Biomedical subjects
G S Golden
Publications and source records attributed to G S Golden.
Management of headaches in children.
Headaches are a common cause of disability in childhood. Although the symptom of headache raises concerns about serious neurologic disease, the cause is most commonly vascular or due to muscle contraction. The differentiation between muscle-contraction and vascular headaches is clinical, and laboratory studies rarely are required. Treatment of muscle-contraction headaches is symptomatic. Migraine headaches sometimes require periods of prophylactic therapy. The chronic nature of headaches mandates a comprehensive approach to management of the child and family. This approach is best carried out in the primary care setting.
Tourette syndrome.
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Stroke syndromes in childhood.
Strokes are uncommon in children but devastating when they occur. The basic principles needed for understanding these syndromes are the same as those that pertain to adults; however, the etiologic factors are quite different. As diagnostic techniques improve, fewer diagnoses of childhood stroke remain in the category of acute infantile hemiplegia. This trend is most important, because specific therapy, when available, of underlying conditions can prevent recurrent strokes.
Psychologic and neuropsychologic aspects of Tourette's syndrome.
Behavioral, psychologic, and neuropsychologic aspects of Tourette's syndrome are reviewed. A hypothesis that unifies the behavioral and organic components is developed, along with recommendations for treatment.
Symposium on learning disorders. Controversial therapies.
Chronic problems such as learning disabilities often stimulate the development of novel therapies that present broad claims of efficacy and of global remedy. The author examines controversial therapies for learning disorders, examines some of the reasons for the popularity of these therapies, discusses their adverse effects, and presents recommendations for their critical analysis.
Tics in childhood.
The tic disorders represent a spectrum of disability ranging from simple transient tics of childhood to severe Tourette syndrome. Diagnosis depends on an awareness of their existence, willingness to accept the child and parents' histories, and appreciation of the broad range of symptoms. Although the etiology is not clear, some cases are familial. Environmental agents, especially psychostimulant drugs, may precipitate occasional cases. Treatment with haloperidol is useful for 80% to 85% of patients but associated with troublesome side effects in one-half of those treated. The long-term prognosis for complex tic disorders is not as bad as once thought, with improvement or remission often occurring in late adolescence. Abnormalities of central nervous system dopamine metabolism may be involved in the pathophysiology of the tic disorders.
Neurobiological correlates of learning disabilities.
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Tics and tremors.
Tics are the most common movement disorder of childhood. The single tic, or habit spasm, is benign and self-limited. Complex tic disorders include other features such a multiple tics, vocal tics, and complex stereotyped movements. Tourette syndrome represents the most-severe end of a spectrum of tic disorders. The basic features are multiple tics and vocalizations with a changing repertoire over time. Severity waxes and wanes spontaneously. Treatment with haloperidol is effective but associated with a high incidence of side effects. Some cases undergo remission in late adolescence. There is a strong genetic component. Sympathomimetic drugs may precipitate the syndrome. Tremors are less common in children. Essential tremor is a benign but troublesome condition which frequently is familial. Treatment with propranolol is effective. The majority of tremors in the pediatric age group are due to underlying metabolic, endocrine, or heredodegenerative disorders. Treatment is that of the underlying biochemical abnormality.
Movement disorders in children: Tourette syndrome.
Movement disorders in childhood are rare, but their occurrence is dramatic and frightening. Differential diagnosis depends primarily on a detailed evaluation of the history and an analysis of the characteristics of the movements. Tics are the most common movement disorder in childhood, ranging in severity for simple transient tics to the complex Tourette syndrome, which may be associated with many bizarre behaviors. Minimal defining characteristics of Tourette syndrome are the presence of multiple motor and vocal tics. Associated features may include echolalia, coprolalia, complex stereotyped movements, and compulsive behavior. There is a prominent familial occurrence of Tourette syndrome. Stimulant drugs may cause exacerbation of symptoms. The only consistency useful medication is haloperidol, but its use is associated with side effects in approximately 50% of the patients treated.
Tourette syndrome in children: ethnic and genetic factors and response to stimulant drugs.
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Asterixis associated with sodium valproate.
Intoxication with most anticonvulsants can produce asterixis. Asterixis rarely occurs with therapeutic serum anticonvulsant levels. We report two patients with asterixis who were taking valproic acid and had serum levels within the therapeutic range. Neither patient had clinical or laboratory evidence of hepatotoxicity. Only one other patient has been reported with valproate-associated asterixis in the absence of toxic serum drug levels or hepatotoxicity. Asterixis seems to be due to a central effect of the drug unrelated to hepatotoxicity or sedation.
Gilles de la Tourette's syndrome.
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Tourette syndrome in mentally retarded children.
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Nonstandard therapies in the developmental disabilities.
The complexity of management issues with regard to developmentally disabled children has led to a broad acceptance of a number of therapeutic approaches that purport to be effective for a wide range of problems. These are generally empiric in origin, and the efficacy of most of them cannot be supported by controlled research studies. In addition, there has been little or no investigation of potential or actual side effects. Acceptance of new therapies and validation of older approaches need to be based on appropriately designed, controlled studies.
Handedness and right-left discrimination.
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Tics and Tourette syndrome.
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