Pediatric neurology
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Pediatric neurology · Jul 2008
ReviewProposed cross-disciplinary training in pediatric neurointensive care.
Training and research in pediatric neurointensive care require unique approaches to childhood diseases that reflect differences in the immature brain's response to injury or disease compared with adults. Pediatric neurocritical care is a collaborative effort to provide consultative care among pediatric subspecialists, coordinated by neonatal and pediatric intensivists. Valuable perspectives for clinical care, training, and research can also be learned through collaboration with adult neurointensivists. ⋯ This review also stresses cross-disciplinary research and training opportunities in pediatric neurointensive care beyond physician training. Nonmedical faculty from multiple academic disciplines should also serve as mentors to design appropriate curricula and research plans for the specific trainee in their respective fields and across specialties. The discipline of neurocritical care must consider a life-course approach for the patient requiring neurointensive care from neonatal through childhood and adult ages, with cross-fertilization from diverse academic disciplines and investigative points of view.
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Although previous studies suggested a relationship between headache and sleep disturbances, polysomnographic findings in children with headache are rarely described. We investigated polysomnographic findings in children with headaches, and correlated them with headache type and severity, body mass index, and medical treatment. Analysis of polysomnographic findings of 90 children with migraine (60), chronic migraine (11), tension headache (6), and nonspecific headache (13) indicated that sleep-disordered breathing was more frequent among children with migraine (56.6%) and nonspecific headache (54%) vs chronic migraine (27%). ⋯ Fifty percent of children with tension headache manifested bruxism vs 2.4% of children with nontension headache (odds ratio, 1.95; 95% confidence interval, 1.2-4.34). Our results support an association between migraine and sleep-disordered breathing, and between tension headache and bruxism, in children. Moreover, disrupted sleep architecture with reduced rapid eye movement and slow-wave sleep in severe and chronic migraine headaches may support an intrinsic relationship between sleep and headache disorders.