Trastornos Paroxísticos No Epilépticos En Pre-Escolares / Non-epileptic paroxysmal disorders in pre-school children

Los trastornos paroxísticos no epilépticos son comunes en la población de niños pre-escolares. Estas condiciones incluyen una variedad de eventos cuyas manifestaciones y fisiopatología son muy distintas. Por esa razón, el diagnóstico puede representar un difícil reto. En algunas ocasiones, estudios como el EEG o la polisomnografía pueden ayudar a clarificar el diagnóstico y descartar un trastorno epiléptico. Sin embargo, la historia clínica y el examen físico suelen ser suficientes para llegar al diagnóstico correcto. En este artículo, presentamos información sobre los trastornos paroxísticos no epilépticos más comunes en la población de niños pre-escolares, incluyendo: tics, discinesias, eventos relacionados al sueño, etc. Además, discutimos estrategias para el diagnóstico y opciones de tratamiento.

Paroxysmal events are commonly encountered in toddlers. These events include a variety of conditions with different manifestations and pathophysiology. For that reason, the diagnosis of these events can be challenging. In some instances, studies such as EEG and polysomnogram may be useful to differentiate between epileptic and non-epileptic events. In the majority of cases, a complete clinical history is enough to make an appropriate diagnosis. In this article, we review some of the most common paroxysmal non-epileptic events affecting toddlers, such as: tics, dyskinesias, sleep related events, etc. We also discuss diagnostic strategies and treatment options.

Can clinical observation differentiate individuals with and without scapular dyskinesis? / O exame clínico de observação da discinese escapular é capaz de diferenciar portadores da disfunção dos normais?

Background: Altered scapular rotation and position have been named scapular dyskinesis. Visual dynamic assessment could be applied to classify this alteration based on the clinical observation of the winging of the inferior medial scapular border (Type I) or of the prominence of the entire medial border (Type II), or by the excessive superior translation of the scapula (Type III). Objective: The aim of this study was to determine if there were differences in scapular rotations (Type I and II) and position (Type III) between a group of subjects with scapular dyskinesis, diagnosed by the clinical observation of an expert physical therapist, using a group of healthy individuals (Type IV). Method: Twenty-six asymptomatic subjects volunteered for this study. After a fatigue protocol for the periscapular muscles, the dynamic scapular dyskinesis tests were conducted to visually classify each scapula into one of the four categories (Type IV dyskinesis-free). The kinematic variables studied were the differences between the maximum rotational dysfunctions and the minimum value that represented both normal function and a small dysfunctional movement. Results: Only scapular anterior tilt was significantly greater in the type I dyskinesis group (clinical observation of the posterior projection of the inferior angle of the scapula) when compared to the scapular dyskinesis-free group (p=0.037 scapular and p=0.001 sagittal plane). Conclusions: Clinical observation was considered appropriate only in the diagnoses of dyskinesis type I. Considering the lower prevalence and sample sizes for types II and III, further studies are necessary to validate the clinical observation as a tool to diagnose scapular dyskinesis. .

Contextualização: A movimentação ou posição alterada da escápula é definida como discinese escapular. O exame visual dinâmico pode ser utilizado para classificá-la de acordo com o julgamento clínico de projeção posterior excessiva da borda inferior medial (tipo I), da borda medial (tipo II) ou ainda translação excessiva no sentido cranial (tipo III). Objetivo: Determinar se há diferenças nas rotações escapulares (tipo I e II) e posição (tipo III) entre grupos de discinese e normais (tipo IV), os quais foram diagnosticados visualmente por um fisioterapeuta experiente. Método: Vinte e seis participantes assintomáticos foram voluntários neste estudo. Após um protocolo de fadiga periescapular, a avaliação dinâmica da discinese foi conduzida para classificar visualmente cada uma das escápulas em uma das quatro categorias (tipo IV - sem discinese). As variáveis cinemáticas estudadas foram a diferença entre o valor máximo indicativo da disfunção e o mínimo valor correspondente ao padrão normal esperado para o movimento ou o mínimo do próprio movimento disfuncional. Resultados: Apenas a inclinação anterior da escápula foi significantemente maior no grupo de discinese tipo I (observação visual de projeção posterior do ângulo inferior da escápula) quando comparada com o grupo sem discinese (p=0,037 plano escapular e p=0,001 plano sagital). Conclusões: A avaliação visual foi considerada apropriada apenas para o diagnóstico da discinese do tipo I. Considerando a baixa prevalência e o tamanho amostral dos tipos II e III, mais estudos são necessários para validar completamente a observação clínica como método adequado para o diagnóstico ...

How to assess scapular dyskinesis precisely: 3-dimensional wing computer tomography--a new diagnostic modality.

BACKGROUND: Aberrations in scapular motion are believed to be associated with the presence of shoulder or elbow pathologies. There are many methods to evaluate scapular kinematics, but they have certain limitations. Nevertheless, it is believed that appropriate rehabilitation for each type of scapular dyskinesis is important. METHODS: Eighty-nine athletes were videotaped and seven blinded observers categorized scapular dyskinesis into 4 types, which was followed by 3-dimensional (3D) wing computer tomography (CT). Four blinded examiners evaluated 5 angles [upward rotation (UR), internal rotation (IR), anterior tilting (AT), superior translation (ST), and protraction (PRO)] on the 3D wing CT. Inter-rater reliability (IRR) was calculated for both the methods. CT scan measurements were compared with the 4 observational types to establish the validity. RESULTS: The IRR with observational assessment of scapular dyskinesis into 4 types was good, 0.780. The 3D wing CT analysis had a very high IRR, 0.972. There was a statistically significant correlation between observational assessment and 3D wing CT analysis. The UR angle, ST angle in type 3 scapular dyskinesis, and AT angle in type 1 scapular dyskinesis were increased as compared with those in the other types of scapular dyskinesis. All these measurements were made in the resting position of the scapula. CONCLUSION: The 3D wing CT analysis allows precise quantification of a position associated with scapular dyskinesis. Therefore, 3D wing CT can be considered as an alternative method for assessing scapular dyskinesis.

Striatal overexpression of DeltaFosB reproduces chronic levodopa-induced involuntary movements.

Long-term dopamine replacement therapy in Parkinson's disease leads to the development of disabling involuntary movements named dyskinesias that are related to adaptive changes in striatal signaling pathways. The chronic transcription factor DeltaFosB, which is overexpressed in striatal neurons after chronic dopaminergic drug exposure, is suspected to mediate these adaptive changes. Here, we sought to demonstrate the ability of DeltaFosB to lead directly to the abnormal motor responses associated with chronic dopaminergic therapy. Using rAAV (recombinant adenoassociated virus) viral vectors, high levels of DeltaFosB expression were induced in the striatum of dopamine-denervated rats naive of chronic drug administration. Transgenic DeltaFosB overexpression reproduced the entire spectrum of altered motor behaviors in response to acute levodopa tests, including different types of abnormal involuntary movements and hypersensitivity of rotational responses that are typically associated with chronic levodopa treatment. JunD, the usual protein partner of DeltaFosB binding to AP-1 (activator protein-1) sites of genes, remained unchanged in rats with high DeltaFosB expression induced by viral vectors. These findings demonstrate that the increase of striatal DeltaFosB in the evolution of chronically treated Parkinson's disease may be a trigger for the development of abnormal responsiveness to dopamine and the emergence of involuntary movements.

Classification of cerebral palsy: association between gender, age, motor type, topography and Gross Motor Function / Classificação da paralisia cerebral: associação entre gênero, idade, tipo motor, topografia e Função Motora Grossa

The goal of this study was to assess the relation between gender, age, motor type, topography and gross motor function, based on the Gross Motor Function System of children with cerebral palsy. Trunk control, postural changes and gait of one hundred children between 5 months and 12 years old, were evaluated. There were no significant differences between gender and age groups (p=0.887) or between gender and motor type (p=0.731). In relation to body topography most children (88 percent) were spastic quadriplegic. Most hemiplegics children were rated in motor level I, children with diplegia were rated in motor level III, and quadriplegic children were rated in motor level V. Functional classification is necessary to understand the differences in cerebral palsy and to have the best therapeutic planning since it is a complex disease which depends on several factors.

Este estudo teve como objetivo avaliar a relação entre gênero, idade, tipo motor, topografia e Função Motora Grossa, baseado no Sistema de Função Motora Grossa em crianças com paralisia cerebral. Participaram desta pesquisa 100 crianças com idade entre 5 meses a 12 anos que foram observadas em relação ao controle de tronco, trocas posturais e marcha. Não houve diferenças significativas entre gêneros e grupos etários (p=0,887) e entre gênero e tipo motor (p=0,731). Em relação à topografia corporal, houve predomínio de crianças com quadriplegia, sendo que a maioria (88 por cento) era do tipo espástico. Quanto ao nível motor, as crianças hemiplégicas pertenciam em sua maioria ao nível I, as diplégicas ao nível III e as quadriplégicas ao nível V. Sendo a paralisia cerebral uma condição complexa que depende de diversos fatores, beneficia-se de classificações funcionais para compreensão da diversidade e melhor planejamento terapêutico.

[Dyskinesias of the tongue and other face structures]. / Dyskinezy jezzyka i innych struktur twarzy.

PURPOSE: A dyskinesia is a permanent disorder consisting of compulsory movements of the tongue, lips and facial muscles. Dyskinesias of other parts of the body are also known. They improve the diagnosis and treatment in dentistry and oral surgery. AIM: The aim of the study is to present cases of dyskinesia manifesting as involuntary movements and their treatment. RESULTS: Dyskinesias of various body parts accompanying Huntington's disease, Parkinson's disease, Down syndrome, Joubert's syndrome, arteriosclerosis, cerebral palsy, and tetanus are discussed.

Long term outcome of unilateral pallidotomy: follow up of 15 patients for 3 years.

OBJECTIVES: With the advent of new antiparkinsonian drug therapy and promising results from subthalamic and pallidal stimulation, this study evaluated the long term efficacy of unilateral pallidotomy, a technique which has gained popularity over the past decade for the management of advanced Parkinson's disease. METHODS: The 15 patients reported here are part of the original cohort of 24 patients who underwent posteroventral pallidotomy for motor fluctuations and disabling dyskinesias 3 years ago as part of a prospective study. Evaluation scales included the unified Parkinson's disease rating scale, the Goetz dyskinesia scale, and the Purdue pegboard test. RESULTS: When compared with the prepallidotomy scores, the reduction in the limb dyskinesias and off state tremor scores persisted on the side contralateral to pallidotomy at the end of 3 years (dyskinesias were reduced by 64% (p<0.01) and tremor by 63% (p<0.05). Other measures tended to deteriorate. The dosage of antiparkinsonian medications did not change significantly from 3 months prepallidotomy to 3 years postpallidotomy. CONCLUSIONS: Although unilateral pallidotomy is useful in controlling the contralateral dyskinesias and tremor 3 years after surgery, all other early benefits disappear and activities of daily living continue to worsen.