الفهرس 
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Abstract
Epilepsy is a common neurological disorder in the pediatric age group. It is a disorder characterized by the occurrence of at least 2 unprovoked seizures. Epilepsy remains one of the most common neurological disorders encountered in clinical practice. Epilepsy affect about 50 million people worldwide. Its incidence is highest among young children. Drug-resistant epilepsy is failure of adequate trials of two (or more) tolerated, appropriately chosen and used antiepileptic drug (AED) schedules (whether as mono therapies or in combination) to achieve sustained seizure freedom.
The patients categorized as intractable when they developed at least 1 seizure or more per month in a 6-month period despite being treated with at least 2 antiepileptic drugs. About 70% of patients have controlled seizures with antiepileptic drugs (AED), and about 25% of the patients with epilepsy don’t have any significant improvement in the reduction of the amount of seizures even when two or three AED are used.
Trace elements such as zinc and copper have physiological effects on neuronal excitability that may play a role in the etiology of intractable epilepsy.
The aim of our work was analysis of serum zinc and copper levels of children with intractable and controlled epilepsy that may identify the potential role of these two trace elements in the development of epilepsy and intractability to antiepileptic drug treatment.
The study was carried out upon 78 children classified as follow:
group I (intractable epilepsy group):
Twenty six patients with intractable epilepsy were studied (13 males and 13 females) their age range from 8 months to 11years with their mean age 4.44 ± 3.03years.
group II (controlled epilepsy group):
Twenty six patients with controlled epilepsy were studied (16 males, 10 females) their age range from 10 months to 12years with their mean age 4.71 ± 2.86 years
group III (normal control group):
Twenty six clinically healthy non anemic children of matched age, sex and socioeconomic status (16 males,10 females) their age range from 6 months to 12 years with their mean age 5.71 ± 3.84years.
All subjects were subjected to:
1- Full history taking and thorough clinical examination especially neurological examination.
2- The following investigations:
A. Magnitic resonance imaging of the brain.
B. Electro- encephalogram.
C. Measurement of serum zinc and copper
D. Metabolic screening
E. Complete blood picture.
Our study revealed that positive family history was present in 23.1% of intractable epilepsy group, 26.9% of controlled epilepsy group so genetic role in the pathogenesis of epilepsy could not be ignored.
The group of intractable epilepsy had significant higher history of perinatal insult than the group of controlled epilepsy and this means that presence of positive perinatal insult is a risk factor for the occurance of intractable epilepsy.
The group of intractable epilepsy had significant higher history of delayed developmental milestones than the group of controlled epilepsy. This means that developmental delay is a risk for the development of intractable epilepsy.
Our study reaveled no significant differences between the two studied groups as regard age, sex, positive family history ,positive consanguinity, and presenece of neonatal seizures
The intractable epilepsy group had significant higher percentage
of abnormal neurological examination than the controlled epilepsy group regarding decreased power ,abnormal tone , reflexes , delayed speech and low mentality. This pointed severity of epilepsy or the severity of the underlying etiology and also this means that abnormal neurological examination is a risk factor for the seizure to be resistant to treatment.
Our study revealed that the intractable epilepsy group had significant higher percentage of patients with mental subnormality than controlled epilepsy group, this reflects the severity of brain insult, severity of epileptic seizures and the effect of epileptic form discharge on the cognitive function.
Generalized tonic colonic convulsions were found to be the most frequent seizure type in our epileptic patients.
The intractable epilepsy group had no significant differences regarding abnormal EEG findings when compared with the controlled epilepsy group, generalized epileptogenic activity was the most common EEG abnormality present in both groups.
The intractable epilepsy group had significant higher percentage of abnormal MRI findings than the controlled epilepsy group with brain atrophy that was representing the most common MRI finding among both groups. The presence of abnormal MRI findings in intractable epilepsy more than controlled epilepsy patients mean that it is a risk factor for the occurance of intractable epilepsy.
Significant higher propotion of patients with intractable epilepsy had low serum zinc level compared to those with controlled epilepsy. Each group had significant lower zinc levels compared to the controls.
Both epileptic groups had significant higher propotion of patients with low serum copper levels compared to the controls with no significant differences between these two epileptic groups.
The percentage of abnormal MRI findings was significantly higher among Zn deficient patients (in the two patients group) compared to those with normal Zn level with brain atrophy representing most common abnormality among two patients group.
So it can be concluded that there is relationship between epilepsy pathogenesis, low serum zinc level so serum analysis of trace elements especially zinc must be considered in the workup of epilepsy and intractable epilepsy and this may suggest alternative therapeutic approach (zinc supplementation) in prevention and treatment of epilepsy.