Phrenic Neuropathy Etiologies and Recovery Trajectories in Outpatient Rehabilitation and Neuromuscular Medicine Clinics: A Retrospective Analysis
Nicholas DemetriouAlexandra S. JensenEllen FarrJohn M. ColemanSenda Ajroud‐DrissAdenike A. AdewuyiLisa F. WolfeColin K. Franz
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Abstract Introduction/Aims Phrenic Neuropathy (PhN) impairs diaphragm muscle function, causing a spectrum of breathing disability. PhN etiologies and their natural history are ill defined. This knowledge gap hinders informed prognosis and management decisions. This study aims to help fill this knowledge gap on PhN etiologies, outcomes, and recovery patterns, especially in the context of non-surgical clinical practice. Methods This is a retrospective study from two interdisciplinary clinics, physiatry and neurology based. Patients were included if PhN was identified, and other causes of hemi-diaphragm muscle dysfunction excluded. Patients were followed serially per the discretion of the neuromuscular trained neurologist or physiatrist. Recovery was assessed using pulmonary function tests (PFTs), diaphragm muscle US thickening ratio, and patient-reported outcomes in patients presenting within two years of PhN onset. Results We identified 151 patients with PhN. The most common etiologies included idiopathic (27%), associated with cardiothoracic procedure (24%), and intensive care unit (17%). Of these patients, 117 (77%) were evaluated within two years of PhN onset. Of patients included in outcome analyses, 69% saw improvement on serial US, 50% on serial PFTs and 79% reported symptomatic improvement at an average of 13, 16, and 17 months respectively. Conclusion This study maps PhN etiologies and recovery. A clear majority of PhN patients show improvement in diaphragm muscle function, but on average improvements took 13-17 months depending on the assessment type. These insights are vital for developing tailored treatments and can guide physicians in prognosis and decision-making, especially if more invasive interventions are being considered.Keywords:
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102 children with uveitis were followed up in both an ophthalmological clinic and in private practice. These cases were studied, using the same criteria for the anatomical and etiological classification. For each etiology arguments for certitude and probability were cautiously defined. The etiology could be ascertained in about 36.5% of the cases. Arguments for a presumptive etiology were found in about 23.1% more cases. The first cause was toxoplasmosis; the second cause was streptococcic hypersensitivity. An etiology was rarely found for intermediate uveitis.
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introduction: Seizure is the most common neurological illness in pediatric population, and its risk is highest in the rst year of life. A comprehensive study regarding etiology, clinical prole is required, hence the current study was undertaken. The objective of this work was to study the etiology, clinical prole of seizures in children aged less than 18 years.Objective: Materials and Methods: A descriptive study of children with seizure was conducted at Neurology outpatient department, and references from pediatrics department. All children with seizures were included. Biochemical and haematological investigations, imaging, and electroencephalogram were performed whenever necessary. Simple descriptive statistics were used to analyse the data in the form of frequencies with percentages as applicable. Out of 65 Pediatric patients who presented with seizures were Febrile seizure – Simple 4.6% (3)Results: ,Atypical 29.2% (19),Fever precipitated seizure 32.3% (21), Seizure disorder with developmental delay 20% (13),Unprovoked 6.1% (4),others (5) Seizure was the commonest neurological condition of children presenting to neurology OPD and referred from pediatrics. FeverConclusion: precipitated seizure being the commonest etiology. The prognosis and outcomes were good but there were prolonged days of hospitalization. Children with unprovoked seizures require brain-imaging studies for better understanding of seizure etiology.
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Pediatric Neurology
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Seizure Disorders
Outpatient clinic
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Febrile seizure
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Seizure is the most common neurological illness in pediatric population and its risk is highest in the first year of life. Studies regarding etiology of afebrile seizures worldwide and in India are limited; hence, the current study was undertaken.The objective of this work was to study the etiology of afebrile seizures in infants aged 1 month to 1 year.A retrospective study of afebrile infantile seizure was conducted at pediatric neurology outpatient department between January 2015 and September 2017. All children with first episode of afebrile seizures were included. Biochemical and hematological investigations, imaging, and electroencephalogram were performed whenever necessary. Simple descriptive statistics were used to analyze the data in the form of frequencies with percentages and median as applicable.One hundred twenty-one children with a mean age of 8.1 months were analyzed. Of these children, 58% were males. Positive family history was found in 1.65% children, developmental delay in 70%, and dysmorphism in 8%. Presenting seizure type were generalized (74%), focal (21%), and unknown (6%) onset. Etiology was deducible in 92% cases. Structural etiology was the most common (66%), followed by metabolic (12%), infections (7%), and others (6%). In structural pathology, common causes were perinatal insult (38%) and cerebral malformations (18%). Imaging was done in 98 cases and yield was 83% (85 cases).Etiology was deducible in 92% of children. Seizures due to structural etiology, secondary to perinatal insult followed by metabolic and infections, are important causes. Imaging aids are important in etiological diagnosis. Etiological evaluation should be considered in children following first episode of afebrile seizures, especially in developing countries like India.
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Epilepsy is one of the most frequent diseases of the central nervous system (CNS) in children. It is considered that roughly 50% of epilepsies begin during childhood. The Department of Childrens' Neurology of the Medical Academy of Białystok embraces with medical attention over 500 children with epilepsy from the north-eastern region of Poland. The aim of the study was the analysis of etiology, clinical symptoms and treatment of epilepsy in children, who are under the medical attention of our Department. 392 children aged from 7 months to 18 and 2/12 years were included in the study. In the analysed groups were 46.6% girls and 53.4% boys. 44.4% of the children live in cities and 55.6% in small towns or villages. The etiology of epilepsy was established in 48.7% of the children. The most common etiology of epilepsy were hypoxic-ischemic damages in perinatal period, developmental malformation of the brain, craniocerebral injuries and neuroinfections in the neonatal period. In 50.3% of the children the etiology of epilepsy was unknown. The most common types of seizures were primary and secondary generalised tonic-clonic seizures. 92.6% of the patients received the antiepileptic drugs during the study. Monotherapy was administered in 66.0%, politherapy in 26.5% of the children. The results relating to the etiology and clinical picture of epilepsy in our children are consisted with many dates from literature. It is a favourable observation, that in many children monotherapy is an effective treatment.
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Etiology and pathogenesis of MCA/MR in 1,023 patients (618 male; 405 female) with mental retardation were studied. Of 1,023 patients, there were 563 cases (317 male; 246 female) with MCA (55%). Among the MCA patients, there were 303 (156 male; 147 female) whose primary etiology was clarified (53.8%). Among the 260 patients with MCA/MR of unknown etiology, there were 23 with recognizable syndromes of unknown etiology and 7 previously reported by us as possibly having a new malformation syndrome. We had 569 patients with mental retardation of unknown etiology including 236 (41.5%) who were involved with MCA.
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Introduction: Neonatal seizures are significant because most of them are treatable if a specific cause is identified. Prompt diagnosis is important to plan correct treatment. The time of onset of seizures is closely related to the aetiology of seizure Objectives: The objective of the present study is to know the etiology of seizures, the time of onset, relation to the cause and the common types of seizures Methodology: 102 neonates presenting with seizures admitted in the NICU of RMH, Thanjavur Medical College, Thanjavur during January 2014 to august 2014 were taken for study, Detailed antenatal, natal and post natal history were taken and examination of baby done and HIE staged according to Modified Sarnat’s staging. Then relevant investigations were done and etiology of neonatal seizures were diagnosed and staged Results: In the present study, out of 102 neonates studied, 82 were full-term, among these 60 (58.8%) were AGA and 22 (21.6%) were SGA. 19 babies (18.6%) were preterm. Male: Female ratio in our study was 1.5:1. Conclusion: The most common etiology for neonatal seizures is HIE. Onset of seizures during first 3 days of life has significant correlation with HIE as etiology. Subtle seizures is the commonest type of seizures and is difficult to identify. Keywords: Neonatal seizures; Birth asphyxia; HIE; Subtle seizures; Hypoglycemia
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The purpose of this study was to investigate the clinical characteristics of children with mental retardation (MR) of unknown etiology for early recognition and intervention. In this study, we defined children with MR of unknown etiology as those without clear etiologies for MR despite extensive evaluation and were not associated with pathological behavioral problems such as pervasive developmental disorders and attention-deficit/hyperactivity disorder. The clinical characteristics of children with MR of unknown etiology were as follows. 1) MR of unknown etiology was 48.8% of all MR. 2) MR of unknown etiology was more common in males. 3) Delayed language development was a leading factor that made the parents of children with MR of unknown etiology seek help from physicians. However, most of the children with MR of unknown etiology showed a relatively uniform delay in several areas of development. 4) Most children with MR of unknown etiology were delayed walkers. 5) Most children with MR of unknown etiology were mild cases.
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One hundred cases of urticaria were studied to find out the etiology and to detect any co-relation between etiology and clinical manifestation. In 59% cases an etiological factor could be detected and the diagnosis was more certain in acute cases. In more than two-third of cases of chronic utricaria, the etiology could not be detected. Type and distribution of the lesions did not suggest any particular etiology except in the cases of physical and cholinergic urticaria.
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