Patent foramen ovale in children with migraine headaches.

OBJECTIVE: To determine the prevalence of patent foramen ovale (PFO) in children with migraine. STUDY DESIGN: Children aged 6.0 to 18.0 years with migraine headache were evaluated for PFO and right-to-left shunting with color-flow Doppler scanning, saline solution contrast transthoracic echocardiography, and contrast transcranial Doppler scanning. RESULTS: The population consisted of 109 children with migraine; 38 (35%) with aura and 71 (65%) without aura. The overall PFO prevalence was 35%, similar to the general population (35% vs 25%; P = .13). However, compared with the general population (25%), the PFO prevalence was significantly greater in subjects with aura (50%, P = .0004) but similar in those without aura (27%, P = .73). Atrial shunt size was not associated with the presence or absence of aura. CONCLUSION: Children with migraine with aura have a significantly higher prevalence of PFO compared with those without aura or the general population. These data suggest that PFO may contribute to the pathogenesis of migraine with aura in children and have implications for clinical decision making.

The Child Neurology Workforce Study: pediatrician access and satisfaction.

OBJECTIVE: To assess the opinions of pediatricians regarding the supply and utilization of child neurologists in the United States. STUDY DESIGN: A 32-item questionnaire was circulated by e-mail to a random sample of 5000 pediatricians with the assistance of the American Academy of Pediatrics. RESULTS: After 2 mailings, 422 responses were received. Respondents ranged in age from 30 to 75 years (median 50 years), 60.4% were male, 96% were board certified in pediatrics, and 76% had a 2 or more-week rotation in child neurology during pediatric training. Approximately 79% indicated that there were few or too few child neurologists in their area, and 90% indicated that there were few or too few child neurologists in the United States. Sixty-one percent indicated that they always or almost always seek consultation from a child neurologist for a child with new onset seizures; 7% and 21% seek consultations for children with migraine or tics. The delay for child neurology consultation was 5 or more weeks in 63% and >12 weeks in 15%. Satisfaction with child neurologists was linked to the level of inter-physician communication. Neither satisfaction nor wait time influenced the frequency of consultations. Increasing level of patient complexity and parental expectations were cited as reasons for increasing numbers of consultations with child neurologists. CONCLUSIONS: Pediatricians perceive that a work force shortage exists in child neurology. Satisfaction with child neurology consultations is linked to communication with pediatricians.

Rheumatic chorea: relationship to systemic manifestations and response to corticosteroids.

OBJECTIVE: To describe Sydenham chorea among children in a cohort of patients with rheumatic fever (RF). STUDY DESIGN: An existing database was used to identify demographic characteristics, clinical manifestations, and therapy in persons with RF identified in Salt Lake City, Utah, from 1985 through January 2002. RESULTS: Of 584 cases in the database, 537 (91%) were new-onset RF (median age of 10 years) and 177 (33%) had chorea. Patients with chorea were more often female (OR = 0.37, 95% CI = 0.25-0.55, P < .0001) and were less likely to have carditis or arthritis. Prednisone treatment may lead to a shortened course of chorea (4.0 weeks in prednisone-treated [n = 32] vs 9.0 weeks in untreated [n = 14]; P < .0001). Among 33 patients seen at a median of 10.3 years (range 6.3-14.9 years) after their initial bout of chorea, 20% reported residual tremor or mood swings. Ten of the 33 (30%) had one or more recurrences of chorea. CONCLUSIONS: Chorea affected one-third of the children with RF. Patients with chorea were less likely to have severe cardiac or rheumatologic complications of RF. Therapy with prednisone shortened the duration of rheumatic chorea; some reported recurrences of chorea and had minor neurologic sequelae.