Brain & development
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Brain & development · Mar 2011
ReviewFilling the evidence gap: how can we improve the outcome of neonatal encephalopathy in the next 10 years?
Neonatal encephalopathy associated with perinatal hypoxia-ischaemia is one of the most common causes of death and permanent disability worldwide. However, of a wide range of "experimentally neuroprotective treatments" invented so far, only therapeutic hypothermia has been promoted into a standard clinical practice. Such a wide gap in the efficacy of neuroprotective treatments between the experimental setting and clinical practice may be attributed to the strategic flaw in translating basic knowledge into clinical care. ⋯ The use of translational large animal models allows the practical simulation and fine-tuning of clinical protocols, which may further assist successful translation of basic knowledge. In addition to the effort to develop alternative therapeutic options, it is important to maximise the effect of the current only neuroprotective option, or therapeutic hypothermia. Independent variables which influence the efficacy of hypothermia have to be elucidated to improve its therapeutic protocol, and to increase the number of patients who will benefit from this treatment.
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Brain & development · Feb 2011
Childhood absence epilepsy: Elctroclinical features and diagnostic criteria.
To analyze the electroclinical features of children with childhood absence epilepsy (CAE) and discuss the diagnostic criteria for CAE. ⋯ Few patients meeting the 1989 ILAE diagnostic criteria for CAE meet the new diagnostic criteria proposed by Panayiotopoulos in 2005. The new criteria for CAE are too strict to appropriately classify some patients.
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Brain & development · Feb 2011
Psychological assessment in children and adolescents with Benign Paroxysmal Vertigo.
Migraine in childhood and adolescence has been associated with the presence of behavioural and emotional difficulties, but only few data are available with respect to unusual types of headache syndromes such as Benign Paroxysmal Vertigo of Childhood (BPVC). Aim of the present study was to evaluate the behavioural and emotional profiles of clinically referred children and adolescents suffering from BPVC and migraine, as compared to normal controls. According to the revised International Classification of Headache Disorders (ICHD-2) the BPVC belongs to the category of "primary headache", as a migraine equivalent, in a subset that is called "periodic syndromes of childhood". ⋯ Furthermore, both BPVC and migraine groups displayed significantly higher CDI and MASC scores than NC group. No differences were found between the two types of headache. In conclusion, clinically referred children and adolescents with BPVC and migraine showed higher indices of behavioural and emotional symptoms, both internalizing and externalizing, as compared to normal peers.
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Brain & development · Nov 2010
Case ReportsUnexpected neurological sequelae following propofol anesthesia in infants: Three case reports.
Propofol is a widely used hypnotic agent for induction and maintenance of pediatric anesthesia with a well known safety profile. Experimental in vitro studies suggest that propofol may be toxic to developing neurons. We report the cases of three infants who underwent surgery before 2 months of age for different benign pathologies. Propofol was used for induction and maintenance of anesthesia in all cases. The three patients developed convulsions with similar clinical characteristics (cluster of recurrent clinical and subclinical seizures) between the 23th and 30th hours following anesthesia. Clinical and electroencephalographic improvement was obtained between the third and fourth day of management in pediatric intensive care unit. The seizures never recurred, and the three patients underwent further uneventful general anesthesia without propofol. Follow-up of the three patients disclosed unexpected neurological dysfunction: progressive microcephaly (head circumferences were normal at birth), developmental impairment with cognitive and behavioural disturbances in two cases, and bilateral symmetrical white-matter abnormalities on cerebral magnetic resonance imaging. ⋯ The causal relationship between propofol anesthesia and the neurological symptoms of our patients remains difficult to ascertain, but we believe that pediatricians, anesthetists and intensive care-givers should be aware of this possible adverse reaction that has never been described before.
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Brain & development · Sep 2010
How do the clinical features of brain tumours in childhood progress before diagnosis?
To investigate the progression of the clinical features from symptom onset to diagnosis in children with brain tumours. ⋯ Paediatric brain tumours present with various initial symptoms and signs. Many are diagnosed as additional symptoms or signs develop. The clinical features exhibit several patterns of progression, which are related to the tumour location.