Journal of Pediatric Neurology - Volume 11, issue 4
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Journal of Pediatric Neurology is an English multidisciplinary peer-reviewed medical journal publishing articles in the fields of child neurology, pediatric neurosurgery, pediatric neuroradiology, child psychiatry and pediatric neuroscience.
Journal of Pediatric Neurology encourages submissions from authors throughout the world. The following articles will be considered for publication: editorials, original and review articles, rapid communications, case reports, letters to the editor and book reviews. The aim of the journal is to share and disseminate knowledge between all disciplines that work in the field of pediatric neurology.
Abstract: Autoimmune and neuroimmune diseases prevalence rates are rising enormously. It would be difficult to explain with genetic and environmental factors. Noteworthy, this rising maybe related with childhood vaccine programs. There is also a lack of information about this topic in pediatric and family medicine practice in some countries like Turkey. Prevention and treatment of these diseases is possible if pathogenesis could be well understood. We attempt to review this topic in immunological and neurological perspectives for…this purpose. We searched Pubmed from year 2000 to date with neuroimmune, autoimmune, measles and vaccine link keywords in some combinations and related topics. The obtained information from this search dealt with some important subheadings. There is a need for further investigations of neuroimmune disease and the possible vaccine link.
Keywords: Neuroimmune, autoimmune, measles, vaccine link
Abstract: Although 85% of children with spina bifida survive to adulthood, there is little information and few proven service practices to guide their healthcare transition (HCT) to adult care. Our objective was to deepen our understanding of the factors that facilitate the HCT experience of these patients. Individual interviews with patients with spina bifida (n=15) and their parents (n=14) were performed to investigate levels of HCT readiness, attitudes, and practices. Data were analyzed for themes that mapped…to theory-based constructs and synthesized as strategic directions for tailoring services. Patient age averaged 18.0 ± 2.8 yr (range 14–28 yr). Factors common to youth who were progressing toward HCT included individual factors: higher cognitive functioning, strong interest in being independent from parents; family factors: exposure to a parenting style that fostered independence; service factors: success negotiating primary care responsibilities with familiar adult healthcare providers. Factors common to youth who were not progressing towards HCT included individual factors: lower cognitive ability, impaired physical ability; family factors: lack of parent awareness of medical transition needs, and, service factors: strong dependence on pediatric providers for care coordination, and negative experiences with adult specialists perceived as not anticipating their needs. Tailoring HCT for individuals with spina bifida may be best done in conjunction with HCT readiness assessments conducted at intervals throughout the HCT period. These assessments should include current and projected cognitive functioning; dyadic support to align patients and parents around HCT goals and care coordination tasks; and methods to familiarize patients and families with adult providers.
Keywords: Spina bifida, healthcare transition to adulthood, children with special healthcare needs, care coordination
Abstract: Accumulating evidence supports the hypothesis that epilepsy is mediated by oxidative stress, studies about psychopathology in children indicates that children with epilepsy are at increased risk for psychopathology, including internalizing and externalizing behavior problems. The aim of the work is to study the child psychopathology and the level of oxidative stress in newly diagnosed children with epilepsy. Eighty-four newly diagnosed children with epilepsy with their ages ranging from 4 yr to 17 yr…(mean 8.62 ± 3.79 yr) and 42 age and sex matched healthy control children were recruited. All cases are subject to full neurologic assessment, child behavioral checklist, and measurement of the levels of oxidative stress enzymes. Anxiety withdrawal, psychotic behavior and motor excess hyperactivity are statistically significantlty more in children with newly diagnosed epilepsy (P < 0.05). There were high level of malondialdehyde and nitrite while the level of both glutathione peroxidase, superoxide dismutase and catalase were low for newly diagnosed children with epilepsy versus control (P=0.000). The state of imbalance of oxidative stress enzymes has important role in seizure development and also associated psychopathology. Long-term follow up studies are needed for child psychopathology and oxidative stress in epileptic children.
Keywords: Psychopathology, oxidative stress, epilepsy, children
Abstract: The purpose of this study was to evaluate whether stool polymerase chain reaction (PCR) has a higher clinical sensitivity for detecting enterovirus compared with cerebrospinal fluid (CSF) PCR in pediatric patients suspected to have enteroviral meningitis. We retrospectively reviewed 139 pediatric patients with enteroviral meningitis diagnosed in our hospital during 2010–2012. Enteroviral meningitis was diagnosed based on detection of virus in CSF and/or stool samples in aseptic meningitis patients. Patients were divided…into definitive enteroviral meningitis (positive CSF PCR) and highly probable enteroviral meningitis (negative CSF PCR, but positive stool PCR) groups. The clinical characteristics of the two groups were compared to identify the characteristics of patients with highly probable enteroviral meningitis. We also analyzed the influence of sampling time on the PCR results of the two specimen types. Patients with highly probable enteroviral meningitis had a lower white blood cell count in CSF (P < 0.01) and a longer latency between symptom onset and CSF sampling (P=0.03) than did patients with definitive enteroviral meningitis. The CSF enterovirus positivity rate was lower in CSF specimens obtained > 1 day after clinical onset, whereas the majority of stool samples were PCR positive throughout the course of the disease. Our results suggest that PCR of stool specimens may be useful in pediatric patients with suspected enteroviral meningitis, particularly when the duration of symptoms is > 1 day and/or a lower degree of CSF pleocytosis is observed.
Abstract: Objective is to evaluate the etiology of focal seizures at a tertiary care center in Indian children. Design is a cross sectional study. Setting is outpatient and inpatient of a tertiary care teaching children hospital in South India. A total of 150 consecutive children aged 1 mo to 18 yr presenting with focal seizures defined as per international league against epilepsy classification, participated in this study. A detailed history was taken and clinical examination was done…was along with the investigation for the etiology of focal seizures with routine and specific tests, computerized tomography (CT) scan and/or magnetic resonance imaging (MRI) and electroencephalography (EEG). All of the findings were recorded in a pre-designed pro forma and results were analyzed. The mean age presentation was 6.5 yr. Male preponderance was noticed with a ratio of 1.2:1. Complex partial seizures were the most common (68%) type of focal seizures. Neurologic deficits were noticed in 36 (24%) patients; most common form was hemiparesis. CT scan abnormalities were noted in 76% of the patients, most common CT finding was inflammatory granuloma. In four cases, where CT scan was inconclusive of neurocysticercosis (NCC) versus tuberculoma, MRI showed features of tuberculoma. The most common etiology of focal seizures was inflammatory granulomas; NCC (69%) and tuberculoma (15%), followed by perinatal insult (8%) and stroke (7.3%). EEG was diagnostic in cases of Rolandic epilepsy in seven (4.6%) cases. CT brain is a valuable tool in identifying the underlying etiology of focal seizures. MRI is helpful in cases of diagnostic dilemma between NCC and tuberculoma by CT scan. EEG is diagnostic of benign Rolandic epilepsy.
Keywords: CT, MRI, EEG, focal seizures, infections, India
Abstract: Primary angiitis of the central nervous system (CNS) is a recently described and rare disease in children. It is confined to the CNS and its etiology is unknown. A 10-year-old boy, previously healthy, presented with fever, headache and focal seizures, followed by left hemiparesis and central facial palsy. Brain magnetic resonance imaging (MRI) showed a large parietooccipital, cortical and subcortical lesion, hyperintense in T2-weighted/fluid attenuated inversion recovery imaging. Subsequently, he presented a…rapid neurological deterioration by weekly relapses, having several focal seizures, worsening of previous deficits and appearance of new ones on the right hemibody. He became aphasic and developed encephalopathy. Accordingly, MRI showed an extension of the previous lesion and appearance of new ones on the left hemisphere. He was initially treated with broad spectrum antibiotics and later immunoglobulin, methylprednisolone pulses and daily oral prednisolone, without sustained improvement. Etiologic investigations, including infectious or neurometabolic disease and systemic vasculitis were negative. Cerebral angiography was normal. A lesional biopsy confirmed a small vessel primary angiitis of the CNS. Seven wk after symptom onset, he was started on monthly cyclophosphamide (seven pulses) with prednisolone, achieving clinical stabilization. Mycophenolate mophetil was then substituted for cyclosphosphamide for 18 months. During a 2-year follow-up, no new clinical or imaging deterioration has been noted. Motor deficits have improved significantly but severe expression aphasia and cognitive deficit remains. He also developed refractory multifocal epilepsy. Small vessel primary angiitis of the CNS should be considered in a child with rapidly progressing acquired neurologic deterioration, multifocal inflammatory lesions on MRI and normal angiography. Prompt diagnosis and aggressive treatment is crucial for a favorable outcome.
Keywords: Angiitis, vasculitis, small vessels, CNS, primary, child
Abstract: We report an 8-year-old girl who presented with acute right foot drop with preserved reflex following minor trauma. Brain magnetic resonance imaging showed a large pial arterio-venous malformation (AVM) over the left frontal paramedian convexity with a large varix draining into the superior sagittal sinus. On post-contrast T1-weighted imaging, the AVM showed a swirling pattern with sharply marginated outer hypo-intense area and inner hyper-intense area reminiscent of the Chinese "yin-yang" symbol. A partially thrombosed varix…in an AVM nidus was suspected which was confirmed on histopathology following resection. Unilateral foot drop with preserved reflex is one of the rare clinical presentations of a frontal paramedian AVM. "Yin-yang" sign is a unique magnetic resonance imaging finding suggestive of a partially thrombosed AVM.
Abstract: Ellis-van Creveld (EVC) syndrome is an uncommon disease which classically presents as a combination of heart anomalies, dwarfism, polydactyly and ectodermal dysplasia. We report an atypical case of EVC syndrome, which involves the nervous system in the form of hydrocephalus besides having an atypical inheritance pattern. Whether it is a conventional case of EVC syndrome or a new syndrome needs to be ascertained as this may have important diagnostic and management related implications for the patient.
Abstract: Alternating hemiplegia of childhood is characterized by episodes of hemiplegia, various non-epileptic paroxysmal events and developmental delay. We are reporting a child with history of recurrent episodes of weakness involving either side of the body with developmental delay. During the course of acute gastroenteritis in the hospital, child developed one sided weakness and completely recovered.