Pediatric neurology
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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.
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Pediatric neurology · Jun 2008
Case ReportsObstructive sleep apnea, seizures, and childhood apraxia of speech.
Associations between obstructive sleep apnea and motor speech disorders in adults have been suggested, though little has been written about possible effects of sleep apnea on speech acquisition in children with motor speech disorders. This report details the medical and speech history of a nonverbal child with seizures and severe apraxia of speech. For 6 years, he made no functional gains in speech production, despite intensive speech therapy. ⋯ The rather late diagnosis and treatment of obstructive sleep apnea, especially in light of what was such a life-altering outcome (gaining functional speech), has significant implications. Most speech sounds develop during ages 2-5 years, which is also the peak time of occurrence of adenotonsillar hypertrophy and childhood obstructive sleep apnea. Hence it is important to establish definitive diagnoses, and to consider early and more aggressive treatments for obstructive sleep apnea, in children with motor speech disorders.
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Pediatric neurology · Jun 2008
Case ReportsEpilepsy surgery in a case of encephalitis: use of 11C-PK11195 positron emission tomography.
The positron emission tomography radiotracer (11)C-PK11195 selectively binds to the peripheral-type benzodiazepine receptors expressed in activated microglia and can, therefore, detect areas of neuroinflammation. (11)C-PK11195 positron emission tomography was used in determining the surgical treatment of a 5-year-old boy with intractable epilepsy due to encephalitis of unknown etiology. After 4 months of treatment in the pediatric intensive care unit for altered consciousness and refractory seizures despite multiple anticonvulsants, including continuous midazolam infusion, (11)C-PK11195 positron emission tomography revealed an area of increased uptake in the left temporal-occipital cortex. ⋯ Focal areas of neuroinflammation may play an important role in seizure pathogenesis in a subset of patients with refractory seizures associated with encephalitis. In such cases, (11)C-PK11195 positron emission tomography may highlight the region of maximal inflammation for palliative surgical treatment.
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Pediatric neurology · Apr 2008
Case ReportsCentral nervous system signs in X-linked Charcot-Marie-Tooth disease after hyperventilation.
The X-linked Charcot-Marie-Tooth disease is the second most common form of inherited neuropathy and, unlike most other forms of this disease, may present with atypical manifestations because of central nervous system involvement. Episodic central nervous system symptoms in X-linked Charcot-Marie-Tooth disease may be triggered by illness, dehydration, physical exercise, or exposure to altitude. We describe a child with transient episodes of hemiplegia after simple hyperventilation, a presentation not previously described in pediatric Charcot-Marie-Tooth disease type X.
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Pediatric neurology · Apr 2008
ReviewCerebral blood flow and autoregulation after pediatric traumatic brain injury.
Traumatic brain injury is a global health concern and is the leading cause of traumatic morbidity and mortality in children. Despite a lower overall mortality than in adult traumatic brain injury, the cost to society from the sequelae of pediatric traumatic brain injury is very high. ⋯ Although altered cerebrovascular hemodynamics early after traumatic brain injury may contribute to disability in children, there is little information regarding changes in cerebral blood flow and cerebral autoregulation after pediatric traumatic brain injury. This review addresses normal pediatric cerebral physiology and cerebrovascular pathophysiology after pediatric traumatic brain injury.