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Biomedical subjects

S Shinnar

Publications and source records attributed to S Shinnar.

123 records · Page 7Linked to original sources
PubMed1985

Discontinuing antiepileptic medication in children with epilepsy after two years without seizures. A prospective study.

Antiepileptic medications were discontinued in 88 children with epilepsy of various causes who had been free of seizures for two to four years. The subjects were then followed for six months to five years (mean, 22 months). Sixty-six (75 per cent) remained free of seizures. Electroencephalographic characteristics, type of seizure, and age at onset were important in predicting outcome. Specific electroencephalographic features (such as the presence or absence of slowing or spikes) were more predictive than simple classification of an electroencephalogram as normal or abnormal. A history of complex partial seizures that had been controlled for two years carried a relatively favorable prognosis (P less than 0.05), whereas a history of atypical febrile seizures carried a poor prognosis (P less than 0.05). The variable of a younger age at onset was also associated with a better outcome (P less than 0.05), but only if accompanied by electroencephalographic slowing. Altogether, six variables (the interaction of age at onset with electroencephalographic slowing, electroencephalographic spikes, atypical febrile seizures, complex partial seizures, electroencephalographic slowing, and electroencephalographic change) were statistically significant (P less than 0.05) in predicting outcome. We conclude that in most children with epilepsy who have been free of seizures for two or more years, antiepileptic medications can safely be discontinued, and that it is possible to predict reasonably well which children will remain free of seizures.

Adolescent↗
PubMed1985

Management of hydrocephalus in infancy: use of acetazolamide and furosemide to avoid cerebrospinal fluid shunts.

Despite its effectiveness, cerebrospinal shunting for hydrocephalus continues to be accompanied by considerable complications and morbidity. Medical therapy with acetazolamide 100 mg/kg/day and furosemide 1 mg/kg/day can be an effective alternative to shunting by halting progression of hydrocephalus until such time as sutures can become fibrosed and spontaneous arrest can occur. In an appropriately selected population older than 2 weeks with hydrocephalus of varied origin, our success rate in avoiding shunting is greater than 50%. The dramatic difference between the number of hospitalizations of patients with shunts and those treated medically, and the potential to avoid shunt dependence would appear to make an initial trial with medical therapy worthwhile.

Acetazolamide↗
PubMed1984

Cerebrospinal metastases in malignant childhood astrocytomas.

Over a period of five years, antemortem diagnosis of leptomeningeal spread was made in six of thirteen children with high grade astrocytomas. These included four of seven children with hemispheral tumors and two of six children with malignant brainstem gliomas. Leptomeningeal spread was diagnosed by the clinical picture and CSF profile. Meningeal spread occurred an average of 5 months (range 0-16) after initial diagnosis of tumor was made. Several patients responded well to local radiation and/or chemotherapy. Mean survival after evidence of meningeal spread was 7 months (range 2-16) with one patient still alive. Meningeal spread of malignant childhood astrocytomas appears to be common and should be sought for in these patients as local radiation is beneficial. Serious consideration should be given to a controlled trial of prophylactic craniospinal radiation in three tumors. The role of chemotherapy also requires further study.

Adolescent↗
PubMed1982

The diagnosis and management of headaches in childhood.

Chronic headaches are relatively common in children and adolescents. The majority of these are benign and do not reflect organic pathology. Diagnosis can usually be made by careful history and physical examination, and extensive laboratory investigations are rarely required. Most children can be managed with reassurance, simple analgesics, and mild sedation. For more severe cases, particularly of migraine, effective pharmacologic agents are available. The prognosis is favorable. Very few of these children go on to develop significant intracranial pathology, and the majority will remit spontaneously. A significant number, however, do have chronic headaches in adult life.

Adolescent↗
PubMedDate not supplied

Syncope in childhood.

The records of 108 children, ages 2 to 19 years (mean age 11.3 years), who were referred to the pediatric neurology and pediatric cardiology clinics for syncope, were reviewed. Sixty-six cases were identified retrospectively, and 42 prospectively. Syncope was defined as transient and complete loss of consciousness with no etiology determined at the time of presentation. The mean follow-up was 2.0 years. In 27 cases (25%), an etiology for syncope was found, including migraines in 12 cases (11%), seizures in 9 cases (8%), and cardiac arrhythmias in 6 cases (6%). All other cases were classified as vasovagal (neurocardiogenic). The past medical history, family history, clinical features of each syncopal episode, and diagnostic tests of each subject were correlated to final diagnosis. No clinical or historical features reliably distinguished children with vasovagal syncope from those with other etiologies. Children referred for the evaluation of syncope have a significant incidence of serious but treatable disorders, which should be actively sought.

Adolescent↗
PubMedDate not supplied

Cranial nerve palsies in Streptococcus pneumoniae meningitis.

Cranial nerve palsies are uncommon in nontuberculous bacterial meningitis. We report a patient with Streptococcus pneumoniae meningitis, multiple cranial nerve involvement, and cerebellar signs suggestive of basilar meningitis. Nontuberculous bacterial meningitis should be considered in the differential diagnosis of basilar meningitis.

Adolescent↗
PubMedDate not supplied

Epilepsy in children with mental retardation: a cohort study.

The cumulative risk of seizures and epilepsy was investigated in a prospectively identified cohort of 221 children with mental retardation (MR) born between 1951 and 1955 in Aberdeen, Scotland. By age 22 years, 33 (15%) had epilepsy. An additional 16 (7%) had had at least one seizure, but did not meet the criteria for epilepsy. The cumulative risk of epilepsy was 9, 11, 13, and 15% at 5, 10, 15, and 22 years, respectively. In children with MR and no associated disabilities, the cumulative risk of epilepsy was only 2.6, 3.2, 3.9, and 5.2% at 5, 10, 15, and 22 years. In children with MR and cerebral palsy (CP), the cumulative risk was 28, 31, and 38% at 5, 10, and 22 years. Children with a postnatal injury associated with MR had a cumulative risk of epilepsy of 53, 66, and 66% at 5, 10, and 15 years after the injury. By age 22 years, 39% had achieved 5-year seizure-free remission, including 56% of children with MR without associated disability, 47% of children with MR and CP, and 11% of children with a postnatal injury. We conclude that, in the absence of associated disability or postnatal injury, the risk of epilepsy in the retarded population is low. Epilepsy in this population also will frequently enter remission in later life.

Adolescent↗
PubMedDate not supplied

Classification of complex features of febrile seizures: interrater agreement.

As part of a prospective study of febrile seizures, three independent pediatric neurologists rated each of 100 febrile seizures for the presence of complex features: focality, long duration (greater than or equal to 10 min), and occurrence of multiple seizures. Seizure descriptions were assembled from all information available in the medical record and from a semistructured interview of a person who had witnessed the seizure. Interrater agreement assessed by kappa indicated excellent agreement with regard to whether the seizures were multiple or prolonged (kappa greater than or equal to 0.85) and fair to good agreement with regard to focality (kappa = 0.61-0.78). Disagreement occurred most often regarding assessment of focality. Reasons for disagreement included variation in interpretation of lateral eye deviation, staring episodes, and motor asymmetries in the context of a bilateral convulsion.

Child↗
PubMedDate not supplied

EEG abnormalities in children with a first unprovoked seizure.

We examined EEG findings from an ongoing study of 347 children with a first unprovoked seizure. EEGs were available in 321 (93%), and 135 (42%) had an abnormal EEG. EEG abnormalities included focal spikes (n = 77), generalized spike and wave discharges (n = 28), slowing (n = 43), and nonspecific abnormalities (n = 7). Abnormal EEGs were more common in children with remote symptomatic seizures (60%) than in those with idiopathic seizures (38%) (p < 0.003), more common in partial seizures (56%) than in generalized seizures (35%) (p < 0.001), and more common in children age > 3 years (52%) than in younger children (12%) (p < 0.001). Records including both awake and sleep tracings were available in 148 (46%) cases. For 122 (38%) only awake tracings and for 51 (16%) only sleep tracings were available. Fifty-nine (40%) of the 148 patients with both an awake and asleep tracing had abnormal EEGs. Of 50 such EEGs with epileptiform abnormalities, 15 (30%) demonstrated the abnormality either only while awake (n = 8) or only while asleep (n = 7). Of 17 patients with EEG slowing, 8 showed slowing only in the awake tracing and 9 showed slowing in both the awake and asleep tracing. Children with even a single unprovoked seizure have a high incidence of EEG abnormalities. Obtaining a combined awake and sleep EEG significantly increases the yield of EEG abnormalities. In children with an idiopathic first seizure, EEG abnormalities are associated with an increased risk of seizure recurrence.

Adolescent↗
PubMedDate not supplied

Edema associated with long-term valproate therapy.

Scattered reports of facial and limb edema have been reported, predominantly in the context of valproate (VPA)-induced hepatic injury. We report seven patients with edema associated with long-term VPA therapy in the absence of hepatic disease.

Adolescent↗