Journal of child neurology
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Case Reports
Pleural effusion: beta-trace protein in diagnosing ventriculoperitoneal shunt complications.
Catheter dysfunction is a common complication with ventriculoperitoneal shunts. Apart from infection, obstruction, and leakage, migration of the shunt tip may cause particular problems. ⋯ Different diagnostic methods can be used in this situation. Below we report a case of pleural effusion-without shunt migration-which was revealed to be a shunt complication by quantifying beta-trace protein in the effusion.
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Seizures are indicative of underlying neurologic dysfunction in neonates. Repeated seizures may be deleterious to the brain even without disturbances of ventilation or perfusion. First-line antiepileptic drugs such as phenobarbital and phenytoin are not very effective in controlling seizures in neonates. ⋯ We report our experience with 3 neonates with status epilepticus. Seizures in all 3 neonates did not respond to phenobarbital and phenytoin but responded to midazolam infusion. Midazolam may be considered a safe and effective antiepileptic drug in refractory neonatal seizures of diverse etiologies.
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Although spasticity is a common symptom in children with cerebral palsy, weakness may be a much greater contributor to disability. We explore whether a treatment that reduces spasticity may also have potential benefit for improving strength. Ten children with cerebral palsy and spasticity in the ankle plantar flexor muscles were treated with oral baclofen for 4 weeks. ⋯ Mean maximal voluntary neuromuscular activation increased from 1.13 +/- 1.02 to 1.60 +/- 1.30 ( P < .05) after treatment, corresponding to an increase in 9 of 10 subjects. Mean maximal plantar flexion torque did not change. We conjecture that antispasticity agents could facilitate strength training by increasing the ability to voluntarily activate muscle.
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Comparative Study Controlled Clinical Trial
Enhancement of muscle activity by electrical stimulation in cerebral palsy: a case-control study.
The objectives of this study were to compare the effects of low-intensity electrical stimulation of the quadriceps muscle in children with cerebral palsy in the following 2 modes: reconditioning by long-term training of the muscle versus real-time assist to the muscle during motion. To evaluate the force enhancement in the assist mode, we developed a method to dissociate the volitional and the induced components from the total electromyographic signal. The study group, including 5 children with cerebral palsy (mean age, 3.3 years; 0.4 SD), underwent 2 testing sessions: 1 before and 1 after 3-month training by electrical stimulation. ⋯ The results obtained for the group with cerebral palsy were statistically different from those of the control group, but this difference decreased after long-term training by electrical stimulation. It was concluded that, in children with cerebral palsy, electrical stimulation is more beneficial in long-term training than when used as a real-time motion assist. Although muscle strength is not affected, more centrally controlled attributes such as co-contraction are improved.
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This study was conducted to evaluate the feasibility of cerebral perfusion pressure-targeted therapy in children with raised intracranial pressure caused by central nervous system infection. A prospective observational pilot study was conducted in the pediatric intensive care unit of a tertiary care teaching hospital. Twenty children (ages 6 months to 12 years) with a clinical diagnosis of meningitis or meningoencephalitis were included. ⋯ All 4 patients with mean cerebral perfusion pressure less than 50 mm Hg died of intractable, raised intracranial pressure. In contrast, only 3 of 16 patients with mean cerebral perfusion pressure more than 50 mm Hg died. In children with raised intracranial pressure caused by central nervous system infection, it was feasible to achieve a cerebral perfusion pressure greater than 50 mm Hg, mainly by increasing the blood pressure within the first 24 hours and by reducing intracranial pressure after the first 24 hours.