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Stephens C, Coghlan Z, Gibson L, McSweeney N, O'Mahony O, O'Leary MJ. Paediatric neuro-disability end-of-life care: symptom burden and management. BMJ Support Palliat Care 2024; 13:e731-e732. [PMID: 34952864 DOI: 10.1136/bmjspcare-2021-003486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/10/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Carol Stephens
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - Zoe Coghlan
- Department of Palliative Medicine, Cork University Hospital, Cork, Ireland
| | - Louise Gibson
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Niamh McSweeney
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- Department of Paediatric Neurology, Cork University Hospital, Cork, Ireland
| | - Olivia O'Mahony
- Department of Paediatric Neurology, Cork University Hospital, Cork, Ireland
| | - Mary Jane O'Leary
- Department of Palliative Medicine, Cork University Hospital, Cork, Ireland
- Department of Palliative Medicine, Marymount University Hospital & Hospice, Cork, Ireland
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Stephens CM, Mathieson SR, McNamara B, McSweeney N, O'Brien R, O'Mahony O, Boylan GB, Murray DM. Electroencephalography Quality and Application Times in a Pediatric Emergency Department Setting: A Feasibility Study. Pediatr Neurol 2023; 148:82-85. [PMID: 37690268 DOI: 10.1016/j.pediatrneurol.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/06/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Status epilepticus is the most common neurological emergency presenting to pediatric emergency departments. Nonconvulsive status epilepticus can be extremely challenging to diagnose, however, requiring electroencephalographic (EEG) confirmation for definitive diagnosis. We aimed to determine the feasibility of achieving a good-quality pediatric EEG recording within 20 minutes of presentation to the emergency department. METHODS Single-center prospective feasibility study in Cork University Hospital, Ireland, between July 2021 and June 2022. Two-channel continuous EEG was recorded from children (1) aged <16 years and (2) with Glasgow Coma Scale <11 or a reduction in baseline Glasgow Coma Scale in the case of a child with a neurodisability. RESULTS Twenty patients were included. The median age at presentation was 65.8 months (interquartile range, 23.2 to 119.0); 50% had a background diagnosis of epilepsy. The most common reason for EEG monitoring was status epilepticus (85%) followed by suspected nonconvulsive status (10%) and reduced consciousness of unknown etiology (5%). The mean length of recording was 93.1 minutes (S.D. 47.4). The mean time to application was 41.3 minutes (S.D. 11.7). The mean percent of artifact in all recordings was 19.3% (S.D. 15.9). Thirteen (65%) EEGs had <25% artifact. Artifact was higher in cases in which active airway management was ongoing. CONCLUSIONS EEG monitoring can be achieved in a pediatric emergency department setting within one hour of presentation. Overall, artifact percentage was low outside of periods of airway manipulation. Future studies are required to determine its use in early seizure detection and its support role in clinical decision-making in these patients.
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Affiliation(s)
- Carol M Stephens
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
| | - Sean R Mathieson
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Brian McNamara
- Department of Neurophysiology, Cork University Hospital, Cork, Ireland
| | - Niamh McSweeney
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland; Department of Paediatric Neurology, Cork University Hospital, Cork, Ireland
| | - Rory O'Brien
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
| | - Olivia O'Mahony
- Department of Paediatric Neurology, Cork University Hospital, Cork, Ireland
| | - Geraldine B Boylan
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Deirdre M Murray
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
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Musto E, Liao VWY, Johannesen KM, Fenger CD, Lederer D, Kothur K, Fisk K, Bennetts B, Vrielynck P, Delaby D, Ceulemans B, Weckhuysen S, Sparber P, Bouman A, Ardern-Holmes S, Troedson C, Battaglia DI, Goel H, Feyma T, Bakhtiari S, Tjoa L, Boxill M, Demina N, Shchagina O, Dadali E, Kruer M, Cantalupo G, Contaldo I, Polster T, Isidor B, Bova SM, Fazeli W, Wouters L, Miranda MJ, Darra F, Pede E, Le Duc D, Jamra RA, Küry S, Proietti J, McSweeney N, Brokamp E, Andrews PI, Gouray Garcia M, Chebib M, Møller RS, Ahring PK, Gardella E. GABRA1-Related Disorders: From Genetic to Functional Pathways. Ann Neurol 2023; 95:27-41. [PMID: 37606373 DOI: 10.1002/ana.26774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE Variants in GABRA1 have been associated with a broad epilepsy spectrum, ranging from genetic generalized epilepsies to developmental and epileptic encephalopathies. However, our understanding of what determines the phenotype severity and best treatment options remains inadequate. We therefore aimed to analyze the electroclinical features and the functional effects of GABRA1 variants to establish genotype-phenotype correlations. METHODS Genetic and electroclinical data of 27 individuals (22 unrelated and 2 families) harboring 20 different GABRA1 variants were collected and accompanied by functional analysis of 19 variants. RESULTS Individuals in this cohort could be assigned into different clinical subgroups based on the functional effect of their variant and its structural position within the GABRA1 subunit. A homogenous phenotype with mild cognitive impairment and infantile onset epilepsy (focal seizures, fever sensitivity, and electroencephalographic posterior epileptiform discharges) was described for variants in the extracellular domain and the small transmembrane loops. These variants displayed loss-of-function (LoF) effects, and the patients generally had a favorable outcome. A more severe phenotype was associated with variants in the pore-forming transmembrane helices. These variants displayed either gain-of-function (GoF) or LoF effects. GoF variants were associated with severe early onset neurodevelopmental disorders, including early infantile developmental and epileptic encephalopathy. INTERPRETATION Our data expand the genetic and phenotypic spectrum of GABRA1 epilepsies and permit delineation of specific subphenotypes for LoF and GoF variants, through the heterogeneity of phenotypes and variants. Generally, variants in the transmembrane helices cause more severe phenotypes, in particular GoF variants. These findings establish the basis for a better understanding of the pathomechanism and a precision medicine approach in GABRA1-related disorders. Further studies in larger populations are needed to provide a conclusive genotype-phenotype correlation. ANN NEUROL 2023.
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Affiliation(s)
- Elisa Musto
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Dianalund, Denmark
- Pediatric Neurology, Department of Woman and Child Health and Public Health, Child Health Area, Catholic University UCSC, Rome, Italy
- Epilepsy and Movement Disorder Neurology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Vivian W Y Liao
- Brain and Mind Centre, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Katrine M Johannesen
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Dianalund, Denmark
- Department of Genetics, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Christina D Fenger
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Dianalund, Denmark
- Amplexa Genetics, Odense, Denmark
| | - Damien Lederer
- Center for Human Genetics, Institut de Pathologie et de Génétique, Gosselies, Belgium
| | - Kavitha Kothur
- Kids Neuroscience Centre, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia
| | - Katrina Fisk
- Sydney Genome Diagnostics, Western Sydney Genetics Program, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Bruce Bennetts
- Sydney Genome Diagnostics, Western Sydney Genetics Program, Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Specialty of Genomic Medicine, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Pascal Vrielynck
- Reference Center for Refractory Epilepsy, Catholic University of Louvain, William Lennox Neurological Hospital, Ottignies, Belgium
| | - Delphine Delaby
- Reference Center for Refractory Epilepsy, Catholic University of Louvain, William Lennox Neurological Hospital, Ottignies, Belgium
| | - Berten Ceulemans
- Department of Pediatric Neurology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Sarah Weckhuysen
- Applied & Translational Neurogenomics Group, VIB-Department of Molecular Genetics, University of Antwerp, Antwerp, Belgium
- Department of Neurology, Antwerp University Hospital, Antwerp, Belgium
- Translational Neurosciences, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Peter Sparber
- Research Center for Medical Genetics Moskvorechie 1, Moscow, Russia
| | - Arjan Bouman
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Simone Ardern-Holmes
- Kids Neuroscience Centre, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia
- T. Y. Nelson Department of Neurology and Neurosurgery, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Christopher Troedson
- T. Y. Nelson Department of Neurology and Neurosurgery, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Domenica I Battaglia
- Pediatric Neurology, Department of Woman and Child Health and Public Health, Child Health Area, Catholic University UCSC, Rome, Italy
| | - Himanshu Goel
- Hunter Genetics, Newcastle, New South Wales, Australia
| | - Timothy Feyma
- Gillette Children's Specialty Healthcare, Saint Paul, MN, USA
| | - Somayeh Bakhtiari
- Pediatric Movement Disorders Program, Division of Pediatric Neurology, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, USA
- Departments of Child Health, Neurology, and Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Linda Tjoa
- Townsville University Hospital, Douglas, Queensland, Australia
| | - Martin Boxill
- Department of Pediatrics, Viborg Regional Hospital, Viborg, Denmark
| | - Nina Demina
- Research Center for Medical Genetics Moskvorechie 1, Moscow, Russia
| | - Olga Shchagina
- Research Center for Medical Genetics Moskvorechie 1, Moscow, Russia
| | - Elena Dadali
- Research Center for Medical Genetics Moskvorechie 1, Moscow, Russia
| | - Michael Kruer
- Pediatric Movement Disorders Program, Division of Pediatric Neurology, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, AZ, USA
- Departments of Child Health, Neurology, and Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Gaetano Cantalupo
- Child Neuropsychiatry Section, Department of Surgical Sciences, Dentistry, Gynecology and Paediatrics, University of Verona, Verona, Italy
- UOC Neuropsichiatria Infantile, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Integrata (full member of the ERN EpiCare), Verona, Italy
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
| | - Ilaria Contaldo
- Pediatric Neurology, Department of Woman and Child Health and Public Health, Child Health Area, Catholic University UCSC, Rome, Italy
| | - Tilman Polster
- Department of Epileptology (Krankenhaus Mara), Bielefeld University Medical School, Bielefeld, Germany
| | | | - Stefania M Bova
- Pediatric Neurology Unit, V. Buzzi Children's Hospital, Milan, Italy
| | - Walid Fazeli
- Department of Neuropediatrics, Children's Hospital, University of Bonn, Bonn, Germany
| | - Leen Wouters
- Department of Pediatrics, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Maria J Miranda
- Department of Pediatrics, Pediatric Neurology, Herlev University Hospital, Copenhagen University, Herlev, Denmark
| | - Francesca Darra
- Child Neuropsychiatry Section, Department of Surgical Sciences, Dentistry, Gynecology and Paediatrics, University of Verona, Verona, Italy
- UOC Neuropsichiatria Infantile, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Integrata (full member of the ERN EpiCare), Verona, Italy
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
| | - Elisa Pede
- Pediatric Neurology, Department of Woman and Child Health and Public Health, Child Health Area, Catholic University UCSC, Rome, Italy
| | - Diana Le Duc
- Department of Human Genetics, University of Leipzig Faculty of Medicine, Leipzig, Germany
| | - Rami Abou Jamra
- Department of Human Genetics, University of Leipzig Faculty of Medicine, Leipzig, Germany
| | - Sébastien Küry
- Service de Génétique Médicale, CHU Nantes, Nantes, France
- l'Institut du Thorax, INSERM, CNRS, Université de Nantes, Nantes, France
| | - Jacopo Proietti
- Child Neuropsychiatry Section, Department of Surgical Sciences, Dentistry, Gynecology and Paediatrics, University of Verona, Verona, Italy
- Irish Centre for Fetal and Neonatal Translational Research, Child Neuropsychiatry, Cork, Ireland
| | - Niamh McSweeney
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - Elly Brokamp
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter Ian Andrews
- Department of Neurology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | | | - Mary Chebib
- Brain and Mind Centre, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rikke S Møller
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Dianalund, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Philip K Ahring
- Brain and Mind Centre, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Elena Gardella
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Dianalund, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Ryan DJ, Coughlan S, McSweeney N, Dineen J, Fanning N. Hemiplegic Migraine as a Stroke Mimic: Imaging and Electroencephalography Findings. Stroke 2023. [PMID: 37194626 DOI: 10.1161/strokeaha.122.041369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Affiliation(s)
- David J Ryan
- Department of Radiology, Cork University Hospital, Wilton, Ireland. (D.J.R., N.F.)
| | - Siobhan Coughlan
- Department of Pediatrics, Cork University Hospital, Wilton, Ireland. (S.C., N.M.S.)
| | - Niamh McSweeney
- Department of Pediatrics, Cork University Hospital, Wilton, Ireland. (S.C., N.M.S.)
| | - Jennifer Dineen
- Department of Neurophysiology, Cork University Hospital, Wilton, Ireland. (J.D.)
| | - Noel Fanning
- Department of Radiology, Cork University Hospital, Wilton, Ireland. (D.J.R., N.F.)
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Kwok TC, Dineen RA, Whitehouse W, Lynn RM, McSweeney N, Sharkey D. Neonatal stroke surveillance study protocol in the United Kingdom and Republic of Ireland. Open Med (Wars) 2022; 17:1417-1424. [PMID: 36128449 PMCID: PMC9449691 DOI: 10.1515/med-2022-0554] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/20/2022] [Accepted: 08/17/2022] [Indexed: 12/04/2022] Open
Abstract
Neonatal stroke is a devastating condition that causes brain injury in babies and often leads to lifelong neurological impairment. Recent prospective population studies of neonatal stroke are lacking. Neonatal strokes are different from those in older children and adults. A better understanding of its aetiology, current management, and outcomes could reduce the burden of this rare condition. The study aims to explore the incidence and 2 year outcomes of neonatal stroke across an entire population in the UK and Republic of Ireland. This is an active national surveillance study using a purpose-built integrated case notification-data collection online platform. Over a 13 month period, with a potential 6 month extension, clinicians will notify neonatal stroke cases presenting in the first 90 days of life electronically via the online platform monthly. Clinicians will complete a primary questionnaire via the platform detailing clinical information, including neuroimaging, for analysis and classification. An outcome questionnaire will be sent at 2 years of age via the platform. Appropriate ethics and regulatory approvals have been received. The neonatal stroke study represents the first multinational population surveillance study delivered via a purpose-built integrated case notification-data collection online platform and data safe haven, overcoming the challenges of setting up the study.
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Affiliation(s)
- T’ng Chang Kwok
- Centre for Perinatal Research, Population and Lifespan Sciences, School of Medicine, University of Nottingham, Queen’s Medical Centre , Nottingham , NG7 2UH , United Kingdom
| | - Robert A. Dineen
- Radiological Sciences, Mental Health & Clinical Neuroscience, School of Medicine, University of Nottingham, Queen’s Medical Centre , Nottingham , NG7 2UH , United Kingdom
- NIHR Nottingham Biomedical Research Centre , Nottingham , United Kingdom
| | - William Whitehouse
- Centre for Perinatal Research, Population and Lifespan Sciences, School of Medicine, University of Nottingham, Queen’s Medical Centre , Nottingham , NG7 2UH , United Kingdom
| | - Richard M. Lynn
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health , London , WC1N 1EH , England
| | - Niamh McSweeney
- Department of Paediatrics and Child Health, Cork University Hospital, Wilton , Cork , T12 DC4A , Ireland
| | - Don Sharkey
- Centre for Perinatal Research, Population and Lifespan Sciences, School of Medicine, University of Nottingham, E floor, East Block, Queen’s Medical Centre , Nottingham , NG7 2UH , United Kingdom
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Harvey S, Allen NM, King MD, Lynch B, Lynch SA, O’Regan M, O’Rourke D, Shahwan A, Webb D, Gorman KM, El Hassan M, Flynn K, Hanrahan D, Kehoe C, Leahy C, Lynch N, McHugh JC, McSweeney N, O’Mahony E, O’Mahony O, Tirupathi S. Response to treatment and outcomes of infantile spasms in Down syndrome. Dev Med Child Neurol 2022; 64:780-788. [PMID: 35092693 PMCID: PMC9303415 DOI: 10.1111/dmcn.15153] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 12/13/2022]
Abstract
AIM To estimate the prevalence, and evaluate presentation, treatment response, treatment side effects, and long-term seizure outcomes in all known cases of children with Down syndrome and infantile spasms on the island of Ireland. METHOD This was a 10-year retrospective multicentre review of clinical records and investigations, focusing on treatment response, side effects, and long-term outcomes. RESULTS The prevalence of infantile spasms in Down syndrome was 3.0% during the study period. Fifty-four infants were identified with median age of spasm onset at 201 days (interquartile range [IQR] 156-242). Spasm cessation was achieved in 88% (n=46) at a median of 110 days (IQR 5-66). The most common first-line medications were prednisolone (n=20, 37%), vigabatrin (n=18, 33.3%), and sodium valproate (n=9, 16.7%). At follow-up (median age 23.7mo; IQR 13.4-40.6), 25% had ongoing seizures and 85% had developmental concerns. Treatment within 60 days did not correlate with spasm cessation. Seventeen children (31%) experienced medication side effects, with vigabatrin accounting for 52%. INTERPRETATION Prednisolone is an effective and well-tolerated medication for treating infantile spasms in Down syndrome. Despite the high percentage of spasm cessation, developmental concerns and ongoing seizures were common.
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Affiliation(s)
- Susan Harvey
- Department of Neurology and Clinical NeurophysiologyChildren’s Health Ireland at Temple StreetDublinIreland
| | - Nicholas M. Allen
- School of MedicineNational University of Ireland GalwayGalwayIreland,Department of PaediatricsGalway University HospitalGalwayIreland
| | - Mary D. King
- Department of Neurology and Clinical NeurophysiologyChildren’s Health Ireland at Temple StreetDublinIreland,School of Medicine and Medical ScienceUniversity College DublinDublinIreland
| | - Bryan Lynch
- Department of Neurology and Clinical NeurophysiologyChildren’s Health Ireland at Temple StreetDublinIreland,School of Medicine and Medical ScienceUniversity College DublinDublinIreland
| | - Sally A. Lynch
- School of Medicine and Medical ScienceUniversity College DublinDublinIreland,National Rare Disease OfficeMater Hospital DublinDublinIreland
| | - Mary O’Regan
- Department of Neurology and Clinical NeurophysiologyChildren’s Health Ireland at CrumlinDublinIreland
| | - Declan O’Rourke
- Department of Neurology and Clinical NeurophysiologyChildren’s Health Ireland at Temple StreetDublinIreland,School of Medicine and Medical ScienceUniversity College DublinDublinIreland,School of MedicineTrinity College DublinDublinIreland
| | - Amre Shahwan
- Department of Neurology and Clinical NeurophysiologyChildren’s Health Ireland at Temple StreetDublinIreland
| | - David Webb
- Department of Neurology and Clinical NeurophysiologyChildren’s Health Ireland at CrumlinDublinIreland,School of MedicineTrinity College DublinDublinIreland
| | - Kathleen M. Gorman
- Department of Neurology and Clinical NeurophysiologyChildren’s Health Ireland at Temple StreetDublinIreland,School of Medicine and Medical ScienceUniversity College DublinDublinIreland
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7
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Stephens CM, Pavel AM, Mathieson SR, McSweeney N, McNamara B, Moore M, Boylan GB. Case Report: Early Neonatal EEG in Two Infants with Pallister Killian Syndrome (PKS). HRB Open Res 2022; 5:14. [PMID: 36249954 PMCID: PMC9530620 DOI: 10.12688/hrbopenres.13493.1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/28/2022] Open
Abstract
Pallister Killian Syndrome (PKS) is a rare genetic disorder caused by a mosaic tetrasomy of the short arm of chromosome 12. The syndrome is characterised by typical craniofacial dysmorphism, congenital anomalies and intellectual disability. Epilepsy is a known complication, with onset usually occurring in early childhood and characterised most commonly by spasms and myoclonic seizures. To the best of our knowledge, there have been no cases describing the early neonatal EEG in PKS and electrographic seizures, to date. Here, we report two cases of PKS presenting in the neonatal period with distinctive EEG features and seizures.
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Affiliation(s)
- Carol M Stephens
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Andreea M Pavel
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland
| | - Sean R Mathieson
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Niamh McSweeney
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- Department of Paediatric Neurology, Cork University Hospital, Cork, Ireland
| | - Brian McNamara
- Department of Neurophysiology, Cork University Hospital, Cork, Ireland
| | - Michael Moore
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Geraldine B Boylan
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
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Murphy M, McSweeney N, Cavalleri G, Greally M, Benson K, Costello D. KBG syndrome mimicking genetic generalized epilepsy. Epilepsy Behav Rep 2022; 19:100545. [PMID: 35573061 PMCID: PMC9092988 DOI: 10.1016/j.ebr.2022.100545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 10/28/2022] Open
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9
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Pavel AM, Stephens CM, Mathieson SR, Walsh BH, McNamara B, McSweeney N, Boylan GB. Case Report: Electroencephalography in a neonate with isolated sulfite oxidase deficiency - a case report and literature review. HRB Open Res 2021; 4:122. [PMID: 34957373 PMCID: PMC8669778 DOI: 10.12688/hrbopenres.13442.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 11/30/2022] Open
Abstract
Isolated sulfite oxidase deficiency (ISOD) is a rare autosomal recessive neuro-metabolic disorder caused by a mutation in the sulfite oxidase (SUOX) gene situated on chromosome 12. Due to the deficiency of this mitochondrial enzyme (sulfite oxidase), the oxidative degradation of toxic sulfites is disrupted. The most common form of this disease has an early onset (classical ISOD) in the neonatal period, with hypotonia, poor feeding and intractable seizures, mimicking hypoxic-ischaemic encephalopathy. The evolution is rapidly progressive to severe developmental delay, microcephaly and early death. Unfortunately, there is no effective treatment and the prognosis is very poor. In this article, we described the evolution of early continuous electroencephalography (EEG) in a case of ISOD with neonatal onset, as severely encephalopathic background, with refractory seizures and distinct delta-beta complexes. The presence of the delta-beta complexes might be a diagnostic marker in ISOD. We also performed a literature review of published cases of neonatal ISOD that included EEG monitoring.
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Affiliation(s)
- Andreea M Pavel
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.,Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland
| | - Carol M Stephens
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Sean R Mathieson
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Brian H Walsh
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.,Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland
| | - Brian McNamara
- Department of Neurophysiology, Cork University Hospital, Cork, Ireland
| | - Niamh McSweeney
- Department of Paediatric Neurology, Cork University Hospital, Cork, Ireland
| | - Geraldine B Boylan
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
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Foran J, Moore M, Crushell E, Knerr I, McSweeney N. Low excretor glutaric aciduria type 1 of insidious onset with dystonia and atypical clinical features, a diagnostic dilemma. JIMD Rep 2021; 58:12-20. [PMID: 33728242 PMCID: PMC7932869 DOI: 10.1002/jmd2.12187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/19/2020] [Accepted: 11/05/2020] [Indexed: 11/09/2022] Open
Abstract
A 4-year-old girl was referred for reassessment of dyskinetic cerebral palsy. Initial investigations in her country of birth, India, had not yielded a diagnosis. MRI brain in infancy revealed bilateral putamen hyperintensity. She had generalized dyskinesia predominantly bulbar and limbs. Motor and speech development were most affected with preservation of cognitive development. There was no history of acute encephalopathic crisis or status dystonicus. Initial urine organic acids and amino acids and acylcarnitine profile (ACP) were normal. A dystonia genetic panel showed compound heterozygosity with a pathogenic variant and a variant of uncertain significance in the GCDH gene. The latter is hitherto undescribed and is indicative of a potential diagnosis of glutaric aciduria type 1 (alternatively glutaric acidemia type 1) (GA-1), an autosomal recessive disorder of mitochondrial lysine/hydroxylysine and tryptophan metabolism. Repeat urine organic acids showed isolated slightly increased 3-hydroxy glutarate excretion consistent with GA-1 and characterizing the patient as a "low excretor," a diagnostic sub-group where diagnosis is more challenging but prognosis is similar. Repeat MRI Brain at age 4 showed volume loss and symmetric T2 hyperintensity in the posterior putamina bilaterally. This case highlights the diagnostic dilemma of GA-1 where differing clinical courses, genetic variants, neuroradiological findings, and biochemical excretion patterns may lead to a later diagnosis. The presence of newborn screening for GA-1 should not dull the clinician's suspicion of the possibility that GA-1 may present with a complex movement disorder. Timely diagnosis and treatment is essential, as neurological sequelae are largely irreversible.
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Affiliation(s)
- Jason Foran
- Department of Paediatric NeurologyCork University HospitalCorkRepublic of Ireland
| | - Michael Moore
- Department of RadiologyCork University HospitalCorkRepublic of Ireland
| | - Ellen Crushell
- National Centre for Inherited Metabolic DisordersChildren's Health Ireland at Temple StreetDublinRepublic of Ireland
| | - Ina Knerr
- National Centre for Inherited Metabolic DisordersChildren's Health Ireland at Temple StreetDublinRepublic of Ireland
| | - Niamh McSweeney
- Department of Paediatric NeurologyCork University HospitalCorkRepublic of Ireland
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Abu Dhais F, McNamara B, O'Mahony O, McSweeney N, Livingstone V, Murray DM, Boylan GB. Impact of therapeutic hypothermia on infantile spasms: an observational cohort study. Dev Med Child Neurol 2020; 62:62-68. [PMID: 31518001 PMCID: PMC6916151 DOI: 10.1111/dmcn.14331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2019] [Indexed: 12/25/2022]
Abstract
AIM To establish the incidence of infantile spasms in children in the southern region of the Republic of Ireland and to compare the incidence of infantile spasms before and after the introduction of therapeutic hypothermia in infants with hypoxic-ischemic encephalopathy (HIE). METHOD Children born between 2003 and 2015 and diagnosed with infantile spasms (epileptic spasms with or without hypsarrhythmia) in the first 2 years of life were identified through audits of electroencephalography reports and paediatric neurology patient lists. Data on live births were obtained from the regional hospital statistics databases. Medical charts of infantile spasm cases were reviewed for demographic information, diagnostic workup results, treatment response, disease course, and developmental outcome. RESULTS Forty-two infants with infantile spasms were identified. The cumulative incidence of infantile spasms up to the age of 2 years was 4.01 per 10 000 live births. Difference due to sex was minimal (22 males, 20 females) and most infants were delivered at or near term with gestational ages ranging between 30.0 and 41.8 weeks (median [interquartile range] 39.6wks [38.1-40.0wks]). The aetiology for infantile spasms was identified in almost two-thirds of cases, with HIE being the single most common cause (n=7). Other causes included chromosomal and monogenetic abnormalities (n=8). Infantile spasms occurred in moderate and severe grades of HIE, with a significantly higher incidence in those with severe HIE (p=0.029). Infants with severe HIE who did not receive therapeutic hypothermia were six times more likely to develop infantile spasms compared to those who did, but the difference was not statistically significant (4 out of 16 vs 1 out of 24, p=0.138). INTERPRETATION This study provides detailed information about infantile spasms before and after the introduction of therapeutic hypothermia. HIE severity is a risk factor for the development of infantile spasms. The introduction of therapeutic hypothermia may have had an impact, but the effect was hard to ascertain in this cohort due to the small number of infants. WHAT THIS PAPER ADDS The incidence of infantile spasms and patient characteristics in the southern region of the Republic of Ireland is similar to internationally published data. None of the infants with a history of mild hypoxic-ischemic encephalopathy (HIE) developed infantile spasms. The risk of infantile spasms was higher in infants with severe HIE. Infantile spasms were more frequent in infants with severe HIE not treated with therapeutic hypothermia.
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Affiliation(s)
- Farah Abu Dhais
- INFANT Research Centre, University College CorkCorkIreland
- Department of Paediatrics and Child HealthUniversity College CorkCorkIreland
| | - Brian McNamara
- Department of NeurophysiologyCork University HospitalCorkIreland
| | - Olivia O'Mahony
- Department of PaediatricsCork University HospitalCorkIreland
| | - Niamh McSweeney
- Department of PaediatricsCork University HospitalCorkIreland
| | - Vicki Livingstone
- INFANT Research Centre, University College CorkCorkIreland
- Department of Paediatrics and Child HealthUniversity College CorkCorkIreland
| | - Deirdre M Murray
- INFANT Research Centre, University College CorkCorkIreland
- Department of Paediatrics and Child HealthUniversity College CorkCorkIreland
| | - Geraldine B Boylan
- INFANT Research Centre, University College CorkCorkIreland
- Department of Paediatrics and Child HealthUniversity College CorkCorkIreland
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Affiliation(s)
- Jayne MacMahon
- Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland
| | - Michael James Carter
- Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland
| | - Michael Moore
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Niamh McSweeney
- Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland
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Finn BP, Power C, McSweeney N, Breen D, Wyse G, O'Connell SM. Subarachnoid and parenchymal haemorrhages as a complication of severe diabetic ketoacidosis in a preadolescent with new onset type 1 diabetes. Pediatr Diabetes 2018; 19:1487-1491. [PMID: 30175460 DOI: 10.1111/pedi.12760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 04/24/2018] [Revised: 07/15/2018] [Accepted: 08/14/2018] [Indexed: 01/24/2023] Open
Abstract
Diabetic ketoacidosis (DKA) is one of the most common causes of morbidity and mortality in new onset type 1 diabetes mellitus (T1DM). Children have a higher rate of neurological complications from DKA when compared to adults. The differential for sudden focal neurological deterioration in the setting of DKA is cerebral oedema followed by ischaemic and haemorrhagic stroke. Spontaneous intracranial haemorrhages can present with non-specific features frequently, for example, impaired consciousness, even when biochemical parameters are improving in the setting of DKA. We report the case of a girl with new onset T1D who presented in severe DKA and subsequently developed intracerebral parenchymal and subarachnoid haemorrhages. Our patient is unique in that no focal neurological or neuropsychological deficits have been found at 1-year follow up, compared to the literature which suggests poor outcomes. Our case contrasts with these previous cases as none of the other case reports demonstrated subarachnoid haemorrhages with survival.
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Affiliation(s)
- Bryan P Finn
- Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland
| | - Claire Power
- Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland
| | - Niamh McSweeney
- Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland
| | - Dorothy Breen
- Department of Intensive Care, Cork University Hospital, Cork, Ireland
| | - Gerald Wyse
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Susan M O'Connell
- Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland
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Compton TJ, Bodnar W, Koolhaas A, Dekinga A, Holthuijsen S, ten Horn J, McSweeney N, van Gils JA, Piersma T. Burrowing Behavior of a Deposit Feeding Bivalve Predicts Change in Intertidal Ecosystem State. Front Ecol Evol 2016. [DOI: 10.3389/fevo.2016.00019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lim D, Todd M, Kourtoglou N, Gerasimidis K, Gardner-Medwin J, Watson L, Tullus K, Pilkington C, Chesters C, Marks SD, Newland P, Jones C, Beresford MW, O'Neill P, Lee H, Tattersall R, McErlane F, Beresford M, Baildam E, Alice Chieng SE, Davidson J, Foster H, Gardner-Medwin J, Lunt M, Wedderburn LR, Thomson W, Hyrich KL, Kavirayani A, Thyagarajan MS, Ellis J, Helen Strike CNS, Ramanan AV, Coda A, Davidson J, Fowlie P, Walsh J, Carline T, Santos D, Brimlow KW, Rangaraj S, Grant C, Little J, Helen Strike CNS, Hinchcliffe A, Dick A, Ramanan A, Ekdawy D, Nagra G, Camina N, Edgerton J, Choi J, Lamb K, Hawley D, Rangaraj S, Cruikshank M, Sen E, Pain C, Leone V, Cruikshank M, Walsh J, Tattersall R, Hawley D, Dunkley L, Lee H, McMahon AM, Bale P, Armon K, Amin T, Wood M, Davies R, Southwood TR, Kearsley-Fleet L, Hyrich KL, Kearsley-Fleet L, Baildam E, Beresford M, Davies R, Foster HE, Mowbray K, Southwood TR, Thomson W, Hyrich KL, Agarwal M, Kavirayani A, Ramanan AV, Ellis J, Smith E, Gray W, Taylor-Robinson D, Foster HE, Beresford MW, Morgan T, Watson L, Beresford MW, Gohar F, Watson L, Beresford MW, Artim-Esen B, Radziszewska A, Pericleous C, Rahman A, Giles I, Ioannou Y, Jashek D, Mosley E, Rangaraj S, Moraitis E, Arnold K, Pilkington C, Russell NJ, Roderick M, Ramanan A, Roderick M, Russell N, Ramanan AV, Smith NSM, Wilson N, Gardner-Medwin J, Sen E, Chan M, Hardy E, Rapley T, Hensman P, Wraith JE, Foster H, Clarkson J, Gardner-Medwin J, Choudhery V, McVitty C, Davidson J, Hughes DH, Martin N, Warrier K, Sen E, Abinun M, Jandial S, O'Leary D, Staunton D, Lowry C, McSweeney N, Sen E, Abinun M, Friswell M, Foster H, Walsh A, Lowry C, Raja A. BSPAR ANNUAL CONFERENCE ABSTRACTS * Oral presentations * O1. The impact of modern management on outcomes of JIA compared with healthy controls. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/ket116] [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: 11/14/2022] Open
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Lim D, Todd M, Kourtoglou N, Gerasimidis K, Gardner-Medwin J, Watson L, Tullus K, Pilkington C, Chesters C, Marks SD, Newland P, Jones C, Beresford MW, O'Neill P, Lee H, Tattersall R, McErlane F, Beresford M, Baildam E, Alice Chieng SE, Davidson J, Foster H, Gardner-Medwin J, Lunt M, Wedderburn LR, Thomson W, Hyrich KL, Kavirayani A, Thyagarajan MS, Ellis J, Helen Strike CNS, Ramanan AV, Coda A, Davidson J, Fowlie P, Walsh J, Carline T, Santos D, Brimlow KW, Rangaraj S, Grant C, Little J, Helen Strike CNS, Hinchcliffe A, Dick A, Ramanan A, Ekdawy D, Nagra G, Camina N, Edgerton J, Choi J, Lamb K, Hawley D, Rangaraj S, Cruikshank M, Sen E, Pain C, Leone V, Cruikshank M, Walsh J, Tattersall R, Hawley D, Dunkley L, Lee H, McMahon AM, Bale P, Armon K, Amin T, Wood M, Davies R, Southwood TR, Kearsley-Fleet L, Hyrich KL, Kearsley-Fleet L, Baildam E, Beresford M, Davies R, Foster HE, Mowbray K, Southwood TR, Thomson W, Hyrich KL, Agarwal M, Kavirayani A, Ramanan AV, Ellis J, Smith E, Gray W, Taylor-Robinson D, Foster HE, Beresford MW, Morgan T, Watson L, Beresford MW, Gohar F, Watson L, Beresford MW, Artim-Esen B, Radziszewska A, Pericleous C, Rahman A, Giles I, Ioannou Y, Jashek D, Mosley E, Rangaraj S, Moraitis E, Arnold K, Pilkington C, Russell NJ, Roderick M, Ramanan A, Roderick M, Russell N, Ramanan AV, Smith NSM, Wilson N, Gardner-Medwin J, Sen E, Chan M, Hardy E, Rapley T, Hensman P, Wraith JE, Foster H, Clarkson J, Gardner-Medwin J, Choudhery V, McVitty C, Davidson J, Hughes DH, Martin N, Warrier K, Sen E, Abinun M, Jandial S, O'Leary D, Staunton D, Lowry C, McSweeney N, Sen E, Abinun M, Friswell M, Foster H, Walsh A, Lowry C, Raja A. BSPAR ANNUAL CONFERENCE ABSTRACTS * Oral presentations * O1. The impact of modern management on outcomes of JIA compared with healthy controls. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes277] [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: 11/12/2022] Open
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Absoud M, Cummins C, Desai N, Gika A, McSweeney N, Munot P, Hemingway C, Lim M, Nischal KK, Wassmer E. Childhood optic neuritis clinical features and outcome. Arch Dis Child 2011; 96:860-2. [PMID: 20554767 DOI: 10.1136/adc.2009.175422] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [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: 11/04/2022]
Abstract
AIM To describe clinical features and outcome of a series of children with first-episode optic neuritis investigated in three paediatric neurology centres. METHODS Databases were searched to identify children (<16 years) with optic neuritis and life table analysis was used. RESULTS 44 children (female/male ratio 1.8) median age 10.9 years were followed up for median 1 year. Optic neuritis was unilateral in 43%. Maximal visual deficit was severe (<6/60) in 77%, with full recovery in 70%. Cumulative probability of developing MS (11/44) or NMO (3/44) at 2 years was 0.45. Relapsing optic neuritis was a strong predictor for development of MS or NMO. A positive MRI (>1 brain T2 hyperintense lesion) was a strong predictor for development of MS. DISCUSSION Childhood optic neuritis is associated with severe visual deficit with good recovery. An initial abnormal MRI brain scan or relapsing optic neuritis should alert the clinician to MS or NMO diagnosis.
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Affiliation(s)
- Michael Absoud
- Institute of Child Health, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH.
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Abstract
OBJECTIVE To describe our experience of treating children with vein of Galen aneurysmal malformation (VGM) in a single UK centre between 2003 and 2008. METHOD Retrospective review of case notes and neuroimaging. RESULTS 33 children were seen (26 neonates, seven infants), of whom 28 underwent endovascular treatment. Four were not offered treatment as they had evidence of severe diffuse brain injury at presentation; treatment was deferred in another who subsequently died. Seven children died (two of whom had endovascular treatment). Of the survivors (all treated), 13 (39%) are neurodevelopmentally intact, seven (21%) have mild neurodevelopmental impairment and the remaining six (18%) have significant neurological impairment. The authors were not able to identify clinical or radiological parameters which strongly predicted outcome. Of note, two children with initially low Bicêtre scores were neurologically intact after successful embolisation. CONCLUSION The outlook for children with VGM is significantly better since the advent of endovascular treatment. Decisions about the appropriateness and timing of treatment should be taken by an experienced multidisciplinary team.
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Affiliation(s)
- N McSweeney
- The Wolfson Centre, Mecklenburgh Square, London, UK
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McSweeney N. 173 Poster a Prospective Study on Changes in Body Composition during a Cardiac Rehabilitation Programme which Includes a Home Exercise Programme. Eur J Cardiovasc Nurs 2010. [DOI: 10.1016/s1474-5151(10)60133-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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McSweeney N, Cowan F, Manzur A, Robb S, Muntoni F. Perinatal dyskinesia as a presenting feature in Prader Willi syndrome. Eur J Paediatr Neurol 2009; 13:350-5. [PMID: 18722147 DOI: 10.1016/j.ejpn.2008.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/22/2007] [Revised: 07/08/2008] [Accepted: 07/09/2008] [Indexed: 11/24/2022]
Abstract
Prader Willi Syndrome (PWS) is a complex genetic disorder. Infants present with hypotonia and feeding difficulties, usually without respiratory symptoms, but with distinctive facial features. Early neonatal diagnosis can however be difficult in children with only subtle distinctive appearances or with atypical clinical signs, leading to a significant delay in the diagnosis. To highlight the diagnostic difficulties we reviewed our experience of infants with PWS referred to our tertiary centre. We describe 14 patients, 10 of whom presented in the neonatal period. All had axial hypotonia, and poor feeding. Twelve had a paucity of movement, 11 had distinctive features and 10 had a reduced level of alertness in the neonatal period. In addition to these typical features, four patients had prominent limb dyskinesia, which has only been reported once before in infants with PWS. We draw attention to this relatively common but poorly acknowledged sign that can be seen at presentation of PWS.
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Affiliation(s)
- Niamh McSweeney
- The Neuromuscular Unit, Department of Paediatrics, Hammersmith Hospital, Imperial NHS Trust, Imperial College, London UK
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