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Sakzewski L, Reedman S, McLeod K, Thorley M, Burgess A, Trost S, Ahmadi M, Rowell D, Chatfield M, Bleyenheuft Y, Boyd RN. Preschool HABIT-ILE: study protocol for a randomised controlled trial to determine efficacy of intensive rehabilitation compared with usual care to improve motor skills of children, aged 2-5 years, with bilateral cerebral palsy. BMJ Open 2021; 11:e041542. [PMID: 33653745 PMCID: PMC7929797 DOI: 10.1136/bmjopen-2020-041542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Young children with bilateral cerebral palsy (BCP) often experience difficulties with gross motor function, manual ability and posture, impacting developing independence in daily life activities, participation and quality of life. Hand Arm Bimanual Intensive Training Including Lower Extremity (HABIT-ILE) is a novel intensive motor intervention integrating upper and lower extremity training that has been developed and tested in older school-aged children with unilateral and BCP. This study aims to compare an adapted preschool version of HABIT-ILE to usual care in a randomised controlled trial. METHODS AND ANALYSIS 60 children with BCP aged 2-5 years, Gross Motor Function Classification System (GMFCS) II-IV will be recruited. Children will be stratified by GMFCS and randomised using concealed allocation to either receive Preschool HABIT-ILE or usual care. Preschool HABIT-ILE will be delivered in groups of four to six children, for 3 hours/day for 10 days (total 30 hours). Children receiving Preschool HABIT-ILE be provided a written home programme with the aim of achieving an additional 10 hours of home practice (total dose 40 hours). Outcomes will be assessed at baseline, immediately following intervention and then retention of effects will be tested at 26 weeks. The primary outcome will be the Peabody Developmental Motors Scales-Second Edition to evaluate gross and fine motor skills. Secondary outcomes will be gross motor function (Gross Motor Function Measure-66), bimanual hand performance (Both Hands Assessment), self-care and mobility (Pediatric Evaluation of Disability Inventory-Computer Adapted Test), goal attainment (Canadian Occupational Performance Measure), global performance of daily activities (ACTIVLIM-CP), cognition and adaptive function (Behavior Rating Inventory of Executive Function-Preschool Version), habitual physical activity (ActiGraph GT3X+) and quality of life (Infant Toddler Quality of Life Questionnaire and Child Health Utility Index-9). Analyses will follow standard principles for RCTs using two-group comparisons on all participants on an intention-to-treat basis. Comparisons between groups for primary and secondary outcomes will be conducted using regression models. ETHICS AND DISSEMINATION Ethics approval has been granted by the Medical Research Ethics Committee Children's Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC/19/QCHQ/59444) and The University of Queensland (2020000336/HREC/19/QCHQ/59444). TRIAL REGISTRATION NUMBER ACTRN126200000719.
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Affiliation(s)
- Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - Sarah Reedman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - Kate McLeod
- Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Megan Thorley
- Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Andrea Burgess
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - Stewart Trost
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Matthew Ahmadi
- Faculty of Medicine and Health, School of Health Sciences, Charles Perkins Centre, Camperdown, New South Wales, Australia
| | - David Rowell
- Faculty of Business, Economics and Law, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Mark Chatfield
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
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Abstract
Xia-Gibbs syndrome (XGS) is a rare genetic disorder that has been discovered as a distinct clinical entity in the recent past. The occurrence has been attributed to the mutation of AT Hook DNA binding motif Containing 1 (AHDC1) gene that is carried on chromosome 1p36. The concerned gene participates in deoxyribonucleic acid (DNA) repair apart from other crucial functions. The mutation results in dysfunction that leads to neurodevelopmental delay. The spectrum of manifestations constitutes intellectual disabilities, hypotonia, expressive language delay, sleep difficulties, and short stature. Dysmorphic facial features include depressed nasal bridge, hypertelorism, down-slanting or up-slanting palpebral fissures, horizontal eyebrows, dysplastic dentition, thin upper lip vermilion, and micrognathia. The phenotype is still expanding. The condition may range from mild to severe dysfunction depending on the area and site of genetic aberration but variation is evident. Thus, the correlation between genotype and phenotype is largely unclear. XGS should be considered as a differential diagnosis for patients presenting with intellectual as well as developmental disabilities. Whole-exome sequencing (WES) is the genetic test that is largely used for the confirmation of diagnosis. Less is known about the natural history as only a few adults with XGS have been documented in the literature. Age-appropriate cancer screening is recommended for patients with XGS as the gene mutation alters DNA repair mechanisms that may trigger tumour formation. The management of patients diagnosed with XGS is an area that needs investigation. Though use of growth hormone replacement therapy and physiotherapy intervention have been reported as effective in previous studies, research on effective means of care of these patients is warranted on a larger number of patients. We present a review of current literature on what is known about XGS that would facilitate to identify knowledge gaps for paving a way for further studies. This, in turn, will help in provision of early and effective rehabilitation services for patients with XGS.
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Affiliation(s)
- Chanan Goyal
- Physiotherapy, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Waqar M Naqvi
- Physiotherapy, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Arti Sahu
- Physiotherapy, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Ashish S Aujla
- Paediatric Neurology, Kids Care Paediatric Neurology Center, Raipur, IND
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Downs J, Lotan M, Elefant C, Leonard H, Wong K, Buckley N, Stahlhut M. Implementing telehealth support to increase physical activity in girls and women with Rett syndrome -ActivRett: protocol for a waitlist randomised controlled trial. BMJ Open 2020; 10:e042446. [PMID: 33376177 PMCID: PMC7778785 DOI: 10.1136/bmjopen-2020-042446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Individuals with Rett syndrome (RTT) experience impaired gross motor skills, limiting their capacity to engage in physical activities and participation in activities. There is limited evidence of the effectiveness of supported physical activity interventions. This study aims to evaluate the effects of a telehealth-delivered physical activity programme on physical activity, sedentary behaviour and quality of life in RTT. METHODS AND ANALYSIS This is a multicentre study, conducted in Australia, Denmark and Israel. It is a randomised waitlist-controlled trial comparing an intervention to support physical activity with usual care. Participants are children and adults with RTT, recruited from the Australian Rett Syndrome Database, the Danish Center for Rett Syndrome and the Rett Syndrome Association of Israel. The intervention duration is 12 weeks, including fortnightly telephone contact to plan, monitor and develop individual activity programmes. Outcomes are measured at baseline, at 13 weeks and then at 25 weeks. The primary outcomes are sedentary behaviour assessed with an activPAL accelerometer and the number of daily steps measured with a StepWatch Activity Monitor. Secondary outcomes include sleep, behaviour and quality of life. Caregiver experiences will be assessed immediately after the intervention using a satisfaction questionnaire. Group differences for each outcome will be evaluated with analysis of covariance, adjusting for baseline values on an intention-to-treat basis. ETHICS AND DISSEMINATION Ethics approval has been obtained in Western Australia from the Child and Adolescent Health Services (RGS3371), in Denmark from the Capital Region Ethics Committee (H-19040514) and in Israel from the Ariel University Institutional Review Board (AU-HEA-ML-20190331). Manuscripts on the development of the intervention from pilot work and the results of the intervention will be submitted to peer-reviewed journals. Results will be presented at conferences and consumer forums. We will develop an online resource documenting the physical activity programme and available supporting evidence. TRIAL REGISTRATION NUMBER NCT04167059; Pre-results.
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Affiliation(s)
- Jenny Downs
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Meir Lotan
- Department of Physiotherapy, Ariel University, Ariel, Israel
| | - Cochavit Elefant
- School of Creative Arts Therapies, University of Haifa, Haifa, Israel
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Kingsley Wong
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Nicholas Buckley
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Michelle Stahlhut
- Department of Paediatrics and Adolescent Medicine, Center for Rett Syndrome, Copenhagen, Denmark
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Ryan JM, Fortune J, Walsh A, Norris M, Kerr C, Hensey O, Kroll T, Lavelle G, Owens M, Byrne M, Walsh M. Transition from child to adult health services for young people with cerebral palsy in Ireland: a mixed-methods study protocol. BMJ Open 2020; 10:e041425. [PMID: 33371036 PMCID: PMC7757447 DOI: 10.1136/bmjopen-2020-041425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The transition from child to adult health services is a challenging and complex process for young people with cerebral palsy (CP). Poorly managed transition is associated with deterioration in health, increased hospitalisations and reduced quality of life. While international research identifies key practices that can improve the experience and outcomes of transition, there is a paucity of data in the Irish context. This research study aims to gain an insight into the experience of transition for young people with CP in Ireland. METHODS AND ANALYSIS A convergent parallel mixed-methods design will be used to collect, analyse and interpret quantitative and qualitative data. Participants will be young people aged 16-22 years with CP, their parent(s)/carer(s) and service providers. Quantitative and qualitative data will be collected through questionnaires and interviews, respectively. Quantitative data will be reported using descriptive statistics. Where sufficient data are collected, we will examine associations between the experience of transition practices and sociodemographic and CP-related factors, respectively, using appropriate regression models. Associations between service provider characteristics and provision of key transition practices may also be explored using appropriate regression models. Qualitative data will be analysed using the Framework Method. A coding matrix based on key transitional practices identified from the literature will be used to identify convergence and divergence across study components at the integration stage. ETHICS AND DISSEMINATION The study has been approved by the RCSI University of Medicine and Health Sciences Research Ethics Committee (REC201911010). Results will be presented to non-academic stakeholders through a variety of knowledge translation activities. Results will be published in open access, peer-reviewed journals and presented at national and international scientific conferences.
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Affiliation(s)
- Jennifer M Ryan
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jennifer Fortune
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Aisling Walsh
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Meriel Norris
- College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - C Kerr
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Owen Hensey
- Medical Department, Central Remedial Clinic, Dublin, Ireland
| | - Thilo Kroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, UK
| | - Grace Lavelle
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mary Owens
- Physiotherapy Department, Central Remedial Clinic, Dublin, Ireland
| | - M Byrne
- National Disability Children & Families Team, Social Care Division, Health Service Executive, Dublin, Ireland
| | - Michael Walsh
- Office of the Chief Clinical Officer, Health Service Executive, Dublin, Ireland
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Johnson RW, Williams SA, Gucciardi DF, Bear N, Gibson N. Can an online exercise prescription tool improve adherence to home exercise programmes in children with cerebral palsy and other neurodevelopmental disabilities? A randomised controlled trial. BMJ Open 2020; 10:e040108. [PMID: 33371023 PMCID: PMC7757494 DOI: 10.1136/bmjopen-2020-040108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Determine the adherence to and effectiveness of an 8-week home exercise programme for children with disabilities delivered using Physitrack, an online exercise prescription tool, compared with traditional paper-based methods. DESIGN Single-blinded, parallel-groups, randomised controlled trial (RCT). SETTING Intervention took place in participants' homes in Western Australia. PARTICIPANTS Children aged 6 to 17 years, with neurodevelopmental disabilities including cerebral palsy (CP), receiving community therapy services. INTERVENTION All participants completed an individualised home exercise programme, which was delivered to the intervention group using Physitrack and conventional paper-based methods for the control group. PRIMARY OUTCOME MEASURES Adherence to exercise programme, goal achievement and exercise performance. SECONDARY OUTCOME MEASURES Enjoyment, confidence and usability of Physitrack. RESULTS Fifty-four participants with CP (n=37) or other neurodevelopmental disabilities (n=17) were recruited. Fifty-three were randomised after one early withdrawal. Forty-six completed the 8-week programme, with 24 in the intervention group and 22 in the control group. There was no difference between the two groups for percentage of exercises completed (intervention (n=22): 62.8% (SD 27.7), control (n=22): 55.8% (SD 19.4), between group mean difference -7.0% (95% CI: -21.6 to 7.5, p=0.34)). Both groups showed significant improvement in their self-rated performance of individualised goal activities, however there was no statistically significant difference between groups for goal achievement, quality of exercise performance, enjoyment, confidence or preferred method of delivery. There were no adverse events. CONCLUSION Physitrack provides a therapist with a new means of providing an exercise programme with online tools such as exercise videos, but our preliminary findings indicate that it may be no better than a traditional paper-based method for improving exercise adherence or the other outcomes measured. Exercise programmes remain an intervention supported by evidence, but a larger RCT is required to fully evaluate online delivery methods. TRIAL REGISTRATION DETAILS Australian New Zealand Clinical Trials Registry; ACTRN12616000743460.
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Affiliation(s)
- Rowan W Johnson
- Therapy Services, Ability Centre, Perth, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Sian A Williams
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Daniel F Gucciardi
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Natasha Bear
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Noula Gibson
- Therapy Services, Ability Centre, Perth, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
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Faruk T, King C, Muhit M, Islam MK, Jahan I, Baset KU, Badawi N, Khandaker G. Screening tools for early identification of children with developmental delay in low- and middle-income countries: a systematic review. BMJ Open 2020; 10:e038182. [PMID: 33234622 PMCID: PMC7684835 DOI: 10.1136/bmjopen-2020-038182] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 10/19/2020] [Accepted: 10/30/2020] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To systematically review, identify and report the screening tools used for early identification of developmental delay in low- and middle-income countries. DESIGN Systematic review. DATA SOURCES Four bibliographic databases: Medline (1946 to 13 July 2020), Embase (1974 to 13 July 2020), Scopus (1823 to 11 July 2020) and PsycINFO (1987 to July week 1 2020). ELIGIBILITY CRITERIA Peer-reviewed original articles published in English addressing validated culturally sensitive developmental screening tools among children aged <5 years were included in this review. DATA EXTRACTION AND SYNTHESIS One author (CK, medical librarian) developed the search strategy. Three authors conducted the database search (phase I: CK; phase II: IJ and MKI). Three authors (TF, IJ and MKI) independently screened the title and abstracts. TF, MKI and GK independently performed the full-text review of the screened articles. During each step of the study selection process, disagreements were resolved through discussion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used to guide the systematic review. Data extraction and analysis were performed using MS Excel. Meta-analysis was not possible due to heterogeneity of the study findings. RESULTS We identified 3349 articles, of which 18 studies from 10 countries, reporting 16 screening tools, were selected for qualitative synthesis. Six cultural contexts were explored. Twelve general, two motor and two speech-language tools were identified. Seven of them found to be parent-completed ones. Five screening tools (American Speech-Language and Hearing Association, Guide for Monitoring Child Development, Infant Neurological International Battery, New Delhi-Development Screening Questionnaire and Woodside Screening Technique) reported relatively higher sensitivity (82.5%-100%) and specificity (83%-98.93%). CONCLUSIONS Limited number of culturally sensitive developmental screening tools were validated for children aged <5 years in low- and middle-income countries. Revising existing screening tools in different ethnic and cultural settings and subsequent validation with normative value should be a research priority.
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Affiliation(s)
- Tasnuva Faruk
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
- Department of Public Health, Independent University Bangladesh, Dhaka, Bangladesh
| | - Catherine King
- The Children's Hospital at Westmead Clinical School, The Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mohammad Muhit
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
- CSF Global, Dhaka, Bangladesh
| | - Md Kafiul Islam
- Department of Electrical and Electronic Engineering, Independent University Bangladesh, Dhaka, Bangladesh
| | - Israt Jahan
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
- CSF Global, Dhaka, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Kamran Ul Baset
- Department of Public Health, Independent University Bangladesh, Dhaka, Bangladesh
- Road Safety and Driving School, BRAC, Dhaka, Bangladesh
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, University of Sydney, Sydney, New South Wales, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Gulam Khandaker
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
- CSF Global, Dhaka, Bangladesh
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
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Mammas IN, Spandidos DA. The challenge of paediatric epilepsy nursing: An interview with Mrs. Jenny O'Brien, paediatric epilepsy nursing specialist at the Wirral University Teaching Hospital, UK. Exp Ther Med 2020; 20:295. [PMID: 33209139 PMCID: PMC7668144 DOI: 10.3892/etm.2020.9425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/24/2020] [Indexed: 11/12/2022] Open
Abstract
Epilepsy in childhood is one of the most common neurological disorders encountered in paediatric clinical practice. The current treatment of paediatric epilepsy aims to improve health outcomes, as well as to manage the educational, social and psychological issues that are involved in the quality of life of paediatric patients and their parents. In this direction, in several countries, a specialized, comprehensive, multidisciplinary service has been developed, including paediatric epilepsy nursing, which constitute a key component of this service. According to Mrs. Jennifer O'Brien, one of the pioneering paediatric epilepsy nursing specialists in the UK with a significant contribution in the care of children with epilepsy in Merseyside, the mission of paediatric epilepsy nursing is to enable children with epilepsy and their families to live as normal a life as possible, to ensure that all those who care for the child are well-educated regarding the child's epilepsy and to promote the child's safety and integration into society. She notes that in the past, epilepsy was not considered as a specialty and was looked after by all paediatricians; it is recognised now that it is an incredibly complex group of conditions, which deserves to have specialist management. She believes that although modern technology is crucial in informing and educating families, face to face education and advice is still the most important method of providing support. She highlights the recent advances in genetics of paediatric neurology along with the drive for epilepsy specialists, both nursing and medical, while she estimates that over the following years, paediatric epilepsy nursing will have progressed beyond nowadays expectations.
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Affiliation(s)
- Ioannis N Mammas
- Institute of Paediatric Virology, Aliveri, 34500 Island of Euboea, Greece.,Paediatric Clinic, Aliveri, 34500 Island of Euboea, Greece.,Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece.,First Department of Paediatrics, University of Athens School of Medicine, 11527 Athens, Greece
| | - Demetrios A Spandidos
- Institute of Paediatric Virology, Aliveri, 34500 Island of Euboea, Greece.,Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
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Toldo M, Varishthananda S, Einspieler C, Tripathi N, Singh A, Verma SK, Vishwakarma K, Zhang D, Dwivedi A, Gupta R, Karn S, Kerketta N, Narayan R, Nikam Singh K, Rani S, Singh A, Singh D, Singh KP, Singh N, Singh N, Singh R, Singh SP, Srivastava R, Srivastava S, Srivastava S, Yadav G, Yadav P, Yadav S, Yadav S, Marschik PB. Enhancing early detection of neurological and developmental disorders and provision of intervention in low-resource settings in Uttar Pradesh, India: study protocol of the G.A.N.E.S.H. programme. BMJ Open 2020; 10:e037335. [PMID: 33148727 PMCID: PMC7640505 DOI: 10.1136/bmjopen-2020-037335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Around 9% of India's children under six are diagnosed with neurodevelopmental disorders. Low-resource, rural communities often lack programmes for early identification and intervention. The Prechtl General Movement Assessment (GMA) is regarded as the best clinical tool to predict cerebral palsy in infants <5 months. In addition, children with developmental delay, intellectual disabilities, late detected genetic disorders or autism spectrum disorder show abnormal general movements (GMs) during infancy. General Movement Assessment in Neonates for Early Identification and Intervention, Social Support and Health Awareness (G.A.N.E.S.H.) aims to (1) provide evidence as to whether community health workers can support the identification of infants at high-risk for neurological and developmental disorders and disabilities, (2) monitor further development in those infants and (3) initiate early and targeted intervention procedures. METHODS This 3-year observational cohort study will comprise at least 2000 infants born across four districts of Uttar Pradesh, India. Community health workers, certified for GMA, video record and assess the infants' GMs twice, that is, within 2 months after birth and at 3-5 months. In case of abnormal GMs and/or reduced MOSs, infants are further examined by a paediatrician and a neurologist. If necessary, early intervention strategies (treatment as usual) are introduced. After paediatric and neurodevelopmental assessments at 12-24 months, outcomes are categorised as normal or neurological/developmental disorders. Research objective (1): to relate the GMA to the outcome at 12-24 months. Research objective (2): to investigate the impact of predefined exposures. Research objective (3): to evaluate the interscorer agreement of GMA. ETHICS AND DISSEMINATION G.A.N.E.S.H. received ethics approval from the Indian Government Chief Medical Officers of Varanasi and Mirzapur and from the Ramakrishna Mission Home of Service in Varanasi. GMA is a worldwide used diagnostic tool, approved by the Ethics Committee of the Medical University of Graz, Austria (27-388 ex 14/15). Apart from peer-reviewed publications, we are planning to deploy G.A.N.E.S.H. in other vulnerable settings.
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Affiliation(s)
- Moreno Toldo
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Swami Varishthananda
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Christa Einspieler
- Division of Phoniatrics, Research Unit iDN (Interdisciplinary Developmental Neuroscience), Medical University of Graz, Graz, Austria
| | - Neeraj Tripathi
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Anshu Singh
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Surendra K Verma
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Kanchan Vishwakarma
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Dajie Zhang
- Division of Phoniatrics, Research Unit iDN (Interdisciplinary Developmental Neuroscience), Medical University of Graz, Graz, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Gottingen, Germany
- Leibniz ScienceCampus Primate Cognition, Goettingen, Germany
| | - Agyeya Dwivedi
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Ritika Gupta
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Sanjay Karn
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Nirmal Kerketta
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Ram Narayan
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | | | - Sumitra Rani
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Akanksha Singh
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Divyanshu Singh
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Krishna Pratap Singh
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Navin Singh
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Neeraj Singh
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Rishi Singh
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Shyam P Singh
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Rakesh Srivastava
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Sandeep Srivastava
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Sanjeev Srivastava
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Gopal Yadav
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Preeti Yadav
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi, India
| | - Sheshnath Yadav
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Sujata Yadav
- Department of Community Medicine, Ramakrishna Mission Home of Service, Varanasi, India
| | - Peter B Marschik
- Division of Phoniatrics, Research Unit iDN (Interdisciplinary Developmental Neuroscience), Medical University of Graz, Graz, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Gottingen, Germany
- Leibniz ScienceCampus Primate Cognition, Goettingen, Germany
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Beauchamp MH, Dégeilh F, Yeates K, Gagnon I, Tang K, Gravel J, Stang A, Burstein B, Bernier A, Lebel C, El Jalbout R, Lupien S, de Beaumont L, Zemek R, Dehaes M, Deschênes S. Kids' Outcomes And Long-term Abilities (KOALA): protocol for a prospective, longitudinal cohort study of mild traumatic brain injury in children 6 months to 6 years of age. BMJ Open 2020; 10:e040603. [PMID: 33077571 PMCID: PMC7574946 DOI: 10.1136/bmjopen-2020-040603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Mild traumatic brain injury (mTBI) is highly prevalent, especially in children under 6 years. However, little research focuses on the consequences of mTBI early in development. The objective of the Kids' Outcomes And Long-term Abilities (KOALA) study is to document the impact of early mTBI on children's motor, cognitive, social and behavioural functioning, as well as on quality of life, stress, sleep and brain integrity. METHODS AND ANALYSES KOALA is a prospective, multicentre, longitudinal cohort study of children aged 6 months to 6 years at the time of injury/recruitment. Children who sustain mTBI (n=150) or an orthopaedic injury (n=75) will be recruited from three paediatric emergency departments (PEDs), and compared with typically developing children (community controls, n=75). A comprehensive battery of prognostic and outcome measures will be collected in the PED, at 10 days, 1, 3 and 12 months postinjury. Biological measures, including measures of brain structure and function (magnetic resonance imaging, MRI), stress (hair cortisol), sleep (actigraphy) and genetics (saliva), will complement direct testing of function using developmental and neuropsychological measures and parent questionnaires. Group comparisons and predictive models will test the a priori hypotheses that, compared with children from the community or with orthopaedic injuries, children with mTBI will (1) display more postconcussive symptoms and exhibit poorer motor, cognitive, social and behavioural functioning; (2) show evidence of altered brain structure and function, poorer sleep and higher levels of stress hormones. A combination of child, injury, socioenvironmental and psychobiological factors are expected to predict behaviour and quality of life at 1, 3 and 12 months postinjury. ETHICS AND DISSEMINATION The KOALA study is approved by the Sainte-Justine University Hospital, McGill University Health Centre and University of Calgary Conjoint Health Research Ethics Boards. Parents of participants will provide written consent. Dissemination will occur through peer-reviewed journals and an integrated knowledge translation plan.
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Affiliation(s)
- Miriam H Beauchamp
- Psychology, Université de Montréal, Montreal, Quebec, Canada
- Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada
| | - Fanny Dégeilh
- Psychology, Université de Montréal, Montreal, Quebec, Canada
- Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada
- Psychiatry, LMU München, Munchen, Bayern, Germany
| | - Keith Yeates
- Psychology, University of Calgary, Calgary, Alberta, Canada
- Research Institute, Alberta Children's Hospital, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Trauma, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Ken Tang
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Jocelyn Gravel
- Pediatric Emergency Medicine, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Antonia Stang
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Brett Burstein
- Pediatric Emergency Medicine, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Annie Bernier
- Psychology, Université de Montreal, Montreal, Quebec, Canada
| | - Catherine Lebel
- Research Institute, Alberta Children's Hospital, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Radiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Sonia Lupien
- Psychiatry, Université de Montréal, Montreal, Quebec, Canada
| | | | - Roger Zemek
- Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Mathieu Dehaes
- Psychology, Université de Montréal, Montreal, Quebec, Canada
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Nonweiler J, Rattray F, Baulcomb J, Happé F, Absoud M. Prevalence and Associated Factors of Emotional and Behavioural Difficulties during COVID-19 Pandemic in Children with Neurodevelopmental Disorders. Children (Basel) 2020; 7:children7090128. [PMID: 32899799 PMCID: PMC7552706 DOI: 10.3390/children7090128] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 01/10/2023]
Abstract
Children and young people (CYP) with neurodevelopmental disorders (NDDs) may be particularly vulnerable to adverse mental health effects due to the COVID-19 pandemic. We conducted a cross-sectional U.K. parent-reported study from 2nd April-2nd June 2020, using the Strengths and Difficulties Questionnaire. CYP with NDDs (n = 371), compared to neurotypical controls, had a higher prevalence of emotional symptoms (42% vs. 15%) and conduct problems (28% vs. 9%), and fewer prosocial behaviours (54% vs. 22%). All groups had worse emotional symptoms than pre-COVID groups, and those with attention-deficit/hyperactivity disorder showed inflated conduct problems, while those with autism spectrum disorder exhibited decreased prosocial behaviours. Females with ASD had higher emotional symptoms compared to males. CYP with NDDs, and those without, showed higher levels of parent-reported mental health problems than comparable cohorts pre-COVID-19.
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Affiliation(s)
- Jacqueline Nonweiler
- Department of Children’s Neurosciences, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK; (J.N.); (J.B.)
| | - Fiona Rattray
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AH, UK; (F.R.); (F.H.)
| | - Jennifer Baulcomb
- Department of Children’s Neurosciences, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK; (J.N.); (J.B.)
| | - Francesca Happé
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AH, UK; (F.R.); (F.H.)
| | - Michael Absoud
- Department of Women & Children’s Health, King’s College, London SE1 7EH, UK
- Correspondence: ; Tel.: +44-2071-884-665
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Balabanova S, Taylor C, Sills G, Burnside G, Plumpton C, Smith PEM, Appleton R, Leach JP, Johnson M, Baker G, Pirmohamed M, Hughes DA, Williamson PR, Tudur-Smith C, Marson AG. Study protocol for a pragmatic randomised controlled trial comparing the effectiveness and cost-effectiveness of levetiracetam and zonisamide versus standard treatments for epilepsy: a comparison of standard and new antiepileptic drugs (SANAD-II). BMJ Open 2020; 10:e040635. [PMID: 32847927 PMCID: PMC7451282 DOI: 10.1136/bmjopen-2020-040635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Antiepileptic drugs (AEDs) are the mainstay of epilepsy treatment. Over the past 20 years, a number of new drugs have been approved for National Health Service (NHS) use on the basis of information from short-term trials that demonstrate efficacy. These trials do not provide information about the longer term outcomes, which inform treatment policy. This trial will assess the long-term clinical and cost-effectiveness of the newer treatment levetiracetam and zonisamide. METHODS AND ANALYSIS This is a phase IV, multicentre, open-label, randomised, controlled clinical trial comparing new and standard treatments for patients with newly diagnosed epilepsy. Arm A of the trial randomised 990 patients with focal epilepsy to standard AED lamotrigine or new AED levetiracetam or zonisamide. Arm B randomised 520 patients with generalised epilepsy to standard AED sodium valproate or new AED levetiracetam. Patients are recruited from UK NHS outpatient epilepsy, general neurology and paediatric clinics. Included patients are aged 5 years or older with two or more spontaneous seizures requiring AED monotherapy, who are not previously treated with AEDs. Patients are followed up for a minimum of 2 years. The primary outcome is time to 12-month remission from seizures. Secondary outcomes include time to treatment failure (including due to inadequate seizure control or unacceptable adverse reactions); time to first seizure; time to 24-month remission; adverse reactions and quality of life. All primary analyses will be on an intention to treat basis. Separate analyses will be undertaken for each arm. Health economic analysis will be conducted from the perspective of the NHS to assess the cost-effectiveness of each AED. ETHICS AND DISSEMINATION This trial has been approved by the North West-Liverpool East REC (Ref. 12/NW/0361). The trial team will disseminate the results through scientific meetings, peer-reviewed publications and patient and public involvement. TRIAL REGISTRATION NUMBERS EudraCT 2012-001884-64; ISRCTN30294119.
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Affiliation(s)
- Silviya Balabanova
- Liverpool Clinical Trials Centre, University of Liverpool, Faculty of Health and Life Sciences, Liverpool, UK
| | - Claire Taylor
- Liverpool Clinical Trials Centre, University of Liverpool, Faculty of Health and Life Sciences, Liverpool, UK
| | - Graeme Sills
- School of Life Sciences, University of Glasgow, Glasgow, UK
| | - Girvan Burnside
- Biostatistics, University of Liverpool, Faculty of Health and Life Sciences, Liverpool, UK
| | - Catrin Plumpton
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Phil E M Smith
- Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - Richard Appleton
- Paediatric Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | - Michael Johnson
- Department of Brain Sciences, Imperial College London Faculty of Medicine-South Kensington Campus, London, UK
| | - Gus Baker
- Molecular and Clinical Pharmacology, University of Liverpool, Faculty of Health and Life Sciences, Liverpool, UK
| | - Munir Pirmohamed
- Department of Pharmacology, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | | | - Catrin Tudur-Smith
- Biostatistics, University of Liverpool, Faculty of Health and Life Sciences, Liverpool, UK
| | - Anthony Guy Marson
- Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
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Scott JC, Van Pelt AE, Port AM, Njokweni L, Gur RC, Moore TM, Phoi O, Tshume O, Matshaba M, Ruparel K, Chapman J, Lowenthal ED. Development of a computerised neurocognitive battery for children and adolescents with HIV in Botswana: study design and protocol for the Ntemoga study. BMJ Open 2020; 10:e041099. [PMID: 32847928 PMCID: PMC7451956 DOI: 10.1136/bmjopen-2020-041099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Neurodevelopmental delays and cognitive impairments are common in youth living with HIV. Unfortunately, in resource-limited settings, where HIV infection impacts millions of children, cognitive and neurodevelopmental disorders commonly go undetected because of a lack of appropriate assessment instruments and local expertise. Here, we present a protocol to culturally adapt and validate the Penn Computerized Neurocognitive Battery (PennCNB) and examine its validity for detecting both advanced and subtle neurodevelopmental problems among school-aged children affected by HIV in resource-limited settings. METHODS AND ANALYSIS This is a prospective, observational cohort study. The venue for this study is Gaborone, Botswana, a resource-limited setting with high rates of perinatal exposure to HIV and limited neurocognitive assessment tools and expertise. We aim to validate the PennCNB in this setting by culturally adapting and then administering the adapted version of the battery to 200 HIV-infected, 200 HIV-exposed uninfected and 240 HIV-unexposed uninfected children. A series of analyses will be conducted to examine the reliability and construct validity of the PennCNB in these populations. ETHICS AND DISSEMINATION This project received ethical approval from local and university Institutional Review Boards and involved extensive input from local stakeholders. If successful, the proposed tools will provide practical screening and streamlined, comprehensive assessments that could be implemented in resource-limited settings to identify children with cognitive deficits within programmes focused on the care and treatment of children affected by HIV. The utility of such assessments could also extend beyond children affected by HIV, increasing general access to paediatric cognitive assessments in resource-limited settings.
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Affiliation(s)
- J Cobb Scott
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- VISN4 Mental Illness Research, Education, and Clinical Center, Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Amelia E Van Pelt
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Pediatrics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Allison M Port
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lucky Njokweni
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Tyler M Moore
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Onkemetse Phoi
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Ontibile Tshume
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Mogomotsi Matshaba
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
- Baylor College of Medicine, Gaborone, Botswana
| | - Kosha Ruparel
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jennifer Chapman
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elizabeth D Lowenthal
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Pediatrics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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DeGiorgio CM, Curtis A, Carapetian A, Hovsepian D, Krishnadasan A, Markovic D. Why are epilepsy mortality rates rising in the United States? A population-based multiple cause-of-death study. BMJ Open 2020; 10:e035767. [PMID: 32839157 PMCID: PMC7449302 DOI: 10.1136/bmjopen-2019-035767] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/06/2020] [Accepted: 06/10/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Epilepsy mortality rates are rising. It is unknown whether rates are rising due to an increase in epilepsy prevalence, changes in epilepsy causes of death, increase in the lethality or epilepsy or failures of treatment. To address these questions, we compare epilepsy mortality rates in the USA with all-cause and all-neurological mortality for the years 1999 to 2017. OBJECTIVES To determine changes in US epilepsy mortality rates versus all-cause mortality, and to evaluate changes in the leading causes of death in people with epilepsy. DESIGN Retrospective population-based multiple cause-of-death study. PRIMARY OUTCOME Change in age-adjusted epilepsy mortality rates compared with mortality rates for all-cause and all-neurological mortality. SECONDARY OUTCOME Changes in the leading causes of death in epilepsy. RESULTS From 1999 to 2017, epilepsy mortality rates in the USA increased 98.8%, from 5.83 per million in 1999 to 11.59 per million (95% CI 88.2%-110.0%), while all-cause mortality declined 16.4% from 8756.34 per million to 7319.17 per million (95% CI 16.3% to 16.6%). For the same period, all-neurological mortality increased 80.8% from 309.21 to 558.97 per million (95% CI 79.4%-82.1%). The proportion of people with epilepsy who died due to neoplasms, vascular dementia and Alzheimer's increased by 52.3%, 210.1% and 216.8%, respectively. During the same period, the proportion who died due to epilepsy declined 27.1%, while ischaemic heart disease as a cause of death fell 42.6% (p<0.001). CONCLUSIONS Epilepsy mortality rates in the USA increased significantly from 1999 to 2017. Likely causes include increases in all-neurological mortality, increased epilepsy prevalence and changes in the underlying causes of death in epilepsy, led by increases in vascular dementia and Alzheimer's. An important finding is that ischaemic heart disease and epilepsy itself are declining as underlying causes of death in people with epilepsy.
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Affiliation(s)
| | - Ashley Curtis
- David Geffen-UCLA School of Medicine, Los Angeles, California, USA
| | - Armen Carapetian
- David Geffen-UCLA School of Medicine, Los Angeles, California, USA
| | - Dominic Hovsepian
- Department of Neurology, Stanford University School of Medicine, Stanford, California, USA
| | | | - Daniela Markovic
- David Geffen-UCLA School of Medicine, Los Angeles, California, USA
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Ho CS, Huang JY, Yang CH, Lin YJ, Huang MY, Su YC. Is the Yale Global Tic Severity Scale a valid tool for parent-reported assessment in the paediatric population? A prospective observational study in Taiwan. BMJ Open 2020; 10:e034634. [PMID: 32819930 PMCID: PMC7440819 DOI: 10.1136/bmjopen-2019-034634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The Yale Global Tic Severity Scale (YGTSS) is the most commonly used clinician-rated evaluation tool for Tourette syndrome (TS), with established reliability and validity. This study aims to determine whether the YGTSS is a valid parent-reported assessment in the TS population. DESIGN A prospective cohort study. SETTING A major medical centre in Taiwan. METHODS A total of 594 patients were enrolled. A revised traditional Chinese version of the YGTSS was made available to parents via Google docs. Parents were encouraged to complete the YGTSS the day before each outpatient clinic visit. At each visit, a paediatric neurology fellow also administered the YGTSS assessment. We investigated whether differences in scores between physicians and parents changed as the number of parent evaluations increased. The results of the physician assessments were also taken as the expert standard for evaluating the sensitivity and specificity of the parent-reported assessments was conducted for the same visit. RESULTS The differences in the YGTSS scores between participants and physicians were small. The mean difference in the total assessment score was 4.15 points. As the number of times the parent evaluation was performed increased, the difference between the parent and physician scores decreased. Discrimination of moderate-to-severe attacks was good using the parent-assessed YGTSS (area under the receiver operating characteristic curve, 0.858; 95% CI 0.839 to 0.876). The sensitivity for detecting a moderate-to-severe attack by YGTSS parent assessment was 79.7% (95% CI 76.6 to 82.8), and the specificity was 91.8% (95% CI 89.9 to 93.7). CONCLUSION The parent-reported YGTSS is a promising tool for TS assessment, demonstrating good discriminative ability for disease severity, with user precision increasing with experience.
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Affiliation(s)
- Che-Sheng Ho
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Division of Pediatric Neurology, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Jia-Yun Huang
- Division of Pediatric Neurology, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Chien-Hui Yang
- Division of Pediatric Neurology, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Yi-Jie Lin
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Division of Pediatric Neurology, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Ming-Yuan Huang
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yung-Cheng Su
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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Pool JW, Siegert RJ, Taylor S, Dunford C, Magee W. Evaluating the validity, reliability and clinical utility of the Music therapy Sensory Instrument for Cognition, Consciousness and Awareness (MuSICCA): protocol of a validation study. BMJ Open 2020; 10:e039713. [PMID: 32792456 PMCID: PMC7430455 DOI: 10.1136/bmjopen-2020-039713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION A growing number of children and young people are surviving severe acquired brain injuries due to advances in healthcare. However, many fail to emerge from coma and continue to live with disorders of consciousness (DOC). Diagnostic, clinical and ethical challenges are prominent in this group. Misdiagnosis can have severe consequences for children and their families, including inadequate care, insufficient access to rehabilitation and stimulation, reduced accessibility to services and inappropriately limited opportunities for participation. The proposed project will develop and validate a diagnostic measure that supports detailed goal-planning-the Music therapy Sensory Instrument for Cognition, Consciousness and Awareness (MuSICCA). METHODS AND ANALYSIS Face validity will be assessed using a short questionnaire and the MuSICCA will be amended if face validity is insufficient. Once face validity is sufficient, 80 participants with suspected DOC will be recruited from multiple sites around the UK, USA and Ireland.Validity will be assessed using external reference standards (Coma Recovery Scale-Revised, Coma Near-Coma Scale and Nociception Coma Scale). Intra-rater reliability will be established using repeated ratings of video recordings from the assessment sessions. Inter-rater reliability will be assessed through video ratings by a second blinded assessor. In addition to these analyses, the clinical utility of the MuSICCA will be evaluated using a questionnaire to be completed by clinicians and relatives of the participants following the completion of the MuSICCA assessment. ETHICS AND DISSEMINATION Ethical approval has been obtained for this study from the Research Ethics Committee and Health Research Authority of the National Health Service of the UK (ID: 167534). Results will be presented at national and international conferences, published in scientific journals and disseminated to participant representatives, clinicians, educators and care providers. TRIAL REGISTRATION DETAILS This study was registered at ClinicalTrials.gov Protocol Registration and Results System on 7th August 2019 (ID: NCT04050995); Pre-results.
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Affiliation(s)
- Jonathan Wain Pool
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge, UK
- Research, The Children's Trust, Tadworth, UK
| | - Richard John Siegert
- School of Public Health and Psychosocial Studies and School of Rehabilitation and Occupational Studies, Auckland University of Technology, Auckland, New Zealand
| | - Steven Taylor
- Department of Biostatistics and Epidemiology, Auckland University of Technology, Auckland, New Zealand
| | - Carolyn Dunford
- Research, The Children's Trust, Tadworth, UK
- Department of Occupational Therapy, Brunel University College of Health and Life Sciences, Uxbridge, Middlesex, UK
| | - Wendy Magee
- Music Therapy, Temple University, Philadelphia, Pennsylvania, USA
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Garcia Jalón EG, Merrick H, Colver A, Linden M. Did previous involvement in research affect recruitment of young people with cerebral palsy to a longitudinal study of transitional health care? BMJ Open 2020; 10:e035525. [PMID: 32788185 PMCID: PMC7422630 DOI: 10.1136/bmjopen-2019-035525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess whether being contacted about or participating in previous research and method of approaching potential participants affected recruitment to a transition study from child to adult healthcare services of young people with cerebral palsy (CP). DESIGN AND METHODS Young people with CP aged 14-18 years without severe intellectual impairment were identified from regional registers of CP in Northern Ireland and the North of England. χ2 and Mann-Whitney U tests were used to assess differences in CP and sociodemographic characteristics between those recruited and those who refused. Logistic regression was used to assess contact about and recruitment to previous research and method of approach as predictors of recruitment, controlling for demographic and CP characteristics. RESULTS Of the 410 young people who were approached; 162 did not respond and of the 248 who responded, 96 (23%) were recruited. There were significant differences between those recruited and those who refused in age and number of previous studies they had participated in. Those who were older or who had previously been approached about research were more likely to be recruited to our study. However, those who had been recruited to previous studies were more likely to refuse to join our study. CONCLUSIONS The method of approach to potential participants did not affect recruitment. Older adolescents and those who had been approached about previous research were more likely to take part in our study, although there was evidence of research fatigue because if they had actually been recruited to the previous studies they were less likely to join our study. Recruitment of adolescents to studies remains challenging.
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Affiliation(s)
| | - Hanna Merrick
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Allan Colver
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mark Linden
- School of Nursing and Midwifery, Queen's University of Belfast, Belfast, UK
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Verfürden M, Harron K, Jerrim J, Fewtrell M, Gilbert R. Infant formula composition and educational performance: a protocol to extend follow-up for a set of randomised controlled trials using linked administrative education records. BMJ Open 2020; 10:e035968. [PMID: 32709645 PMCID: PMC7380883 DOI: 10.1136/bmjopen-2019-035968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 06/03/2020] [Accepted: 06/10/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION The effect of infant nutrition on long-term cognition is important for parents and policy makers. However, most clinical trials typically have short follow-up periods, when measures of cognition are poorly predictive of later function. The few trials with longer-term follow-up have high levels of attrition, which can lead to selection bias, and in turn to erroneous interpretation of long-term harms and benefits of infant nutrition. We address the need for unbiased, long-term follow-up, by linking measures of educational performance from administrative education records. Educational performance is a meaningful marker of cognitive function in children and it is strongly correlated with IQ. We aim to evaluate educational performance for children who, as infants, were part of a series of trials that randomised participants to either nutritionally modified infant formula or standard formula. Most trialists anticipated positive effects of these interventions on later cognitive function. METHODS AND ANALYSIS Using data from 1923 participants of seven randomised infant formula trials linked to the English National Pupil Database (NPD), this study will provide new insights into the effect of nutrient intake in infancy on school achievement. Our primary outcome will be the mean differences in z-scores between intervention and control groups for a compulsory Mathematics exam sat at age 16. Secondary outcomes will be z-scores for a compulsory English exam at age 16 and z-scores for compulsory Mathematics and English exams at age 11. We will also evaluate intervention effects on the likelihood of receiving special educational needs (SEN) support. All analyses will be performed separately by trial. ETHICS AND DISSEMINATION Research ethics approval, and approval from the Health Research Authority Confidentiality Advisory Group, has been obtained for this study. The results of this study will be disseminated to scientific, practitioner, and lay audiences, submitted for publication in peer-reviewed journals, and will contribute towards a PhD dissertation.
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Affiliation(s)
- Maximiliane Verfürden
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Katie Harron
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - John Jerrim
- Institute of Education, University College London, London, UK
| | - Mary Fewtrell
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Ruth Gilbert
- Great Ormond Street Institute of Child Health, University College London, London, UK
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Manjourides J, Zimmerman E, Watkins DJ, Carpenito T, Vélez-Vega CM, Huerta-Montañez G, Rosario Z, Ayala I, Vergara C, Feric Z, Ondras M, Suh HH, Gu AZ, Brown P, Cordero JF, Meeker JD, Alshawabkeh A. Cohort profile: Center for Research on Early Childhood Exposure and Development in Puerto Rico. BMJ Open 2020; 10:e036389. [PMID: 32690520 PMCID: PMC7371225 DOI: 10.1136/bmjopen-2019-036389] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/23/2020] [Accepted: 05/28/2020] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Puerto Rican children experience high rates of asthma and obesity. Further, infants born in Puerto Rico are more at risk for being born prematurely compared with infants on the mainland USA. Environmental exposures from multiple sources during critical periods of child development, potentially modified by psychosocial factors, may contribute to these adverse health outcomes. To date, most studies investigating the health effects of environmental factors on infant and child health have focused on single or individual exposures. PARTICIPANTS Infants currently in gestation whose mother is enrolled in Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) cohort, and infants and children already born to mothers who participated in the PROTECT study. FINDINGS TO DATE Data collection and processing remains ongoing. Demographic data have been collected on 437 mother-child pairs. Birth outcomes are available for 420 infants, neurodevelopmental outcomes have been collected on 319 children. Concentrations of parabens and phenols in maternal spot urine samples have been measured from 386 mothers. Center for Research on Early Childhood Exposure and Development mothers have significantly higher urinary concentrations of dichlorophenols, triclosan and triclocarban, but lower levels of several parabens compared with reference values from a similar population drawn from the National Health and Nutrition Examination Survey. FUTURE PLANS Data will continue to be collected through recruitment of new births with a target of 600 children. Seven scheduled follow-up visits with existing and new participants are planned. Further, our research team continues to work with healthcare providers, paediatricians and early intervention providers to support parent's ability to access early intervention services for participants.
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Affiliation(s)
- Justin Manjourides
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Emily Zimmerman
- Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts, USA
| | - Deborah J Watkins
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Thomas Carpenito
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Carmen M Vélez-Vega
- University of Puerto Rico Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Gredia Huerta-Montañez
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts, USA
| | - Zaira Rosario
- University of Puerto Rico Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Ishwara Ayala
- University of Puerto Rico Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Carlos Vergara
- University of Puerto Rico Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Zlatan Feric
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts, USA
| | - Martha Ondras
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, USA
| | - Helen H Suh
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, USA
| | - April Z Gu
- School of Civil and Environmental Engineering, Cornell University, Ithaca, New York, USA
| | - Phil Brown
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
- Department of Sociology and Anthropology, Northeastern University, Boston, Massachusetts, USA
- Social Science Environmental Health Research Institute, Northeastern University, Boston, Massachusetts, USA
| | - José F Cordero
- University of Puerto Rico Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, USA
| | - John D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Akram Alshawabkeh
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts, USA
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Rahlin M, Duncan B, Howe CL, Pottinger HL. How does the intensity of physical therapy affect the Gross Motor Function Measure (GMFM-66) total score in children with cerebral palsy? A systematic review protocol. BMJ Open 2020; 10:e036630. [PMID: 32690525 PMCID: PMC7371020 DOI: 10.1136/bmjopen-2019-036630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Intensive physical therapy (PT) interventions administered to children with cerebral palsy (CP) have received a significant amount of attention in published literature. However, there is considerable variability in therapy intensity among studies and notable lack of information on optimal intervention dosing. This makes it difficult for clinicians to use evidence to inform practice. Many studies use the Gross Motor Function Measure (GMFM-66) to assess functional progress in children with CP. The purpose of this systematic review will be to identify the GMFM-66 change score reported in published studies, with outcomes based on intervention intensity. Whether the type of PT intervention, child's age, and Gross Motor Function Classification System level influence the GMFM-66 scores will be also assessed. METHODS AND ANALYSIS This systematic review protocol was developed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) 2015 checklist. In March 2018, nine databases (PubMed, Ovid MEDLINE, Cochrane Library, Embase, Scopus, Web of Science, CINAHL, ClinicalTrials.gov, and REHABDATA) were searched for controlled clinical trials and single-subject design studies of PT interventions of any kind and intensity that used the GMFM-66 as an outcome measure for children with CP, age up to 18 years. Two authors independently reviewed the titles and abstracts and arrived at consensus on paper selection for a full-text review. The same process was used for a full-text article screening based on further detailed inclusion criteria, with a final selection made for those suitable for data extraction. Prior to commencement of data extraction, all searches will be updated, and new results re-screened. ETHICS AND DISSEMINATION This study will involve a systematic review of published articles and no primary data collection. Therefore, no ethical approval will be necessary. Results will be disseminated in a peer-reviewed publication and presented at scientific conferences. PROSPERO REGISTRATION NUMBER CRD42020147669.
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Affiliation(s)
- Mary Rahlin
- Department of Physical Therapy, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Burris Duncan
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Carol L Howe
- Health Sciences Library, University of Arizona, Tucson, Arizona, USA
| | - Heidi L Pottinger
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
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Ryan J, Theis N, Koufaki P, Phillips S, Anokye N, Andreopoulou G, Kennedy F, Jagadamma KC, vanSchie P, Dines H, van der Linden ML. Effect of RaceRunning on cardiometabolic disease risk factors and functional mobility in young people with moderate-to-severe cerebral palsy: protocol for a feasibility study. BMJ Open 2020; 10:e036469. [PMID: 32611743 PMCID: PMC7332180 DOI: 10.1136/bmjopen-2019-036469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION There is consistent evidence that people with cerebral palsy (CP) do not engage in the recommended physical activity guidelines for the general population from a young age. Participation in moderate-to-vigorous physical activity is particularly reduced in people with CP who have a moderate-to-severe disability. RaceRunning is a growing disability sport that provides an opportunity for people with moderate-to-severe disability to participate in physical activity in the community. It allows those who are unable to walk independently to propel themselves using a RaceRunning bike, which has a breastplate for support but no pedals. The aim of this study is to examine the feasibility and acceptability of RaceRunning for young people with moderate-to-severe CP and the feasibility of conducting a definitive study of the effect of RaceRunning on cardiometabolic disease risk factors and functional mobility. METHODS AND ANALYSIS Twenty-five young people (age 5-21 years) with CP or acquired brain injury affecting coordination will be included in this single-arm intervention study. Participants will take part in one RaceRunning session each week for 24 weeks. Outcomes assessed at baseline, 12 and 24 weeks include body mass index, waist circumference, blood pressure, muscle strength, cardiorespiratory fitness, physical activity and sedentary behaviour, functional mobility, activity competence and psychosocial impact. Adverse events will be systematically recorded throughout the 24 weeks. Focus groups will be conducted with participants and/or parents to explore their views and experiences of taking part in RaceRunning. ETHICS AND DISSEMINATION Approval has been granted by Queen Margaret University Research Ethics Committee (REC) and the South East of Scotland REC. Results will be disseminated through peer-reviewed journals and distributed to people with CP and their families through RaceRunning and Athletic Clubs, National Health Service trusts and organisations for people with disabilities. TRIAL REGISTRATION NUMBER NCT04034342; pre-results.
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Affiliation(s)
- Jennifer Ryan
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nicola Theis
- School of Sport and Exercise, University of Gloucestershire, Cheltenham, Gloucestershire, UK
| | - Pelagia Koufaki
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University Edinburgh, Musselburgh, East Lothian, UK
| | - Shaun Phillips
- Institute for Sport, Physical Education and Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Nana Anokye
- Health Economics Research Group, Brunel University, London, Middlesex, UK
| | - Georgia Andreopoulou
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University Edinburgh, Musselburgh, East Lothian, UK
| | - Fiona Kennedy
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University Edinburgh, Musselburgh, East Lothian, UK
| | - Kavi C Jagadamma
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University Edinburgh, Musselburgh, East Lothian, UK
| | - Petra vanSchie
- Department of Rehabilitation Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Hannah Dines
- Department of Exercise and Sports Science, Manchester Metropolitan University, Manchester, Greater Manchester, UK
| | - Marietta L van der Linden
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University Edinburgh, Musselburgh, East Lothian, UK
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Blotière PO, Miranda S, Weill A, Mikaeloff Y, Peyre H, Ramus F, Mahmoud Z, Coste J, Dray-Spira R. Risk of early neurodevelopmental outcomes associated with prenatal exposure to the antiepileptic drugs most commonly used during pregnancy: a French nationwide population-based cohort study. BMJ Open 2020; 10:e034829. [PMID: 32513880 PMCID: PMC7282331 DOI: 10.1136/bmjopen-2019-034829] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To assess the association between prenatal exposure to monotherapy with the antiepileptic drugs (AEDs) most commonly used during pregnancy and the risk of various neurodevelopmental outcomes compared with lamotrigine. DESIGN Nationwide population-based cohort study. SETTING French national healthcare databases. PARTICIPANTS Children born alive between 2011 and 2014 and prenatally exposed to AED monotherapy. PRIMARY AND SECONDARY OUTCOME MEASURES Outcomes included neurodevelopmental disorders (NDD), defined by International Classification of Diseases, 10th Revision codes F70-F98-pervasive developmental disorders (PDD, F84) and mental retardation (MR, F70-F79) were studied separately-and visits to speech therapists. The reference group comprised children prenatally exposed to lamotrigine. Children were followed until outcome, loss to follow-up, death or 31 December 2016. We performed inverse probability of treatment weighting analyses using the propensity score, which included maternal and infant characteristics. Hazard ratios (HRs) were calculated using Cox models. RESULTS The cohort comprised 9034 children, 2916 of which were exposed to lamotrigine, 1627 to pregabalin, 1246 to clonazepam, 991 to valproic acid (VPA), 621 to levetiracetam, 502 to carbamazepine, 477 to topiramate, 378 to gabapentin and 143 to oxcarbazepine. None of these AEDs, except VPA, was associated with an increased risk of any of the four neurodevelopmental outcomes investigated. Exposure to VPA was associated with increased risks of NDDs (HR=2.7, 95% CI (1.8 to 4.0)), PDD (HR=4.4 (2.1 to 9.3)), MR (HR=3.1 (1.5 to 6.2)) and visits to speech therapists (HR=1.5 (1.1 to 1.9)), with a dose-response relationship. CONCLUSIONS No increased risk of any of the neurodevelopmental outcomes investigated in this study was observed with prenatal exposure to levetiracetam, pregabalin, oxcarbazepine, topiramate, gabapentin, clonazepam or carbamazepine, compared with lamotrigine. However, this study corroborates the well-known association between maternal use of VPA during pregnancy and the risk of neurodevelopmental disorders in the offspring. Longer follow-up is necessary to confirm these findings.
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Affiliation(s)
- Pierre-Olivier Blotière
- Department of Public Health Studies, French National Health Insurance (CNAM), Paris, France
- Apemac, EA 4360, Université de Lorraine, Université Paris-Descartes, Nancy, France
| | - Sara Miranda
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - Alain Weill
- Department of Public Health Studies, French National Health Insurance (CNAM), Paris, France
| | - Yann Mikaeloff
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Unité de Rééducation Neurologique Infantile, Bicêtre, France
- CESP, Faculté de médecine-Université Paris-Sud, Faculté de médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
| | - Hugo Peyre
- Laboratoire de Sciences Cognitives et Psycholinguistique, Ecole Normale Supérieure, EHESS, CNRS, PSL University, Paris, France
- Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris, France
- INSERM UMR 1141, Paris Diderot University, Paris, France
| | - Franck Ramus
- Laboratoire de Sciences Cognitives et Psycholinguistique, Ecole Normale Supérieure, EHESS, CNRS, PSL University, Paris, France
| | - Zureik Mahmoud
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, Saint-Denis, France
- Versailles Saint-Quentin-en-Yvelines University, Versailles, France
| | - Joël Coste
- Department of Public Health Studies, French National Health Insurance (CNAM), Paris, France
- Biostatistics and Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, and Paris Descartes University, Paris, France
| | - Rosemary Dray-Spira
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety, Saint-Denis, France
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Tan TSE, Sanamandra SK. Multinodular and vacuolating neuronal tumour of the cerebrum: an incidental diagnosis in a child presenting with absence seizures. Postgrad Med J 2020; 97:125-126. [PMID: 32404494 DOI: 10.1136/postgradmedj-2020-137789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/25/2020] [Indexed: 11/03/2022]
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George JM, Pagnozzi AM, Bora S, Boyd RN, Colditz PB, Rose SE, Ware RS, Pannek K, Bursle JE, Fripp J, Barlow K, Iyer K, Leishman SJ, Jendra RL. Prediction of childhood brain outcomes in infants born preterm using neonatal MRI and concurrent clinical biomarkers (PREBO-6): study protocol for a prospective cohort study. BMJ Open 2020; 10:e036480. [PMID: 32404396 PMCID: PMC7228524 DOI: 10.1136/bmjopen-2019-036480] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Infants born very preterm are at risk of adverse neurodevelopmental outcomes, including cognitive deficits, motor impairments and cerebral palsy. Earlier identification enables targeted early interventions to be implemented with the aim of improving outcomes. METHODS AND ANALYSIS Protocol for 6-year follow-up of two cohorts of infants born <31 weeks gestational age (PPREMO: Prediction of Preterm Motor Outcomes; PREBO: Prediction of Preterm Brain Outcomes) and a small term-born reference sample in Brisbane, Australia. Both preterm cohorts underwent very early MRI and concurrent clinical assessment at 32 and 40 weeks postmenstrual age (PMA) and were followed up at 3, 12 and 24 months corrected age (CA). This study will perform MRI and electroencephalography (EEG). Primary outcomes include the Movement Assessment Battery for Children second edition and Full-Scale IQ score from the Wechsler Intelligence Scale for Children fifth edition (WISC-V). Secondary outcomes include the Gross Motor Function Classification System for children with cerebral palsy; executive function (Behavior Rating Inventory of Executive Function second edition, WISC-V Digit Span and Picture Span, Wisconsin Card Sorting Test 64 Card Version); attention (Test of Everyday Attention for Children second edition); language (Clinical Evaluation of Language Fundamentals fifth edition), academic achievement (Woodcock Johnson IV Tests of Achievement); mental health and quality of life (Development and Well-Being Assessment, Autism Spectrum Quotient-10 Items Child version and Child Health Utility-9D). AIMS Examine the ability of early neonatal MRI, EEG and concurrent clinical measures at 32 weeks PMA to predict motor, cognitive, language, academic achievement and mental health outcomes at 6 years CA.Determine if early brain abnormalities persist and are evident on brain MRI at 6 years CA and the relationship to EEG and concurrent motor, cognitive, language, academic achievement and mental health outcomes. ETHICS AND DISSEMINATION Ethical approval has been obtained from Human Research Ethics Committees at Children's Health Queensland (HREC/19/QCHQ/49800) and The University of Queensland (2019000426). Study findings will be presented at national and international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12619000155190p. WEB ADDRESS OF TRIAL: http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619000155190p.
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Affiliation(s)
- Joanne M George
- Child Health Research Centre, Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Alex M Pagnozzi
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Brisbane, Queensland, Australia
| | - Samudragupta Bora
- Mothers, Babies and Women's Health Program, Mater Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Child Health Research Centre, Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul B Colditz
- Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
- Perinatal Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Stephen E Rose
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Kerstin Pannek
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Brisbane, Queensland, Australia
| | - Jane E Bursle
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jurgen Fripp
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Brisbane, Queensland, Australia
| | - Karen Barlow
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Kartik Iyer
- Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Shaneen J Leishman
- Child Health Research Centre, Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Abstract
INTRODUCTION Preterm brain injury continues to be an important complication of preterm birth, especially in extremely premature infants. Umbilical cord blood-derived cells (UCBCs) are increasingly being evaluated for their neuroprotective and neuroreparative properties in preclinical and clinical studies. There remains a paucity of information on the feasibility and safety of autologous UCBC transplantation in extremely premature infants. METHODS AND ANALYSIS A single centre safety and feasibility study in preterm babies born before 28 weeks gestation. Cord blood will be collected after birth and if sufficient blood is obtained, UCB mononuclear cells will be harvested from the cord blood, characterised and stored. After excluding infants who have already suffered severe preterm brain injury, based on cranial ultrasounds in first week of life, preterm infants will be infused with autologous UCBCs via the intravenous route at a dose of 25-50 million UCBCs/kg body weight of live cells, with the cell number being the maximum available up to 50 million cells/kg. A minimum of 20 infants will be administered autologous UCBCs. Primary outcomes will include feasibility and safety. Feasibility will be determined by access to sufficient cord blood at collection and UCBCs following processing. Safety will be determined by lack of adverse events directly related to autologous UCBC administration in the first few days after cell administration. Secondary outcomes studied will include neonatal and neurodevelopmental morbidities till 2 years of life. Additional outcomes will include cell characteristics of all collected cord blood, and cytokine responses to cell administration in transplanted infants till 36 weeks' corrected age. ETHICS AND DISSEMINATION Monash Health Human Research Ethics Committee approved this study in December 2019. Recruitment is to commence in July 2020 and is expected to take around 12 months. The findings of this study will be disseminated via peer-reviewed journals and at conferences. TRIAL REGISTRATION NUMBER ACTRN12619001637134.
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Affiliation(s)
- Atul Malhotra
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Iona Novak
- Cerebral Palsy Alliance, Sydney, New South Wales, Australia
| | - Suzanne Lee Miller
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Graham Jenkin
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
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Eshaghi A. First approved treatment in children with multiple sclerosis slows brain atrophy. J Neurol Neurosurg Psychiatry 2020; 91:454. [PMID: 32132223 DOI: 10.1136/jnnp-2019-322519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Arman Eshaghi
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, University College London, London, UK .,Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, London, United Kingdom
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Hong Y, Yuan Y, Shu S, Hou B, Dai Y, Ni J, Feng F, Qiu Z, Peng B. Steno-occlusive cerebral arteriopathy in patients with glycogen storage disease type I. J Neurol Neurosurg Psychiatry 2020; 91:434-435. [PMID: 31852724 DOI: 10.1136/jnnp-2019-321489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/07/2019] [Accepted: 12/08/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Yuehui Hong
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuheng Yuan
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shi Shu
- McKusick-Zhang Center for Genetic Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Hou
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Dai
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Ni
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengqing Qiu
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Boardman JP, Hall J, Thrippleton MJ, Reynolds RM, Bogaert D, Davidson DJ, Schwarze J, Drake AJ, Chandran S, Bastin ME, Fletcher-Watson S. Impact of preterm birth on brain development and long-term outcome: protocol for a cohort study in Scotland. BMJ Open 2020; 10:e035854. [PMID: 32139495 PMCID: PMC7059503 DOI: 10.1136/bmjopen-2019-035854] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Preterm birth is closely associated with altered brain development and is a leading cause of neurodevelopmental, cognitive and behavioural impairments across the life course. We aimed to investigate neuroanatomic variation and adverse outcomes associated with preterm birth by studying a cohort of preterm infants and controls born at term using brain MRI linked to biosamples and clinical, environmental and neuropsychological data. METHODS AND ANALYSIS Theirworld Edinburgh Birth Cohort is a prospective longitudinal cohort study at the University of Edinburgh. We plan to recruit 300 infants born at <33 weeks of gestational age (GA) and 100 healthy control infants born after 37 weeks of GA. Multiple domains are assessed: maternal and infant clinical and demographic information; placental histology; immunoregulatory and trophic proteins in umbilical cord and neonatal blood; brain macrostructure and microstructure from structural and diffusion MRI (dMRI); DNA methylation; hypothalamic-pituitary-adrenal axis activity; social cognition, attention and processing speed from eye tracking during infancy and childhood; neurodevelopment; gut and respiratory microbiota; susceptibility to viral infections; and participant experience. Main analyses include creation of novel methods for extracting information from neonatal structural and dMRI, regression analyses of predictors of brain maldevelopment and neurocognitive outcome associated with preterm birth, and determination of the quantitative predictive performance of MRI and other early life factors for childhood outcome. ETHICS AND DISSEMINATION Ethical approval has been obtained from the National Research Ethics Service (NRES), South East Scotland Research Ethics Committee (NRES numbers 11/55/0061 and 13/SS/0143 (phase I) and 16/SS/0154 (phase II)), and NHS Lothian Research and Development (2016/0255). Results are disseminated through open access journals, scientific meetings, social media, newsletters anda study website (www.tebc.ed.ac.uk), and we engage with the University of Edinburgh public relations and media office to ensure maximum publicity and benefit.
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Affiliation(s)
- James P Boardman
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Jill Hall
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | | | - Rebecca M Reynolds
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Debby Bogaert
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK
| | - Donald J Davidson
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK
| | - Jurgen Schwarze
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK
| | - Amanda J Drake
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | | | - Mark E Bastin
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Sue Fletcher-Watson
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
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Lhamtsho D, Rajesh U, Saxena A, Bhardwaj G, Sondhi V. Novel RNASEH2C mutation in multiple members of a large family: insights into phenotypic spectrum of Aicardi-Goutières Syndrome. BMJ Neurol Open 2020; 2:e000018. [PMID: 33681774 PMCID: PMC7871725 DOI: 10.1136/bmjno-2019-000018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2019] [Indexed: 11/17/2022] Open
Abstract
Background Aicardi-Goutières syndrome (AGS) is a genetic inflammatory disorder that presents with early infantile encephalopathy. We report the clinical and molecular details of multiple members of a family with AGS secondary to a novel RNASEH2C mutation, highlighting the evolution of phenotypic abnormalities in AGS. Methods Between February 2018 and June 2019, a pedigree tree was constructed for 141 members of a family. The clinical and radiological details of 14 symptomatic children were chronicled and compared with the asymptomatic family members. Genetic analysis was performed on 23 individuals (six symptomatic). This involved whole exome sequencing for one patient and confirmation of the identified indel variant in other family members. Results The symptomatic children were diagnosed as AGS secondary to a novel indel variation in exon 2 of the RNASEH2C gene (chr11:65487843_65487846delinsGCCA). Clinically, between the ages of 2 and 6 months, the symptomatic children developed irritability (14/14), unexplained fever (9/14), chill blains (12/14), sleep irregularities (14/14) and developmental delay (14/14), with deterioration to vegetative state at a median (IQR) age of 10.5 months (9.25–11). In addition, chill blains were observed in 5/17 (29.4%) carrier individuals. Neuroimaging demonstrated a gradual progression of calcification involving basal ganglia, periventricular white matter and dentate nucleus. Three patients also demonstrated presence of subependymal germinolytic cysts. Conclusion This report highlights a novel founder RNASEH2C mutation and the phenotypic evolution of AGS. In addition, we report chill blains in one-third of RNASEH2C mutation carriers. Neuroradiologically, the report illustrates novel MRI findings and demonstrates a progression pattern of disease. These findings will aid in earlier suspicion and diagnosis of AGS.
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Affiliation(s)
- Dema Lhamtsho
- Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | - Uddandam Rajesh
- Radiodiagnosis, Armed Forces Medical College, Pune, Maharashtra, India
| | - Apoorv Saxena
- Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | - Girish Bhardwaj
- Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | - Vishal Sondhi
- Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
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Ehrler M, Naef N, Tuura RO, Latal B. Executive function and brain development in adolescents with severe congenital heart disease (Teen Heart Study): protocol of a prospective cohort study. BMJ Open 2019; 9:e032363. [PMID: 31666273 PMCID: PMC6830656 DOI: 10.1136/bmjopen-2019-032363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Congenital heart disease (CHD) is the most frequent congenital malformation. With recent advances in medical care, the majority of patients with CHD survive into adulthood. As a result, interest has shifted towards the neurodevelopmental outcome of these patients, and particularly towards the early detection and treatment of developmental problems. A variety of mild to moderate cognitive impairments as well as emotional and behavioural problems has been observed in this population. However, a more detailed assessment of the various domains of executive function and their association with structural and functional brain development is lacking. Therefore, the current study will examine all domains of executive function and brain development in detail in a large sample of children and adolescents with CHD and healthy control children. METHODS AND ANALYSIS A total of 192 children and adolescents with CHD aged 10-15 years, who participated in prospective cohort studies at the University Children's Hospital Zurich, will be eligible for this study. As a control group, approximately 100 healthy children will be enrolled. Primary outcome measures will include executive function abilities, while secondary outcomes will consist of other neurodevelopmental measures, including intelligence, processing speed, attention, fine motor abilities and brain development. An MRI will be performed to assess structural and functional brain development. Linear regression analyses will be applied to investigate group differences and associations between executive function performance and neurodevelopmental measures. ETHICS AND DISSEMINATION This study is supported by the Swiss National Science Foundation (SNF 32003B_172914) and approved by the ethical committee of the Canton Zurich (KEK 2019-00035). Written informed consent will be obtained from all the parents and from children aged 14 years or older. Findings from this study will be published in peer-reviewed journals and presented at national and international conferences for widespread dissemination of the results.
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Affiliation(s)
- Melanie Ehrler
- Child Development Center, University Children Hospital Zurich, Zurich, Switzerland
| | - Nadja Naef
- Child Development Center, University Children Hospital Zurich, Zurich, Switzerland
| | - Ruth O'Gorman Tuura
- MR Research Centre, University Children Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children Hospital Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children Hospital Zurich, Zurich, Switzerland
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80
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Joste V, Maurice L, Bertin GI, Aubouy A, Boumédiène F, Houzé S, Ajzenberg D, Argy N, Massougbodji A, Dossou-Dagba I, Alao MJ, Cot M, Deloron P, Faucher JF. Identification of Plasmodium falciparum and host factors associated with cerebral malaria: description of the protocol for a prospective, case-control study in Benin (NeuroCM). BMJ Open 2019; 9:e027378. [PMID: 31142528 PMCID: PMC6549734 DOI: 10.1136/bmjopen-2018-027378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION In 2016, an estimated 216 million cases and 445 000 deaths of malaria occurred worldwide, in 91 countries. In Benin, malaria causes 26.8% of consultation and hospitalisation motif in the general population and 20.9% in children under 5 years old.The goal of the NeuroCM project is to identify the causative factors of neuroinflammation in the context of cerebral malaria. There are currently very few systematic data from West Africa on the aetiologies and management of non-malarial non-traumatic coma in small children, and NeuroCM will help to fill this gap. We postulate that an accurate understanding of molecular and cellular mechanisms involved in neuroinflammation may help to define efficient strategies to prevent and manage cerebral malaria. METHODS AND ANALYSIS This is a prospective, case-control study comparing cerebral malaria to uncomplicated malaria and non-malarial non-traumatic coma. This study takes place in Benin, precisely in Cotonou for children with coma and in Sô-Ava district for children with uncomplicated malaria. We aim to include 300 children aged between 24 and 71 months and divided in three different clinical groups during 12 months (from December 2017 to November 2018) with a 21 to 28 days follow-up for coma. Study data, including clinical, biological and research results will be collected and managed using CSOnline-Ennov Clinical. ETHICS AND DISSEMINATION Ethics approval for the NeuroCM study has been obtained from Comité National d'Ethique pour la Recherche en santé of Benin (n°67/MS/DC/SGM/DRFMT/CNERS/SA; 10/17/2017). NeuroCM study has also been approved by Comité consultatif de déontologie et d'éthique of Institut de Recherche pour le Développement (IRD; 10/24/2017). The study results will be disseminated through the direct consultations with the WHO's Multilateral Initiative on Malaria (TDR-MIM) and Roll Back Malaria programme, through scientific meetings and peer-reviewed publications in scientific or medical journals, and through guidelines and booklets.
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Affiliation(s)
| | - Laurine Maurice
- MERIT, Sorbonne Paris Cité, IRD, 75006, Paris, France
- PHARMADEV, Université de Toulouse, IRD, UPS, France, Toulouse, France
| | | | - Agnès Aubouy
- PHARMADEV, Université de Toulouse, IRD, UPS, France, Toulouse, France
| | | | - Sandrine Houzé
- MERIT, Sorbonne Paris Cité, IRD, 75006, Paris, France
- Parasitology Laboratory, Hopital Bichat - Claude-Bernard, Paris, France
| | | | - Nicolas Argy
- MERIT, Sorbonne Paris Cité, IRD, 75006, Paris, France
- Parasitology Laboratory, Hopital Bichat - Claude-Bernard, Paris, France
| | | | | | - Maroufou Jules Alao
- Paediatric Department, Mother and Child University and Hospital Center (CHU-MEL), Cotonou, Benin
| | - Michel Cot
- MERIT, Sorbonne Paris Cité, IRD, 75006, Paris, France
| | | | - Jean-François Faucher
- Tropical Neuroepidemiology, INSERM UMR 1094, Limoges, France
- Infectious diseases and tropical medicine department, Limoges University Hospital, Limoges, France
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81
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Saxena A, Jones L, Shankar R, McLean B, Newman CGJ, Hamandi K. Sudden unexpected death in epilepsy in children: a focused review of incidence and risk factors. J Neurol Neurosurg Psychiatry 2018; 89:1064-1070. [PMID: 29632029 DOI: 10.1136/jnnp-2017-317702] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/21/2018] [Accepted: 03/12/2018] [Indexed: 11/04/2022]
Abstract
Sudden unexpected death in epilepsy (SUDEP) in children, although rare, needs critical attention given the tragic nature and devastating consequences for families and caregivers. True incidence is unknown and risk factors are not completely understood, more so in children compared with adults. A focused narrative review of available studies on paediatric SUDEP was undertaken to comprehend its risk factors and to develop strategies to recognise and where possible modify SUDEP risk and ultimately reduce incidence. We reviewed 16 population-based studies from various settings. We found overlapping risk factors from different studies. The prime risk factor is uncontrolled seizures. This review supports the view that children entering adolescence with optimal seizure control could be a key aspect in reducing adult mortality related to SUDEP. Ideally, clinicians would want to be able to predict prospective, individualised SUDEP risk, which is challenging due to a myriad of risk factors and an inherent non-homogeneous paediatric epilepsy population. Nevertheless, an adequate evidence base exists as evidenced by this review to support information giving and communication to support young people with epilepsy and their families in being active partners in recognising and reducing their SUDEP risk. More work particularly in the form of prospective studies and registries are needed to further clarify true incidence which may have been previously underestimated and to update risk factors.
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Affiliation(s)
- Anurag Saxena
- The Noah's Ark Children's Hospital for Wales, Cardiff, UK
| | | | | | | | - Craig G J Newman
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Khalid Hamandi
- Wales Epilepsy Unit, Department of Neurology, University Hospital of Wales, Cardiff, UK
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82
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Israni AV, Kumar S, Hussain N. Fifteen-minute consultation: an approach to a child presenting to the emergency department with acute psychotic symptoms. Arch Dis Child Educ Pract Ed 2018; 103:184-188. [PMID: 29222181 DOI: 10.1136/archdischild-2017-313386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/17/2017] [Indexed: 11/03/2022]
Abstract
Presentation of a child in the A&E with altered behaviour including psychotic features is not unusual. New-onset psychotic symptoms in children pose a significant diagnostic challenge due to several reasons. First, primary psychotic conditions are uncommon in pre-pubertal children. Second, differentiating between delirium and psychosis can be difficult in children, more so in infants, toddlers and young children. Third, intervening and managing a secondary cause of psychosis can significantly optimise outcome. Prompt recognition of a possible underlying cause for a child's psychotic behaviour is essential, and at the same time challenging, in the emergency department. This article attempts to present a systematic approach to a child with acute onset of psychotic symptoms in an emergency setting.
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Affiliation(s)
- Anil Vasudev Israni
- Department of Paediatric Neurology, Leicester Royal Infirmary, Leicester, UK
| | - Sumant Kumar
- Department of Paediatric Neurology, Leicester Royal Infirmary, Leicester, UK
| | - Nahin Hussain
- Department of Paediatric Neurology, Leicester Royal Infirmary, Leicester, UK
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83
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Goldsmith S, Garcia Jalon G, Badawi N, Blair E, Garne E, Gibson C, McIntyre S, Scott H, Smithers-Sheedy H, Andersen GL. Comprehensive investigation of congenital anomalies in cerebral palsy: protocol for a European-Australian population-based data linkage study (The Comprehensive CA-CP Study). BMJ Open 2018; 8:e022190. [PMID: 30037879 PMCID: PMC6059266 DOI: 10.1136/bmjopen-2018-022190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/17/2018] [Accepted: 06/07/2018] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Cerebral palsy (CP), an umbrella term for non-progressive conditions of cerebral origin resulting in motor impairments, is collectively the most common cause of physical disability in childhood. Cerebral and/or non-cerebral congenital anomalies are present in 15%-40% of children with CP. In order to identify effective prevention strategies for this substantial proportion of CP, a comprehensive understanding of the epidemiology of these congenital anomalies is required. International collaboration is needed, as previous attempts have fallen short due to a lack of power, since the anomalies are individually rare and CP comprises many clinical descriptions. The aim of this study is to generate new knowledge about the aetiologies of CP through a focused investigation into the role of congenital anomalies. METHODS AND ANALYSIS This collaborative, population-based data linkage study includes nine geographic regions (six in Europe, three in Australia) served by both congenital anomaly and CP registers. Register data for children with CP (both with and without congenital anomalies) and children with specific congenital anomalies (without CP) born between 1991 and 2009 will be linked and de-identified within each region. The resulting linked data sets will be quality assured, recoded, harmonised and then pooled into one data set. Analysis of the combined data set will include: frequencies/proportions of congenital anomalies and outcomes (type of CP, severity, impairments); descriptive analyses comparing timing of congenital anomaly development and brain injury/abnormality responsible for CP; ORs to calculate the odds of CP following a specific congenital anomaly; and identification of anomalies on causal pathways to CP. ETHICS AND DISSEMINATION Ethics approval for this collaborative study, The Comprehensive CA-CP Study, has been obtained from the Cerebral Palsy Alliance Human Research Ethics Committee (EC00402). Study findings will be disseminated at conferences and published in peer-reviewed journals, and recommendations will be made regarding the collection and classification of congenital anomaly data by CP registers.
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Affiliation(s)
- Shona Goldsmith
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Guiomar Garcia Jalon
- Northern Ireland Cerebral Palsy Register, School of Nursing and Midwifery, Queen’s University Belfast, Royal Group of Hospitals, Belfast, UK
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Grace Centre for Newborn Care, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Eve Blair
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Ester Garne
- Paediatric Department, Hospital Lillebaelt Kolding, Kolding, Denmark
| | - Catherine Gibson
- South Australian Birth Defects Register, Women’s and Children’s Hospital, Women’s and Children’s Health Network, Adelaide, South Australia, Australia
| | - Sarah McIntyre
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Heather Scott
- South Australian Birth Defects Register, Women’s and Children’s Hospital, Women’s and Children’s Health Network, Adelaide, South Australia, Australia
| | - Hayley Smithers-Sheedy
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Guro L Andersen
- The Cerebral Palsy Register of Norway, Vestfold Hospital Trust, Tønsberg, Norway
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84
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Abstract
OBJECTIVE To describe the neurodevelopment of children with congenital Zika syndrome during the second year of life. DESIGN Case series study. SETTING Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Pernambuco, Brazil. PARTICIPANTS 24 children with congenital Zika syndrome born with microcephaly during the Zika outbreak in Brazil in 2015 and followed up at the IMIP during their second year of life. MAIN OUTCOME MEASURE Denver Developmental Screening Test II, head circumference and clinical neurological examination. RESULTS All children presented neurodevelopmental delay: for an average chronological age of 19.9 months, language was equivalent to that of age 2.1 months, gross motor 2.7 months, fine motor/adaptive 3.1 months and personal/social 3.4 months. Head circumference remained below the third percentile for age and gender, and growth rate up to the second year of life was 10.3 cm (expected growth 13 cm). Muscle tone was increased in 23 (95.5%) of 24 children, musculotendinous reflexes were increased in the whole sample and clonus was present in 18 (77.3%) of 24 children. All children except one had epilepsy. CONCLUSION Children born with microcephaly associated with congenital Zika virus have a significant neurodevelopmental delay.
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Affiliation(s)
- Lucas V Alves
- Department of Paediatrics Neurology, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
| | - Camila E Paredes
- Teaching Department, Faculdade Pernambucana de Saude, Recife, Pernambuco, Brazil
| | - Germanna C Silva
- Teaching Department, Faculdade Pernambucana de Saude, Recife, Pernambuco, Brazil
| | - Júlia G Mello
- Department of Paediatrics, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
| | - João G Alves
- Department of Paediatrics, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
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85
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Affiliation(s)
- Richard F M Chin
- Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, UK.,Department of Paediatric Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK
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86
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Braakman HMH, Engelen M, Nicolai J, Willemsen MAAP. Stroke mimics add to the phenotypic spectrum of GLUT1 deficiency syndrome. J Neurol Neurosurg Psychiatry 2018; 89:668-670. [PMID: 28951496 DOI: 10.1136/jnnp-2017-316861] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/14/2017] [Accepted: 09/17/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Hilde M H Braakman
- Department of Neurology, Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Centre, Heeze, The Netherlands
| | - Marc Engelen
- Department of Pediatric Neurology, Academisch Medisch Centrum, University of Amsterdam, Amsterdam, The Netherlands
| | - Joost Nicolai
- Department of Neurology, Academic Center for Epileptology, Kempenhaeghe and Maastricht University Medical Centre, Heeze, The Netherlands.,Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Michèl A A P Willemsen
- Department of Pediatric Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
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87
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Yumoto T, Naito H, Yorifuji T, Maeyama H, Kosaki Y, Yamamoto H, Tsukahara K, Osako T, Nakao A. Cushing's sign and severe traumatic brain injury in children after blunt trauma: a nationwide retrospective cohort study in Japan. BMJ Open 2018; 8:e020781. [PMID: 29502094 PMCID: PMC5855168 DOI: 10.1136/bmjopen-2017-020781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We tested whether Cushing's sign could predict severe traumatic brain injury (TBI) requiring immediate neurosurgical intervention (BI-NSI) in children after blunt trauma. DESIGN Retrospective cohort study using Japan Trauma Data Bank. SETTING Emergency and critical care centres in secondary and tertiary hospitals in Japan. PARTICIPANTS Children between the ages of 2 and 15 years with Glasgow Coma Scale motor scores of 5 or less at presentation after blunt trauma from 2004 to 2015 were included. A total of 1480 paediatric patients were analysed. PRIMARY OUTCOME MEASURES Patients requiring neurosurgical intervention within 24 hours of hospital arrival and patients who died due to isolated severe TBI were defined as BI-NSI. The combination of systolic blood pressure (SBP) and heart rate (HR) on arrival, which were respectively divided into tertiles, and its correlation with BI-NSI were investigated using a multiple logistic regression model. RESULTS In the study cohort, 297 (20.1%) exhibited BI-NSI. After adjusting for sex, age category and with or without haemorrhage shock, groups with higher SBP and lower HR (SBP ≥135 mm Hg; HR ≤92 bpm) were significantly associated with BI-NSI (OR 2.84, 95% CI 1.68 to 4.80, P<0.001) compared with the patients with normal vital signs. In age-specific analysis, hypertension and bradycardia were significantly associated with BI-NSI in a group of 7-10 and 11-15 years of age; however, no significant association was observed in a group of 2-6 years of age. CONCLUSIONS Cushing's sign after blunt trauma was significantly associated with BI-NSI in school-age children and young adolescents.
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Affiliation(s)
- Tetsuya Yumoto
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, Okayama, Japan
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiromichi Naito
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, Okayama, Japan
| | - Takashi Yorifuji
- Department of Human Ecology, Okayama University Graduate School of Environmental and Life Science, Okayama, Japan
| | - Hiroki Maeyama
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshinori Kosaki
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, Okayama, Japan
| | - Hirotsugu Yamamoto
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, Okayama, Japan
| | - Kohei Tsukahara
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, Okayama, Japan
| | - Takaaki Osako
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, Okayama, Japan
| | - Atsunori Nakao
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, Okayama, Japan
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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88
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Cock HR. Learning from an exceptional boy. Pract Neurol 2018; 18:170-171. [PMID: 29419419 DOI: 10.1136/practneurol-2017-001853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Hannah R Cock
- Atkinson Morley Regional Epilepsy Network, St George's University Hospitals NHS Foundation Trust, London, UK.,Institute of Medical & Biomedical Education, St George's University, London, UK
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Johnson RW, Williams SA, Gucciardi DF, Bear N, Gibson N. Evaluating the effectiveness of home exercise programmes using an online exercise prescription tool in children with cerebral palsy: protocol for a randomised controlled trial. BMJ Open 2018; 8:e018316. [PMID: 29362255 PMCID: PMC5786075 DOI: 10.1136/bmjopen-2017-018316] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Children with cerebral palsy (CP) and other neurodevelopmental disabilities often receive a home programme of exercises to assist in reaching their therapy goals. Adherence to exercise programmes is necessary to attain the level of practice required to achieve goals; however, adherence can be difficult to accomplish. In this paper, we describe the protocol for a randomised controlled trial to evaluate the effectiveness of delivering a home exercise programme to school-age children with disabilities using Physitrack, an online exercise prescription tool with a website or app interface. METHODS AND ANALYSIS Participants aged 6-17 years, with CP or other neurodevelopmental disabilities, receiving community physiotherapy services in Western Australia, will be recruited. Participants will be stratified by age and functional mobility and randomised to either the intervention group, who will complete an 8-week home exercise programme using Physitrack, or the control group, who will complete an 8-week exercise programme without Physitrack. Researcher blinding to group allocation, and participant blinding to outcome, will be maintained. The primary outcome measures are adherence to the home exercise programme with weekly collection of home exercise logs; achievement of individualised goals by phone interview before and after intervention; and correctness of exercise performance by collection and analysis of videos of participants performing home exercises. Secondary outcome measures include enjoyment of physical activity, confidence to complete exercise programme, preferred method of delivery of programme and usability of Physitrack. A sample size of 58 participants will be necessary to see an effect on home programme adherence. Data will be analysed using the intention-to-treat principle. ETHICS AND DISSEMINATION Ethical approval was obtained from Curtin University Human Research Ethics Committee in July 2016 (10391). Outcomes will be disseminated through publication in peer-reviewed journals and presentations at scientific conferences. TRIAL REGISTRATION NUMBER ACTRN12616000743460; Pre-results.
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Affiliation(s)
- Rowan W Johnson
- Therapy and Health Services, Ability Centre, Perth, Western Australia, Australia
| | - Sian A Williams
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Daniel F Gucciardi
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Natasha Bear
- Department of Physiotherapy, Princess Margaret Hospital for Children, Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Noula Gibson
- Therapy and Health Services, Ability Centre, Perth, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
- Department of Physiotherapy, Princess Margaret Hospital for Children, Child and Adolescent Health Service, Perth, Western Australia, Australia
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90
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Sasaki K, Nagase H, Maruyama A, Fujita K, Nishiyama M, Tanaka T, Nukina S, Takumi T, Takenaka K, Oyazato Y, Nishiyama A, Kawata T, Saeki K, Takami Y, Satake-Inoue E, Iijima K, Morioka I, Uetani Y. Clinical prediction rule for neurological sequelae due to acute encephalopathy: a medical community-based validation study in Harima, Japan. BMJ Open 2017; 7:e016675. [PMID: 29127224 PMCID: PMC5695471 DOI: 10.1136/bmjopen-2017-016675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study aimed to verify the screening performance of our clinical prediction rule for neurological sequelae due to acute encephalopathy (NSAE-CPR), which previously identified the following three variables as predictive of poor outcomes: (1) refractory status epilepticus; (2) consciousness disturbance and/or hemiplegia at 6 hours from onset and (3) aspartate aminotransferase >90 IU/L within 6 hours of onset. DESIGN Medical community-based multicentre retrospective cohort study. SETTING Six regional hospitals in Harima and one tertiary centre in Kobe, Japan, from 2008 to 2012. PARTICIPANTS We enrolled a total of 1612 patients aged <16 years who met the diagnostic criteria for an initial diagnosis of complex febrile seizure. Patients with a history of neurological disease and those included in the derivation cohort were excluded. PRIMARY OUTCOME MEASURES Univariate and multivariate analyses were performed to determine the association between each of the three predictor variables and poor AE outcome (Pediatric Cerebral Performance Category score ≥2). Receiver operating characteristic curve (ROC) analysis was also performed to assess the screening performance of the NSAE-CPR. RESULTS The ROC analysis identified at least one of the three predictive variables as an optimal cut-off point, with an area under the curve of 0.915 (95% CI 0.825 to 1.000). The sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios and Matthews correlation coefficient were 0.867, 0.954, 0.149, 0.999, 18.704, 0.140 and 0.349, respectively. CONCLUSIONS Our findings indicate that the NSAE-CPR can be used for the screening and identification of patients with poor outcomes due to acute encephalopathy within 6 hours of onset.
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Affiliation(s)
- Kaori Sasaki
- Department of Pediatrics, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Hiroaki Nagase
- Department of Pediatrics, Kobe University Hospital, Kobe, Japan
| | - Azusa Maruyama
- Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Kyoko Fujita
- Emergency and General Mediciine, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | | | - Tsukasa Tanaka
- Department of Neurology, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
| | - Sadayuki Nukina
- Department of Pediatrics, Akashi City Hospital, Akashi, Japan
| | - Toru Takumi
- Department of Pediatrics, Kita-Harima Medical Center, Ono, Japan
| | - Kanae Takenaka
- Department of Pediatrics, Kita-Harima Medical Center, Ono, Japan
| | - Yoshinobu Oyazato
- Department of Pediatrics, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Atsushi Nishiyama
- Department of Pediatrics, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Tomoko Kawata
- Department of Pediatrics, St Mary’s Hospital, Himeji, Japan
| | - Keisuke Saeki
- Department of Pediatrics, Nishiwaki City Hospital, Nishiwaki, Japan
| | - Yuichi Takami
- Department of Pediatrics, Japanese Red Cross Society Himeji Hospital, Himeji, Japan
| | - Eriko Satake-Inoue
- Department of Pediatrics, Japanese Red Cross Society Himeji Hospital, Himeji, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Hospital, Kobe, Japan
| | - Ichiro Morioka
- Department of Pediatrics, Kobe University Hospital, Kobe, Japan
| | - Yoshiyuki Uetani
- Emergency and General Mediciine, Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan
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91
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Yeates KO, Beauchamp M, Craig W, Doan Q, Zemek R, Bjornson BH, Gravel J, Mikrogianakis A, Goodyear B, Abdeen N, Beaulieu C, Dehaes M, Deschenes S, Harris A, Lebel C, Lamont R, Williamson T, Barlow KM, Bernier F, Brooks BL, Emery C, Freedman SB, Kowalski K, Mrklas K, Tomfohr-Madsen L, Schneider KJ. Advancing Concussion Assessment in Pediatrics (A-CAP): a prospective, concurrent cohort, longitudinal study of mild traumatic brain injury in children: protocol study. BMJ Open 2017; 7:e017012. [PMID: 28710227 PMCID: PMC5724225 DOI: 10.1136/bmjopen-2017-017012] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Paediatric mild traumatic brain injury (mTBI) is a public health burden. Clinicians urgently need evidence-based guidance to manage mTBI, but gold standards for diagnosing and predicting the outcomes of mTBI are lacking. The objective of the Advancing Concussion Assessment in Pediatrics (A-CAP) study is to assess a broad pool of neurobiological and psychosocial markers to examine associations with postinjury outcomes in a large sample of children with either mTBI or orthopaedic injury (OI), with the goal of improving the diagnosis and prognostication of outcomes of paediatric mTBI. METHODS AND ANALYSIS A-CAP is a prospective, longitudinal cohort study of children aged 8.00-16.99 years with either mTBI or OI, recruited during acute emergency department (ED) visits at five sites from the Pediatric Emergency Research Canada network. Injury information is collected in the ED; follow-up assessments at 10 days and 3 and 6 months postinjury measure a variety of neurobiological and psychosocial markers, covariates/confounders and outcomes. Weekly postconcussive symptom ratings are obtained electronically. Recruitment began in September 2016 and will occur for approximately 24 months. Analyses will test the major hypotheses that neurobiological and psychosocial markers can: (1) differentiate mTBI from OI and (2) predict outcomes of mTBI. Models initially will focus within domains (eg, genes, imaging biomarkers, psychosocial markers), followed by multivariable modelling across domains. The planned sample size (700 mTBI, 300 OI) provides adequate statistical power and allows for internal cross-validation of some analyses. ETHICS AND DISSEMINATION The ethics boards at all participating institutions have approved the study and all participants and their parents will provide informed consent or assent. Dissemination will follow an integrated knowledge translation plan, with study findings presented at scientific conferences and in multiple manuscripts in peer-reviewed journals.
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Affiliation(s)
- Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Miriam Beauchamp
- Department of Psychology, Universite de Montreal and Ste Justine Hospital, Montreal, Québec, Canada
| | - William Craig
- Department of Pediatrics, University of Alberta and Stollery Children’s Hospital, Edmonton, Alberta, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia and BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Bruce H Bjornson
- Department of Pediatrics, University of British Columbia and BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Jocelyn Gravel
- Department of Pediatrics, Universite de Montreal and Ste Justine Hospital, Montreal, Québec, Canada
| | - Angelo Mikrogianakis
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Bradley Goodyear
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Nishard Abdeen
- Department of Radiology, University of Ottawa and Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Christian Beaulieu
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Mathieu Dehaes
- Department of Radiology, Radiooncology and Nuclear Medicine, Université de Montréal and Ste Justine Hospital, Montreal, Québec, Canada
| | - Sylvain Deschenes
- Department of Radiology, Radiooncology and Nuclear Medicine, Université de Montréal and Ste Justine Hospital, Montreal, Québec, Canada
| | - Ashley Harris
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Catherine Lebel
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Ryan Lamont
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Medical Genetics, University of Calgary and Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Karen Maria Barlow
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary and Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Francois Bernier
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Medical Genetics, University of Calgary and Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Brian L Brooks
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary and Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Carolyn Emery
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Stephen B Freedman
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Kristina Kowalski
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kelly Mrklas
- Research Innovation and Analytics, Alberta Health Services, Calgary, Alberta, Canada
| | - Lianne Tomfohr-Madsen
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn J Schneider
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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92
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Krabbenborg L, Schieving J, Kleefstra T, Vissers LELM, Willemsen MA, Veltman JA, van der Burg S. Evaluating a counselling strategy for diagnostic WES in paediatric neurology: an exploration of parents' information and communication needs. Clin Genet 2015; 89:244-50. [PMID: 25916247 DOI: 10.1111/cge.12601] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/20/2015] [Accepted: 04/20/2015] [Indexed: 01/17/2023]
Abstract
As whole exome sequencing (WES) is just starting to be used as a diagnostic tool in paediatric neurology for children with a neurological disorder, and patient experiences and preferences with regard to counselling are relatively underexplored. This article explores experiences and preferences of parents with pre-test and post-test counselling in a trial that uses WES for diagnostics. Second, it maps information and communication needs which exceed the counselling protocol, in order to acquire insight into how it can be improved. Data were gathered through in-depth interviews with parents of 15 children who were included in the trial. Information and communication needs of parents differed from the protocol with respect to (i) the type and amount of information provided about WES research, (ii) incidental findings, (iii) communication about progress of the study, and (iv) the communication of the results. Furthermore, parents preferred to have more of a communicative exchange with health care providers about their daily struggles and concerns related to their life with a diseased child and wanted to know how a diagnosis could offer help. There are different ways to meet parental needs, but we suggest that assigning a case manager might be a helpful option that deserves further exploration.
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Affiliation(s)
- L Krabbenborg
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Schieving
- Department of Paediatric Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - T Kleefstra
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L E L M Vissers
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M A Willemsen
- Department of Paediatric Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J A Veltman
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S van der Burg
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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93
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Huhn K, Lämmer R, Oberwahrenbrock T, Lämmer A, Waschbisch A, Gosar D, Brandt A, Paul F, Linker RA, Lee DH. Optical coherence tomography in patients with a history of juvenile multiple sclerosis reveals early retinal damage. Eur J Neurol 2014; 22:86-92. [PMID: 25104178 DOI: 10.1111/ene.12532] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 06/09/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Some 3%-10% of patients with multiple sclerosis (MS) experience disease onset before the age of 18 years ('early' onset MS, EOMS). Optical coherence tomography is a non-invasive method to measure retinal nerve fibre layer thickness (RNFLT) and total macular volume (TMV) and may be useful to differentiate axonal and neuronal damage in the retina of patients with a history of EOMS. Here RNFLT and TMV in EOMS patients after a mean disease duration of 11.6 years were compared with patients with age- or disease-duration-matched later onset MS (LOMS) and healthy controls (HCs). METHODS In this observational cross-sectional study at two German academic MS centres, RNFLT and TMV were measured by spectral-domain optical coherence tomography in 32 HCs, 36 EOMS (mean age at onset 15.5 ± 2.0 years) and 58 LOMS patients. RESULTS In comparison with HCs, EOMS patients displayed a significant reduction of RNFLT and TMV independently of a history of optic neuritis. In particular, RNFLT loss in EOMS was similar to that in LOMS and TMV loss was slightly higher compared with disease-duration-matched LOMS. In a generalized estimating model, the EOMS group also displayed a similar correlation between disease duration and RNFLT or TMV loss to LOMS patients. CONCLUSIONS These data argue for a significant amount of axonal and neuronal damage in the retina of EOMS patients and may provide a structural basis for the observation that EOMS patients reach states of irreversible disability at a younger age than patients with LOMS.
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Affiliation(s)
- K Huhn
- Department of Neurology, University of Erlangen, Erlangen, Germany
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