Are Patients with Syndromic Craniosynostosis at Greater Risk for Epilepsy than Patients with Nonsyndromic Craniosynostosis?

OBJECTIVE: The aim of this study was to determine whether patients with syndromic craniosynostosis (SCS) are at increased risk for epilepsy relative to patients with nonsyndromic craniosynostosis (NSCS). METHODS: A retrospective cohort study was completed using the Kids' Inpatient Database (KID). All patients diagnosed with craniosynostosis (CS) were included. The primary predictor variable was study grouping (SCS vs. NSCS). The primary outcome variable was a diagnosis of epilepsy. Descriptive statistics, univariate analyses and multivariate logistic regression were performed to identify independent risk factors for epilepsy. RESULTS: The final study sample included a total of 10,089 patients (mean age, 1.78 years ± 3.70; 37.7% female). 9278 patients (92.0%) had NSCS, and the remaining 811 patients (8.0%) had SCS. A total of 577 patients (5.7%) had epilepsy. Not controlling for other variables, patients with SCS were at increased risk for epilepsy relative to patients with NSCS (OR 2.1, P < 0.001). After controlling for all significant variables, patients with SCS were no longer at increased risk for epilepsy relative to patients with NSCS (OR 0.73, P = 0.063). Hydrocephalus, Chiari malformation (CM), obstructive sleep apnea (OSA), atrial septal defect (ASD), gastro-esophageal reflux disease (GERD) were all independent risk factors (P < 0.05) for epilepsy. CONCLUSIONS: Syndromic craniosynostosis (SCS) in itself is not a risk factor for epilepsy relative to NSCS. The greater prevalence of hydrocephalus, CM, OSA, ASD, and GERD, all of which were risk factors for epilepsy, in patients with SCS relative to patients with NSCS likely explains the greater prevalence of epilepsy in SCS relative to NSCS.

Strategies for managing dental care for refugee patients.

AIMS: To outline key factors that contribute to oral health issues of refugees and asylum seekers and provide management strategies for dental providers to teach desensitization and fear reduction for this special population. METHODS AND RESULTS: We researched published literature in the PubMed database and incorporated lessons gained from treating refugee and asylee patients at a Vulnerable Populations Clinic (VPC) at an urban academic dental school. Refugees and asylees are at high risk for oral conditions due to a tendency to not seek routine dental treatment, psychological stressors, and various systemic factors. Oral health providers can teach patients desensitization and fear reduction by working to gain patients' trust by having effective communication and prioritizing comfort in the dental operatory. Providers should also utilize translation, psychological, and/or multicultural support services during their management of care. CONCLUSION: By having a stronger understanding of the key causes of oral health issues among refugees and asylees in the United States, dental providers can better approach managing care for this vulnerable patient population. The concepts of teaching desensitization and fear reduction utilized for this special population can be applied to managing care for the wider special needs patient community.