Pediatric neurology
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Children with disabilities require special education and related services that are as diverse as the individual children themselves. Special education is not necessarily a special classroom but a well thought-out program of collaborative interventions leading to educational goals set forth by a multidisciplinary team. ⋯ Pediatricians and pediatric subspecialists are in a unique position to develop a medical home for the disabled child, and in doing so must be well-versed in both case law and federal legislation as it applies to special education, in an effort to be a child's best advocate. A chronological review of case law and federal legislation, including the Individuals with Disabilities Education Act, No Child Left Behind Act, and recent amendments, are discussed, and their relevance to physician practice is detailed.
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Pediatric neurology · Sep 2008
Case ReportsInfant botulism type Ba: first culture-confirmed case in the United Arab Emirates.
We report on a 3-month-old girl with culture-confirmed infant botulism caused by a rare double toxin-producing Clostridium botulinum type Ba. This case was not related to honey-feeding. The clinical course was prolonged, with minimal spontaneous improvement at onset, and a period of fluctuating motor weakness and nasogastric feeding dependence afterward. ⋯ Human botulism immune globulin was administered empirically on day 23 of presentation, with rapid full recovery. This case highlights the importance of pursuing diagnoses of infant botulism despite normal results of neurophysiologic testing and no history of honey-feeding. Our case also demonstrates a favorable response to human botulism immune globulin, despite the relatively late treatment.
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Structured interviews regarding peri-ictal headaches and personal or family histories of interictal headaches were conducted on 101 children (aged 5-18 years), with generalized tonic-clonic or partial seizures. Epilepsy-specific details were collected by interviews and reviews of neurology clinic charts. Peri-ictal headaches were reported by 41% (29%, postictal only; 5%, preictal only; 7%, both). ⋯ Whereas only half of children received abortive medications for these headaches, simple analgesics were effective in most cases. We conclude that peri-ictal headaches are common, affecting 41% of children with epilepsy. Their presence should be routinely queried, and if documented, treatment with simple analgesics appears beneficial and should be considered.
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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.