Pediatric neurology
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Pediatric neurology · Apr 2015
Cardiac autonomic balance in children with epilepsy: value of antiepileptic drugs.
Dysfunction of the autonomous nervous system causes arrhythmias and, although previous studies have investigated the effects of epilepsy on the autonomic control of the heart, there is still uncertainty about whether imbalance of sympathetic, vagal, or both systems occurs in epilepsy as well as the effect of anticonvulsants on the autonomic system. ⋯ Children with epilepsy have cardiac autonomic dysfunction evident in their heart rate variability assessment. Patients on antiepileptic drugs had better autonomic balance than those not on antiepileptic drugs. Holter and EKG follow-up should be considered for early detection in those at high-risk cardiac complications.
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Pediatric neurology · Mar 2015
Review Case ReportsInternal carotid artery dissection after a roller coaster ride in a 4-year-old: case report and review of the literature.
Strokes associated with roller-coaster rides are unusual. ⋯ We speculate that repetitive forces of acceleration and deceleration may have led to a cervical internal carotid artery intimal tear, followed by thromboembolism. It remains uncertain what the threshold of susceptibility to repetitive rotational changes and tolerability to G forces in an otherwise healthy child truly is.
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Pediatric neurology · Mar 2015
Review Historical ArticleChild neurology practice guidelines: past, present, and future.
Practice guidelines have been developed in child neurology during the last fifteen years to address important clinical questions and provide evidence-based recommendations for patient care. ⋯ Child neurology practice guidelines are a helpful resource for clinicians, families and institutions as they provide evidence-based recommendations concerning the diagnosis and management of common neurological conditions affecting children. Incorporating consensus processes has allowed expansion of clinically relevant recommendations that has increased the utility of guidelines.
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Pediatric neurology · Mar 2015
ReviewMechanistic target of rapamycin (mTOR) in tuberous sclerosis complex-associated epilepsy.
Tuberous sclerosis complex is a multiorgan disease resulting from a mutation of one of two TSC genes. The two gene products form a functional complex that regulates the mTOR signaling pathway (mTOR initially represented mammalian target of rapamycin, but increasingly the term mechanistic target of rapamycin is used to reflect the ubiquitous occurrence of mTOR). Epilepsy is the most common neurological symptom of tuberous sclerosis complex, occurring in 80% to 90% of affected individuals over the course of their lifetimes and causing significant morbidity and mortality. The mechanistic target of rapamycin (mTOR) signaling pathway is intricately involved in multiple cellular functions--including protein synthesis, cell growth and proliferation, and synaptic plasticity--which may influence neuronal excitability and precipitate epileptogenesis. Recent preclinical and clinical studies have increased interest in the potential role of mTOR inhibitors for the treatment of tuberous sclerosis complex-related epilepsy. ⋯ Various preclinical models provide substantial evidence for the role of mTOR inhibition in the treatment of epilepsy in individuals with tuberous sclerosis complex. Preliminary clinical studies provide supportive evidence for a role of mTOR inhibition in the management of tuberous sclerosis complex-associated epilepsy and pave the way for new randomized placebo-controlled studies. This article reviews current treatment recommendations for the management of tuberous sclerosis complex-associated epilepsy as well as the rationale and evidence to support the use of mTOR inhibitors.
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Pediatric neurology · Mar 2015
Nimodipine for the prevention of cerebral vasospasm after subarachnoid hemorrhage in 12 children.
Subarachnoid hemorrhage is a rare, but life-threatening neurological emergency. Cerebral vasospasm is a complication of subarachnoid hemorrhage that contributes significantly to morbidity and mortality. Nimodipine has been used in adults to reduce the incidence of cerebral vasospasm after subarachnoid hemorrhage and improve long-term outcomes. There are, however, no data in children. ⋯ Oral nimodipine after subarachnoid hemorrhage in children does not eliminate vasospasm, rebleeding, or infarction and is associated with significant hypotension. Nevertheless, clinical outcomes appear favorable relative to the adult population who receive nimodipine. Further study, with dose titration, is warranted.