European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society
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Eur. J. Paediatr. Neurol. · Jul 2009
Cerebral infarction and neurodevelopmental outcome in childhood tuberculous meningitis.
Cerebral infarction is an important cause of neurological sequelae in childhood tuberculous meningitis (TBM). ⋯ Infarct characteristics should be taken into account when neurodevelopmental outcome is prognosticated in TBM. Young age, unilateral multiple or bilateral infarction on CT at 1 month, advanced stage of TBM and the interaction term stage x Glasgow coma score are the best predictors of neurodevelopmental outcome at 6 months.
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Eur. J. Paediatr. Neurol. · May 2009
Randomized Controlled TrialEfficacy of intrathecal baclofen therapy in children with intractable spastic cerebral palsy: a randomised controlled trial.
Intractable spasticity can be treated effectively with continuous infusion of intrathecal baclofen. Because evidence for its use in the treatment of children with spastic cerebral palsy is lacking, we conducted a randomised controlled trial. ⋯ The results of this randomised controlled trial establish continuous infusion of intrathecal baclofen to be effective in carefully selected children with problems caused by intractable spastic cerebral palsy.
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Eur. J. Paediatr. Neurol. · May 2009
Safety and one-year efficacy of intrathecal baclofen therapy in children with intractable spastic cerebral palsy.
Prospective studies that address both efficacy and safety of continuous infusion of intrathecal baclofen (CITB) in children with spastic cerebral palsy (CP), and that use outcome measures beyond muscle tone are lacking. ⋯ CITB was effective at 12 months and safe up to 24 months for carefully selected children with intractable spastic CP. CITB relieved pain, facilitated ease of care and improved mental health. The majority of children could extend their activities and participation.
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Eur. J. Paediatr. Neurol. · Mar 2009
ReviewApproach to pediatric epilepsy surgery: State of the art, Part I: General principles and presurgical workup.
In 1990, the National Institute of Health adopted epilepsy surgery in children as an option when medications fail. In the past few years several concepts have become increasingly recognized as key to a successful approach to epilepsy surgery in children. These include the concepts of neuronal plasticity, the epileptogenic lesion, the ictal onset, symptomatogenic, irritative, and epileptogenic zones. ⋯ When these diagnostic modalities are discordant, not definitive, or when the epileptogenic zone is close to eloquent cortex, invasive EEG, complemented by other imaging techniques may be needed. These include magnetoencephalography, single photon emission tomography, various types of positron emission tomography, various magnetic resonance imaging modalities (functional, diffusion weighted, other) and other emerging and experimental techniques. While MRI, video-EEG, and neuropsychological assessments are well established components of the presurgical evaluation, the use of the new emerging imaging technologies is dictated by the degree of anatomo-electro-clinical correlations, and, awaiting multicentric studies and more detailed guidelines, remains center-dependent.
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Eur. J. Paediatr. Neurol. · Mar 2009
ReviewApproach to pediatric epilepsy surgery: State of the art, Part II: Approach to specific epilepsy syndromes and etiologies.
The second of this 2-part review depicts the specific approach to the common causes of pediatric refractory epilepsy amenable to surgery. These include tumors, malformations due to abnormal cortical development, vascular abnormalities and certain epileptic syndromes. ⋯ In such cases, palliative procedures such as callosotomy, multiple subpial transections and vagus nerve stimulation can achieve reduction in seizure severity but rarely seizure freedom. Integration of the new imaging techniques and the concepts of neuronal plasticity, the epileptogenic lesion, the ictal onset, symptomatogenic, irritative, and epileptogenic zones is an expanding and dynamic process that will allow us, in the future, to better decide on the surgical approach of choice and its timing.