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Neuroepidemiology ; 37(2): 90-5, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21894047


BACKGROUND: Mild hand tremor occurs in most normal adults. There are no surveys of the prevalence or clinical correlates of such tremor among children. METHODS: A cross-sectional study of tics, tremor and other neurological disorders was conducted in Spanish children; thus, 819 schoolchildren in Burgos, Spain, drew Archimedes spirals with each hand. Tremor in spirals was rated (0-2) by a blinded neurologist and an overall tremor rating (0-4) was assigned. RESULTS: The mean age was 10.9 ± 3.1 years. A tremor rating of 1 (mild tremor) was present in either hand in 424 (51.7%) children, and in both hands in 88 (10.7%) children. Higher tremor ratings were very uncommon. The overall tremor rating was higher in boys than girls (1.31 ± 0.41 vs. 1.22 ± 0.34, p = 0.002) and correlated weakly yet significantly with age (ρ = 0.09, p = 0.01). Within subjects, the left hand spiral rating was greater than the right (p < 0.001). CONCLUSIONS: In this cross-sectional study of 819 Spanish schoolchildren, mild tremor was commonly observed. As in adults, males had more tremor than females, tremor scores increased with age, and tremor scores were higher in the left than right arm, demonstrating that these clinical correlations seem to be more broadly generalizable to children. The functional significance of tremor in children, particularly as it relates to handwriting proficiency, deserves additional scrutiny.

Instituições Acadêmicas , Tremor/diagnóstico , Tremor/epidemiologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Espanha/epidemiologia , Adulto Jovem
Pediatr Neurol ; 45(2): 100-8, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21763950


Tic disorders constitute a neurodevelopmental disorder of childhood. This study sought to determine the prevalence of tic disorders in a school-based sample. A randomized sample of 1158 schoolchildren, based on clusters (classrooms) in the province of Burgos (Spain), was identified on a stratified sampling frame combining types of educational center and setting (mainstream schools and special education), using a two-phase approach (screening and diagnosis ascertainment by a neurologist). Tics with/without impairment criterion were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders criteria. In mainstream schools, tics were observed in 125/741 students (16.86%; 95% confidence interval, 14.10-19.63), and were more frequent in boys (87/448, 19.42%; 95% confidence interval, 15.64-23.19) compared with girls (38/293, 12.96%; 95% confidence interval, 8.95-16.98; P = 0.03). In special education centers, tics disorders were observed in 11/54 of children (20.37%; 95% confidence interval, 8.70-32.03). Overall, tics with impairment criteria were less frequent than tics without impairment criteria (4.65% vs 11.85%, P < 0.0001). The most frequent diagnoses involved chronic motor tics (6.07%) and Tourette syndrome (5.26%). Tic disorders are common in childhood, and the use or nonuse of impairment criteria exerts a significant impact on tic prevalence estimates.

Vigilância da População/métodos , Estudantes , Transtornos de Tique/diagnóstico , Transtornos de Tique/epidemiologia , Adolescente , Criança , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Espanha/epidemiologia , Estudantes/estatística & dados numéricos , Inquéritos e Questionários
Mov Disord ; 26(3): 520-6, 2011 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-21259342


BACKGROUND: The main purpose was to validate a multistage protocol to screen tic disorders in mainstream and special education centers and to investigate whether telephone-based interviews were accurate to diagnose tic disorders when compared with in-person neurological interviews. METHODS: A school-based survey of children and adolescents (6-16 years). A proxy report questionnaire for tic disorders was completed by teachers, observers, and parents. The diagnosis was confirmed by the neurologist based on the Diagnostic and Statistical Manual of Mental disorders (DSM-IV TR) criteria. The sensitivity, specificity, positive and negative predictive values, the likelihood ratio for a positive result (LR+), and the Kappa coefficients (k) for telephone-based interviews reliability were calculated. RESULTS: One hundred twenty subjects, 57 from special education center and 63 from a mainstream school were studied. The sensitivity of the proxy report questionnaire was 58% and 36% when completed by the observers (mainstream and special education center, respectively), 40 and 73% when completed by the teachers, and 58 and 36% when completed by the parents. Using any of these 3 screening sources, the sensitivity was 92%, the positive predictive value was 38%, and negative predictive value was 97% (mainstream schools), whereas the sensitivity was 82%, the positive predictive value was 20%, and negative predictive value was 82% (special education centers). Parents (mainstream schools) and teachers (special education center) produced the highest LR+ (7.25 and 1.26, respectively) and the intraobserver reliability of the telephone-based interviews versus in-person neurological interviews gave a k coefficient of 0.83. CONCLUSIONS: The efficiency of different screening instruments for tic disorders seems to vary in different settings. Telephone-based interviews may be a valid and convenient backup to ascertain the diagnosis of tic disorders when face-to-face neurological examination is not possible.

Programas de Rastreamento/instrumentação , Programas de Rastreamento/métodos , Transtornos de Tique/diagnóstico , Transtornos de Tique/epidemiologia , Adolescente , Criança , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Entrevistas como Assunto , Masculino , Exame Neurológico/métodos , Projetos Piloto , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Fatores de Tempo
Clin Pract Epidemiol Ment Health ; 6: 86-93, 2010 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-21139991


INTRODUCTION: This study was designed to evaluate the psychometric attributes and screening efficiency of a Spanish version of the Children Predictive Scales (DPS) against the Spanish Diagnostic Interview Schedule for Children (DISC-IV). METHOD: This pilot cross-sectional study included 61 children aged 9 to 14 years in a mainstream school. The following psychometric attributes were analyzed: acceptability, scale assumptions, internal consistency, and precision, as well the predictive validity (AUC). RESULTS: The scale did not show ceiling or floor effects (6.4%, 1.3%, respectively). The internal consistency was high (α=0.92), and the standard error of measurement was adequate (SEM=1.54). The overall DPS AUC was 0.72 against DISC IV corresponding diagnosis. CONCLUSION: The Spanish version of the DPS-4.32 seems to be a reliable and precise tool for screening mental health disorders in a school-age population.