- Email: [email protected]
OP28 – 2809: Structural MRI, transcranial magnetic stimulation, magnetoencephalography and DTI tractography findings in relation to sensorimotor outcome after perinatal stroke
EUROPEAN JOURNAL O F PAEDIATRIC NEUROLOGY
investigator expert reviews defined stroke etiology diagnostic categories. Tortuosity scores were compared between definitive dissection (spontaneous and traumatic), FCA, moyamoya, meningitis, and cardioembolic (disease controls) and healthy controls (ANOVA, post-hoc pair-wise Tukey). Results: A total of 116 children were studied (median age 10.1 years, 57% male). Age and gender were comparable across groups. Software-generated tortuosity score means and variances were consistent with previous adult validation studies and intra-rater reliability was excellent (intraclass correlation >0.97). Tortuosity scores in healthy controls (1.333±0.039, n=15) were comparable to moyamoya (1.324±0.038, p=0.998, n=15), meningitis (1.348±0.052, p=0.989, n=12) and cardioembolic (1.379±0.056, p=0.190, n=27) cases. Tortuosity was higher in both dissection (1.398±0.072, p=0.021, n=22) and FCA (1.421±0.076, p=0.001, n=25) children. Tortuosity scores did not differ between traumatic (1.391±0.036, n=9) and atraumatic (1.403±0.090, p=0.671, n=13) dissection cases. Conclusion: Children with dissection have more tortuous arteries. An association between FCA and increased tortuosity may suggest an inherent difference in vascular biology. Quantified arterial tortuosity may represent a clinically relevant imaging biomarker of pathophysiology in pediatric stroke.
OP26 - 2867 Recurrent stroke in toddlers and hemiplegic or atypical migraine in school aged children: Think of Moyamoya! A. Hackenberg, B. Plecko, N. Khan. Department of Pediatric Neurology, University Children’s Hospital, Zurich, Switzerland Objective: Characterization of clinical symptoms and disease course in children with Moyamoya angiopathy. Methods: Between 2011 and 2014 34 children and adolescents were treated in the Moyamoya Center in Zurich. Evaluation comprised a detailed history, neurologic and developmental status including pediatric stroke outcome measure (PSOM). Cerebral MRI and MR angiography (MRA), conventional cerebral angiography and H215O-PET with acetazolamid challenge were performed followed by individualized treatment. Results: Median age at symptom onset was 4 1/2 years (range 6 months–14 years). We found a female preponderance (female/male ratio 1.8/1). Diagnosis was Moyamoya disease in 18 and Moyamoya syndrome in 16 children. 5/16 Moyamoya syndromic children had Neurofibromatosis Type 1. Most but not all children presented with a transitory ischemic attack (TIA) or stroke. In 11 children headaches and migraine were the main complaint. Besides weakness and focal sensory deficits headache was often accompanied by peculiar and unspecific symptoms like short episodes of altered consciousness, involuntary movements, general weakness and falls. On presentation MRI revealed ischemic lesions in 21 cases. Cortical lesions were observed in 11 patients (mean age 2 years), subcortical in 10 patients (mean age 6 1/2 years). In 6 children under 3 years we found a rapid progressive angiopathy. Posterior circulation was involved in 10 patients, all of them were younger than 6 years. PSOM score tended to be higher in young children. Conclusion: Early diagnosis and surgical revascularisation are mandatory for stroke prevention in Moyamoya angiopathy, especially in young toddlers. In school aged children with migraines or chronic headaches accompanied by weakness, focal sensory deficits, altered consciousness or involuntary movements it is worthwhile to consider Moyamoya angiopathy as an important differential in the diagnostic assessment.
19s (2015) S1 – S152
S9
OP27 - 2989 Prevention of stroke in pediatric Moyamoya angiopathy: From diagnosis to multiple tailormade cerebral revascularisations N. Khan, A. Hackenberg, D. Deanovic, G. Warnock, A. Buck, G. Baltsavias. Moyamoya Center, Division of Pediatric Neurosurgery, Dept. of Surgery, University Children’s Hospital, Zurich, Switzerland Objective: Pediatric moyamoya is a rapidly progressive intracranial angiopathy affecting the anterior [internal carotid artery (ICA) bifurcation, middle (MCA), anterior (ACA)] and posterior (PCA) cerebral circulation. Headaches, transient Ischemic attacks (TIAs) and strokes are common initial presentations. We present the preoperative diagnostic workup, neurosurgical treatment and postoperative outcome in newly diagnosed patients referred to our Moyamoya Center, University Children’s Hospital Zurich. Methods: Thirty four children (female:male 21:13) diagnosed with Moyamoya angiopathy at a mean age of 7.7 years at time of surgery underwent preoperative workup and cerebral revascularisation between 2011 and 2014. Depending on clinical symptomatology, number of arterial territories involved on cerebral angiogram and extent of perfusion reserve deficits on H215-O PET with acetazolamide challenge, surgery was tailormade to each individual child. Results: Bilateral angiopathy was observed in 29 patients with involvement of MCA in all, ACA in 24 and PCA in 10. All but 2 patients were clinically symptomatic at time of surgery with all showing perfusion reserve deficits after acetazolamideH215O-PET in one or more affected arterial territories. Hundred and five revascularisations were performed with 41 in ACA (bilateral in19 patients), 54 in MCA (bilateral in 23 patients) and 10 in PCA territories (bilateral in 1 patient). Multiple combined direct (EC-IC bypass: extracranial to intracranial bypass) and indirect cerebral revascularisation procedures (EDAS: encephaloduro-arterio- synangiosis, EGPMS: encephalo-galeaperiost-myosynangiosis and EDS: encephalo- duro-synangiosis) were procedures of choice. There were no perioperative complications. All patients remain stroke free at 1.6 years (1 month to 3 years) follow-up. TIAs and headaches have continued in 2/33 (0.06%) and 3/33 (0.09%) patients but with reduced intensity and frequency. Long term follow-up (up to age of 18 years) continues. Conclusion: Early systematic diagnostic workup is essential in pediatric moyamoya. Individualised tailor made multiple cerebral revascularisations are effective in prevention of future strokes.
OP28 - 2809 Structural MRI, transcranial magnetic stimulation, magnetoencephalography and DTI tractography findings in relation to sensorimotor outcome after perinatal stroke S. Lõo, L. Kuusela, L. Valanne, S. Vaalto, P. Nevalainen, L. Lauronen, H. Mäenpää. Department of Paediatric Neurology, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland Objective: Despite the frequency and importance of sensorimotor deficits after perinatal stroke (PS), the correlation between brain damage and severity of hemiparesis remains unclear. We aimed to investigate inter-relations between stroke topography, (re)organization of motor and sensory pathways, and clinical grade of hemiparesis in children with PS. Methods: Seven children (3 boys; age 12–18 years) with mild to profound upper limb impairment (MACS I-V) after left-sided PS were enrolled. 3T structural MRI scans were reviewed to define vascular origin and extent of the infarction. Information about gestational age, delivery, and type of presentation, were collected from patient records. Navigated transcranial magnetic stimulation (nTMS) was used to map cortical hand muscle representations. The integrity of thalamocortical pathways was evaluated with somatosensory evoked magnetic fields to electrical median nerve stimulation and tractography based on regions of interest defined by neuroradiologist.
S10
EUROPEAN JOURNAL O F PAEDIATRIC NEUROLOGY
Asymmetry of tract volume (TV), tract mean fractional anisotropy and mean diffusivity (MD) were estimated. Somatosensory responses were assessed by Semmes-Weinstein monofilaments. Results: In two children with unilateral truncal middle cerebral artery (MCA) infarctions, moderate to severe hemiparesis (MACS II-III; sensory deficits in one) was associated with ipsilateral motor and contralateral somatosensory representation of the paretic hand. In a child with proximal MCA stroke, profound hemiplegia with sensory impairment (MACS V) was found in relation to purely contralateral motor and somatosensory projections, distinguished by decreased ipsilesional thalamocortical TV and increased MD in comparison to other subjects. While MEG showed contralateral somatosensory representation in four children with periventricular venous infarctions, who had less severe hemiparesis (MACS I-II, no sensory deficits), nTMS revealed bilateral motor representation. Conclusion: Distinct (re)organization patterns after different subtypes of PS are demonstrated by modern neuroimaging techniques, which complement structural MRI in the prediction of severity of hemiparesis after PS.
OP29 - 2815 Brain stimulation and constraint for perinatal stroke hemiparesis: The PLASTIC CHAMPS trial A. Kirton, J. Andersen, M. Herrero, L. Carsolio, A. Nettel-Aguirre, J. Keess, O. Damji, A. Mineyko, J. Hodge, M.D. Hill. Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada Objective: Perinatal stroke causes hemiparetic cerebral palsy and lifelong disability. Constraint-induced movement therapy (CIMT) can improve motor function in congenital hemiparesis and adult stroke. Repetitive transcranial magnetic stimulation (rTMS) may improve motor function in adult stroke. The two have not been formally tested in perinatal stroke hemiparesis. Methods: PLASTIC CHAMPS (www.clinicaltrials.gov/NCT01189058) was a blinded, controlled, factorial trial of rTMS and CIMT in perinatal stroke hemiparesis. Children 6–18 years participated in a 2 week, goal-directed, peer-supported, motor learning camp. Subjects were randomized to daily inhibitory rTMS (1Hz, 1200 stimulations) over contralesional primary motor cortex, CIMT, both or neither. Primary outcomes were the Assisting Hand Assessment (AHA) and Canadian Occupational Performance Measure (COPM) at 1 week, 2 months, and 6 months. Additional outcomes included the Melbourne Assessment, quality-of-life, safety and tolerability. Corticospinal tract arrangement was defined using single-pulse TMS. Intent-to-treat analysis assessed change across treatment groups over time (ANOVA, linear mixed effects model). Results: All forty-five children completed the trial (median 11.4 years). Across all subjects, COPM performance and satisfaction scores increased >100% with sustained, maximal gains at 6 months (p<0.002). Addition of rTMS and/or CIMT doubled the chances of clinically significant AHA gains (>5 logit units). Combined rTMS+CIMT resulted in larger AHA gains at all time points (6 months p=0.006). CIMT alone increased AHA at 2 months (p=0.007), rTMS alone increased AHA at 1 week (p=0.002). Neither treatment decreased unaffected hand function. Affected hand function did not decrease with rTMS in children with ipsilateral corticospinal tract arrangements. Procedures were well tolerated. Conclusion: Children with hemiparesis participating in intensive, psychosocial rehabilitation programs perceive marked and sustained increases in goal-specific function. Non-invasive brain stimulation trials are feasible in children with CP. Contralesional inhibitory rTMS may enhance motor learning therapy in children with perinatal stroke.
19s (2015) S1 – S152
OP30 - 2317 Vitamin D status in children with headache: A case-control study F.M. Sonmez, A. Donmez, M. Namuslu, M. Canbal, E. Orun, B. Isik. Prof. Turgut Ozal University, Faculty of Medicine, Dept. of Child Neurology, Ankara,Turkey Objective: Vitamin D is a fat soluble vitamin with hormonal properties, plays crucial functions in bone and mineral metabolism and has important regulatory functions in brain development, cell differentiation and apoptosis. There are associations between vitamin D deficiency and a number of neurological and psychological conditions. In this study, we investigated the relationship between headache and vitamin D deficiency in pediatric patients suffering from headache, and considered the effect of high solar-exposure (HSE) and low solar-exposure (LSE). Materials and methods: In this study, 150 patients with headache and 101 healthy controls (5–16 years of age) were evaluated. Patient data were investigated retrospectively and included the following measures: physical examination, EEG, neuroimaging studies, Calcium, Phosphor, Alkaline phosphates, Parathyroid hormone, and 25-OH Vitamin D levels. Patient and control groups were divided into two separate sub-groups based on presentation to the clinic in either LSE or HSE months. Results: 25-OH Vitamin D levels of the group with headache and headache subtypes (migraine, tension-type headache) were significantly lower than that of the control group (17.09±9.46, 17.35±9.02, 16.99±9.91 and 38±12.80, respectively p<0.05). This difference was also seen in HSE and LSE groups (p<0.05). Furthermore, levels were lower in migraine patients than in control group in HSE and in the tension-type headache group in LSE (p<0.05). Conclusion: There is a relationship between vitamin D deficiency and headache, with particular significance in LSE. Therefore, vitamin D deficiency should be evaluated when investigating headache in children.
Thursday, 28 May 2015 Free paper session 4: Cerebral Palsy / Neurorehabilitation OP31 - 2974 Magnetic resonance imaging findings in children with dyskinetic CP consequent to severe neonatal hyperbilirubinemia A.G. Saini, P. Singhi, N. Sankhyan, C. Ahuja, N. Khandelwal. Department of Pediatrics, PGIMER, Chandigarh, India Objective: To evaluate clinical and cranial magnetic-resonanceimaging (MRI) findings in dyskinetic children with serious hyperbilirubinemia. Methods: Perinatal details, neurological examination and MRI were evaluated in 52 children with dyskinetic CP and kernicterus, aged 1–14 years over 2 years from North India. Results: Mean age at presentation was 34.9±31.2 months; common reasons were global delay (90%), abnormal twisting postures (52%) and speech difficulties (27%). Majority were males (N=39)75%, first-borns (N=24)46% and term-gestation (N=40)77%. Mean birth weight was 2680±600 gm. Mean age of onset of neonatal-jaundice was 3.4±1.1day; mean serum bilirubin was 31.2±7.5 mg/dL. Most (92%,N=48) neonates received phototherapy, 75% (N=39) underwent exchange-transfusion (once in 44%, twice in 27%), 29% (N=15) were G-6-PD deficient and 29% (N=15) had Rh-isoimmunization. In (N=20)38% neonates, post-natal course was complicated by sepsis (25%), meningitis (10%), hypoglycaemia (10%), seizures (4%) and respiratory distress (6%). Of dyskinetic CP, 87% (N=45) had dystonic subtype, 10% (N=5) choreo-athetoid and 2% (N=1) mixed features; one child was neurologically normal. Abnormal brain-stem-evokedresponse (N=38, 73%), upgaze palsy (N=36, 69%), tooth-enamel
investigator expert reviews defined stroke etiology diagnostic categories. Tortuosity scores were compared between definitive dissection (spontaneous and traumatic), FCA, moyamoya, meningitis, and cardioembolic (disease controls) and healthy controls (ANOVA, post-hoc pair-wise Tukey). Results: A total of 116 children were studied (median age 10.1 years, 57% male). Age and gender were comparable across groups. Software-generated tortuosity score means and variances were consistent with previous adult validation studies and intra-rater reliability was excellent (intraclass correlation >0.97). Tortuosity scores in healthy controls (1.333±0.039, n=15) were comparable to moyamoya (1.324±0.038, p=0.998, n=15), meningitis (1.348±0.052, p=0.989, n=12) and cardioembolic (1.379±0.056, p=0.190, n=27) cases. Tortuosity was higher in both dissection (1.398±0.072, p=0.021, n=22) and FCA (1.421±0.076, p=0.001, n=25) children. Tortuosity scores did not differ between traumatic (1.391±0.036, n=9) and atraumatic (1.403±0.090, p=0.671, n=13) dissection cases. Conclusion: Children with dissection have more tortuous arteries. An association between FCA and increased tortuosity may suggest an inherent difference in vascular biology. Quantified arterial tortuosity may represent a clinically relevant imaging biomarker of pathophysiology in pediatric stroke.
OP26 - 2867 Recurrent stroke in toddlers and hemiplegic or atypical migraine in school aged children: Think of Moyamoya! A. Hackenberg, B. Plecko, N. Khan. Department of Pediatric Neurology, University Children’s Hospital, Zurich, Switzerland Objective: Characterization of clinical symptoms and disease course in children with Moyamoya angiopathy. Methods: Between 2011 and 2014 34 children and adolescents were treated in the Moyamoya Center in Zurich. Evaluation comprised a detailed history, neurologic and developmental status including pediatric stroke outcome measure (PSOM). Cerebral MRI and MR angiography (MRA), conventional cerebral angiography and H215O-PET with acetazolamid challenge were performed followed by individualized treatment. Results: Median age at symptom onset was 4 1/2 years (range 6 months–14 years). We found a female preponderance (female/male ratio 1.8/1). Diagnosis was Moyamoya disease in 18 and Moyamoya syndrome in 16 children. 5/16 Moyamoya syndromic children had Neurofibromatosis Type 1. Most but not all children presented with a transitory ischemic attack (TIA) or stroke. In 11 children headaches and migraine were the main complaint. Besides weakness and focal sensory deficits headache was often accompanied by peculiar and unspecific symptoms like short episodes of altered consciousness, involuntary movements, general weakness and falls. On presentation MRI revealed ischemic lesions in 21 cases. Cortical lesions were observed in 11 patients (mean age 2 years), subcortical in 10 patients (mean age 6 1/2 years). In 6 children under 3 years we found a rapid progressive angiopathy. Posterior circulation was involved in 10 patients, all of them were younger than 6 years. PSOM score tended to be higher in young children. Conclusion: Early diagnosis and surgical revascularisation are mandatory for stroke prevention in Moyamoya angiopathy, especially in young toddlers. In school aged children with migraines or chronic headaches accompanied by weakness, focal sensory deficits, altered consciousness or involuntary movements it is worthwhile to consider Moyamoya angiopathy as an important differential in the diagnostic assessment.
19s (2015) S1 – S152
S9
OP27 - 2989 Prevention of stroke in pediatric Moyamoya angiopathy: From diagnosis to multiple tailormade cerebral revascularisations N. Khan, A. Hackenberg, D. Deanovic, G. Warnock, A. Buck, G. Baltsavias. Moyamoya Center, Division of Pediatric Neurosurgery, Dept. of Surgery, University Children’s Hospital, Zurich, Switzerland Objective: Pediatric moyamoya is a rapidly progressive intracranial angiopathy affecting the anterior [internal carotid artery (ICA) bifurcation, middle (MCA), anterior (ACA)] and posterior (PCA) cerebral circulation. Headaches, transient Ischemic attacks (TIAs) and strokes are common initial presentations. We present the preoperative diagnostic workup, neurosurgical treatment and postoperative outcome in newly diagnosed patients referred to our Moyamoya Center, University Children’s Hospital Zurich. Methods: Thirty four children (female:male 21:13) diagnosed with Moyamoya angiopathy at a mean age of 7.7 years at time of surgery underwent preoperative workup and cerebral revascularisation between 2011 and 2014. Depending on clinical symptomatology, number of arterial territories involved on cerebral angiogram and extent of perfusion reserve deficits on H215-O PET with acetazolamide challenge, surgery was tailormade to each individual child. Results: Bilateral angiopathy was observed in 29 patients with involvement of MCA in all, ACA in 24 and PCA in 10. All but 2 patients were clinically symptomatic at time of surgery with all showing perfusion reserve deficits after acetazolamideH215O-PET in one or more affected arterial territories. Hundred and five revascularisations were performed with 41 in ACA (bilateral in19 patients), 54 in MCA (bilateral in 23 patients) and 10 in PCA territories (bilateral in 1 patient). Multiple combined direct (EC-IC bypass: extracranial to intracranial bypass) and indirect cerebral revascularisation procedures (EDAS: encephaloduro-arterio- synangiosis, EGPMS: encephalo-galeaperiost-myosynangiosis and EDS: encephalo- duro-synangiosis) were procedures of choice. There were no perioperative complications. All patients remain stroke free at 1.6 years (1 month to 3 years) follow-up. TIAs and headaches have continued in 2/33 (0.06%) and 3/33 (0.09%) patients but with reduced intensity and frequency. Long term follow-up (up to age of 18 years) continues. Conclusion: Early systematic diagnostic workup is essential in pediatric moyamoya. Individualised tailor made multiple cerebral revascularisations are effective in prevention of future strokes.
OP28 - 2809 Structural MRI, transcranial magnetic stimulation, magnetoencephalography and DTI tractography findings in relation to sensorimotor outcome after perinatal stroke S. Lõo, L. Kuusela, L. Valanne, S. Vaalto, P. Nevalainen, L. Lauronen, H. Mäenpää. Department of Paediatric Neurology, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland Objective: Despite the frequency and importance of sensorimotor deficits after perinatal stroke (PS), the correlation between brain damage and severity of hemiparesis remains unclear. We aimed to investigate inter-relations between stroke topography, (re)organization of motor and sensory pathways, and clinical grade of hemiparesis in children with PS. Methods: Seven children (3 boys; age 12–18 years) with mild to profound upper limb impairment (MACS I-V) after left-sided PS were enrolled. 3T structural MRI scans were reviewed to define vascular origin and extent of the infarction. Information about gestational age, delivery, and type of presentation, were collected from patient records. Navigated transcranial magnetic stimulation (nTMS) was used to map cortical hand muscle representations. The integrity of thalamocortical pathways was evaluated with somatosensory evoked magnetic fields to electrical median nerve stimulation and tractography based on regions of interest defined by neuroradiologist.
S10
EUROPEAN JOURNAL O F PAEDIATRIC NEUROLOGY
Asymmetry of tract volume (TV), tract mean fractional anisotropy and mean diffusivity (MD) were estimated. Somatosensory responses were assessed by Semmes-Weinstein monofilaments. Results: In two children with unilateral truncal middle cerebral artery (MCA) infarctions, moderate to severe hemiparesis (MACS II-III; sensory deficits in one) was associated with ipsilateral motor and contralateral somatosensory representation of the paretic hand. In a child with proximal MCA stroke, profound hemiplegia with sensory impairment (MACS V) was found in relation to purely contralateral motor and somatosensory projections, distinguished by decreased ipsilesional thalamocortical TV and increased MD in comparison to other subjects. While MEG showed contralateral somatosensory representation in four children with periventricular venous infarctions, who had less severe hemiparesis (MACS I-II, no sensory deficits), nTMS revealed bilateral motor representation. Conclusion: Distinct (re)organization patterns after different subtypes of PS are demonstrated by modern neuroimaging techniques, which complement structural MRI in the prediction of severity of hemiparesis after PS.
OP29 - 2815 Brain stimulation and constraint for perinatal stroke hemiparesis: The PLASTIC CHAMPS trial A. Kirton, J. Andersen, M. Herrero, L. Carsolio, A. Nettel-Aguirre, J. Keess, O. Damji, A. Mineyko, J. Hodge, M.D. Hill. Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada Objective: Perinatal stroke causes hemiparetic cerebral palsy and lifelong disability. Constraint-induced movement therapy (CIMT) can improve motor function in congenital hemiparesis and adult stroke. Repetitive transcranial magnetic stimulation (rTMS) may improve motor function in adult stroke. The two have not been formally tested in perinatal stroke hemiparesis. Methods: PLASTIC CHAMPS (www.clinicaltrials.gov/NCT01189058) was a blinded, controlled, factorial trial of rTMS and CIMT in perinatal stroke hemiparesis. Children 6–18 years participated in a 2 week, goal-directed, peer-supported, motor learning camp. Subjects were randomized to daily inhibitory rTMS (1Hz, 1200 stimulations) over contralesional primary motor cortex, CIMT, both or neither. Primary outcomes were the Assisting Hand Assessment (AHA) and Canadian Occupational Performance Measure (COPM) at 1 week, 2 months, and 6 months. Additional outcomes included the Melbourne Assessment, quality-of-life, safety and tolerability. Corticospinal tract arrangement was defined using single-pulse TMS. Intent-to-treat analysis assessed change across treatment groups over time (ANOVA, linear mixed effects model). Results: All forty-five children completed the trial (median 11.4 years). Across all subjects, COPM performance and satisfaction scores increased >100% with sustained, maximal gains at 6 months (p<0.002). Addition of rTMS and/or CIMT doubled the chances of clinically significant AHA gains (>5 logit units). Combined rTMS+CIMT resulted in larger AHA gains at all time points (6 months p=0.006). CIMT alone increased AHA at 2 months (p=0.007), rTMS alone increased AHA at 1 week (p=0.002). Neither treatment decreased unaffected hand function. Affected hand function did not decrease with rTMS in children with ipsilateral corticospinal tract arrangements. Procedures were well tolerated. Conclusion: Children with hemiparesis participating in intensive, psychosocial rehabilitation programs perceive marked and sustained increases in goal-specific function. Non-invasive brain stimulation trials are feasible in children with CP. Contralesional inhibitory rTMS may enhance motor learning therapy in children with perinatal stroke.
19s (2015) S1 – S152
OP30 - 2317 Vitamin D status in children with headache: A case-control study F.M. Sonmez, A. Donmez, M. Namuslu, M. Canbal, E. Orun, B. Isik. Prof. Turgut Ozal University, Faculty of Medicine, Dept. of Child Neurology, Ankara,Turkey Objective: Vitamin D is a fat soluble vitamin with hormonal properties, plays crucial functions in bone and mineral metabolism and has important regulatory functions in brain development, cell differentiation and apoptosis. There are associations between vitamin D deficiency and a number of neurological and psychological conditions. In this study, we investigated the relationship between headache and vitamin D deficiency in pediatric patients suffering from headache, and considered the effect of high solar-exposure (HSE) and low solar-exposure (LSE). Materials and methods: In this study, 150 patients with headache and 101 healthy controls (5–16 years of age) were evaluated. Patient data were investigated retrospectively and included the following measures: physical examination, EEG, neuroimaging studies, Calcium, Phosphor, Alkaline phosphates, Parathyroid hormone, and 25-OH Vitamin D levels. Patient and control groups were divided into two separate sub-groups based on presentation to the clinic in either LSE or HSE months. Results: 25-OH Vitamin D levels of the group with headache and headache subtypes (migraine, tension-type headache) were significantly lower than that of the control group (17.09±9.46, 17.35±9.02, 16.99±9.91 and 38±12.80, respectively p<0.05). This difference was also seen in HSE and LSE groups (p<0.05). Furthermore, levels were lower in migraine patients than in control group in HSE and in the tension-type headache group in LSE (p<0.05). Conclusion: There is a relationship between vitamin D deficiency and headache, with particular significance in LSE. Therefore, vitamin D deficiency should be evaluated when investigating headache in children.
Thursday, 28 May 2015 Free paper session 4: Cerebral Palsy / Neurorehabilitation OP31 - 2974 Magnetic resonance imaging findings in children with dyskinetic CP consequent to severe neonatal hyperbilirubinemia A.G. Saini, P. Singhi, N. Sankhyan, C. Ahuja, N. Khandelwal. Department of Pediatrics, PGIMER, Chandigarh, India Objective: To evaluate clinical and cranial magnetic-resonanceimaging (MRI) findings in dyskinetic children with serious hyperbilirubinemia. Methods: Perinatal details, neurological examination and MRI were evaluated in 52 children with dyskinetic CP and kernicterus, aged 1–14 years over 2 years from North India. Results: Mean age at presentation was 34.9±31.2 months; common reasons were global delay (90%), abnormal twisting postures (52%) and speech difficulties (27%). Majority were males (N=39)75%, first-borns (N=24)46% and term-gestation (N=40)77%. Mean birth weight was 2680±600 gm. Mean age of onset of neonatal-jaundice was 3.4±1.1day; mean serum bilirubin was 31.2±7.5 mg/dL. Most (92%,N=48) neonates received phototherapy, 75% (N=39) underwent exchange-transfusion (once in 44%, twice in 27%), 29% (N=15) were G-6-PD deficient and 29% (N=15) had Rh-isoimmunization. In (N=20)38% neonates, post-natal course was complicated by sepsis (25%), meningitis (10%), hypoglycaemia (10%), seizures (4%) and respiratory distress (6%). Of dyskinetic CP, 87% (N=45) had dystonic subtype, 10% (N=5) choreo-athetoid and 2% (N=1) mixed features; one child was neurologically normal. Abnormal brain-stem-evokedresponse (N=38, 73%), upgaze palsy (N=36, 69%), tooth-enamel