Has clinical activity in paediatric neurology changed in the past 11 years? / ¿Ha cambiado la actividad asistencial de la neurología pediátrica en 11 años?

INTRODUCTION: We believe that the demand for paediatric neurology (PN) care has increased over the past decade, and that reasons for requesting consultations have also changed. The objective of this study is to complete a registry study to profile the demand for PN care in 2013 and compare results to those from a study performed in 2002. METHODS: A prospective registry of PN healthcare activities was completed at Hospital Universitario de Getafe in 2013. Results were compared with those from a prospective registry study conducted in 2002. RESULTS: The number of visits increased from 1,300 in 2002 to 1,982 in 2013 (a 52.46% increase), and from 32.6 visits per 1,000 children to 57.48 (a 76.32% increase). Outpatient consultations accounted for 92.2% of all PN consultations in 2013. Currently, attention deficit-hyperactivity disorder (ADHD) is the most frequent diagnosis (27.6% in 2013 vs. 8.1% in 2002). Although the percentage of headache consultations has decreased (19% in 2013 vs. 22% in 2002), headache was still the most common reason for an initial visit in 2013 (32.1%), followed by ADHD (19.1%). Epilepsy remains the most frequent diagnosis in hospitalised patients (30.3% in 2013 vs. 36.7% in 2002). CONCLUSIONS: PN is fundamentally an outpatient activity that has increased considerably in recent years. This increase is mainly due to neurodevelopmental disorders, especially ADHD. We might state that the role of ADHD in PN is comparable to that of dementia in general neurology.

Systematic review of the safety and effectiveness of peripheral neurostimulation of the sphenopalatine ganglion for the treatment of refractory chronic cluster headache.

INTRODUCTION: This study aimed to assess the safety and effectiveness of peripheral neurostimulation of the sphenopalatine ganglion (SPG) in the treatment of refractory chronic cluster headache. DEVELOPMENT: Various medical databases were used to perform a systematic review of the scientific literature. The search for articles continued until 31 October 2016, and included clinical trials, systematic reviews and/or meta-analyses, health technology assessment reports, and clinical practice guidelines that included measurements of efficiency/effectiveness or adverse effects associated with the treatment. The review excluded cohort studies, case-control studies, case series, literature reviews, letters to the editor, opinion pieces, editorials, and studies that had been duplicated or outdated by later publications from the same institution. Regarding effectiveness, we found that SPG stimulation had positive results for pain relief, attack frequency, medication use, and patients' quality of life. In the results regarding safety, we found a significant number of adverse events in the first 30 days following the intervention. Removal of the device was necessary in some patients. Little follow-up data, and no long-term data, is available. CONCLUSIONS: These results are promising, despite the limited evidence available. We consider it essential for research to continue into the safety and efficacy of SPG stimulation for patients with refractory chronic cluster headache. In cases where this intervention may be indicated, treatment should be closely monitored.

[Migraine in childhood: a trivial condition?]. / La jaqueca en la infancia: una patologia banal?

INTRODUCTION: Migraine is seen as being a trivial disease, and more so in childhood, but in many cases it has a detrimental effect on the patient's quality of life. PATIENTS AND METHODS: Prospective study. All the patients were evaluated by the same neuropaediatrician and all of them satisfied diagnostic criteria for migraine. 127 children were examined. The mean age was 9.4 years, with an interval of 3-14 years; there were no differences between sexes. 67 males and 60 females. RESULTS: The mean length of time the episodes lasted was 22.5 h. The most frequently observed clinical features were: hemicranial localisation, 44.4%; throbbing, 74.4%; photophobia, 74.8%; phonophobia, 83.5%; nausea-vomiting, 63.5%; and aura, 14.3%; with predominance of acutely intense visual and sensory symptoms (74%), functional repercussions in 87% and absence from school in up to 36.9% of cases. 16% of patients have had episodes of status migrainous. At the time of the visit 46% had several attacks a week; 13.7% once a week; 16.1% fortnightly; 13.7 % monthly; 5.6% every three months; and others, 4.8%. 48.7% of the patients were given preventive treatment, which was wholly effective in 48%, partially effective in 35% and not at all effective in 15.4%. CONCLUSIONS: Migraine in childhood is not a trivial pathology. It is disabling: it interferes with their daily life in 85% of cases, causes them to miss school in almost 40% of patients and nearly 50% of them have several episodes a week. A similar figure required prophylactic treatment that was seen to be very effective.

[Paediatric neurology health care activity in a tertiary hospital. A study comparing it with adult neurology and non-neurological paediatrics]. / Actividad asistencial de la neurología pediátrica en un hospital de nivel 3. Estudio comparativo con la neurología de adultos y la pediatría no neurológica.

INTRODUCTION: Paediatric neurology (PN) remains 'hidden' somewhere between paediatrics and neurology in almost all health care centres and this makes it difficult to allocate resources in a proper manner. AIMS: Our objective in this study was to analyse PN health care activity and compare it with adult neurology (AN) and with non-neurological paediatrics (NNP). MATERIAL AND METHODS: PN health care activity registry for the year 2002. AN and NNP data were collected from the hospital's Computer Service. RESULTS: In all, 1300 PN visits were made, 428 of which were new and 872 successive, which represent 16.2% of paediatric visits (30% new, 13.3% successive) and 10.3% of neurological visits (12.4% new, 10.2% successive). The rates of new and successive visits in PN are: 32.6, 10.7 and 21.9 per 1000 children, and in AN: 44.2, 12.5 and 31.7 per 1000 adults. A total number of 94 hospitalised children were attended, 3.3% of all paediatric admissions and 9.2% of the total neurological attention in inpatients. The rates are 2.36 per 1000 children in PN and 3.9 per 1000 adults in AN. There is greater demand among smaller children. The most frequent pathologies are headaches in clinical visits and epilepsy in hospitalised patients. CONCLUSIONS: PN is essentially a service used by outpatients. It accounts for a high percentage of hospital paediatric visits. The activity rates per 1000 children and per 1000 adults are similar. The increased birth rate raises PN activity to a level that is higher than would normally be desirable, due to the growth in the population.

[The present state of paediatric neurology in the Autonomous Community of Madrid: variability in the distribution of resources]. / Situacion de la neurologia pediatrica en la Comunidad Autonoma de Madrid: variabilidad en la distribucion de los recursos.

INTRODUCTION: Paediatric neurology (PN) lies halfway between neurology and paediatrics, with no official acknowledgment. It is therefore difficult to determine exactly how resources are shared out. AIMS: The aim of this study is to analyse the public resources devoted to PN in the different health care areas within the Autonomous Community of Madrid (ACM). MATERIALS AND METHODS: In May 2002 we carried out a survey among child neurologists (CN) from the 9 independent health care districts within the ACM. RESULTS: A total of 28 CN work for the public health service in the ACM, eight of whom are employed on a part time basis. Only 53% are owners. The ratio of CN per 100000 inhabitants (inhab.) is 0.55 (0.45 after correction for part time work). The figure varies from one area to another from 0.07 to 1 CN/100000 inhab. (1/12000 1/220000 children). Part time neurologists work in the outer districts of the ACM. In most areas it is difficult to carry out diagnostic tests and these become even complicated when the child is small and requires some anaesthetic procedure. Neuropsychological assessment is one of the basic evaluations performed in PN and this is not easily performed in most centres. CONCLUSIONS: The CN/100000 inhab. ratio in the ACM is lower than that commonly recommended. The distribution of resources varies greatly and does not match demographic criteria. Temporary and part time jobs are commonplace in the peripheral areas. It is difficult for most centres to perform diagnostic tests.