Journal of child neurology
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Therapeutic hypothermia is the recommended treatment for neonates with moderate or severe hypoxic ischemic encephalopathy (HIE). There is an increasing trend to use therapeutic hypothermia even in infants with mild hypoxic ischemic encephalopathy, even though there is little evidence to support/refute this. ⋯ A significant proportion of infants who received therapeutic hypothermia had mild hypoxic ischemic encephalopathy. Randomized trials are urgently needed to evaluate the efficacy and safety of therapeutic hypothermia in infants with mild hypoxic ischemic encephalopathy.
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Since its creation, patients on ketogenic diet are told to avoid liquid medications due to theoretical concerns of "hidden" carbohydrates. However, switching from liquid to tablet formulations can be problematic, especially for infants and young children. We theorized that increasing the daily ketogenic ratio might compensate for liquid antiseizure drug carbohydrates. ⋯ This proof-of-principle study demonstrates feasibility of compensating for carbohydrates in liquid medications by increases in the daily ketogenic ratio. This ratio adjustment protocol may help ease an already complex adjustment to dietary therapy.
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This study aimed to investigate the treatment-related annual cost of childhood epilepsy and its related factors in mainland China. A total of 244 cases were collected at the outpatient clinics of Peking University First Hospital Pediatrics from April 2010 to August 2013. The median annual epilepsy treatment-related costs per patient were estimated to be RMB7822 (US$1160), accounting for 43.72% (median) of urban residents' disposable income in China. ⋯ This study concluded that the treatment of children with epilepsy produces a heavy burden on both families and society in mainland China. The constitution ratio of antiepileptic drugs and travel expenses are much higher than those of other countries. Adjusting medical insurance coverage, balancing medical resource distribution, and taking good control of seizures might be effective in reducing the economic burden of childhood epilepsy in China.
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Loeys-Dietz syndrome is a rare connective tissue disorder characterized by cardiovascular, craniofacial, skeletal, and neurocognitive abnormalities. Recurrent headaches may constitute the neurological presentation of Loyes-Dietz syndrome in the absence of an intracranial aneurysm, subarachnoid hemorrhage, or dissection. The etiology of headaches occurring in Loeys-Dietz syndrome can be diverse but underrecognized and underreported. ⋯ Migraine, Chiari I malformation, and spontaneous intracranial hypotension are known features of Loeys-Dietz syndrome and these 3 children will require serial angiographic monitoring for development of intra- and extracranial dissections and aneurysms and appropriate interventions to forestall neurologic complications. It is important to raise awareness of headaches in this population so that appropriate counseling can be given to the child and parents at diagnosis. The neurology community must familiarize itself with the phenotype of the disease for earlier recognition and meticulous surveillance for optimum care for these patients.
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Inherited leukodystrophies are a group of diseases affecting central nervous system myelin that lead to death or significant health problems. Although for most leukodystrophies there are no curative treatments, for a handful of diseases hematopoietic stem cell transplantation (HSCT; bone marrow transplant) can stop disease progression, and if initiated in a timely fashion, prevent many or all neurologic and other systems involvement. However, HSCT is a complex procedure with significant morbidity and mortality risks. ⋯ HSCT was performed at 20 of the hospitals, with the majority performed at only 6 hospitals. Average costs ($786 846) per patient were more than 6 times higher than patients who did not have HSCT. The data show that an unexpectedly large number of leukodystrophy patients are receiving transplants for conditions in which HSCT is not typically used, and which are associated with high medical costs.