Autonomic nervous system function in childhood migraine

BACKGROUND: Although the pathogenesis of migraine is controversial, autonomic nervous system (ANS) dysfunction has been reported in patients with adult migraine in recent years. The present study was planned to investigate ANS function in childhood migraine. METHODS: The migraine and control groups consisted of 25 migraineur and 30 healthy children, respectively. Orthostatic test, sustained handgrip, Valsalva ratio, 30/15 ratio and heart rate responses to deep breathing were used as non-invasive ANS function tests in both groups. RESULTS: In the orthostatic test, systolic (SBP) and diastolic blood pressures (DBP) were higher in the upright than the supine position in the migraine group, but were higher in the supine than upright position in the control group. In the sustained handgrip test, the mean difference in SBP was higher in the migraine than the control group (P = 0.0278), but there was no significant difference in DBP between migraine and control groups (P = 0.107). The Valsalva ratio was higher in the migraine than the control group (P = 0.0002), as was the 30/15 ratio (P = 0.0108). Heart rate responses to deep breathing were not different between the migraine and control groups (P = 0.749). CONCLUSIONS: Our results demonstrate ANS dysfunction, with hyperactivity of both the sympathetic and parasympathetic nervous system, in children with migraine.     

Autonomic nervous system functions in children with breath-holding spells and effects of iron deficiency

Aim: To analyse the activity of the autonomic nervous system during breath-holding spells, we assessed the ECG changes, including ventricular repolarization parameters before and during the spell. We also analysed the effects of iron deficiency on these ECG parameters. Methods: The study group consisted of 37 children with breath-holding spells (30 cyanotic, 7 pallid) (mean age±SD: 12.9±10.8 mo). Twenty-six healthy children (mean age±SD: 14.4±8.6 mo) served as a control group. All patients and controls had standard 12-lead simultaneous surface ECG. All patients had ECG recordings during at least one severe breath-holding spell obtained by “event recorder”. Traces obtained by “event recorder” were analysed in terms of mean heart rate and the frequency and duration of asystole during the spell. Results: Respiratory sinus arrhythmia on standard ECGs and asystole frequency during spells were higher in patients with pallid breath-holding spells. Patients with iron deficiency had a lower frequency of respiratory sinus arrhythmia and prolonged asystole time during the spell. There was no difference in terms of ventricular repolarization parameters (QT/QTc intervals and QT/QTc dispersions) between patients and controls and between patient subgroups (cyanotic versus pallid).

Conclusion: These results confirmed the presence of autonomic dysregulation in children with breath-holding spells. Iron deficiency may have an impact on this autonomic dysregulation. Ventricular repolarization was unaffected in patients with breath-holding spells.     

Central nervous system involvement in severe arterial hypertension of childhood

The case histories of 125 children with hypertension and no apparent primary CNS disease were analyzed for neurological symptoms or complications. Eleven children had neurological symptoms of high blood pressure. In only one of these patients was the diagnosis of arterial hypertension made before the observation of the neurological findings. The symptoms were severe headache in eight children, convulsions and coma in four, hemiplegia in two, and impaired vision and apraxia in one child. Symptomatology was rapidly reversed by antihypertensive treatment in four children, while six had long-term stigmata and one child died in hypertensive crisis. Because elevated arterial pressure can cause severe neurological disease, routine blood pressure measurement in children--especially those with neurological symptomatology--is stressed.     

儿童心脏自主神经功能检查方法

<正>随着临床诊断技术的发展,心脏自主神经功能检查方法也得到不断改进和完善,成为评价自主神经功能状态及对自主神经功能紊乱性疾病诊断和鉴别诊断的依据。本文就目前儿童常用的心脏自主神经功能检查方法作一介     

心脏自主神经系统调节在儿童血管迷走性晕厥中的研究现状

血管迷走性晕厥(vasovagal syncope,VVS)是自主神经介导性晕厥中最常见的一种类型,其发病机制复杂。自主神经系统包括交感神经和副交感神经,心脏受两者双重支配并保持平衡。目前普遍认为VVS存在心脏自主神经调节功能的失衡。文章就VVS中心脏自主神经主要神经递质的作用、心脏自主神经功能的评价指标及针对自主神经功能失衡的治疗等方面的研究进展作一介绍。     

Autonomic function testing in children and adolescents with diabetes mellitus

Cardiac autonomic neuropathy (CAN) is a common complication in type 1 diabetes mellitus (T1DM) and associated with an increased mortality. Early detection of CAN would be desirable for a better individual risk stratification. The aim of this study was to determine whether autonomic dysfunction can be diagnosed in young patients with a recent history of T1DM. Autonomic function was assessed in 20 pediatric patients with T1DM, aged 10-19 yr, and a control group of 136 non-diabetic patients using four cardiorespiratory reflexes: heart rate and blood pressure response in standing position, deep breathing, and Valsalva maneuver. Furthermore, power spectral analyses of the low- and high-frequency band of heart rate variability (HRV) and baroreflex sensitivity (BRS) were tested with the non-invasive Task force monitor (CNSystems, Graz, Austria). Cardiorespiratory reflexes were pathologic for at least one item in 75% of the diabetic and 60% in the healthy control group. A reduced BRS was always combined with abnormal HRV. We found this pattern in 30% of diabetic patients and never in the control group. In patients with impaired BRS, mean hemoglobin A1c (HbA1c) was 7.7% and duration of diabetes 6.5 yr. This did not differ from the overall value of the diabetic group: HbA1c level 8.4% and diabetes duration 7.3 yr. In conclusion, signs of autonomic dysfunction are not uncommon in an early stage of diabetes in young patients. Classical cardiorespiratory reflexes seem to be less specific than HRV and BRS as testing methods.     

儿童继发性甲减对神经系统的影响初探

为了解儿童继发性甲状对神经系统的影响，收集15例儿童期确诊继发性甲减的患儿在发病前后及进行激素治疗后的脑电图、智能测定、学习成绩评实等相关神经系统方面的资料，进行对比分析，结果显示继发性甲减患儿存在脑电图异常、智能和学习成绩不佳等系统方面的资料，进行对比分析，结果显示继发性甲状患儿存在脑电图异常、智能和学习成绩不佳等神经系统影响。随着替代治疗激素水平保持正常后随访数年，其神经系统方面的异常并未得到明显改善。提示继发性甲减对儿童神经系统的影响主要表现在智能落后和学习困难方面，应予重视，给予早期干预。     

儿童狼疮中枢神经系统的急症表现

目的　 探讨儿童系统性红斑狼疮中枢神经系统急症的特征。 方法 　将狼疮脑病患儿与继发中枢神经系统损害狼疮患儿的ANA、dsDNA滴度、Sm阳性率及补体C3下降的阳性率进行比较 ,并对两组患儿的临床特征进行分析。 结果 　ANA、ds DNA滴度及Sm阳性率、补体C3下降阳性率与狼疮脑病并不相关 ,脑电图有助于狼疮脑病的诊断。 结论 　儿童红斑狼疮中枢急症原发及继发性损害的鉴别诊断需结合临床及有关辅助检查综合分析。     

Circadian rhythm of the autonomic nervous system in long QT syndrome

The circadian changes in the activity of the autonomic nervous system in a group showing long QT duration in electrocardiogram (ECG) were studied in order to differentiate symptomatic congenital long QT syndrome from asymptomatic. The asymptomatic group presented only long QT duration (QTc > 0.46). Seven girls and two boys, including two subjects experiencing syncope of non-neurological origins, were examined by using heart rate (HR) power spectrum analysis. In three subjects, the peak of the high frequency band, indicating the parasympathetic activity, disappeared during night-time (sleep), which means the possibility of a high risk of sudden cardiac death. In two of three subjects, moreover, the averaged sympathetic activity during daytime was significantly increased compared to that during night-time, in addition to the abrupt increase of sympathetic activity in the morning. These two subjects, in which one boy had a family history of Romano-Ward syndrome, were the same people experiencing the syncope attack. We succeeded in objectively elucidating that congenital long QT syndrome is adrenergic-dependent, and suggest that HR power spectrum analysis may be of value in distinguishing symptomatic congenital long QT syndrome from asymptomatic showing only long QT duration.     

儿童中枢神经系统白血病22例临床分析

目的分析22例急性白血病合并中枢神经系统白血病(CNSL)患儿的住院资料,为CNSL诊治提供参考。方法分析22例儿童CNSL的临床特征、实验室检查及预后。结果在303例儿童急性白血病中发生CNSL 22例,发生率7.3%,其中急性淋巴细胞白血病(ALL)18例,急性混合型白血病(MPAL)1例,急性髓细胞白血病(AML)3例;在18例ALL中,B-ALL 11例,T-ALL 7例,T-ALL合并CNSL发生率(22.6%)高于B-ALL(5.6%);CNSL常见临床表现有头痛、呕吐、惊厥及瘫痪等;CNSL预后差,死亡率高。结论 CNSL是急性白血病复发的主要原因之一,根据危险度来预防和治疗CNSL是关键。     

Involvement of the central nervous system in renal hypertension

Involvement of the central nervous system (CNS) is a major complication of renal hypertension and is usually due to hypertensive encehalopathy. During a 17-year period we observed 25 children with renal hypertension associated with CNS manifestations in the absence of (group A) and 33 in the presence of advanced renal failure (group B). Convulsions were the most important symptom (65% in both groups combined). Other manifestations were reduced consciousness (69%), visual disturbances (28%), hemiplegia (14%), and cranial nerve palsy (10%). In 56% of children in group A, hypertension was recognised only after appearance of CNS symptoms. Three patients in group A and 19 in group B died. Intracranial haemorrhage associated with hemiplegia was found in 3 cases. From 1970–1977 to 1978–1986 the number of patients and the mortality in group B declined dramatically, probably as a result of improved antihypertensive and renal replacement therapy. In contrast, in group A the number of patients and of CNS symptoms remained similar. The study underlines the importance of frequent blood pressure monitoring in presence of acute or chronic renal disease.     

中国儿童原发性高血压影响因素的Meta分析

目的 探讨中国儿童原发性高血压的影响因素,为制定中国儿童原发性高血压的预防和干预措施提供科学依据。方法 计算机检索PubMed、ISI Web of Knowledge、OVID、中国期刊全文数据库、中国生物医学文献数据库和维普数据库,收集国内外2002年1月至2011年12月发表的关于中国儿童原发性高血压影响因素的病例对照研究。应用Stata 11.0软件进行Meta分析,根据异质性检验结果选择相应效应模型进行数据合并,计算各影响因素合并比值比（OR）及其95％CI。采用Egger′s检验和非参数剪补法评估发表偏倚。结果 共纳入文献7篇,累计病例2 385例,对照32 093例。儿童原发性高血压各影响因素的合并OR（95％CI）分别为：性别（男性）1.495（1.057~2.115）、年龄0.997（0.933~1.066）、BMI 1.870（1.436~2.434）、家族史1.668（0.736~3.783）,体育活动频率0.593（0.484~0.726）。结论 目前的证据表明男性、超重和肥胖是中国儿童原发性高血压的危险因素,体育活动频率作为保护因素可降低中国儿童原发性高血压的患病风险。     

Pulmonary hypertension associated with portal hypertension in a child

A 14-year-old girl with extrahepatic portal hypertension developed fatal pulmonary hypertension 5 months after a modified Warren shunt operation. There are 13 previously reported cases of pulmonary hypertension associated with portal hypertension in childhood. In cases of pediatric portal hypertension, it is assumed that the development of pulmonary hypertension is caused by vasoconstrictive substances directly shunted from the splanchnic circulation to the lung through portal-systemic connections. Offprint requests to: K. Kumada     

Autonomic Reflexes in Preterm Infants

ABSTRACT. Some autonomic nervous reflexes often tested in adult medicine have been studied in 21 preterm infants (25-37 gestational weeks). The aim was to develop such tests for preterm infants and see if there were any differences in babies with recurrent apnea and bradycardia and babies who had been exposed to sympathicolytic drugs before birth. To test sympathetic nervous activity the peripheral vascular resistance was measured before and during 45° of head-up tilting. To test parasympathetic nervous activity the degree of bradycardia was measured in response to cold face test (application of an ice-cube on the fore-head) and laryngeal stimulation with saline. Finally the heart rate changes after a sudden noise (85 dB) were studied as an indicator of both sympathetic and vagal activity. The peripheral resistance was found to be relatively low in these preterm infants, particularly in some infants tested at the postnatal age of about two months. Heart rate and mean blood pressure did not change during tilting, while the peripheral resistance increased significantly mainly due to lowered limb blood flow. The median decrease of the heart rate during the cold face test was 20.0% and during laryngcal receptor stimulation 23.7%. The sudden noise usually caused a biphasic heart rate response. An autonomic nervous reflex score was calculated and found to be negative (parasympathetic) in infants with recurrent prolonged apnea and bradycardia and positive in infants with clinical signs of increased sympathetic nervous activity.     

室性早搏与自主神经系统活性的关系及临床意义

研究目的小儿室性早搏（ＶＰＣ）与自主神经系统活性的关系及运动试验评价及其临床意义。研究方法６８ＶＰＣ患儿作自立神经功能检查及运动试验。研究结果无器质性心脏组中，与自主神经功能失衡有关者２９／３８例（７４％），而心肌炎组仅１４／３０例（４７％）有关．（Ｐ＜０．０５）。交感组１２／１５例（８０％）运动后早搏增加；迷走组仅５／２２例（２３％）增加（Ｐ＜０．０１），迷走组运动后ＶＰＣ增加者５例全部为心肌炎，而交感组仅４例（３３％）。结论自主神经功能紊乱与小儿无症状性ＶＰＣ的发生密切相关，可能是引起无症状性ＶＰＣ的原因之一，预后良好，运动试验对病理性早搏的判断价值属迷走性ＶＰＣ者较有意义。     

Polymorphisms in four candidate genes in young patients with essential hypertension

Aim: To determine whether four potential genetic factors (polymorphisms in genes for alpha-adducin, beta-adducin, the G-protein beta-3 subunit and nitric oxide synthase) are important for the development of essential hypertension (EH) in Slovenian children and young adults with EH. Methods: Both a nuclear families approach and case-control study have been performed. Genotyping of common polymorphisms in these genes using polymerase chain reaction was carried out in 104 nuclear families (an affected child, both parents) and in 200 control patients. Results: Using the transmission disequilibrium test, no statistically significant differences were found between the frequencies of transmitted and non-transmitted alleles in nuclear families for all four investigated polymorphisms. In addition, the distributions of genotypes and alleles for the four polymorphisms did not differ significantly between our children and 200 healthy control patients. The allele frequencies of all polymorphisms were concordant with those observed in some other Caucasian populations.

Conclusion: We found no association between the investigated gene variants and EH, so we conclude that they do not confer a significantly increased risk of the development of EH in the Slovenian population of hypertensive children.     

以肥胖为首发症状的复发性中枢神经系统白血病

目的分析罕见的以肥胖为首发症状的中枢神经系统白血病(CNSL)的诊断。方法 1例6岁4个月男孩,近3个月来进行性肥胖伴性格改变,以往患急性淋巴细胞白血病(ALL,普通B细胞,BCR-ABL阴性,中危),经化疗后持续缓解超过2年。根据临床表现做一系列的实验室和影像学检查进行诊断和鉴别诊断,并进行相关中英文文献复习。结果脑脊液(CSF)白细胞中度升高,以单个核细胞为主,伴少量可疑的幼稚淋巴细胞,葡萄糖和氯化物低,蛋白稍高,MRI示脑膜、大脑皮质、下丘脑和垂体柄以及桥脑等中线结构、颅神经根等信号异常。临床检查分析排除单纯肥胖、Cushing综合征等继发性肥胖和结核性脑膜炎;CSF流式细胞术检查发现65%的有核细胞符合ALL细胞的特征而诊断为CNSL复发,经化疗和头颅放疗后缓解。目前中、英文文献只检索到3篇相似病例的个案报道。结论肥胖和性格改变可以是CNSL的首发症状,但由于罕见,需注意与其他疾病鉴别,传统的CSF细胞形态学结合流式细胞术检查将提高CNSL诊断的可靠性。     

Atypical clinical features of children with central nervous system tumor: Delayed diagnosis and switch in handedness

Herein is described the cases of three children with central nervous system (CNS) tumor, who had switch in handedness occurring before diagnostic confirmation. Although the onset, age, tumor location, and histology were heterogeneous, the diagnosis of CNS tumor was delayed in all three patients. The present experience indicates that switch in handedness should be recognized as a sign of CNS tumor in pediatric patients, and which might prevent delay in diagnosis. Pediatricians should carefully examine such patients who present with some suggestive symptoms of CNS tumor, even when they are unusual, in order to make a timely and appropriate diagnosis.