European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society
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Eur. J. Paediatr. Neurol. · Mar 2009
ReviewThe use of generic medication in epilepsy: a review of potential issues and challenges.
Changing from brand name to generic antiepileptic drugs (AEDs) is increasingly being advocated by the authorities, principally for budgetary reasons. However, caution should be exercised since AEDs may have a narrow therapeutic margin, the regimen with AEDs may be complex, the consequences of uncontrolled seizures may be severe, and risk of side effects is relatively high, particularly when seizures are difficult to control. This article focuses on the possible problems that can arise from the substitution of AEDs formulations, such as loss of seizure control and emergence of new side effects. ⋯ Switching AED formulations should always be done with the necessary caution and under the physician's supervision. Closer follow-up during the transitional period is necessary, and dosage adjustment may be required. The patient should be given full and correct advice about risks involved in switching AED formulations.
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Eur. J. Paediatr. Neurol. · Mar 2009
The effect of changes in tPCO2 on the fractional tissue oxygen extraction--as measured by near-infrared spectroscopy--in neonates during the first days of life.
The cerebral fractional oxygen extraction (FOE) reflects the balance between cerebral oxygen delivery (OD) and consumption (VO(2)). PCO(2) affects the cerebral blood flow (CBF): hypocapnia decreases CBF and OD and increases FOE. We recently showed that the fractional tissue oxygen extraction (FTOE) reflects FOE and hypothesized that a decrease in tPCO(2) increases FTOE. ⋯ This implies that tPCO(2) influences the cerebral oxygenation independently of MABP. We therefore believe that for the interpretation of cerebral oxygenation in mechanically ventilated neonates during the first days of life continuous measurements of tPCO(2) are needed. Moreover we suggest FTOE to become a continuous parameter in the clinical setting for the non-invasive measurement of the neonatal brain oxygenation.
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Eur. J. Paediatr. Neurol. · Nov 2008
Childhood encephalitis in Sweden: etiology, clinical presentation and outcome.
Acute encephalitis is a relatively uncommon but potentially harmful CNS inflammation usually caused by infection. The diagnosis is difficult to establish and the etiology often remains unclear. Furthermore, the long-term prognosis of acute encephalitis in children is poorly described. ⋯ We conclude that the etiology of encephalitis among Swedish children is at large the same as in other European countries with similar vaccination programs. Fever and encephalopathy were seen in a majority of children and the most sensitive tool for making the diagnosis was EEG examination. Furthermore, many children display persisting sequele at discharge for which the strongest predictive factor was focal neurological findings at presentation.
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In 1984, Jean Aicardi and Françoise Goutières described 8 children showing both severe brain atrophy and chronic cerebrospinal fluid lymphocytosis, with basal ganglia calcification in at least one member of each affected family. The course was rapid to death or a vegetative outcome. Aicardi and Goutières correctly predicted that the disorder would be genetic, but emphasised that "some features, especially the pleocytosis, may erroneously suggest an inflammatory condition". ⋯ At the time of writing, Crow's team has discovered that over 80% of families with Aicardi-Goutières syndrome have mutations in one of four nuclease genes, the exonuclease TREX1 and the genes for all three subunits of the ribonuclease H2 enzyme complex. Aicardi-Goutières syndrome is both genetically and phenotypically heterogeneous, with a range of severity from life-threatening perinatal illness to mild late infancy onset. All infants of whatever genotype have increased interferon-alpha in the first year of life and this appears to be the final common pathway that links Aicardi-Goutières syndrome, congenital virus infection and systemic lupus erythematosus.
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Eur. J. Paediatr. Neurol. · Sep 2008
Long-term outcome of speech and language in children after corrective surgery for cyanotic or acyanotic cardiac defects in infancy.
The purpose of this prospective study was to assess whether outcome of speech and language in children 5-10 years after corrective surgery for tetralogy of Fallot (TOF) or ventricular septal defect (VSD) in infancy was influenced by the preoperative condition of hypoxemia or cardiac insufficiency and whether it was associated with perioperative risk factors and neurodevelopmental outcome. A total of 35 unselected children, 19 with TOF and hypoxemia and 16 with VSD and cardiac insufficiency, operated with combined deep hypothermic circulatory arrest and low-flow cardiopulmonary bypass at mean age 0.7+/-0.3 (mean+/-standard deviation) years, underwent, at mean age 7.4+/-1.6 years, standardized evaluation of speech and language functions. Results were compared between subgroups and related to perioperative factors, sociodemographic and neurodevelopmental status. ⋯ Children with preoperative hypoxemia due to cyanotic cardiac defects in infancy are at higher risk for dysfunction in speech and language than those with cardiac insufficiency due to acyanotic heart defects. Age at testing, socioeconomic status, and duration of cardiopulmonary bypass influenced test results. Long-term outcome in speech and language functions can be considered as a sensitive indicator of overall child development after cardiac surgery.