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Wan Chek WAF, Teh YG, Eddy Suryono DN, Ng CY, Ahmed S. MR imaging of hypothalamic hamartoma in a patient with gelastic seizures. Radiol Case Rep 2021; 16:2706-2709. [PMID: 34345334 PMCID: PMC8319011 DOI: 10.1016/j.radcr.2021.06.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/20/2021] [Indexed: 11/17/2022] Open
Abstract
Hypothalamic hamartomas (HHs) are non-neoplastic malformations that occur in the region of the hypothalamus. HH is the leading cause of gelastic seizures in children and adolescents, where laughing is characteristically manifested. However, these patients can also experience different forms of complex or generalized tonic-clonic seizures that can obscure the diagnosis of HHs. We present a case of a 10 year-old boy that experienced several seizure types, but was subsequently diagnosed with HH after MR imaging was performed. This case highlights the complementary role of MR imaging in ascertaining seizure etiololgy when the clinical history and EEG findings are non-specific. The importance of early diagnosis with MR imaging is further underscored by the fact that patients diagnosed with HH usually develop drug resistance towards antiepileptic drugs, mandating neurosurgical assessment and intervention.
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Affiliation(s)
| | - Yong Guang Teh
- Department of Radiology, Sabah Women & Childen's Hospital, Kota Kinabalu, Sabah, Malaysia
- Faculty of Medicine & Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
- Corresponding author.
| | | | - Chiak Yot Ng
- Faculty of Medicine & Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Selim Ahmed
- Faculty of Medicine & Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
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Improvement of Hypothalamic Hamartoma-Related Psychiatric Disorder After Stereotactic Laser Ablation: Case Report and Review of Literature. World Neurosurg 2019; 122:680-683. [DOI: 10.1016/j.wneu.2018.11.166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/16/2018] [Accepted: 11/18/2018] [Indexed: 11/20/2022]
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Psicobiología de la agresión y la violencia. REVISTA IBEROAMERICANA DE PSICOLOGÍA 2017. [DOI: 10.33881/2027-1786.rip.10206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
El presente trabajo expone la revisión y análisis de distintas investigaciones realizadas por múltiples autores quienes han aportado valiosos descubrimientos para la comprensión de las conductas agresivas y los comportamientos violentos de los seres humanos. La agresión y la violencia son conductas bastante complejas que, en dosis moderadas, pueden tener unafunción adaptativa en entornos ambientales exigentes que supongan retos para la supervivencia del individuo. De este modo, la agresión y la violencia podrían considerarse como parte de una misma dimensión continua (Vassos, 2014). Diversos factores psicobiológicos convergen e interactúan en el marco de las causas y consecuencias de la agresión y la violencia, como las bases genéticas (genes y herencia), la neuroquímica del cerebro (neurotransmisores y hormonas), las estructuras subcorticales (hipotálamo, amígdala, corteza cingulada anterior, fascículo uncinado), el desempeño de la corteza prefrontal y las funciones ejecutivas (corteza orbitofrontal, corteza ventromedial, corteza dorsolateral). No podemos olvidar la interacción de los factores anteriormente mencionados con la interacción e influencia de los factores ambientales, psicosociales y culturales en la manifestación de actos violentos por parte de los seres humanos
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Khawaja AM, Pati S, Ng YT. Management of Epilepsy Due to Hypothalamic Hamartomas. Pediatr Neurol 2017; 75:29-42. [PMID: 28886982 DOI: 10.1016/j.pediatrneurol.2017.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 06/28/2017] [Accepted: 07/01/2017] [Indexed: 11/18/2022]
Abstract
A hypothalamic hamartoma consists of hyperplastic heterotopic tissue growing in a disorganized fashion. These lesions occur in about one per 50,000 to 100,000 people. Hypothalamic hamartomas can cause intrinsic epileptogenesis leading to gelastic seizures. Surrounding cortical structures may also develop secondary epileptogenesis. Persistent seizures caused by hypothalamic hamartomas can be debilitating and result in significant cognitive and behavioral impairment. Early recognition and treatment is important in controlling seizures and in preventing further cognitive deterioration. Some patients experience improved cognition and behavior following early treatment, suggesting that hypothalamic hamartomas represent a reversible epileptic encephalopathy. The outcome of epilepsy associated with these lesions has significantly evolved with the availability of new treatment techniques and an improved understanding of its pathogenesis. Increasing evidence supporting the role of hypothalamic hamartomas as a cause of gelastic seizures and secondary epileptogenesis has led to more frequent use of surgery as the definitive treatment. Several minimally invasive procedures have been devised, including neuroendoscopic approaches and different stereotactic radio and laser ablation techniques. Each of these techniques can lead to unique adverse events. We review the various classification schemes used to characterize hypothalamic hamartomas and the recommended surgical approaches for each subtype. We also review the literature for currently available treatment modalities and compare their efficacy in controlling seizures and their safety profiles.
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Affiliation(s)
- Ayaz M Khawaja
- Department of Neurology, University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - Sandipan Pati
- Department of Neurology, University of Alabama at Birmingham Hospital, Birmingham, Alabama.
| | - Yu-Tze Ng
- Department of Pediatrics, Baylor College of Medicine, The Children's Hospital of San Antonio, San Antonio, Texas
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Killeen Z, Bunch R, Kerrigan JF. Psychiatric comorbidity with hypothalamic hamartoma: Systematic review for predictive clinical features. Epilepsy Behav 2017. [PMID: 28636978 DOI: 10.1016/j.yebeh.2017.05.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We conducted a systematic review of the English-language literature to identify clinical features associated with a higher risk of psychiatric symptoms (aggression and rage behaviors) in patients with hypothalamic hamartoma (HH) and epilepsy. METHODS Two publicly-accessible databases (PubMed and Cochrane Library) were searched for Hypothalamic Hamartoma AND Epilepsy. We identified peer-reviewed original research publications (case reports or clinical series; N=19) in which clinical data was provided on an individual basis. Subjects were cohorted into those with (N=51) and without (N=68) behavioral aggression. Multiple clinical features were collated and subjected to univariate analysis to determine possible differences between these two cohorts. RESULTS The presence of aggression significantly correlated with 1) male gender, 2) younger age at time of first seizure onset, 3) the presence of intellectual disability, and 4) the presence of multiple seizure types (versus gelastic seizures only). For those patients undergoing surgical treatment, aggression also correlated with younger age at the time of surgical intervention. CONCLUSION Possible predictive clinical features for the presence of aggression and rage behaviors in patients with hypothalamic hamartoma and epilepsy are identified. These results may contribute to the complex treatment decisions that are unique to this population.
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Affiliation(s)
- Zachary Killeen
- University of Arizona College of Medicine, Phoenix, AZ, United States
| | - Raymond Bunch
- Division of Psychiatry and Hypothalamic Hamartoma Program, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States
| | - John F Kerrigan
- Division of Pediatric Neurology and Hypothalamic Hamartoma Program, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.
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Striano S, Striano P. Clinical features and evolution of the gelastic seizures-hypothalamic hamartoma syndrome. Epilepsia 2017; 58 Suppl 2:12-15. [DOI: 10.1111/epi.13753] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Salvatore Striano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; Epilepsy Center; School of Medicine; Federico II University; Napoli Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health; Institute “G. Gaslini”; University of Genova; Genova Italy
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Du VX, Gandhi SV, Rekate HL, Mehta AD. Laser interstitial thermal therapy: A first line treatment for seizures due to hypothalamic hamartoma? Epilepsia 2017; 58 Suppl 2:77-84. [DOI: 10.1111/epi.13751] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Victor X. Du
- Northwell Health Department of Neurosurgery; Manhasset New York U.S.A
| | | | - Harold L. Rekate
- Northwell Health Department of Neurosurgery; Manhasset New York U.S.A
| | - Ashesh D. Mehta
- Northwell Health Department of Neurosurgery; Manhasset New York U.S.A
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Ding P, Liang S, Zhang S, Zhang J, Hu X, Yu X. Resective surgery combined with corpus callosotomy for children with non-focal lesional Lennox-Gastaut syndrome. Acta Neurochir (Wien) 2016; 158:2177-2184. [PMID: 27629372 DOI: 10.1007/s00701-016-2947-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/24/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The first prospective trial for resective surgery combined with corpus callosotomy (CCT) was performed to investigate the outcomes of the combined surgery in children with Lennox-Gastaut syndrome (LGS) without focal lesion on brain MRI. METHODS This study enrolled 68 children with LGS and without focal lesion on brain MRI, of which 25 received medicine (medicine group) and 43 underwent surgery (surgery group), including 20 with exclusively resective surgery (exclusively resection subgroup) and 23 with resective surgery combined with CCT (combined CCT subgroup). All patients were followed for 3-5 years. RESULTS Significant differences in seizure control were observed between the medicine group and the exclusively resection subgroup and combined CCT subgroup at the 1-year, 3-year, and 5-year follow-ups. There was a trend that the children with resection combined with CCT had better seizure control than those with exclusively resection at the three follow-ups, but this could not be verified by the statistical method used. Furthermore, significant differences were not observed in seizure control between children with different MRI findings, age at surgery, or pathology in the surgery group. The percentage of long-term seizure-free did not remain as high as the percentage of early stage seizure-free at 1-year follow-up. However, the children with combined CCT surgery demonstrated more postoperative improvement than the children with resective surgery alone based on the mean QOL score (10.78 vs. 5.75, p = 0.0152) and full-scale IQ (7.91 vs. 4.55, p = 0.0446). CONCLUSIONS Resective surgery combined with CCT can provide favorable seizure control and obvious improvements in QOL and IQ in children with LGS. This combined approach can be performed in carefully selected LGS children without focal lesions and can localize the epileptogenic zone following a comprehensive preoperative evaluation.
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Ottenhausen M, Bittigau P, Koch A, Lankes E, Schulz M, Thomale UW. Hamartoma of the optic nerve in a young child—case report and review of the literature. Childs Nerv Syst 2015; 31:1401-6. [PMID: 25925579 DOI: 10.1007/s00381-015-2727-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 04/20/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Hamartomas are well described but yet incompletely understood sporadic benign lesions that can arise in various locations. Hypothalamic hamartomas of infancy are often associated with severe developmental disturbances. We present a case of an infant boy with a hamartoma that arises from the optic nerve and lead to progressive unspecific seizure activity, behavioral problems and precautious puberty. METHODS A 1-year-old male patient was presented with horizontal nystagmus and developmental retardation. Magnetic resonance imaging (MRI) with contrast revealed an isointense mass ventral of the chiasm consistent with a hamartoma. Soon after the MRI, the mother of the patient reported gelastic-like seizures. The patient was evaluated by an interdisciplinary team, and surgery was recommended. Intraoperatively, a firm attachment to the optic nerve was recognized and a thin remnant layer of tissue was left behind. RESULTS After an uncomplicated near total resection, the patient improved significantly. After 6 months, the frequency of seizures reoccurred, which were again unresponsive to antiepileptic medication. In a second operation, a complete resection of the remnants was performed, and the patient showed lasting clinical improvement. CONCLUSION We conclude that hamartomas mimicking hypothalamic symptoms can also arise from the optic pathway and that a reoperation, if feasible, of even small remnants is essential in order to achieve lasting symptom relieve.
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Ng YT, Pati S, Fesler JR. Lennox-Gastaut syndrome may be a curable, reversible epileptic encephalopathy. Epilepsia 2015; 56:499-500. [PMID: 25778755 DOI: 10.1111/epi.12891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Yu-Tze Ng
- Department of Pediatrics, Baylor College of Medicine, Children's Hospital of San Antonio, San Antonio, Texas, U.S.A.
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Liang S, Zhang S, Hu X, Zhang Z, Fu X, Jiang H, Xiaoman Y. Anterior corpus callosotomy in school-aged children with Lennox-Gastaut syndrome: a prospective study. Eur J Paediatr Neurol 2014; 18:670-6. [PMID: 24912732 DOI: 10.1016/j.ejpn.2014.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 03/11/2014] [Accepted: 05/10/2014] [Indexed: 12/01/2022]
Abstract
AIMS To compare outcomes of anterior corpus callosotomy (CCT) with anti-epileptic drugs (AEDs) treatment in school-aged children with Lennox-Gastaut syndrome (LGS). METHODS Sixty school-aged children with LGS were prospectively enrolled and divided into either the medicine or surgery group according the choice of the patients' caregivers. Cases in the medicine group were treated with multiple rational AEDs and patients in the surgery group underwent anterior CCT. Seizure control at 1-5 years after enrollment and changes of intelligence quotient (IQ) and quality of life (QOL) from pre-treatment to the 2-year follow-up were compared between the two groups. RESULTS The percentages of patients who were totally seizure-free in the surgery group were 17.4% at the 1-year follow-up, 13.0% at the 2-year follow-up and 8.7% at the 5-year follow up, and the data for patients in the medicine group were 2.9%, 5.9% and 2.9%, respectively. Significant differences were found in total seizure control between the two groups at 1, 2, and 5-year follow-up (personal χ2 test). Significant differences were found in mean changes of IQ and overall QOL between the medicine and surgery groups at the 2-year follow-up, showing positive results for the surgery group, but these changes were not related to postoperative outcomes of seizure control (t-test). CONCLUSION Anterior CCT is a promising treatment for school-aged children with LGS, and can present marked seizure control and improvement in QOL and IQ, all of which were significantly better than the effects of treatment with multiple AEDs.
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Affiliation(s)
- Shuli Liang
- Department of Neurosurgery, Capital Epilepsy Therapy Center, First Affiliated Hospital of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
| | - Shaohui Zhang
- Capital Epilepsy Therapy Center, First Affiliated Hospital of PLA General Hospital, Beijing, China
| | - Xiaohong Hu
- Department of Pediatrics, First Affiliated Hospital of PLA General Hospital, Beijing, China
| | - Zhiwen Zhang
- Department of Neurosurgery, First Affiliated Hospital of PLA General Hospital, Beijing, China
| | - Xiangping Fu
- Department of Neurosurgery, First Affiliated Hospital of PLA General Hospital, Beijing, China
| | - Hong Jiang
- Department of Psychology, First Affiliated Hospital of PLA General Hospital, Beijing, China
| | - Yu Xiaoman
- Capital Epilepsy Therapy Center, First Affiliated Hospital of PLA General Hospital, Beijing, China
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Ng YT. Increasing blurriness of the borders between focal and generalized as well as cryptogenic and idiopathic epilepsies in defining the role for focal epilepsy surgery. Semin Pediatr Neurol 2014; 21:104-5. [PMID: 25149938 DOI: 10.1016/j.spen.2014.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Yu-Tze Ng
- Department of Neurology, University of Oklahoma Medical Center, Oklahoma City, OK.
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Errichiello L, Striano P, Galletta D, Striano S. Psychiatric features in gelastic epilepsy and hypothalamic hamartoma: long-term psychodiagnostic observations. Neurol Sci 2013; 35:469-71. [DOI: 10.1007/s10072-013-1559-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
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VanStraten AF, Ng YT. Update on the management of Lennox-Gastaut syndrome. Pediatr Neurol 2012; 47:153-61. [PMID: 22883278 DOI: 10.1016/j.pediatrneurol.2012.05.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 05/09/2012] [Indexed: 11/26/2022]
Abstract
Lennox-Gastaut syndrome is a severe childhood epilepsy disorder characterized by encephalopathy and multiple, often intractable, seizure types. The drop attack is the most frequently recognizable seizure type in this patient population, and is also the most dangerous physically, thus severely limiting quality of life. The diagnosis is confirmed by electroencephalography, for which the classic pattern is a slow 2.5 Hz generalized spike-and-wave. Newer pharmacologic treatments include rufinimide and clobazam. However, antiepileptic drugs are often exhausted in pursuit of seizure control requiring nonpharmacologic interventions. These include dietary therapies, vagus nerve stimulation, and epilepsy surgery, including corpus callosotomy and focal curative resection. Although large lobar resections are often required, very localized, discrete resections may be possible, as in symptomatic Lennox-Gastaut syndrome (specifically, hypothalamic hamartoma). We review the history of the disease and current management options.
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Affiliation(s)
- Amanda F VanStraten
- Department of Neurology, University of Oklahoma Health Sciences Center, 711 Stanton L. Young Boulevard, Oklahoma City, OK 73104, USA
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Castaño De La Mota C, Martín Del Valle F, Pérez Villena A, Calleja Gero M, Losada Del Pozo R, Ruiz-Falcó Rojas M. Hypothalamic hamartoma in paediatric patients: Clinical characteristics, outcomes and review of the literature. NEUROLOGÍA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.nrleng.2011.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Castaño De La Mota C, Martín Del Valle F, Pérez Villena A, Calleja Gero ML, Losada Del Pozo R, Ruiz-Falcó Rojas ML. Hamartoma hipotalámico en la edad pediátrica: características clínicas, evolución y revisión de la literatura. Neurologia 2012; 27:268-76. [PMID: 22341983 DOI: 10.1016/j.nrl.2011.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 11/06/2011] [Accepted: 12/20/2011] [Indexed: 12/01/2022] Open
Affiliation(s)
- C Castaño De La Mota
- Unidad de Neuropediatría, Hospital Infantil Universitario Niño Jesús, Madrid, España.
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Bodensteiner JB, Ng YT. Ethical considerations in paediatric neurology: neuromuscular disease and epilepsy. J Paediatr Child Health 2011; 47:599-602. [PMID: 21951440 DOI: 10.1111/j.1440-1754.2011.02159.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The pace of developing technology with respect to many diagnostic tests, as well as available treatments including artificial ventilation, may have progressed at a faster rate than our ethical, humane ability to decide on the optimal choices for our patients. In fact, who should make these choices; physicians or patients and families? Certain ethical aspects of neuromuscular disorders and epilepsy are reviewed. For neuromuscular disease, the example of Duchenne muscular dystrophy (DMD) with regards to genetic testing, relatively early wheelchair placement and individualised invasive ventilation is discussed. In epilepsy, performing neurosurgery in severely impaired children is probably appropriate in some cases if desired by the family. Financial and human costs restrict therapies and testing for epilepsy as well as other neurological and medical diseases. Whether it is ethical to consider costs in medical treatment or not, it is certainly a reality.
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Affiliation(s)
- John B Bodensteiner
- Division of Pediatric Neurology, Barrow Neurological Institute/St. Joseph's Children's Health Center, Phoenix, Arizona, United States
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