Seminars in pediatric neurology
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Semin Pediatr Neurol · Jun 2008
ReviewObstructive sleep apnea in children: implications for the developing central nervous system.
Recent increases in our awareness to the high prevalence of sleep disorders in general and of sleep-disordered breathing among children, in particular, has led to concentrated efforts aiming to understand the pathophysiological mechanisms, clinical manifestations, and potential consequences of such conditions. In this review, I will briefly elaborate on some of the pathogenetic elements leading to the occurrence of obstructive sleep apnea (OSA) in children, focus on the psychobehavioral consequences of pediatric OSA, and review the evidence on the potential mechanisms underlying the close association between central nervous system morbidity and the episodic hypoxia and sleep fragmentation that characterize OSA.
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This article reviews the most common pharmacologic options in the treatment of sleep disorders in children. Despite the high prevalence of sleep disorders in children, there is a paucity of education and information available on the pharmacologic management of sleep disorders in children. The principles of sleep physiology and pathophysiology that help provide more rational pharmacologic management are discussed. ⋯ Ideally, these guidelines should be FDA approved for the specific sleep disorder and for the pediatric age range. The development of easy to swallow, chewable or liquid forms of these medications are needed. Training programs should play the lead role in enhancing pediatricians' knowledge of the pharmacologic treatment of sleep disorders in children.
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Cerebral palsy refers to a collective of neurologic conditions that share in common disorders of motor function and posture. Traditionally, and still today in many circles, the term is considered almost synonymous with brain injury. Multiple lines of evidence, however, point to the fact that cerebral palsy is rarely caused by problems with perinatal management. ⋯ The best descriptor of the inheritance of cerebral palsy would be that of "multifactorial inheritance." This implies etiologic and genetic heterogeneity with complex interactions with multiple environmental influences. This article reviews known genetic influences on the origin of cerebral palsy. A proposed scheme for the genetic evaluation in identifying the etiology of cerebral palsy is provided.
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Semin Pediatr Neurol · Dec 2007
ReviewComplications and consequences of epilepsy surgery, ketogenic diet, and vagus nerve stimulation.
Children with medically intractable epilepsy may be candidates for nonpharmacologic therapies such as resective and disconnection epilepsy surgery, the ketogenic diet and its variants, and vagus nerve stimulation. Each of these therapies offers unique advantages and disadvantages, and careful consideration of the risk-benefit analysis must be tailored to each child. ⋯ These may be serious and irreversible or more commonly mild and transient. An appreciation of these complications and consequences is necessary for the comprehensive management of these complex patients.