Pediatric neurology
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Pediatric neurology · Jun 2008
Case ReportsObstructive sleep apnea, seizures, and childhood apraxia of speech.
Associations between obstructive sleep apnea and motor speech disorders in adults have been suggested, though little has been written about possible effects of sleep apnea on speech acquisition in children with motor speech disorders. This report details the medical and speech history of a nonverbal child with seizures and severe apraxia of speech. For 6 years, he made no functional gains in speech production, despite intensive speech therapy. ⋯ The rather late diagnosis and treatment of obstructive sleep apnea, especially in light of what was such a life-altering outcome (gaining functional speech), has significant implications. Most speech sounds develop during ages 2-5 years, which is also the peak time of occurrence of adenotonsillar hypertrophy and childhood obstructive sleep apnea. Hence it is important to establish definitive diagnoses, and to consider early and more aggressive treatments for obstructive sleep apnea, in children with motor speech disorders.
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Pediatric neurology · Jun 2008
Case ReportsEpilepsy surgery in a case of encephalitis: use of 11C-PK11195 positron emission tomography.
The positron emission tomography radiotracer (11)C-PK11195 selectively binds to the peripheral-type benzodiazepine receptors expressed in activated microglia and can, therefore, detect areas of neuroinflammation. (11)C-PK11195 positron emission tomography was used in determining the surgical treatment of a 5-year-old boy with intractable epilepsy due to encephalitis of unknown etiology. After 4 months of treatment in the pediatric intensive care unit for altered consciousness and refractory seizures despite multiple anticonvulsants, including continuous midazolam infusion, (11)C-PK11195 positron emission tomography revealed an area of increased uptake in the left temporal-occipital cortex. ⋯ Focal areas of neuroinflammation may play an important role in seizure pathogenesis in a subset of patients with refractory seizures associated with encephalitis. In such cases, (11)C-PK11195 positron emission tomography may highlight the region of maximal inflammation for palliative surgical treatment.