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HCP05 The ontogeny of melatonin production in infants with an apparent life threatening event
Abstracts: Poster Presentations, the Seventh European Paediatric Neurology Society (EPNS) Congress Results: Sixty-four parents whose children had a febrile convulsion for the first time (Group 1) and 61 parents whose children had a recurrent febrile convulsion (Group 2) completed the survey. Parents in both Group 1 and Group 2 were generally aware that febrile convulsion is a lifethreatening disease (81.2% and 90%), it could cause brain damage (90.6% and 100%), body temperature must be followed-up frequently in order to take fever under control (95.3% and 95%), and EEG and CT must be performed immediately (79.7% and 85.2%). Fourteen percent of parents in Group 1 tried to do cardiovascular resuscitation, while this ratio was 5% among parents in Group 2. As a conclusion, although parents whose children had recurrent episodes were more knowledgeable most of the parents in either group had insufficient information about the disease and inadequate first aid practice. HCP02 Risk factors for reccurence of febrile seizures and the development of epilepsy R. Gune¸ N. Senbil, ¸ Y. Gurer. Dr Sami ¨ s *, D. Yılmaz, D. Yuksel, ¨ ¨ Ulus Children’s Hospital, Department of Pediatric Neurology, Ankara, Turkey Febrile seizures (FS) are the most common neurological disease in pediatric neurology with an incidence of 2−5% of children. In this study, we investigated risk factors for reccurence of febrile seizures and the development of epilepsy. A total of 680 patients with FS were retrospectively analysed. The patients who had afebrile convulsions since onset or older than 6 years were excluded. In our study we found that after FS, developing epilepsy rate was 4%. The main factors in recurrence of FS were: family history of FS and fever under 40ºC. The risk factors for the development of epilepsy after febrile seizures were neurodevelopmental abnormality, consanguinity, having the first febrile attack under age one, eventful prenatal or natal history. Since the vast majority of children had a normal long-term outcome, antiepileptic medication was not recommended to prevent recurrence of febrile seizures and epilepsy. We found that 65.9% of EEGs were normal. EEG was unnecessary to predict the recurrence of febrile seizure and developing epilepsy. The probability of possible recurrences is low and the longterm prognosis is excellent. HCP03 The development of severe refractory epilepsy during rehabilitation after near-drowning is highly correlated with a disastrous prognosis S. Kenis2 *, J. van Rhijn1 , M. Boel1 , L. Schuddinck1 , M. Moens1 , B. Ceulemans2 . 1 Rehabilitation Centre for Children and Youth, Pulderbos, Belgium, 2 Department of Child Neurology, University hospital, Antwerp, Belgium Introduction: Long-term prognosis is difficult to predict shortly after near-drowning. We hypothesize that development of severe therapy-resistant epilepsy is highly correlated with a bad prognosis. Methods: We retrospectively reviewed 18 patients who came for long term residential rehabilitation to our centre and divided them into two groups, those who developed severe untreatable epilepsy and those who did not. Results: From the 18 patients 8 developed severe untreatable epilepsy, 6 of which died and 2 of which stabilised in a persistent vegetative status (PVS). Only 2 of the 10 patients who did not develop severe epilepsy died, 1 remained in a PVS, 3 developed a picture of severe quadriplegia yet remained in contact with and interacted with the environment, and 4 were able to walk again yet remained mentally disabled or developed learning difficulties.
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Both groups are comparable on most parameters including gender, circumstances and severity of brain lesions on central nerve imaging. The main difference between the two groups was that the median age at time of near-drowning was lower in the group with severe epilepsy (2 year 6 months versus 3 year 10 months). Conclusion: The development of severe refractory epilepsy during rehabilitation after near-drowning is a severe negative prognostic factor for the long term outcome of these children. HCP04 Neurological causes of apparent life threatening events G. Vlahovic *, M. Djuric, J. Martic, A. Sarajlija, G. Ristic. Mother and Child Health Care Institute, Belgrade, Serbia Introduction: Apparent life threatening event (ALTE) is defined as “an episode that is frightening to the observer and that is characterized by combination of apnoea, colour change, marked change in muscle tone, choking or gagging”. Different medical causes may be responsible for the initial clinical presentation, but in over 50% the cause of the event remains undetermined (“idiopathic ALTE”). Neurological problems account for about 30% of explained ALTEs. Aim of the study: to investigate neurological causes of ALTE. Methods: a retrospective-prospective study enrolled all infants admitted to our Institute with clinical presentation of ALTE episodes from 01.07.2003 to 01.04.2007. The evaluation of affected children involved a thorough description of the event, as well as prenatal, birth, medical, social and family history. Careful physical and neurological examination was performed. Laboratory and imaging study was performed on the basis of the history and physical examination. Results: During the study period a total of 80 infants met the diagnostic criteria for ALTE. Majority of them (76%) was infants younger then 3 months. Specific diagnosis which explains ALTE episode are made in 46, 7% children, and no diagnosis was reached in 43 cases (53, 3%). The most frequent causes of ALTE were gastrointestinal problems. Neurological problems were found in seven infants (8, 75%) seizures in 3 and vasovagal reflexes in 4 cases. EEG was performed in 61 infants; among them we have 49 normal, and 12 abnormal EEG (focal or generalized sharps and waves). Diagnosis of seizures was mostly based on the clinical history if EEG recordings were not diagnostic. Only one infant requires anticonvulsive therapy. The outcome of our ALTE patients is good, including 7 patients with neurological problems. Conclusion: Relatively low percent of neurological causes and substantial proportion of idiopathic ALTE could be explain by the fact that one part of our study was retrospective, in the time when we didn’t have standardized investigations protocols. A careful history, examination, standardized appropriate investigations, and multidisciplinary approach are necessary to establish causality for the ALTE. HCP05 The ontogeny of melatonin production in infants with an apparent life threatening event B.G. Strazisar1 *, B. Claustrat2 , D. Neubauer1 , J. Brun2 . 1 Department of Child Neurology, University Children’s Hospital, Vrazov trg 1, 1525 Ljubljana, Slovenia, 2 Service de Radioanalyse, Centre de MService de Radioanalyse, Centre de Madecine Nuclaaire, ´ ´ Hopital Neurologique, Lyon, France ˆ Objective: To evaluate the ontogeny of melatonin secretion in infants with an apparent life threatening event (ALTE) and to determine whether there are any differences in the ontogeny regarding the clinical classification of the ALTE. Methods: 24-hour urinary excretion of the major melatonin metabolite 6-sulfatoxymelatonin (aMT6s) was studied in 42 infants with ALTE at the event occurrence and followedup longitudinally at 3, 4.5, 6, 9 and 12 months of age.
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Abstracts: Poster Presentations, the Seventh European Paediatric Neurology Society (EPNS) Congress
Infants’ mean age-at-event was 8.6 weeks (SD 5.5 weeks, span from 0 to 28 weeks). Urine samples were taken at regular 4-hour intervals. Urinary aMT6s were determined by radioimmunoassay after dilution of the samples. Statistical analysis was performed using nonparametric tests (Wilcoxon, Kruskal-Wallis and Freidman two-way ANOVA tests). Results: ALTE was etiologically explained in 24 patients (57.1%) and the remaining 18 patients (42.9%) were included in the group of idiopathic ALTE. Between the two groups of patients, important differences in the ontogeny of melatonin secretion and its circadian rhythm were uncovered. At the age of 3 months total amount of 6SMT excreted in the urine was significantly lower in idiopathic as compared to that of the etiologically explained ALTE infants (p = 0.023). In the former a delay in the ontogeny of the circadian rhythm of melatonin secretion was also observed with statistically significant differences in nigh-time and daytime urinary values of 6SMT not being present earlier than 6 months of age (p = 0.010). Conclusion: Our data confirm delayed ontogeny of melatonin production in the idiopathic ALTE infants in comparison to those infants who’s ALTE can be etiologically explained suggesting that an impaired maturation of the photoneuroendocrine system might be involved in the pathogenesis of idiopathic ALTE. HCP06 Acute encephalopathy from lead poisoning: case report V. Tashko *, A. Haruni, A. Bushati. Pediatric Department, Neuropediatry, University Hospital Centre “Mother Theresa”, Tirana, Albania Introduction: Lead ingested by children can be gradually accumulated in their organism. About 40−50% of ingested lead is absorbed and 20−25% is accumulated in bones and soft tissues that serve as the lead reservoir. The lead is detected in the blood, urine and hairs. Acute encephalopathy represents the classic form of lead poisoning, when the blood lead level is about 150 mg /dl and urine ALA level is more than 20 mg/l. Vomiting, epigastric pain, cerebral ataxia are followed by the sudden onset of series of generalized convulsions, or by depression of consciousness and coma. Widespread interstitial edema occurs. 50% of the children survive but they have permanent neurological damages. Method: Is based on family history, clinic signs, urine lead and ALA (24 hours) level, EEG, fundus oculi, Cerebral Arteriography and CT scan of the head. Case Report: A girl of 8 years old was born and developed normally. No important diseases during her life. She represented vomiting, strong headache, generalized seizures 2−3 times a day for a week, temperature 38.5ºC, depression of consciousness and coma. After six days she is conscious, but has still seizures, profound visual loss and behavioral disorders. During examination she has nuchal rigidity, inferior paraparesis, palsies of the third and sixth cranial nerves. The treatment was: manitol, CaEDTA i.v., diazepam, phenobarbital, folic acid and vitamins. Discussion: Family history: parents and the sister with lead poisoning caused by flour grinded in the village corn-mill. <80 mg/l) and Lab evaluation: lead urine level 370 mg/l, (N urine level ALA 49−54 mg/l (N 7−8 mg/l) indicate the lead poisoning. The signs of increased intracranial pressure and coma indicate an acute encephalopathy, the severe form of the lead poisoning. This was confirmed by the fundus oculi with papilledema of the first to second stage, Cerebral Arteriography of. carotid artery of the left side with mild hydrocephaly, EEG with decreased voltage over the bilateral side, CT scan of the head with cerebral atrophy. The child was treated with chelating agent, anti edema and anticonvulsant drugs. She was recovered but the visual loss and recurrent
convulsions persisted. After some months the visual became normal, the child went to the school but she continues to be treated for epilepsy with two anticonvulsant drugs for five years. Conclusion: Ingested lead may cause in the children the acute encephalopathy with severe cerebral damages, so they must be treated for many years or for all the life. HCP07 Application of noofen in complex treatment of children with patrimonial traumas of CNS G. Tursunhodjaeva *, N. Abdumavljanova. Tashkent Pediatric Medical Institute, Uzbekistan Urgency: Noofen improves memory, intellectual activity, raises stability of a brain to harmful influences. Purpose: Will estimate efficiency of noofen in treatment of children with consequences of patrimonial traumas of CNS. Material and Methods of research: 20 patients taking place on treatment in neurological branch, in the age of 1−3 years, with consequences of patrimonial traumas of CNS are surveyed. All patients received noofen in a dose 0.15? 3 times day within 30 days. Results of research: Noofen at intake it is quickly soaked up, will penetrate through hematoencephalic barrier. Treatment of 20 children with consequences of patrimonial traumas of nervous system showed positive results. The most expressed positive effect was observed at patients with a delay of psycho-speech development and cognitive functions. Reception of noofen in complex treatment caused positive changes in behavior and cognitive activity. Children became quieter, better concentrated and fixed the attention, improvement of speech functions and behavior was marked also. Conclusions: Application of noofen at children of 1−3 years with consequences of patrimonial traumas of CNS has given a positive effect in complex therapy and it dictates its wide application. HCP08 Spinal injuries and associated trauma in children M.S. Bavil *. Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Iran Background and Objective: Pediatric spinal injuries, although rare, are associated with the higher mortality rate of all orthopedic injuries in children. Because of diagnostic difficulty and high frequency of other organs injuries, in children, spinal injury may be missed. Materials and Methods: A 10 year cross-sectional retrospective study was undertaken of all pediatrics treated for a spinal injury at our institute. Results: A total of 40 patients had a documented diagnosis of spinal injury in 10 years. The patients ranged in age from 2−15 years, 62.5% of the patients were male. The average Glasgow score (GCS) was 14 (range 3−15). The mean hospital stay was 10.9 days. The area most commonly injured was the cervical spine. The most common mechanism of injury was motor vehicle accident and 61.5% of patients suffered one or more concomitant injuries. Conclusion: The spine injury is vulnerable in children due to the biomechanical and anatomical features. Although it is rare in children, the cervical area injured commonly and concomitant injury is higher. HCP09 Ophthalmoscopy
A 7-step program
J. Dooley *, K. Gordon . Dalhousie University, 2 IWK Health Centre, Canada 1
2
1
Objectives: Fundoscopy is viewed as a difficult or impossible task by many students and physicians. We have used a novel 7 step approach to teach trainees to use the ophthalmoscope. The technique is based on the premise that success is most
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Both groups are comparable on most parameters including gender, circumstances and severity of brain lesions on central nerve imaging. The main difference between the two groups was that the median age at time of near-drowning was lower in the group with severe epilepsy (2 year 6 months versus 3 year 10 months). Conclusion: The development of severe refractory epilepsy during rehabilitation after near-drowning is a severe negative prognostic factor for the long term outcome of these children. HCP04 Neurological causes of apparent life threatening events G. Vlahovic *, M. Djuric, J. Martic, A. Sarajlija, G. Ristic. Mother and Child Health Care Institute, Belgrade, Serbia Introduction: Apparent life threatening event (ALTE) is defined as “an episode that is frightening to the observer and that is characterized by combination of apnoea, colour change, marked change in muscle tone, choking or gagging”. Different medical causes may be responsible for the initial clinical presentation, but in over 50% the cause of the event remains undetermined (“idiopathic ALTE”). Neurological problems account for about 30% of explained ALTEs. Aim of the study: to investigate neurological causes of ALTE. Methods: a retrospective-prospective study enrolled all infants admitted to our Institute with clinical presentation of ALTE episodes from 01.07.2003 to 01.04.2007. The evaluation of affected children involved a thorough description of the event, as well as prenatal, birth, medical, social and family history. Careful physical and neurological examination was performed. Laboratory and imaging study was performed on the basis of the history and physical examination. Results: During the study period a total of 80 infants met the diagnostic criteria for ALTE. Majority of them (76%) was infants younger then 3 months. Specific diagnosis which explains ALTE episode are made in 46, 7% children, and no diagnosis was reached in 43 cases (53, 3%). The most frequent causes of ALTE were gastrointestinal problems. Neurological problems were found in seven infants (8, 75%) seizures in 3 and vasovagal reflexes in 4 cases. EEG was performed in 61 infants; among them we have 49 normal, and 12 abnormal EEG (focal or generalized sharps and waves). Diagnosis of seizures was mostly based on the clinical history if EEG recordings were not diagnostic. Only one infant requires anticonvulsive therapy. The outcome of our ALTE patients is good, including 7 patients with neurological problems. Conclusion: Relatively low percent of neurological causes and substantial proportion of idiopathic ALTE could be explain by the fact that one part of our study was retrospective, in the time when we didn’t have standardized investigations protocols. A careful history, examination, standardized appropriate investigations, and multidisciplinary approach are necessary to establish causality for the ALTE. HCP05 The ontogeny of melatonin production in infants with an apparent life threatening event B.G. Strazisar1 *, B. Claustrat2 , D. Neubauer1 , J. Brun2 . 1 Department of Child Neurology, University Children’s Hospital, Vrazov trg 1, 1525 Ljubljana, Slovenia, 2 Service de Radioanalyse, Centre de MService de Radioanalyse, Centre de Madecine Nuclaaire, ´ ´ Hopital Neurologique, Lyon, France ˆ Objective: To evaluate the ontogeny of melatonin secretion in infants with an apparent life threatening event (ALTE) and to determine whether there are any differences in the ontogeny regarding the clinical classification of the ALTE. Methods: 24-hour urinary excretion of the major melatonin metabolite 6-sulfatoxymelatonin (aMT6s) was studied in 42 infants with ALTE at the event occurrence and followedup longitudinally at 3, 4.5, 6, 9 and 12 months of age.
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Abstracts: Poster Presentations, the Seventh European Paediatric Neurology Society (EPNS) Congress
Infants’ mean age-at-event was 8.6 weeks (SD 5.5 weeks, span from 0 to 28 weeks). Urine samples were taken at regular 4-hour intervals. Urinary aMT6s were determined by radioimmunoassay after dilution of the samples. Statistical analysis was performed using nonparametric tests (Wilcoxon, Kruskal-Wallis and Freidman two-way ANOVA tests). Results: ALTE was etiologically explained in 24 patients (57.1%) and the remaining 18 patients (42.9%) were included in the group of idiopathic ALTE. Between the two groups of patients, important differences in the ontogeny of melatonin secretion and its circadian rhythm were uncovered. At the age of 3 months total amount of 6SMT excreted in the urine was significantly lower in idiopathic as compared to that of the etiologically explained ALTE infants (p = 0.023). In the former a delay in the ontogeny of the circadian rhythm of melatonin secretion was also observed with statistically significant differences in nigh-time and daytime urinary values of 6SMT not being present earlier than 6 months of age (p = 0.010). Conclusion: Our data confirm delayed ontogeny of melatonin production in the idiopathic ALTE infants in comparison to those infants who’s ALTE can be etiologically explained suggesting that an impaired maturation of the photoneuroendocrine system might be involved in the pathogenesis of idiopathic ALTE. HCP06 Acute encephalopathy from lead poisoning: case report V. Tashko *, A. Haruni, A. Bushati. Pediatric Department, Neuropediatry, University Hospital Centre “Mother Theresa”, Tirana, Albania Introduction: Lead ingested by children can be gradually accumulated in their organism. About 40−50% of ingested lead is absorbed and 20−25% is accumulated in bones and soft tissues that serve as the lead reservoir. The lead is detected in the blood, urine and hairs. Acute encephalopathy represents the classic form of lead poisoning, when the blood lead level is about 150 mg /dl and urine ALA level is more than 20 mg/l. Vomiting, epigastric pain, cerebral ataxia are followed by the sudden onset of series of generalized convulsions, or by depression of consciousness and coma. Widespread interstitial edema occurs. 50% of the children survive but they have permanent neurological damages. Method: Is based on family history, clinic signs, urine lead and ALA (24 hours) level, EEG, fundus oculi, Cerebral Arteriography and CT scan of the head. Case Report: A girl of 8 years old was born and developed normally. No important diseases during her life. She represented vomiting, strong headache, generalized seizures 2−3 times a day for a week, temperature 38.5ºC, depression of consciousness and coma. After six days she is conscious, but has still seizures, profound visual loss and behavioral disorders. During examination she has nuchal rigidity, inferior paraparesis, palsies of the third and sixth cranial nerves. The treatment was: manitol, CaEDTA i.v., diazepam, phenobarbital, folic acid and vitamins. Discussion: Family history: parents and the sister with lead poisoning caused by flour grinded in the village corn-mill. <80 mg/l) and Lab evaluation: lead urine level 370 mg/l, (N urine level ALA 49−54 mg/l (N 7−8 mg/l) indicate the lead poisoning. The signs of increased intracranial pressure and coma indicate an acute encephalopathy, the severe form of the lead poisoning. This was confirmed by the fundus oculi with papilledema of the first to second stage, Cerebral Arteriography of. carotid artery of the left side with mild hydrocephaly, EEG with decreased voltage over the bilateral side, CT scan of the head with cerebral atrophy. The child was treated with chelating agent, anti edema and anticonvulsant drugs. She was recovered but the visual loss and recurrent
convulsions persisted. After some months the visual became normal, the child went to the school but she continues to be treated for epilepsy with two anticonvulsant drugs for five years. Conclusion: Ingested lead may cause in the children the acute encephalopathy with severe cerebral damages, so they must be treated for many years or for all the life. HCP07 Application of noofen in complex treatment of children with patrimonial traumas of CNS G. Tursunhodjaeva *, N. Abdumavljanova. Tashkent Pediatric Medical Institute, Uzbekistan Urgency: Noofen improves memory, intellectual activity, raises stability of a brain to harmful influences. Purpose: Will estimate efficiency of noofen in treatment of children with consequences of patrimonial traumas of CNS. Material and Methods of research: 20 patients taking place on treatment in neurological branch, in the age of 1−3 years, with consequences of patrimonial traumas of CNS are surveyed. All patients received noofen in a dose 0.15? 3 times day within 30 days. Results of research: Noofen at intake it is quickly soaked up, will penetrate through hematoencephalic barrier. Treatment of 20 children with consequences of patrimonial traumas of nervous system showed positive results. The most expressed positive effect was observed at patients with a delay of psycho-speech development and cognitive functions. Reception of noofen in complex treatment caused positive changes in behavior and cognitive activity. Children became quieter, better concentrated and fixed the attention, improvement of speech functions and behavior was marked also. Conclusions: Application of noofen at children of 1−3 years with consequences of patrimonial traumas of CNS has given a positive effect in complex therapy and it dictates its wide application. HCP08 Spinal injuries and associated trauma in children M.S. Bavil *. Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Iran Background and Objective: Pediatric spinal injuries, although rare, are associated with the higher mortality rate of all orthopedic injuries in children. Because of diagnostic difficulty and high frequency of other organs injuries, in children, spinal injury may be missed. Materials and Methods: A 10 year cross-sectional retrospective study was undertaken of all pediatrics treated for a spinal injury at our institute. Results: A total of 40 patients had a documented diagnosis of spinal injury in 10 years. The patients ranged in age from 2−15 years, 62.5% of the patients were male. The average Glasgow score (GCS) was 14 (range 3−15). The mean hospital stay was 10.9 days. The area most commonly injured was the cervical spine. The most common mechanism of injury was motor vehicle accident and 61.5% of patients suffered one or more concomitant injuries. Conclusion: The spine injury is vulnerable in children due to the biomechanical and anatomical features. Although it is rare in children, the cervical area injured commonly and concomitant injury is higher. HCP09 Ophthalmoscopy
A 7-step program
J. Dooley *, K. Gordon . Dalhousie University, 2 IWK Health Centre, Canada 1
2
1
Objectives: Fundoscopy is viewed as a difficult or impossible task by many students and physicians. We have used a novel 7 step approach to teach trainees to use the ophthalmoscope. The technique is based on the premise that success is most