[Types of diagnosis in the outpatient practice during the years 2006-2007]. / Typy rozpoznan u dzieci objetych opieka Neurologicznych Poradni Przyklinicznych w latach 2006-2007.

INTRODUCTION: In recent years significant increase of children reffered to neurological consultations has been observed. Also structure of diagnosis has changed fundamentally. AIM: The aim of the study was to reveal differentiated structure of diagnosis in children reffered to neurology outpatient clinics during 2 years of their work. MATERIAL AND METHODS: Analysis included medical documentation of 18127 children aged 1-18 years, patients of Neurology Outpatient Clinic, Headache Outpatient Clinic and Neuromuscular Diseases Outpatient Clinic. These outpatient clinics are under supervision of Pediatric Neurology Clinic of Chair of Pediatric and Adolescent Neurology, Jagiellonian University. RESULTS: The most numerous group consisted of children with paroxysmal events (11192, 61.74%). Diagnostics performed in outpatient clinics or during hospitalisation enabled to diagnose epilepsy in 52.42% and in remaining 9.31% other paroxysmal events: syncopes, tics, febrile convulsions, breath-holding spells, sleep disorders, night terrors, infantile masturbation and pseudoepileptic seizures. Second, in respect to number, group included children with headaches. Majority of them were reffered after exclusion of laryngological and ophtalmological causes of headaches. Specialist neuroimaging examinations, EEG examination and psychological consultations enabled to diagnose tension-type headaches in most cases, less often migraine and sporadically brain tumors were diagnosed. Another group enclose children with CNS lesions: fetopathies, congenital defects, cerebral palsy, metabolic and genetic disorders. Numerous group consisted of children with psychomotor retardation, emotional disorders, nocturnal enuresis, suspect of ADHD and scholar difficulties who needed longer development observation in order to establish final diagnosis. Group of children with neuromuscular diseases (375, 2.16%) was also differentiated. It consisted of children with muscular dystrophies and myopathies (50%), acquired peripheral mononeuropathies (post-traumatic, post-inflamatory and tunnel syndromes) and genetically determined and acquired polyneuropathies (45%) and also myasthenia and myasthenic syndromes (5%). CONCLUSIONS: Analysis of two years work of three specialist outpatient clinics revealed differentiated causes of consultations of treated children. Paroxysmal events and necessity of initial differential diagnosis performance were main problems of their work. Fast increase in number of children with headaches, scholar difficulties and suspect of ADHD has been observed.

[Status epilepticus as a cause of hospitalization]. / Stan padaczkowy jako przyczyna hospitalizacji.

OBJECTIVES: Status epilepticus (SE) in children as the most severe, life-threatening condition requires rapid, correct, standard and efficient treatment. The results depend on the properly coordinated management at patient's home, emergency, intensive care units and pediatric neurology departments. THE AIM: The aim of this research was to recognise type of diagnostic and therapeutic problems in children hospitalized with SE. Differences between two groups of children: I group with SE as the first manifestation of epilepsy and group II with epilepsy treated before occurrence of SE were studied as well. MATERIALS AND METHODS: In this retrospective study, 33 hospitalizations of 24 children (14 boys and 10 girls) aged 5 months to 15 years (mean 7 years) were analysed. Patients with SE hospitalized in the Intensive Care Unit and Emergency Department, Collegium Medicum Jagiellonian University in Cracow between 1.01.2002 and 31.12.2004 were included. The group I consisted of 13 children (54%) and the group II consisted of 11 children. In both groups the age and gender of patients, duration of hospitalisation, necessity of assisted ventilation and thiopental coma were analysed. Causes of epilepsy and SE were studied as well. RESULTS: Duration of SE before hospitalization, similar in both groups ranged between 30 minutes and 2 hours, counting to its termination in the hospital. The cause of epilepsy was established in 15/24 children. Out of 33 SE, 10 were provoked by hyperthermia in children of both groups. The probable risk factor of SE was the association with mental retardation. The mean age of SE occurrence was in I group 4 years, while in the II group 10 years (with epilepsy duration since 1,5 year of age). The mean duration of hospitalisation was similar in both groups (21:22 days), however children of the I group were hospitalized in the Intensive Care Unit shorter, almost twice (2,5:4,5 days) as compared to the II group; intubation was necessary less often (3:6) and assisted ventilation shorter (1,5:3 days), respectively. None of the children died due to SE during 3 years. CONCLUSIONS: The better outcome of intensive care in children of group I may be a result of later occurrence of epilepsy. In the management of SE in children of group II, especially with recurrent SE, the early employment of intensive care procedures should be considered. The effective management of SE in the emergency department may help to prevent of death caused by SE in children.