepr
eval
enceandet
iol
ogyofsei
zur
einpaedi
atr
icpat
ient
sandsi
de
ef
fectofant
iepi
l
ept
icdr
ug.
 REVI
EW OFLI
TERATURE
“ Sei
zur
eisat
ransi
entoccur
renceofsi
gnsand/
orsy
mpt
omsr
esul
ti
ngf
rom
1
abnor
malexcessi
veorsy
nchr
onousneur
onalact
ivi
tyi
nthebr
ain” .
Epi
l
epsyi
sa
di
sor
deroft
hebr
ain char
act
eri
zed byan endur
ing pr
edi
sposi
ti
on t
o gener
ates
sei
zur
esandbyt
heneur
obi
ologi
c,cogni
ti
ve,
psy
chol
ogi
cal
,
andsoci
alconsequences
oft
hiscondi
ton1.
i
Yur
i.
Yetal(
2018)i
nthei
rst
udyt
heyf
oundt
hatt
her
educt
ioni
nWBCcountmi
ghtbe
dose-
dependent
lyr
elat
edt
oAEDs.El
evat
edGGTact
ivi
tywasobser
vedi
nal
lpat
ient
s
t
reat
edwi
thCBZ,
butt
heav
eragei
ncr
easei
nGGTact
ivi
tywas35.
19±33.
08U/
L.I
n
pat
ient
sunder
goi
ngVPAt
reat
ment
,decr
easedPLTcount
swer
eal
soobser
vedat
hi
ghf
requency
.Thus,hemat
ologi
calandbi
ochemi
calpar
amet
ersshoul
dbecl
osel
y
moni
tor
edi
npat
ient
srecei
vi
ngAED,
especi
all
yinpat
ient
str
eat
edwi
thhi
ghdosesof
AEDs
Dl
c
n
w
a
f
t
,e
h
r
o
b
o
s
a
ir
e
u
t
s
mp
n
em
c
hl
r
n
t
o
e
vt
a
dt
u
c
ep
n
a
o
a
ri
l
o
y
a
n
ea
l
rs
e
h
,
n
ev
t
r
gt
h
p
e
a
i
eh
co
d
t
n
o
ih
u
e
cc
t
d
d
ne
a
l
r
w
i
db
v
m
r
s
mi
dv
ui
r
h
t
t
e
ul
h
i
nDl
e
s
al
d
r
i
a
d
a
t
n
bu
mo
nt
a
r
i
nt
e
c
n
e
mi
it
dv
c
e
na
c
e
ho
n
d
t
r
nDd
v
ec
h
e
i
n
t
e
ie
a
n
t
v
o
b
l
ar
s
dt
u
r
o
a
i
mi
e
ne
l
n
p
sd
da
e
t
hemi
a
ya
nDl
rf
e
n
p
i
i
bn
yw
c
t
i
r
lu
i
dc
e
c
el
t
et
h
i
n
p
e
i
n
dn
e
e
t
v
o
ce
i
gf
r
r
cc
e
y
wr
ef
n
a
r
l
.c
p
l
e
a
pT
e
h
ya
c
r
o
c
d
oh
i
t
u
t
l
es
el
d
o
h
n
n
rdi
s
r
a
fr
el
dt
s
e
i
o
F
bi
no
nA
t
n
a
l
fo
i
yt
y
h
c
gt
te
w
.
a
h
k
S
nl
E
p
t
h
yZ
e
.D
e
i
K
ec
r
l
t
Vo
e
r
s
-
a
m
t
ip
n
.
t
r
h
Pa
o
e
gt
s
g
,
a
omi
u
y
a
n
e
nt
s
.
h
s
t
rA
e
Ce
t
a
eo
nDl
e
r
eo
de
h
m
n
q
ol
a
(
u
l
G
ma
e
2
f
t
a
e
pc
0
a
n
e
i
oB
t
l
1
n
l
e
v
t
i
c
fa
v
i
5
e
p
t
eo
ce
c
s
n
i
)
l
t
co
l
i
:I
e
o
i
y
ao
i
c
n
ne
l(
n
fn
v
c
c
-
nt
a
,
u
v
e
i
i
h
r
2
nu
l
p
c
i
s
0
cl
t
h
i
u
d
s
a
i
l
1
re
l
a
r
e
n
a6
i
e
p
n
a
r
t
t)
n
i
t
i
s
t
:
l
ti
s
n
H
e
.
cc
h
eh
t
gv
p
e
ua
t
r
d
ri
sb
h
a
et
cd
i
yt
s
t
i
y
l
ak
d
mi
a
eh
r
n
u
eo
d
g
ny
f
S.Kargeretal( 2016)Di sturbedv i
taminDl evelswer epossiblytheconsequenceof
AEDt
her
apy
,rat
hert
hant
hecont
ri
but
ingf
act
orofepi
l
epsy
.Col
l
ect
ivel
y,ci
rcul
ati
ng
v
itami
nD l
evel
s shoul
d be moni
tor
ed and cor
rect
ed i
n AEDs-
tr
eat
ed epi
l
ept
ic
chi
l
dren.

R.
Shar
maetal(
2016)I
nthei
rst
udyt
heyf
oundt
hatchi
l
dren r
ecei
vi
ng ant
iepi
l
ept
ic
monot
her
apywi
thcar
bamazepi
ne,Pheny
toi
nandv
alpr
oat
eadmi
nist
eredf
ort
he
dur
ati
onf
ormor
ethant
hreemont
hsshowedal
ter
ati
onsi
nbi
ochemi
cal
par
amet
ers.
P.Z.
Pohanetal(
2015) I
nthei
rst
udyt
heycompar
ed25(
OH)
Dlev
elsi
nepi
l
ept
ic
chi
l
drenonl
ong-
ter
m ant
iconv
ulsantt
her
apyandnon-
epi
l
ept
icchi
l
drenandf
ound
t
hatVi
tami
nD l
evel
sin epi
l
ept
ic chi
l
dren wi
thl
ong-
ter
m ant
iconv
ulsantt
her
apy
ar
elowert
hant
hatofnon-
epi
l
ept
icchi
l
drenbutnonehadv
itami
nDdef
ici
ency
.

UmaA.
Bhosal
eetal2014)Accor
dingt
othei
rst
udyt
heyf
oundmonot
her
apyf
ound
l
esst
oxi
cwi
thnosi
gni
fi
cantef
fect
sonl
i
pidpr
ofi
l
e,Hb,
RBCcountandO2car
ryi
ng
capaci
tyandl
essi
mpactonspl
atl
ets.
Whi
l
ecombi
nat
iont
her
apydi
dnotshow any
adv
ant
ageov
ermonot
her
apyandi
tsusemustber
eser
vedonl
yforr
efr
act
orycases.

Menon.
Betal(
2010)I
nthei
rst
udyt
heyf
oundt
hatSubj
ect
swi
thnor
mal25(
OH)
D
l
evel
s,i
rr
espect
iveoft
het
ypeofant
iepi
l
ept
icmedi
cat
ionsev
enatsub-
ther
apeut
ic
ser
um l
evel
soft
hedr
ug,wenti
nto25(
OH)
D def
ici
encyandi
nsuf
fi
ciencyst
ates.
Theor
eti
cal
l
yitcanbewor
thwhi
l
etosuppl
ementcal
cium andv
itami
nDev
enbef
ore
i
nit
iat
ionofant
iepi
l
ept
ict
her
apy
.
O
i
V
t
e
si
n
r
tm
a
ep
lmi
oa
nnD
n
o
gt
t
-
ie
c
tn
o
e
lt
e
n
r
im
v
ae
u
ll
s
c
ua
ai
s
ne
nu
e
ts
teo
h
o
pe
i
fa
le
r
a
fv
p
pt
n
i
yc
t
it
a
i
c
a
cr
h
mi
eo
il
n
d
onD
v
r
we
ue
nw
lr
sd
t
a
he
i
n
a
tf
hl
t
nt
ic
si
o
h
ei
a
n
nt
g
co
-
y
ef
pn
io
l
enp
-
et
pi
c
il
ept
MATERI
ALANDMETHODS

STUDYAREA : Depar
tment of Paedi
atr
ics Ut
tar Pr
adesh
Uni
ver
sit
yofMedi
cal
Sci
ences(
UPUMS)
,Sai
fai
,Et
awah.

STUDYPOPULATI
ON : I
ndoorPat
ientadmi
tt
edi
nDepar
tmentof
Paedi
atr
icswi
thsei
zur
eandr
equi
ri
ngl
ongcour
seofant
iepi
l
ept
ict
her
apy
.

STUDYDESI
GN : Pr
ospect
ivecr
osssect
ional
Study

STUDYPERI
OD : Januar
y2021-
June2022

I
NCLUSI
ONCRI
TERI
A:
1.Al
ltheheal
thychi
l
drenwi
thcompl
aintofsei
zur
eofagegr
oup1t
o15y
ear
andr
equi
ri
ngl
ongcour
seofant
iepi
l
ept
ict
her
apy
.

EXCLUSI
ONCRI
TERI
A:
 1.
Chi
l
drenl
esst
han1y
earandmor
ethan15y
earofage.

2.
Chi
l
drenwi
thchr
oni
cdi
seasesofki
dney
,l
iv
er.

3.
Chi
l
drenwhof
ail
tohemody
nami
cal
l
yst
abi
l
izewi
thi
n48hour
sofadmi
ssi
on
anddi
ewi
thi
n48hour
sofadmi
ssi
on.

4.
Sei
zur
eduet
oel
ect
rol
ytei
mbal
ance.

5.
Chi
l
drenwi
tht
ypi
cal
febr
il
esei
zur
e.

6.
Pat
ient
snotwi
l
li
ngt
opar
ti
cipat
einst
udy
.

7.
Knowncaseofsei
zur
ewhi
chal
readyonant
iepi
l
ept
icdr
ugs.

SAMPLESI
ZE:
Thi
swi l
lbeti
meboundstudyandallt
hepati
entswit
hcompl ai
ntofsei
zur
eadmit
ted
i
npaediatr
icwardofUPUMSSaifaiEt
awahbetweenJanuary2021toJune2022and
ful
lfi
l
li
ngtheincl
usi
oncri
ter
iawi
l
l bei
ncl
udedinthestudy
.

METHODOLOGY
Thepr
esentst
udywi
l
lbeenr
oll
i
ngal
lindoorpat
ient
sadmi
tt
edi
ndepar
tmentof
paedi
atr
icsaged1y
eart
o15y
earwi
thsei
zur
edi
sor
der
.Al
lthepat
ient
swi
thsei
zur
e
admi
tt
edi
nPaedi
atr
icwar
dwi
l
lbeev
aluat
edr
egar
dingt
hei
rel
i
gibi
l
ityt
oincl
usi
onor
excl
usi
oncr
it
eri
a.Fi
rstt
hepar
ent
swi
l
lbei
nter
viewedr
egar
dingt
hef
ami
l
yhi
stor
yof
sei
zur
eoranychr
oni
cil
l
nesset
c.Pat
ientwi
l
lbeexami
nedf
oranymaj
orcongeni
tal
mal
for
mat
ions,
car
diacdi
seaseorr
enaldi
sease,
etc.Thent
hepar
ent
soft
heel
i
gibl
e
pat
ient
swi
l
lbebr
ief
edr
egar
dingt
hepur
poseoft
hest
udy
.Inf
ormedandwr
it
ten
consentwi
l
lbeobt
ainedf
rom car
egi
verr
egar
dingpar
ti
cipat
ioni
nthi
sst
udy
..A
st
andar
dized pr
ofor
ma wi
l
lbe used t
o col
l
ectsoci
o-demogr
aphi
cinf
ormat
ion,
cl
i
nical sy
mpt
oms and t
hei
r dur
ati
on,i
mmuni
zat
ion hi
stor
y,ant
hropomet
ri
c
measur
ement
s,phy
sicalsi
gns,r
esul
tsofl
abor
ator
yinv
est
igat
ion.
Thepat
ient
’sshal
l
be f
oll
owed up f
orev
ery15 day
sto know t
he pat
ientcondi
ti
ons(
impr
ove or
det
eri
orat
e)andt
oknowt
hecompl
i
ance&pr
operdosi
ngofdr
ugy
ouwi
l
lal
sot
alkt
o
t
hepat
ient
svi
atel
ephonyandaf
ter3mont
hsamei
nvest
igat
ionsshal
lber
epeat
ed
t
olookf
orhaemat
ologi
cal
&bi
ochemi
cal
changesf
orf
inal
out
come.

Forest
imat
ionofhemat
ologi
calandbi
ochemi
calchanges:
The f
oll
owi
ng i
nvest
igat
ions wi
l
lbe sentt
o ev
aluat
ethe haemat
ologi
caland
bi
ochemi
calchangescompl
etebl
oodcount(
CBC),l
i
verf
unct
iont
est(
LFT),
ki
dney
f
unct
iont
est(
KFT)
,Ser
um al
kal
i
nephosphat
e,ser
um cal
cium ,
ser
um phosphat
e
andser
um v
itami
nD.

Forcol
l
ect
ingt
hesampl
ethepoperpr
ocedur
ewi
l
lbedone.Thepar
tpr
epar
ati
onwi
l
l
bedonewi
thspi
ri
t,and at
orni
qut
tewi
l
lbet
ied.5mlofv
enousbl
ood wi
l
lbe
wi
thdr
awnunderasept
icpr
ecaut
ionsi
napl
ast
icsy
ringeaf
tert
hat2mlsampl
etaken
i
nEDTAv
ialf
orCBCest
imat
ionand3mlsampl
etakeni
npl
anev
ialf
orest
imat
ionof
ot
herbi
ochemi
calchanges.
Thepl
anev
ialsampl
eshoul
dbecet
ri
fugeat5000r
pm
f
or5 mi
nut
es af
tert
hatser
um shoul
d be sepr
eted and st
ored at-
40 degr
ee
cent
igr
adef
orest
imat
ionofser
um v
itami
nDandphosphat
e.

CBCest
imat
edbyMEDONI
CHEMATOLOGYANALYSER.
LFTest
imat
edbyf
ull
yaut
omat
edbi
ochemi
str
yanal
yserSELECTRAPROXL.
KFTest
imat
edbyf
ull
yaut
omat
edbi
ochemi
str
yanal
yserSELECTRAPROXL.
SERUM Alkal
inephosphat
eest
imat
edbyf
ull
yaut
omat
edbi
ochemi
str
yanal
yser
SELECTRAPROXL.
SERUM CALCI
UM&PHOSPHATEest
imat
edbyf
ull
yaut
omat
edbi
ochemi
str
yanal
yser
SELECTRAPROXL.
SERUM VI
TAMI
NDest
imat
edbyELI
SA.
 REFERENCES

1.
MohamadA.
Mikat
iandDmi
tr
yTchapy
jni
kov
.Sei
zur
einchi
l
dren,
Nel
sont
ext
bookof
paedi
atr
ics21stedi
ti
onv
ol2,
I
ndi
aEl
sev
ier
;page3086-
87.
2.
Scot
tR.
A.Lhat
ooS.
D.SanderJ.
W.A.Thet
reat
mentofepi
l
epsyi
ndev
elopi
ng
count
ri
es:
Bul
lWor
ldHeal
t gan.2001;
hOr 79:
344-
351
3.
Shor
von S.
D. Far
mer P.
J. Epi
l
epsy i
n dev
elopi
ng count
ri
es:a r
evi
ew of
epi
demi
ologi
cal
,soci
ocul
tur
al,
andt
reat
mentaspect
s.Epi
l a.1988;
epsi 29:
S36-
S54
4.
Sri
dhar
anR.Mur
thyB.
N.Pr
eval
enceandpat
ter
nofepi
l
epsyi
nIndi
a.Epi
l a.
epsi
1999;
40:
631-
632
5.
 St
asi
uky
niene,V.
;Pi
l
vini
s,V.
;Rei
ngar
diene,D.
;Janauskai
te,L. ( .
2009) 
"[
Epi
l
ept
ic
sei
zur
esi
ncr
it
ical
l
yil
lpat
ient
s].
" 
Medi
ci  
na.45 
(6)
:501–7.
 
6."
dietandnut
ri
ti .8May2013.
on"  Ar
chi
ved f
rom t
heor
igi on29 June2015.
nal
7.Si
mon,Dav
idA.Gr
eenber
g,Mi
chaelJ.Ami
nof
f,RogerP.(
2012)
. "
12"
. 
Cli
nical
neur
ology
 (8t
hed.
).NewYor
k:McGr
aw-
Hil
lMedi
cal
. 
8. 
Bhal
l
a,D.
;Godet
,B.
;Dr
uet
-Cabanac,M.
;Pr
eux,PM.(
June2011)
."Et
iol
ogi
esof
epi
l
epsy
:acompr
ehensi
ver
evi
ew"
. 
Exper
tRevNeur
other
. 
11 
(6)
:861–76.
 
9) 
"ManagementofConv
ulsi
oni
nChi
l
dren,aHeal
thconcer
ninNi
ger
i .
a" 
Publ
i
c
Heal
th Ni
ger
ia.Oct
ober2018.Ar
chi
ved f
rom 
the or
igi  
nal
on 18 Oct
ober2018.
Ret
ri
eved 
18Oct
ober
 2018.
10)Car
lson,
Nei
l(22Januar
y2012)
. 
Phy
siol
ogyofBehav
ior
.Neur
ologi
cal
Disor
der
s.
11t
hedi
ti
on.Pear
son.p.
 550.
 
11)Hi
l
debr
and,J (
Jul
y 2004)
."Managementofepi
l
ept
ic sei
zur
es"
. 
Cur
rOpi
n
Oncol
. 
16 
(4)
:314–7.
12)HahnT.
J.Hendi
nB.
A.Schar
pC.
R.Ef
fectofchr
oni
cant
iconv
ulsantt
her
apyon
ser
um 25-
hydr
oxy
cal
cif
erol
lev
elsi
nadul
ts.
NEngl
JMed.
1972;
287:
900-
904
13)Ri
chensA.RoweD.
F.J.Di
stur
banceofcal
cium met
abol
i
sm byant
iconv
ulsant
dr
ugs.
BrMedJ.1970;
4:73-
76
14) Boui
l
lonR.Rey
naer
tJ.Cl
aesJ.
H.Li
ssensW.
DeMoorP.Theef
fect of
ant
iconv
ulsantt
her
apy on ser
um l
evel
s of25-
hydr
oxy
vit
ami
n D,cal
cium,and
par
athy
roi
dhor
mone.
JCl
i
nEndocr
inol ab.1975;
Met 41:
1130
15)Ganapat
hyG.
R.RaoG.
V.G.
K.Gour
ieDev
iM.Bonechangesaf
terl
ongt
erm
ant
iconv
ulsantt
her
apy
.Neur
olI a.1973;
ndi 21:
159-
164
8.DewanP,Aggar
walA,Far
idiMMA.Ef
fectofpheny
toi
nandv
alpr
oicaci
dther
apy
onl
i
pidl
evel
sandl
i
verf
unct
iont
est
s.I
ndi
anPaedi
atr
ics2008;
45:
855-
58
9.
KumarP,
TyagiM,
TyagiYK,
KumarA,
RaiYK.Ef
fect
sof ant
iconv
ulsantdr
ugson
l
i
pid pr
ofi
l
ein epi
l
ept
icpat
ient
s.Thei
nter
netJour
nalofNeur
ology
.2004:3(
1)
10.
Demi
rci
ogl
uS,Soy
lu A,
Dir
ikE:Car
bamazepi
neandv
alpr
oic aci
d:ef
fect
son
t
heser
um l
i
pidsandl
i
verf
unct
ionsi
nchi
l
dren.Pedi
atr
Neur
ol,
2000,
23,
142–146

11.
Ver
ma NP,Hai
dukewy
ch D.Di
ff
erent
ialbuti
nfr
equental
ter
ati
onsofhepat
ic
enzy
mel
evel
sandt
hyr
oidhor
monel
evel
sbyant
iconv
ulsantdr
ugs.Ar
chNeur
ol.
1994Apr
;51(
4):
381-
4.

12.
Shet
hRD,
Wesol
owski
CA,
JacobJC,
PenneyS,
HobbsGR,
RiggsJE,
Bodenst
einer
JBEf
fectofcar
bamazepi
neandv
alpr
oat
eonbonemi
ner
aldensi
ty.JPedi
atr
.1995

Aug;
27(
2):
256-
62

13.
Geor
geJ,Kul
kar
niC,Sar
maGRK.Ant
il
ept
icdr
ugsandqual
i
tyofl
i
fei
npat
ient
s
wi
thepi
l
epsy
:At
ert
iar
ycar
ehospi
tal
basedst
udy
.Val
uei
nHeal
thRegul
ati
onI
ssues.
2015;
6C:
1–6.

14.Recommendat
ion:Gui
del
i
nes f
ordi
agnosi
s and managementofchi
l
dhood
epi
l
epsy
:Exper
tCommi
tt
eeonPedi
atr
icEpi
l
epsy
.Indi
anAcademi
csofPedi
atr
ics.
I
ndi
an
Pedi
atr
ics.
2009;
46:
681-698.

15.Kr
ishnanPR,Tr
ipat
hiM,Jai
nS.Exper
iencewi
thnew epi
l
ept
icdr
ugsamong
I
ndi
answi
thr
efr
act
oryepi
l
epsy
.Neur
ologyJSout
heastAsi
a2003;
8:87–95
16.DewanP,Aggar
walA,Far
idiMMA.Ef
fectofpheny
toi
nandv
alpr
oicaci
dther
apy
onl
i
pidl
evel
sandl
i
verf
unct
iont
est
s.I
ndi
anPaedi
atr
ics2008;
45:
855-
58

17.KumarP,
TyagiM,
TyagiYK,
KumarA,
RaiYK.Ef
fect
sofant
iconv
ulsantdr
ugson
l
i
pidpr
ofi
l
einepi
l
ept
icpat
ient
s.Thei
nter
netJour
nal
ofNeur
ology
.2004:
3(1)

18.Demi
rci
ogl
uS,Soy
lu A,Di
ri
k E:Car
bamazepi
ne andv
alpr
oicaci
d:ef
fect
son
t
heser
um l
i
pidsandl
i
verf
unct
ionsi
nchi
l
dren.Pedi
atr
Neur
ol,
2000,
23,
142–146

19.Ver
maNP,Hai
dukewy
chD.Di
ff
erent
ialbuti
nfr
equental
ter
ati
onsofhepat
ic
enzy
mel
evel
sandt
hyr
oidhor
monel
evel
sbyant
iconv
ulsantdr
ugs.Ar
chNeur
ol.
1994Apr
;51(
4):
381-
4.

20.Shet
h RD,Wesol
owskiCA,Jacob JC,Penney S,Hobbs GR,Ri
ggs JE,
Bodenst
einerJBEf
fectofcar
bamazepi
neandv
alpr
oat
eonbonemi
ner
aldensi
ty.J
Pedi
atr
.1995Aug;
27(
2):
256-
62.

21.Geor
geJ,Kul
kar
niC,Sar
maGRK.Ant
il
ept
icdr
ugsandqual
i
tyofl
i
fei
npat
ient
s
wi
thepi
l
epsy
:At
ert
iar
ycar
ehospi
tal
basedst
udy
.Val
uei
nHeal
thRegul
ati
onI
ssues.
2015;
6C:
1–6.

22. Recommendat
ion:Gui
del
i
nesf
ordi
agnosi
sand managementofchi
l
dhood
epi
l
epsy
:Exper
tCommi
tt
eeonPedi
atr
icEpi
l
epsy
.Indi
anAcademi
csofPedi
atr
ics.
I
ndi
anPedi
atr
ics.
2009;
46:
681-698.
23.Kr
ishnanPR,Tr
ipat
hiM,Jai
nS.Ex
per
iencewi
thnewant
iepi
l
ept
icdr
ugsamong
I
ndi
answi
thr
efr
act
oryepi
l
epsy
.Neur
olJSout
heastAsi
a.2003;
8:87-
95.
24.Gr
eenwood RS.Adv
erse ef
fect
s of ant
iepi
l
ept
ic dr
ugs.Epi
l
epsi
a.2000
Feb;
41:
S42-
52.

STUDYPROFORMA

•Name: Fat
her
’sname:

•Regi
str
ati
onno. Age/
Sex:

•DOA: DOD/
Out
come

•Phno:

•Addr
ess: •Rur
al/
Urban

•Soci
oeconomi
cSt
atus:

HI
STORY:

CHI
EFCOMPLAI
NTS:

HI
STORYOFPRESENTI
LLNESS:

FAMI
LYHI
STORY:
-
I
MMUNI
ZATI
ONHI
STORY:

NUTRI
TIONALHI
STORY:

GENERALPHYSI
CALEXsAMI
NATI
ON:

•Gen.Condi
ti
on:

•Pal
l
or:

•I
cter
us:

•Cl
ubbi
ng:

•Ly
mphadenopat
hy:

•Oedema:
Hydr
ati
on:

•Hear
trat
e:

•Respi
rat
oryr
ate:

•Temper
atur
e:

•Bl
oodpr
essur
e:

•Hai
rchanges:

•Anyabnor
mal
pigment
ati
on

ANTHROPOMETRY

•Wei
ght
:

•Hei
ght
:

•Headci
rcumf
erence:

•Chestci
rcumf
erence:

•Mi
d-ar
m ci
rcumf
erence:

•Wei
ght
/Age

•Hei
ght
/Age

•Wei
ght
/Hei
ght
•US:
LS:

SYSTEMI
CEXAMI
NATI
ON:
Cent
ral
ner
voussy
stem exami
nat
ion:

 Dev
elopment
almi
l
est
ones:

 Language:

 Gr
ossmot
or:

 Fi
nemot
or:

 Soci
alandadapt
ive:

 Modi
fi
edGl
asgowcomascal
e(<6y
ear
s):

 Hi
gherment
alf
unct
ion:

 Cr
ani
alner
ves:

 mot
orf
unct
ion:
-Tone Ri
ght Lef
t Ri
ght Lef
t

UL UL UL LL

 Power Ri
ght Lef
t Ri
ght Lef
t
UL UL UL LL

 Deept
endonr
efl
exes Ri
ght Lef
t Ri
ght Lef
t
UL UL UL LL
  super
fi
cial
ref
lexes: cr
emast
ri
c abdomi
nal

 bul
k

 Sensor
yexami
nat
ion

 neckr
igi
dit
y:

 Ker
nigsi
gn:

 br
udzi
nski
sign:

 Pl
ant
er:

 Gai
t:

 Spi
nal
exami
nat
ion:

Car
diov
ascul
arexami
nat
ion:

 Pul
se:

 Apexbeat
:

 Hear
tsounds:

 Addedsounds:

 Neckv
eins

Respi
rat
orysy
stem exami
nat
ion:

 Chestmov
ement
:

 Ai
rent
ry:

 Ret
ract
ions:

 Br
eat
hsounds:

Addi
ti
onal
sounds:

Abdomi
nal
syst
em exami
nat
ion:
Li
verspan:

Spl
een

Fl
uidt
hri
l
l:

Shi
ft
ingdul
l
ness:

Bi
ochemi
cal
changes:

DAY-
1 AFTER3MONTH
CBC
CRP
S.
ELECTROLYTE
LFT
KFT
S.
ALBUMI
N
S.
VITAMI
ND
S.
CALCI
UM
S.
PHOSPHATE

Ty
peof Fr
equency monot
her
a Combi
ne Dat
eof Doseof Si
de
sei
zur
e ofsei
zur
e py t
her
apy st
art
ing dr
ug sef
fect
ofdr
ug

DI
AGNOSI
S:

TREATMENT:
OUTCOME:

PATI
ENTI
NFORMEDCONSENTFORM
Pr
otocol
/St
udynumber
:__
___
___
___
___
___
___
__
Pat
ienti
dent
if
icat
ionnumberf
ort
hist
ri
al:
___
___
___
___
___
___
___
Ti
tl
eofpr
oject
:__
___
___
___
___
___
___
___
___
___
___
___
___
___
_
NameofPr
inci
pal
Inv
est
igat
or:
___
___
___
___
__Tel
.No(
s).
___
___
___
___
__
Thecont
ent
soft
hei
nfor
mat
ionsheetdat
ed……………….
.(Ver
sion)
…………….
.
Thatwaspr ovi
dedhav ebeenr eadcarefull
ybyme/expl ai
nedindet ai
ltome, i
na
l
anguaget hatIcompr ehend,andIhav efull
yunderst
oodt hecont ent
s.Iconfir
mt hat
Ihavehadt heoppor t
unit
yt oaskquestions.Thenatureandpur poseoft hestudyand
i
tspot ent
ialri
sks/benef i
tsandexpect eddurat
ionofthest udy
, andotherrel
evant
detai
lsofthest udyhavebeenexpl ai
nedt omeindet ai
l.Iunderstandthatmy
parti
cipat
ionisv ol
untar
yandt hatIam f r
eetowithdr
awatanyt ime,withoutgivi
ng
anyreason,withoutmymedi calcar
eorlegalr
ightbeingaf
fected.Iunderstandt
hat
theinf
ormat i
oncollectedaboutmef r
om myparti
cipati
oni
nt hisresearchand
secti
onsofanyofmymedi cal not
esmaybel ookedatbyresponsi bl
eindiv
idual
s.I
givepermissi
onf ortheseindivi
dualstohav
eaccesst omyr ecords.
Iagr
eet
otakepar
tint
heabov
est
udy
.
-
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
--
-

Dat
e: Si
gnat
ure/
lef
tthumbi
mpr
essi
on
Pl
ace:
Nameoft
hePar
ti
cipant
:__
___
___
___
___
___
___
___
___
___
___
___
_
Son/Daught
er/Spouseof
:__
___
___
___
___
___
___
___
___
___
___
__
Compl
etepost
aladdr
ess:
___
___
___
___
___
___
___
__s_
___
___
___
___
_
Thi
sist
ocer
ti
fyt
hatt
heabov
econsenthasbeenobt
ainedi
nmypr
esence
-
--
--
--
--
--
--
--
--
--
--
--
--
--
--
-
Si
gnat
uresoft
hePr
inci
pal
Inv
est
igat
or
Dat
e:
Pl
ace:

1)
Wit
ness-
1 2)
Wit
ness-
2
-
--
--
--
--
--
--
--
--
-- -
--
--
--
--
--
--
--
--
--
--
--
-
Si
gnatur
e: Signat
ure:
Name: Name:
Addr
ess: Addr
ess: