Journal of child neurology
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A 9-year-old girl with akinetic-rigid parkinsonism with tremor is described. She was hospitalized with neuroleptic malignant syndrome that started 3 days after anticonvulsant drug treatment owing to epileptic seizures. Cranial magnetic resonance imaging (MRI) was normal, and during the follow-up, magnetic resonance spectroscopy revealed a decrement on N-acetylaspartate in the basal ganglia, suggesting neuronal dysfunction. ⋯ Parkinsonism in children is considered an acquired, secondary, and reversible disorder with a dramatic improvement to treatment. However, our patient still has parkinsonism 2 years after diagnosis. This case represents the unusual presentation of epilepsy, parkinsonism, and neuroleptic malignant syndrome, which might have a common pathophysiologic pathway (dopaminergic dysfunction) involving the basal ganglia and the hypothalamus.
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Botulinum toxin type A can be both safe and effective in relieving spasticity in pediatric patients with cerebral palsy. In our prospective study, we evaluated the functional effect of botulinum toxin A in spastic diplegic-type cerebral palsy. Patients were examined on enrollment and at 1, 3, and 6 months after injection. ⋯ Improvement in the gross motor classification system is continued after 6 months in 12 children. The main goal of spasticity treatment in cerebral palsy is functional improvement. In our study, most of our patients had functional improvement according to the gross motor function classification system and did not change at 6 months.
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Three normal children with headache occurring only with exertion were advised to try "head cooling" (eg, immersion of the head in cold water, cold water poured over the head, application of a cold, wet towel or ice pack) at the onset of headache. The patients were followed up quarterly as outpatients, and the effectiveness of head cooling in terms of the frequency of headaches, intensity (interference with play), duration, and side effects was assessed over 18 months.