[Head injuries in children and adolescents: epidemiology and prevention].
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Adolescent↗
Biomedical subjects
O Papazian
Publications and source records attributed to O Papazian.
[Single photon emission computer tomography in the differential diagnosis of the paroxysmal clinical events in newborns].
Conventional computerized cranial tomography by single photon emission (TLCESF) is a nuclear medicine technique which makes use of a radioactive chemical complex to obtain a qualitative image of cerebral, cerebellar and brain-stem vascularization. This technique shows the changes in vascularization which occur between (decrease) and during (increase) the clinical events of paroxysmal epilepsy (ECP) in the area of origin. This technique is indicated in neonates with ECP which does not disappear on etiological treatment, where a non-epileptic cause cannot be ruled out on clinical grounds and where there are no associated encephalographic epileptic changes during the ECP.
Brain↗
Reversible dementia and apparent brain atrophy during valproate therapy.
Two children developed severe cognitive and behavioral deterioration suggestive of a degenerative disease while being treated with sodium valproate for idiopathic, localization-related epilepsy with centrotemporal spikes. Magnetic resonance imaging revealed marked central and generalized cortical and cerebellar atrophy. In both patients, clinical symptoms and signs cleared in a few weeks following valproate withdrawal. The magnetic resonance imaging appearance improved within 3 months in 1 of the patients and normalized in both after 6 and 12 months. No metabolic changes were associated with the clinical or imaging abnormalities. Although the mechanism of this rare idiosyncratic complication of valproate therapy is unknown, we advocate discontinuing valproate therapy in all epileptic patients with neuromental deterioration or brain atrophy of unknown etiology.
Atrophy↗
A simple maneuver to provoke benign neonatal sleep myoclonus.
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Diagnosis, Differential↗
[The development of electrocardiogram].
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Brain↗
[Cerebral congenital hypotonia].
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Brain↗
Transient neonatal myasthenia gravis.
Transient neonatal myasthenia gravis is a postsynaptic neuromuscular transmission defect occurring in 21% of infants born to women with active (and, less commonly, in remission) acquired myasthenia gravis. Although passive-transfer acetylcholine receptor (AChR) antibodies are found in the majority of these newborns, their pathogenic role is questionable because only some infants are symptomatic. Pathogenesis in infants without AChR antibodies is unknown. There is still no biologic marker for prenatal identification of this subpopulation of newborns, although HLA typing may be a promising tool. Sucking, swallowing, and respiratory difficulties are the most common presenting signs in the first day of life. Final diagnosis is done when administration of acetylcholinesterase agents transiently corrects the neuromuscular transmission defect. Serum AChR antibody titers follow the same pattern as their mothers. Supportive management and anticholinesterase agents prior to feedings are necessary in about 80% of patients. In the majority of infants the condition resolves spontaneously.
Autoantibodies↗
Common epileptic syndromes in children.
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Adolescent↗
Narcolepsy-cataplexy and gelastic-atonic seizures.
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Cataplexy↗
Rapid eye movement sleep alterations in myasthenia gravis.
The nocturnal sleep patterns of 10 patients with myasthenia gravis and five controls were recorded in the conventional manner for 7 hours on two consecutive nights. One patient was retested 4 weeks after institution of prednisone therapy. All the myasthenics had a significant disturbance in rapid eye movement (REM) sleep cycles. In the patient who was retested after clinically successful prednisone therapy, the REM sleep pattern had become normal. Since acetylcholine is the putative brain stem transmitter substance involved in the maintenance of REM sleep, our findings suggest a disturbed central mechanism of acetylcholine in myasthenia gravis.
Adult↗
Control of spasticity and involuntary movements--cerebellar stimulation.
By stimulating the medial aspect of the superior surface of the cerebellum with relatively short, low current stimulating pulses, spasticity and some involuntary movements have been reduced. Voluntary movements, as a result, are able to come through better; however, if the child has little voluntary ability, he is at least more relaxed, thus allowing the parents to care for him more easily. The children and adults with cerebral palsy have not been transformed from their previous status, although CCS has allowed them to become more independent, more ambulatory, and more communicative.
Cerebellum↗
[Evaluation of children with developmental disorders by evoked potentials and event-related potentials].
INTRODUCTION AND DEVELOPMENT: Evoked potentials evaluation of children with central nervous system developmental disorders o dysfunctions is better than clinical and imaging assessment for determination of: 1) conceptional age, 2) auditory and visual threshold, 3) integrity of sensory pathways, 4) neurologic motor outcome, and 5) course and evaluation of treatment of neurometabolic disorders. CONCLUSIONS: However, it is not the same for predicting or making the diagnosis of the majority of primary developmental disorders (autism, receptive and expressive language disorders, learning disability, attention deficit disorders and Gilles de la Tourette syndrome.
Asphyxia Neonatorum↗
[Syndrome of Ohtahara].
INTRODUCTION: A literature review using the term Ohtahara syndrome and early infantile epileptic encephalopathy revealed 51 cases. DEVELOPMENT: The characteristics of these cases were: 1) early onset of seizures; 2) tonic seizures; 3) poor response to treatment; 4) mental retardation; 5) poor prognosis; 6) burst-suppression EEG pattern; 7) evolution to West syndrome, and 8) multiple causes. These characteristics are non specific. No cause was found in most cases. The onset of seizures was between 7 hours and 86 days of age. The most frequent brain imaging abnormality was diffuse atrophy. ACTH was effective in a few cases and hemispherectomy was successful in one case. CONCLUSION: We believe that Ohtahara syndrome and early myoclonic encephalopathy are the same entity.
Epilepsy, Tonic-Clonic↗
[Lennox-Gastaut syndrome].
INTRODUCTION: The Lennox-Gestaut syndrome is classified as an epileptic syndrome shown by the presence of various types of generalized seizures (tonic, atonic and atypical absences) which appear at a certain age (1-8 years), with an interictal EEG showing an abnormally slow basic rhythm interrupted by slow spike-and-wave complexes (< 3 Hz) and progressive mental deterioration. DEVELOPMENT: From the aetiological point of view there are cryptogenic (25%) and symptomatic (75%) forms. There is a previous history of West syndrome in 9.4-30% of the symptomatic cases. The commonest types of seizures are tonic (17-95%), atypical absences (17-60%) and atonic (25-56%). The mixed form of an epileptic state with typical absences and tonic seizures is the most frequent (27%). Follow-up studies show that in 90% and 100% of cryptogenic and symptomatic patients, respectively, mental retardation develops and the initial seizures persist in 67% and 45% of the patients with cryptogenic and symptomatic forms respectively, when they become adults. CONCLUSIONS: There is still no successful treatment for these seizures and progressive mental deterioration occurs even when using the newer anti-epileptic drugs. Electrical stimulation of the vagus nerve seems a promising possibility but further experience is necessary.
Anticonvulsants↗
[New techniques used to monitor cerebral function in the newborn].
INTRODUCTION: Continuous display four channels EEG monitoring and near infrared spectroscopy (NIRS) are relatively new and valuable techniques used for continuous brain monitoring in the neonatal period. Supporting the value of continuous display four channels EEG monitoring in the evaluation of neonates with paroxysmal motor events is a study recently conducted at Miami Children s Hospital. DEVELOPMENT: In this study 30 events were captures in 88 hours of simultaneous continuous display four channels EEG monitoring and continuous video EEG telemetry recording in five patients. Fourteen of the events were consider epileptic and 16 were considered non epileptic after evaluation of the continuous display four channels EEG monitoring printed epochs. RESULTS: The continuous video EEG telemetry confirmed the diagnosis for all the events. Several studies attest to the usefulness of NIRS in neonates and in older children with pathologies similar to those seeing in neonates. CONCLUSIONS: 1. NIRS is the best method to monitor regional cerebral oxygen saturation; 2. Regional cerebral oxygen saturation values are primarily those of the venous circulation in the subcortical white matter below the sensor; 3. Values of regional oxygen saturation should be considered not independently but only relative as a change over time; 4. Decreased regional cerebral oxygen saturation may be a sign of impending or established hypoxemia or hypotension, increased cerebral metabolic demands, or a cerebral oxygenation or perfusion problem that involve only brain, and 5. NIRS should be used in conjunction with arterial oxygen saturation and pressure monitoring (to detect hypoxemia and hypotension), with EEG to detect increased cerebral metabolic demands (electroencephalographic seizures) and with anterior cerebral artery Doppler ultrasound to detect perfusion (decreased flow velocity) and oxygenation (constant flow velocity) problems that involve only the brain.
Cerebrovascular Circulation↗
[Acute autoimmune polyradiculoneuropathies].
Landry Guillain Barr Sthrol Syndrome (LGBS) is an acute autoimmune monophasic and selflimiting polyradiculoneuropathy affecting patients aged 19 to 59 years (1.7/100,000/year) more than below 18 year of age (0.8/100,000/year). Diagnostic criteria require: I. Progressive motor weakness of more than one limb, and II) absent muscle stretch reflexes. Features that strongly support the diagnosis are: 1. Cease of progression of weakness by 4 weeks, relative symmetrical involvement of the limbs, presence of mild sensory symptoms or signs, involvement of cranial nerves VII (50%) more than IX, X, III, IV and VI, recovery within 2 to 3 weeks after progression stop, presence of autonomic dysfunction, and absent of fever at onset; 2. Cerebral spinal fluid elevation of protein after first week of symptoms and less than 10 mononuclear leukocytes/mm3 except HIV seropositive patients (<50 cells/mm3), and 3. Nerve conduction slowing (<60% of normal ) or block at some point during the illness (80%), and increased distal motor latency up to 3 times above normal and F wave latency. There are four well defined clinical, pathological, neurophysiological and serological subtypes. Acute inflamatory demyelinating polyradiculoneuropathy (90%) and Miller Fisher syndrome (5%) are primarily demyelinating. Acute motor axonal neuropathy and acute motor sensory axonal neuropathy are primarily axonal (5%). Treatment includes supportive care and immunotherapy with high doses of intravenous IgG and plasmapheresis.
Autoantibodies↗
[Neurophysiological evaluation of children with peripheral neuropathy].
OBJECTIVE: The purpose of this review is to demostrate the value and limitations of neurophysiological evaluation of children with peripheral neuropathy. DEVELOPMENT: The neurophysiological evaluation (NPE) is an extension of the neurologic examination. The NPE has a high diagnostic sensitiviy but lacks etiologic specificity. The NPE includes motor and sensory nerve conduction velocity studies (NCV), needle EMG, somatosensory evoked potential (SEP) and motor evoked potential (MEP). The NCV allows to determine the component of the peripheral nerve fiber involved (axon and/or myelin), type of fibers affected (motor and/or sensory), the location of the lesion (proximal and/or distal) and the pattern of the nerve involvement (segmental or continuos). The EMG allows to determine the presence and degree of denervation and reinervation. CONCLUSIONS: The combination of NCV, EMG, SEP and MEP allow: 1. To localize a lesion to the diferent regions of the peripheral nervous system (preganglionic and/or postganglionic segments of dorsal root, ventral root, spinal nerve, plexus and peripheral nerves); 2. To determine severity and prognosis; 3. To select candidates for reconstructive exploratory surgery; and 4. To determine treatment efficacy and/or natural course of the disease
Child↗