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Zlotnik S, Schiff A, Ravid S, Shahar E, Toglia J. A New Approach for Assessing Functional Cognition and Its Unique Expression in Adolescents With Epilepsy. Am J Occup Ther 2019. [DOI: 10.5014/ajot.2019.73s1-rp401e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented 04/07/19
We describe a new approach for assessing executive functions in everyday life and its unique expression in adolescents with epilepsy, using the Weekly Calendar Planning Activity (WCPA). The WCPA provides functionally relevant information on task performance and strategy use that can guide intervention and measure outcomes. We recommend that OTs assess EF among adolescents with epilepsy using a performance-based assessment.
Primary Author and Speaker: Sharon Zlotnik
Contributing Authors: Aharon Schiff
Sarit Ravid, Eli Shahar, Joan Toglia
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Affiliation(s)
| | | | | | - Eli Shahar
- Rambam Health Care Campus, Haifa, Israel
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Kiros YK, Elinav H, Gebreyesus A, Gebremeskel H, Azar J, Chemtob D, Abreha H, Elbirt D, Shahar E, Chowers M, Turner D, Grossman Z, Haile A, Sutton RE, Maayan SL, Wolday D. Identification and characterization of HIV positive Ethiopian elite controllers in both Africa and Israel. HIV Med 2019; 20:33-37. [PMID: 30318718 PMCID: PMC6510948 DOI: 10.1111/hiv.12680] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES HIV elite controllers (ECs) are a unique subgroup of HIV-positive patients who are long-term virologically suppressed in the absence of antiretroviral treatment (ART). The prevalence of this subgroup is estimated to be < 1%. Various cohorts of ECs have been described in developed countries, most of which have been demographically heterogeneous. The aim of this study was to identify ECs in two large African cohorts and to estimate their prevalence in a relatively genetically homogenous population. METHODS We screened two cohorts of HIV-positive Ethiopian patients. The first cohort resided in Mekelle, Ethiopia. The second was comprised of HIV-positive Ethiopian immigrants in Israel. In the Mekelle cohort, ART-naïve subjects with stable CD4 counts were prospectively screened using two measurements of viral load 6 months apart. Subjects were defined as ECs when both measurements were undetectable. In the Israeli cohort, subjects with consistently undetectable viral loads (mean of 17 viral load measurements/patient) and stable CD4 count > 500 cells/μL were defined as ECs. RESULTS In the Mekelle cohort, 16 of 9515 patients (0.16%) fitted the definition of EC, whereas seven of 1160 (0.6%) in the Israeli cohort were identified as ECs (P = 0.011). CONCLUSIONS This is the first large-scale screening for HIV-positive ECs to be performed in entirely African cohorts. The overall prevalence of ECs is within the range of that previously described in developing countries. The significant difference in prevalence between the two cohorts of similar genetic background is probably a consequence of selection bias but warrants further investigation into possible environmental factors which may underlie the EC state.
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Affiliation(s)
- Y K Kiros
- Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
| | - H Elinav
- Clinical Microbiology and Infectious Diseases Department, Hadassah University Medical Center, Jerusalem, Israel
| | - A Gebreyesus
- Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
| | - H Gebremeskel
- Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
| | - J Azar
- Internal Medicine Division, Hadassah University Medical Center, Jerusalem, Israel
| | - D Chemtob
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel
| | - H Abreha
- Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
| | - D Elbirt
- The Allergy, Clinical Immunology and AIDS Unit, Kaplan Medical Center, Rehovot, Israel
| | - E Shahar
- Institute of Allergy, Immunology and AIDS Rambam Medical Center, Haifa, Israel
| | - M Chowers
- Infectious Diseases Unit, Meir Medical Center, Kfar Saba, Israel
| | - D Turner
- Crusaid Kobler AIDS Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Z Grossman
- Clinical Microbiology and Infectious Diseases Department, Hadassah University Medical Center, Jerusalem, Israel
| | - A Haile
- Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
| | - R E Sutton
- Division of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - S L Maayan
- Division of Infectious Diseases, Barzilai Medical Center, Ashkelon, Israel
| | - D Wolday
- Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
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Zlotnik S, Schiff A, Ravid S, Shahar E, Toglia J. A new approach for assessing executive functions in everyday life, among adolescents with Genetic Generalised Epilepsies. Neuropsychol Rehabil 2018; 30:333-345. [PMID: 29712502 DOI: 10.1080/09602011.2018.1468272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Studies have characterised relationships between cognitive status and a variety of clinical epilepsy factors. The aim of this study was to describe a new approach for assessing executive functions in everyday life and its unique expression in adolescents with Genetic Generalised Epilepsies (GGEs) compared with typical peers. Twenty adolescents with a diagnosis of GGEs and 20 typical healthy peers, matched by age and gender, were studied. Assessment of everyday executive function was carried out using: (1) the Weekly Calendar Planning Activity (WCPA), a direct performance based and outcome measure of strategy use and cognitive performance; and (2) Behavior Rating Inventory of Executive Function (BRIEF) parental report. Adolescents with GGEs demonstrated significantly less accuracy, less efficiency and fewer strategies used, as measured by the WCPA. Parents of adolescents with GGEs rated their child's daily performance as less efficient compared with typical peers. Better ratings of executive function (low BRIEF score) were associated with greater WCPA accuracy in the entered appointments. The WCPA provides a useful evaluation of cognitive performance for adolescents with GGEs and a functionally relevant information on task efficiency, self-monitoring and effective strategy use. Direct observation of performance supplements parental ratings and has strong potential to guide intervention and measure outcomes.
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Affiliation(s)
- Sharon Zlotnik
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Aharon Schiff
- Meyer Children's Hospital, Paediatric Neurology Unit, Haifa, Israel
| | - Sarit Ravid
- Meyer Children's Hospital, Paediatric Neurology Unit, Haifa, Israel
| | - Eli Shahar
- Meyer Children's Hospital, Paediatric Neurology Unit, Haifa, Israel
| | - Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, USA
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Cahn P, Kaplan R, Sax PE, Squires K, Molina JM, Avihingsanon A, Ratanasuwan W, Rojas E, Rassool M, Bloch M, Vandekerckhove L, Ruane P, Yazdanpanah Y, Katlama C, Xu X, Rodgers A, East L, Wenning L, Rawlins S, Homony B, Sklar P, Nguyen BY, Leavitt R, Teppler H, Cahn PE, Cassetti I, Losso M, Bloch MT, Roth N, McMahon J, Moore RJ, Smith D, Clumeck N, Vanderkerckhove L, Vandercam B, Moutschen M, Baril J, Conway B, Smaill F, Smith GHR, Rachlis A, Walmsley SL, Perez C, Wolff M, Lasso MF, Chahin CE, Velez JD, Sussmann O, Reynes J, Katlama C, Yazdanpanah Y, Ferret S, Durant J, Duvivier C, Poizot-Martin I, Ajana F, Rockstroh JK, Faetkanheuer G, Esser S, Jaeger H, Degen O, Bickel M, Bogner J, Arasteh K, Hartl H, Stoehr A, Rojas EM, Arathoon E, Gonzalez LD, Mejia CR, Shahar E, Turner D, Levy I, Sthoeger Z, Elinav H, Gori A, Monforte AD, Di Perri G, Lazzarin A, Rizzardini G, Antinori A, Celesia BM, Maggiolo F, Chow TS, Lee CKC, Azwa RISR, Mustafa M, Oyanguren M, Castillo RA, Hercilla L, Echiverri C, Maltez F, da Cunha JGS, Neves I, Teofilo E, Serrao R, Nagimova F, Khaertynova I, Orlova-Morozova E, Voronin E, Sotnikov V, Yakovlev AA, Zakharova NG, Tsybakova OA, Botes ME, Mohapi L, Kaplan R, Rassool MS, Arribas JR, Gatell JM, Negredo E, Ortega E, Troya J, Berenguer J, Aguirrebengoa K, Antela A, Calmy A, Cavassini M, Rauch A, Stoeckle M, Sheng WH, Lin HH, Tsai HC, Changpradub D, Avihingsanon A, Kiertiburanakul S, Ratanasuwan W, Nelson MR, Clarke A, Ustianowski A, Winston A, Johnson MA, Asmuth DM, Cade J, Gallant JE, Ruane PJ, Kumar PN, Luque AE, Panther L, Tashima KT, Ward D, Berger DS, Dietz CA, Fichtenbaum C, Gupta S, Mullane KM, Novak RM, Sweet DE, Crofoot GE, Hagins DP, Lewis ST, McDonald CK, DeJesus E, Sloan L, Prelutsky DJ, Rondon JC, Henn S, Scarsella AJ, Morales JO, Ramirez, Santiago L, Zorrilla CD, Saag MS, Hsiao CB. Raltegravir 1200 mg once daily versus raltegravir 400 mg twice daily, with tenofovir disoproxil fumarate and emtricitabine, for previously untreated HIV-1 infection: a randomised, double-blind, parallel-group, phase 3, non-inferiority trial. The Lancet HIV 2017; 4:e486-e494. [DOI: 10.1016/s2352-3018(17)30128-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 12/20/2022]
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Ravid S, Shahar E, Schif A, Yehudian S. Visual Outcome and Recurrence Rate in Children With Idiopathic Intracranial Hypertension. J Child Neurol 2015; 30:1448-52. [PMID: 25713004 DOI: 10.1177/0883073815569306] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 01/03/2015] [Indexed: 11/15/2022]
Abstract
The purpose of this retrospective study was to evaluate the visual outcome and recurrence rate of idiopathic intracranial hypertension in children. The study included 68 patients who were diagnosed with idiopathic intracranial hypertension according to the modified Dandy criteria. Permanent visual impairment was rare. Three percent remained with mild visual impairment, 4% with minimal visual field defects, and only 1 patient had severe visual impairment. However, 26% had either a prolonged course of disease or a recurring condition. Higher cerebrospinal fluid opening pressure was the only clinical predictor at presentation (P = .04). Recurrence rate was 18%, and in most cases, the second episode occurred during the first year after remission. There was no significant difference between the group of patients with only 1 episode and the group of patients with more than 1 episode. We suggest long-term follow-up after remission, for at least a year, for all children with idiopathic intracranial hypertension.
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Affiliation(s)
- Sarit Ravid
- Child Neurology Unit, Meyer Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Eli Shahar
- Child Neurology Unit, Meyer Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Aharon Schif
- Child Neurology Unit, Meyer Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Shawn Yehudian
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Zlotnik S, Ravid S, Engel-Yeger B, Shahar E. Sensory processing disabilities in childhood-onset generalized epilepsy. J Pediatr Neurol 2015. [DOI: 10.3233/jpn-130600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sharon Zlotnik
- Department of Occupational Therapy, Rambam Medical Center, Haifa, Israel
| | - Sarit Ravid
- Child Neurology Unit and Epilepsy Service, Meyer Children Hospital, Rambam Medical Center, Rappaport School of Medicine, Haifa, Israel
| | - Batya Engel-Yeger
- Department of Occupational Therapy, Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel
| | - Eli Shahar
- Child Neurology Unit and Epilepsy Service, Meyer Children Hospital, Rambam Medical Center, Rappaport School of Medicine, Haifa, Israel
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Watemberg N, Zelnik N, Shahar E, Lerman-Sagie T, Goldberg-Stern H, Ben-Zeev B, Kramer U. Efficacy of corticosteroid therapy in treating epileptic encephalopathies and refractory epilepsies other than West syndrome. J Pediatr Neurol 2015. [DOI: 10.1055/s-0035-1557323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Nathan Watemberg
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nathanel Zelnik
- Pediatric Neurology Unit, Carmel Medical Center, The Technion, Haifa, Israel
| | - Eli Shahar
- Pediatric Neurology Unit, Rambam Medical Center, The Technion, Haifa, Israel
| | - Tally Lerman-Sagie
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadassah Goldberg-Stern
- Pediatric Neurology Unit, Schneider Medical Center, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bruria Ben-Zeev
- Pediatric Neurology Unit, Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Kramer
- Pediatric Neurology Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Engel-Yeger B, Zlotnik S, Ravid S, Shahar E. Childhood-onset primary generalized epilepsy--impacts on children's preferences for participation in out-of-school activities. Epilepsy Behav 2014; 34:1-5. [PMID: 24662943 DOI: 10.1016/j.yebeh.2014.02.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 09/16/2013] [Revised: 02/16/2014] [Accepted: 02/19/2014] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to compare preferences for participation in out-of-school activities between children with childhood-onset primary generalized epilepsy and their healthy peers. Overall, participants were 56 children aged 6-11 years. The study group included 26 children with childhood-onset primary generalized epilepsy. The controls were 30 healthy children. Parents of all participants completed a demographic and health status questionnaire. All children completed the Preference Assessment of Children (PAC) that profiles the out-of-school activities the child wishes to participate in. Scores are calculated for five activity types, namely, recreational, active physical, social, skill-based, and self-improvement and for two domains of formal and informal activities. Children with generalized epilepsy showed a similar preference for participation in out-of-school activities as did their healthy peers. The study group showed a lower preference for participation in social activities but showed a higher preference for participation in self-improvement activities. In both groups, younger children (aged 6-8 years) showed a lower preference for participation in most PAC scales. Older children (aged 9-11 years) showed a higher preference for participation in social activities. Difference between genders was close to being statistically significant in the skill-based activities (F(1,21)=3.84, p=.06), where girls showed a higher preference compared with boys. Intervention policies need to be undertaken in order to encourage children with epilepsy to participate in activities together with their healthy peers, aiming to enhance the well-being of children with primary generalized epilepsy.
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Affiliation(s)
- Batya Engel-Yeger
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Sharon Zlotnik
- Department of Occupational Therapy, Rambam Medical Center, Rappaport School of Medicine, Haifa, Israel
| | - Sarit Ravid
- Child Neurology Unit & Epilepsy Service, Meyer Children Hospital, Rambam Medical Center, Haifa, Israel
| | - Eli Shahar
- Child Neurology Unit & Epilepsy Service, Meyer Children Hospital, Rambam Medical Center, Haifa, Israel.
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Abstract
OBJECTIVES To examine the long-term motor and neurocognitive outcome of children with acute encephalitis and to look at possible prognostic factors. METHODS Children who were treated for acute encephalitis in 2000-2010 were reevaluated. All children and their parents were interviewed by using structured questionnaires, and the children underwent full neurologic examinations, along with comprehensive neurocognitive, attention, and behavioral assessments. RESULTS Of the 47 children enrolled, 1 died and 29 had neurologic sequelae, including motor impairment, mental retardation, epilepsy, and attention and learning disorders. Children with encephalitis had a significantly higher prevalence of attention-deficit/hyperactivity disorder (50%) and learning disabilities (20%) compared with the reported rate (5%-10%) in the general population of Israel (P < .05) and lower IQ scores. Lower intelligence scores and significantly impaired attention and learning were found even in children who were considered fully recovered at the time of discharge. Risk factors for long-term severe neurologic sequelae were focal signs in the neurologic examination and abnormal neuroimaging on admission, confirmed infectious cause, and long hospital stay. CONCLUSIONS Encephalitis in children may be associated with significant long-term neurologic sequelae. Significant cognitive impairment, attention-deficit/hyperactivity disorder, and learning disabilities are common, and even children who were considered fully recovered at discharge may be significantly affected. Neuropsychological testing should be recommended for survivors of childhood encephalitis.
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Shahar E, Attias U, Savulescu D, Genizin J, Gavish M, Nagler R. Oxidative stress, metalloproteinase and LDH in children with intractable and non-intractable epilepsy as reflected in salivary analysis. Epilepsy Res 2014; 108:117-24. [DOI: 10.1016/j.eplepsyres.2013.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 09/09/2013] [Accepted: 10/13/2013] [Indexed: 12/15/2022]
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Geretti AM, Conibear T, Hill A, Johnson JA, Tambuyzer L, Thys K, Vingerhoets J, Van Delft Y, Rieger A, Vetter N, Greil R, Pedersen C, Storgaard M, Morlat P, Katlama C, Durant J, Cotte L, Duvivier C, Rey D, Esser S, Stellbrink C, Schmidt W, Stoll M, Stephan C, Fatkenheuer G, Stoehr A, Rockstroh J, Banhegyi D, Itzchak L, Shahar E, Maayan S, Turner D, Lazzarin A, Antinori A, Carosi G, Minoli L, di Perri G, Filice G, Andreoni M, Duiculescu D, Rugina S, Erscoiu S, Streinu A, Pronin A, Pokrovsky V, Gruzdev B, Yakovlev A, Voronin E, Clotet B, Gatell J, Arribas J, Podzamczer D, Domingo P, Alvarez CM, Quero JH, Furrer H, Feher J, Johnson M, Fox J, Nelson M, Fisher M, Orkin C. Sensitive testing of plasma HIV-1 RNA and Sanger sequencing of cellular HIV-1 DNA for the detection of drug resistance prior to starting first-line antiretroviral therapy with etravirine or efavirenz. J Antimicrob Chemother 2013; 69:1090-7. [DOI: 10.1093/jac/dkt474] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ravid S, Shachor-Meyouhas Y, Shahar E, Kra-Oz Z, Kassis I. Viral-induced intracranial hypertension mimicking pseudotumor cerebri. Pediatr Neurol 2013; 49:191-4. [PMID: 23831246 DOI: 10.1016/j.pediatrneurol.2013.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 02/05/2013] [Accepted: 03/10/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pseudotumor cerebri or idiopathic intracranial hypertension is characterized by normal spinal fluid composition and increased intracranial pressure in the absence of a space-occupying lesion. METHODS This study describes a subgroup of 10 patients with the same typical presenting symptoms (headache, vomiting, and papilledema) but without nuchal rigidity, meningeal signs, or change in mental status. Patients had normal neuroimaging studies and intracranial hypertension but also pleocytosis in the cerebrospinal fluid, suggesting central nervous system infection. From the results it can be hypothesized that those children represent a unique subgroup of viral-induced intracranial hypertension when comparing their risk factors, clinical course, treatment, and outcome with 58 patients who had idiopathic intracranial hypertension. RESULTS All patients with viral-induced intracranial hypertension presented with papilledema but none had reduced visual acuity or abnormal visual fields, compared with 20.7% of patients who had idiopathic intracranial hypertension. They also responded better to treatment with acetazolamide, needed a shorter duration of treatment (7.7 ± 2.6 months vs 12.2 ± 6.3 months, P = 0.03), and had no recurrences. CONCLUSIONS The results suggest that children who fulfill the typical presenting signs and symptoms and all diagnostic criteria for pseudotumor cerebri other than the normal cerebrospinal fluid component may represent a unique subgroup of viral-induced intracranial hypertension and should be managed accordingly. The overall prognosis is excellent.
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Affiliation(s)
- Sarit Ravid
- Meyer Children's Hospital, Rambam Health Care Campus, Haifa, Israel.
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Abstract
The purpose of this retrospective study was to compare headache etiology, type, and burden and the learning and behavioral profile in children with early-onset (under 6 years) and late-onset (8-12 years) headaches. The study included 133 patients, 35 in the early-onset group and 98 in the late-onset group. Headache diagnosis was based on International Classification of Headache Disorders -II (ICHD-II) criteria. Learning profile and behavioral problems were assessed by parental reports. Tension headache was the most common diagnosis in the early-onset headache group (51.4%). No significant differences were found between the age groups with regard to headache etiology, disability, abnormal neuroimaging results, school performance, or attention problems. Nevertheless, the early-onset group patients had a significantly higher prevalence of behavioral problems: 25.7% versus 11.2% (P < .02). The authors suggest that early age of headache onset does not imply a harmful etiology or a relentless headache disability or burden.
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Affiliation(s)
- Sarit Ravid
- Department of Pediatrics, Meyer Children's Hospital, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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Genizi J, Gordon S, Kerem NC, Srugo I, Shahar E, Ravid S. Primary headaches, attention deficit disorder and learning disabilities in children and adolescents. J Headache Pain 2013; 14:54. [PMID: 23806023 PMCID: PMC3698063 DOI: 10.1186/1129-2377-14-54] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 05/27/2013] [Indexed: 11/14/2022] Open
Abstract
Background Primary headaches and Learning difficulties are both common in the pediatric population. The goal of our study was to assess the prevalence of learning disabilities and attention deficit disorder in children and adolescents with migraine and tension type headaches. Methods Retrospective review of medical records of children and adolescents who presented with headache to the outpatient pediatric neurology clinics of Bnai-Zion Medical Center and Meyer Children’s Hospital, Haifa, during the years 2009–2010. Demographics, Headache type, attention deficit disorder (ADHD), learning disabilities and academic achievements were assessed. Results 243 patients met the inclusion criteria and were assessed: 135 (55.6%) females and 108 (44.4%) males. 44% were diagnosed with migraine (35.8% of the males, 64.2% of the females, p = 0.04), 47.7% were diagnosed with tension type headache (50.4% of the males, 49.6% of the females). Among patients presenting with headache for the first time, 24% were formerly diagnosed with learning disabilities and 28% were diagnosed with attention deficit disorder (ADHD). ADHD was more prevalent among patients with tension type headache when compared with patients with migraine (36.5% vs. 19.8%, p = 0.006). Poor to average school academic performance was more prevalent among children with tension type headache, whereas good to excellent academic performance was more prevalent among those with migraine. Conclusions Learning disabilities and ADHD are more common in children and adolescents who are referred for neurological assessment due to primary headaches than is described in the general pediatric population. There is an association between headache diagnosis and school achievements.
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Affiliation(s)
- Jacob Genizi
- Pediatric Department, Bnai Zion Medical Center, Haifa, Israel.
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Ravid S, Shahar E, Schiff A, Gordon S. Obesity in Children With Headaches: Association With Headache Type, Frequency, and Disability. Headache 2013; 53:954-61. [DOI: 10.1111/head.12088] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Sarit Ravid
- Child Neurology Unit; Meyer Children's Hospital; Rambam Health Care Campus; Rappaport Faculty of Medicine; Technion-Israel Institute of Technology; Haifa; Israel
| | - Eli Shahar
- Child Neurology Unit; Meyer Children's Hospital; Rambam Health Care Campus; Rappaport Faculty of Medicine; Technion-Israel Institute of Technology; Haifa; Israel
| | - Aharon Schiff
- Child Neurology Unit; Meyer Children's Hospital; Rambam Health Care Campus; Rappaport Faculty of Medicine; Technion-Israel Institute of Technology; Haifa; Israel
| | - Shirie Gordon
- Child Neurology Unit; Meyer Children's Hospital; Rambam Health Care Campus; Rappaport Faculty of Medicine; Technion-Israel Institute of Technology; Haifa; Israel
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Shahar E, Nagler R. Oxidative Stress in Children with Intractable Epilepsy Reflected by Salivary Glands Anti-Oxidant Profile (P01.073). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p01.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Genizi J, Shamay-Tsoory SG, Shahar E, Yaniv S, Aharon-Perez J. Impaired social behavior in children with benign childhood epilepsy with centrotemporal spikes. J Child Neurol 2012; 27:156-61. [PMID: 21868370 DOI: 10.1177/0883073811414420] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of the present study was to assess the emotional and cognitive aspects of social cognition among patients with rolandic epilepsy. A computerized neuropsychological battery was used for cognitive evaluation. Affective and cognitive social cognition were evaluated using two computerized Theory of Mind tasks. Cognitive abilities and social behavior of 15 children, diagnosed with rolandic epilepsy, ages 7 to 13 years were assessed and compared with 15 age- and education-matched healthy controls. Compared with controls, the epileptic patients had lower scores on verbal and visual learning rate parameters and on verbal processing and were significantly impaired on "affective Theory of Mind" tasks but not on "cognitive Theory of Mind" conditions. Our findings raise the possibility that rolandic epilepsy may affect neural networks affecting cognition and mediating social cognition essential for social behavior, thus challenging the benign nature of the condition.
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Affiliation(s)
- Jacob Genizi
- Pediatric Department, Bnai Zion Medical Center, Rappaport School of Medicine, Technion, Haifa.
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Ravid S, Shachor-Meyouhas Y, Shahar E, Kra-Oz Z, Kassis I. Reactivation of varicella presenting as pseudotumor cerebri: three cases and a review of the literature. Pediatr Neurol 2012; 46:124-6. [PMID: 22264708 DOI: 10.1016/j.pediatrneurol.2011.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 11/22/2011] [Indexed: 11/19/2022]
Abstract
The possible association of pseudotumor cerebri and varicella infection was previously mentioned in a few case reports. In those cases, the history and clinical features of active varicella were obvious, and signs were directly related to the varicella infection. We describe three immunocompetent children with pseudotumor cerebri as the only manifestation of Varicella zoster virus reactivation, with a review of the literature. We suggest considering Varicella zoster virus in children with pseudotumor cerebri, even in the absence of a history of recent varicella infection.
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Affiliation(s)
- Sarit Ravid
- Pediatric Neurology Unit and Epilepsy Service, Meyer Children's Hospital, Rambam Health Care Campus, Haifa, Israel.
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Fatkenheuer G, Duvivier C, Rieger A, Durant J, Rey D, Schmidt W, Hill A, van Delft Y, Marks S, Rieger A, Vetter N, Greil R, Pedersen C, Storgaard M, Morlat P, Katlama C, Durant J, Cotte L, Duvvier C, Rey D, Esser S, Stellbrink C, Schmidt W, Stoll M, Stephan C, Fatkenheuer G, Stoehr A, Rockstroh J, Banhegyi D, Itzchak L, Shahar E, Maayan S, Turner D, Lazzarin A, Antinori A, Carosi G, Minoli L, di Perri G, Filice G, Andreoni M, Duiculescu D, Rugina S, Erscoiu S, Streinu A, Pronin A, Pokrovsky V, Gruzdev B, Yakovlev A, Voronin E, Clotet B, Gatell J, Arribas J, Podzamczer D, Domingo P, Miralles Alvarez C, Hernandez Quero J, Furrer H, Feher J, Johnson M, Fox J, Nelson M, Fisher M, Orkin C. Lipid profiles for etravirine versus efavirenz in treatment-naive patients in the randomized, double-blind SENSE trial. J Antimicrob Chemother 2011; 67:685-90. [DOI: 10.1093/jac/dkr533] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Shahar E, Genizi J, Ravid S, Schif A. The complementary value of sleep-deprived EEG in childhood onset epilepsy. Eur J Paediatr Neurol 2010; 14:308-12. [PMID: 19740685 DOI: 10.1016/j.ejpn.2009.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Revised: 08/07/2009] [Accepted: 08/15/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although EEG is an important diagnostic tool in suspected childhood onset epilepsy, as many as 50% of wakefulness records remain normal. Sleep-deprived EEG has been reported in adults to serve as an activator of epileptic discharges but such effect is still not agreed upon in children reporting small series. PURPOSE Assess the complementary diagnostic value of sleep deprivation on the induction of epileptic discharges in childhood onset epilepsy having a normal awake record within a period of 5 years. EEG recording was performed during the awake, drowsiness and sleep states following sleep deprivation of 6h. BACKGROUND RESULTS: Fifty five children of whom the initial record failed to detect epileptiform discharges, were assessed at age 5-17 years (mean: 10+/-3.7), 27 boys and 28 girls. Sleep occurred in 51 (92.7%) after sleep deprivation and in only 1 (1.8%) during an awake record. Epileptic discharges were detected in 15 of 55 (27.2%) previous non-epileptic awake records during the sleep-deprived EEG either during wakefulness and more frequent during sleep. Eight abnormal records were detected in 18 (44%) children presenting with a focal seizure and 7 of 35 (20%) associated with generalized seizures. Epileptic discharges were recorded mainly and more frequent during sleep. CONCLUSIONS Our data suggests that sleep deprivation imposes an apparent activating impact uncovering epileptic discharges children corroborating with overt clinical seizures even beyond the sampling effect of repeat records.
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Affiliation(s)
- Eli Shahar
- Child Neurology Unit & Epilepsy Service, Meyer Children Hospital, Rambam Medical Center, Rappaport School of Medicine, Haifa 31096, Israel.
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Abstract
We report herein 2 children who presented with acute deafness heralding an epileptic event manifesting thereafter by loss of consciousness and tonic generalized posturing, possibly reflecting a negative epileptic phenomenon. The first previously healthy male had 2 paroxysmal episodes 7 months apart, starting with acute deafness lasting for a few minutes followed by loss of consciousness and generalized tonic posturing for 10 minutes. Electroencephalography (EEG) during the second episodes demonstrated generalized epileptiform discharges. The second with previously controlled partial complex seizures presented with episodes of complete deafness lasting for a few minutes followed by loss of consciousness and focal tonic posturing lasting 10 minutes. Such acute deafness represented an aura of a focal seizure substantiated by right focal temporal epileptic discharges within the region of the primary auditory cortex. Therefore, EEG should be performed in any case of acute transient deafness, even in the absence of accompanying overt clinical seizures.
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Affiliation(s)
- Eli Shahar
- Child Neurology Unit and Epilepsy Service, Meyer Children Hospital, Rambam Medical Center, Rappaport School of Medicine, Haifa, Israel.
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Bar-Sela G, Kedem E, Hadad S, Pollack S, Haim N, Atrash F, Shahar E. Successful Desensitization Protocol for Hypersensitivity Reaction Caused by Sunitinib in a Patient with a Gastrointestinal Stromal Tumor. Jpn J Clin Oncol 2010; 40:163-165. [DOI: 10.1093/jjco/hyp118] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Yamagishi K, Ohira T, Nakano H, Bielinski SJ, Sakurai S, Imano H, Kiyama M, Kitamura A, Sato S, Konishi M, Shahar E, Folsom AR, Iso H, Tanigawa T. Cross-cultural comparison of the sleep-disordered breathing prevalence among Americans and Japanese. Eur Respir J 2010; 36:379-84. [PMID: 20110399 DOI: 10.1183/09031936.00118609] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The aim of the present study was to compare the prevalence of sleep-disordered breathing among Hispanic and white Americans and Japanese. A 1-night sleep study using a single-channel airflow monitor was performed on 211 Hispanics and 246 Whites from the Minnesota field centre (St Paul, MN, USA) of the Multi-Ethnic Study of Atherosclerosis (MESA), and 978 Japanese from three community-based cohorts of the Circulatory Risk in Communities Study (CIRCS) in Japan. The respiratory disturbance index and sleep-disordered breathing, defined as a respiratory disturbance index of > or =15 events x h(-1), were estimated. The prevalence of sleep-disordered breathing was higher in males (34.2%) than females (14.7%), and among Hispanics (36.5%) and Whites (33.3%) than among Japanese (18.4%), corresponding to differences in body mass index. Within body mass index strata, the race difference in sleep-disordered breathing was attenuated. This was also true when body mass index was adjusted for instead of stratification. The strong association between body mass index and sleep-disordered breathing was similar in Japanese and Americans. The prevalence of sleep-disordered breathing was lower among Japanese than among Americans. However, the association of body mass index with sleep-disordered breathing was strong, and similar among the race/ethnic groups studied. The majority of the race/ethnic difference in sleep-disordered breathing prevalence was explained by a difference in body mass index distribution.
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Affiliation(s)
- K Yamagishi
- Dept of Public Health Medicine, Graduate School of Comprehensive Human Sciences and Institute of Community Medicine, University of Tsukuba, Tsukuba, Japan
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Schif A, Ravid S, Hafner H, Shahar E. [Acute hemiplegia and hemianesthesia together with decreased tendon reflexes mimicking acute stroke representing a conversion disorder]. Harefuah 2010; 149:29-62. [PMID: 20422837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Acute hemiplegia and hemianesthesia is commonly caused by obstruction of major cortical arteries. Such a presentation secondary to a conversion reaction is very rare, especially in the pediatric age group. The authors report an adolescent presenting with acute complete left-sided hemiplegia and sensory loss together with decreased tendon reflexes mimicking an acute arterial stroke. Examination revealed Hoover's sign was present and the patient was oblivious to his stern neurological state. Movement of his paralytic limbs was observed during sleep. Cortical and spinal CT, cortical MRI, motor and somatosensory evoked potentials and a PET study were all normal. As such, the diagnosis of psychogenic hemiplegia was established, apparently within a period that the patient had experienced severe emotional stress while questioning his gender identity. After three days, the adolescent began to move the paralytic limbs along gradual resolution of sensory deficit, leading to complete clinical recovering within two months. Although extremely rare, a conversion reaction should be taken into account in children presenting with acute hemiplegia and anaesthesia, even accompanied with decreased tendon reflexes, when the patient is oblivious to his alleged grave state, and when clinical observations such as Hoover's sign remain intact, substantiated by normal extensive radiological and neurophysiological investigation. Intact motor evoked potentials serve as a key for the diagnosis of psychogenic hemiplegia and, should therefore be performed in suspected cases.
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Affiliation(s)
- Aharon Schif
- Child Neurology Unit and Epilepsy Service, Meyer Children Hospital, Haifa, Israel
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Ravid S, Afek I, Suraiya S, Shahar E, Pillar G. Sleep Disturbances are Associated With Reduced School Achievements in First-Grade Pupils. Dev Neuropsychol 2009; 34:574-87. [DOI: 10.1080/87565640903133533] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Every year, 7% to 15% of preschool children are found to be underqualified for first grade. We examined whether sleep disturbances are factors in school readiness and their association with neurocognitive skills and behavior. The population included 148 kindergarten students. The study group consisted of 50 students who were assessed by the educational authority as unready for first grade. Children who were scheduled to attend first grade (n = 98) were in the control group. All children/parents filled in a sleep questionnaire and underwent a week of actigraphic sleep/wake study as well as cognitive and behavioral assessments. Children in the study group had significantly shorter total sleep time, reduced sleep efficiency, and increased number of nighttime awakenings. There were significant correlations between sleep variables, and cognitive and behavioral scores. In conclusion, children who fail to qualify for first grade have significantly inferior sleep patterns. Sleep disturbances were associated with cognitive and emotional immaturity.
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Affiliation(s)
- Sarit Ravid
- Pediatric Department, Meyer Children's Hospital, Rambam Medical Center and Technion-Israel Institute of Technology, Haifa, Israel
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Ulanovsky I, Sujov P, Weiner Z, Shahar E, Makhoul IR. [Identical, for better and for worse]. Harefuah 2009; 148:370-412. [PMID: 19902600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report on identical premature twins (monochorionic diamniotic). As fetuses, they both demonstrated sonographic and MRI evidence of cerebral bilateral ventriculomegaly. Neonatal brain US showed bilateral ventriculomegaly, similar in both twins. During follow-up, these physical and imaging similarities persisted. To the best of our knowledge, this is the first report on similar bilateral ventriculomegaly in Identical Twins (IT). A genetic origin of this finding in our IT is suggested. Should more cases of ventriculomegaly be reported in the future in several sets of IT, cerebral ventriculomegaly can then be added to the list of similar CNS features observed in identical twins.
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Affiliation(s)
- Irena Ulanovsky
- Department of Neonatology, Meyer Children's Hospital, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Shahar E, Derchansky M, Carlen P. The role of altered tissue osmolality on the characteristics and propagation of seizure activity in the intact isolated mouse hippocampus. Clin Neurophysiol 2009; 120:673-8. [DOI: 10.1016/j.clinph.2009.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Revised: 12/28/2008] [Accepted: 01/19/2009] [Indexed: 10/21/2022]
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Abstract
The purpose of this study was to estimate the prevalence of neurological causes for apparent life-threatening events in infants and assess the neurological work-up mandatory to diagnose such diagnosis, hypothesizing that acute neurological disorders constitute the most common etiology for such an acute event. A retrospective chart review allocated 93 infants fulfilling the criteria of the National Institutes of Health presenting at 1 week to 8 months with apnea, color changes, gagging, unresponsiveness, and alterations of body tone. An underlying neurological etiology was detected in 18 (19%), whereby 15 had seizures and 3 had central apnea. Only one electroencephalography demonstrated epileptic discharges, and brain imaging was intact. Thus, it has been concluded that neurological impairment, mainly that of seizures inducing an apparent life-threatening event, are relatively uncommon. As such, recommendations are that history taking and repeat physical examination still remain the major diagnostic tools before resorting to extensive laboratory studies.
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Affiliation(s)
- Jacob Genizi
- Child Neurology Unit & Epilepsy Service, Meyer Childrens Hospital, Rambam Medical Center, Rappaport School of Medicine, Haifa 31096, Israel
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NS Granado, Smith T, Swanson G, Harris R, Shahar E, Smith B, Boyko E, Wells T, Ryan MAK. P37 Relationship Of Incident Hypertension And Military Deployment In A Large Cohort. Ann Epidemiol 2008. [DOI: 10.1016/j.annepidem.2008.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zelnik N, Isler N, Goez H, Shiffer M, David M, Shahar E. Vigabatrin, lamotrigine, topiramate and serum carnitine levels. Pediatr Neurol 2008; 39:18-21. [PMID: 18555168 DOI: 10.1016/j.pediatrneurol.2008.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 03/10/2008] [Indexed: 11/25/2022]
Abstract
Clinical studies indicate a decrease in free and total carnitine in children treated with old-generation antiepileptic drugs (especially valproate). Here, we studied the effect of new-generation antiepileptic drugs on serum carnitine levels. Serum carnitine levels were measured in 91 children: 24 treated with vigabatrin, 28 treated with lamotrigine, and 21 treated with topiramate. These drugs were given as monotherapy (54 children) or polytherapy (19 children). Eighteen additional children treated with valproate served as control subjects. Reduced mean serum carnitine level was evident only in children treated with valproate, with mean free and total carnitine level of 26.9 +/- 8.6 micromol/L and 29.1 +/- 10.4 micromol/L, respectively. In contrast, the mean serum carnitine levels of children treated with vigabatrin, lamotrigine, or topiramate were similar and normal. In these children, the free carnitine levels were 38.5 +/- 7.8 micromol/L, 37.2 +/- 7.7 microg/mL, and 40.4 +/- 8.7 micromol/L, respectively, and total carnitine levels were 43.5 +/- 8.8 micromol/L, 44.4 +/- 9.2 micromol/L, and 45.5 +/- 9.8 micromol/L (+/-S.D.), respectively. Only 4 children (treated with valproate) exhibited considerably lower serum carnitine levels. None of these children had significant clinical adverse effects attributable to carnitine deficiency. In conclusion, these new-generation antiepileptic drugs probably do not cause carnitine deficiency. In contrast, valproate may induce carnitine deficiency, but most cases are asymptomatic.
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Affiliation(s)
- Nathanel Zelnik
- Department of Pediatrics, Carmel Medical Center, Haifa, Israel.
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Abstract
This review reports on the various presentations as well as new revealed data relating to the epileptic disorder defined as childhood epilepsy with occipital paroxysms characterized by occipital epileptic discharges recorded by electroencephalography. The initial rigidly delineated subtypes by the International League Against Epilepsy included the following: (a) Panayiotopoulos syndrome-early-onset seizure disorder presenting with prolonged infrequent, nocturnal autonomic seizures, accompanied by eye deviation and ictal vomiting. (b) Gastaut syndrome-late-onset type presenting with short diurnal frequent seizures and visual ictal manifestations along with migrainous headaches. A high percentage of children present, however, with mixed clinical phenomena making it difficult to comply with the rigidly segregated syndromes reported by several authorities including our recent report on 28 children of whom 14 showed mixed phenomena. Therefore, childhood epilepsy with occipital paroxysm should be suspected at any age presenting with nocturnal vomiting, autonomic impairment, focal motor fits with head deviation, migraine headaches, and/or visual perturbations.
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Affiliation(s)
- Eli Shahar
- Child Neurology Unit & Epilepsy Service, Meyer Children's Hospital, Rambam Medical Center, Rappaport School of Medicine, Haifa, Israel.
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Shahar E, Goldsher D, Genizi J, Ravid S, Keidar Z. Intractable gelastic seizures during infancy: ictal positron emission tomography (PET) demonstrating epileptiform activity within the hypothalamic hamartoma. J Child Neurol 2008; 23:235-9. [PMID: 18160558 DOI: 10.1177/0883073807308703] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Gelastic seizures comprise a very rare form of epilepsy. They present with recurrent bursts of laughter voices without mirth and are most commonly associated with the evolution of a hypothalamic hamartoma. The purpose of this article is to describe the second reported ictal fluorodeoxyglucose-positron emission tomography study in a unique case of an infant with intractable gelastic seizures since the neonatal period associated with a hypothalamic hamartoma. The patient presented at 4 months old with recurrent, almost persistent, gelastic seizures consisting of laughter bouts without mirth. The seizures were noticeable at the first week of life and increased in frequency to last up to 12 hours, namely status gelasticus. These gelastic fits were accompanied with focal motor seizures, including unilateral right-eye blinking and mouth twitching. Developmental mile-stones were intact for age. Magnetic resonance imaging of the cortex demonstrated a large hypothalamic hamartoma within the third ventricle, hampering cerebrovascular fluid drainage of the lateral ventricles. An electroencephalography was nondiagnostic. Ictal fluorodeoxyglucose-positron emission tomography demonstrated a large circumscribed hypermetabolic region within the location of the hypothalamic hamartoma, representing localized intense epileptiform activity. The infant became instantly free of all seizure types given minute doses of oral benzodiazepine (clonazepam) and remains completely controlled after 12 months. Her overall development remains intact. This ictal fluorodeoxyglucose-positron emission tomography is the second reported study verifying that the main source of the epileptic activity inducing gelastic seizures originates from the hypothalamic hamartoma itself; therefore, a complementary fluorodeoxyglucose-positron emission tomography study should be considered in any patient presenting with intractable gelastic seizures, especially in those associated with hypothalamic hamartoma, in order to localize the region of epileptiform activity amenable to surgical resection if intensive drug therapy fails.
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Affiliation(s)
- Eli Shahar
- Child Neurology Unit and Epilepsy Service, Meyer Children Hospital, Rambam Medical Center, Haifa 31096, Isreal.
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Turner D, Pollack S, Kachman E, Kedem E, Shahar E, Burk M, Matos N, Hassoun G, Grisaru G, Avidor B. Incidence of the resistance mutation K65R on reverse transcriptase in different HIV-1 subtypes. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Guttman-Yassky E, Bergman R, Pollack S, Shahar E. Chronic idiopathic urticaria: what is the meaning of skin reactivity to autologous serum? A response. J Eur Acad Dermatol Venereol 2007. [DOI: 10.1111/j.1468-3083.2007.02501.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shahar E, Genizi J, Nevo Y, Kaufman R, Cabot S, Zelnik N. Typical absence epilepsy presenting prior to age of 3 years: an uncommon form of idiopathic generalized epilepsy. Eur J Paediatr Neurol 2007; 11:346-52. [PMID: 17500018 DOI: 10.1016/j.ejpn.2007.02.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Revised: 02/22/2007] [Accepted: 02/26/2007] [Indexed: 11/24/2022]
Abstract
PURPOSE An attempt to allocate patients with the clinical features and electroencephalography (EEG) abnormalities of typical absence epilepsy presenting before the age of 3 years, similar to childhood and juvenile absence epilepsy (JAE) and delineate the clinical manifestations, EEG abnormalities, therapy and outcome of such an epileptic disorder by conducting a nationwide survey. RESULTS Overall, eight infants, six males and two females, abided by the inclusion criteria of typical absence epilepsy: They were born after an unremarkable pregnancy and labor presenting at the age of 12-34 months (mean: 19.6 months) with frequent absences time-linked with an EEG demonstrating generalized occasionally irregular epileptiform discharges of 3-4 Hz spike/wave and normal background activity along with an electrographic photosensitive response in one patient. Neurological examination was intact in all infants. All eight infants were initially treated with valproic acid, of whom seven immediately responded and one had increase in frequency and duration of absences completely aborted with treatment of lamotrigine. Three relapsed after termination of therapy of whom two again presented with recurrent absences and another one with generalized tonic-clonic seizures and as such these children had virtually transformed into a later form of idiopathic generalized epilepsy (IGE) during childhood. All eight patients are seizure-free, seven still on therapy; seven children within a follow-up period of 2-7 years and the most recently diagnosed infant for 6 months. Cognitive skills were found normal in all children within the low normal range in three children with short attention and concentration spans. CONCLUSION The data presented here delineate a very rare form of idiopathic benign generalized epilepsy presenting with typical absences before age of 3 years and a favorable outcome, similar to childhood and JAE, recognized as distinct IGE syndromes by the International League Against Epilepsy (ILAE) classification.
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Affiliation(s)
- Eli Shahar
- Child Neurology Unit and Epilepsy Service, Meyer Children Hospital, Rambam Medical Center, Rappaport School of Medicine, Haifa 31096, Israel.
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Genizi J, Kasis I, Schif A, Shahar E. Effect of high-dose methyl-prednisolone on brainstem encephalopathy and basal ganglia impairment complicating cat scratch disease. Brain Dev 2007; 29:377-9. [PMID: 17174500 DOI: 10.1016/j.braindev.2006.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2006] [Revised: 10/18/2006] [Accepted: 11/06/2006] [Indexed: 11/30/2022]
Abstract
Cat scratch disease (CSD) is a zoonotic illness caused by the Gram negative bacillus Bartonella henselae characterized by a small skin lesion at the site of a bite, lick or scratch by a cat, commonly followed by regional lymphadenopathy 1 or 2 weeks later. We report herein on severe neurological complications of CSD combining brainstem encephalopathy and basal ganglia impairment. This 12-year-old female acutely presented to a local hospital with profound coma and a prolonged tonic posturing of extremities. On the neurological examination she was deeply comatose with pin-point pupils and lack of vestibulo-ocular responses, suggestive of brainstem encephalopathy, along with marked rigid hypertonicity suggestive also of basal ganglia impairment. Initially suspecting Herpes simplex encephalitis or acute disseminated encephalomyelitis she was promptly started with high-dose methyl-prednisolone and acyclovir. Her parents apparently reported that she was scratched by a kitten some 4 weeks prior to her present admission and as such, suspecting CSD, she was begun with doxycycline and rifampicin. Her serology had proven positive for IgM antibodies to Bartonella henselae establishing the diagnosis. She regained consciousness after 4 days and the signs of brainstem and extra-pyramidal impairment also gradually abated and disappeared after 10 days. A follow-up exam after a month disclosed mild extra-pyramidal abnormalities which disappeared after 3 months. Although extremely rare, CSD should be also considered in a patient presenting with a severe encephalopathy and associated basal ganglia impairment. The prompt administration of high-dose methyl-prednisolone upon admission may have contributed to the favorable outcome in our patient and therefore should be advocated in any patient presenting with profound encephalopathy regardless the underlying etiology recovered later.
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Affiliation(s)
- Jacob Genizi
- Child Neurology Unit & Epilepsy Service, Meyer Children Hospital, Rambam Medical Center, Rappaport School of Medicine, Haifa, Israel
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Shahar E, Kramer U, Mahajnah M, Lerman-Sagie T, Goez R, Gross V, Kutai M, Genizi J. Pediatric-onset gelastic seizures: clinical data and outcome. Pediatr Neurol 2007; 37:29-34. [PMID: 17628219 DOI: 10.1016/j.pediatrneurol.2007.03.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Revised: 01/26/2007] [Accepted: 03/05/2007] [Indexed: 10/23/2022]
Abstract
Gelastic seizures are an extremely rare form of epilepsy defined as automatic bouts of laughter without mirth commonly associated with a hypothalamic hamartoma. The objective was to survey all Israeli children found to develop recurrent gelastic seizures and report presenting symptoms, electroencephalographic and radiologic data, and response to either antiepileptic drugs or surgery. Ten children who developed gelastic seizures at the age of 1 week to 6.5 years (mean, 25 months) at a frequency from 3 bouts per week to >10 prolonged bouts per day were followed for a period of 1.3-12 years (mean, 6 years). Seven cases were defined as symptomatic: cortical magnetic resonance imaging revealed a hypothalamic hamartoma in four patients and cortical abnormalities in three others. Seizure control was achieved in four patients, including a neonate with status gelasticus and hypothalamic hamartoma, and partial control in one more. Five children remained resistant to polytherapy, including three with hypothalamic hamartoma even after two of them underwent hemartoma excision. Thus, children with gelastic seizures may respond relatively well to drug therapy. Four of the 10 patients became seizure free with drug therapy; in three intractable symptomatic cases, surgery was tried but failed in two of the three.
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Affiliation(s)
- Eli Shahar
- Child Neurology Unit and Epilepsy Service, Meyer Children Hospital, Rambam Medical Center, Rappaport School of Medicine, Haifa, Israel.
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Abstract
The clinical features of 37 patients from 32 Israeli families with congenital myopathies evaluated between 1983 and 2004 are described: 13 children were diagnosed with congenital fiber type disproportion, 10 had myotubular myopathy, 7 had nemaline myopathy, 5 had central core disease, 1 had actin myopathy, and 1 had multi-minicore disease. There were 7 families (22%) that had parental consanguinity, and 4 families (12%) had more than 1 patient with congenital myopathy. Of the patients, 31 (84%) presented with clinical symptoms before 4 months of age, and 6 children (16%) presented after 1 year of age. Thirteen children (35%) had a severe phenotype with chronic ventilatory dependence or mortality before the age of 11 years. Facial weakness was associated with a severe phenotype. There was a high rate of a severe clinical phenotype in patients with myotubular myopathy (60%) and in patients with nemaline myopathy (57%), whereas in patients with congenital fiber type disproportion and in patients with central core disease, the proportion of a severe phenotype was lower (23% and 0%, respectively).
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Genizi J, Zelnik N, Ravid S, Shahar E. Childhood epilepsy with occipital paroxysms: difficulties in distinct segregation into either the early-onset or late-onset epilepsy subtypes. J Child Neurol 2007; 22:588-92. [PMID: 17690066 DOI: 10.1177/0883073807302607] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Commission on Classification and Terminology of the International League Against Epilepsy Childhood rigidly segregated epilepsy with occipital paroxysms into 2 separate syndromes with different predominant seizure types: early-onset seizure susceptibility type consisting of prolonged infrequent, nocturnal autonomic seizures and accompanied by eye deviation and ictal vomiting and late onset with short diurnal frequent seizures and visual ictal manifestations along with throbbing headaches. Epileptic clinical manifestations and electroencephalographic data were analyzed in 28 patients with suspected occipital lobe epilepsy in an attempt to segregate them into either the early or late forms according to the International League Against Epilepsy classification. Electroencephalography in 25 children demonstrated occipital epileptiform paroxysms compatible with the suspected epileptic syndrome. Only 14 (50%) children complied with the rigid criteria of either early-onset or late-onset presentations. The other 14 (50%) children presented with mixed diverse epileptic phenomena such as short-lived seizures in infancy or prolonged seizures during childhood, not complying with either rigid syndrome (ie, short-lived epileptic blindness at an early age or vomiting during later childhood). Despite present attempts to rigidly segregate childhood epilepsy with occipital paroxysms into 2 distinct epileptic syndromes, a high percentage of children still present with various mixed clinical phenomena. Therefore, clinicians should be aware of possible unique and unusual presentations of occipital lobe epilepsy at various ages.
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Affiliation(s)
- Jacob Genizi
- Child Neurology Unit & Epilepsy Service, Meyer Children Hospital, Rambam Medical Center, Rappaport School of Medicine, Haifa, Israel
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Genizi J, Lahat E, Zelnik N, Mahajnah M, Ravid S, Shahar E. Childhood-onset idiopathic intracranial hypertension: relation of sex and obesity. Pediatr Neurol 2007; 36:247-9. [PMID: 17437908 DOI: 10.1016/j.pediatrneurol.2007.01.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2006] [Revised: 12/06/2006] [Accepted: 01/02/2007] [Indexed: 11/30/2022]
Abstract
The purpose of the present study was to perform a meta-analysis of all children with idiopathic intracranial hypertension reported since 1997 combined with our experience in order to investigate sex distribution and frequency of obesity among young children up 11 years of age vs adolescents at age 12-17 years. Overall, 244 children diagnosed with idiopathic intracranial hypertension were found suitable for the proposed meta-analysis: 132 (54%) were younger than 11 years of age; 72 (55%) were male and 60 (44%) were female. In contrast, of 112 older children (age 12-17 years), 79 (70%) were female. The association between age and obesity could be analyzed in 147 patients: only 19 (26%) out of 74 younger children up to age 11 years were reportedly obese, whereas 47 (64%) out of 73 older children were found obese. Differences in age at presentation, sex, and obesity were statistically significant (P < 0.01). Thus, a wide-scale meta-analysis of childhood-onset idiopathic intracranial hypertension revealed that the female/male ratio in children younger than age 11 years seems to be fairly equal, with a relatively low rate of obesity, contrasting to a majority of females in the group of adolescents at high risk to become obese.
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Affiliation(s)
- Jacob Genizi
- Child Neurology Unit, Meyer Children Hospital, Rambam Medical Center, Rappaport School of Medicine, Haifa, Israel
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Brik R, Gepstein V, Shahar E, Goldsher D, Berkovitz D. Tumor necrosis factor blockade in the management of children with orphan diseases. Clin Rheumatol 2007; 26:1783-5. [PMID: 17219021 DOI: 10.1007/s10067-006-0521-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Accepted: 12/19/2006] [Indexed: 11/29/2022]
Abstract
Tumor necrosis factor (TNF) blockade has been used successfully to treat a number of rheumatic disorders that have a substantial burden of illness. In children, the TNF antagonists are used mainly for the treatment of juvenile idiopathic arthritis (JIA). There are, however, a variety of rare systemic inflammatory diseases, in which TNF blockade appears promising. Preliminary data in adults suggest that several forms of vasculitis appear to be responsive to TNF antagonists-Behcet's disease, polyarteritis nodosa, Wegener granulomatosis, among others. Some of them respond better to infliximab, a chimeric monoclonal anti-TNF antibody, than to etanercept, a recombinant p75 TNF receptor. We describe our limited experience with infliximab in the treatment of three children with rare vasculitic conditions.
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Affiliation(s)
- Riva Brik
- Department of Pediatrics, Meyer Children's Hospital of Haifa, P.O. Box 9602, Technion, Haifa 31096, Israel.
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Shahar E, Landau E, Genizi J. Adolescence peroneal neuropathy associated with rapid marked weight reduction: case report and literature review. Eur J Paediatr Neurol 2007; 11:50-4. [PMID: 17166754 DOI: 10.1016/j.ejpn.2006.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Revised: 09/18/2006] [Accepted: 10/30/2006] [Indexed: 02/06/2023]
Abstract
PURPOSE We report herein an uncommon presentation of peroneal nerve palsy and possible myelopathy in an adolescent associated with marked uncontrolled weight loss during a relatively short period. CASE PRESENTATION He presented with left drop foot accompanied with sensory impairment at the foot dorsum. Neurophysiologic studies revealed a severe neuropathy of the left peroneal nerve with evidence of a conduction block at the left fibular head suggestive of entrapment neuropathy. ETIOLOGY As for the underlying etiology of acute peroneal neuropathy (PN) and possible myelopathy associated with marked weight loss, it has been suggested that rapid loss of the subcutaneous tissue may lead to entrapment of the peroneal nerve at the fibular head leading to foot drop. Body fat percentage was found remarkably low for age at 10% (normal value for age for males: 22.3%) indicative of massive rapid weight reduction markedly depleting fat stores. CONCLUSION When an adolescent presents with acute foot drop, PN associated with rapid uncontrolled weight reduction should be taken into account. Prompt resumption of a balanced diet including vital nutritional ingredients may avoid permanent neurological damage and probably assist in recovery from severe flaccid weakness of the lower extremity.
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Affiliation(s)
- Eli Shahar
- Child Neurology Unit, Rambam Medical Center, Rappaport School of Medicine, Haifa, Israel.
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Abstract
The incidence and natural history of childhood absence epilepsy are well documented, but those of juvenile absence epilepsy are poorly delineated. We conducted a retrospective chart study to evaluate the incidence and outcome of patients with juvenile absence epilepsy by retrieving the medical records of consecutive patients with juvenile absence epilepsy who were evaluated in three pediatric neurology outpatient clinics in Israel. Inclusion criteria included the onset of epilepsy after the age of 10 years and follow-up until at least 15 years of age. The patients with an electroencephalogram (EEG) suggestive of myoclonic epilepsy (polyspike and wave) were excluded from the study. Seventeen patients (10 female and 7 male) fulfilled the inclusion criteria for juvenile absence epilepsy. They presented with epilepsy at a mean age of 11.94 years (range 10-16.5 years). The mean duration of follow-up was 6.05 years (range 2-12 years). Five patients (29.4%) had a family history of epilepsy. All 17 patients had a normal neurodevelopmental status. Eight patients (47%) experienced generalized tonic-clonic seizures. At follow-up, eight patients (43.7%) were seizure free. Only three (37.5%) of the patients who experienced generalized tonic-clonic seizures were seizure free during follow-up compared with five (55.5%) patients without generalized tonic-clonic seizures. Our results indicate that the outcome of patients with juvenile absence epilepsy is less favorable than children with childhood absence epilepsy and that the presence of generalized tonic-clonic seizures is a predictor for poorer outcome.
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Affiliation(s)
- Eliel Tovia
- Epilepsy Unit, Schneider Children's Medical Center, Petah Tiqva, Israel
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Stang PE, Carson AP, Rose KM, Mo J, Ephross SA, Shahar E, Szklo M. Headache, cerebrovascular symptoms, and stroke: the Atherosclerosis Risk in Communities Study. Neurology 2006; 64:1573-7. [PMID: 15883318 DOI: 10.1212/01.wnl.0000158326.31368.04] [Citation(s) in RCA: 187] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the occurrence of stroke/TIA symptoms and ischemic stroke events among those with a lifetime history of migraine or other headaches with some migraine features in a biracial cohort of older adults. METHODS Participants were 12,750 African-American and white men and women from the Atherosclerosis Risk in Communities Study (1993 to 1995). The participants were queried about their lifetime headache history and characterized using modified International Headache Society diagnostic criteria. Stroke/TIA symptoms were classified using a computerized diagnostic algorithm, and ischemic stroke events were identified and validated using medical records. Multivariate logistic regression was used to assess the relationship between headache types and stroke/TIA symptoms and ischemic stroke events. RESULTS Migraine with aura was strongly associated with stroke symptoms (odds ratio [OR] 5.46, 95% CI: 3.64 to 8.18), TIA symptoms (OR 4.28, 95% CI: 3.02 to 6.08), and verified ischemic stroke events (OR 2.81, 95% CI: 1.60 to 4.92). Similarly, other headaches with aura were significantly associated with stroke symptoms (OR 3.68, 95% CI: 2.26 to 5.99) and TIA symptoms (OR 4.53, 95% CI: 3.08 to 6.67). In contrast, the associations for migraine without aura and other headaches without aura were not as consistent or robust. CONCLUSIONS Migraines and other headaches, particularly those accompanied by aura, were associated with an increased occurrence of stroke/TIA symptoms and ischemic stroke events.
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Affiliation(s)
- P E Stang
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
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Abstract
The classical form of Guillain-Barré syndrome (GBS) refers to an acute monophasic demyelinating motor and sensory polyneuropathy characterized by symmetric ascending flaccid weakness, along with sensory impairment and, less commonly, autonomic perturbations. Pure motor axonal forms, axonal motor, and sensory forms, as well as pure autonomic forms, have also been identified. A complex immune-mediated process leads to segmental demyelination accompanied with axonal involvement in protracted cases. Establishing strategies of immunomodulation may therefore halt and even reverse the harmful autoimmune insult to peripheral nerves. The present article reviews the current immunomodulatory options in severe GBS. A recent Cochrane meta-analysis of 6 randomized studies showed no significant improvement using corticosteroids, including either oral or intravenous methylprednisolone. Combined methylprednisolone and immunoglobulins shortened the time lapse to regain independent walking. Plasmapheresis (PE) was the first effectively proven method of immunomodulation, followed by intravenous immunoglobulins (IVIG). Both methods are comparable in their beneficial effect and were used either separately or in combination, but PE was more frequently associated with severe adverse effects requiring cessation of therapy, including a bleeding diathesis. In addition, PE is feasible only in major referral centers requiring the appropriate equipment and trained personnel. In addition, younger children may be at risk for bleeding after insertion of wide catheters. Therefore, in cases of severe GBS, IVIG is recommended as the first-line drug using a total empiric dose of 2 g/kg administered over 2 consecutive days, especially in children proven highly effective with negligible adverse effects. In protracted cases, the addition of intravenous corticosteroids to IVIG should be considered, which may shorten the duration to regain independent walking. If such therapy fails, PE should be applied using centrifugal blood separators with 5% albumin as the substitute solution.
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Affiliation(s)
- Eli Shahar
- Child Neurology Unit, Meyer Children Hospital, Rambam Medical Center, Rappaport School of Medicine, Haifa, Israel.
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Shahar E, Bentur Y, Bar-Joseph G, Cahana A, Hershman E. Extrapyramidal parkinsonism complicating acute organophosphate insecticide poisoning. Pediatr Neurol 2005; 33:378-82. [PMID: 16243228 DOI: 10.1016/j.pediatrneurol.2005.05.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2005] [Revised: 04/12/2005] [Accepted: 05/23/2005] [Indexed: 10/25/2022]
Abstract
The aim of this study is to report our experience with a child who developed extrapyramidal perturbations complicating acute organophosphate insecticides poisoning and to review the literature reporting on basal ganglia impairment associated with this poisoning. Our patient had developed overt parkinsonism presenting with a resting tremor, expressionless face, and lack of blinking along with marked cogwheel rigidity and a stooped, slow gait. He was alert, coherent, and cooperative, yet agitated. The parkinsonian perturbations developed 5 days after an accidental ingestion of a raw eggplant sprayed with the organophosphate dimethoate (Rogor) when he had already recovered from the acute cholinergic crisis, the first stage of organophosphate poisoning. Such a presentation was initially perceived by his caregivers as severe reactive depression or even psychosis. Once a parkinsonian syndrome was diagnosed, he was begun on amantadine and completely recovered within 1 week with no relapse of symptoms. Basal ganglia impairment should be considered in any patient who develops extrapyramidal symptoms such as marked rigidity and bradykinesia or choreoathetosis while recovering from the acute cholinergic phase of organophosphate insecticide poisoning. Thus, administration of a drug such as amantadine, which probably enhances neurotransmission, may hasten the rate of recovery and prevent long-term neurologic and emotional sequelae.
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Affiliation(s)
- Eli Shahar
- Child Neurology Unit, Meyer Children Hospital, Haifa, Israel
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Schanen JG, Iribarren C, Shahar E, Punjabi NM, Rich SS, Sorlie PD, Folsom AR. Asthma and incident cardiovascular disease: the Atherosclerosis Risk in Communities Study. Thorax 2005; 60:633-8. [PMID: 16061703 PMCID: PMC1747501 DOI: 10.1136/thx.2004.026484] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND A possible association between asthma and cardiovascular disease has been described in several exploratory studies. METHODS The association of self-reported, doctor diagnosed asthma and incident cardiovascular disease was examined in a biracial cohort of 45-64 year old adults (N = 13501) followed over 14 years. RESULTS Compared with never having asthma, the multivariate adjusted hazard ratio (HR) of stroke (n = 438) was 1.50 (95% CI 1.04 to 2.15) for a baseline report of ever having asthma (prevalence 5.2%) and 1.55 (95% CI 0.95 to 2.52) for current asthma (prevalence 2.7%). The relative risk of stroke was 1.43 (95% CI 1.03 to 1.98) using a time dependent analysis incorporating follow up reports of asthma. Participants reporting wheeze attacks with shortness of breath also had greater risk for stroke (HR = 1.56, 95% CI 1.18 to 2.06) than participants without these symptoms. The multivariate adjusted relative risk of coronary heart disease (n = 1349) was 0.87 (95% CI 0.66 to 1.14) for ever having asthma, 0.69 (95% CI 0.46 to 1.05) for current asthma at baseline, and 0.88 (95% CI 0.69 to 1.11) using the time dependent analysis. CONCLUSIONS Asthma may be an independent risk factor for incident stroke but not coronary heart disease in middle aged adults. This finding warrants replication and may motivate a search for possible mechanisms that link asthma and stroke.
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Affiliation(s)
- J G Schanen
- University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, 1300 South 2nd Street, Suite 300, Minneapolis, MN 55454, USA
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