Pediatric neurology
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Pediatric neurology · Aug 2009
Case ReportsIs a reversible splenial lesion a sign of encephalopathy?
A reversible splenial lesion of the corpus callosum has been recognized in patients with mild encephalitis/encephalopathy associated with various infectious diseases. All reported cases of encephalitis/encephalopathy, by definition, present with neurologic signs, many of which involve seizures or mildly altered states of consciousness, such as drowsiness. ⋯ This case indicates that a transient splenial lesion in the corpus callosum may occur during a febrile illness, without neurologic manifestations. Therefore, physicians should not diagnose or treat a patient as encephalopathic merely because of the presence of a splenial lesion on magnetic resonance imaging.
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Pediatric neurology · Aug 2009
Dexmedetomidine for procedural sedation in children with autism and other behavior disorders.
Dexmedetomidine has been increasingly in use for pediatric noninvasive procedural sedation. This retrospective study examined experience in children with autism and other neurobehavioral disorders, populations often difficult to sedate. Records of children with autism or neurobehavioral disorders sedated with dexmedetomidine at Chris Evert Children's Hospital and Kosair Children's Hospital were reviewed. ⋯ All but four procedures were successfully completed (4/315, or 98.7%). Dexmedetomidine with or without midazolam was an effective sedative in this population. The regimen appeared to be well tolerated with few adverse events, including recovery-related agitation, and appears to be an attractive option for this population.
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Pediatric neurology · Jul 2009
Comparative Study Clinical TrialNarcolepsy: action of two gamma-aminobutyric acid type B agonists, baclofen and sodium oxybate.
This study was performed to evaluate the actions of baclofen and sodium oxybate, two medications with gamma-aminobutyric acid type B (GABA(B)) receptor agonist properties, on symptoms of narcolepsy in drug-naïve teenagers. Twenty-six narcoleptic teenagers with recent onset of narcolepsy-cataplexy syndrome who were human leukocyte antigen DQB1 0602 positive were matched for age and sex and received either baclofen or sodium oxybate. If deemed necessary to combat excessive daytime sleepiness, the alerting agent modafinil was also prescribed. ⋯ Both drugs increased total sleep time and delta waves during sleep, but only sodium oxybate had an effect on daytime sleepiness and cataplexy at 3 months. Improvement of total nocturnal sleep time had no beneficial effect on daytime sleepiness. The mechanism by which sodium oxybate improves cataplexy and sleepiness is inferred to be due to properties beyond direct GABA(B) agonist action.
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Pediatric neurology · Jul 2009
Role of intravenous levetiracetam in acute seizure management of children.
Status epilepticus is defined as a seizure lasting beyond 30 minutes. Children with intractable epilepsy undergo frequent hospital admissions secondary to status epilepticus or because of acute exacerbation of seizures. Intravenous levetiracetam became available in August 2006 for use in patients aged above 16 years. ⋯ No serious side effects were evident. Fifteen patients (46.8%) were discharged on levetiracetam monotherapy, and 9 (28.1%) received levetiracetam as adjunctive therapy after discharge from the hospital. Intravenous levetiracetam can be used adjunctively or as monotherapy in children with status epilepticus and acute exacerbation of seizures.
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Pediatric neurology · May 2009
Clinical TrialPregabalin: preliminary experience in intractable childhood epilepsy.
Pregabalin is a new antiepileptic drug that acts at presynaptic calcium channels, modulating neurotransmitter release. We report on treating consecutive children with severe drug-resistant epilepsy in a prospective, open-label, add-on trial. Nineteen children (63% male) aged 4-15 years (mean, 9.7; S. ⋯ We conclude that pregabalin is a useful addition in the treatment of refractory childhood epilepsy. The drug should be used with caution in myoclonic epilepsy. Controlled studies are needed to establish long-term efficacy and tolerability.