Seminars in pediatric neurology
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Migraine and epilepsy, more alike than different, are two of the most common conditions faced in pediatric neurology. This review covers the epidemiology of both disorders, similarities and differences which aid in their mutual diagnoses, and predisposing conditions for the combination of both. Treatments for both migraine and epilepsy can be very useful, although rarely completely successful for migraines. Although the abortive agents used are vastly different, the preventative treatments share mostly similarities, and are commonly anticonvulsant drugs.
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Spasticity and other forms of muscle overactivity caused by cerebral palsy may impair function or ease of care or may cause discomfort or poor body image. The treatment program for a child with spasticity may include allied health therapy, exercise, casting, constraint-induced therapy, oral medications, chemodenervation, intrathecal baclofen, selective dorsal rhizotomy, and orthopedic surgery. Techniques may be combined for greater efficacy and better tailoring to the needs of the child. This article provides an overview of each approach, with a review of significant research findings in support of each.
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This article reviews the most common pharmacologic options in the treatment of sleep disorders in children. Despite the high prevalence of sleep disorders in children, there is a paucity of education and information available on the pharmacologic management of sleep disorders in children. The principles of sleep physiology and pathophysiology that help provide more rational pharmacologic management are discussed. ⋯ Ideally, these guidelines should be FDA approved for the specific sleep disorder and for the pediatric age range. The development of easy to swallow, chewable or liquid forms of these medications are needed. Training programs should play the lead role in enhancing pediatricians' knowledge of the pharmacologic treatment of sleep disorders in children.
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Semin Pediatr Neurol · Jun 2008
ReviewObstructive sleep apnea in children: implications for the developing central nervous system.
Recent increases in our awareness to the high prevalence of sleep disorders in general and of sleep-disordered breathing among children, in particular, has led to concentrated efforts aiming to understand the pathophysiological mechanisms, clinical manifestations, and potential consequences of such conditions. In this review, I will briefly elaborate on some of the pathogenetic elements leading to the occurrence of obstructive sleep apnea (OSA) in children, focus on the psychobehavioral consequences of pediatric OSA, and review the evidence on the potential mechanisms underlying the close association between central nervous system morbidity and the episodic hypoxia and sleep fragmentation that characterize OSA.
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Cerebral palsy refers to a collective of neurologic conditions that share in common disorders of motor function and posture. Traditionally, and still today in many circles, the term is considered almost synonymous with brain injury. Multiple lines of evidence, however, point to the fact that cerebral palsy is rarely caused by problems with perinatal management. ⋯ The best descriptor of the inheritance of cerebral palsy would be that of "multifactorial inheritance." This implies etiologic and genetic heterogeneity with complex interactions with multiple environmental influences. This article reviews known genetic influences on the origin of cerebral palsy. A proposed scheme for the genetic evaluation in identifying the etiology of cerebral palsy is provided.