Post-traumatic stress syndrome in children]

Post traumatic stress disorder occurs in children as well as in adults following a stressful traumatic event, either unique and exceptionally severe, or recurrent as in abused children. The main symptoms are repetition, avoidance and neurovegetative activation. Prevention and recognition of this disorder are important. Parents must be sensitized to the necessity of an early management.     

Photosensitive epilepsy and television epilepsy]

Photosensitivity is defined by the appearance of occipital or more diffuse electroencephalographic spikes and waves induced by intermittent light stimulation (ILS), particular patterns, TV-watching, and video games. Photosensitivity is a genetic characteristic. Only the diffuse spikes and waves induced by ILS are correlated with epilepsy. Pure photogenic epilepsy is characterized by seizures which are only visually induced, usually by watching TV. Video games sometimes add a trigger effect due to slowly moving patterns or intense brightness. Several epileptic syndromes are associated with a photosensitivity with or without visually-induced seizures, mainly generalized idiopathic epilepsy.     

Post-traumatic lower limb pain in children]

Injuries to the lower extremity are frequent. They present as pain, reduction of joint function, alteration in gait. Most of the orthopaedic emergencies for teenagers are related to trauma. For younger children, a history of recent fall is prevalent but the non traumatic orthopaedic conditions are especially important to investigate when the reported injury is minor or when onset of symptoms is delayed.     

Post-traumatic hepatic artery pseudoaneurysm. A case report]

CASE REPORT: We report a case of traumatic hepatic artery pseudoaneurysm in a 9-year-old child. The diagnosis was made by duplex sonography and helical CT angiography. Arteriography confirmed and managed the lesion with transcatheter embolization. CONCLUSION: The traumatic hepatic artery pseudoaneurysm is an uncommon complication of liver trauma in children whose diagnosis is made by duplex sonography and CT angiography. Endovascular embolotherapy is the treatment of choice.     

Imaging in paediatric epilepsy]

Epilepsy is a chronic disease, often with an onset during childhood and characterized by spontaneous and recurrent seizures. It concerns 0.5-1% of children under 16 years of age. A classification proposed by the International League Against Epilepsy (ILEA) in 2001 takes into account recent genetic factors involved in epilepsy and attenuates the sharp demarcation between generalized and partial seizures. This classification tends to define whether imaging is indicated or not. Imaging is useless in simple cases of fits associated with hyperthermia and in benign idiopathic epilepsy. It is debated if it is a first episode of epilepsy without a particular context and no neurological signs. In all other cases of epilepsy in children, imaging is indicated. In descending order of frequency the possible causes include malformations (as abnormal gyral development and phakomatoses), hypoxic-ischemic lesions, non-accidental injuries, infections, metabolic diseases and tumors. Being much more sensitive than computed tomography (CT), magnetic resonance imaging (MRI) is the technique of choice to identify an underlying cause in symptomatic epilepsy. Clinical data are mandatory in order to direct a proper MRI investigation. The recently developed diffusion-weighted sequence is particularly useful in the acute phase of certain events such as hypoxia-ischemia, trauma and metabolic disease. CT scan is used in emergency situations and also as a complement to MRI for example to identify calcified lesions. In this way, imaging contributes to establish the nature and define the extension of epileptogenic lesions, thereby guiding therapeutic management. MRI also allows follow-up of the consequences of repeated seizures (such as mesial temporal sclerosis and selective neuronal necrosis) on the cerebral parenchyma and plays a role in the establishment of a prognosis.     

Post-traumatic lung pneumatocele. A case in an infant]

Traumatic lung pseudocyst is a lung injury due to closed chest trauma. The authors report one case in a 20 month-old boy. This cavitary lesion is underestimated since associated lesions often mask the pneumatocele. Its frequency is higher in children and young adults. Diagnosis can be assessed early when chest film shows the characteristic cavitary lesion. Computed tomography may be helpful in the recognition of paramediastinal traumatic lung pseudocyst. Since the lung pseudocyst usually involves, no aggressive therapy is justified.     

Teratogenic risks of epilepsy and anticonvulsants]

This paper presents a review of the literature regarding the risks of birth defects in infants born of an epileptic mother or father. It appears that epileptic women on anticonvulsant drugs have a 2-3-fold greater risk of delivering a baby with a major malformation. The risk is more specific for facial clefts, congenital heart defects and spina bifida. The risk increase for mild anomalies, especially facial dysmorphology, is evaluated in a very variable manner (5-45%). The respective roles of the disease itself and its treatment are discussed; it seems likely that genes play a part in the general risk increase, but that maternal epilepsy plays a more important role than paternal epilepsy, and that therefore a non-genetic mechanism exists. One hypothesis could conciliate all theories (genes, seizures during pregnancy, teratogenic effect of drugs), ie that of the existence of genetically-determined differing susceptibility to drugs. Monotherapy seems to induce a lower risk than polytherapy, and is thus to be preferred if clinically possible. Because of minor differences in teratogenic effect between drugs (with the exception of a more specific association between sodium valproate and spina bifida), choice should be determined by the particular therapeutic necessities, with suitable surveillance of the pregnancy.     

New treatments of epilepsy in infancy]

Epilepsy is a repetition of seizures. It is frequent child pathology: 40% of all epileptic people have less than 15 years of age. Seizures appear on a developing brain. Treatment must avoid frequent and long lasting seizures but at the same time must spare cognitive development. New antiepileptic drugs seem to have more specialized indications, less side effects and thus represent a very interesting tool for neuropediatrician. Monotherapy has to be preferred as often as possible to assure good cognitive function.     

Electroencephalography, epilepsy and brain tumor]

The authors present a critical analysis of electroencephalographic (EEG) data recorded in children with supratentorial intracranial tumor. They emphasize the value of clinical and EEG presentation in the diagnosis of epileptogenic tumor in children and in the evolution of the children who underwent surgery.     

Neonatal epilepsy and inborn errors of metabolism]

Metabolic disorders constitute an important cause of neurologic disease, including neonatal epilepsy. Epilepsy rarely dominates the clinical presentation, which is more frequently associated with other neurologic symptoms, such as hypotonia and/or vigilance disturbances. In most cases, epilepsy secondary to inherited metabolic disorders presents with polymorphic clinical and electrographic features that are difficult to classify into precise epileptic syndromes. However, specific types of seizures, such as myoclonic seizures or distinctive electroencephalographic patterns, such as suppression burst patterns, epileptic syndrome or early myoclonic encephalopathy, may suggest a specific metabolic disease. The aim of this article is to help clinicians in reviewing potential metabolic diagnoses and approaching metabolic evaluations.     

Pathogenesis of epilepsy in childhood and adolescence]

After a short discussion of the basic mechanisms of epileptic reactions, the conditions for epileptrogenesis are reviewed. As demonstrated by studies in animal models, distinctive structural and neurochemical characteristics of the brain tissue, probably genetically determined, build a main precondition for seizure manifestation. Starting from these basic concepts, the multifactorial pathogenesis of human epilepsy is discussed with special regard to genetic factors. The seizure liability results from the interaction of several independently transmitted genetic and lesional factors. None of these traits are epileptogenic by themselves, but effective only in interaction with other pathogenetic factors. Genetically determined "normal" structural and functional properties of the brain, e.g. expressed by generalized alpha rhythm, are involved in the complex pathogenesis of epilepsy. From a neurobiological point of view, epilepsy is always a multifactorially determined disease. The nowadays usual separation of idiopathic and symptomatic types of epilepsy may be helpful for communication in daily practice, but represents a simplification under pathogenetic aspects.     

Post-traumatic intradiploic pseudomeningocele

We report a four year old boy who was detected to have an occipital intradiploic pseudomeningocele three years following a traumatic skull fracture, and which was managed by ventriculo-peritoneal shunt placement. Traumatic intradiploic pseudomeningoceles behave differently from traditional growing skull fractures and may require individualized management decisions.     

Treatment of status epilepticus in children with epilepsy]

The treatment of status epilepticus (SE) in children with epilepsy depends on the epilepsy syndrome, in order to avoid worsening drugs such as IV barbiturates in severe myoclonic epilepsy in infancy (SMEI) (Dravet's syndrome) or IV benzodiazepam in tonic SE of Lennox-Gastaut syndrome. Intensive care procedures should not be systematical in convulsive SE (CSE) and are not indicated in non-convulsive SE (NCSE). Generalized CSE mostly involve SMEI before 3 years of age, symptomatic generalized epilepsy and partial lesional epilepsy. Treatment is an emergency and relies on IV benzodiazepines and, if necessary, IV phenytoine using plasmatic concentrations for an optimal management. The partial CSE of partial lesional epilepsy can result in focal deficit and need the same treatment as generalized CSE. NCSE consist in absence and/or myoclonic SE and are often unrecognised during a long time until EEG is performed. They mostly involve myoclonic epilepsies and can be controlled by IV benzodiazepines. The frequency of partial NCSE is underestimated, particularly in infants. Diagnosis relies on video EEG and treatment is the same as that used in partial CSE.