Trazodone improves sleep and decreases rage attacks in opsoclonus-myoclonus syndrome

The ‘‘essential’’ work-up of hypertension As we are paying more and more attention to childhood blood pressure, we are recognizing that primary (‘‘essential’’) hypertension is much more common in children than had heretofore been suspected. Consequently, not every child with newly diagnosed hypertension requires an exhaustive search for an underlying cause. The problem for the clinician, then, becomes that of recognizing the child in whom ‘‘secondary’’ hypertension is likely, and for whom a more thorough series of investigations is necessary. In the current issue of The Journal, Seeman and colleagues from the Czeck Republic introduce us to one tool to assist in this recognition. Ambulatory blood pressure (ABP) monitoring was performed in a series of hypertensive children before beginning therapy. The presence of sustained nocturnal hypertension, associated with lack of the usual drop in blood pressure at night (‘‘dipping’’) proved to be useful markers for secondary hypertension in this series. Readers of The Journal have been introduced to ABP monitoring in our pages previously. In addition to identifying the child with ‘‘white coat’’ hypertension and to providing objective evidence of response to antihypertensive agents, the procedure may help identify children for whom more detailed investigations are in order.

Sleep restriction for rhythmic movement disorder Rhythmic movement disorder (RMD) is defined as a group of stereotyped repetitive movements involving large muscles that typically occurs just before sleep onset. It usually affects the head and neck in the form of ‘‘head banging.’’ Etzioni et al report the results of three weeks of controlled sleep restriction with hypnotic administration in the first week. They saw almost complete resolution of the movements in all patients who participated in this open study. They believe that RMD should be treated actively to present secondary social and psychological consequences, as well as physical harm. Hypnotics alone may fail, but the combination of hypnotic administration with mild sleep restriction appeared to allow children with RMD to develop the ability to fall asleep.

—Robert W. Wilmott, MD page 393

—Thomas R. Welch, MD

page 366

Trazodone improves sleep and decreases rage attacks in opsoclonus-myoclonus syndrome Pranzatelli and colleagues report a study of 51 young children with opsoclonus-myoclonus syndrome. Poor sleep and rage attacks are common symptoms in this syndrome. They report that 19 of the most severely affected patients were treated with trazadone, a soporific serotonergic agent, and that the majority had improved sleep and behavior. They conclude that the trazodone was effective in improving sleep and decreasing rage attacks in this syndrome, and that it is well tolerated even in toddlers.

—Robert W. Wilmott, MD

page 372

The Journal of Pediatrics

September 2005

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