Nitric oxide metabolites, nitrates and nitrites in the cerebrospinal fluidin children with west syndrome

Nitric oxide (NO) has been implicated in the mediation of the neuronal exci totoxic cascade. In order to estimate brain NO production, cerebrospinal fl uid (CSF) levels of NO metabolites, nitrates and nitrites (NNx) were measur ed in 31 children with west syndrome (WS) and in 12 controls. There was no age-related change in the NNx levels during the first year of life. The mea n of the NNx levels was significantly higher in patients with WS than in co ntrols (8.43 vs. 5.27 muM; P = 0.01). Analysis of the etiological subgroups showed that the patients with a symptomatic etiology of WS had significant ly higher NNx levels than controls (P < 0.005) or than the patients with a cryptogenic etiology. The cryptogenic cases, in turn, did not differ from t he controls (P = 0.48). Levels of NNx were also significantly higher in chi ldren with focal brain abnormalities (infarction, atrophy or previous infec tion) than in those with other abnormalities or with normal neuroradiologic al findings (P < 0.005). No correlation was found between the NNx levels an d the duration of the symptoms, while paired samples obtained From eight ch ildren with WS showed that the NNx levels rose significantly (P = 0.02) wit hin the first 40 days of symptoms. The levels of NNx did not correlate with the CSF levels of neuronal growth factor or with the later decline in ment al performance. This study demonstrates that the production of NO can be me asured in human epileptic conditions and supports the idea gained from expe rimental studies that NO is involved in the pathophysiology of epilepsy. Ho wever, normal levels of NNx in patients with cryptogenic infantile spasms s uggest that an increase in NO production be due to the concomitant neuronal damage rather than seizure activity per se. The findings suggest that ther e are no age-related changes in the NNx levels during the first year of lif e, and that children with symptomatic WS have elevated levels of NNx, which rise during the first 40 days of symptoms. Although the NNx levels cannot be used to estimate the duration of symptoms or to predict the prognosis of mental development, they may support the differentiation of symptomatic fr om cryptogenic etiologies of WS. <(c)> 2001 Elsevier Science B.V. All right s reserved.