- Email: [email protected]
PP10.12 – 2525: Neurological adverse events following immunization (AEFI): Brazilian data
S72
EUROPEAN JOURNAL O F PAEDIATRIC NEUROLOGY
sion in these situations must be individualized and during the clinical course frequently re-evaluated
PP10.9 - 2483 Neurodevelopmental outcome of infants with neonatal seizures S. Uzicanin, S. Heljic, S. Zubcevic, F. Catibusic, B. Krdzalic, S. Heljic, S. Zubcevic, F. Catibusic, B. Krdzalic. Pediatric Hospital, Department of Child Neurology, University Clinical Center Sarajevo, Bosnia and Herzegovina Objective: Prospective study was performed on a cohort of 100 patients: term and preterm newborns, who had clinically manifested seizures during the neonatal period. Methods: Initial assessment was performed during their hospitalisation, while furder follow-up was done through regular visits to outpatient facilities of Deparment of Child Neurology.Patients were divided into two groups – preterm and term newborns (67/33). During early and late neonatal period, 23 children died (12 terms/11 preterms). Use of medications and drugs during pregnancy (38%), underlaying disease in mothers (22%), type of labour (vaginaly 61%), intrauterine growth restriction (28%), necessity for resustitation mesures (54%), perinatal aspyxia (52%) and mechanical ventilation (54%) were considered as risk factor.Neurodevelopmental assessment was performed at the age of one year with Alberta Infant Motor scale (AIMS) and Developmental scale. Results: According to AIMS 68.83% patients had scores below 10 th percentile which corresponded to motoric developmental delay. According to Developmental scale, 62.33% of children showed developmental discordance with the results expected for chronological age. 28.57% of patients with diagnosis of epilepsy at the age of one year had also low scores at AIMS (<10th percentile). Children who had to be resusciated and those who needed mechanical ventilation (MV), as well as patients with verified asphyxia are marked with low scores on AIMS (below 10 th percentile). In addition, this group of children showed greater discordance with results expected for age in neuropsychological assessment. Analyzing correlation of examined variables of outcome: epilepsy, motoric assessment and neuropsychological assasment with the varaiables that correspond to risk factors for neonatal morbidity (resusitation, MV,asppyxia), the highest correaltion was found with the variable of perinatal aspyxia (p<0.01). Conclusion: Neonatal seizures have strong prediction for short and long term morbidity and mortality.
PP10.10 - 2241
19s (2015) S1 – S152
staring were more common in patients younger than 6 years of age, whereas conversion disorder predominated in patients older than 6 years. Vasogenic syncope was also frequently observed in adolescent group and was confirmed by tilt test. There was no significant difference of specific PNE types between the groups of patients with or without neurologic deficits. Conclusion: In this study, physiologic symptoms predominated in younger age group, while conversion disorder was more often observed in older age groups. Clinical pattern recognition by age plays an important role in clinical practice in that pediatric patients present with various types of PNEs showing age-specific patterns. Considering inconsistent manifestation of conversion disorder, longterm VEM can be helpful in diagnosing normal infant behavior and conversion disorder.
PP10.11 - 2341 Comparison the effect of Phenytoin on inflammatory mediator’s production by gingival fibroblast in children and adults V. Surena, N. Bahareh. SBMU Objective: About 30 to 50% of patients taking Phenytoin develop significant gingival alternations especially in buccal anterior part of oral cavity. This study was done to compare the synthesis of its inflammatory mediators and related gingival overgrowth in different ages. Methods: Samples were collected from biopsy of a healthy gingival of four adults in 35–42 years old through crown lengthening surgery and four children in 4–11 years old through impact tooth surgery, after local anesthesia and from the keratinized soft tissues around the teeth. Gingival biopsies were transferred to a medium which containing DMEM and cultured on specific plates 25 cm2 and put on incubator containing CO2 with temperature of 37ºc. MTT was used to compare the Proliferation rate of fibroblasts. Supernatant of culture medium of test and control sinks were collected by sampler and concentration of IL1β, PGE2, IL6, TGFβ, TNFα and IL8 were analyzed by ELISA. Results: Different proliferation rate of Phenytoin induced gingival fibroblasts in adults (0.073±0.177) as compared to children (0.056±0.028) was not significant. Production of PGE2, TGFβ and IL6 by Phenytoin induced gingival fibroblasts in children was increased as compared to adults (p<0.05). Production of IL8 by Phenytoin induced gingival fibroblasts in children was decreased compared to adults (P=0.02). Conclusion: Phenytoin induced gingival fibroblasts of children produce more amounts of IL1β, PGE2, IL6, TGFβ and IL8 as compared to adults’ fibroblasts. More Comprehensive studies with well-documented designs using other methods are recommended to verify these results.
Paroxysmal nonepileptic events in pediatric patients E.G. Park, J. Lee, B.L. Lee, J. Lee, M. Lee. Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Objective: Paroxysmal nonepileptic events (PNEs) are frequently encountered in children. Although the frequencies and types of PNEs have been extensively studied in the adult population, the data available for children and adolescents are limited. In this study, we evaluate and compare the characteristics of PNEs between the age groups and the patients with or without neurologic deficits to enable early detection and diagnosis of PNEs. Methods: We retrospectively reviewed 887 pediatric patients who were admitted to epilepsy monitoring unit at Samsung Medical Center between December 2001 and July 2014. One hundred forty one patients (15.9%) were diagnosed as having PNEs on the basis of clinical history and long-term video-EEG monitoring (VEM). Results: Children with PNEs were divided into 3 groups by age as follows; 1) infant, toddler, and preschool group (<6 years, N=50, 35.5%); 2) school-age group (6–<12 years, N=30, 21.3%); 3) adolescent group (12–<18 years, N=61, 43.3%). Physiologic disorders such as normal infant behavior, sleep movement, and
PP10.12 - 2525 Neurological adverse events following immunization (AEFI): Brazilian data A.R. Fernandes, R.M. Martins, S.M.D. de Carvalho, M.I.M. Pinto, S. Monteiro, S. Dourado, H.K. Sato, R. Mohrdieck, P.M. de Figueiredo, J.A.C. da Costa. Department of Child Neurology, Universidade Federal Fluminense and CIFAVI (National Interinstitutional Committee for Pharmacovigilance in Vaccines and other Immunobiologicals), Rio de janeiro, Brazil Objective: Despite the benefits of vaccines, it is well recognized that some cases of AEFI occur; among them, adverse events that affect the nervous system are that cause more concern. The nervous system can be affected directly by vaccines’ antigens, or by inflammatory processes triggered by them. Herein we describe all the neurological AEFI reported to the Ministry of Health (MoH) surveillance system in the period from 2008 to 2013 in Brazil. Methods: A retrospective study based on the AEFI data from 2008 to 2013. AEFI seriousness, demographic data, frequency and vaccine data were analysed. Results: 3,200 neurological events
EUROPEAN JOURNAL O F PAEDIATRIC NEUROLOGY
were reported to the MoH during the period and 2,885 were consistent with AEFI (52.1% male). Three deaths were reported and 1.32% presented some sequel. Among all the vaccines that are part of the Brazilian calendar, the most frequent neurological AEFI reported were febrile and afebrile seizures (67.83% and 21.21%, respectively) and the highest rates were observed after the Diphtheria, Tetanus, Pertussis, and Haemophilus influenzae type b combined vaccine (50.36%). Guillain Barré syndrome also was reported (1.4%). The Influenza vaccine was the most related with this AEFI (0.7 cases per 1,000,000 doses). Conclusion: Brazil’s National Immunization Program (NIP) is one of the most extensive (27 vaccines, 4 immunoglobulins and 13 sera), offered with no cost to all its population. In this period more than 550 million of vaccines’ doses were administered. Although the Brazilian AEFI surveillance system is mostly passive (based in the received reports), and on the fact that AEFI data can be underestimated, this large series shows that the majority of the AEFI are not serious and rates are within the expected from the literature. It is necessary to stimulate reporting, adequate investigation and causality assessment for keeping the population’s confidence in NIP.
PP10.13 - 2944 An unusual case of infantile botulism: Clostridium botulinum Bf (C. botulinum Bf) infection in UK D.S.T. Kariyawasam, K. Grant, G. Godbole, R. Knight, D. Kelly, S. Jayawant, S.R. Chandratre. John Radcliffe Hospital, Oxford, UK Objective: We discuss a rare case of infantile Clostridium botulinum Bf infection, the associated diagnostic pitfalls and paediatric-specific management strategies. Methods: A retrospective review of the patient’s medical notes was undertaken. Results: A previously well, weaned infant presented at 6 months with two days of reduced feeding and salivary pooling. There was no history of honey exposure. Initially, gag-reflex was absent, with preservation of other cranial nerves. Antigravity movements of limbs, reflexes, and respiratory effort, were maintained. Symptoms progressed within a week to reveal hypotonia, absent antigravity movements, with preservation of reflexes, within upper limbs. Lower limb examination was normal. Eye-movements were preserved, however pupils were slowly and asymmetrically reactive. Respiratory decompensation led to intubation and subsequent tracheostomy. Lumbar puncture, metabolic screens, and MRI brain were normal. Neurophysiology showed diffuse, severely attenuated motor nerve amplitude consistent with axonal variant Guillian-Barre Syndrome, thus IVIG was commenced. Due to the atypical presentation of descending paralysis, infantile botulism was considered. Stool specimens were positive for C. botulinum Bf. Botulinum antitoxin therapy (Baby BIG) was initiated, leading to rapid recovery. Public health investigation did not show a reservoir for this infection. Conclusion: C. botulinum Bf is rare, with eight previous international cases. Our case is only the second recent presentation in UK. The case confirms that dual C.botulinum neurotoxins should be considered in diagnoses for infants presenting with isolated cranial nerve palsies, including bulbar signs. Furthermore, rapidly descending paralysis involving pupillary mydriasis and poorly reactive pupils are consistent features of infantile botulism. Additionally this case highlights that neurophysiology interpretation in infants is unreliable, with clinical suspicion of botulism guiding investigation. Treatment for infantile botulism centres on Baby BIG therapy. This immunoglobulin is specifically selected for high titres of type A and B “neutralising antibodies”, which combat the most common strains of infantile botulism.
19s (2015) S1 – S152
S73
PP10.14 - 2620 An unusual presentation of Listeria meningitis in an immunocompetent child with selective spinal grey matter involvement A. Hedrera-Fernández, A. Papandreou, W.K.C. Chong, S. Bhate. Department of Neurology, Great Ormond Street Hospital for Children, London, UK Objective: Report an unusual case of Listeria meningitis in an immunocompetent child with selective spinal grey matter involvement. Methods: Review of clinical records. Results: A previously healthy 35 month-old girl presented back arching and neck stiffness in a context of fever and irritability. Listeria monocytogenes was confirmed by PCR on CSF and she was firstly treated with amoxicillin and gentamicin and then with ampicillin and amikacin. Five days after, she was transferred to PICU due to fluctuating GCS. CT scan revealed symmetrical hydrocephalus with herniation of tonsils through foramen magnum needing EVD insertion. At that time, a marked ependymal and leptomeningeal enhancement was seen in MRI head scan with contrast, as a pattern of meningitis with ventriculitis. MRI spine scan with contrast showed extensive whole grey matter signal changes, associated with loss of volume, consistent with myelomalacia, also anterior conus and ventral root enhancement of cauda equina, likely related to shunting. Clinically, she had mild hypotonia of the four limbs, developed bladder dysfunction, not being able to speak more than three words, not fixing nor following objects. EMG revealed acute inflammatory demyelinating polyneuropathy. She received intravenous immunoglobulin and corticoids, recovering gradually with improved responsiveness as well with mobility, being able sit with support. Conclusions: Listeria monocytogenes causes 5% of neonatal meningitis (Heath, 2010) but is a rare cause in other ages, especially uncommon in immunocompetent patients. However, some cases of neurolisteriosis in immunocompetent children have been reported (Peer, 2010) with radiological findings as meningeal enhancement, ventriculitis and, less commonly, brain abscesses. Acute spinal symptoms are rare and spinal radiological findings (abscesses, arachnoiditis, and syringomyelia) are also uncommon. Selective grey matter involvement in spinal cord (parainfectious event or autoimmune response to infection) and features of peripheral demyelination on neurophysiological studies as in this case has not been reported before in children.
PP10.15 - 2739 Do the paediatricians perceive the impact of disability of children same as their parents? V. Mundada, A. Bem, D. Parashar. Great Ormond street hospital, London, UK Background: The clinicians treating the children with disability need to know the personal and environmental factors limiting their activity and participation as it can help in designing the appropriate management plans for them. Methodology: We included children diagnosed with cerebral palsy registered on the “Norfolk Register of Disabled Children and Young People” which is a parental/self–assessment based register. 44 parents consented to participate. Blank registration forms were sent to these children’s respective paediatricians who were asked to fill in “sections E” which has 18 areas of impairment/functioning and “section F” including a “scale of impact of their impairment on their daily life” from 1 to 5 (1 = “no difficulty” and 5 = “impact felt on almost all activities every day”). Results: 40 completed forms (90.9%) from the paediatricians were compared with those by the respective parents. 24 were male (60%). Mean age of children was 11 years. Using weighted Kappa statistic for section E, the patients’ and doctor’s scores agreed on 76.01% of the observations (k=0.3134, SE 0.0738; p<0.0001). Hence both
EUROPEAN JOURNAL O F PAEDIATRIC NEUROLOGY
sion in these situations must be individualized and during the clinical course frequently re-evaluated
PP10.9 - 2483 Neurodevelopmental outcome of infants with neonatal seizures S. Uzicanin, S. Heljic, S. Zubcevic, F. Catibusic, B. Krdzalic, S. Heljic, S. Zubcevic, F. Catibusic, B. Krdzalic. Pediatric Hospital, Department of Child Neurology, University Clinical Center Sarajevo, Bosnia and Herzegovina Objective: Prospective study was performed on a cohort of 100 patients: term and preterm newborns, who had clinically manifested seizures during the neonatal period. Methods: Initial assessment was performed during their hospitalisation, while furder follow-up was done through regular visits to outpatient facilities of Deparment of Child Neurology.Patients were divided into two groups – preterm and term newborns (67/33). During early and late neonatal period, 23 children died (12 terms/11 preterms). Use of medications and drugs during pregnancy (38%), underlaying disease in mothers (22%), type of labour (vaginaly 61%), intrauterine growth restriction (28%), necessity for resustitation mesures (54%), perinatal aspyxia (52%) and mechanical ventilation (54%) were considered as risk factor.Neurodevelopmental assessment was performed at the age of one year with Alberta Infant Motor scale (AIMS) and Developmental scale. Results: According to AIMS 68.83% patients had scores below 10 th percentile which corresponded to motoric developmental delay. According to Developmental scale, 62.33% of children showed developmental discordance with the results expected for chronological age. 28.57% of patients with diagnosis of epilepsy at the age of one year had also low scores at AIMS (<10th percentile). Children who had to be resusciated and those who needed mechanical ventilation (MV), as well as patients with verified asphyxia are marked with low scores on AIMS (below 10 th percentile). In addition, this group of children showed greater discordance with results expected for age in neuropsychological assessment. Analyzing correlation of examined variables of outcome: epilepsy, motoric assessment and neuropsychological assasment with the varaiables that correspond to risk factors for neonatal morbidity (resusitation, MV,asppyxia), the highest correaltion was found with the variable of perinatal aspyxia (p<0.01). Conclusion: Neonatal seizures have strong prediction for short and long term morbidity and mortality.
PP10.10 - 2241
19s (2015) S1 – S152
staring were more common in patients younger than 6 years of age, whereas conversion disorder predominated in patients older than 6 years. Vasogenic syncope was also frequently observed in adolescent group and was confirmed by tilt test. There was no significant difference of specific PNE types between the groups of patients with or without neurologic deficits. Conclusion: In this study, physiologic symptoms predominated in younger age group, while conversion disorder was more often observed in older age groups. Clinical pattern recognition by age plays an important role in clinical practice in that pediatric patients present with various types of PNEs showing age-specific patterns. Considering inconsistent manifestation of conversion disorder, longterm VEM can be helpful in diagnosing normal infant behavior and conversion disorder.
PP10.11 - 2341 Comparison the effect of Phenytoin on inflammatory mediator’s production by gingival fibroblast in children and adults V. Surena, N. Bahareh. SBMU Objective: About 30 to 50% of patients taking Phenytoin develop significant gingival alternations especially in buccal anterior part of oral cavity. This study was done to compare the synthesis of its inflammatory mediators and related gingival overgrowth in different ages. Methods: Samples were collected from biopsy of a healthy gingival of four adults in 35–42 years old through crown lengthening surgery and four children in 4–11 years old through impact tooth surgery, after local anesthesia and from the keratinized soft tissues around the teeth. Gingival biopsies were transferred to a medium which containing DMEM and cultured on specific plates 25 cm2 and put on incubator containing CO2 with temperature of 37ºc. MTT was used to compare the Proliferation rate of fibroblasts. Supernatant of culture medium of test and control sinks were collected by sampler and concentration of IL1β, PGE2, IL6, TGFβ, TNFα and IL8 were analyzed by ELISA. Results: Different proliferation rate of Phenytoin induced gingival fibroblasts in adults (0.073±0.177) as compared to children (0.056±0.028) was not significant. Production of PGE2, TGFβ and IL6 by Phenytoin induced gingival fibroblasts in children was increased as compared to adults (p<0.05). Production of IL8 by Phenytoin induced gingival fibroblasts in children was decreased compared to adults (P=0.02). Conclusion: Phenytoin induced gingival fibroblasts of children produce more amounts of IL1β, PGE2, IL6, TGFβ and IL8 as compared to adults’ fibroblasts. More Comprehensive studies with well-documented designs using other methods are recommended to verify these results.
Paroxysmal nonepileptic events in pediatric patients E.G. Park, J. Lee, B.L. Lee, J. Lee, M. Lee. Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Objective: Paroxysmal nonepileptic events (PNEs) are frequently encountered in children. Although the frequencies and types of PNEs have been extensively studied in the adult population, the data available for children and adolescents are limited. In this study, we evaluate and compare the characteristics of PNEs between the age groups and the patients with or without neurologic deficits to enable early detection and diagnosis of PNEs. Methods: We retrospectively reviewed 887 pediatric patients who were admitted to epilepsy monitoring unit at Samsung Medical Center between December 2001 and July 2014. One hundred forty one patients (15.9%) were diagnosed as having PNEs on the basis of clinical history and long-term video-EEG monitoring (VEM). Results: Children with PNEs were divided into 3 groups by age as follows; 1) infant, toddler, and preschool group (<6 years, N=50, 35.5%); 2) school-age group (6–<12 years, N=30, 21.3%); 3) adolescent group (12–<18 years, N=61, 43.3%). Physiologic disorders such as normal infant behavior, sleep movement, and
PP10.12 - 2525 Neurological adverse events following immunization (AEFI): Brazilian data A.R. Fernandes, R.M. Martins, S.M.D. de Carvalho, M.I.M. Pinto, S. Monteiro, S. Dourado, H.K. Sato, R. Mohrdieck, P.M. de Figueiredo, J.A.C. da Costa. Department of Child Neurology, Universidade Federal Fluminense and CIFAVI (National Interinstitutional Committee for Pharmacovigilance in Vaccines and other Immunobiologicals), Rio de janeiro, Brazil Objective: Despite the benefits of vaccines, it is well recognized that some cases of AEFI occur; among them, adverse events that affect the nervous system are that cause more concern. The nervous system can be affected directly by vaccines’ antigens, or by inflammatory processes triggered by them. Herein we describe all the neurological AEFI reported to the Ministry of Health (MoH) surveillance system in the period from 2008 to 2013 in Brazil. Methods: A retrospective study based on the AEFI data from 2008 to 2013. AEFI seriousness, demographic data, frequency and vaccine data were analysed. Results: 3,200 neurological events
EUROPEAN JOURNAL O F PAEDIATRIC NEUROLOGY
were reported to the MoH during the period and 2,885 were consistent with AEFI (52.1% male). Three deaths were reported and 1.32% presented some sequel. Among all the vaccines that are part of the Brazilian calendar, the most frequent neurological AEFI reported were febrile and afebrile seizures (67.83% and 21.21%, respectively) and the highest rates were observed after the Diphtheria, Tetanus, Pertussis, and Haemophilus influenzae type b combined vaccine (50.36%). Guillain Barré syndrome also was reported (1.4%). The Influenza vaccine was the most related with this AEFI (0.7 cases per 1,000,000 doses). Conclusion: Brazil’s National Immunization Program (NIP) is one of the most extensive (27 vaccines, 4 immunoglobulins and 13 sera), offered with no cost to all its population. In this period more than 550 million of vaccines’ doses were administered. Although the Brazilian AEFI surveillance system is mostly passive (based in the received reports), and on the fact that AEFI data can be underestimated, this large series shows that the majority of the AEFI are not serious and rates are within the expected from the literature. It is necessary to stimulate reporting, adequate investigation and causality assessment for keeping the population’s confidence in NIP.
PP10.13 - 2944 An unusual case of infantile botulism: Clostridium botulinum Bf (C. botulinum Bf) infection in UK D.S.T. Kariyawasam, K. Grant, G. Godbole, R. Knight, D. Kelly, S. Jayawant, S.R. Chandratre. John Radcliffe Hospital, Oxford, UK Objective: We discuss a rare case of infantile Clostridium botulinum Bf infection, the associated diagnostic pitfalls and paediatric-specific management strategies. Methods: A retrospective review of the patient’s medical notes was undertaken. Results: A previously well, weaned infant presented at 6 months with two days of reduced feeding and salivary pooling. There was no history of honey exposure. Initially, gag-reflex was absent, with preservation of other cranial nerves. Antigravity movements of limbs, reflexes, and respiratory effort, were maintained. Symptoms progressed within a week to reveal hypotonia, absent antigravity movements, with preservation of reflexes, within upper limbs. Lower limb examination was normal. Eye-movements were preserved, however pupils were slowly and asymmetrically reactive. Respiratory decompensation led to intubation and subsequent tracheostomy. Lumbar puncture, metabolic screens, and MRI brain were normal. Neurophysiology showed diffuse, severely attenuated motor nerve amplitude consistent with axonal variant Guillian-Barre Syndrome, thus IVIG was commenced. Due to the atypical presentation of descending paralysis, infantile botulism was considered. Stool specimens were positive for C. botulinum Bf. Botulinum antitoxin therapy (Baby BIG) was initiated, leading to rapid recovery. Public health investigation did not show a reservoir for this infection. Conclusion: C. botulinum Bf is rare, with eight previous international cases. Our case is only the second recent presentation in UK. The case confirms that dual C.botulinum neurotoxins should be considered in diagnoses for infants presenting with isolated cranial nerve palsies, including bulbar signs. Furthermore, rapidly descending paralysis involving pupillary mydriasis and poorly reactive pupils are consistent features of infantile botulism. Additionally this case highlights that neurophysiology interpretation in infants is unreliable, with clinical suspicion of botulism guiding investigation. Treatment for infantile botulism centres on Baby BIG therapy. This immunoglobulin is specifically selected for high titres of type A and B “neutralising antibodies”, which combat the most common strains of infantile botulism.
19s (2015) S1 – S152
S73
PP10.14 - 2620 An unusual presentation of Listeria meningitis in an immunocompetent child with selective spinal grey matter involvement A. Hedrera-Fernández, A. Papandreou, W.K.C. Chong, S. Bhate. Department of Neurology, Great Ormond Street Hospital for Children, London, UK Objective: Report an unusual case of Listeria meningitis in an immunocompetent child with selective spinal grey matter involvement. Methods: Review of clinical records. Results: A previously healthy 35 month-old girl presented back arching and neck stiffness in a context of fever and irritability. Listeria monocytogenes was confirmed by PCR on CSF and she was firstly treated with amoxicillin and gentamicin and then with ampicillin and amikacin. Five days after, she was transferred to PICU due to fluctuating GCS. CT scan revealed symmetrical hydrocephalus with herniation of tonsils through foramen magnum needing EVD insertion. At that time, a marked ependymal and leptomeningeal enhancement was seen in MRI head scan with contrast, as a pattern of meningitis with ventriculitis. MRI spine scan with contrast showed extensive whole grey matter signal changes, associated with loss of volume, consistent with myelomalacia, also anterior conus and ventral root enhancement of cauda equina, likely related to shunting. Clinically, she had mild hypotonia of the four limbs, developed bladder dysfunction, not being able to speak more than three words, not fixing nor following objects. EMG revealed acute inflammatory demyelinating polyneuropathy. She received intravenous immunoglobulin and corticoids, recovering gradually with improved responsiveness as well with mobility, being able sit with support. Conclusions: Listeria monocytogenes causes 5% of neonatal meningitis (Heath, 2010) but is a rare cause in other ages, especially uncommon in immunocompetent patients. However, some cases of neurolisteriosis in immunocompetent children have been reported (Peer, 2010) with radiological findings as meningeal enhancement, ventriculitis and, less commonly, brain abscesses. Acute spinal symptoms are rare and spinal radiological findings (abscesses, arachnoiditis, and syringomyelia) are also uncommon. Selective grey matter involvement in spinal cord (parainfectious event or autoimmune response to infection) and features of peripheral demyelination on neurophysiological studies as in this case has not been reported before in children.
PP10.15 - 2739 Do the paediatricians perceive the impact of disability of children same as their parents? V. Mundada, A. Bem, D. Parashar. Great Ormond street hospital, London, UK Background: The clinicians treating the children with disability need to know the personal and environmental factors limiting their activity and participation as it can help in designing the appropriate management plans for them. Methodology: We included children diagnosed with cerebral palsy registered on the “Norfolk Register of Disabled Children and Young People” which is a parental/self–assessment based register. 44 parents consented to participate. Blank registration forms were sent to these children’s respective paediatricians who were asked to fill in “sections E” which has 18 areas of impairment/functioning and “section F” including a “scale of impact of their impairment on their daily life” from 1 to 5 (1 = “no difficulty” and 5 = “impact felt on almost all activities every day”). Results: 40 completed forms (90.9%) from the paediatricians were compared with those by the respective parents. 24 were male (60%). Mean age of children was 11 years. Using weighted Kappa statistic for section E, the patients’ and doctor’s scores agreed on 76.01% of the observations (k=0.3134, SE 0.0738; p<0.0001). Hence both