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Pembegul Yildiz E, Coskun O, Kurekci F, Maras Genc H, Ozaltin O. Machine learning models for predicting treatment response in infantile epilepsies. Epilepsy Behav 2024; 160:110075. [PMID: 39393146 DOI: 10.1016/j.yebeh.2024.110075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 10/01/2024] [Accepted: 10/03/2024] [Indexed: 10/13/2024]
Abstract
Epilepsy stands as one of the prevalent and significant neurological disorders, representing a critical healthcare challenge. Recently, machine learning techniques have emerged as versatile tools across various healthcare domains, encompassing diagnostics, treatment assessment, and prognosis. We compared 11 machine learning model to find the best ML model to predict drug treatment outcomes for our cohort, which we previously evaluated using classical statistical methods. METHODS In our study, we evaluated patients who presented to the pediatric neurology department of our university hospital with seizures at the age of 1 to 24 months and were diagnosed with epilepsy. We utilized 11 different machine learning techniques namely Decision Tree, Bagging, K-Nearest Neighbour, Linear Discriminant Analysis, Logistic Regression, Neural Networks, Deep Neural Networks, Support Vector Machine. Besides, we compared these techniques using various performance metrics to identify anti-seizure medicine response. We also utilized the chi-square feature selection methods to enhance performance in machine learning algorithms. RESULTS Two hundred and twenty-nine patients (110 male and 119 female) who were diagnosed between the ages of 1-24 months were included in the study. Support Vector Machine algorithm was found to be effective in drug resistant epilepsy detection, with the highest aure under curve value (0.9934) and achieving a test accuracy of 97.06 %. CONCLUSION This study can shed light on future studies by showing that the Support Vector Machine algorithm can effectively determine the drug resistant epilepsy. The pediatric neurologist and experts should be referred to non-medical treatment (epilepsy surgery, ketogenic diet) at the early stages and multidisciplinary approach should be provided.
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Affiliation(s)
| | - Orhan Coskun
- Department of Pediatric Neurology, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkiye
| | - Fulya Kurekci
- Department of Pediatric Neurology, Istanbul Faculty of Medicine, Istanbul, Turkiye.
| | - Hulya Maras Genc
- Department of Pediatric Neurology, Istanbul Faculty of Medicine, Istanbul, Turkiye
| | - Oznur Ozaltin
- Department of Statistics, Faculty of Science, Ataturk University, Erzurum, Turkiye
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2
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Hartman L, Greene HM. Acute presentation of abusive head trauma. Semin Pediatr Neurol 2024; 50:101135. [PMID: 38964810 DOI: 10.1016/j.spen.2024.101135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/22/2024] [Accepted: 05/07/2024] [Indexed: 07/06/2024]
Abstract
Child abuse is a major cause of morbidity and mortality in the United States. The leading cause of child physical abuse related deaths is abusive head trauma, formerly known as shaken baby syndrome, making the rapid identification and assessment of these children critical. The clinical presentation of cases of abusive head trauma ranges from neurological complaints, such as seizures, to vague or subtle symptoms, such as vomiting. This results in frequent missed diagnoses of abusive head trauma. The identification of abusive head trauma relies on a thorough medical history and physical examination, followed by lab evaluation and imaging. The goal of the evaluation is to discover further injury and identify possible underlying non-traumatic etiologies of the patient's symptoms. In this article we present a framework for the assessment of abusive head trauma and provide information on common presentations and injuries, as well as differential diagnoses. A strong foundational knowledge of abusive head trauma will lead to greater recognition and improved safety planning for victims of this unfortunate diagnosis.
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Affiliation(s)
- Luke Hartman
- Division of Child and Family Advocacy, Department of Pediatrics, Nationwide Children's Hospital, 655 E Livingston Ave, Columbus, OH 43205.
| | - H Michelle Greene
- Division of Child and Family Advocacy, Department of Pediatrics, Nationwide Children's Hospital, 655 E Livingston Ave, Columbus, OH 43205
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Amagasa S, Uematsu S, Tsuji S, Nagai A, Abe Y, Kubota M. Identification of children with first afebrile seizure for whom neuroimaging is unnecessary. Seizure 2021; 93:140-144. [PMID: 34749253 DOI: 10.1016/j.seizure.2021.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/01/2021] [Accepted: 10/27/2021] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To find ways to identify children with first afebrile seizure for whom neuroimaging is unnecessary. METHODS We retrospectively reviewed the clinical records of children younger than 19 years of age with the first afebrile seizure who visited the emergency department of the National Center for Child Health and Development in Japan between May 2014 and December 2020. We investigated the relationship between age, sex, focal seizure, seizure duration, seizure cluster, neurological findings, and CT and/or MRI abnormalities by univariate analysis. Furthermore, to identify children with low probability of intracranial abnormality, we performed decision tree analysis by classification and regression tree methods. RESULTS Among the eligible 611 children, 14 children had a CT abnormality (4.2% of patients who underwent CT) and 26 had a CT or MRI abnormality (7.1% of patients who underwent CT or MRI). Six children had an urgent neuroimaging abnormality. In the univariate analysis, seizure cluster (P = 0.02) was significantly associated with CT abnormality, and focal seizure (P = 0.01) and seizure prolonged for more than 5 min (P = 0.04) were significantly associated with CT or MRI abnormality. The decision tree analysis identified seizure cluster, prolonged seizure, neurological disorder, and focal seizure as risk factors for CT abnormalities in that order. CONCLUSION Children without seizure cluster, seizure prolonged for more than 5 min, and neurological disorder may not require CT in the emergency room. The clinician could determine the necessity of neuroimaging by seizure cluster, prolonged seizure, focal seizure, and neurological disorder.
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Affiliation(s)
- Shunsuke Amagasa
- Division of Emergency and Transport Services, National Center for Child Health and Development.
| | - Satoko Uematsu
- Division of Emergency and Transport Services, National Center for Child Health and Development.
| | - Satoshi Tsuji
- Division of Emergency and Transport Services, National Center for Child Health and Development.
| | - Akira Nagai
- Division of General Pediatrics, Department of Interdisciplinary Medicine, National Center for Child Health and Development.
| | - Yuich Abe
- Division of Neurology, National Center for Child Health and Development.
| | - Mitsuru Kubota
- Division of General Pediatrics, Department of Interdisciplinary Medicine, National Center for Child Health and Development.
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Lin CH, Chou IC, Hong SY. Genetic factors and the risk of drug-resistant epilepsy in young children with epilepsy and neurodevelopment disability: A prospective study and updated meta-analysis. Medicine (Baltimore) 2021; 100:e25277. [PMID: 33761731 PMCID: PMC8049163 DOI: 10.1097/md.0000000000025277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 03/03/2021] [Indexed: 11/26/2022] Open
Abstract
Drug-resistant epilepsy (DRE) affects 7% to 20% of children with epilepsy. Although some risk factors for DRE have been identified, the results have not been consistent. Moreover, data regarding the risk factors for epilepsy and its seizure outcome in the first 2 years of life are limited.We analyzed data for children aged 0 to 2 years with epilepsy and neurodevelopmental disability from January, 2013, through December, 2017. These patients were followed up to compare the risk of DRE in patients with genetic defect (genetic group) with that without genetic defect (nongenetic group). Additionally, we conducted a meta-analysis to identify the pooled prevalence of genetic factors in children with DRE.A total of 96 patients were enrolled. A total of 68 patients were enrolled in the nongenetic group, whereas 28 patients were enrolled in the genetic group. The overall DRE risk in the genetic group was 6.5 times (95% confidence interval [CI], 2.15-19.6; p = 0.03) higher than that in the nongenetic group. Separately, a total of 1308 DRE patients were participated in the meta-analysis. The pooled prevalence of these patients with genetic factors was 22.8% (95% CI 17.4-29.3).The genetic defect plays a crucial role in the development of DRE in younger children with epilepsy and neurodevelopmental disability. The results can serve as a reference for further studies of epilepsy panel design and may also assist in the development of improved treatments and prevention strategies for DRE.
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Affiliation(s)
- Chien-Heng Lin
- Division of Pediatrics Pulmonology, China Medical University, Children's Hospital, Taichung, Taiwan
- Department of Biomedical Imaging and Radiological Science, College of Medicine, China Medical University
| | - I-Ching Chou
- Division of Pediatrics Neurology, China Medical University, Children's Hospital
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Syuan-Yu Hong
- Division of Pediatrics Neurology, China Medical University, Children's Hospital
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Curcio AM, Shekhawat P, Reynolds AS, Thakur KT. Neurologic infections during pregnancy. HANDBOOK OF CLINICAL NEUROLOGY 2020; 172:79-104. [PMID: 32768096 PMCID: PMC7402657 DOI: 10.1016/b978-0-444-64240-0.00005-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Neurologic infections during pregnancy represent a significant cause of maternal and fetal morbidity and mortality. Immunologic alterations during pregnancy increase the susceptibility of the premature brain to damage. This chapter summarizes the epidemiology, pathophysiology, and clinical manifestations in the pregnant woman and the infant, and the diagnosis, treatment, and prevention of the major viral, parasitic, and bacterial infections known to affect pregnancy. These organisms include herpes virus, parvovirus, cytomegalovirus, varicella, rubella, Zika virus, toxoplasmosis, malaria, group B streptococcus, listeriosis, syphilis, and tuberculosis. There is an emphasis on the important differences in diagnosis, treatment, and fetal outcome between trimesters. An additional overview is provided on the spectrum of neurologic sequelae of an affected infant, which ranges from developmental delay to hydrocephalus and seizures.
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Affiliation(s)
- Angela M Curcio
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States; NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, United States
| | - Priyanka Shekhawat
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Alexandra S Reynolds
- Departments of Neurosurgery and Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Kiran T Thakur
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States; NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, United States.
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Drapkin Z, Franchek-Roa K, Srinivas GL, Buchi KF, Miescier MJ. Is my baby normal? A review of seemingly worrisome but normal newborn signs, symptoms and behaviors. Am J Emerg Med 2019; 37:1153-1159. [PMID: 30952605 DOI: 10.1016/j.ajem.2019.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/18/2019] [Accepted: 03/20/2019] [Indexed: 12/20/2022] Open
Abstract
Infant patients are a unique challenge to emergency department (ED) physicians as the spectrum of normal infant signs, symptoms and behaviors are often difficult to differentiate from abnormal and potentially life-threatening conditions. In this article, we address some common chief complaints of neonates and young infants presenting to the ED, and contrast reassuring neonatal and young infant signs and symptoms against those that need further workup and intervention.
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Affiliation(s)
- Zachary Drapkin
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, UT, USA; Department of Surgery, Division of Emergency Medicine, University of Utah, Salt Lake City, UT, USA.
| | | | - Ganga L Srinivas
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Karen F Buchi
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Michael J Miescier
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, UT, USA
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Neuro-imaging evaluation after the first afebrile seizure in children: A retrospective observational study. Seizure 2016; 43:26-31. [PMID: 27821269 DOI: 10.1016/j.seizure.2016.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 10/03/2016] [Accepted: 10/11/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To evaluate the role of neuro-imaging in children presenting with the first afebrile seizure and determine factors that influence the outcome of imaging in a large paediatric emergency centre. METHOD This is a retrospective review of the medical records of all patients presenting with the first non-febrile seizure to a large paediatric emergency centre in the state of Qatar. Seizure classification followed the current ILAE classification system. Imaging was undertaken in our tertiary hospital and all images were reviewed by experienced neuro-radiologists. Student t test was used for statistical analysis. RESULTS Ninety-six children underwent neuro-imaging following the first afebrile seizure. Of them, thirty-two patients (33%) were reported to have abnormalities. Children below the age of two demonstrated a significantly higher percentage of abnormal imaging (59%); (p=0.002). Children presenting with prolonged seizures showed a high percentage of imaging abnormalities (58%); (p=0.003). Children with focal seizures demonstrated a higher percentage of imaging abnormality compared to those presenting with generalized seizures (35% vs 31%). This difference did not reach statistical significance. CONCLUSION Children below the age of two demonstrated significantly higher percentages of abnormal imaging (59%), as did children presenting with status epilepticus (58%). Neuro-imaging should be considered in infants and those with focal or prolonged seizures. Neuro-imaging informed decision making in 6-8% of children.
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Dayan PS, Lillis K, Bennett J, Conners G, Bailey P, Callahan J, Akman C, Feldstein N, Kriger J, Hauser WA, Kuppermann N. Prevalence of and Risk Factors for Intracranial Abnormalities in Unprovoked Seizures. Pediatrics 2015. [PMID: 26195538 PMCID: PMC4516940 DOI: 10.1542/peds.2014-3550] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Prospective data are lacking to determine which children might benefit from prompt neuroimaging after unprovoked seizures. We aimed to determine the prevalence of, and risk factors for, relevant intracranial abnormalities in children with first, unprovoked seizures. METHODS We conducted a 6-center prospective study in children aged >28 days to 18 years with seemingly unprovoked seizures. Emergency department (ED) clinicians documented clinical findings on a standardized form. Our main outcome was the presence of a clinically relevant intracranial abnormality on computed tomography (CT) or MRI, defined as those that might change management, either emergently, urgently, or nonurgently. RESULTS We enrolled 475 of 625 (76%) eligible patients. Of 354 patients for whom cranial MRI or CT scans were obtained in the ED or within 4 months of the ED visit, 40 (11.3%; 95% confidence interval [CI]: 8.0-14.6%) had clinically relevant intracranial abnormalities, with 3 (0.8%; 95% CI: 0.1-1.8%) having emergent/urgent abnormalities. On logistic regression analysis, a high-risk past medical history (adjusted odds ratio: 9.2; 95% CI: 2.4-35.7) and any focal aspect to the seizure (odds ratio: 2.5; 95% CI: 1.2-5.3) were independently associated with clinically relevant abnormalities. CONCLUSIONS Clinically relevant intracranial abnormalities occur in 11% of children with first, unprovoked seizures. Emergent/urgent abnormalities, however, occur in <1%, suggesting that most children do not require neuroimaging in the ED. Findings on patient history and physical examination identify patients at higher risk of relevant abnormalities.
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Affiliation(s)
- Peter S. Dayan
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York
| | - Kathleen Lillis
- Department of Pediatrics, State University of New York at Buffalo, Buffalo, New York
| | - Jonathan Bennett
- Department of Pediatrics, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Gregory Conners
- Department of Emergency Medicine, University of Rochester, Rochester, New York
| | - Pam Bailey
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - James Callahan
- Departments of Emergency Medicine and Pediatrics, Upstate Medical College, Syracuse, New York
| | - Cigdem Akman
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York
| | - Neil Feldstein
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York
| | - Joshua Kriger
- Department of Biostatistics, Columbia University Medical Center, New York, New York
| | - W. Allen Hauser
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York;,Gertrude Sergievsky Center, New York, New York; and
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, Davis School of Medicine, University of California, Sacramento, California
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Baratloo A, Rouhipour A, Forouzanfar M, Rahmati F, Hashemi B. Hypokalemia-induced abnormal movements: case report. Trauma Mon 2013; 18:141-4. [PMID: 24350174 PMCID: PMC3864401 DOI: 10.5812/traumamon.12016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 06/21/2013] [Accepted: 07/26/2013] [Indexed: 11/23/2022] Open
Abstract
Introduction A sudden loss of consciousness followed by abnormal movements can be ictal or syncopal in origin. Transient response by the brain to sudden decrease of blood flow may cause sudden loss of consciousness followed by abnormal movements that mimic seizure. Dysrhythmia is one of the important and critical reasons of such events that should be differentiated from seizure. Case Presentation In this case report we describe a 55 year-old woman admitted to our emergency department first with the impression of seizure. Eventually, it was realized that she had suffered from brain hypo-perfusion secondary to hypokalemia induced arrhythmia. Her arrhythmia was managed by unsynchronized biphasic shock in acute phase and also potassium replacement. She was then admitted to the CCU (Coronary Care Unit) where she received further care for medical management and drug dose adjustment and was discharged 4 days later. Conclusions Syncope from arrhythmia most commonly results from ventricular tachycardia, which accounts for 11% of all cases of syncope. Torsades de point is a unique type of ventricular tachycardia, characterized by QRS complexes of changing amplitude proceeded by prolonged QT intervals and almost often followed by loss of consciousness and also seizure like movements. Prolonged QT interval which is an important provocative factor for torsades de point commonly results from interactions between drug therapy, myocardial ischemia, and electrolyte disturbances such as hypokalemia or hypomagnesaemia. Changes in the extracellular potassium level have predominant and profound influences on the function of the cardiovascular system that may provoke fatal demonstrations such as QT prolongation, ventricular arrhythmia and even cardiac arrest. Electrolyte assessment is particularly important in certain patient populations, such as the elderly in whom a variety of pathological states or conditions like dehydration or renal failure are more common. Early identification and correction of these disturbances are necessary to control either seizures or seizure-like movements and prevent permanent brain damage, as anticonvulsants alone are generally ineffective.
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Affiliation(s)
- Alireza Baratloo
- Department of Emergency Medicine, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Alaleh Rouhipour
- Department of Pediatrics, Vali Asr Hospital, Ghazvin University of Medical Sciences, Abyek, IR Iran
- Corresponding author: Alaleh Rouhipour, Department of Pediatrics, Vali Asr Hospital, Ghazvin University of Medical Sciences, Abyek, IR Iran. Tel.: +98-9124961735, Fax: +98-2122721155, E-mail:
| | - Mohammadmahdi Forouzanfar
- Department of Emergency Medicine, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Farhad Rahmati
- Department of Emergency Medicine, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Behrooz Hashemi
- Department of Emergency Medicine, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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Generalized Convulsive Status Epilepticus in Adults and Children: Treatment Guidelines and Protocols. Emerg Med Clin North Am 2011; 29:51-64. [DOI: 10.1016/j.emc.2010.08.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Most well-appearing children who have had an afebrile seizure can be managed as outpatients with instructions for an outpatient electroencephalogram and primary care physician follow-up. Laboratory studies are needed only in children younger than 6 months, in patients with prolonged seizures or altered level of consciousness, or in those with history of a metabolic disorder or dehydration. Emergent neuroimaging is not recommended in children with a first unprovoked afebrile seizure, although studies should be considered in children with a predisposing condition or focal seizures if younger than 3 years.
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Affiliation(s)
- Ghazala Q Sharieff
- Department of Emergency Medicine, Palomar-Pomerado Health System/California Emergency Physicians, 3020 Children's Way, San Diego, CA 92011, USA
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Abstract
Seizures are the most common pediatric neurologic disorder. Four to ten percent of children suffer at least one seizure in the first 16 years of life. The incidence is highest in children less than 3 years of age, with a decreasing frequency in older children. Epidemiologic studies reveal that approximately 150,000 children will sustain a first-time unprovoked seizure each year, and of those, 30,000 will develop epilepsy. This article describes the types, diagnoses, and management and disposition of this pediatric neurologic disorder.
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Affiliation(s)
- Marla J Friedman
- Division of Emergency Medicine, Miami Children's Hospital, FL 33155, USA.
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Capovilla G, Beccaria F, Montagnini A. 'Benign focal epilepsy in infancy with vertex spikes and waves during sleep'. Delineation of the syndrome and recalling as 'benign infantile focal epilepsy with midline spikes and waves during sleep' (BIMSE). Brain Dev 2006; 28:85-91. [PMID: 15967619 DOI: 10.1016/j.braindev.2005.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Revised: 05/05/2005] [Accepted: 05/09/2005] [Indexed: 11/22/2022]
Abstract
PURPOSE To better delineate the electroclinical features of infants who presented with focal seizures and typical midline sleep EEG abnormalities with a benign outcome. We discuss the significance of the typical EEG marker in non-epileptic patients. METHODS Patients were selected from a group of epileptic subjects with seizure onset less than 3 years we observed from 1st November 1990 and 31st December 2003. Inclusion criteria were the presence of typical sleep EEG marker and focal seizures with benign outcome. Cases with less than 18 month follow-up period were excluded from this study. RESULTS There were 19 patients (12 males, 7 females). Pre-, peri- and post-natal personal history was negative in all patients. Psychomotor development was normal, both before and after seizure onset. Neuroradiological investigations gave normal results. Seizure manifestations were typical, characterized by cyanosis, staring and rare lateralizing signs, of short duration. Age at onset was comprised between 4 and 30 months. The typical EEG marker, a spike followed by a bell-shaped slow-wave, localized in the midline regions, was present in all subjects only during sleep. All had a favorable outcome and the overwhelming majority of the patients were not treated. CONCLUSIONS Our patients have an homogeneous electroclinical picture to constitute a new epileptic syndrome not included in the ILAE classification. We propose to call it 'benign focal epilepsy in infancy with midline spikes and waves during sleep' (BIMSE).
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Affiliation(s)
- G Capovilla
- Department of Child Neuropsychiatry, Epilepsy Center, 'C. Poma' Hospital, Viale Albertoni 1, 46100 Mantova, Italy.
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Claudius I, Fluharty C, Boles R. The Emergency Department Approach to Newborn and Childhood Metabolic Crisis. Emerg Med Clin North Am 2005; 23:843-83, x. [PMID: 15982549 DOI: 10.1016/j.emc.2005.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
For most emergency medicine physicians, the phrases "newborn workup" and "metabolic disease" are, at best, uncomfortable. This article, however, provides a simple approach to the recognition,evaluation, and treatment of infants with all manners of metabolic issues, including hypoglycemia, inborn errors of metabolism, jaundice, and electrolyte abnormalities. The disorders are grouped based on symptomatology, and have simple guidelines for work-up and management, with an emergency department practitioner perspective in mind.
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MESH Headings
- Acid-Base Equilibrium
- Adrenal Hyperplasia, Congenital/diagnosis
- Adrenal Hyperplasia, Congenital/metabolism
- Diagnosis, Differential
- Electrolytes/blood
- Emergency Service, Hospital
- Humans
- Hypoglycemia/diagnosis
- Hypoglycemia/drug therapy
- Hypoglycemia/physiopathology
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/therapy
- Jaundice, Neonatal/diagnosis
- Jaundice, Neonatal/physiopathology
- Jaundice, Neonatal/therapy
- Metabolism, Inborn Errors/diagnosis
- Metabolism, Inborn Errors/therapy
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Affiliation(s)
- Ilene Claudius
- Department of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS113, Los Angeles, CA 90027, USA
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15
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Freedman SB, Powell EC. Pediatric seizures and their management in the emergency department. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2003. [DOI: 10.1016/s1522-8401(03)00059-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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