Biomedical subjects
Publications and source records attributed to Sarit Ravid.
Rhythmic movement disorder is a parasomnia that is difficult to treat. In our study, 3 weeks of controlled sleep restriction with hypnotic administration in the first week resulted in almost complete resolution of the movements in 6 children. This therapeutic success suggests that rhythmic movement disorder results from a voluntary self-soothing behavior.
STUDY OBJECTIVES: Children with attention-deficit/hyperactive disorder (ADHD), in spite of being hyperactive, still benefit from treatment with stimulant medications. We hypothesized that children with ADHD are in fact sleepy during the day, and we sought to test it objectively. DESIGN: Single blind comparative study SETTING: University medical center PARTICIPANTS: Thirty-four children with a previous diagnosis of ADHD (mean age +/- SD, 12.4 +/- 4.6 years) and 32 matched controls (mean age, 12.0 +/- 3.6 years). INTERVENTIONS: N/A. MEASUREMENTS: All participants underwent a full-night polysomnographic study followed by a multiple sleep latency test (MSLT). RESULTS: Sleep latency, total sleep time, and sleep efficiency were comparable between the groups, yet children with ADHD were significantly sleepier during the day than those in the control group (mean MSLT score of 21.9 +/- 5.5 minutes versus 27.9 +/- 2.0 minutes, P < .005). Of the children with ADHD, 17 (50%) had signs of sleep-disordered breathing, compared with 7 of the control group (22%, P < .05). Five of the ADHD group had periodic limb movements during sleep (15%) versus none in the control group. Children without sleep-disordered breathing or periodic limb movements during sleep had the lowest nocturnal sleep efficiency and total sleep time. CONCLUSIONS: We conclude that children with ADHD demonstrate objective daytime somnolence, which may explain the beneficial effects of treatment with stimulant medications. Primary sleep disorders, especially sleep-disordered breathing and periodic limb movement disorder, should be looked for in children with ADHD.
AIM: Acute blindness is a rare presentation of epileptic disorders referring to loss of sight without loss of consciousness corroborating with epileptic discharges recorded on the EEG. We summarized the pertinent literature on childhood-onset epileptic blindness. We also report on our overall experience with 26 children having developed epileptic amaurosis. This includes descriptions of the associated seizures. EEG abnormalities and reports on the response to anti-epileptic therapy as regards to resolution of blindness and control of associated seizures. RESULTS: Our data for children with epileptic blindness is similar to previous reports regarding the reported duration of blindness and associated seizures, as well as the overall response to therapy and outcome. In our study, 25 children experienced acute episodes of complete visual obscuration lasting for 1-10 minutes and one 4-month-old infant had blindness from birth, representing status epilepticus amauroticus. Ten patients had accompanying generalized seizures, with a photosensitive response recorded in three cases. All of these children were treated with valproic acid regaining full vision and eight became seizure free. Ten children had accompanying focal motor seizures and unilateral temporo-posterior epileptic discharges recorded on EEG and two additional cases had isolated blindness and focal discharges. All 12 children were treated with carbamazepine, regaining full vision and complete seizure control in eleven. One infant with status epilepticus amauroticus since birth, secondary to a persistent epileptic focus over the right central-posterior areas, regained full vision following resection of an area of cortical dysplasia at the age of 8 months. Four additional children had the constellation of migraine headaches, focal motor seizures and complete blindness along with occipital EEG discharges, compatible with the syndrome of late-onset benign childhood epilepsy with occipital paroxysms (Gastaut syndrome). They were treated with carbamazepine and all became asymptomatic within a period of 1-4 years. CONCLUSIONS: Analysis of the literature, in addition to our overall experience, indicates that epileptic blindness in children is associated with a favorable outcome providing prompt diagnosis and treatment of the associated seizures or epileptic syndrome. This resulted in complete and long-standing resolution of blindness in all children together with satisfactory control of seizures. As such, we recommend a prompt EEG in any child presenting acute visual obscuration, even in the absence of additional overt epileptic phenomena.
Subdural hemorrhage is common in infancy, particularly in the first year of life. The most common cause is nonaccidental (child abuse), with accidental in second place. We present three healthy infants, ages 4, 5, and 7 months that, during an evaluation for macrocephaly, were found to have frontal subdural hematoma in association with prominent extracerebral cerebrospinal fluid spaces (external hydrocephalus). There was no history of trauma or risk factors for child abuse. Skull surveys and ophthalmologic examinations were normal. All infants were neurologically intact and achieved normal developmental milestones in one-year follow-up. We suggest that some infants with external hydrocephalus may be at risk for development of subdural hematoma with minimal or no trauma, most likely secondary to stretching of the bridging veins in the unusually widened subarachnoid spaces. Child abuse, although it should always be kept in mind and should be excluded, may not be the most common cause in this specific context.
The objective of the study was to validate the effectiveness of a questionnaire and computer-assisted algorithm in diagnosing children with dizziness or vertigo. Dizziness and vertigo are common complaints in children, causing an extensive, often unnecessary evaluation. A pediatric "dizziness questionnaire" was designed and a computer-assisted algorithm was developed to facilitate the diagnostic task. A retrospective medical record review was conducted on all children presenting to the clinic for dizziness or vertigo throughout a 2-year period. The information was used by one investigator to complete the questionnaire and by the other, the algorithm. The two diagnoses thus obtained were compared by the third investigator to the medical record diagnosis. Sixty-two records were reviewed. The final diagnoses were migraine (39%), benign paroxysmal vertigo (15%), vestibular neuronitis (14%), and anxiety (13%). In 57 patients (92%), the questionnaire-derived diagnosis was identical to the medical record diagnosis. In 52 patients (84%), the algorithm-derived diagnosis matched the medical record diagnosis. The questionnaire and computer-assisted algorithm are reliable diagnostic screening tools for children with dizziness or vertigo. When these tools combined provide a clear-cut diagnosis, no further evaluation is necessary.
INTRODUCTION: Spontaneous spinal epidural hematoma is rare in children. The presenting symptoms are usually pain, either local or radicular, followed by progressive bilateral weakness, and sensory loss hours and even days later. In the absence of significant precipitating factors such as severe trauma or previously known coagulopathies the diagnosis is usually delayed, and it is not until the full picture of severe cord compression is developed, that MRI is done and the diagnosis is finally made. CASE REPORT: We describe a case of 10-year-old girl who presented with pain and pure brachial plexus radiculopathy as the only clinical manifestations of spinal epidural hematoma. CONCLUSION: A high index of suspicion can lead to the correct diagnosis even before the development of full cord compression and thus improve the overall prognosis.