Wow!! She's wonderful - 2/2/10. 7 lb 8 oz. Name to follow - still counting votes.
Thursday, February 04, 2010
Monday, February 01, 2010
Big News - Evidence Basis for CP Treatment
Finally, the AAN has published an analysis of the evidence for medications used for spasticity. Botulinum toxin injections (Botox) have CLASS A evidence supporting safety and efficacy. Oral baclofen's literature support is uncertain.
Editorial - I have been using chemodenervation with botulinum toxins for ten years with robust response and minimal side effects. I perform the procedure in the office and under sedation when needed. The key is setting realistic expectations and finding the right dose.
Practice Parameter: Pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review)
Objective: To evaluate published evidence of efficacy and safety of pharmacologic treatments for childhood spasticity due to cerebral palsy.
Methods: A multidisciplinary panel systematically reviewed relevant literature from 1966 to July 2008.
Results: For localized/segmental spasticity, botulinum toxin type A is established as an effective treatment to reduce spasticity in the upper and lower extremities. There is conflicting evidence regarding functional improvement. Botulinum toxin type A was found to be generally safe in children with cerebral palsy; however, the Food and Drug Administration is presently investigating isolated cases of generalized weakness resulting in poor outcomes. No studies that met criteria are available on the use of phenol, alcohol, or botulinum toxin type B injections. For generalized spasticity, diazepam is probably effective in reducing spasticity, but there are insufficient data on its effect on motor function and its side-effect profile. Tizanidine is possibly effective, but there are insufficient data on its effect on function and its side-effect profile. There were insufficient data on the use of dantrolene, oral baclofen, and intrathecal baclofen, and toxicity was frequently reported.
Recommendations: For localized/segmental spasticity that warrants treatment, botulinum toxin type A should be offered as an effective and generally safe treatment (Level A). There are insufficient data to support or refute the use of phenol, alcohol, or botulinum toxin type B (Level U). For generalized spasticity that warrants treatment, diazepam should be considered for short-term treatment, with caution regarding toxicity (Level B), and tizanidine may be considered (Level C). There are insufficient data to support or refute use of dantrolene, oral baclofen, or continuous intrathecal baclofen (Level U).
Friday, January 29, 2010
Interesting news for those who have had a denial for therapy services
http://www.metnews.com/articles/2010/arce012810.htm
C.A. Revives UCL Action Against Kaiser Over Autism Services
By KENNETH OFGANG, Staff Writer
Class action allegations charging Kaiser Foundation Health Plan with violating the Unfair Competition Law by denying speech and behavioral therapies to children with autism spectrum disorders were revived yesterday by this district’s Court of Appeal.
Div. Seven said the complaint raised issues that are properly resolved in a class action, and that Los Angeles Superior Court Judge Emilie Elias erred in dismissing the case on the ground that the court would be required to resolve individual issues with respect to the medical necessity of the therapies.
http://www.metnews.com/articles/2010/arce012810.htm
C.A. Revives UCL Action Against Kaiser Over Autism Services
By KENNETH OFGANG, Staff Writer
Class action allegations charging Kaiser Foundation Health Plan with violating the Unfair Competition Law by denying speech and behavioral therapies to children with autism spectrum disorders were revived yesterday by this district’s Court of Appeal.
Div. Seven said the complaint raised issues that are properly resolved in a class action, and that Los Angeles Superior Court Judge Emilie Elias erred in dismissing the case on the ground that the court would be required to resolve individual issues with respect to the medical necessity of the therapies.
British doctor rebuked over research linking vaccine and autism
Britain's medical regulator finds that Dr. Andrew Wakefield, who now practices in Texas, conducted his now-discredited research on the MMR shot in an unethical and irresponsible manner.
http://www.latimes.com/news/nation-and-world/la-fg-britain-autism29-2010jan29,0,2589393.story
Reporting from London - The British doctor whose suggestion of a link between the MMR shot and autism helped cause vaccination rates to plunge conducted his now-discredited research in a dishonest and irresponsible manner, medical authorities here concluded Thursday.
Britain's medical regulator finds that Dr. Andrew Wakefield, who now practices in Texas, conducted his now-discredited research on the MMR shot in an unethical and irresponsible manner.
http://www.latimes.com/news/nation-and-world/la-fg-britain-autism29-2010jan29,0,2589393.story
Reporting from London - The British doctor whose suggestion of a link between the MMR shot and autism helped cause vaccination rates to plunge conducted his now-discredited research in a dishonest and irresponsible manner, medical authorities here concluded Thursday.
Sunday, January 24, 2010
Medical treatment of autism spectrum disorders - Review
Curr Opin Neurol. 2010 Jan 16.
Medical treatment of autism spectrum disorders.
Department of Pediatrics, The Ohio State University College of Medicine, Developmental and Behavioral Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA.
PURPOSE OF REVIEW: There are several common medical conditions occurring in people with autism spectrum disorders (ASD) that can benefit from treatment and can in turn improve the health and quality of life of people with ASD. This review will primarily focus on these medical comorbidities, with a brief review of potential future treatments.
RECENT FINDINGS: There continues to be disagreement regarding the exact prevalence and etiological significance of gastrointestinal conditions, epilepsy and other abnormal electroencephalographic findings, and sleep problems. It is not clear whether gastrointestinal conditions occur more frequently than in typically developing children, and whether there are distinct conditions that occur more often in ASD than in non-ASD populations. Abnormal electroencephalographic findings have been reported in up to 60% of children with ASD, and some believe that these abnormalities may be responsible for parts of the ASD phenotype. Sleep problems are reported more frequently than in the general population, and effective treatments are available. Future medical treatments for ASD may be directed at underlying core symptoms and have greater impact than today's symptomatic approach.
SUMMARY: Further research in these areas is needed to better guide diagnosis and treatment of a variety of medical conditions experienced by people with ASD.
RECENT FINDINGS: There continues to be disagreement regarding the exact prevalence and etiological significance of gastrointestinal conditions, epilepsy and other abnormal electroencephalographic findings, and sleep problems. It is not clear whether gastrointestinal conditions occur more frequently than in typically developing children, and whether there are distinct conditions that occur more often in ASD than in non-ASD populations. Abnormal electroencephalographic findings have been reported in up to 60% of children with ASD, and some believe that these abnormalities may be responsible for parts of the ASD phenotype. Sleep problems are reported more frequently than in the general population, and effective treatments are available. Future medical treatments for ASD may be directed at underlying core symptoms and have greater impact than today's symptomatic approach.
SUMMARY: Further research in these areas is needed to better guide diagnosis and treatment of a variety of medical conditions experienced by people with ASD.
PMID: 20087181 [PubMed - as supplied by publisher]
Are you sure its epilepsy? Nonepileptic paroxysmal events in children are common, and may be more diverse in etiology than those seen in adults.
Epilepsy Behav. 2010 Jan 19. [Epub ahead of print]
Nonepileptic paroxysmal events in a pediatric population.
Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.
Nonepileptic paroxysmal events in children are common, and may be more diverse in etiology than those seen in adults.
We determined the types of nonepileptic events that are most prominent in the pediatric population, and stratified those events by age group. Ninety-four of 416 pediatric patients monitored during a 3-year period (23%) were found to have had nonepileptic events. Thirty-eight percent of these children were diagnosed with psychogenic nonepileptic seizures, and 72% of those were adolescents.
In children younger than 5 years of age, behavioral events and parasomnias were the most common mimickers of epilepsy. Other events, including stereotyped movements and myoclonus, were also diagnosed.
We suggest that children with refractory paroxysmal events should be considered for early inpatient monitoring.
Copyright © 2009 Elsevier Inc. All rights reserved.
We determined the types of nonepileptic events that are most prominent in the pediatric population, and stratified those events by age group. Ninety-four of 416 pediatric patients monitored during a 3-year period (23%) were found to have had nonepileptic events. Thirty-eight percent of these children were diagnosed with psychogenic nonepileptic seizures, and 72% of those were adolescents.
In children younger than 5 years of age, behavioral events and parasomnias were the most common mimickers of epilepsy. Other events, including stereotyped movements and myoclonus, were also diagnosed.
We suggest that children with refractory paroxysmal events should be considered for early inpatient monitoring.
Copyright © 2009 Elsevier Inc. All rights reserved.
PMID: 20093099 [PubMed - as supplied by publisher]
1/3 of epilepsy patients have ADHD - Be vigilant for comorbidities.
Summary
Recent studies suggest that Attention Deficit Hyperactivity Disorder (ADHD) is a common comorbid condition in childhood epilepsy, but little is known regarding the nature, frequency and timing of associated neurobehavioural/cognitive complications or the underlying aetiology of ADHD in epilepsy. This investigation examined: (i) the prevalence of ADHD and its subtypes; (ii) the association of ADHD with abnormalities in academic, neuropsychological, behavioural and psychiatric status and (iii) the aetiology of ADHD in paediatric epilepsy. Seventy-five children (age 8-18) with new/recent onset idiopathic epilepsy and 62 healthy controls underwent structured interview (K-SADS) to identify the presence and type of DSM-IV defined ADHD, neuropsychological assessment, quantitative MR volumetrics, characterization of parent observed executive function, review of academic/educational progress and assessment of risk factors during gestation and delivery. The results indicate that ADHD is significantly more prevalent in new onset epilepsy than healthy controls (31% versus 6%), characterized predominantly by the inattentive variant, with onset antedating the diagnosis of epilepsy in the majority of children. ADHD in childhood epilepsy is associated with significantly increased rates of school based remedial services for academic underachievement, neuropsychological consequences with prominent differences in executive function, and parent-reported dysexecutive behaviours. ADHD in paediatric epilepsy is neither associated with demographic or clinical epilepsy characteristics nor potential risk factors during gestation and birth. Quantitative MRI demonstrates that ADHD in epilepsy is associated with significantly increased gray matter in distributed regions of the frontal lobe and significantly smaller brainstem volume. Overall, ADHD is a prevalent comorbidity of new onset idiopathic epilepsy associated with a diversity of salient educational, cognitive, behavioural and social complications that antedate epilepsy onset in a significant proportion of cases, and appear related to neurodevelopmental abnormalities in brain structure.
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