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Sayar Y, Yıldırım M, Teber S. Management of neurological problems in children on home invasive mechanical ventilation. Pediatr Pulmonol 2024; 59:2196-2202. [PMID: 38131516 DOI: 10.1002/ppul.26830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Home invasive mechanical ventilation (HIMV) has become a crucial long-term respiratory support for children with neurological disorders, but requires advanced technological skills and 24-h care. The increasing global population of children on HIMV is attributed to advancements in intensive care and improved survival rates. METHOD The manuscript will review the most common neurological problems encountered in children on HIMV. CONCLUSION The manuscript emphasizes the multidisciplinary nature of managing these patients, involving pediatric pulmonologists, pediatric neurologists, pediatric intensivists, nurses, therapists, dietitians, psychologists, and caregivers. The manuscript outlines the challenges posed by neurological disorders, such as spinal muscular atrophy, muscular dystrophy, cerebral palsy, spinal cord injuries, and neurodegenerative disorders, which may result in respiratory muscle weakness and impaired ventilation. The importance of individualized assessments, appropriate ventilator mode and equipment selection, training of caregivers, airway clearance techniques, nutritional support, regular follow-up visits, psychological and educational support, and addressing specific neurological issues such as involuntary movement disorders, prolonged seizures, sleep disorders, pain, sialorrhea, and immobilization-related complications are discussed. The treatment options for these specific challenges are outlined. This review highlights the complex nature of managing children with neurological disorders on HIMV and the importance of a collaborative approach among healthcare professionals and caregivers to optimize care and improve the quality of life for these children.
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Affiliation(s)
- Yavuz Sayar
- Department of Pediatrics, Division of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Miraç Yıldırım
- Department of Pediatrics, Division of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Serap Teber
- Department of Pediatrics, Division of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey
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Agashe S. Osteoporosis: The Brittle Reality of an Epilepsy Diagnosis. Epilepsy Curr 2024; 24:168-170. [PMID: 38898910 PMCID: PMC11185198 DOI: 10.1177/15357597241238532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
Independent Associations of Incident Epilepsy and Enzyme-Inducing and Non-Enzyme-Inducing Antiseizure Medications With the Development of Osteoporosis Josephson CB, Gonzalez-Izquierdo A, Denaxas S, Sajobi TT, Klein KM, Wiebe S. JAMA Neurol . 2023;80(8):843-850. doi:10.1001/jamaneurol.2023.1580 Importance: Both epilepsy and enzyme-inducing antiseizure medications (eiASMs) having varying reports of an association with increased risks for osteoporosis. Objective: To quantify and model the independent hazards for osteoporosis associated with incident epilepsy and eiASMS and non-eiASMs. Design, Setting, and Participants: This open cohort study covered the years 1998 to 2019, with a median (IQR) follow-up of 5 (1.7-11.1) years. Data were collected for 6275 patients enrolled in the Clinical Practice Research Datalink and from hospital electronic health records. No patients who met inclusion criteria (Clinical Practice Research Datalink-acceptable data, aged 18 years or older, follow-up after the Hospital Episode Statistics patient care linkage date of 1998, and free of osteoporosis at baseline) were excluded or declined. Exposure: Incident adult-onset epilepsy using a 5-year washout and receipt of 4 consecutive ASMs. Main Outcomes and Measures: The outcome was incident osteoporosis as determined through Cox proportional hazards or accelerated failure time models where appropriate. Incident epilepsy was treated as a time-varying covariate. Analyses controlled for age, sex, socioeconomic status, cancer, 1 or more years of corticosteroid use, body mass index, bariatric surgery, eating disorders, hyperthyroidism, inflammatory bowel disease, rheumatoid arthritis, smoking status, falls, fragility fractures, and osteoporosis screening tests. Subsequent analyses (1) excluded body mass index, which was missing in 30% of patients; (2) applied propensity score matching for receipt of an eiASM; (3) restricted analyses to only those with incident onset epilepsy; and (4) restricted analyses to patients who developed epilepsy at age 65 years or older. Analyses were performed between July 1 and October 31, 2022, and in February 2023 for revisions. Results: Of 80 95 441 adults identified, 6275 had incident adult-onset epilepsy (3220 female [51%] and 3055 male [49%]; incidence rate, 62 per 100 000 person-years) with a median (IQR) age of 56 (38-73) years. When controlling for osteoporosis risk factors, incident epilepsy was independently associated with a 41% faster time to incident osteoporosis (time ratio [TR], 0.59; 95% CI, 0.52-0.67; P < .001). Both eiASMs (TR, 0.91; 95% CI, 0.87-0.95; P < .001) and non-eiASMs (TR, 0.77; 95% CI, 0.76-0.78; P < .001) were also associated with significant increased risks independent of epilepsy, accounting for 9% and 23% faster times to development of osteoporosis, respectively. The independent associations among epilepsy, eiASMs, and non-eiASMs remained consistent in propensity score-matched analyses, cohorts restricted to adult-onset epilepsy, and cohorts restricted to late-onset epilepsy. Conclusions and Relevance: These findings suggest that epilepsy is independently associated with a clinically meaningful increase in the risk for osteoporosis, as are both eiASMs and non-eiASMs. Routine screening and prophylaxis should be considered in all people with epilepsy.
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Bindels-de Heus KGCB, Hagenaar DA, Mous SE, Dekker I, van der Kaay DCM, Kerkhof GF, Elgersma Y, Moll HA, de Wit MCY. Bone health in children with Angelman syndrome at the ENCORE Expertise Center. Eur J Pediatr 2024; 183:103-111. [PMID: 37831301 PMCID: PMC10857954 DOI: 10.1007/s00431-023-05231-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023]
Abstract
Angelman syndrome (AS) is a rare genetic disorder due to lack of UBE3A function on chromosome 15q11.2q13 caused by a deletion, uniparental paternal disomy (UPD), imprinting center disorder (ICD), or pathological variant of the UBE3A gene. AS is characterized by developmental delay, epilepsy, and lack of speech. Although fractures are observed frequently in our clinical practice, there are few studies on bone health in AS. The aim of this study is to investigate bone health in children with AS. In this prospective cohort study, we describe bone health in 91 children with AS visiting the ENCORE Expertise Center for AS between April 2010 and December 2021. Bone health was assessed with the bone health index (BHI) in standard deviation score (SDS) measured by digital radiogrammetry of the left hand using BoneXpert software. Risk factors analyzed were age, sex, genetic subtype, epilepsy, anti-seizure medication use, mobility, body mass index (BMI), and onset of puberty. Children with AS had a mean BHI of -1.77 SDS (SD 1.4). A significantly lower BHI was found in children with a deletion (-2.24 SDS) versus non-deletion (-1.02 SDS). Other factors associated with reduced BHI-SDS were inability to walk and late onset of puberty. Children with a history of one or more fractures (22%) had a significantly lower BHI than children without fractures (-2.60 vs -1.56 SDS). Longitudinal analysis showed a significant decrease in BHI-SDS with age in all genetic subtypes. Conclusions: Children with AS have a reduced bone health. Risk factors are deletion genotype, no independent walking, and late onset of puberty. Bone health decreased significantly with age. What is Known: • Children with neurological disorders often have a low bone health and higher risk of fractures. • Little is known about bone health in children with Angelman syndrome (AS). What is New: • Children with AS showed a reduced bone health and this was significantly associated with having a deletion, not being able to walk independently, and late onset of puberty. • Longitudinal analysis showed a significant decrease in bone health as children got older.
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Affiliation(s)
- Karen G C B Bindels-de Heus
- Dept. of Pediatrics, Erasmus MC Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands.
| | - Doesjka A Hagenaar
- Dept. of Pediatrics, Erasmus MC Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Dept. of Child- and Adolescent Psychiatry and Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sabine E Mous
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Dept. of Child- and Adolescent Psychiatry and Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ilonka Dekker
- Dept. of Pediatrics, Erasmus MC Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | | | - Gerthe F Kerkhof
- Dept. of Pediatric Endocrinology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ype Elgersma
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Dept. of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Henriette A Moll
- Dept. of Pediatrics, Erasmus MC Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
| | - Marie-Claire Y de Wit
- ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus MC, Rotterdam, The Netherlands
- Dept. of Neurology and Pediatric Neurology, Erasmus MC, Rotterdam, The Netherlands
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Shi XY, Ju J, Lu Q, Hu LY, Tian YP, Guo GH, Liu ZS, Wu GF, Zhu HM, Zhang YQ, Li D, Gao L, Yang L, Wang CY, Liao JX, Wang JW, Zhou SZ, Wang H, Li XJ, Gao JY, Zhang L, Shu XM, Li D, Li Y, Chen CH, Zhang XJ, Zhong JM, Zhai QX, Sun YH, Lin XF, Ren RN, Yin F, Chen YH, Jia FY, Yang ZX, Wang JL, Xia ZZ, Wang LW, Luo R, Zou LP. Both epilepsy and anti-seizure medications affect bone metabolism in children with self-limited epilepsy with centrotemporal spikes. Epilepsia 2023; 64:2667-2678. [PMID: 37522416 DOI: 10.1111/epi.17733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE Bone metabolism can be influenced by a range of factors. We selected children with self-limited epilepsy with centrotemporal spikes (SeLECTS) and lifestyles similar to those of healthy children to control for the confounding factors that may influence bone metabolism. We aimed to identify the specific effects of epilepsy and/or anti-seizure medications (ASMs) on bone metabolism. METHODS Patients with SeLECTS were divided into an untreated group and a monotherapy group, and the third group was a healthy control group. We determined the levels of various biochemical markers of bone metabolism, including procollagen type I nitrogenous propeptide (PINP), alkaline phosphatase (ALP), osteocalcin (OC), collagen type I cross-linked C-telopeptide (CTX), calcium, magnesium, phosphorus, parathyroid hormone (PTH), and vitamin D3 (VD3 ). RESULTS A total of 1487 patients (from 19 centers) were diagnosed with SeLECTS; 1032 were analyzed, including 117 patients who did not receive any ASMs (untreated group), 643 patients who received only one ASM (monotherapy group), and 272 children in the healthy control group. Except for VD3 , other bone metabolism of the three groups were different (p < .001). Bone metabolism was significantly lower in the untreated group than the healthy control group (p < .05). There were significant differences between the monotherapy and healthy control group in the level of many markers. However, when comparing the monotherapy and untreated groups, the results were different; oxcarbazepine, levetiracetam, and topiramate had no significant effect on bone metabolism. Phosphorus and magnesium were significantly lower in the valproic acid group than the untreated group (adjusted p < .05, Cliff's delta .282-.768). CTX was significantly higher in the lamotrigine group than in the untreated group (adjusted p = .012, Cliff's delta = .316). SIGNIFICANCE Epilepsy can affect many aspects of bone metabolism. After controlling epilepsy and other confounders that affect bone metabolism, we found that the effects of ASMs on bone metabolism differed. Oxcarbazepine, levetiracetam, and topiramate did not affect bone metabolism, and lamotrigine corrected some of the abnormal markers of bone metabolism in patients with epilepsy.
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Affiliation(s)
- Xiu-Yu Shi
- Department of Pediatrics, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jun Ju
- Department of Pediatrics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Qian Lu
- Department of Pediatrics, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Lin-Yan Hu
- Department of Pediatrics, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ya-Ping Tian
- Research Center of Birth Defect Prevention Technology, Medical Innovation Research Division of Chinese PLA General Hospital, Beijing, China
| | - Guang-Hong Guo
- Department of Laboratory Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Sheng Liu
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Ge-Fei Wu
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Hong-Min Zhu
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yu-Qin Zhang
- Department of Neurology, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| | - Dong Li
- Department of Neurology, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| | - Li Gao
- Department of Pediatrics, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, China
| | - Liu Yang
- Department of Pediatrics, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, China
| | - Chun-Yu Wang
- Department of Neurology, Harbin Children's Hospital, Harbin, China
| | - Jian-Xiang Liao
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, China
| | - Ji-Wen Wang
- Department of Neurology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shui-Zhen Zhou
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Hua Wang
- Department of Pediatric Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiao-Jing Li
- Department of Neurology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jing-Yun Gao
- Department of Pediatric Neurology, Hebei Tangshan City Maternal and Child Health Care Hospital, Tangshan, China
| | - Li Zhang
- Department of Pediatrics, Linyi People's Hospital, Linyi, China
| | - Xiao-Mei Shu
- Department of Pediatrics, Zunyi Medical College, Zunyi, China
| | - Dan Li
- Department of Pediatrics, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yan Li
- Department of Neurology, Children's Hospital Affiliated to Soochow University, Suzhou, China
| | - Chun-Hong Chen
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiu-Ju Zhang
- Department of Pediatrics, Xingtai People's Hospital, Xingtai, China
| | - Jian-Min Zhong
- Department of Neurology, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Qiong-Xiang Zhai
- Department of Pediatrics, Guangdong General Hospital, Guangzhou, China
| | - Yan-Hong Sun
- Department of Pediatrics, Cangzhou Central Hospital, Cangzhou, China
| | - Xue-Feng Lin
- Department of Neurology, Quanzhou Children's Hospital, Quanzhou, China
| | - Rong-Na Ren
- Department of Pediatrics, 900 Hospital of the Joint Logistics Team, Fuzhou, China
| | - Fei Yin
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Yan-Hui Chen
- Department of Pediatrics, Fujian Medical University Union Hospital, Fuzhou, China
| | - Fei-Yong Jia
- Department of Development and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Zhi-Xian Yang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Ju-Li Wang
- Department of Epilepsy, The Central Hospital of Jiamusi City, Jiamusi, China
| | - Zhe-Zhi Xia
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li-Wen Wang
- Department of Neurology, Capital Institute of Pediatrics, Beijing, China
| | - Rong Luo
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Li-Ping Zou
- Department of Pediatrics, the First Medical Center, Chinese PLA General Hospital, Beijing, China
- Center for Brain Disorders Research, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
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