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Idler J, Turkoglu O, Patek K, Stuart S, Taskin B, Sivaswamy L, Whitten A. Neurocutaneous Disorders in Pregnancy. Obstet Gynecol Surv 2023; 78:606-619. [PMID: 37976316 DOI: 10.1097/ogx.0000000000001202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Importance Neurocutaneous disorders have significant implications for care of the pregnant patient. As neurocutaneous disorders are uncommon, obstetricians may be unfamiliar with these disorders and with recommendations for appropriate care of this population. Objective This review aims to summarize existing literature on the interaction between neurocutaneous disorders and pregnancy and to provide a guide for physicians caring for an affected patient. Evidence Acquisition A PubMed, MEDLINE, and Google Scholar search was carried out with a broad range of combinations of the medical subject headings (MeSH) terms "pregnancy," "Sturge -Weber," "Neurofibromatosis Type 1," "neurofibromatosis type 2," "von Hippel Lindau," "Tuberous Sclerosis," "neurocutaneous disorder," "treatment," "congenital malformations," "neurodevelopmental defects," "miscarriage," "breastfeeding," "autoimmune," "pathophysiology," and "management." References of included articles were searched to identify any articles that may have been missed after the above method was used. Results Neurocutaneous disorders are associated with increased pregnancy-associated maternal and fetal/neonatal morbidity, largely surrounding hypertensive disorders, epilepsy, and medication exposure. Some features of neurocutaneous disorders may be worsened or accelerated by pregnancy. Neurocutaneous disorders can often be diagnosed prenatally. Therefore, directed assessment should be offered to affected individuals with a personal or family history of a neurocutaneous disorder. Conclusion and Relevance Patients affected by neurocutaneous disorders who are pregnant or planning for future pregnancy should be carefully followed by a multidisciplinary team, which could include maternal-fetal medicine, neurology, and anesthesia, as well as other relevant subspecialists. Additional research is required regarding optimal counseling and management of these patients.
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Affiliation(s)
- Jay Idler
- Maternal Fetal Medicine Specialist, Allegheny Health Network, Pittsburgh, PA; Assistant Professor, Drexel College of Medicine, Philadelphia, PA
| | | | | | - Sean Stuart
- Obstetrics and Gynecology Resident, William Beaumont University Hospital, Corewell Health, Royal Oak
| | - Birce Taskin
- Child Neurologist, Pediatric Neurology Department, Children's Hospital of Michigan, Wayne State University, Detroit
| | - Lalitha Sivaswamy
- Child Neurologist, Pediatric Neurology Department, Children's Hospital of Michigan, Wayne State University, Detroit
| | - Amy Whitten
- Maternal Fetal Medicine Fellow; Maternal Fetal Medicine Specialist and Associate Professor, William Beaumont University Hospital, Corewell Health, Royal Oak, MI
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2
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Castellucci G, Figueroa M, Sivaswamy L. Hereditary Neuropathy With Liability to Pressure Palsy Detected During the Use of Recreational Drugs. Neurohospitalist 2023; 13:376-380. [PMID: 37701266 PMCID: PMC10494818 DOI: 10.1177/19418744231174396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Background: Nitrous oxide (N2O) has been an increasingly popular recreational drug over the past few years. Abuse is associated with severe neurological complications and even fatal outcomes. Purpose: Here we present a case of chronic nitric oxide abuse in a teenager presenting with rapidly progressive mixed sensory and motor polyneuropathy. Results: The initial diagnostic workup excluded electrolyte derangement, heavy metal intoxication, autoimmune neuropathy, myopathy, hematological disorders, and thyroid disease. On further questioning, patient reported 8-months of inhalation of nitrous oxide, commonly known as "whippets". Subsequent tests revealed low Vitamin B12 and elevated homocysteine level. Eventual genetic test demonstrated a heterozygous deletion in the gene that encodes the peripheral myelin protein 22 (PMP22), consistent with a diagnosis of Hereditary Neuropathy with Liability to Pressure Palsies (HNPP). Conclusion: The association of neurologic and genetic findings with the timeline of nitrous oxide inhalation suggests a multifactorial etiology of her symptoms, with the N2O acting as a trigger to the axonal degeneration and demyelination detected on electrodiagnostic studies.
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Affiliation(s)
| | - Michelle Figueroa
- Detroit Medical Center, Children’s Hospital of Michigan, Detroit, MI, USA
| | - Lalitha Sivaswamy
- Detroit Medical Center, Children’s Hospital of Michigan, Detroit, MI, USA
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3
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Ospina Jimenez C, Sivaswamy L, Castellucci G, Taskin B, Farooqi A, Kannikeswaran N. Yield of Neurodiagnostic Testing in Children Presenting to a Pediatric Emergency Department With Altered Mental Status. Pediatr Neurol 2023; 146:8-15. [PMID: 37379589 DOI: 10.1016/j.pediatrneurol.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/07/2023] [Accepted: 05/28/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Emergency department (ED) visits for altered mental status (AMS) in children are common. Neuroimaging is often performed to ascertain etiology, but its utility has not been well studied. Our objective is to describe the yield of neuroimaging studies in children who present to an ED with AMS. METHODS We performed a retrospective chart review of children 0-18 years of age, presenting to our PED between 2018 and 2021 with AMS. We abstracted patient demographics, physical examination, neuroimaging and EEG results, and final diagnosis. Neuroimaging and EEG studies were classified as normal or abnormal. Abnormal studies were categorized as clinically important and contributory: abnormalities that were clinically important and contributed to the etiology, clinically important but noncontributory: abnormalities that were clinically significant but did not explain the etiology, and incidental: abnormalities that were not clinically significant. RESULTS We analyzed 371 patients. The most common etiology of AMS was toxicologic (188, 51%) with neurologic causes (n = 50, 13.5%) accounting for a minority. Neuroimaging was performed in one-half (169, 45.5%) and abnormalities were noted in 44 (26%) studies. Abnormalities were clinically important and contributed to the etiologic diagnosis of AMS in 15/169 (8.9%), clinically important and noncontributory in 18/169 (10.7%), and incidental in 11/169 (6.5%). EEG was performed in 65 patients (17.5%), of which 17 (26%) were abnormal with only one being clinically important and contributory. CONCLUSIONS Though neuroimaging was performed in approximately one half of the cohort, it was contributory in a minority. Similarly, diagnostic utility of EEG in children with AMS was low.
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Affiliation(s)
| | - Lalitha Sivaswamy
- Professor of Pediatrics and Neurology, Division of Neurology, Central Michigan University, Children's Hospital of Michigan, Detroit, Michigan
| | - Giovanni Castellucci
- Pediatric Neurology Resident, Children's Hospital of Michigan, Detroit, Michigan
| | - Birce Taskin
- Pediatric Neurology Resident, Children's Hospital of Michigan, Detroit, Michigan
| | - Ahmad Farooqi
- Assistant Professor Biostatistics, Clinical Research Institute CMU College of Medicine, Detroit, Michigan
| | - Nirupama Kannikeswaran
- Professor of Pediatrics & Emergency Medicine, Division of Emergency Medicine, Central Michigan University, Children's Hospital of Michigan, Detroit, Michigan
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4
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Govil-Dalela T, Thomas R, Weber A, Kamat D, Williams MT, Przyklenk K, Sivaswamy L. Pediatric Resident Confidence in Assessing Neurological Cases: A Nationwide Survey. Pediatr Neurol 2023; 145:57-66. [PMID: 37279616 DOI: 10.1016/j.pediatrneurol.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/16/2023] [Accepted: 05/07/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND A relative shortage of pediatric neurologists in proportion to estimated neurological disorders often results in general pediatricians evaluating and treating children with complex neurological conditions. Dedicated rotations in pediatric neurology are not mandated during medical school or pediatric residency. We evaluated the perceptions of a large cohort of pediatric residents and program directors (PDs) regarding child neurology training. METHODS Using an online tool, surveys were sent to pediatric residents and pediatric and pediatric neurology PDs. RESULTS Response rates were 41% from pediatric residency programs, yielding 538 resident responses; 31% from pediatric PDs; and 62% from pediatric neurology PDs. Only 27% of the surveyed residents reported completing a neurology rotation during residency, 89% of whom expressed a subjective improvement in confidence with neurological assessments. Factors affecting comfort with eliciting a neurological history included exposure to a neurology rotation during residency, year of training, duration of neurology rotation in medical school, and inpatient exposure to neurological patients, whereas those associated with examination additionally included program size and postresidency plans. Overall, 80% of surveyed residents, 78% of pediatric PDs, and 96% of pediatric neurology PDs acknowledged the potential value of a mandatory pediatric neurology rotation during residency. CONCLUSION We suggest that a mandatory pediatric neurology rotation will boost the confidence of current and future pediatric trainees in assessing common neurological conditions of childhood.
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Affiliation(s)
- Tuhina Govil-Dalela
- Chief Resident in the Department of Pediatrics, Division of Neurology, Children's Hospital of Michigan, Detroit, Michigan
| | - Ronald Thomas
- Senior Biostatistician in the Department of Pediatrics, Central Michigan University and Clinical Research Institute, Children's Hospital of Michigan, Detroit, Michigan
| | - Amanda Weber
- Assistant Professor in the Department of Pediatrics, Division of Neurology, Central Michigan University and Children's Hospital of Michigan, Detroit, Michigan
| | - Deepak Kamat
- Professor and Vice-Chair for Academic Affairs in the Department of Pediatrics, UT Health San Antonio, San Antonio, Texas
| | - Mitchel T Williams
- Assistant Professor in the Department of Pediatrics, Division of Neurology, Central Michigan University and Children's Hospital of Michigan, Detroit, Michigan
| | - Karin Przyklenk
- Professor and Carman and Ann Adams Endowed Chair in Pediatric Research, Department of Pediatrics, Central Michigan University and Clinical Research Institute, Children's Hospital of Michigan, Detroit, Michigan
| | - Lalitha Sivaswamy
- Professor and Division Chief in the Department of Pediatrics, Division of Neurology, Central Michigan University and Children's Hospital of Michigan, Detroit, Michigan.
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5
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Muacevic A, Adler JR, Sivaswamy L. An Atypical Radiologic Presentation of Right Sixth Lateral Rectus Palsy: A Case Report. Cureus 2022; 14:e32597. [PMID: 36660533 PMCID: PMC9845534 DOI: 10.7759/cureus.32597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Isolated ocular palsies are often associated with a benign process in the pediatric population but early diagnosis is critical to exclude any serious pathology. In this case, a six-year-old female with no significant past medical history presented with isolated right-eye medial deviation. The patient reported right-eye medial deviation for the past several weeks and associated double vision, but denied any pain with eye movements, other cranial nerve changes, or headaches. This case highlights the key radiologic finding which may ultimately allow for a leading diagnosis and inform further management in cases of isolated ocular nerve palsy.
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6
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Alsherbini A, Kannikeswaran N, Barran D, Sivaswamy L. Toddler with Horner's Syndrome. J Pediatr 2022; 251:215-216. [PMID: 35944711 DOI: 10.1016/j.jpeds.2022.07.052] [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: 06/29/2022] [Revised: 07/17/2022] [Accepted: 07/22/2022] [Indexed: 10/15/2022]
Affiliation(s)
| | | | | | - Lalitha Sivaswamy
- Central Michigan University, Children's Hospital of Michigan, Detroit, Michigan
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7
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Singla R, Sivaswamy L, Mody S, Thomas R, Kannikeswaran N. Incidence of Pediatric Stroke During the COVID-19 Pandemic in a Tertiary Care Center. Clin Pediatr (Phila) 2022; 61:217-221. [PMID: 34965749 DOI: 10.1177/00099228211062735] [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)
- Ramit Singla
- Children's Hospital of Michigan, Detroit, MI, USA.,Central Michigan University, Detroit, MI, USA
| | - Lalitha Sivaswamy
- Children's Hospital of Michigan, Detroit, MI, USA.,Central Michigan University, Detroit, MI, USA
| | - Swati Mody
- Children's Hospital of Michigan, Detroit, MI, USA
| | | | - Nirupama Kannikeswaran
- Children's Hospital of Michigan, Detroit, MI, USA.,Central Michigan University, Detroit, MI, USA
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8
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Govil-Dalela T, Mody S, Sivaswamy L. Trigeminal Autonomic Cephalgia Secondary to Cervical Myelopathy. Neurohospitalist 2022; 12:195-196. [PMID: 34950413 PMCID: PMC8689544 DOI: 10.1177/1941874421993666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
| | - Swati Mody
- Department of Neuroradiology, Children’s Hospital of MI, Detroit, MI, USA
| | - Lalitha Sivaswamy
- Pediatrics and Neurology, Central Michigan University, Children’s Hospital of Michigan, MI, USA,Lalitha Sivaswamy, Pediatrics and Neurology, Central Michigan University, Children’s Hospital of Michigan, 3950 Beaubien, Detroit, MI 48201, USA.
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9
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Abstract
The COVID-19 pandemic has spread rapidly across the world in 2020, affecting both adults and, to a lesser extent, children. In this article, the authors describe the neurologic manifestations of COVID-19 in children, including the epidemiology, pathogenesis, clinical features, laboratory and imaging findings, and treatment options. The management of patients with concomitant neuroimmunologic disorders and drug interactions between medications used to treat COVID-19 and other neurologic disorders (especially immune-modifying drugs) is also discussed.
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Affiliation(s)
- Tuhina Govil-Dalela
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA; Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA; Department of Pediatric Neurology, Children's Hospital of Michigan Specialty Center, 2nd Floor, 3950 Beaubien Street, Detroit, MI 48202, USA
| | - Lalitha Sivaswamy
- Department of Pediatric Neurology, Children's Hospital of Michigan Specialty Center, 2nd Floor, 3950 Beaubien Street, Detroit, MI 48202, USA; Department of Pediatrics, Central Michigan University, Pleasant, MI, USA; Department of Neurology, Central Michigan University, Pleasant, MI, USA.
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10
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Abstract
BACKGROUND Knowledge of the factors that predispose to postdural puncture headache in children may help reduce the occurrence of this complication. MATERIALS AND METHODS A retrospective cohort study of children who presented to the study institution between 2010 and 2018 was conducted. Children were divided into 2 groups: those who experienced postdural puncture headache and those who did not. The 2 groups were compared with respect to certain demographic, technical, and personnel-related factors. Only children who had opening pressure documented during the procedure were included in the core study group. RESULTS In univariate analysis, children aged ≥10 years, female gender, children with higher body mass index, standard blinded lumbar puncture procedure, use of sedation, higher opening pressure, and presence of pseudotumor cerebri increased the probability of postdural puncture headache. In multivariable logistic regression analysis, presence of pseudotumor cerebri was the only factor that attained statistical significance when the opening pressure was measured and documented. CONCLUSIONS The risk factors for postdural puncture headache in a pediatric cohort varied from risk factors that are classically implicated in adults.
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Affiliation(s)
- Madhav Bandatmakur
- Department of Pediatric Neurology, 2969Children's Hospital of MI, Detroit, MI, USA
| | - Carter Bench
- 12267Wayne State University School of Medicine, Detroit, MI, USA
| | - Ngum Ngwa
- Department of Pediatrics, 2969Children's Hospital of MI, Detroit, MI, USA
| | - Heba Osman
- Department of Anesthesia, Detroit Medical Center, Detroit, MI, USA
| | - Pooja Dave
- Department of Pediatrics, 2969Children's Hospital of MI, Detroit, MI, USA
| | - Ahmad Farooqi
- Department of Biostatistics, Children's Hospital of MI, Detroit, MI, USA
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11
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Abstract
Children with complex febrile seizure (CFS) are often hospitalized for concerns for serious bacterial infection (SBI) or seizure recurrence. We describe the yield of diagnostic studies and seizure recurrence during hospitalization in CFS children. We performed a retrospective review of 372 visits in 350 developmentally normal children aged 6 to 60 months between 2011 and 2016 for CFS. Majority of patients were male (200; 57.1%), with a mean age of 19.8 ± 11.3 months. Active seizures were noted in 42 (11.3%), status epilepticus in 35 (9.4%) while 97 (26.1%) had a seizure in the pediatric emergency department. The distribution of SBI was as follows: bacteremia (3; 1.1%), urinary tract infection (7; 3.7%), pneumonia (15; 6.8%), and bacterial meningitis (0; 0%). Electroencephalography (EEG) abnormality was rare (7/158; 4.4%). Seizure recurrence during hospitalization was uncommon (19; 5.1%). Logistic regression analysis did not reveal any predictors for seizure recurrence. The seizure recurrence rate during hospitalization, EEG yield, and SBI incidence was low in children with CFS.
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Affiliation(s)
- Nirupama Kannikeswaran
- Central Michigan University, Detroit, MI, USA.,Children's Hospital of Michigan, Detroit, MI, USA
| | - Lalitha Sivaswamy
- Central Michigan University, Detroit, MI, USA.,Children's Hospital of Michigan, Detroit, MI, USA
| | | | - Usha Sethuraman
- Central Michigan University, Detroit, MI, USA.,Children's Hospital of Michigan, Detroit, MI, USA
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12
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Kannikeswaran N, Desai L, Farooqi A, Sivaswamy L. Effectiveness of Standard Combination Therapy in Pediatric Migraine. Pediatr Neurol 2021; 116:68-73. [PMID: 33493999 DOI: 10.1016/j.pediatrneurol.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/12/2020] [Revised: 10/14/2020] [Accepted: 12/10/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND A combination of parenteral medications (often referred to as standard combination therapy) is frequently used in the treatment of acute migraine in the pediatric emergency department (PED). The primary aim of this study was to evaluate the two-hour, 24-hour, and seven-day impact of one such regimen on pain in children who present to the PED. Standard combination therapy for purposes of our study is defined as a bolus of intravenous saline, and a combination of intravenous ketorolac, prochlorperazine, and diphenhydramine. METHODS This prospective observational study included 120 children between the ages seven and 18 years who presented to the PED with migraine, whose parents could read and understand the consent form in English, and who were treated with standard combination therapy. The primary outcome measure for this study was the change in severity of pain as noted by the child using the Faces Pain Scale-Revised. We analyzed normally distributed continuous variables by mean and standard deviation, whereas non-normally distributed continuous variables are reported by median and interquartile range. RESULTS Nonparametric Friedman testing on the entire cohort (n = 120) noted that there was a statistically significant change in the Faces pain scale from before administration of standard combination therapy to the two-hour, 24-hour, and one-week time point with a reduction in pain score of 87.5%, 100%, and 50%, respectively, at the three time points. CONCLUSIONS This study noted moderate relief of pain after administration of standard combination therapy, which persisted at one-week after administration.
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Affiliation(s)
- Nirupama Kannikeswaran
- Professor of Pediatrics and Emergency Medicine, Children's Hospital of Michigan/Central Michigan University, Detroit, Michigan
| | - Lavina Desai
- Resident in Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
| | - Ahmad Farooqi
- Biostatistician, Children's Hospital of Michigan, Detroit, Michigan
| | - Lalitha Sivaswamy
- Professor of Pediatrics and Neurology, Children's Hospital of Michigan/Central Michigan University, Detroit, Michigan.
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13
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Regling K, Pomerantz D, Narayanan S, Altinok D, Sivaswamy L, Marupudi NI, Callaghan MU, Martin A. Reversible Cerebral Vasoconstriction Syndrome and Sickle Cell Disease: A Case Report. J Pediatr Hematol Oncol 2021; 43:e95-e98. [PMID: 31789782 DOI: 10.1097/mph.0000000000001683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS), is rare in the pediatric population and is characterized by severe headaches and other neurologic symptoms. We present a case of RCVS occurring concomitantly with posterior reversible encephalopathy syndrome in an 8-year-old African American child with sickle cell disease (HbSS). Imaging studies including computed tomography, magnetic resonance imaging and cerebral angiography of the brain showed acute hemorrhagic stroke and a beaded appearance of peripheral cerebral vessels. In this report, we focus on the typical features of RCVS and discuss the underlying risk factors that may increase the risk in patients with HbSS disease.
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Affiliation(s)
- Katherine Regling
- Carman and Ann Adams Department of Pediatrics, Division of Hematology/Oncology
| | - Daniel Pomerantz
- Carman and Ann Adams Department of Pediatrics, Wayne State University/Detroit Medical Center/Children's Hospital of Michigan
| | - Sandra Narayanan
- Department of Neurosurgery, Detroit Medical Center, Wayne State University, Detroit, MI
| | - Deniz Altinok
- Carman and Ann Adams Department of Pediatrics, Division of Radiology
| | - Lalitha Sivaswamy
- Carman and Ann Adams Department of Pediatrics, Division of Neurology
| | - Neena I Marupudi
- Department of Pediatric Neurosurgery, Children's Hospital of Michigan/Wayne State University
| | - Michael U Callaghan
- Carman and Ann Adams Department of Pediatrics, Division of Hematology/Oncology
| | - Alissa Martin
- Carman and Ann Adams Department of Pediatrics, Division of Hematology/Oncology
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14
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Govil-Dalela T, Sivaswamy L. Diagnosing Pseudotumor Cerebri: An Age-based Approach. Pediatr Neurol Briefs 2020; 34:19. [PMID: 33354101 PMCID: PMC7747552 DOI: 10.15844/pedneurbriefs-34-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Investigators from Hillel-Yaffe, Carmel, and Bnai Zion Medical Centers in Israel studied the comparative clinical presentations and predisposing factors for idiopathic intracranial hypertension (IIH) across age groups
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Affiliation(s)
- Tuhina Govil-Dalela
- Department of Child Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, MI
| | - Lalitha Sivaswamy
- Department of Child Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, MI
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15
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Williams MT, Sivaswamy L. Quality of Life in Multiple Sclerosis. Pediatr Neurol Briefs 2020; 34:14. [PMID: 33304088 PMCID: PMC7718100 DOI: 10.15844/pedneurbriefs-34-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Investigators from Karolinska Institute in Stockholm, Sweden report on their findings comparing quality of life (QoL) measures in both pediatric-onset multiple sclerosis (POMS) and adult-onset multiple sclerosis (AOM).
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Affiliation(s)
- Mitchell T Williams
- Departments of Pediatrics and Neurology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
| | - Lalitha Sivaswamy
- Departments of Pediatrics and Neurology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
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16
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De Jong G, Kannikeswaran N, DeLaroche A, Farooqi A, Sivaswamy L. Rapid Sequence MRI Protocol in the Evaluation of Pediatric Brain Attacks. Pediatr Neurol 2020; 107:77-83. [PMID: 32111563 DOI: 10.1016/j.pediatrneurol.2019.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 12/02/2019] [Accepted: 12/08/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND The objective of our study was to evaluate the clinical utility of rapid sequence magnetic resonance imaging (MRI) utilizing diffusion-weighted imaging and fluid-attenuated inversion recovery sequences in children with acute ischemic strokes and nonstroke brain attacks. METHODS We performed a retrospective chart review of patients aged one month to 25 years for whom a pediatric stroke clinical pathway was activated. Diffusion-weighted imaging and fluid-attenuated inversion recovery were obtained followed by a complete MRI. Imaging was interpreted by a pediatric radiologist and the study neurologist. We collected information regarding patient demographics, neuroimaging results, and final diagnosis. RESULTS The Pediatric Stroke Clinical Pathway was activated for 59 patients of whom 52 were included for analysis. The majority of patients were female (n = 29, 55.8%) and African American (n = 32, 61.5%), with a median age of 12 years (interquartile range 9, 16). Six patients had an ischemic stroke. Seizures, migraines, and psychosomatic disorders (each with n = 7; 13.5%) were the most common nonstroke diagnoses. Diffusion-weighted imaging was more sensitive (100% [55.0% to 100%] versus 80 % [32% to 99%]) and specific (73.9% [68% to 74%] versus 37.2% [32% to 39%]) compared with fluid-attenuated inversion recovery in identification of an ischemic stroke. However, fluid-attenuated inversion recovery was useful in the identification of inflammatory and metabolic disorders. CONCLUSION Rapid sequence MRI can be utilized as a screening imaging modality in children with suspected brain attacks in cases where there may be delays in obtaining full sequence brain imaging.
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Affiliation(s)
- Gracia De Jong
- Pediatric Resident, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.
| | - Nirupama Kannikeswaran
- Division of Emergency Medicine, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Amy DeLaroche
- Division of Emergency Medicine, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Ahmad Farooqi
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan
| | - Lalitha Sivaswamy
- Division of Neurology, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan
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17
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Mandle Q, Kannikeswaran S, Surapaneni M, Sivaswamy L. A Teenager With Facial Numbness. Pediatr Neurol 2020; 104:68-69. [PMID: 31409503 DOI: 10.1016/j.pediatrneurol.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/07/2019] [Accepted: 07/10/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Quinton Mandle
- Wayne State University School of Medicine, Detroit, Michigan.
| | | | | | - Lalitha Sivaswamy
- Department of Pediatric Neurology, Children's Hospital of Michigan, Detroit, Michigan
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18
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Gutta R, Valentini KJ, Kaur G, Farooqi AA, Sivaswamy L. Management of Childhood Migraine by Headache Specialist vs Non‐Headache Specialists. Headache 2019; 59:1537-1546. [DOI: 10.1111/head.13660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Radhika Gutta
- Michigan State University School of Medicine Lansing MI USA
| | | | | | - Ahmad A. Farooqi
- Department of Pediatrics Wayne State University School of Medicine Detroit MI USA
| | - Lalitha Sivaswamy
- Department of Pediatrics at Children's Hospital of Michigan Wayne State University School of Medicine Detroit MI USA
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Kawaji Q, Watson CR, Sivaswamy L. Toddler with Ptosis: Now You See It, Now You Don’t. Paediatr Child Health 2019; 24:151-152. [DOI: 10.1093/pch/pxy031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Qingwen Kawaji
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit, Michigan
| | - Carla R Watson
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit, Michigan
| | - Lalitha Sivaswamy
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit, Michigan
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20
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Watson C, Sivaswamy L, Agarwal R, Du W, Agarwal R. Functional Neurologic Symptom Disorder in Children: Clinical Features, Diagnostic Investigations, and Outcomes at a Tertiary Care Children's Hospital. J Child Neurol 2019; 34:325-331. [PMID: 30819032 DOI: 10.1177/0883073819830193] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 11/15/2022]
Abstract
OBJECTIVE To describe the presenting symptoms and short-term outcomes of children diagnosed with functional neurologic symptom disorder and to compare the demographic and clinical characteristics of children who received neurodiagnostic testing to those who did not. STUDY DESIGN Single center, retrospective review of 222 children who presented to the emergency department of a children's hospital, and diagnosed with functional neurologic symptom disorder, between 2010 and 2015. RESULTS Out of 222 visits (females = 156, African Americans = 130, mean age = 13.9 years), neurodiagnostic tests were performed in 102/222 (46%) visits. The most commonly performed investigations were magnetic resonance imaging (MRI) of brain (n = 37) and electroencephalogram (EEG) (n = 56) and were noted to be unremarkable in all instances. Neurodiagnostic tests were more likely to be performed in patients who (1) were non-African American (54% vs 40%; P = .03), (2) presented with new-onset symptoms (55% vs 31%; P < .01), (3) underwent hospitalization (61% vs 17%; P < .01), and (4) were evaluated by a neurologist (59% vs 9%; P < .01) or a psychiatrist (58% vs 28%; P < .01). Common clinical presentations included seizurelike or strokelike symptoms. Short-term follow-up was possible in 20%, with an alternate diagnosis of syncope, noted in only 1 child. CONCLUSIONS Most children who presented with a functional neurologic symptom disorder in our study were noted to have seizurelike or strokelike presentations and were adolescent females. Caucasians were more likely to undergo neurodiagnostic investigations. Radiologic and neurophysiological tests were more commonly performed when neurology and psychiatry consultations were sought. Such investigations had low diagnostic utility.
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Affiliation(s)
- Carla Watson
- 1 Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.,2 Divisions of Neurology, Wayne State University School of Medicine, Detroit, MI, USA.,3 Divisions of Neurology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
| | - Lalitha Sivaswamy
- 1 Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.,2 Divisions of Neurology, Wayne State University School of Medicine, Detroit, MI, USA.,3 Divisions of Neurology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
| | - Roshani Agarwal
- 1 Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.,4 Divisions of Hospital Medicine, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
| | - Wei Du
- 1 Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
| | - Rajkumar Agarwal
- 1 Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.,2 Divisions of Neurology, Wayne State University School of Medicine, Detroit, MI, USA.,3 Divisions of Neurology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
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21
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Lulla D, Altinok D, Sivaswamy L. Recurrent Painful Cranial Neuropathy in a Child Involving Multiple Cranial Nerves. Headache 2018; 59:111-112. [PMID: 30378693 DOI: 10.1111/head.13430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Dinesh Lulla
- Department of Pediatric Neurology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Deniz Altinok
- Department of Radiology-Pediatric Neuroradiology, Wayne State University School of Medicine Children's Hospital of Michigan, Detroit, MI, USA
| | - Lalitha Sivaswamy
- Department of Pediatrics and Neurology, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI, USA
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22
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Sriwastava S, Desai A, Yuliati A, Watson CR, Sivaswamy L. A Child With a Hoarse Cry and Intracranial Calcification. Pediatr Neurol 2018; 87:78-79. [PMID: 30501889 DOI: 10.1016/j.pediatrneurol.2018.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/19/2018] [Accepted: 08/07/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Shitiz Sriwastava
- Dept. of Neurology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
| | - Aaron Desai
- Dept. of Neurology, Detroit Medical Center, Wayne State University, Detroit, Michigan
| | - Asri Yuliati
- Dept. of Pediatric Neurology, Childrens Hospital of Michigan, Wayne State University, Detroit, Michigan
| | - Carla R Watson
- Dept. of Pediatric Neurology, Childrens Hospital of Michigan, Wayne State University, Detroit, Michigan
| | - Lalitha Sivaswamy
- Dept. of Pediatric Neurology, Childrens Hospital of Michigan, Wayne State University, Detroit, Michigan
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23
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DeLaroche AM, Sivaswamy L, Farooqi A, Kannikeswaran N. Pediatric Stroke and Its Mimics: Limitations of a Pediatric Stroke Clinical Pathway. Pediatr Neurol 2018; 80:35-41. [PMID: 29429783 DOI: 10.1016/j.pediatrneurol.2017.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/29/2017] [Accepted: 10/06/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Acute stroke protocols improve delivery of care but it is unclear whether these resource intensive protocols are able to differentiate stroke from mimics in children. The aim of this study is to describe our institution's experience with stroke mimics identified through our pediatric stroke clinical pathway (PSCP). METHODS The PSCP was implemented in our level 1 pediatric emergency department in June 2014 for children aged one month to 18 years. For patients managed using the PSCP from June 2014 to December 2016, demographic and clinical data were compared for patients diagnosed with stroke or a stroke mimic. RESULTS A total of 59 children were evaluated with the PSCP. Fourteen children were identified as having a stroke and 45 children had stroke mimics. The most common stroke mimics were functional neurological disorders (20.0%), transient neurological deficits (17.8%), migraine (15.6%), and seizure (11.1%). Patient demographics and time to neuroimaging did not differ between patients with and without stroke. Vomiting was commonly reported by patients with stroke (odds ratio: 4.00, 95% confidence interval: 1.12 to 14.35), whereas weakness was not (odds ratio: 0.7, 95% confidence interval: 0.07 to 0.90), but the physical examination did not differ between patients with and without stroke. CONCLUSIONS The PSCP ensures timely evaluation of patients presenting with neurological deficits but fails to reliably differentiate between patients with stroke and patients with stroke mimics. Further multicentered studies are needed to develop a "stroke screen" that reliably distinguishes pediatric stroke from its mimics.
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Affiliation(s)
- Amy M DeLaroche
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.
| | - Lalitha Sivaswamy
- Division of Neurology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
| | - Ahmad Farooqi
- School of Medicine, Wayne State University, Detroit, Michigan
| | - Nirupama Kannikeswaran
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
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25
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Abstract
Life-threatening headaches in children can present in an apoplectic manner that garners immediate medical attention, or in an insidious, more dangerous form that may go unnoticed for a relatively long period of time. The recognition of certain clinical characteristics that accompany the headache should prompt recognition and referral to an institution equipped with neuroimaging facilities, pediatric neurosurgeons, and neurologists. Thunderclap headaches, which reach a peak within a very short period of time, may be the presenting feature of conditions such as arterial dissection, venous sinus thrombosis, and reversible cerebral vasoconstriction syndrome, which can be addressed by specific pharmacological options instituted in an intensive care setting. On the other hand, subacute to chronic headaches that are accompanied by focal neurological signs, such as abducens nerve palsy, restriction of upward gaze, or papilledema, may be indicative of the need for urgent imaging and neurosurgical referral. [Pediatr Ann. 2018;47(2):e74-e80.].
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26
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Martin AAC, Ubaidulhaq M, Sivaswamy L. Visual Diagnosis: A Toddler with a Large Birthmark and Developmental Delay. Pediatr Rev 2018; 39:e1-e4. [PMID: 29292296 DOI: 10.1542/pir.2016-0046] [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)
| | - Muhammad Ubaidulhaq
- Department of Pediatric Neurology, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI
| | - Lalitha Sivaswamy
- Department of Pediatrics and.,Department of Pediatric Neurology, Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI
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27
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Haidar-El-Atrache S, Agarwal R, Sivaswamy L. An Unusual Cause of a Scalp Mass. J Pediatr 2017; 181:325-325.e1. [PMID: 27871688 DOI: 10.1016/j.jpeds.2016.10.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 10/24/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Sara Haidar-El-Atrache
- Division of Emergency Medicine Division of Hospital Medicine Carman and Ann Adams Department of Pediatrics Children's Hospital of Michigan Detroit, Michigan; Michigan State University College of Human Medicine Lansing, Michigan
| | - Rajkumar Agarwal
- Division of Neurology Carman and Ann Adams Department of Pediatrics Children's Hospital of Michigan Detroit, Michigan; Wayne State University School of Medicine Detroit, Michigan
| | - Lalitha Sivaswamy
- Division of Neurology Carman and Ann Adams Department of Pediatrics Children's Hospital of Michigan Detroit, Michigan; Wayne State University School of Medicine Detroit, Michigan
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28
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Whitcomb V, Kannikeswaran N, Bhaya N, Altinok D, Sivaswamy L. Speechless After a Roller Coaster Ride. Clin Pediatr (Phila) 2017; 56:190-193. [PMID: 28006955 DOI: 10.1177/0009922816684614] [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)
- Valerie Whitcomb
- 1 Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
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29
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DeLaroche AM, Sivaswamy L, Farooqi A, Kannikeswaran N. Pediatric Stroke Clinical Pathway Improves the Time to Diagnosis in an Emergency Department. Pediatr Neurol 2016; 65:39-44. [PMID: 27743748 DOI: 10.1016/j.pediatrneurol.2016.09.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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: 06/04/2016] [Accepted: 09/06/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Identified barriers to the diagnosis of pediatric stroke include delays in provider recognition and definitive neuroimaging (magnetic resonance imaging). Clinical pathways are recommended to address these barriers; yet few studies have evaluated their impact. Our aim is to describe the effect of a pediatric stroke clinical pathway on the diagnosis of stroke in patients presenting with focal neurological dysfunction to a pediatric emergency department. METHODS The pediatric stroke clinical pathway was implemented in our level 1 pediatric emergency department in June 2014 for children aged one month to 18 years. Demographic and clinical data were collected for patients ultimately diagnosed with stroke using the pediatric stroke clinical pathway and compared with data collected on patients diagnosed with stroke before implementation of the pediatric stroke clinical pathway. RESULTS The pediatric stroke clinical pathway was activated for 36 patients. Stroke was diagnosed in 11 patients (33%), of whom 55% were male with a median age 11 ± 7 years. Focal deficits (82%) and headache (55%) were common presenting complaints. There was a significant improvement in the median time to magnetic resonance imaging from arrival to the emergency department (before implementation of the pediatric stroke clinical pathway: 17 hours [interquartile range 6, 22] versus after implementation of the pediatric stroke clinical pathway: four hours [interquartile range 3, 12]; P = 0.02). CONCLUSIONS The pediatric stroke clinical pathway improved time to definitive diagnosis and streamlined the care provided to children presenting to the pediatric emergency department with focal neurological dysfunction.
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Affiliation(s)
- Amy M DeLaroche
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.
| | - Lalitha Sivaswamy
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
| | - Ahmad Farooqi
- Department of Pediatrics, Children's Research Center of Michigan, School of Medicine, Wayne State University, Detroit, Michigan
| | - Nirupama Kannikeswaran
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
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30
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Abstract
Investigators from the Ohio State University, Oregon Health and Science University and Rosalind Franklin School of Medicine examined the presenting manifestations, demographics and treatment strategies in children enrolled in the Intracranial Hypertension Registry (IHR).
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Affiliation(s)
- Lalitha Sivaswamy
- Departments of Pediatrics and Neurology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI
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31
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Lee YA, Tomsak RL, Sadikovic Z, Bahl R, Sivaswamy L. Use of Ocular Coherence Tomography in Children With Idiopathic Intracranial Hypertension-A Single-Center Experience. Pediatr Neurol 2016; 58:101-106.e1. [PMID: 26971313 DOI: 10.1016/j.pediatrneurol.2015.10.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 07/07/2015] [Revised: 10/22/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Idiopathic intracranial hypertension is a disorder characterized by elevated intracranial pressure without an identifiable etiology. Detection of papilledema may be challenging and leads to diagnostic uncertainty in evaluating a child for possible idiopathic intracranial hypertension. Ocular coherence tomography has the potential to add accuracy to the diagnosis of idiopathic intracranial hypertension. The goal of the present study was to determine if there was a relationship between severity of papilledema (as determined by direct ophthalmoscopy and confirmed by fundus photography) and measures of ocular coherence tomography in a pediatric population with idiopathic intracranial hypertension. METHODS Thirteen pediatric patients were recruited prospectively after diagnosis of either definitive idiopathic intracranial hypertension (with papilledema) or possible idiopathic intracranial hypertension (without papilledema) at Children's Hospital of Michigan over a period of one year. Clinical data and results of initial ocular coherence tomography and visual field testing were collected and statistically analyzed. RESULTS The Frisén scale of papilledema significantly correlated with average retinal nerve fiber layer thickness of each eye (r = 0.633, P = 0.02 in right eye and r = 0.868, P = 0.001 in left eye). The retinal nerve fiber layer thickness (mean ± SD) was significantly higher in the definitive group than in the possible group (189 ± 65 μm vs 104 ± 10 μm in right eye, 165 ± 42 μm vs 106 ± 9 μm in left eye, P < 0.01 in both eyes). CONCLUSIONS Ocular coherence tomography may be used as a supplementary method to aid in the reliable detection of papilledema in evaluating a child for idiopathic intracranial hypertension.
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Affiliation(s)
- Young Ah Lee
- Division of Pediatric Neurology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
| | - Robert L Tomsak
- Wayne State University School of Medicine, Kresge Eye Institute, Detroit, Michigan
| | - Zlatan Sadikovic
- Ophthalmic Photography Department, Kresge Eye Institute, Detroit, Michigan
| | - Reecha Bahl
- Department of Ophthalmology, Wayne State University School of Medicine, Kresge Eye Institute, Detroit, Michigan
| | - Lalitha Sivaswamy
- Wayne State University School of Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.
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Affiliation(s)
- Sanjeev Sivakumar
- Department of Neurology, Detroit Medical Center/Wayne State University, Detroit, MI, USA
| | - Janet Poulik
- Department of Pathology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Lalitha Sivaswamy
- Department of Pediatrics and Neurology, Children's Hospital of Michigan, Detroit, MI, USA
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Abstract
Neurocutaneous syndromes are a diverse group of neurologic disorders with concurrent skin manifestations. Most neurocutaneous syndromes have a genetic basis and are believed to arise from a defect in the differentiation of the primitive ectoderm. In this regard, the skin can be a window into the central nervous system and can aid in the diagnosis of neurologic disease in children. The cutaneous signs may be subtle, which places great importance on the physical examination skills of clinicians providing primary care to children. Early recognition can help with proper diagnosis, formulating a treatment plan, anticipating potential complications, making appropriate referrals, and offering genetic counseling to families.
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34
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Affiliation(s)
- Riddhiben Patel
- Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Meghan Harper-Shankie
- Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Ekta Patel
- Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Lalitha Sivaswamy
- Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
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35
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Sivaswamy L, Rajamani K. Vascular causes of stroke in children. J Pediatr Neurol 2015. [DOI: 10.3233/jpn-2010-0409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Lalitha Sivaswamy
- Carman and Ann Adams Department of Pediatrics, Wayne State University, School of Medicine, Detroit, MI, USA
| | - Kumar Rajamani
- Department of Neurology, Comprehensive Stroke Program, Wayne State University, School of Medicine, Detroit, MI, USA
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36
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Altinok D, Juhász C, Sivaswamy L. Imaging of pediatric stroke. J Pediatr Neurol 2015. [DOI: 10.3233/jpn-2010-0403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Deniz Altinok
- Department of Radiology, Wayne State University, School of Medicine, Detroit, MI, USA
| | - Csaba Juhász
- Carman and Ann Adams Department of Pediatrics, Wayne State University, School of Medicine, Detroit, MI, USA
| | - Lalitha Sivaswamy
- Carman and Ann Adams Department of Pediatrics, Wayne State University, School of Medicine, Detroit, MI, USA
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37
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Agarwal RL, Mills S, Sivaswamy L. Case 1: failure to thrive, microcephaly, and intracranial calcifications in a 6-week-old girl. Pediatr Rev 2015; 36:172-4. [PMID: 25834221 DOI: 10.1542/pir.36-4-172] [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)
- Rajkumar L Agarwal
- Departments of Pediatrics and Neurology, Children's Hospital of Michigan, Detroit, MI
| | - Stacey Mills
- Departments of Pediatrics and Neurology, Children's Hospital of Michigan, Detroit, MI
| | - Lalitha Sivaswamy
- Departments of Pediatrics and Neurology, Children's Hospital of Michigan, Detroit, MI
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38
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Affiliation(s)
- Young Ah Lee
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan; Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
| | - William Kupsky
- Department of Pathology, Harper Hospital, Wayne State University, Detroit, Michigan
| | - Deniz Altinok
- Department of Radiology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
| | - Zhihong Joanne Wang
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
| | - Lalitha Sivaswamy
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan; Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan.
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Abstract
There are a wide variety of paroxysmal nonepileptic events (PNEEs) in children that can mimic seizures. The type of PNEEs that need to be considered in the differential diagnosis depends on the age of symptom onset and the clinical features. In infants and toddlers, conditions that are relatively common in clinical practice such as apnea, jitteriness, shuddering attacks, and breath-holding spells may not present much of a diagnostic conundrum, whereas unusual conditions such as hyperekplexia may cause concern. Similarly, although most types of migraine are easily distinguished from seizures in school-aged children, certain variants such as the "Alice in Wonderland" syndrome or basilar migraine can create diagnostic confusion. Most types of PNEE are exclusive to childhood; therefore, the pediatrician must be familiar with a variety of physiological processes and pathological entities that can raise concern in parents. The pediatrician is in the unique position of being able to reassure families and/or guide further work-up. Many of the PNEEs in young children require no treatment and resolve spontaneously. It is important to distinguish these episodes from true seizures as to avoid unnecessary testing and pharmacological treatment. This review highlights common PNEEs in children, beginning with the neonatal age group and moving upward to adolescence.
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Agarwal R, Patel R, Set K, Zidan M, Sivaswamy L. Safety, Awareness, and Familiarity regarding Epilepsy in Teenage Years (SAFETY): understanding the adolescents' perspective about their disease. Epilepsy Behav 2014; 41:114-8. [PMID: 25461200 DOI: 10.1016/j.yebeh.2014.09.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 07/23/2014] [Revised: 09/11/2014] [Accepted: 09/20/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the understanding of adolescent patients regarding epilepsy. METHODS The SAFETY (Safety, Awareness, and Familiarity regarding Epilepsy in Teenage Years) questionnaire (content validity index: 0.96, Flesch readability score: 66.6) was administered to 165 cognitively normal adolescents with epilepsy (85 females, mean age: 15.2 ± 1.6 years, range: 13-18 years). The first part of the questionnaire was devised to evaluate knowledge about epilepsy and antiepileptic medications (SAFETY-K: 7 questions). The second part queried lifestyle modifications and safety (SAFETY-S: 10 questions). Female participants answered 5 additional questions related to reproductive health (RH questionnaire). RESULTS The correct response rate for the composite SAFETY questionnaire was 51.5%. The average rates of correct responses for the SAFETY-K and SAFETY-S questions were 47.9% and 53.9%, respectively. On univariate logistic regression analysis, factors which were significant predictors of correct responses included age (odds ratio: 1.8, C.I. = 1.3-2.4), race (Caucasian vs. African-American; odds ratio: 3.9, C.I. = 1.4-10.4), and employment of at least one parent in a professional occupation (odds ratio: 3.3, C.I. = 1.1-10.3). The correct response rate did not correlate with the duration of epilepsy, extent of seizure control, number of antiepileptic medications, parental educational, or (un)employment status. The mean rate of correct responses for the RH questions amongst teenage girls was 17.4%. CONCLUSIONS There is lack of awareness about epilepsy and its associated lifestyle modifications in adolescents with epilepsy seen at our institution. This is especially true in young adolescents, African-American patients, and those whose parents are not employed in professional occupations. Teenage girls with epilepsy appear to have limited knowledge with respect to contraception and childbearing.
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Affiliation(s)
- Rajkumar Agarwal
- Division of Neurology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Blvd., Detroit, MI 48201, USA.
| | - Riddhiben Patel
- Division of Neurology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Blvd., Detroit, MI 48201, USA.
| | - Kallol Set
- Division of Neurology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Blvd., Detroit, MI 48201, USA.
| | - Marwan Zidan
- Department of Biostatistics, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Blvd., Detroit, MI 48201, USA.
| | - Lalitha Sivaswamy
- Division of Neurology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Blvd., Detroit, MI 48201, USA.
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42
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Ilyas M, Wickland J, Sivaswamy L. Case 1: Transient quadriplegia in a teenager. Paediatr Child Health 2014; 19:459-61. [DOI: 10.1093/pch/19.9.459] [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] [Accepted: 05/02/2014] [Indexed: 11/13/2022] Open
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43
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Sivaswamy L, Lee YA, Borgohain P. A 2-year-old boy with gelastic seizures. J Pediatr 2014; 165:1067. [PMID: 25189823 DOI: 10.1016/j.jpeds.2014.07.030] [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: 06/19/2014] [Revised: 07/07/2014] [Accepted: 07/16/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Lalitha Sivaswamy
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Young Ah Lee
- Division of Pediatric Neurology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Preeti Borgohain
- Division of Electroneurophysiology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
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Agarwal R, Sivaswamy L. An 11-year-old with a tongue twister. J Paediatr Child Health 2014; 50:931, 935. [PMID: 25376352 DOI: 10.1111/jpc.12563] [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: 11/29/2022]
Affiliation(s)
- Rajkumar Agarwal
- Paediatric Neurology, Children's Hospital of Michigan, Detroit, Michigan, USA
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Todd S, Arora R, Kannikeswaran N, Allarakhia I, Sivaswamy L, Wallenstein MB, Burgener EB, Klotz J, Kerner JA. Index of suspicion. Pediatr Rev 2014; 35:439-46. [PMID: 25274971 DOI: 10.1542/pir.35-10-439] [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)
| | - Rajan Arora
- Children's Hospital of Michigan, Detroit, MI,* and
| | | | - Iqbal Allarakhia
- Department of Pediatrics, St John Hospital and Medical Center, Detroit, MI
| | | | | | | | - Jenna Klotz
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - John A Kerner
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
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Ilyas M, Sivaswamy L, Asano E, Sood S, Zidan M, Chugani H. Seizure control following palliative resective surgery for intractable epilepsy-a pilot study. Pediatr Neurol 2014; 51:330-5. [PMID: 25160538 DOI: 10.1016/j.pediatrneurol.2014.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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] [Received: 02/24/2014] [Revised: 04/19/2014] [Accepted: 05/04/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with intractable epilepsy who have bilateral epileptic foci may not qualify for curative epilepsy surgery. In some cases palliative resection may be undertaken with a goal to decrease seizure frequency and improve quality of life. Here we present data on the outcome of palliative epilepsy surgery in children. METHODS We reviewed medical charts of children who underwent palliative resection for intractable epilepsy during the years 1999-2013 at Children's Hospital of Michigan. The palliative intent of resection was declared preoperatively. Outcome was assessed in terms of seizure reduction. RESULTS There were 18 patients (11 males, median age of surgery was 3.5 years [range 0.5-16 years]). The median duration of follow-up after surgery was 12.5 months (range 6-60 months). Hemispherectomy was the most commonly performed palliative resection (nine patients), followed by lobectomy (six patients), multilobar resection (one patient), and tuberectomy (two patients). Reduction in seizure frequency was observed in 11 patients, with eight patients achieving seizure freedom on antiepileptic drugs and three with >50% reduction in seizure frequency. Transient improvement in seizure frequency occurred in two patients, whereas there was no benefit in five patients. CONCLUSIONS Beneficial effects of epilepsy surgery may be realized in carefully selected situations wherein the most epileptogenic focus is resected to reduce seizure burden and improve quality of life.
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Affiliation(s)
- Mohammed Ilyas
- Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan.
| | - Lalitha Sivaswamy
- Carmen and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Eishi Asano
- Children's Hospital of Michigan, Detroit, Michigan
| | - Sandeep Sood
- Carmen and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Marwan Zidan
- Carmen and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Research Center of Michigan, Detroit, Michigan
| | - Harry Chugani
- Carmen and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan
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Affiliation(s)
- Riddhiben Patel
- Department of Pediatrics and Neurology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Cresha Davis
- Department of Pediatrics and Neurology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Lalitha Sivaswamy
- Department of Pediatrics and Neurology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
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Agarwal RL, Agarwal RR, Sivaswamy L. How well are we preparing pediatricians to manage seizures and epilepsy? A single-center questionnaire-based pilot study. Clin Pediatr (Phila) 2014; 53:682-8. [PMID: 24671875 DOI: 10.1177/0009922814528280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the knowledge of pediatric residents regarding principles of management of seizures and epilepsy. METHODS A 10-item multiple-choice questionnaire with single correct response each (scored as 1) was administered to pediatric residents at an academic hospital. RESULTS Out of 92 questionnaires, 73 were returned (79.3%). The mean score was 5 ± 1.9 (range = 1 to 9). Most correct responses (53/70, 75.5%) were received for the question on diagnosis of epilepsy. Questions on febrile seizures and on pharmacology of valproic acid received <50% correct responses among senior as well as junior residents, with no significant improvement in the correct response rate of senior residents. CONCLUSIONS Deficiencies exist in pediatric residents' knowledge of seizures and epilepsy, especially with respect to febrile seizures and pharmacology of antiepileptic medications. Improved mechanisms to promote understanding in these areas are needed during pediatric training.
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Affiliation(s)
| | - Roshani R Agarwal
- Children's Hospital of Michigan and Wayne State University, Detroit, MI, USA
| | - Lalitha Sivaswamy
- Children's Hospital of Michigan and Wayne State University, Detroit, MI, USA
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Prasun P, Hankerd M, Kristofice M, Scussel L, Sivaswamy L, Ebrahim S. Compound heterozygous microdeletion of chromosome 15q13.3 region in a child with hypotonia, impaired vision, and global developmental delay. Am J Med Genet A 2014; 164A:1815-20. [PMID: 24700535 DOI: 10.1002/ajmg.a.36535] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 02/16/2014] [Indexed: 11/06/2022]
Abstract
Homozygous or compound heterozygous microdeletion of 15q13.3 region is a rare but clinically recognizable syndrome manifested by profound intellectual disability, muscular hypotonia, intractable seizures, and visual impairment. We identified a compound heterozygous 15q13.3 microdeletion in a 23-month-old girl with global developmental delay, generalized muscular hypotonia, and visual dysfunction. The larger deletion was approximately 1.28 Mb in size and contained seven genes including the TRPM1 and CHRNA7, while the smaller deletion was estimated to be 410 Kb in size and contained only CHRNA7. Compound heterozygous 15q13.3 microdeletion is extremely rare and to the best of our knowledge only two such patients have been reported in literature thus far. The findings in our patient suggest that the pathogenesis of visual dysfunction, which is a consistent finding in homozygous/compound heterozygous 15q13.3 microdeletion depends upon the size of microdeletion. Homozygous loss of TRPM1 likely causes retinal dysfunction while homozygous loss of CHRNA7 alone may lead to visual impairment by cortical mechanisms.
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Affiliation(s)
- Pankaj Prasun
- Division of Genetics & Metabolic Disorders, Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan
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Abstract
Ataxia refers to motor incoordination that is usually most prominent during movement or when a child is attempting to maintain a sitting posture. The first part of the review focuses on the anatomic localization of ataxia--both within the nervous system and without--using a combination of historical features and physical findings. The remainder of the review discusses etiological considerations that vary depending on the age group under consideration. In infancy, certain specific diseases, such as opsoclonus myoclonus ataxia syndrome, must receive special mention because the underlying disease process may be amenable to surgical intervention. In the toddler- and school-age groups, certain conditions (such as stroke and acute cerebellitis) require immediate recognition and imaging, whereas others (such as post-infectious ataxia and concussion) require close follow-up. Finally, mention must be made of diseases outside of the central nervous system that can present with ataxia, such as Guillain-Barré syndrome.
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