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McPherson JI, Marsh AC, Cunningham A, Leddy JJ, Corrado C, Cheema ZD, Nazir MSZ, Nowak AS, Farooq O, Willer BS, Haider MN. An Exploratory Analysis of Physical Examination Subtypes in Pediatric Athletes With Concussion. Clin J Sport Med 2024:00042752-990000000-00173. [PMID: 38329287 DOI: 10.1097/jsm.0000000000001207] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/01/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Pediatric athletes with concussion present with a variety of impairments on clinical assessment and require individualized treatment. The Buffalo Concussion Physical Examination is a brief, pertinent clinical assessment for individuals with concussion. The purpose of this study was to identify physical examination subtypes in pediatric athletes with concussion within 2 weeks of injury that are relevant to diagnosis and treatment. DESIGN Secondary analysis of a published cohort study and clinician consensus. SETTING Three university-affiliated sports medicine centers. PARTICIPANTS Two hundred seventy children (14.9 ± 1.9 years). INDEPENDENT VARIABLES Orthostatic intolerance, horizontal and vertical saccades, smooth pursuits, vestibulo-ocular reflex, near-point convergence, complex tandem gait, neck range of motion, neck tenderness, and neck spasm. MAIN OUTCOME MEASURES Correlations between independent variables were calculated, and network graphs were made. k-means and hierarchical clustering were used to identify clusters of impairments. Optimal number of clusters was assessed. Results were reviewed by experienced clinicians and consensus was reached on proposed subtypes. RESULTS Physical examination clusters overlapped with each other, and no optimal number of clusters was identified. Clinician consensus suggested 3 possible subtypes: (1) visio-vestibular (horizontal and vertical saccades, smooth pursuits, and vestibulo-ocular reflex), (2) cervicogenic (neck range of motion and spasm), and (3) autonomic/balance (orthostatic intolerance and complex tandem gait). CONCLUSIONS Although we identified 3 physical examination subtypes, it seemed that physical examination findings alone are not enough to define subtypes that are both statistically supported and clinically relevant, likely because they do not include symptoms, assessment of mood or cognitive problems, or graded exertion testing.
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Affiliation(s)
- Jacob I McPherson
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York
| | | | - Adam Cunningham
- University Concussion Management Clinic and Research Center, UBMD Orthopedics and Sports Medicine, Buffalo, New York
| | - John J Leddy
- University Concussion Management Clinic and Research Center, UBMD Orthopedics and Sports Medicine, Buffalo, New York
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
| | - Cathlyn Corrado
- University Concussion Management Clinic and Research Center, UBMD Orthopedics and Sports Medicine, Buffalo, New York
| | - Zaheerud D Cheema
- Department of Neurology, Division of Pediatric Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
| | - Muhammad S Z Nazir
- University Concussion Management Clinic and Research Center, UBMD Orthopedics and Sports Medicine, Buffalo, New York
| | - Andrew S Nowak
- University Concussion Management Clinic and Research Center, UBMD Orthopedics and Sports Medicine, Buffalo, New York
- Central Michigan University College of Medicine, Mt. Pleasant, Michigan; and
| | - Osman Farooq
- Department of Neurology, Division of Pediatric Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
| | - Barry S Willer
- University Concussion Management Clinic and Research Center, UBMD Orthopedics and Sports Medicine, Buffalo, New York
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
| | - Mohammad N Haider
- University Concussion Management Clinic and Research Center, UBMD Orthopedics and Sports Medicine, Buffalo, New York
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
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Braun J, Haider M, Leddy J, Willer B, Farooq O, Saleem G. Young Pediatric Buffalo Concussion Exam Identified Physiological Dysfunction in an Adolescent after Repetitive Concussions. Arch Phys Med Rehabil 2022. [DOI: 10.1016/j.apmr.2022.08.741] [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: 12/04/2022]
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Lee BH, Deng S, Chiriboga CA, Kay DM, Irumudomon O, Laureta E, Delfiner L, Treidler SO, Anziska Y, Sakonju A, Kois C, Farooq O, Engelstad K, Laurenzano A, Hogan K, Caggana M, Saavedra-Matiz CA, Stevens CF, Ciafaloni E. Newborn Screening for Spinal Muscular Atrophy in New York State: Clinical Outcomes From the First 3 Years. Neurology 2022; 99:e1527-e1537. [PMID: 35835557 PMCID: PMC9576300 DOI: 10.1212/wnl.0000000000200986] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 02/03/2022] [Accepted: 06/03/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Spinal muscular atrophy (SMA) was added to the Recommended Uniform Screening Panel in July 2018 largely on the basis of the availability and efficacy of newly approved disease-modifying therapies. New York State (NYS) started universal newborn screening for SMA in October 2018. The authors report the findings from the first 3 years of screening. METHODS Statewide neonatal screening was conducted using DNA extracted from dried blood spots using a real-time quantitative PCR assay. Retrospective follow-up data were collected from 9 referral centers across the state on 34 infants. RESULTS In the first 3 years since statewide implementation, nearly 650,000 infants have been screened for SMA. Thirty-four babies screened positive and were referred to a neuromuscular specialty care center. The incidence remains lower than previously predicted. The majority (94%), including all infants with 2-3 copies of survival motor neuron (SMN) 2, have received treatment. Among treated infants, the overwhelming majority (94%; 30/32) have received gene replacement. All infants in this cohort with 3 copies of SMN2 are clinically asymptomatic posttreatment based on early clinical follow-up data. Infants with 2 copies of SMN2 are more variable in their outcomes. Electrodiagnostic outcomes data obtained from a subgroup of patients (n = 11) demonstrated either improvement or no change in compound muscle action potential (CMAP) amplitude at last clinical follow-up compared with pretreatment baseline. Most infants were treated before 6 weeks of age (median = 34.5 days of life; range 11-180 days). Delays and barriers to treatment identified by treating clinicians followed 2 broad themes: medical and nonmedical. Medical delays most commonly reported were the presence of AAV9 antibodies and elevated troponin I levels. Nonmedical barriers included delays in obtaining insurance and insurance policies regarding specific treatment modalities. DISCUSSION The findings from the NYS cohort of newborn screen-identified infants are consistent with other reports of improved outcomes from early diagnosis and treatment. Additional biomarkers of motor neuron health including EMG can potentially be helpful in detecting preclinical decline.
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Affiliation(s)
- Bo Hoon Lee
- From the Department of Neurology (B.H.L., S.D., E.C.), University of Rochester NY; Columbia University (C.A.C., K.E., A.L.), Department of Neurology, Division of Child Neurology, New York, NY; Newborn Screening Program (D.M.K., M.C., C.A.S.-M., C.F.S.), Division of Genetics, Wadsworth Center, New York State Department of Health, Albany; Cohen Children's Medical Center (O.I., E.L., K.H.), New Hyde Park, NY; Montefiore Medical Center (L.D.), Bronx, NY; Stony Brook University (S.O.T.), Department of Neurology, Stony Brook, NY; SUNY Downstate Medical Center (Y.A.), Brooklyn, NY; SUNY Upstate Medical Center (A.S.), Department of Neurology, Syracuse, NY; Albany Medical Center (C.K.), Department of Pediatrics, Genetics and Metabolism, NY; and University of Buffalo (O.F.), NY.
| | - Stella Deng
- From the Department of Neurology (B.H.L., S.D., E.C.), University of Rochester NY; Columbia University (C.A.C., K.E., A.L.), Department of Neurology, Division of Child Neurology, New York, NY; Newborn Screening Program (D.M.K., M.C., C.A.S.-M., C.F.S.), Division of Genetics, Wadsworth Center, New York State Department of Health, Albany; Cohen Children's Medical Center (O.I., E.L., K.H.), New Hyde Park, NY; Montefiore Medical Center (L.D.), Bronx, NY; Stony Brook University (S.O.T.), Department of Neurology, Stony Brook, NY; SUNY Downstate Medical Center (Y.A.), Brooklyn, NY; SUNY Upstate Medical Center (A.S.), Department of Neurology, Syracuse, NY; Albany Medical Center (C.K.), Department of Pediatrics, Genetics and Metabolism, NY; and University of Buffalo (O.F.), NY
| | - Claudia A Chiriboga
- From the Department of Neurology (B.H.L., S.D., E.C.), University of Rochester NY; Columbia University (C.A.C., K.E., A.L.), Department of Neurology, Division of Child Neurology, New York, NY; Newborn Screening Program (D.M.K., M.C., C.A.S.-M., C.F.S.), Division of Genetics, Wadsworth Center, New York State Department of Health, Albany; Cohen Children's Medical Center (O.I., E.L., K.H.), New Hyde Park, NY; Montefiore Medical Center (L.D.), Bronx, NY; Stony Brook University (S.O.T.), Department of Neurology, Stony Brook, NY; SUNY Downstate Medical Center (Y.A.), Brooklyn, NY; SUNY Upstate Medical Center (A.S.), Department of Neurology, Syracuse, NY; Albany Medical Center (C.K.), Department of Pediatrics, Genetics and Metabolism, NY; and University of Buffalo (O.F.), NY
| | - Denise M Kay
- From the Department of Neurology (B.H.L., S.D., E.C.), University of Rochester NY; Columbia University (C.A.C., K.E., A.L.), Department of Neurology, Division of Child Neurology, New York, NY; Newborn Screening Program (D.M.K., M.C., C.A.S.-M., C.F.S.), Division of Genetics, Wadsworth Center, New York State Department of Health, Albany; Cohen Children's Medical Center (O.I., E.L., K.H.), New Hyde Park, NY; Montefiore Medical Center (L.D.), Bronx, NY; Stony Brook University (S.O.T.), Department of Neurology, Stony Brook, NY; SUNY Downstate Medical Center (Y.A.), Brooklyn, NY; SUNY Upstate Medical Center (A.S.), Department of Neurology, Syracuse, NY; Albany Medical Center (C.K.), Department of Pediatrics, Genetics and Metabolism, NY; and University of Buffalo (O.F.), NY
| | - Obehioya Irumudomon
- From the Department of Neurology (B.H.L., S.D., E.C.), University of Rochester NY; Columbia University (C.A.C., K.E., A.L.), Department of Neurology, Division of Child Neurology, New York, NY; Newborn Screening Program (D.M.K., M.C., C.A.S.-M., C.F.S.), Division of Genetics, Wadsworth Center, New York State Department of Health, Albany; Cohen Children's Medical Center (O.I., E.L., K.H.), New Hyde Park, NY; Montefiore Medical Center (L.D.), Bronx, NY; Stony Brook University (S.O.T.), Department of Neurology, Stony Brook, NY; SUNY Downstate Medical Center (Y.A.), Brooklyn, NY; SUNY Upstate Medical Center (A.S.), Department of Neurology, Syracuse, NY; Albany Medical Center (C.K.), Department of Pediatrics, Genetics and Metabolism, NY; and University of Buffalo (O.F.), NY
| | - Emma Laureta
- From the Department of Neurology (B.H.L., S.D., E.C.), University of Rochester NY; Columbia University (C.A.C., K.E., A.L.), Department of Neurology, Division of Child Neurology, New York, NY; Newborn Screening Program (D.M.K., M.C., C.A.S.-M., C.F.S.), Division of Genetics, Wadsworth Center, New York State Department of Health, Albany; Cohen Children's Medical Center (O.I., E.L., K.H.), New Hyde Park, NY; Montefiore Medical Center (L.D.), Bronx, NY; Stony Brook University (S.O.T.), Department of Neurology, Stony Brook, NY; SUNY Downstate Medical Center (Y.A.), Brooklyn, NY; SUNY Upstate Medical Center (A.S.), Department of Neurology, Syracuse, NY; Albany Medical Center (C.K.), Department of Pediatrics, Genetics and Metabolism, NY; and University of Buffalo (O.F.), NY
| | - Leslie Delfiner
- From the Department of Neurology (B.H.L., S.D., E.C.), University of Rochester NY; Columbia University (C.A.C., K.E., A.L.), Department of Neurology, Division of Child Neurology, New York, NY; Newborn Screening Program (D.M.K., M.C., C.A.S.-M., C.F.S.), Division of Genetics, Wadsworth Center, New York State Department of Health, Albany; Cohen Children's Medical Center (O.I., E.L., K.H.), New Hyde Park, NY; Montefiore Medical Center (L.D.), Bronx, NY; Stony Brook University (S.O.T.), Department of Neurology, Stony Brook, NY; SUNY Downstate Medical Center (Y.A.), Brooklyn, NY; SUNY Upstate Medical Center (A.S.), Department of Neurology, Syracuse, NY; Albany Medical Center (C.K.), Department of Pediatrics, Genetics and Metabolism, NY; and University of Buffalo (O.F.), NY
| | - Simona O Treidler
- From the Department of Neurology (B.H.L., S.D., E.C.), University of Rochester NY; Columbia University (C.A.C., K.E., A.L.), Department of Neurology, Division of Child Neurology, New York, NY; Newborn Screening Program (D.M.K., M.C., C.A.S.-M., C.F.S.), Division of Genetics, Wadsworth Center, New York State Department of Health, Albany; Cohen Children's Medical Center (O.I., E.L., K.H.), New Hyde Park, NY; Montefiore Medical Center (L.D.), Bronx, NY; Stony Brook University (S.O.T.), Department of Neurology, Stony Brook, NY; SUNY Downstate Medical Center (Y.A.), Brooklyn, NY; SUNY Upstate Medical Center (A.S.), Department of Neurology, Syracuse, NY; Albany Medical Center (C.K.), Department of Pediatrics, Genetics and Metabolism, NY; and University of Buffalo (O.F.), NY
| | - Yaacov Anziska
- From the Department of Neurology (B.H.L., S.D., E.C.), University of Rochester NY; Columbia University (C.A.C., K.E., A.L.), Department of Neurology, Division of Child Neurology, New York, NY; Newborn Screening Program (D.M.K., M.C., C.A.S.-M., C.F.S.), Division of Genetics, Wadsworth Center, New York State Department of Health, Albany; Cohen Children's Medical Center (O.I., E.L., K.H.), New Hyde Park, NY; Montefiore Medical Center (L.D.), Bronx, NY; Stony Brook University (S.O.T.), Department of Neurology, Stony Brook, NY; SUNY Downstate Medical Center (Y.A.), Brooklyn, NY; SUNY Upstate Medical Center (A.S.), Department of Neurology, Syracuse, NY; Albany Medical Center (C.K.), Department of Pediatrics, Genetics and Metabolism, NY; and University of Buffalo (O.F.), NY
| | - Ai Sakonju
- From the Department of Neurology (B.H.L., S.D., E.C.), University of Rochester NY; Columbia University (C.A.C., K.E., A.L.), Department of Neurology, Division of Child Neurology, New York, NY; Newborn Screening Program (D.M.K., M.C., C.A.S.-M., C.F.S.), Division of Genetics, Wadsworth Center, New York State Department of Health, Albany; Cohen Children's Medical Center (O.I., E.L., K.H.), New Hyde Park, NY; Montefiore Medical Center (L.D.), Bronx, NY; Stony Brook University (S.O.T.), Department of Neurology, Stony Brook, NY; SUNY Downstate Medical Center (Y.A.), Brooklyn, NY; SUNY Upstate Medical Center (A.S.), Department of Neurology, Syracuse, NY; Albany Medical Center (C.K.), Department of Pediatrics, Genetics and Metabolism, NY; and University of Buffalo (O.F.), NY
| | - Chelsea Kois
- From the Department of Neurology (B.H.L., S.D., E.C.), University of Rochester NY; Columbia University (C.A.C., K.E., A.L.), Department of Neurology, Division of Child Neurology, New York, NY; Newborn Screening Program (D.M.K., M.C., C.A.S.-M., C.F.S.), Division of Genetics, Wadsworth Center, New York State Department of Health, Albany; Cohen Children's Medical Center (O.I., E.L., K.H.), New Hyde Park, NY; Montefiore Medical Center (L.D.), Bronx, NY; Stony Brook University (S.O.T.), Department of Neurology, Stony Brook, NY; SUNY Downstate Medical Center (Y.A.), Brooklyn, NY; SUNY Upstate Medical Center (A.S.), Department of Neurology, Syracuse, NY; Albany Medical Center (C.K.), Department of Pediatrics, Genetics and Metabolism, NY; and University of Buffalo (O.F.), NY
| | - Osman Farooq
- From the Department of Neurology (B.H.L., S.D., E.C.), University of Rochester NY; Columbia University (C.A.C., K.E., A.L.), Department of Neurology, Division of Child Neurology, New York, NY; Newborn Screening Program (D.M.K., M.C., C.A.S.-M., C.F.S.), Division of Genetics, Wadsworth Center, New York State Department of Health, Albany; Cohen Children's Medical Center (O.I., E.L., K.H.), New Hyde Park, NY; Montefiore Medical Center (L.D.), Bronx, NY; Stony Brook University (S.O.T.), Department of Neurology, Stony Brook, NY; SUNY Downstate Medical Center (Y.A.), Brooklyn, NY; SUNY Upstate Medical Center (A.S.), Department of Neurology, Syracuse, NY; Albany Medical Center (C.K.), Department of Pediatrics, Genetics and Metabolism, NY; and University of Buffalo (O.F.), NY
| | - Kristin Engelstad
- From the Department of Neurology (B.H.L., S.D., E.C.), University of Rochester NY; Columbia University (C.A.C., K.E., A.L.), Department of Neurology, Division of Child Neurology, New York, NY; Newborn Screening Program (D.M.K., M.C., C.A.S.-M., C.F.S.), Division of Genetics, Wadsworth Center, New York State Department of Health, Albany; Cohen Children's Medical Center (O.I., E.L., K.H.), New Hyde Park, NY; Montefiore Medical Center (L.D.), Bronx, NY; Stony Brook University (S.O.T.), Department of Neurology, Stony Brook, NY; SUNY Downstate Medical Center (Y.A.), Brooklyn, NY; SUNY Upstate Medical Center (A.S.), Department of Neurology, Syracuse, NY; Albany Medical Center (C.K.), Department of Pediatrics, Genetics and Metabolism, NY; and University of Buffalo (O.F.), NY
| | - Alexandra Laurenzano
- From the Department of Neurology (B.H.L., S.D., E.C.), University of Rochester NY; Columbia University (C.A.C., K.E., A.L.), Department of Neurology, Division of Child Neurology, New York, NY; Newborn Screening Program (D.M.K., M.C., C.A.S.-M., C.F.S.), Division of Genetics, Wadsworth Center, New York State Department of Health, Albany; Cohen Children's Medical Center (O.I., E.L., K.H.), New Hyde Park, NY; Montefiore Medical Center (L.D.), Bronx, NY; Stony Brook University (S.O.T.), Department of Neurology, Stony Brook, NY; SUNY Downstate Medical Center (Y.A.), Brooklyn, NY; SUNY Upstate Medical Center (A.S.), Department of Neurology, Syracuse, NY; Albany Medical Center (C.K.), Department of Pediatrics, Genetics and Metabolism, NY; and University of Buffalo (O.F.), NY
| | - Katherine Hogan
- From the Department of Neurology (B.H.L., S.D., E.C.), University of Rochester NY; Columbia University (C.A.C., K.E., A.L.), Department of Neurology, Division of Child Neurology, New York, NY; Newborn Screening Program (D.M.K., M.C., C.A.S.-M., C.F.S.), Division of Genetics, Wadsworth Center, New York State Department of Health, Albany; Cohen Children's Medical Center (O.I., E.L., K.H.), New Hyde Park, NY; Montefiore Medical Center (L.D.), Bronx, NY; Stony Brook University (S.O.T.), Department of Neurology, Stony Brook, NY; SUNY Downstate Medical Center (Y.A.), Brooklyn, NY; SUNY Upstate Medical Center (A.S.), Department of Neurology, Syracuse, NY; Albany Medical Center (C.K.), Department of Pediatrics, Genetics and Metabolism, NY; and University of Buffalo (O.F.), NY
| | - Michele Caggana
- From the Department of Neurology (B.H.L., S.D., E.C.), University of Rochester NY; Columbia University (C.A.C., K.E., A.L.), Department of Neurology, Division of Child Neurology, New York, NY; Newborn Screening Program (D.M.K., M.C., C.A.S.-M., C.F.S.), Division of Genetics, Wadsworth Center, New York State Department of Health, Albany; Cohen Children's Medical Center (O.I., E.L., K.H.), New Hyde Park, NY; Montefiore Medical Center (L.D.), Bronx, NY; Stony Brook University (S.O.T.), Department of Neurology, Stony Brook, NY; SUNY Downstate Medical Center (Y.A.), Brooklyn, NY; SUNY Upstate Medical Center (A.S.), Department of Neurology, Syracuse, NY; Albany Medical Center (C.K.), Department of Pediatrics, Genetics and Metabolism, NY; and University of Buffalo (O.F.), NY
| | - Carlos A Saavedra-Matiz
- From the Department of Neurology (B.H.L., S.D., E.C.), University of Rochester NY; Columbia University (C.A.C., K.E., A.L.), Department of Neurology, Division of Child Neurology, New York, NY; Newborn Screening Program (D.M.K., M.C., C.A.S.-M., C.F.S.), Division of Genetics, Wadsworth Center, New York State Department of Health, Albany; Cohen Children's Medical Center (O.I., E.L., K.H.), New Hyde Park, NY; Montefiore Medical Center (L.D.), Bronx, NY; Stony Brook University (S.O.T.), Department of Neurology, Stony Brook, NY; SUNY Downstate Medical Center (Y.A.), Brooklyn, NY; SUNY Upstate Medical Center (A.S.), Department of Neurology, Syracuse, NY; Albany Medical Center (C.K.), Department of Pediatrics, Genetics and Metabolism, NY; and University of Buffalo (O.F.), NY
| | - Colleen F Stevens
- From the Department of Neurology (B.H.L., S.D., E.C.), University of Rochester NY; Columbia University (C.A.C., K.E., A.L.), Department of Neurology, Division of Child Neurology, New York, NY; Newborn Screening Program (D.M.K., M.C., C.A.S.-M., C.F.S.), Division of Genetics, Wadsworth Center, New York State Department of Health, Albany; Cohen Children's Medical Center (O.I., E.L., K.H.), New Hyde Park, NY; Montefiore Medical Center (L.D.), Bronx, NY; Stony Brook University (S.O.T.), Department of Neurology, Stony Brook, NY; SUNY Downstate Medical Center (Y.A.), Brooklyn, NY; SUNY Upstate Medical Center (A.S.), Department of Neurology, Syracuse, NY; Albany Medical Center (C.K.), Department of Pediatrics, Genetics and Metabolism, NY; and University of Buffalo (O.F.), NY
| | - Emma Ciafaloni
- From the Department of Neurology (B.H.L., S.D., E.C.), University of Rochester NY; Columbia University (C.A.C., K.E., A.L.), Department of Neurology, Division of Child Neurology, New York, NY; Newborn Screening Program (D.M.K., M.C., C.A.S.-M., C.F.S.), Division of Genetics, Wadsworth Center, New York State Department of Health, Albany; Cohen Children's Medical Center (O.I., E.L., K.H.), New Hyde Park, NY; Montefiore Medical Center (L.D.), Bronx, NY; Stony Brook University (S.O.T.), Department of Neurology, Stony Brook, NY; SUNY Downstate Medical Center (Y.A.), Brooklyn, NY; SUNY Upstate Medical Center (A.S.), Department of Neurology, Syracuse, NY; Albany Medical Center (C.K.), Department of Pediatrics, Genetics and Metabolism, NY; and University of Buffalo (O.F.), NY
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Zhang JF, Nickerson K, Piryani R, Farooq O, Swayampakula AK. Macroglossia Associated With Clobazam Administration: A Case Report and Literature Review. Front Neurol 2022; 13:900763. [PMID: 35614921 PMCID: PMC9124931 DOI: 10.3389/fneur.2022.900763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/21/2022] [Accepted: 04/05/2022] [Indexed: 12/12/2022] Open
Abstract
Clobazam is a benzodiazepine derivative used as an antiepileptic agent for the treatment of focal and generalized seizures and drug-resistant epilepsy associated with Lennox-Gastaut Syndrome. While somnolence and mood-related side effects are commonly observed, acute macroglossia following initiation of Clobazam therapy has not been previously reported in the medical literature. In this case report, we present a female pediatric patient who developed significant tongue swelling with protrusion beyond the oral cavity after initiation of Clobazam for treatment-resistant epilepsy. Symptoms were unresponsive to antihistamines and steroids but resolved gradually in the days following discontinuation of Clobazam with no lingering sequelae.
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Affiliation(s)
- Jeff F. Zhang
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
- *Correspondence: Jeff F. Zhang
| | - Kevin Nickerson
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Ravi Piryani
- Division of Critical Care Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, Buffalo, NY, United States
| | - Osman Farooq
- Division of Pediatric Neurology, John R. Oishei Children's Hospital, Buffalo, NY, United States
| | - Anil K. Swayampakula
- Division of Critical Care Medicine, Department of Pediatrics, John R. Oishei Children's Hospital, Buffalo, NY, United States
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Zhang JF, Piryani R, Swayampakula AK, Farooq O. Levetiracetam‐induced aggression and acute behavioral changes: A case report and literature review. Clin Case Rep 2022; 10:e05586. [PMID: 35317062 PMCID: PMC8922949 DOI: 10.1002/ccr3.5586] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/28/2022] [Accepted: 02/25/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jeff F Zhang
- Jacobs School of Medicine and Biomedical Sciences University at Buffalo Buffalo New York USA
| | - Ravi Piryani
- Division of Critical Care Medicine Department of Pediatrics University at Buffalo Buffalo New York USA
| | - Anil K Swayampakula
- Division of Critical Care Medicine Department of Pediatrics University at Buffalo Buffalo New York USA
| | - Osman Farooq
- Division of Pediatric Neurology Oishei Children's Hospital Buffalo New York USA
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Jakimovski D, Awan S, Eckert SP, Farooq O, Weinstock-Guttman B. Multiple Sclerosis in Children: Differential Diagnosis, Prognosis, and Disease-Modifying Treatment. CNS Drugs 2022; 36:45-59. [PMID: 34940954 PMCID: PMC8697541 DOI: 10.1007/s40263-021-00887-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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] [Accepted: 12/02/2021] [Indexed: 12/19/2022]
Abstract
Pediatric-onset multiple sclerosis (POMS) is a rare neuroinflammatory and neurodegenerative disease that has a significant impact on long-term physical and cognitive patient outcomes. A small percentage of multiple sclerosis (MS) diagnoses occur before the age of 18 years. Before treatment initiation, a careful differential diagnosis and exclusion of other similar acquired demyelinating syndromes such as anti-aquaporin-4-associated neuromyelitis optica spectrum disorder (AQP4-NMOSD) and myelin oligodendrocyte glycoprotein antibody spectrum disorder (MOGSD) is warranted. The recent 2017 changes to the McDonald criteria can successfully predict up to 71% of MS diagnoses and have good specificity of 95% and sensitivity of 71%. Additional measures such as the presence of T1-weighted hypointense lesions and/or contrast-enhancing lesions significantly increase the accuracy of diagnosis. In adults, early use of disease-modifying therapies (DMTs) is instrumental to a better long-term prognosis, including lower rates of relapse and disability worsening, and numerous FDA-approved therapies for adult-onset MS are available. However, unlike their adult counterparts, the development, testing, and regulatory approval of POMS treatments have been significantly slower and hindered by logistic and/or ethical considerations. Currently, only two MS DMTs (fingolimod and teriflunomide) have been tested in large phase III trials and approved by regulatory agencies for use in POMS. First-line therapies not approved by the FDA for use in children (interferon-β and glatiramer acetate) are also commonly used and result in a significant reduction in inflammatory activity when compared with non-treated POMS patients. An increasing number of POMS patients are now treated with moderate efficacy therapies such as dimethyl fumarate and high-efficacy therapies such as natalizumab, anti-CD20 monoclonal antibodies, anti-CD52 monoclonal antibodies, and/or autologous hematopoietic stem cell transplantation. These high-efficacy DMTs generally provide additional reduction in inflammatory activity when compared with the first-line medications (up to 62% of relapse-rate reduction). Therefore, a number of phase II and III trials are currently investigating their efficacy and safety in POMS patients. In this review, we discuss potential changes in the regulatory approval process for POMS patients that are recommended for DMTs already approved for the adult MS population, including smaller sample size for pharmacokinetic/pharmacodynamic studies, MRI-centered primary outcomes, and/or inclusion of teenagers in the adult trials.
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Affiliation(s)
- Dejan Jakimovski
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Science, University of Buffalo, 1010 Main Street, Buffalo, NY 14202 USA ,Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY USA
| | - Samreen Awan
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Science, University of Buffalo, 1010 Main Street, Buffalo, NY 14202 USA
| | - Svetlana P. Eckert
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Science, University of Buffalo, 1010 Main Street, Buffalo, NY 14202 USA
| | - Osman Farooq
- Division of Pediatric Neurology, Oishei Children’s Hospital of Buffalo, Buffalo, NY USA ,Department of Neurology, Jacobs School of Medicine, State University of New York at Buffalo, Buffalo, NY USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Science, University of Buffalo, 1010 Main Street, Buffalo, NY, 14202, USA.
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Fanshawe J, Warren H, Clark C, Kum F, Smekal M, Masiha E, Saada L, Tan C, Deen S, Farooq O, Siddiqi M, Apata-Omisore J, Stroman L, Rusere J, Tasleem A, Nkwam N, Brown C, Elhage O, Cathcart P, Challacombe B, Popert R, Di Benedetto E, Hadjipavlou M. The role of psa density in decision making to perform transperineal prostate biopsy in men with multi-parametric MRI Likert 2 or 3 scores: A retrospective analysis from a multi-centre cancer network study. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01312-9] [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]
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8
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Jiang B, Hills NK, Forsyth R, Jordan LC, Slim M, Pavlakis SG, Freidman N, Dlamini N, Farooq O, Li Y, Zhu G, Fullerton H, Wintermark M, Lo WD. Imaging Predictors of Neurologic Outcome After Pediatric Arterial Ischemic Stroke. Stroke 2020; 52:152-161. [PMID: 33280552 DOI: 10.1161/strokeaha.120.030965] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To assess whether initial imaging characteristics independently predict 1-year neurological outcomes in childhood arterial ischemic stroke patients. METHODS We used prospectively collected demographic and clinical data, imaging data, and 1-year outcomes from the VIPS study (Vascular Effects of Infection in Pediatric Stroke). In 288 patients with first-time stroke, we measured infarct volume and location on the acute magnetic resonance imaging studies and hemorrhagic transformation on brain imaging studies during the acute presentation. Neurological outcome was assessed with the Pediatric Stroke Outcome Measure. We used univariate and multivariable ordinal logistic regression models to test the association between imaging characteristics and outcome. RESULTS Univariate analysis demonstrated that infarcts involving uncinate fasciculus, angular gyrus, insular cortex, or that extended from cortex to the subcortical nuclei were significantly associated with poorer outcomes with odds ratios ranging from 1.95 to 3.95. All locations except the insular cortex remained significant predictors of poor outcome on multivariable analysis. When infarct volume was added to the model, the locations did not remain significant. Larger infarct volumes and younger age at stroke onset were significantly associated with poorer outcome, but the strength of the relationships was weak. Hemorrhagic transformation did not predict outcome. CONCLUSIONS In the largest pediatric arterial ischemic stroke cohort collected to date, we showed that larger infarct volume and younger age at stroke were associated with poorer outcomes. We made the novel observation that the strength of these associations was modest and limits the ability to use these characteristics to predict outcome in children. Infarcts affecting specific locations were significantly associated with poorer outcomes in univariate and multivariable analyses but lost significance when adjusted for infarct volume. Our findings suggest that infarcts that disrupt critical networks have a disproportionate impact upon outcome after childhood arterial ischemic stroke.
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Affiliation(s)
- Bin Jiang
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA (B.J., Y.L., G.Z., M.W.)
| | - Nancy K Hills
- Department of Neurology, University of California, San Francisco (N.K.H., H.F.)
| | - Rob Forsyth
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kindgom (R.F.)
| | - Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN (L.C.J.)
| | - Mahmoud Slim
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada (M.S., N.D.)
| | | | - Neil Freidman
- Center for Pediatric Neurosciences, Cleveland Clinic, OH (N.F.)
| | - Nomazulu Dlamini
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada (M.S., N.D.)
| | - Osman Farooq
- Department of Neurology, Jacobs School of Medicine, University at Buffalo, NY (O.F.)
| | - Ying Li
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA (B.J., Y.L., G.Z., M.W.)
| | - Guangming Zhu
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA (B.J., Y.L., G.Z., M.W.)
| | - Heather Fullerton
- Department of Neurology, University of California, San Francisco (N.K.H., H.F.)
| | - Max Wintermark
- Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Palo Alto, CA (B.J., Y.L., G.Z., M.W.)
| | - Warren D Lo
- Department of Neurology and Pediatrics, The Ohio State University, Columbus (W.D.L.).,Departments of Pediatrics and Neurology, Nationwide Children's Hospital, Columbus, OH (W.D.L.)
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Saraswat DK, Fung PH, Dong A, Sultanian R, Farooq O, Wong C. A160 THE EFFECT OF AN INSTRUCTIVE VIDEO ON THE BOWEL PREPARATION EXPERIENCE. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.159] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Over 26000 new cases of colorectal cancer (CRC) are diagnosed each year in Canada. This number has been decreased significantly by the implementation of CRC screening that includes removal of any polyps found during colonoscopies. Despite this, approximately 1 in 4 colonoscopies are inadequate for the detection of early neoplasms due to insufficient bowel preparation prior to the colonoscopy. Consequently, there is a need to improve patient adherence to the bowel preparation protocol. Previous research has shown that enhanced education, including the methods and rationale for bowel preparation prior to a colonoscopy, improves the quality of the bowel preparation.
Aims
We hypothesised that patients with access to a replayable video explaining the bowel preparation protocol and its importance would have increased satisfaction and noninferior bowel preparations.
Methods
100 patients undergoing programmatic screening colonoscopy were randomly assigned into one of two groups. The control group was given the standard presentation currently given to patients. The experimental group was given the same presentation and also given access to an educational video. This video is based on Alberta provincial bowel preparations which have been tested and evaluated. Participants in both groups were sent a survey one day after their colonoscopy. Subjects completed a modified version of the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems survey with added questions designed to assess their satisfaction with the education they received on the bowel preparation. Bowel preparation quality was assessed on a 4-point Likert scale by the endoscopist.
Results
17 participants (10 female), aged 40–72 (Mage = 60) have enrolled in the study thus far; however, most have yet to have their colonoscopy. Initial results revealed that all participants had high levels of satisfaction with the presentation they were given. Those in the control group indicated that they would have liked to have had access to a video guide to the bowel preparation before their procedure. The participant in the experimental group indicated high levels of satisfaction with this video, noting that it provided important information not available from other sources. Information on the quality of their bowel preparations is pending.
Conclusions
The use of multimedia explanations of the bowel preparation has promise in improving patient satisfaction with the bowel preparation. Further studies may guide best methods for implementing a video assisted educational model to enhance colonoscopy preparation.
Funding Agencies
The first author received an Edna Wakefield Rowe Memorial Summer Research Award from the Faculty of Medicine & Dentistry at the University of Alberta to support this work.
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Affiliation(s)
- D K Saraswat
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - P H Fung
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - A Dong
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - R Sultanian
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - O Farooq
- Division of General Surgery, University of Alberta, Edmonton, AB, Canada
| | - C Wong
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
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10
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Rukhsar S, Khan Y, Farooq O, Sarfraz M, Khan A. Patient-Specific Epileptic Seizure Prediction in Long-Term Scalp EEG Signal Using Multivariate Statistical Process Control. Ing Rech Biomed 2019. [DOI: 10.1016/j.irbm.2019.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Weinstock A, Agarwal N, Farooq O, Cheema Z, Hamilton D, Parrish J. Evaluation of the Effects of Clobazam on Seizure Control and Quality of Life in Children With Lennox-Gastaut Syndrome: A Pilot Study. J Child Neurol 2019; 34:432-439. [PMID: 30913948 DOI: 10.1177/0883073819836534] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This is a prospective study of children with Lennox-Gastaut syndrome receiving clobazam as adjunctive therapy. This pilot study aims to examine medication effectiveness as it relates to seizure reduction, as well as improvement in parent-reported behavior and quality of life (QOL). METHODS Ten patients with Lennox-Gastaut syndrome aged 3-11 years were enrolled in this 6-week, 4 phase study. Seizure frequency, QOL, and Aberrant Behavior Checklist questionnaires were evaluated at 0, 2, 6, and 10 weeks during the study. RESULTS Patients showed improvement on indices of QOL, including physical activities (62.5%), well-being (37.5%), cognition (87.5%), social activities (37.5%), behavior (87.5%), general health (50%), and overall QOL (87.5%). The Quality of Life in Childhood Epilepsy (QOLCE) questionnaire revealed significant improvement in cognition (P = .008), social activities (P = .049), behavior (P = .038), and overall QOL (P = .018). The Aberrant Behavior Checklist exhibited a trend toward improvement in hyperactivity. CONCLUSION There was improvement in all patients with documented baseline seizures (8/10), with 5 showing significant improvement (95%-100% reduction) and 3 showing minor improvement (7%-23% reduction). Statistically significant improvement in areas of cognition, social activities, behavior, and overall QOL were seen. An overall trend toward a positive well-being was seen in our patients with clobazam, as adjunct therapy for Lennox-Gastaut syndrome in children.
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Affiliation(s)
- Arie Weinstock
- 1 Division of Child Neurology, The Women and Children's Hospital of Buffalo, Buffalo, NY, USA.,2 Department of Neurology, Jacobs School of Medicine at the University at Buffalo, Buffalo, NY, USA
| | | | - Osman Farooq
- 1 Division of Child Neurology, The Women and Children's Hospital of Buffalo, Buffalo, NY, USA.,2 Department of Neurology, Jacobs School of Medicine at the University at Buffalo, Buffalo, NY, USA
| | - Zaheer Cheema
- 1 Division of Child Neurology, The Women and Children's Hospital of Buffalo, Buffalo, NY, USA.,2 Department of Neurology, Jacobs School of Medicine at the University at Buffalo, Buffalo, NY, USA
| | - Deanna Hamilton
- 1 Division of Child Neurology, The Women and Children's Hospital of Buffalo, Buffalo, NY, USA
| | - Joy Parrish
- 2 Department of Neurology, Jacobs School of Medicine at the University at Buffalo, Buffalo, NY, USA
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12
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Abstract
Alice in Wonderland syndrome is a disorienting neurological condition that affects human perception to the senses of vision, hearing, touch, sensation, and the phenomenon of time. Individuals affected with Alice in Wonderland syndrome can experience alterations in their perception of the size of objects or their own body parts, known as metamorphopsias. It is known to occur in conditions including migraine, epilepsy, and certain intoxicants and infectious diseases. The name refers to Lewis Carrol's well-known children's book Alice's Adventures in Wonderland, in which the title character experiences alterations of sensation in which she felt that her body had grown too tall or too small, or parts of her body were changing shape, size, or relationship to the rest of her body. The syndrome was described in 1952 by Caro Lippman, and given its name in 1955 by John Todd. The metamorphopsias characteristic of this condition are also sometimes referred to as Lilliputian hallucinations, a reference to the fictional island of Lilliput in the novel Gulliver's Travels, written by Jonathan Swift in 1726. As such, many literary and medical publications have roots in the description of this syndrome. The purpose of this review is to summarize the literary and historical significance of Alice in Wonderland syndrome, as well as to provide the reader with a medical overview of the condition.
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Affiliation(s)
- Osman Farooq
- Division of Pediatric Neurology, Women and Children's Hospital of Buffalo, Buffalo, New York; Department of Neurology, Jacobs School of Medicine, State University of New York at Buffalo, Buffalo, New York.
| | - Edward J Fine
- Department of Neurology, Jacobs School of Medicine, State University of New York at Buffalo, Buffalo, New York
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13
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Agarwal N, Arkilo D, Farooq O, Gillogly C, Kavak KS, Weinstock A. Ketogenic diet: Predictors of seizure control. SAGE Open Med 2017; 5:2050312117712887. [PMID: 28620490 PMCID: PMC5464518 DOI: 10.1177/2050312117712887] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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] [Received: 06/21/2016] [Accepted: 05/10/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The ketogenic diet is an effective non-pharmacologic treatment for medically resistant epilepsy. The aim of this study was to identify any predictors that may influence the response of ketogenic diet. METHODS A retrospective chart review for all patients with medically resistant epilepsy was performed at a tertiary care epilepsy center from 1996 to 2012. Patient- and diet-related variables were evaluated with respect to seizure reduction at 1, 3, 6, 9 and 12-month intervals and divided into four possible outcome classes. RESULTS Sixty-three patients met inclusion. Thirty-seven (59%) reported >50% seizure reduction at 3 months with 44% and 37% patients benefiting at 6-month and 12-month follow up, respectively. A trend toward significant seizure improvement was noted in 48% patients with seizure onset >1 year at 12-month (p = 0.09) interval and in 62% patients with >10 seizure/day at 6-month interval (p = 0.054). An ordinal logistic regression showed later age of seizure to have higher odds of favorable response at 1-month (p = 0.005) and 3-month (p = 0.013) follow up. Patients with non-fasting diet induction were more likely to have a favorable outcome at 6 months (p = 0.008) as do females (p = 0.037) and those treated with higher fat ratio diet (p = 0.034). CONCLUSION Our study reports the effectiveness of ketogenic diet in children with medically resistant epilepsy. Later age of seizure onset, female gender, higher ketogenic diet ratio and non-fasting induction were associated with better odds of improved seizure outcome. A larger cohort is required to confirm these findings.
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Affiliation(s)
- Nitin Agarwal
- Department of Pediatric Neurology, The State University of New York at Buffalo, Buffalo, NY, USA.,Department of Pediatric Neurology, Children's Hospitals and Clinics of Minnesota, St. Paul, MN, USA.,Minnesota Epilepsy Group, P.A., United Hospital and Children's Hospitals and Clinics of Minnesota, St. Paul, MN, USA
| | - Dimitrios Arkilo
- Minnesota Epilepsy Group, P.A., United Hospital and Children's Hospitals and Clinics of Minnesota, St. Paul, MN, USA
| | - Osman Farooq
- Department of Pediatric Neurology, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Cynthia Gillogly
- Department of Pediatric Neurology, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Katelyn S Kavak
- Department of Pediatric Neurology, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Arie Weinstock
- Department of Pediatric Neurology, The State University of New York at Buffalo, Buffalo, NY, USA
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14
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Mahfooz N, Weinstock A, Afzal B, Noor M, Lowy DV, Farooq O, Finnegan SG, Lakshminrusimha S. Optimal Duration of Continuous Video-Electroencephalography in Term Infants With Hypoxic-Ischemic Encephalopathy and Therapeutic Hypothermia. J Child Neurol 2017; 32:522-527. [PMID: 28112011 DOI: 10.1177/0883073816689325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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] [Indexed: 11/16/2022]
Abstract
Continuous video-electroencephalography (EEG) is an important diagnostic and prognostic tool in newborns with hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia. The optimal duration of continuous video-EEG during whole-body hypothermia is not known. We conducted a retrospective study of 35 neonates with hypoxic-ischemic encephalopathy undergoing whole-body hypothermia with continuous video-EEG. EEG ictal changes were detected in 9/35 infants (26%). Of these 9 infants, the seizures were initially observed within 30 minutes of EEG monitoring in 6 (67%), within 24 hours in 2 (22%), and during rewarming in 1 infant (11%). No new seizures were detected between 24-72 hours of therapeutic hypothermia. Background suppression was detected in 14 infants (40%) by 24 hours. In neonates with hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia, continuous video-EEG has the highest diagnostic yield within the first 24 hours and during the rewarming phase. In the absence of prior seizures or antiepileptic therapy, limiting continuous video-EEG to these periods in resource-limited settings may reduce cost during therapeutic hypothermia.
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Affiliation(s)
- Naeem Mahfooz
- 1 Department of Neurology, Division of Pediatric Neurology, Women & Children's Hospital of New York, State University of New York at Buffalo, Buffalo, NY, USA.,2 Neurological Institute, Epilepsy Center, Cleveland, OH, USA
| | - Arie Weinstock
- 1 Department of Neurology, Division of Pediatric Neurology, Women & Children's Hospital of New York, State University of New York at Buffalo, Buffalo, NY, USA
| | - Bushra Afzal
- 3 Division of Neonatology, Department of Pediatrics, Women & Children's Hospital of New York, State University of New York at Buffalo, Buffalo, NY, USA
| | - Mariam Noor
- 1 Department of Neurology, Division of Pediatric Neurology, Women & Children's Hospital of New York, State University of New York at Buffalo, Buffalo, NY, USA
| | - David Vargas Lowy
- 3 Division of Neonatology, Department of Pediatrics, Women & Children's Hospital of New York, State University of New York at Buffalo, Buffalo, NY, USA
| | - Osman Farooq
- 1 Department of Neurology, Division of Pediatric Neurology, Women & Children's Hospital of New York, State University of New York at Buffalo, Buffalo, NY, USA
| | - Sarah G Finnegan
- 1 Department of Neurology, Division of Pediatric Neurology, Women & Children's Hospital of New York, State University of New York at Buffalo, Buffalo, NY, USA
| | - Satyan Lakshminrusimha
- 3 Division of Neonatology, Department of Pediatrics, Women & Children's Hospital of New York, State University of New York at Buffalo, Buffalo, NY, USA
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15
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Din F, Agarwal N, Mahfooz N, Hafeez MU, Ahmad R, Farooq O. Lyme in the coconut: Paediatric neuroborreliosis. J Paediatr Child Health 2016; 52:1042. [PMID: 28967678 DOI: 10.1111/jpc.13310] [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] [Received: 05/18/2016] [Revised: 06/07/2016] [Accepted: 06/07/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Farid Din
- Department of Pediatric Neurology, State University of New York at Buffalo, Buffalo, New York, United States of America
| | - Nitin Agarwal
- Department of Pediatric Neurology, Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota, United States of America
| | - Naeem Mahfooz
- Department of Pediatric Neurology, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Muhammad U Hafeez
- Department of Pediatric Neurology, State University of New York at Buffalo, Buffalo, New York, United States of America
| | - Rahil Ahmad
- Department of Pediatric Neurology, State University of New York at Buffalo, Buffalo, New York, United States of America
| | - Osman Farooq
- Department of Pediatric Neurology, State University of New York at Buffalo, Buffalo, New York, United States of America
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Farooq O. Embarrassing moments. J Paediatr Child Health 2016; 52:971-972. [PMID: 27739203 DOI: 10.1111/jpc.13346] [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] [Received: 06/02/2016] [Accepted: 06/07/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Osman Farooq
- Department of Pediatric Neurology, State University of New York at Buffalo, Buffalo, New York, United States
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Beatty C, Bowler RA, Farooq O, Dudeck L, Ramasamy D, Yeh EA, Zivadinov R, Weinstock-Guttman B, Parrish JB. Long-Term Neurocognitive, Psychosocial, and Magnetic Resonance Imaging Outcomes in Pediatric-Onset Acute Disseminated Encephalomyelitis. Pediatr Neurol 2016; 57:64-73. [PMID: 26996404 DOI: 10.1016/j.pediatrneurol.2016.01.003] [Citation(s) in RCA: 18] [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: 11/12/2014] [Revised: 12/12/2015] [Accepted: 01/01/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute disseminated encephalomyelitis (ADEM) is a demyelinating disorder that is usually self-limited. Recent studies have suggested ongoing neurological deficits and neurocognitive impairment in these patients. Little information on the correlation of clinical and neuroimaging markers in ADEM is available. We examined potential clinical factors (e.g., age of onset, acute symptom duration, magnetic resonance imaging [MRI] lesions) and their relation to neurocognitive and psychosocial outcomes. METHODS This is a retrospective chart review of consecutive pediatric patients diagnosed with ADEM between 2006 and 2012. Patients were evaluated with standard neurological assessment, MRI of the brain, and neuropsychological evaluation. RESULTS Twenty-three patients with ADEM with average age at neuropsychological assessment of 10.1 years (±3.50) were included. Five (22.7%) patients were impaired on three or more neurocognitive measures. Psychosocial problems were reported in 20%-40% of patients. Earlier age of onset was correlated with poorer sustained attention and psychosocial problems, whereas acute symptom duration and Expanded Disability Status Scale were not. MRI outcomes were correlated with psychosocial outcomes but not neuropsychological findings. CONCLUSIONS Our findings suggest lingering cognitive and psychosocial deficits in children with a history of ADEM. Clinical features and MRI findings correlated more strongly with psychosocial outcomes than cognitive functioning. Further studies are needed to confirm relationships and other possible contributing factors to lingering deficits.
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Affiliation(s)
- Cynthia Beatty
- Division of Pediatric Neurology, Department of Neurology, University at Buffalo, Women & Children's Hospital of Buffalo, Buffalo, New York
| | - Rachael A Bowler
- Department of Neurology, University at Buffalo, Buffalo, New York
| | - Osman Farooq
- Division of Pediatric Neurology, Department of Neurology, University at Buffalo, Women & Children's Hospital of Buffalo, Buffalo, New York
| | - Lindsay Dudeck
- Division of Pediatric Neurology, Department of Neurology, University at Buffalo, Women & Children's Hospital of Buffalo, Buffalo, New York
| | - Deepa Ramasamy
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Buffalo, New York
| | - E Ann Yeh
- Department of Neurology, Sick Kids Hospital, Toronto, Canada
| | - Robert Zivadinov
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Buffalo, New York
| | | | - Joy B Parrish
- Department of Neurology, University at Buffalo, Buffalo, New York.
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Kohli S, Farooq O, Jani RB, Wolfe GI. Cerebral paragonimiasis: an unusual manifestation of a rare parasitic infection. Pediatr Neurol 2015; 52:366-9. [PMID: 25556153 DOI: 10.1016/j.pediatrneurol.2014.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 07/25/2014] [Revised: 10/27/2014] [Accepted: 11/01/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Paragonimiasis is a parasitic disease that typically produces a subacute to chronic inflammatory disease of the lung. Although rare in the United States, paragonimiasis is sporadically observed in the immigrant population. Rarely, paragonimiasis can affect the nervous system. This infection is even more unusual in the pediatric population, and therefore can be challenging to diagnose. PATIENTS Here we present a child with cerebral paragonimiasis. She presented with new onset seizures in the setting of a febrile illness. Magnetic resonance imaging of the brain with contrast revealed a ring-enhancing lesion within the right frontal lobe and a second lesion in the left parietal lobe extending from the cortex to the centrum semiovale. Extensive evaluation including stool ova and parasite analysis confirmed the diagnosis of Paragonimus westermani. She was treated with praziquantel and prednisone and improved both clinically and radiographically. CONCLUSIONS Cerebral paragonimiasis is diagnosable and treatable and therefore is important to consider in the differential of immigrants presenting with cavitary lung lesions and central nervous system findings.
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Affiliation(s)
- Supriya Kohli
- Department of Neurology, University at Buffalo School of Medicine and Biomedical Sciences, The State University of New York, Buffalo, New York
| | - Osman Farooq
- Department of Neurology, University at Buffalo School of Medicine and Biomedical Sciences, The State University of New York, Buffalo, New York.
| | - Ronak B Jani
- Department of Neurology, University at Buffalo School of Medicine and Biomedical Sciences, The State University of New York, Buffalo, New York
| | - Gil I Wolfe
- Department of Neurology, University at Buffalo School of Medicine and Biomedical Sciences, The State University of New York, Buffalo, New York
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Affiliation(s)
- Lubna Jafri
- Dow University of Health Sciences, Karachi, Pakistan
| | - Osman Farooq
- Department of Pediatric Neurology, University of Buffalo, Buffalo, New York.
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Parrish JB, Farooq O, Weinstock-Guttman B. Cognitive deficits in pediatric-onset multiple sclerosis: what does the future hold? Neurodegener Dis Manag 2014; 4:137-46. [PMID: 24832031 DOI: 10.2217/nmt.14.4] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Pediatric-onset multiple sclerosis is relatively rare and research regarding disease characteristics is in its infancy. Regardless, there are a growing number of studies finding early cognitive deficits in this population. There are some similarities in outcomes to those seen in the adult-onset multiple sclerosis population, but also several important differences. With specific regard to cognitive functioning in pediatric-onset multiple sclerosis, there is evidence of deficit in nearly a third of patients, with impairment primarily in areas of processing speed, visual-spatial processing and language. There are additional findings of fatigue and depression that impact functional outcomes requiring further attention in assessment and treatment considerations. This paper also explores other areas requiring increased focus, including treatment and outcomes, neuroimaging and additional disease-modifying factors (comorbidities, socioeconomic status, race and so on).
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Affiliation(s)
- Joy B Parrish
- Department of Neurology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo General Medical Center, 100 High Street, Ste. D-2, Buffalo, NY 14203, USA
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21
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Affiliation(s)
- Aisha Bushra
- Department of Pediatric Neurology, State University of New York at Buffalo, Buffalo, New York
| | - Naeem Mahfooz
- Department of Pediatric Neurology, State University of New York at Buffalo, Buffalo, New York
| | - Osman Farooq
- Department of Pediatric Neurology, State University of New York at Buffalo, Buffalo, New York.
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22
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Goldberg H, Weinstock A, Bergsland N, Dwyer MG, Farooq O, Sazgar M, Poloni G, Treu C, Weinstock-Guttman B, Ramanathan M, Zivadinov R. MRI segmentation analysis in temporal lobe and idiopathic generalized epilepsy. BMC Neurol 2014; 14:131. [PMID: 24938118 PMCID: PMC4070342 DOI: 10.1186/1471-2377-14-131] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 06/10/2014] [Indexed: 11/21/2022] Open
Abstract
Background Temporal lobe epilepsy (TLE) and idiopathic generalized epilepsy (IGE) patients have each been associated with extensive brain atrophy findings, yet to date there are no reports of head to head comparison of both patient groups. Our aim was to assess and compare between tissue-specific and structural brain atrophy findings in TLE to IGE patients and to healthy controls (HC). Methods TLE patients were classified in TLE lesional (L-TLE) or non-lesional (NL-TLE) based on presence or absence of MRI temporal structural abnormalities. High resolution 3 T MRI with automated segmentation by SIENAX and FIRST tools were performed in a group of patients with temporal lobe epilepsy (11 L-TLE and 15 NL-TLE) and in15 IGE as well as in 26 HC. Normal brain volume (NBV), normal grey matter volume (NGMV), normal white matter volume (NWMV), and volumes of subcortical deep grey matter structures were quantified. Using regression analyses, differences between the groups in both volume and left/right asymmetry were evaluated. Additionally, laterality of results was also evaluated to separately quantify ipsilateral and contralateral effects in the TLE group. Results All epilepsy groups had significantly lower NBV and NWMV compared to HC (p < 0.001). L-TLE had lower hippocampal volume than HC and IGE (p = 0.001), and all epilepsy groups had significantly lower amygdala volume than HC (p < = 0.004). In L-TLE, there was evidence of atrophy in both ipsilateral and contralateral structures. Conclusions Our study revealed that TLE and IGE patients demonstrated similar overall tissue-specific brain atrophy, although specific structures differences were appreciated. L-TLE also appeared to behave differently than NL-TLE, with atrophy not limited to the ipsilateral side.
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Affiliation(s)
| | - Arie Weinstock
- Comprehensive Epilepsy Program, State University of New York, Buffalo, NY, USA.
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Farooq O, Kirmani A, Agarwal N, Purushotham H, Kandel A. Visual diagnosis: 6-month-old boy with strange body movements. Pediatr Rev 2014; 35:e20-4. [PMID: 24692159 DOI: 10.1542/pir.35-4-e20] [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: 11/24/2022]
Affiliation(s)
- Osman Farooq
- Department of Pediatric Neurology, University of Buffalo, The State University of New York, Buffalo, NY
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24
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Weinstock A, Ruiz M, Gerard D, Toublanc N, Stockis A, Farooq O, Dilley D, Karmon Y, Elgie MJ, Schiemann-Delgado J. Prospective Open-Label, Single-Arm, Multicenter, Safety, Tolerability, and Pharmacokinetic Studies of Intravenous Levetiracetam in Children With Epilepsy. J Child Neurol 2013; 28:1423-1429. [PMID: 23533164 DOI: 10.1177/0883073813480241] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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] [Indexed: 11/16/2022]
Abstract
Levetiracetam given via intravenous administration has been shown to be an effective alternative in adults with epilepsy when oral administration is not feasible. This study was a prospective single-arm, multicenter study to assess tolerability, safety, and pharmacokinetics of intravenous levetiracetam in children with epilepsy. Children with epilepsy ages 1 month to 16 years requiring intravenous levetiracetam were enrolled. Assessments included vital signs, electrocardiogram, hematology, chemistry, plasma concentrations of antiepileptic medications, weight, physical/neurological examinations, and pharmacokinetics. A total of 52 patients were enrolled. Mild to moderate treatment-emergent adverse events occurred in 63%, the most frequent being pyrexia and dry mouth. Most other treatment-emergent adverse events were considered unrelated to intravenous levetiracetam administration. Therefore, intravenous levetiracetam in the acute setting was overall well tolerated in children 1 month to 16 years.
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Affiliation(s)
- Arie Weinstock
- 1State University of New York at Buffalo, Buffalo, NY, USA
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25
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Sternberg Z, Ching M, Sawyer RN, Chichelli T, Li F, Janicke D, Radovic V, Mehta B, Farooq O, Munschauer FE. Clopidogrel Responsiveness in Stroke Patients on a Chronic Aspirin Regimen. J Stroke Cerebrovasc Dis 2013; 22:725-32. [DOI: 10.1016/j.jstrokecerebrovasdis.2011.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 11/27/2011] [Accepted: 11/28/2011] [Indexed: 10/14/2022] Open
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26
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Menascu S, Weinstock A, Farooq O, Hoffman H, Cortez MA. EEG and neuroimaging correlations in children with lissencephaly. Seizure 2013; 22:189-93. [PMID: 23298604 DOI: 10.1016/j.seizure.2012.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 04/13/2012] [Revised: 12/01/2012] [Accepted: 12/03/2012] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To study the usefulness of EEG in the diagnosis of lissencephaly, a rare cortical developmental disorder associated with abnormal cellular proliferation. Currently, the clinical emphasis is placed on the radiological and genetic aspects for the diagnosis of lissencephaly. METHODS This is a retrospective review of consecutive EEG recordings and imaging data from 14 children, with the diagnosis of lissencephaly, who were admitted from January 1998 to January 2010. All EEG recordings were performed with the 10-20 system of electrode placement, in both awake and sleep states. All EEG recordings were reviewed using anterior-posterior bipolar and transverse montages and then they were interpreted blindly, with respect to the imaging and genetic investigations for each patient. RESULTS All children showed one of the three characteristic EEG patterns reported in the literature of lissencephaly. The EEG pattern I, showed an anterior posterior gradient that corresponded to the severity of the imaging study abnormality. All patients were on two or more AEDs and reported to continue having active epilepsy. CONCLUSION In a child with clinical characteristics of lissencephaly, one of these three reported EEG patterns can prove useful in making the diagnosis very probable, preceding imaging and genetic testing.
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Affiliation(s)
- S Menascu
- Pediatric Neurology Unit, Edmond & Lili Safra Children's Hospital, Sheba Medical Center, Israel
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27
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Farooq O, Fine EJ. Neurognostics question: an American physician-physiologist who had profound impacts on physiology and medical education in the United States. Henry Pickering Bowditch. J Hist Neurosci 2013; 22:198-224. [PMID: 23586548 DOI: 10.1080/0964704x.2012.678044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Osman Farooq
- Women and Children's Hospital of Buffalo, Department of Pediatric Neurology, Buffalo, NY 14222, USA.
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28
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Fine E, Riggins N, Farooq O. Evoking Potentials from the Brain (P04.009). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.009] [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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Farooq O, Faden HS, Cohen ME, Ramanathan M, Barrett H, Farkas MK, Langan TJ, Yeh EA. Neurologic complications of 2009 influenza-a H1N1 infection in children. J Child Neurol 2012; 27:431-8. [PMID: 21997845 DOI: 10.1177/0883073811417873] [Citation(s) in RCA: 14] [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] [Indexed: 11/17/2022]
Abstract
Little is known about the neurologic complications of the 2009 Influenza-A H1N1 epidemic in children. We present a retrospective analysis of children evaluated at a tertiary children's hospital who tested positive for H1N1 with neurologic complications. A total of 164 children tested positive for H1N1. Thirty-one of these patients (19%) were evaluated and discharged from the emergency department. Thirty-nine (24%) were treated in the intensive care unit, the remaining 94 (57%) were treated in medical in-patient units. Six subjects died (3.7%). Neurologic complications identified included headache, encephalitis, polyneuropathy, seizures, and malignant hyperthermia. The rate of neurologic complications in this cohort of patients who tested positive for H1N1 was 19%. The incidence of serious neurologic complications was 3%, with another 3% of patients who experienced rapid clinical deterioration and subsequently died. Our observation of neurologic complications associated with 2009 influenza-A H1N1 epidemic suggests the need for clinical vigilance during future influenza epidemics.
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Affiliation(s)
- Osman Farooq
- Women and Children's Hospital of Buffalo, Buffalo, NY, USA.
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Farooq O, Memon Z, Saikali N, Langan TJ. A 4-year-old male who has a persistent, severe headache. Pediatr Rev 2012; 33:175-7. [PMID: 22474115 DOI: 10.1542/pir.33-4-175] [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: 11/24/2022]
Affiliation(s)
- Osman Farooq
- Department of Pediatric Neurology, University of Buffalo, SUNY, Buffalo, NY, USA
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31
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Affiliation(s)
- Osman Farooq
- Department of Pediatric Neurology, Women and Children's Hospital of Buffalo, University of Buffalo, Buffalo, NY 14222, USA.
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Abstract
We report a child who developed agitation and choreoathetoid movements with azithromycin therapy on 2 separate occasions. In both instances, the symptoms resolved when the antibiotic was discontinued. By means of the Naranjo adverse drug reaction probability scale, we classified this event as a probable adverse drug reaction (score of 6 points). To our knowledge, this is the first published case of azithromycin-induced agitation with choreoathetosis. Because this is a widely used medication for many common infectious conditions, including otitis media and pneumonia, this potential serious adverse reaction should be considered.
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Affiliation(s)
- Osman Farooq
- Department of Pediatrics, Women and Children's Hospital of Buffalo, Buffalo, NY, USA.
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O'Neil KM, Varma C, Farooq O, Memon A. Glucocorticoid-responsive hypertension in Henoch-Schonlein purpura. Clin Pediatr (Phila) 2010; 49:702-6. [PMID: 20164069 DOI: 10.1177/0009922809359420] [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: 11/15/2022]
Affiliation(s)
- Kathleen M O'Neil
- Department of Pediatrics, Division of Pediatric Rheumatology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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34
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Affiliation(s)
- Osman Farooq
- Department of Pediatrics, Division of Child Neurology, Women and Children's Hospital of Buffalo, Buffalo, New York, USA.
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35
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Goldin S, Cannarozzi M, Wahi M, Arce M, Farooq A, Farooq O, Schrock C, Shah N, Nixon L. QS78. Student Quality-of-Life Declines Equally on Third-Year Surgical and Internal Medicine/Pediatrics Clerkships. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.372] [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: 11/28/2022]
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Debas HT, Farooq O, Grossman MI. Inhibition of gastric emptying is a physiological action of cholecystokinin. Gastroenterology 1975; 68:1211-7. [PMID: 1126597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
This study was designed to determine whether cholecystokinin (CCK) plays a physiological role in the inhibition of gastric emptying. Physiological conditions were simulated by giving CCK by continuous intravenous infusion rather than by bolus injection, by using doses known to be distinctly submaximal for pancreatic protein secretion, and for gallbladder contraction, and by releasing endogenous CCK. The rate of gastric emptying was determined in 4 dogs with gastric fistulas by measuring the volume of fluid remaining in the stomach 10 min after instillation of 300 ml of 0.15 M NaCl. Rate of emptying was studied during intravenous infusion of saline (control) and of different doses of 98% pure CCK, commerically available 20% pure CCK, synthetic COOH-terminal octapeptide of CCK (OP-CCK), pentagastrin, and heptadecapeptide gastrin. The effect of endogenously released CCK was studied by measuring the rate of emptying of solutions in which different concentrations of tryptophan replaced equiosmolar amounts of NaCl. The d50's of 20% pure CCK (3 U kg minus-1 hr minus-1) and of OP-CCK (125 ng kg minus-1 hr minus-1) for inhibition of gastric emptying were about the same as their D50's for cholecystokinetic and pancreozyminic actions. By contrast, although both pentagastrin and heptadecapeptide gastrin inhibited gastric emptying, the doses required for this action were much higher than the D50's required for stimulation of gastric acid secretion. The effectiveness of OP-CCK indicates that inhibition of gastric emptying is attributable to CCK itself and not to an impurity in the CCK preparation. We have confirmed this directly by showing that pure CCK is a potent inhibitor of gastric emptying. Tryptophan also inhibited gastric emptying. In other dogs pancreatic protein secretion and gallbladder contraction were shown to be stimulated during the time tryptophan was inhibiting gastric emptying. This evidence supports the view that inhibition of gastric emptying is one of the physiological actions of CCK, but in the case of gastrin it must be regarded as a pharmacological action.
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Farooq O, Walsh JH. Atropine enhances serum gastrin response to insulin in man. Gastroenterology 1975; 68:662-6. [PMID: 235480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Farooq O, Isenberg JI. Effect of continuous intravenous infusion of insulin versus rapid intravenous injection of insulin on gastric acid secretion in man. Gastroenterology 1975; 68:683-6. [PMID: 1123136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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42
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Farooq O, Sturdevant RA, Isenberg JI. Comparison of synthetic and natural porcine secretins on human pancreatic secretion. Gastroenterology 1974; 66:204-9. [PMID: 4855752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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