Frequent arousals with sleep fragmentation have been correlated with difficulties in emotion/behavioral regulation, attention, and cognitive functioning in children with sleep disorders.1
Sodium oxybate, also known as γ-hydroxybutyrate (Xyrem), is a highly regulated and controlled substance currently approved in the United States for the treatment of cataplexy accompanying narcolepsy2 and also improves daytime sleepiness in patients with narcolepsy.3 Recent studies using sodium oxybate in patients with fibromyalgia improved sleep patterns, including decreased alpha intrusion, sleep fragmentation, and increased slow wave sleep along with improvement in symptoms of pain and fatigue.4
We report an 8-year-old boy with bithalamic lesions with daytime attention and behavioral difficulties and severely disturbed sleep patterns since age 4, who was unresponsive to treatment with traditional medications and interventions but was successfully treated with sodium oxybate.
An 8-year-old boy with past medical history of acute alteration in consciousness and change in cognitive functioning at age 4 had brain MRI showing bithalamic enhancing signal …
Lacosamide is a US Food and Drug Administration (FDA)–approved antiepileptic drug for patients 17 years or older with partial epilepsy. There are sparse data on children. The objective of our study was to evaluate its efficacy/safety in children with refractory epilepsy. Forty children (mean age 14.3 years) were treated with lacosamide at our institution (adjunctive therapy in 36, monotherapy in 4). Fifteen patients had symptomatic focal epilepsy, 2 had cryptogenic focal epilepsy, 20 had symptomatic generalized epilepsy, and 3 had cryptogenic generalized epilepsy. Two had juvenile myoclonic epilepsy and 5 had Lennox-Gastaut syndrome. Forty-two percent had at least >50% reduction in seizure frequency, and 6 became seizure free. Average dose was 7 mg/kg/d and average follow-up was 9.2 months. Responders had a 76.5% mean decrease in seizures. Fifteen children experienced an adverse reaction and 7 discontinued lacosamide (4: Ineffective, I: insurance denial, 1: tremor, 1: behavior). Lacosamide is effective and well-tolerated in children with refractory epilepsy.
El genero Panopea incluye a uno de los bivalvos excavadores mas grandes y longevos del mundo. En el noroeste de Mexico ocurren dos especies de estos bivalvos (P. generosa y P. globosa), sin embargo la informacion respecto su taxonomia y biogeografia es contradictoria e incompleta, mientras que la relacion filogenetica con sus congeneres del Pacifico Norte y Sur es desconocida. En el presente trabajo se analizaron las diferencias morfometricas entre P. generosa y P. globosa, analizando el contorno de la valva derecha y sus marcas internas, asi como la relacion filogenetica de ambas especies con P. japonica, P. abbreviata y P. zelandica, utilizando el gen de ADN mitocondrial: citocromo oxidasa 1 (CO1) y los genes de ADN nuclear: 28S y 18S. El analisis morfometrico evidencio diferencias significativas entre ambas especies con los metodos utilizados, sugiriendo que P. globosa tambien se distribuye en la costa Pacifico de Baja California Sur. Incluso a nivel intraespecifico revelo la existencia de stocks fenotipicos en ambas especies. Contrario a lo esperado, el analisis filogenetico con el gen CO1 mostro que las especies geograficamente mas cercanas (P. generosa y P. globosa) tuvieron valores de divergencia tan grandes como los observados entre especies tan distantes geograficamente como por ejemplo, P. globosa y P. abbreviata. Ademas, P. zelandica conservo la mayor similitud con el ancestro comun del genero. En contraste P. generosa fue geneticamente mas similar a P. japonica con los genes analizados. La presencia de haplotipos compartidos entre P. generosa—P. japonica y P. globosa—P. abbreviata con el gen 18S permiten inferir que aunque actualmente son especies completamente separadas, que probablemente P. generosa fue la especie ancestral de P. japonica, mientras que hace mas de 50 millones de anos P. globosa pudo haber compartido un ancestro comun con P. zelandica y P. abbreviata. El analisis filogenetico en las especies de Mexico permitio corroborar que las almejas de Bahia Magdalena, que se asumia eran P. generosa, en realidad son P. globosa y que incluso esta especie que es la unica con una distribucion subtropical, podria estar bajo un proceso de divergencia hacia un nuevo genero. Por su parte, P. zelandica es probablemente una especie relicto.
The interpretation of QT interval is often neglected during electroencephalography (EEG) reading. We compared the incidence of prolonged QT interval, as seen in the electrocardiography (ECG) recording lead of the EEG, in children presenting with seizure, syncope, or attention-deficit hyperactivity disorder (ADHD). Abnormal QT was defined as >460 ms. The incidence of prolonged QT in the seizure, syncope, and ADHD groups was 1/50 (2%), 7/50 (14%), and 2/50 (4%), respectively (P = .036, chi-square). The mean +/- SD of QT were 405 +/- 34, 424 +/- 39, and 414 +/- 36, respectively (P = .035, analysis of variance [ANOVA], syncope group, compared with seizure group). The incidence of prolonged QT as measured in the EEG was unexpectedly high in children presenting with seizure, syncope, or ADHD. These data support the concept that QT evaluation should be emphasized during routine EEG reading, as it may aid in identifying cases of undiagnosed cardiac conduction abnormalities. Prospective studies comparing EEG-ECG tracings with 12-lead ECG are warranted.
Randomized controlled trials have shown that stimulants reduce symptoms of impulsivity and hyperactivity in children with attention deficit/hyperactivity disorder (ADHD); however, these rigid protocols show no advantage of one medication over another. Our study examined the question of differential efficacy and tolerability of five medications used for ADHD, in the open-label setting of our outpatient child neurology clinic. This retrospective study identified 137 children and adolescents (109 boys and 28 girls), with a mean age of 10 years (range 4 to 19 years) treated for ADHD. Treatment options were amphetamine/dextroamphetamine extended release (adderall XR) in 19.0%, amphetamine/dextroamphetamine (adderall), osmotic controlled-released (OROS) formulation of methylphenidate (OROS-MPH, concerta) in 29.2%, atomoxetine (strattera) in 21.9% and methylphenidate standard release (MPH) in 16.8%. Global effectiveness was assessed for each medication. Overall, 78% of patients improved with medication, with no significant statistical difference in efficacy among the five medications. Side effects included decreased appetite (14.6%), insomnia (10.2%), headaches (7.3%), and tics (3.7%). The only difference in side effects was with atomoxetine showing a significantly lower incidence of headaches than amphetamine/dextroamphetamine XR, amphetamine/dextroamphetamine or OROS-MPH. In conclusion, our results in the open-label setting were comparable to those found in randomized controlled trials; the medications we examined were equally effective with minimal differences in side effect profiles.
