Pediatric neurology
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Pediatric neurology · Jul 2008
ReviewProposed cross-disciplinary training in pediatric neurointensive care.
Training and research in pediatric neurointensive care require unique approaches to childhood diseases that reflect differences in the immature brain's response to injury or disease compared with adults. Pediatric neurocritical care is a collaborative effort to provide consultative care among pediatric subspecialists, coordinated by neonatal and pediatric intensivists. Valuable perspectives for clinical care, training, and research can also be learned through collaboration with adult neurointensivists. ⋯ This review also stresses cross-disciplinary research and training opportunities in pediatric neurointensive care beyond physician training. Nonmedical faculty from multiple academic disciplines should also serve as mentors to design appropriate curricula and research plans for the specific trainee in their respective fields and across specialties. The discipline of neurocritical care must consider a life-course approach for the patient requiring neurointensive care from neonatal through childhood and adult ages, with cross-fertilization from diverse academic disciplines and investigative points of view.
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Pediatric neurology · Apr 2008
ReviewCerebral blood flow and autoregulation after pediatric traumatic brain injury.
Traumatic brain injury is a global health concern and is the leading cause of traumatic morbidity and mortality in children. Despite a lower overall mortality than in adult traumatic brain injury, the cost to society from the sequelae of pediatric traumatic brain injury is very high. ⋯ Although altered cerebrovascular hemodynamics early after traumatic brain injury may contribute to disability in children, there is little information regarding changes in cerebral blood flow and cerebral autoregulation after pediatric traumatic brain injury. This review addresses normal pediatric cerebral physiology and cerebrovascular pathophysiology after pediatric traumatic brain injury.
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Although the genetics and biochemistry of leukodystrophies have been extensively explored, the immune response in these disorders has received relatively little attention. Both the disease course and its response to treatment may be highly dependent on the immune system. ⋯ We also review the response of leukodystrophies to immunomodulatory therapies and interventions such as hematopoietic stem-cell transplantation. Future studies may delineate specific inflammatory markers as possible candidates for therapeutic intervention.
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Pediatric neurology · Dec 2006
Review Case ReportsThe neurologic aspects of PHACE: case report and review of the literature.
PHACE syndrome is a neurocutaneous disorder characterized by large cervicofacial infantile hemangiomas and associated anomalies of the brain, cerebrovasculature, aorta, heart, and eyes. Two categories of neurologic disease are observed among PHACE patients: congenital malformations of the cerebellum, cerebrum, and cerebral vasculature and progressive stenoses and occlusions of principal cerebral arteries. A subgroup of patients develops a moyamoya-like vasculopathy and consequent ischemic strokes. ⋯ She underwent bilateral pial-synangiosis procedures and has not had stroke recurrence in 2 years of follow-up. The presence of a characteristic infantile hemangioma necessitates further evaluation for the extracutaneous features of PHACE. In cases of steno-occlusive vasculopathy, we recommend early consideration of encephaloduroarteriosynangiosis or a commensurate revascularization procedure.
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Pediatric neurology · Jun 2006
ReviewNonepileptic uses of antiepileptic drugs in children and adolescents.
Antiepileptic drugs are often prescribed for nonepileptic neurologic and psychiatric conditions. The United States Food and Drug Administration has approved several antiepileptic drugs for the treatment of neuropathic pain, migraine, and mania in adults. For pediatric patients, use of antiepileptic drugs for non-seizure-related purposes is supported mainly by adult studies, open-label trials, and case reports. ⋯ Valproate and carbamazepine are "possibly effective" in the treatment of Sydenham chorea, and valproate is "probably effective" in decreasing aggressive behavior. Carbamazepine is "probably ineffective" in the treatment of aggression, and lamotrigine is "possibly ineffective" in improving the core symptom of pervasive developmental disorders. Despite the frequent use of antiepileptic drugs in the treatment of juvenile bipolar disorder, migraine, and neuropathic pain, the data are insufficient to make recommendations regarding the efficacy of antiepileptics in these conditions in children and adolescents.