Complex regional pain syndrome type 1 in a child with migraine.

Complex regional pain syndrome type 1 is a rare painful syndrome in children involving an extremity which consists of pain out of proportion to the cause, loss of function, and significant evidence of autonomic dysfunction. We report a child, a known case of migraine who presented with spontaneous onset pain and sudomotor changes in an extremity not preceded by any trauma. A good clinical eye is required for the identification and diagnosis of this underreported condition to prevent doing extensive investigations. The coexistence of migraine and complex regional pain syndrome type 1 in a patient is interesting and is probably due to the common underlying pathophysiological abnormalities involving central serotonin activity and neurogenic inflammatory mechanisms.

Evaluation of ELISA and dot blots for the serodiagnosis of neurocysticercosis, in children found to have single or multiple enhancing lesions in computerized tomographic scans of the brain.

Although human neurocysticercosis (NCC) is being increasingly recognized in children, diagnosis of the disease can be difficult, and the 'gold standard' criteria that indicate an unambiguous case have still to be established. In the present study, the performances of an ELISA and dot-blot assay, for the detection of antibodies against antigens from larval Taenia solium, were investigated and compared, using sera, from children aged 5-12 years, that were diluted to at least 1:400. Eighty of the subjects (20 aged 5-<8 years and 60 older children) each had the signs and symptoms of NCC, including one brain lesion (N=69) or multiple brain lesions (N=11) that were visible by computed tomography. Another 100 sera, from children who had tubercular meningitis (N=20) or a parasitic disease other than taeniasis/cysticercosis (N=20) or, apart from a minor respiratory-tract infection, appeared healthy (N=60), were also investigated. Most (86%) of the cases of NCC had presented with focal seizures. Analysis of antibody response indicated that the optimum threshold titres for seropositivity were 1:800 for the ELISA and 1:6400 for the dot-blot assays. When used with these thresholds, the ELISA gave a sensitivity, specificity, positive and negative predictive values and diagnostic efficacy of 89%, 81%, 79%, 90%, 85%, respectively. The corresponding values for the dot-blot assay were similar, at 89%, 73%, 72.5%, 89%, 82%, respectively. Both assays were more sensitive, in the detection of the specific antibody response, when used among the paediatric cases of NCC who had multiple brain lesions (100%) than when used among the single-lesion cases (87%). As the ELISA gave higher specificity and diagnostic efficacy than the dot-blot assay, it should be considered the better method for the serological confirmation of NCC in children.

Shaken baby syndrome masquerading as apparent life threatening event.

A variety of diseases and disorders can present as an acute life-threatening event among which shaken baby syndrome has been recently recognized. A high index of suspicion along with an ophthalmologic evaluation and cranial imaging helps to identify this form of child abuse, which needs multidisciplinary management.

Cerebral gigantism with West syndrome.

A case of cerebral gigantism (Sotos syndrome) with West syndrome in a one-year-old male child is reported. The case had a large stature, typical facies and neurodevelopmental delay along with infantile spasms, which were refractory to treatment with valproate and clonazepam.

Morphometry of single small enhancing computed tomographic lesions: outcome and effect of albendazole therapy.

Single small enhancing computerized tomographic (CT) lesions (SSECTLs) are common in children with focal seizures. However, there is a paucity of systematic information regarding their morphometry, effect of albendazole therapy and long-term outcome. The objectives were to study the pattern of SSECTL on radiological follow up, alterations made by albendazole therapy, and correlation with seizure recurrence. A randomized, placebo controlled, double blind trial was carried out at the Advanced Pediatric Center, PGIMER, an urban tertiary-care teaching hospital. Sixty-three children between 2 and 12 years of age with focal seizures for < 3 months and SSECTLs were included in the study. All children were randomly assigned to receive either albendazole (15 mg/kg/day) or placebo for 28 days. CT scan was done at 1 and 3 months after beginning treatment. Codes opened after 6 months of recruitment in the study showed that 31 had received albendazole and 32 had received placebo. Over a period of 3 months, natural resolution of SSECTL passed through many stages. Albendazole was seen to accelerate this natural process as evident by the progression of various morphometric markers. An increase in the size of the lesion was associated with early seizure recurrence.

Single small enhancing computed tomographic lesions in indian children--II. Clinical features, pathology, radiology and management.

Single small enhancing computed tomographic lesions (SSECTL) are commonly seen in Indian children presenting with focal or at times generalized seizures. One-third of the subjects have raised intracranial pressure; focal deficit may occasionally occur depending on the localization of the lesion. SSECTLs mostly represent neurocysticercosis granulomas; visualization of scolex on MRI confirms the diagnosis. As most lesions resolve spontaneously, the use of anthehminthics has been controversial. Albendazole has been shown to cause faster resolution with decreased calcification of lesions. Short duration anticonvulsants may suffice in cases where the lesion disappears and EEG is normal. An approach to the diagnosis and management of SSECTL is presented.

Single small enhancing computed tomographic lesion in Indian children--I: Evolution of current concepts.

Single, small (<20 mm) enhancing CT lesions are the commonest cause of focal seizures in Indian children and are also frequently reported from other tropical countries. They often resolve spontaneously on follow-up and have therefore led to controversies regarding their etiology and appropriate management. Initially, these lesions were often considered to be tuberculomas. However, as research progressed over the last two decades, solitary cysticercus granuloma has been found to be the most likely cause for these lesions. In this article we discuss the evolution of current etiological concepts regarding single, small enhancing CT lesions among Indian children, and an approach towards management.

Seizure recurrence in children with focal seizures and single small enhancing computed tomographic lesions: prognostic factors on long-term follow-up.

Single small enhancing computed tomographic (CT) lesions are common in children with focal seizures. There is a paucity of information regarding their long-term outcome and prognostic factors for seizure recurrence. The objective of this work was to study the frequency of seizure recurrence in children with single small enhancing computed tomographic lesions and to identify prognostic factors, if any, for seizure recurrence. A prospective long-term follow-up was conducted at the Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, an urban tertiary care teaching hospital. Sixty-three children between 2 and 12 years of age with focal seizures for less than 3 months and single small enhancing computed tomographic lesions were enrolled in a randomized, double-blind, placebo-controlled trial of albendazole therapy and followed up for 4 years. On long-term follow-up, the albendazole and placebo groups were left with 29 and 28 children, respectively. After several months of seizure-free period, antiepileptic drug was tapered off. Children with relapse underwent magnetic resonance imaging examination. All children were followed up for at least 18 months after stopping of the antiepileptic drug. Seizure recurrence was seen in three children each in both groups, after a mean interval of 6.4 weeks after stopping the antiepileptic drug. Magnetic resonance imaging revealed persistent chronic granuloma in 2 and calcified granuloma in 4 children. Residual lesions were significantly correlated with seizure recurrence. In children whose lesions completely disappeared, no seizure recurrence was seen even during shorter periods of antiepileptic drug treatment. Seizure recurrence was seen in a small number of children with focal seizures and single small enhancing computed tomographic lesions. It appears to be related to either a persistent or a calcified lesion.

Newer antiepileptic drugs and non surgical approaches in epilepsy.

Newer antiepileptic drugs (AEDs) have helped the management of about one third of children with epilepsy who are refractory to primary AED(s). Vigabatrin and lamotrigine are being used as first line drugs for infantile spasms and Lennox Gestaut syndrome (LGS) respectively. Most of the others are, as of now, used as add-on drugs with specific indications. The ketogenic diet has been used successfully in some children with LGS. Steroids have a clear role in infantile spasms. Efficacy of immunoglobulins is mainly anecdotal. Physicians should familiarise themselves with the efficacy, pharmacokinetics and side effects of these drugs and ensure their rational use.

Aldosterone-producing adrenocortical adenoma in childhood: a case report.

Aldosterone-producing adrenal tumor is an exceptional cause of hypertension in childhood. The authors describe an 11-year-old girl with hypertension and lower limb weakness who had hyperaldosteronism and left adrenocortical adenoma.

Albendazole therapy in children with focal seizures and single small enhancing computerized tomographic lesions: a randomized, placebo-controlled, double blind trial.

BACKGROUND: Single small enhancing computerized tomographic (CT) lesions (SSECTLs) are common in children with focal seizures. These are considered to represent solitary cysticercus granulomas. Controversy exists regarding their treatment. OBJECTIVE: To evaluate the efficacy of albendazole in cases of focal seizures with SSECTLs. DESIGN: Randomized, placebo-controlled, double blind trial. SETTING: Pediatric service of Nehru Hospital, PGIMER, an urban tertiary care teaching hospital. SUBJECTS: 63 children between 2 and 12 years of age with focal seizures for <3 months and SSECTLs. INTERVENTION: All children were randomly assigned to receive either albendazole (15 mg/kg/ day) or placebo for 28 days. CT scan was done at 1 and 3 months after beginning treatment. Codes opened after 6 months of inclusion in the study showed that 31 had received albendazole and 32 had received placebo. All children were followed up for at least 15 months. RESULTS: Disappearance of lesions on CT scan was noted in 41% of albendazole vs. 16.2% of placebo patients after 1 month of follow-up (P < 0.05) and 64.5% of albendazole- vs. 37.5% of placebo-treated patients after 3 months of follow-up (P < 0.05). During the first 4 weeks of therapy seizure recurrence was seen in 9.7% of albendazole vs. 3.2% of placebo-treated children (odds ratio, 3.32; 95% confidence interval, 0.33 to 33.8). After 4 weeks seizure recurrence was seen in 31.3% of placebo-treated children vs. 12.9% of albendazole-treated children (odds ratio, 3.07; 95% confidence interval, 1.18 to 11.15). CONCLUSIONS: Albendazole therapy results in significantly faster and increased resolution of solitary cysticercus lesions (SSECTLs) and appears to reduce the risk of late seizure recurrences.

Public awareness, understanding & attitudes toward epilepsy.

The public awareness, understanding and attitudes towards epilepsy were evaluated in a north Indian population in 1992 by personal interview method. The study revealed that 92 per cent of the respondents had read or heard about epilepsy. More than 55 per cent knew someone and had seen a case of seizure. Eighty five per cent of the respondents were not aware of the cause of epilepsy or had wrong beliefs. Eighteen and 15 per cent thought epilepsy to be a hereditary disorder and a form of insanity respectively. About 40 per cent of the respondents felt that children with epilepsy should not be sent to school and also objected to their children's contact with epileptics at school or at play. Two-thirds of the respondents objected to their children marrying a person who had ever had epilepsy. Twenty per cent were ignorant about the manifestation of epilepsy and an equal number were unable to recommend any therapy in case their relatives or friends had epilepsy. Fifty seven per cent did not know what kind of first aid should be given during the epileptic attack. Although the awareness of epilepsy among Indian people was comparable to that of individuals in Western countries, the attitudes of the Indians were much more negative. Better educated people belonging to higher occupational groups were less prejudiced against social contact and schooling of their children with epileptic children compared to low educational and occupational groups.