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Shah LM, Turner Z, Bessone SK, Winesett SP, Stanfield A, Kossoff EH. How often is antiseizure drug-free ketogenic diet therapy achieved? Epilepsy Behav 2019; 93:29-31. [PMID: 30831398 DOI: 10.1016/j.yebeh.2019.01.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/18/2019] [Accepted: 01/28/2019] [Indexed: 11/29/2022]
Abstract
The ketogenic diet (KD) is often started not only for seizure reduction but also to potentially wean antiseizure drugs (ASDs) in children with epilepsy. Although there have been several publications regarding ASD reduction on the KD, it is unknown how often complete medication withdrawal occurs. We reviewed the charts of all children started on the KD at Johns Hopkins Hospital and Johns Hopkins All Children's Hospital from 1/11 to 4/18. Children were defined as achieving drug-free diet (DFD) status if they started the KD on at least 1 ASD and achieved a period of time where they were on the KD alone. Over the time period, 232 children were evaluated; DFD status occurred in 43 (18.5%), of which 32 (13.8% of the full cohort) remained off ASDs for the remainder of their KD treatment course. Eleven children restarted ASD after a mean of 7 months. Children achieving DFD therapy were more likely to be younger, have fewer ASDs at KD onset, have Glut1 deficiency or epilepsy with myoclonic-atonic seizures, but were less likely to have Lennox-Gastaut syndrome or a gastrostomy tube.
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Affiliation(s)
- Lochan M Shah
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zahava Turner
- Department of Pediatrics, The Johns Hopkins Hospital, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Stacey K Bessone
- Neuroscience Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - S Parrish Winesett
- Neuroscience Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Anthony Stanfield
- Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Eric H Kossoff
- Department of Pediatrics, The Johns Hopkins Hospital, Baltimore, MD, USA; Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD, USA.
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2
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La Buissonnière-Ariza V, Hart D, Schneider SC, McBride NM, Cepeda SL, Haney B, Tauriello S, Glenn S, Ung D, Huszar P, Tetreault L, Petti E, Winesett SP, Storch EA. Quality and Correlates of Peer Relationships in Youths with Chronic Pain. Child Psychiatry Hum Dev 2018; 49:865-874. [PMID: 29637480 DOI: 10.1007/s10578-018-0802-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Indexed: 10/17/2022]
Abstract
Youths with chronic pain may experience difficulties with peer relationships. We investigated the quality and correlates of peer relationships in a sample of 181 youths with chronic pain. A majority of youths were satisfied with their relationships with peers; however, levels were highly variable. Higher functional impairment and depression levels predicted lower peer relationship quality, controlling for demographic and other pain-related factors. In addition, peer relationship quality and pain severity predicted child depression and anxiety symptoms, whereas peer relationship quality only predicted anger symptoms. Relationship quality moderated the association between pain severity and functional impairment, suggesting that strong relationships with peers may buffer the effects of pain on functioning. Peer relationships seem particularly important for the adjustment and psychological well-being of youths with chronic pain. Particular attention should be given to functionally impaired and depressed children, who may be at higher risk of peer difficulties.
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Affiliation(s)
- Valérie La Buissonnière-Ariza
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA.
| | - Dennis Hart
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | - Sophie C Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA
| | - Nicole M McBride
- Division of Child and Adolescent Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sandra L Cepeda
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA
| | - Brandon Haney
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Sara Tauriello
- Division of Behavioral Medicine, University at Buffalo, Buffalo, USA
| | - Shannon Glenn
- Miller School of Medicine, University of Miami, Coral Gables, USA
| | - Danielle Ung
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Peter Huszar
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | - Lisa Tetreault
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | - Erin Petti
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | | | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA.
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3
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Wright E, Amankwah EK, Winesett SP, Tuite GF, Jallo G, Carey C, Rodriguez LF, Stapleton S. Incidentally found brain tumors in the pediatric population: a case series and proposed treatment algorithm. J Neurooncol 2018; 141:355-361. [DOI: 10.1007/s11060-018-03039-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/27/2018] [Indexed: 12/18/2022]
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4
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Ung D, De Nadai AS, McBride NM, Haney B, Huszar P, Hart D, Tauriello S, Glenn S, Cepeda S, Petti EA, Winesett SP, Storch EA. The Association Between Quality of Life and Clinical Characteristics Youth with Headaches. Children's Health Care 2018. [DOI: 10.1080/02739615.2018.1425872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Danielle Ung
- Department of Pediatrics, University of South Florida, Tampa, Florida
| | | | - Nicole M McBride
- Department of Pediatrics, University of South Florida, Tampa, Florida
| | - Brandon Haney
- Department of Pediatrics, University of South Florida, Tampa, Florida
| | - Peter Huszar
- Department of Neurology, Johns Hopkins All Children’s Hospital, Saint Petersburg, Florida
| | - Dennis Hart
- Department of Neurology, Johns Hopkins All Children’s Hospital, Saint Petersburg, Florida
| | - Sara Tauriello
- Department of Pediatrics, University of South Florida, Tampa, Florida
| | - Shannon Glenn
- Department of Pediatrics, University of South Florida, Tampa, Florida
| | - Sandra Cepeda
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Erin A Petti
- Department of Neurology, Johns Hopkins All Children’s Hospital, Saint Petersburg, Florida
| | - S. Parrish Winesett
- Department of Neurology, Johns Hopkins All Children’s Hospital, Saint Petersburg, Florida
| | - Eric A. Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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Tuite GF, Carey CM, Nelson WW, Raffa SJ, Winesett SP. Use of a contoured bioresorbable plate with a hemostatic plug to control life-threatening bleeding from the superior sagittal sinus during hemispherotomy: technical note. J Neurosurg Pediatr 2016; 18:487-492. [PMID: 27391919 DOI: 10.3171/2016.5.peds1633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/06/2022]
Abstract
Profuse bleeding originating from an injured cerebral sinus can be a harrowing experience for any surgeon, particularly during an operation on a young child. Common surgical remedies include sinus ligation, primary repair, placement of a hemostatic plug, and patch or venous grafting that may require temporary stenting. In this paper the authors describe the use of a contoured bioresorbable plate to hold a hemostatic plug in place along a tear in the inferomedial portion of a relatively inaccessible part of the posterior segment of the superior sagittal sinus in an 11-kg infant undergoing hemispherotomy for epilepsy. This variation on previously described hemostatic techniques proved to be easy, effective, and ultimately lifesaving. Surgeons may find this technique useful in similar dire circumstances when previously described techniques are ineffective or impractical.
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Affiliation(s)
- Gerald F Tuite
- Divisions of 1 Pediatric Neurosurgery and.,Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa; and
| | - Carolyn M Carey
- Divisions of 1 Pediatric Neurosurgery and.,Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa; and
| | - William W Nelson
- Division of Anesthesiology, Department of Surgery, All Children's Hospital/Johns Hopkins Medicine, St. Petersburg, Florida
| | - Scott J Raffa
- Divisions of 1 Pediatric Neurosurgery and.,Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa; and
| | - S Parrish Winesett
- Neurology, Neuroscience Institute, All Children's Hospital/Johns Hopkins Medicine, St. Petersburg.,Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa; and
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Tuite GF, Polsky EG, Homsy Y, Reilly MA, Carey CM, Parrish Winesett S, Rodriguez LF, Storrs BB, Gaskill SJ, Tetreault LL, Martinez DG, Amankwah EK. Lack of efficacy of an intradural somatic-to-autonomic nerve anastomosis (Xiao procedure) for bladder control in children with myelomeningocele and lipomyelomeningocele: results of a prospective, randomized, double-blind study. J Neurosurg Pediatr 2016; 18:150-63. [PMID: 27137626 DOI: 10.3171/2015.10.peds15271] [Citation(s) in RCA: 9] [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: 01/23/2023]
Abstract
OBJECTIVE Xiao et al. and other investigators have studied an intradural somatic-to-autonomic (e.g., L-5 to S3-4) nerve transfer as a method to create a reflex arc to allow bladder emptying in response to cutaneous stimulation (the Xiao procedure). In previous clinical studies of patients with spinal dysraphism who underwent the Xiao procedure, high success rates (70%-85%) were reported for the establishment of a "skin-CNS-bladder" reflex arc that allows spontaneous, controlled voiding in children with neurogenic bladder dysfunction. However, many of these studies did not use blinded observers, did not have control groups, and/or featured only limited follow-up durations. METHODS A randomized, prospective, double-blind trial was initiated in March 2009, enrolling children with myelomeningocele (MM), lipomyelomeningocele (LMM), and neurogenic bladder dysfunction who were scheduled for spinal cord detethering (DT) for the usual indications. At the time of DT, patients were randomized between 2 arms of the study: half of the patients underwent a standard spinal cord DT procedure alone (DT group) and half underwent DT as well as the Xiao procedure (DT+X group). Patients, families, and study investigators, all of whom were blinded to the surgical details, analyzed the patients' strength, sensory function, mobility, voiding, and urodynamic bladder function before surgery and at regular intervals during the 3-year follow-up. RESULTS Twenty patients were enrolled in the study: 10 underwent only DT and the other 10 underwent DT+X. The addition of the Xiao procedure to spinal cord DT resulted in longer operative times (p = 0.024) and a greater chance of wound infection (p = 0.03). Patients in both treatment arms could intermittently void or dribble small amounts of urine (< 20% total bladder capacity) in response to scratching in dermatomes T-9 through S-2 using a standardized protocol, but the voiding was not reproducible and the volume voided was not clinically useful in any patient. Voiding in response to scratching was not more frequent in patients who underwent DT+X compared with those who underwent only DT. Bladder contractions in response to scratching occurred in both treatment arms at various intervals after surgery, but they were not more reproducible or more frequent in the patients who underwent the Xiao procedure than in the patients who did not. No patient in either treatment arm was continent of urine before, during, or after the study. CONCLUSIONS Patients with MM and LMM who underwent the Xiao procedure during spinal cord DT were no more likely to be able to void, to control their urination, to achieve continence, or to have a demonstrable urodynamic bladder contraction in response to cutaneous stimulation than patients who underwent only spinal cord DT. This study, in the context of disappointing results reported in other recent studies of the Xiao procedure, raises doubts about the clinical applicability of this procedure in humans until further basic science research is performed.
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Affiliation(s)
- Gerald F Tuite
- Division of Pediatric Neurosurgery, Neuroscience Institute.,Department of Pediatrics, Johns Hopkins Medicine, Baltimore, Maryland;,Division of Pediatric Neurosurgery, Department of Neurosurgery and Brain Repair, and
| | | | - Yves Homsy
- Children's Urology Group, Tampa, Florida
| | | | - Carolyn M Carey
- Division of Pediatric Neurosurgery, Neuroscience Institute.,Division of Pediatric Neurosurgery, Department of Neurosurgery and Brain Repair, and
| | - S Parrish Winesett
- Division of Pediatric Neurology, Department of Pediatrics, University of South Florida, Tampa; and
| | - Luis F Rodriguez
- Division of Pediatric Neurosurgery, Neuroscience Institute.,Division of Pediatric Neurosurgery, Department of Neurosurgery and Brain Repair, and
| | - Bruce B Storrs
- Division of Pediatric Neurosurgery, Neuroscience Institute.,Division of Pediatric Neurosurgery, Department of Neurosurgery and Brain Repair, and
| | - Sarah J Gaskill
- Division of Pediatric Neurosurgery, Department of Neurosurgery and Brain Repair, and
| | - Lisa L Tetreault
- Clinical and Translational Research Organization, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Denise G Martinez
- Clinical and Translational Research Organization, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Ernest K Amankwah
- Clinical and Translational Research Organization, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
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Tuite GF, Polsky EG, Homsy Y, Reilly MA, Carey CM, Parrish Winesett S, Rodriguez LF, Storrs BB, Gaskill SJ, Tetreault LL, Martinez DG, Amankwah EK. Response: Some lessons learned from negative results of a randomized controlled trial for bladder reinnervation with the Xiao procedure. J Neurosurg Pediatr 2016; 18:148-9. [PMID: 27137925 DOI: 10.3171/2015.12.peds15710] [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: 11/06/2022]
Affiliation(s)
- Gerald F Tuite
- Division of Pediatric Neurosurgery, Neuroscience Institute.,Department of Pediatrics, Johns Hopkins Medicine, Baltimore, Maryland;,Division of Pediatric Neurosurgery, Department of Neurosurgery and Brain Repair, and
| | | | - Yves Homsy
- Children's Urology Group, Tampa, Florida
| | | | - Carolyn M Carey
- Division of Pediatric Neurosurgery, Neuroscience Institute.,Division of Pediatric Neurosurgery, Department of Neurosurgery and Brain Repair, and
| | - S Parrish Winesett
- Division of Pediatric Neurology, Department of Pediatrics, University of South Florida, Tampa; and
| | - Luis F Rodriguez
- Division of Pediatric Neurosurgery, Neuroscience Institute.,Division of Pediatric Neurosurgery, Department of Neurosurgery and Brain Repair, and
| | - Bruce B Storrs
- Division of Pediatric Neurosurgery, Neuroscience Institute.,Division of Pediatric Neurosurgery, Department of Neurosurgery and Brain Repair, and
| | - Sarah J Gaskill
- Division of Pediatric Neurosurgery, Department of Neurosurgery and Brain Repair, and
| | - Lisa L Tetreault
- Clinical and Translational Research Organization, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Denise G Martinez
- Clinical and Translational Research Organization, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Ernest K Amankwah
- Clinical and Translational Research Organization, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
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Tuite GF, Storrs BB, Homsy YL, Gaskill SJ, Polsky EG, Reilly MA, Gonzalez-Gomez I, Winesett SP, Rodriguez LF, Carey CM, Perlman SA, Tetreault L. Attempted bladder reinnervation and creation of a scratch reflex for bladder emptying through a somatic-to-autonomic intradural anastomosis. J Neurosurg Pediatr 2013; 12:80-6. [PMID: 23662931 DOI: 10.3171/2013.4.peds12302] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 11/06/2022]
Abstract
An intradural somatic-to-autonomic anastomosis, or Xiao procedure, has been described to create a "skin-CNS-bladder" reflex that improves bladder and bowel function in patients with neurogenic bladder and bowel dysfunction. The authors present their experience with a 10-year-old boy with chronic neurogenic bladder and bowel dysfunction related to spinal cord injury who underwent the Xiao procedure. After undergoing a left L-5 ventral root to left S2-3 intradural anastomosis, the patient reported that his bladder and bowel dysfunction improved between 6 and 12 months. Two years after the procedure, however, he reported that there was no change in his bladder or bowel dysfunction as compared with his condition prior to the procedure. Frequent, systematic multidisciplinary evaluations produced conflicting data. Electrophysiological and histological evaluation of the previously performed anastomosis during surgical reexploration 3 years after the Xiao procedure revealed that the anastomosis was in anatomical continuity but neuroma formation had prevented reinnervation. Nerve action potentials were not demonstrable across the anastomosis, and stimulation of the nerve above and below the anastomosis created no bladder or perineal contractions. This is the first clinical report on the outcome of the Xiao procedure in a child with spinal cord injury outside of China. It is impossible to draw broad conclusions about the efficacy of the procedure based on a single patient with no demonstrable benefit. However, future studies should carefully interpret transient improvements in bladder function, urodynamic findings, and the patient's ability to void in response to scratching after the Xiao procedure. The authors' experience with the featured patient, in whom reinnervation could not be demonstrated, suggests that such changes could be related to factors other than the establishment of a skin-CNS-bladder reflex as a result of a somatic-to-autonomic anastomosis.
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Affiliation(s)
- Gerald F Tuite
- Pediatric Neuroscience Center, All Children's Hospital, Neuroscience Institute, 601 5th Street South, Suite 511, St. Petersburg, Florida 33701, USA.
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Abstract
The effect of surgery on the postictal state has not been studied in a systematic fashion. There is limited literature looking at the effect on postictal psychosis. The effect of surgery on this phenomenon has been varied with post ictal psychosis occurring post surgery when it has not occurred prior to surgery as well as resolution after surgery. Case reports of post ictal Kluver Bucy Syndrome and Capgas Syndrome have been reported after resective epilepsy surgery as well.
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