Presence and grade of undertreatment of pain in children with cerebral palsy.

OBJECTIVES: To investigate if chronic pain in children with cerebral palsy is undertreated with the current pharmacological/non-pharmacological interventions using a pain management index. METHODS: Parents of 120 children with cerebral palsy between the ages of 2-19 years from our region in Denmark answered a questionnaire about whether their child had everyday pain. When answering in pain, we inquired about pain status and pharmacological/non-pharmacological pain coping interventions. Everyday pain was viewed as chronic pain with acute exacerbations. Pain experienced was divided into worst pain (highest moments of pain intensity) and least pain (lowest moments of pain intensity). To describe and evaluate the effectiveness of pain interventions used, a pain management index was utilized. Everyday pain was assessed using a logistical regression by adjusting for age, sex, and gross motor function classification system level. RESULTS: 59/115 (0.51) of parents answering the questionnaire reported everyday pain. Of those, the median age was 10 years. For pain alleviation, massage was reported by parents as being used by 29/59 (0.49) children and paracetamol by 21/59 (0.36). Pain affected daily life in 44/59 (0.75). By our evaluation 44/59 (0.75) were inadequately treated for their pain. Our evaluation also revealed that 19/59 (0.32) of children in pain had inadequately treated pain combined with an undesirable intensity of least pain. CONCLUSIONS: Half of the children with cerebral palsy experienced chronic pain according to our pain questionnaire answered by parents. Among these children three-quarters were insufficiently treated for their pain. In the same group, one-third were impacted by pain felt at both its highest and lowest moments of intensity. Massage therapy and paracetamol were the most frequently utilized pain-alleviating interventions. In our cohort, pain was undertreated and likely underdiagnose (Protocol number H-17008823).

[Acute neonatal myocarditis with cardiogenic shock caused by enterovirus infection].

In this case report, a 16-days-old boy presented with reduced feeding, vomiting, respiratory distress and pallor. He developed cardiogenic shock with cardiac arrest and was resuscitated. Echocardiography showed reduced left ventricular systolic function and he was diagnosed with enterovirus myocarditis since enterovirus RNA was found in the blood by polymerase chain reaction. After one month of hospitalization, the patient was discharged without any apparent sequelae. The condition is rare but associated with a high mortality. Early diagnosis and initiation of treatment is essential for survival.

[A teenager with a rare cause of migraine-like headaches and neurological deficits - syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis].

In this case report, a 14-year-old male presented with episodes of migraine-like headaches preceded by unilateral hemiparaesthesia, hemiparesis, confusion, and dysphasia with the last two lasting more than four hours. The cerebrospinal fluid (CSF) showed lymphocytosis with no detectable aetiology, neuroimaging was normal, and an electroencephalogram showed diffuse slowing. The patient was diagnosed with headache associated with neurologic deficits and CSF lymphocytosis, i.e. syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis. The condition is a rare disorder, especially in children. Normally, a complete remission takes place within few weeks to months without treatment.