Pediatric neurology
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This review focuses on so-called "periodic syndromes of childhood that are precursors to migraine," as included in the second edition of the International Classification of Headache Disorders. Presentation is characterized by an episodic pattern and intervals of complete health. Benign paroxysmal torticollis is characterized by recurrent episodes of head tilt, secondary to cervical dystonia, with onset between ages 2-8 months. ⋯ Their mean ages of onset are 5 and 7 years, respectively. Diagnostic criteria and appropriate evaluation represent the key issues. Therapeutic recommendations include reassurance, lifestyle changes, and prophylactic as well as acute antimigraine therapy.
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Pediatric neurology · Dec 2009
Diffusion-weighted imaging predicts cognition in pediatric brain injury.
Apparent diffusion coefficient maps from diffusion-weighted imaging predict gross neurologic outcome in adults with traumatic brain injury. Few studies in children have been reported, and none have used apparent diffusion coefficient maps to predict long-term (>1 year) neurocognitive outcomes. In this study, pooled regional and total brain diffusion coefficients were used to predict long-term outcomes in 17 pediatric brain injury patients. ⋯ Peripheral gray diffusion coefficients alone explained an additional 20% of variance after accounting for clinical variables. These results suggest that obtaining apparent diffusion coefficient values, specifically from peripheral brain regions, may predict long-term outcome after pediatric brain injury. Discrepancies in the literature on this topic, as well as possible explanations, including sampling and clinical considerations, are discussed.
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The postsurgical medication policy was reviewed for 109 children (age at surgery, 0-16 years) who had epilepsy surgery between 1991 and 2005. Intervals between surgery and both start (n = 84) and completion (n = 68) of withdrawal of antiepileptic drugs (AEDs) were calculated and analyzed in relation to demographic and epilepsy variables and to recurrent seizures. Postoperative seizure freedom was associated with completeness of surgical resection, defined as complete removal of the cortical region exhibiting ictal or interictal abnormalities on intracranial electroencephalography and lesion on magnetic resonance imaging (P = 0.008). ⋯ Eight children with early discontinuation (0.6 years from surgery to start of withdrawal and 0.8 years to complete withdrawal) had no seizure recurrence. Long-term continuation of AEDs is probably not indicated in children with complete resection of the epileptogenic zone. The optimal timing needs to be further explored.
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Pediatric neurology · Oct 2009
Review Case ReportsLocked-in syndrome in children: report of five cases and review of the literature.
The locked-in syndrome is a rare neurologic disorder defined by (1) the presence of sustained eye opening; (2) preserved awareness; (3) aphonia or hypophonia; (4) quadriplegia or quadriparesis; and (5) a primary mode of communication that uses vertical or lateral eye movement or blinking. Five cases are reported here, and previous literature is reviewed. ⋯ In terms of prognosis, 35% of pediatric locked-in syndrome patients experienced some motor recovery, 26% had good recovery, 23% died, and 16% remained quadriplegic and anarthric. These findings raise important ethical considerations in terms of quality of life and end-of-life decisions in such challenging cases.
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Pediatric neurology · Sep 2009
Motor cortex plasticity in ischemic perinatal stroke: a transcranial magnetic stimulation and functional MRI study.
To assess motor cortex plasticity after constraint-induced movement therapy in patients with ischemic perinatal stroke, functional MRI and transcranial magnetic stimulation were applied. Seven hemiparetic patients with ischemic perinatal stroke of the middle cerebral artery and preserved crossed corticospinal projections to the paretic hand were studied before and after 12 days of constraint-induced movement therapy. After therapy, all patients demonstrated improved manual motor function. ⋯ Functional MRI revealed increased activation of the contralateral central region (including primary sensorimotor cortex) and supplementary motor area during active movement of the paretic hand. No change in functional MRI activation was detected during passive movement of the paretic hand or during active and passive movement of the nonparetic hand. In ischemic perinatal stroke with crossed corticospinal projections, constraint-induced movement therapy induces neuroplastic changes on the synaptic level, detected as increased excitability (transcranial magnetic stimulation) and increased task-related brain activation (functional MRI) in the primary motor cortex of the lesioned hemisphere.