Developmental medicine and child neurology
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Dev Med Child Neurol · Dec 2007
Case ReportsEarly relapse risk after a first CNS inflammatory demyelination episode: examining international consensus definitions.
The International Pediatric Multiple Sclerosis Study Group (IPMS) has recently proposed consensus definitions for paediatric multiple sclerosis (MS) and related disorders. The term 'acute disseminated encephalomyelitis' (ADEM) has been used previously to describe any monophasic episode of disseminated demyelination. The study group now propose that ADEM must be multifocal, polysymptomatic, and include encephalopathy (as an essential requirement). ⋯ Only one of 12 patients with ADEM went on to develop MS during the study period, whereas 13 of 28 patients with CIS relapsed and fulfilled a diagnosis of MS (p<0.025). The new diagnostic criteria for ADEM may be criticized for being overly restrictive (particularly with encephalopathy being an essential criterion), and it is suspected that many practising physicians will be of the opinion that these new criteria will underdiagnose ADEM, and overdiagnose MS at the expense of multiphasic ADEM. However, it is hoped that these new criteria may improve prognostic specificity and provide uniformity to future paediatric CNS demyelination research.
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Dev Med Child Neurol · Sep 2007
Randomized Controlled TrialIntrathecal baclofen in children with spastic cerebral palsy: a double-blind, randomized, placebo-controlled, dose-finding study.
Intrathecal baclofen (ITB) therapy can be very effective in the treatment of intractable spasticity, but its effectiveness and safety have not yet been thoroughly studied in children with cerebral palsy (CP). The aims of this double-blind, randomized, placebo-controlled, dose-finding study were to select children eligible for continuous ITB infusion, to assess the effective ITB bolus dose, and to evaluate the effects, side effects, and complications. Outcome measures included the original Ashworth scale and the Visual Analogue Scale for individually formulated problems. ⋯ Nine side effects of ITB were registered, including slight lethargy in seven children. Fourteen children had symptoms of lowered cerebrospinal fluid pressure. We conclude that ITB bolus administration is effective and safe for carefully selected children with intractable spastic CP.
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Dev Med Child Neurol · Aug 2007
Case ReportsIntravenous diazepam infusion in the management of planned intrathecal baclofen withdrawal.
Intrathecal baclofen is used in the management of spasticity associated with cerebral palsy (CP). Sudden cessation of intrathecal baclofen may give rise to the potentially life-threatening baclofen withdrawal syndrome. We report three cases in which intravenous diazepam is used effectively in the management of planned intrathecal withdrawal. ⋯ In the first patient, a 19-year-old male with quadriplegia, the intrathecal catheter had to be removed. The other two patients, an 11-year-old female with diplegia and a 16-year-old male with quadriplegia, both required the entire device to be removed. The purpose of this case report is to illustrate the potential management for elective cases in a similar situation.