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Biomedical subjects

G S Golden

Publications and source records attributed to G S Golden.

At least 19 recordsLinked to original sources
PubMed1992

Pharmacologic treatment of childhood migraine.

This review of pharmacologic treatment of childhood migraine shows that no agent for abortive treatment has been proved effective in controlled studies and that most commonly used prophylactic agents (e.g., propranolol and cyproheptadine) lack proof of their effectiveness. Flunarizine seems to be the only agent with positive results in controlled studies. This drug, although well tolerated, is slow to act. For the treatment of an acute attack, aspirin or acetaminophen may be chosen. Two of us currently use propranolol as the first-choice prophylactic agent because of its tolerance and cost, and on the assumption of its effectiveness reported by the adult studies. For children with a history of asthma, metoprolol may be chosen because of its selective blocking of the beta 1-adrenoreceptor. One of us (W.N.M.) prefers cyproheptadine as the drug of choice. Behavioral therapy may be a good alternative to pharmacotherapy in the management of childhood migraine.

Child↗
PubMed1992

Nonepileptic paroxysmal events in childhood.

Seizures are the most commonly occurring paroxysmal events of childhood. There are a large number of other disorders, however, that present with discrete attacks separated by symptom-free intervals. The differentiation of these conditions from seizures depends on a willingness to consider alternate diagnoses and a thorough review of the history of the events. Laboratory tests, and especially the electroencephalogram, are aids to diagnosis, but reliance on laboratory data has many pitfalls. The clinical features of the important nonepileptic paroxysmal disorders of childhood are reviewed.

Child↗
PubMed1991

Role of attention deficit hyperactivity disorder in learning disabilities.

ADHD refers to a combination of symptoms in the general areas of inattention, impulsivity, and hyperactivity. This condition becomes evident in the preschool years and affects males predominantly. The behavior is seen as being disruptive and unacceptable by parents and teachers, and the child is socially handicapped as a result. Treatment relies on behavioral techniques and medication, predominantly psychostimulants. ADHD is strongly associated with learning disabilities; the treatment of the learning disorder should be based on educational intervention, not drug therapy. Symptoms of ADHD may continue into adulthood, and recommendations for treatment of adults are being made with increasing frequency. The prognosis is best for children who do not have symptoms of a conduct disorder and who lose the symptoms of ADHD before adolescence. A superimposed conduct disorder and maintenance of the symptoms of ADHD put the patient at high risk for antisocial behavior and substance abuse in adolescence and adulthood.

Attention Deficit Disorder with Hyperactivity↗
PubMed1990

Pertussis vaccine and injury to the brain.

A syndrome of pertussis vaccine encephalopathy was first reported 56 years ago. Analysis of the recent literature, however, does not support the existence of such a syndrome and suggests that neurologic events after immunization are chance temporal associations of neurologic conditions that occur in the target age group, even in the absence of immunization. Population-based studies do not prove a causal relationship with acute encephalopathy. There are no consistent neuropathologic findings suggesting a specific pathophysiologic process, and hypotheses concerning possible mechanisms of damage are not supported by reproducible studies in children. No acceptable animal model exists. There clearly is an increased risk of a convulsion after diphtheria-tetanus-pertussis immunization but no evidence that this produces brain injury or is a forerunner of epilepsy. Studies have also not linked immunization with either sudden infant death syndrome or infantile spasms.

Brain Diseases↗
PubMed1990

Tourette syndrome: recent advances.

Clinical and genetic studies have allowed the limits of Tourette syndrome to be broadened. There is now strong evidence that chronic motor tics and Tourette syndrome are different manifestations of an autosomal dominant gene with high penetrance. A genetic link with obsessive-compulsive disorder also appears to have been established. Up to 10% of cases of Tourette syndrome may be nongenetic phenocopies, however. There is also an association between Tourette syndrome and attention deficit hyperactivity disorder. This complicates therapy, as psychostimulant drugs may precipitate or exacerbate tics in some individuals. A high proportion of patients with Tourette syndrome also has neuropsychological deficits and learning disabilities. The pathophysiology is incompletely understood. The best supported hypothesis is that there is dopamine receptor supersensitivity, although there are strong suggestions of abnormalities in serotonin metabolism. The possibility of abnormalities in neuropeptide systems is being explored. Treatment of tics relies primarily on neuroleptics with dopamine receptor blocking activity. Clonidine may be useful in some patients, especially those with behavior problems. Obsessive-compulsive symptoms can be treated using appropriate pharmacologic agents. The treatment of attention deficit disorder in patients with tics should begin with behavioral strategies. Clonidine can be tried as the first-line drug, and psychostimulants should be used only if necessary and with great caution. In rare instances it may be necessary to combine a psychostimulant and a neuroleptic.

Child↗
PubMed1989

Promotion of patient appointment compliance in indigent pediatric medical care by use of a microcomputer.

A computerized system for appointment scheduling, medical record keeping, medical billing, patient tracking, and epidemiologic data generation was developed and applied in an indigent pediatric otologic clinic. Functions used to augment appointment compliance are 1) notifying the referring physicians, agencies, and health department coordinators of failed appointments and sending medical information on the attended appointments, 2) listing patients who failed appointments, 3) production of mailings for failed appointments, 4) automatic rescheduling of failed appointments, and 5) automatic calculation of patient attendance ratios. The attendance ratio can be used to help identify patients for referral to social service workers and to implement rewards designed to promote medical compliance. The automatic rescheduling of failed appointments resulted in 21% of new patients and 30% of return patients above controls returning for a medical visit. The recalled had much lower economic status than our average clinic patient, ie, the system was effective in reaching the target population.

Ambulatory Care Information Systems↗
PubMed1988

The relationship between stimulant medication and tics.

Clinical evidence supports the observation that stimulant drugs increase the severity of tics in 25% to 50% of patients with TS, and occasionally can precipitate TS in a patient who did not previously manifest symptoms of this disorder. As ADD is frequently associated with TS, the clinician is often faced with a dilemma. A conservative approach to the use of stimulant medication, stringent criteria for its use, adequate counseling of the child and parents, and a thorough cost-benefit analysis before initiating treatment are required. Behavior management and environmental manipulation can be useful techniques with the child with ADD, and should be tried before medication is considered.

Attention Deficit Disorder with Hyperactivity↗
PubMed1979

The effect of developmental disabilities on mental health.

Behavioral abnormalities in the developmentally disabled child are usually ascribed to parental mismanagement of a child perceived as abnormal. (Review of the available data points to the existence of primary behavioral abnormalities due directly to the cerebral dysfunction.) This has important implications for parental counseling and management.

Autistic Disorder↗
PubMed1979

The Alice in Wonderland syndrome in juvenile migraine.

Two children are reported who had recurrent attacks of impairment of time sense, body image, and visual analysis of the environment. These occurred with a clear state of consciousness and in the absence of any evidence of an encephalitic process, seizures, drug ingestion, or psychiatric illness. Both children had recurrent headaches; one was clearly migrainous. There was a family history of migraine in both cases. These children represent examples of the Alice in Wonderland syndrome in juvenile migraine.

Child↗
PubMed1978

Basilar artery migraine. A review of 30 cases.

Thirty patients with basilar artery migraine were followed up for a period of six months to three years. The mean age of onset was 7 years. The patients were seen with recurrent transient attacks of neurological disturbances localized to the vertebrobasilar arterial tree. Attacks often included pulsatile cephalagia. A history of migraine was present in 86% of the families studied. The majority of family members with migraine were female and on the maternal side. Permanent neurological residua developed in only one patient. There was a tendency for attacks to be more severe with an older age of onset. Basilar artery migraine is a migraine variant that may affect children from late infancy through adolescence.

Adolescent↗
PubMed1978

Infantile spasms in Down syndrome: a report of 5 cases and review of the literature.

Five patients with Down syndrome (DS) and infantile spasms were examined in a four-year interval. Previous reports of this association have been infrequent except during experimental treatment with 5-hydroxytryptophan, a precursor of serotonin. Malformations of the brain in DS are associated with an increased incidence of epilepsy, and both gross and cytoarchitectural anomalies have been described. The severity and distribution of these central nervous system anomalies presumably predispose to the infantile spasms. The contribution of altered serotonin metabolism is uncertain.

5-Hydroxytryptophan↗
PubMed1978

Tics and Tourette's: a continuum of symptoms?

Analysis of the families of 39 unselected children with Tourette syndrome revealed other members with tic disorders in twenty kindreds. In eight families there were 13 individuals with chronic multiple tics, usually motor, not vocal. Twelve different families contained 18 subjects with Tourette syndrome other than the index patient. In three of these families there were 6 additional individuals with chronic motor tics, forming a bridge to the first group. An autosomal dominant mode of inheritance was suggested in all cases. Tourette syndrome and chronic motor tics appear to represent conditions along a continuum and have, in many instances, a hereditary basis.

Child↗