Serum prolactin in seizure disorders

This study aimed to determine the post-ictal prolactin (PL) response in different types of seizures and seizure-like events in children, and correlate with the post-ictal duration. Patients were divided into group I (generalized tonic-clonic seizures, complex partial seizures or simple partial seizures), group II (febrile convulsions) and group III (conditions mimicking seizures). Group IV consisted of 25 controls. Blood was collected within 2 hours of the seizure and PL levels assayed. PL levels were significantly high only within group I; highest and baseline levels were attained within 10 minutes and by 100 minutes respectively. The sensitivity and specificity of elevated PL for epileptic seizures were 64 percent and 98 percent respectively. It is concluded that a high prolactin level within 100 minutes of a seizure is suggestive that a generalized or complex partial seizure has occurred.     

Antecedents of seizure disorders in early childhood

One or more nonfebrile seizures occurred between the ages of 1 month and 7 years in eight per 1000 white and in nine per 1000 black children enrolled in a large prospective study. We examined hundreds of prenatal and perinatal factors as predictors of childhood seizure disorders. Congenital malformations of the fetus (cerebral and noncerebral), family history of certain neurologic disorders, and neonatal seizures were the major predictors identified. Forty percent of children with postneonatal seizures and 68% of children with minor motor seizures had one or more of these risk factors compared with 21% of the seizure-free population. More than half of the children with minor motor seizures and a third of the infants with neonatal seizures had congenital malformations. Based on the prenatal and perinatal factors examined, prediction of postneonatal seizures carried a high rate of false-positive identification, indicating that our knowledge of the etiology of childhood seizure disorders is still very limited.     

Single photon emission computed tomography in seizure disorders.

Fourteen children with various seizure disorders were studied using a cerebral blood flow tracer, 123I iodoamphetamine (0.05 mCi/kg), and single photon emission computed tomography (SPECT). In the five patients with radiological lesions, SPECT showed congruent or more extensive abnormalities. Five of the nine children with a normal scan on computed tomography had abnormal SPECT studies consisting of focal hypoperfusion, diffuse hemispheric hypoperfusion, multifocal and bilateral hypoperfusion, or focal hyperperfusion. A focal lesion seen on SPECT has been found in children with tonic-clonic seizures suggesting secondarily generalised seizures. Moreover the pattern seen on SPECT seemed to be related to the clinical status. An extensive impairment found on SPECT was associated with a poor evolution in terms of intellectual performance and seizure frequency. Conversely all children with a normal result on SPECT had less than two seizures per year and normal neurological and intellectual development.     

Update on the management of disorders of sex development

A number of factors have contributed to a sharp increase in the number of publications related to disorders of sex development (DSD) in the past 5 years, namely: the establishment of a consensus in 2006 about nomenclature, investigations and the need to treat these patients in a multidisciplinary setting; increase of the knowledge base about genetic mechanisms of normal and abnormal sex development; critical appraisal about the timing and nature of genital surgery in patients with DSD. Herein, the authors present a comprehensive review with up-to-date data about the approach to the newborn with ambiguous genitalia as well as the diagnosis and management of the most common DSD.     

Consensus statement on management of intersex disorders

The birth of an intersex child prompts a long-term management strategy that involves a myriad of professionals working with the family. There has been progress in diagnosis, surgical techniques, understanding psychosocial issues and in recognizing and accepting the place of patient advocacy. The Lawson Wilkins Paediatric Endocrine Society (LWPES) and the European Society for Paediatric Endocrinology (ESPE) considered it timely to review the management of intersex disorders from a broad perspective, to review data on longer term outcome and to formulate proposals for future studies. The methodology comprised establishing a number of working groups whose membership was drawn from 50 international experts in the field. The groups prepared prior written responses to a defined set of questions resulting from an evidence based review of the literature. At a subsequent gathering of participants, a framework for a consensus document was agreed. This paper constitutes its final form.     

Advances in the management of histiocytic disorders

Childhood histiocytoses span a range of diseases. They can vary from a single, small skin lesion that spontaneously regresses, to a systemic disease leading to multiorgan failure and death. They can be classified into Langerhans cell histiocytosis (LCH), non-Langerhans cell histiocytoses (non-LCHs), haemophagocytic lymphohistiocytoses (HLHs) and histiocyte lineage-related malignancies. The establishment of diagnostic, staging and response criteria for LCH has enabled a series of international randomized clinical trials to be conducted that are the basis of evidence-based treatment. As with non-LCHs, individual cases are often difficult to manage and require expert advice. Familial HLH is an inherited disease in which initial remission can be gained by chemotherapeutic or immunological strategies, but allogeneic stem cell transplant is required for cure. There are a variety of leukaemias and sarcomas that are phenotypically derived from the histiocytic lineage; treatment and outcomes for these are generally similar to those of the wider malignant spectrum.     

儿童惊厥及惊厥性癫(癎)持续状态的急诊处理

惊厥(convulsion)与惊厥性癫(癎)(epilepsy)持续状态是临床经常遇到的一种急诊情况.每个儿科医生都应形成一个清晰完整的概念和掌握正确的规范化处理流程,从而能够更好的处理这种急重症.为此,本文拟从惊厥及惊厥性癫(癎)持续状态的急诊处理诸方面结合文献和临床实践所见进行剖析,供儿科同仁参考.     

Pediatric management of anxiety disorders

The first step in the pediatric management of anxiety disorders is to determine whether a child or adolescent has acute, situational anxiety symptoms or a pervasive, chronic anxiety disorder. Such anxiety symptoms can most frequently be handled with reassurance and practical advice to the child and the parents, and followed by monitoring. However, if an anxiety disorder is suspected, then referral to a mental health professional is in order for confirmation of the diagnosis and institution of comprehensive treatment. Medication currently has a limited role in the treatment of any anxiety disorder, although psychopharmacologic treatment may become part of the overall care of obsessive-compulsive disorder in the future. Pediatricians may wish to learn more about behavioral-cognitive treatment approaches used by mental health professionals in the treatment of anxiety symptoms and disorders in children and adolescents. An excellent general text has been edited by R. Gittelman, Anxiety Disorders of Childhood.     

Surgical management of voice disorders

Voice disorders are frequently seen in the pediatric population. They can have significant impact on the patient. Voice disorders may result from aberrations in the speech mechanism. The salient features of four common voice disorders and their clinical relevance are discussed.