No to hattatsu. Brain and development
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We prospectively examined the natural history of children who suffered a first unprovoked seizure (FUS). Forty-five children who suffered a seizure without any detectable precipitating factors were enrolled in this study. Absence seizure, myoclonic seizure, and epileptic spasms were excluded from this study. ⋯ Of the 30 patients with recurrence, 11 suffered the second seizure within 1 month, 19 within 3 months, 24 within 6 months, 26 within 1 year, and 30 within 2 years. Occurrence of generalized convulsions, a past history and family history of febrile seizures, epileptic discharges on the EEG (especially a diffuse pattern), and developmental delay prior to the FUS were risk factors for seizure recurrence. Up to one third of the patients had no more recurrent seizures during the next 2 years, so it seems reasonable to follow FUS patients without medication.
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We investigated the sequence of the administration, the efficacy and the safety of antiepileptic drugs (AED) given intravenously for the treatment of status epilepticus and frequent seizures in children. Our institute has a recommended sequence of AED administration for treatment of status epilepticus: the first-line agent is diazepam (0.3 - 0.5 mg/kg administered intravenously, once or twice). The second-line drugs include midazolam (0.15 - 0.4 mg/kg intravenously, once or twice, and if necessary, followed by continuous infusion at 0.06 - 0.18 mg/kg/hour), lidocaine (1 - 2 mg/kg intravenously, once or twice, and if necessary, followed by continuous infusion at 2 - 4 mg/kg/hour) and phenytoin (10 - 20 mg/kg, infused slowly). ⋯ Thiopental was statistically more effective than midazolam, lidocaine, diazepam or phenytoin (p < 0.01), and midazolam was statistically more effective than diazepam (p < 0.01) or phenytoin (p < 0.05). Administration of thiopental caused complications more frequently than the other agents (p < 0.01): The complications by thiopental were severe in some cases requiring intratracheal intubations and artificial ventilation. From the viewpoint of both efficacy and safety, midazolam should be recommended as one of the first-line agents for status epilepticus.
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An intrapulmonary percussive ventilator (IPV) improves airway clearance and lung function, and is useful for wide variety of respiratory disorders, such as cystic fibrosis, chronic obstructive pulmonary disease, aspiration pneumonia, and neuromuscular diseases. However, there are few reports on IPV use in patients with severe neurological impairment, scoliosis and thoracic deformity. They have poor mobility of the rib cage and difficulty in sputum expectoration. ⋯ Chest CT at day 44 showed further improvement. In patients with severe motor and intellectual disabilities, it is sometimes difficult to control progressive deterioration of pulmonary function and persistent atelectasis even with tracheostomy, mechanical ventilation, and conventional physiotherapy. Our results indicate that IPV may improve respiratory functio and the quality of life in such patients.
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The Nobel Prize was created in 1901, according to the will of Alfred Nobel who left tremendous estate by inventing of dynamite. In the fields of natural science, prizes are given to distinguished scientists in three categories, namely physics, chemistry, and physiology or medicine. During the past 100 years, the Nobel Prize have become undoubtedly the most prestigious international prize. ⋯ In particular, Japanese laureates, including Drs. Ezaki, Tonegawa, Shirakawa and Noyori met together at the Symposium, and discussed what is creativity and how it is nurtured? At about the same time the Centennial Exhibition of the Nobel Prize was held in the National Science Museum in Tokyo. From these two commemorative events, informative messages were extracted and given to young colleagues of the Japanese Society of Child Neurology.
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Two adolescents with complex regional pain syndrome (CRPS) were treated safely and effectively by spinal cord stimulation (SCS). They complained of intractable pain resistant to conservative therapies. Whereas continuous epidural anesthesia temporarily reduced pain, SCS was more effective in alleviating chronic severe pain and improving the quality of life. With careful selection of patients, SCS therapy might be recommended even in young cases.