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  • 1
    Online Resource
    Online Resource
    Educational Intervention Improves Compliance With AAN Guidelines for Return Epilepsy Visits : A Quality Improvement Project
    SAGE Publications ; 2016
    In:  Journal of Child Neurology Vol. 31, No. 11 ( 2016-10), p. 1320-1323
    Details
    In: Journal of Child Neurology, SAGE Publications, Vol. 31, No. 11 ( 2016-10), p. 1320-1323
    Abstract: In 2011, the American Academy of Neurology (AAN) released guidelines for return seizure visits detailing 8 points that should be addressed during such visits. These guidelines are designed to improve routine follow-up care for epilepsy patients. The authors performed a quality improvement project aimed at increasing compliance with these guidelines after educating providers about them. The authors performed a chart review before and after an intervention which included: education regarding the guidelines, providing materials to remind providers of the guidelines, and templates to facilitate compliance. The authors reviewed charts at 2 and 6 months after the intervention. Significant improvement in documentation of 4 of the 8 measures was observed after this educational intervention. This suggests that simple educational interventions may help providers change practice and can improve compliance with new guidelines while requiring minimal time and resources to implement.
    Type of Medium: Online Resource
    ISSN: 0883-0738 , 1708-8283
    URL: Article
    DOI: 10.1177/0883073816653200
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
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  • 2
    Online Resource
    Online Resource
    Seizure Action Plans Do Not Reduce Health Care Utilization in Pediatric Epilepsy Patients
    SAGE Publications ; 2016
    In:  Journal of Child Neurology Vol. 31, No. 4 ( 2016-03), p. 433-438
    Details
    In: Journal of Child Neurology, SAGE Publications, Vol. 31, No. 4 ( 2016-03), p. 433-438
    Abstract: Management of pediatric epilepsy requires complex coordination of care. We hypothesized that an improved seizure management care plan would reduce health care utilization and improve outcomes. The authors conducted a cohort study with historical controls of 120 epilepsy patients before and after implementation of a “Seizure Action Plan.” The authors evaluated for differences in health care utilization including emergency department visits, hospitalizations, clinic visits, telephone calls, and the percentage of emergency department visits that resulted in hospitalization in patients who did or did not have a Seizure Action Plan. The authors found that there was no decrease in these measures of health care utilization, and in fact the number of follow-up clinic visits was increased in the group with Seizure Action Plans (4.2 vs 3.3, P = .006). However, the study was underpowered to detect smaller differences. This study suggests that pediatric epilepsy quality improvement measures may require alternative approaches to reduce health care utilization and improve outcomes.
    Type of Medium: Online Resource
    ISSN: 0883-0738 , 1708-8283
    URL: Article
    DOI: 10.1177/0883073815597755
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
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  • 3
    Online Resource
    Online Resource
    Efficacy of the Ketogenic Diet as a Treatment Option for Epilepsy: Meta-analysis
    SAGE Publications ; 2006
    In:  Journal of Child Neurology Vol. 21, No. 3 ( 2006-03), p. 193-198
    Details
    In: Journal of Child Neurology, SAGE Publications, Vol. 21, No. 3 ( 2006-03), p. 193-198
    Abstract: The evidence base for the efficacy of the ketogenic diet was assessed among pediatric epileptic patients by application of a rigorous statistical meta-analysis. Nineteen studies from 392 abstracts met the inclusion criteria. The sample size was 1084 patients (mean age at initiation 5.78 ± 3.43 years). The pooled odds ratio, using a random effects model, of treatment success ( 〉 50% seizure reduction) among patients staying on the diet relative to those discontinuing the diet was 2.25 (95% confidence interval = 1.69—2.98). The reasons for diet discontinuation included 〈 50% seizure reduction (47.0%), diet restrictiveness (16.4%), and incurrent illness or diet side effects (13.2%). The results indicate that children with generalized seizures and patients who respond with 〉 50% seizure reduction within 3 months tend to remain on the diet longer. Although no class I or II studies have been published regarding the efficacy of the ketogenic diet, this meta-analysis shows that current observational studies reporting on the therapeutic effect of the ketogenic diet contain valuable statistical data. Future observational studies should aim for long-term follow-up, patient dropout analysis, and improved seizure type characterization. ( J Child Neurol 2006;21:193—198; DOI 10.2310/7010.2006.00044).
    Type of Medium: Online Resource
    ISSN: 0883-0738 , 1708-8283
    URL: Article
    DOI: 10.2310/7010.2006.00044
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2006
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  • 4
    Online Resource
    Online Resource
    Disparities in Pediatric Epilepsy Remission Are Associated With Race and Ethnicity
    SAGE Publications ; 2019
    In:  Journal of Child Neurology Vol. 34, No. 14 ( 2019-12), p. 928-936
    Details
    In: Journal of Child Neurology, SAGE Publications, Vol. 34, No. 14 ( 2019-12), p. 928-936
    Abstract: The purpose of our study was to assess whether race/ethnicity was associated with seizure remission in pediatric epilepsy. Methods: This was a retrospective population-based cohort study of children who were evaluated for new-onset epilepsy in the clinic, emergency department, and/or hospital by a pediatric neurologist in an integrated health care delivery system. Children were between ages 6 months and 15 years at their initial presentation of epilepsy. The cohort, identified through an electronic database, was assembled over 6 years, with no less than 5 years of follow-up. All children were evaluated for race, ethnicity, insurance type, and socioeconomic background. Patient outcome was determined at the conclusion of the study period and categorized according to their epilepsy control as either drug resistant (pharmacoresistant and intractable) or drug responsive (controlled, probable remission, and terminal remission). Results: In the final cohort of 776 patients, 63% were drug responsive (control or seizure remission). After controlling for confounding socioeconomic and demographic factors, children of Hispanic ethnicity experienced reduced likelihood (hazard) of drug-responsive epilepsy (hazard ratio 0.6, P 〈 .001), and had longer median time to remission (8 years; 95% CI 5.9-9.6 years) compared to white non-Hispanic patients (5.6 years; 95% CI 4.9-6.1 years). Among Hispanic patients, higher health care costs were associated with reduced likelihood of drug responsiveness. Significance: We found that Hispanic ethnicity is associated with a reduced likelihood of achieving seizure control and remission. This study suggests that factors associated with the race/ethnicity of patients contributes to their likelihood of achieving seizure freedom.
    Type of Medium: Online Resource
    ISSN: 0883-0738 , 1708-8283
    URL: Article
    DOI: 10.1177/0883073819866623
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
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  • 5
    Online Resource
    Online Resource
    Seizures In Children Following an Apparent Life-threatening Event
    SAGE Publications ; 2009
    In:  Journal of Child Neurology Vol. 24, No. 6 ( 2009-06), p. 709-713
    Details
    In: Journal of Child Neurology, SAGE Publications, Vol. 24, No. 6 ( 2009-06), p. 709-713
    Abstract: The characteristics of seizures and epilepsy in infants who have had an apparent life-threatening event have been poorly defined. Our objective was to characterize in depth the cohort of patients with apparent life-threatening events who developed seizures. We collected data from infants hospitalized for an apparent life-threatening event, and evaluated patients for subsequent seizures or chronic epilepsy. Of 471 patients with an apparent life-threatening event, 25 (5.3%) had seizures and 17 (3.6%) developed chronic epilepsy. There was no increased risk for febrile seizures. Abnormal brain magnetic resonance imaging results and developmental delay were only found in those patients who developed chronic epilepsy. Of those who developed chronic epilepsy, 47% were diagnosed with seizures within 1 week of their apparent life-threatening event. The discharge diagnosis at the time of the apparent life-threatening event was poorly predictive of those who developed seizures. In most cases the cause of chronic epilepsy was unknown, although cortical dysplasias made up a significant percentage (12%).
    Type of Medium: Online Resource
    ISSN: 0883-0738 , 1708-8283
    URL: Article
    DOI: 10.1177/0883073808329532
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2009
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  • 6
    Online Resource
    Online Resource
    Hydrogen Peroxide Neurotoxicity in Childhood: Case Report With Unique Magnetic Resonance Imaging Features
    SAGE Publications ; 2003
    In:  Journal of Child Neurology Vol. 18, No. 11 ( 2003-11), p. 805-808
    Details
    In: Journal of Child Neurology, SAGE Publications, Vol. 18, No. 11 ( 2003-11), p. 805-808
    Abstract: Concentrated hydrogen peroxide (H 2 O 2 ) intoxication is relatively rare in children. Serious irreversible neurotoxicity generally results. The case of an 11-year-old boy who inadvertently drank a concentrated (35%) H 2 O 2 solution is described. He exhibited signs of an acute encephalopathy with cortical visual impairment. Extensive cerebrocortical diffusion restriction with apparent gyral edema was evident at 3 days following ingestion, particularly in the parieto-occipital regions bilaterally. Spontaneous neurologic improvement quickly followed, and nearly full clinical resolution was evident 1 month later. The pattern of imaging abnormalities closely resembles that of reversible posterior leukoencephalopathy. Concentrated H 2 O 2 neurotoxicity in children can exhibit unique patterns (a reversible posterior leukoencephalopathy) and a better than expected outcome. ( J Child Neurol 2003;18:805—808).
    Type of Medium: Online Resource
    ISSN: 0883-0738 , 1708-8283
    URL: Article
    DOI: 10.1177/08830738030180111501
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2003
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  • 7
    Online Resource
    Online Resource
    Extrapontine Myelinolysis in a Pediatric Case of Diabetic Ketoacidosis and Cerebral Edema
    SAGE Publications ; 2003
    In:  Journal of Child Neurology Vol. 18, No. 2 ( 2003-02), p. 144-147
    Details
    In: Journal of Child Neurology, SAGE Publications, Vol. 18, No. 2 ( 2003-02), p. 144-147
    Abstract: Central pontine and extrapontine myelinolysis are characterized by symmetric demyelination following rapid shifts in serum osmolality, although in extrapontine myelinolysis, demyelination is confined to the supratentorial compartment. We present a case of extrapontine myelinolysis in a 17-year-old female that occurred in the setting of diabetic ketoacidosis, cerebral edema, mannitol therapy, and meningitis. The rate of correction of this patient's glucose and electrolyte levels was within well-accepted limits. Extrapontine myelinolysis is rare in pediatric patients: there are only 12 reports of extrapontine myelinolysis in children under age 20 years and no pediatric cases of extrapontine myelinolysis or central pontine myelinolysis associated with diabetic ketoacidosis. We review the published cases of extrapontine myelinolysis and examine the underlying etiologies and electrolyte disturbances that characterize these cases. This case expands the list of conditions in which extrapontine myelinolysis occurs to include pediatric patients with complicated diabetic ketoacidosis, emphasizing the importance of sudden osmolar shifts in the genesis of this disorder. ( J Child Neurol 2003; 18: 144—147).
    Type of Medium: Online Resource
    ISSN: 0883-0738 , 1708-8283
    URL: Article
    DOI: 10.1177/08830738030180021201
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2003
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  • 8
    Online Resource
    Online Resource
    Neuropathophysiology of Movement Disorders in Cerebral Palsy
    SAGE Publications ; 1996
    In:  Journal of Child Neurology Vol. 11, No. 1_suppl ( 1996-11), p. S5-S12
    Details
    In: Journal of Child Neurology, SAGE Publications, Vol. 11, No. 1_suppl ( 1996-11), p. S5-S12
    Abstract: Recent developments in understanding the pathophysiology of disordered motor control in cerebral palsy are reviewed. In spastic cerebral palsy, evidence for abnormal segmental as well as supraspinal control of motor neuron output exists. Impaired Ia inhibition of antagonist muscles has been suggested but recently contested. Evidence also supports the role of decreased presynaptic inhibition of Ia afferents and decreased nonreciprocal Ib inhibition. Furthermore, early cerebral injury results in reorganization of supraspinal (corticospinal) inputs to motor neuron pools. In extrapyramidal cerebral palsy, injury of basal ganglia or thalamus has been demonstrated. A scheme for understanding the neurochemical circuitry of the extrapyramidal system is discussed. Animal models and certain specific human diseases provide examples of how this circuitry may be disturbed, thereby resulting in an imbalance between the direct and indirect striatal output systems and in impaired motor control. Future studies employing postmortem neurochemical analysis, functional magnetic resonance imaging, and positron emission tomographic scanning may foster progress in this area. (J Child Neurol 1996;11(Suppl 1):S5-S 12).
    Type of Medium: Online Resource
    ISSN: 0883-0738 , 1708-8283
    URL: Article
    DOI: 10.1177/0883073896011001S02
    Language: English
    Publisher: SAGE Publications
    Publication Date: 1996
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  • 9
    Online Resource
    Online Resource
    Splenial Corpus Callosum Lesion and Hemifield Visual Color Anomia Associated With Intracranial Hypertension
    SAGE Publications ; 2007
    In:  Journal of Child Neurology Vol. 22, No. 9 ( 2007-09), p. 1132-1134
    Details
    In: Journal of Child Neurology, SAGE Publications, Vol. 22, No. 9 ( 2007-09), p. 1132-1134
    Abstract: Lesions in the splenium of the corpus callosum are a rare complication of a variety of clinical conditions including ischemia, trauma, acute disseminated encephalomyelitis, infection, electrolyte imbalances, seizures, and antiepileptic drugs. This report describes a child presenting with hemifield visual color anomia, headache, and papilledema, who was found to have a midline splenial lesion on diffusion-weighted magnetic resonance imaging (MRI). Lumbar puncture revealed elevated intracranial pressure. His symptoms and MRI findings resolved quickly following treatment of his increased intracranial pressure. This is the first report describing an association between intracranial hypertension and a lesion in the splenium of the corpus callosum.
    Type of Medium: Online Resource
    ISSN: 0883-0738 , 1708-8283
    URL: Article
    DOI: 10.1177/0883073807306252
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2007
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  • 10
    Online Resource
    Online Resource
    Cerebral Sinovenous Thrombosis in Children: Another Reason to Treat Iron Deficiency Anemia
    SAGE Publications ; 2004
    In:  Journal of Child Neurology Vol. 19, No. 7 ( 2004-07), p. 526-531
    Details
    In: Journal of Child Neurology, SAGE Publications, Vol. 19, No. 7 ( 2004-07), p. 526-531
    Abstract: Iron deficiency anemia is a rare cause of cerebral sinovenous thrombosis in children. We report three cases of cerebral sinovenous thrombosis and iron deficiency anemia treated at Primary Children's Medical Center in Salt Lake City, Utah, between 1998 and 2001. The children were 9, 19, and 27 months old at the time of admission. Hemoglobin levels ranged from 6.6 to 7.0 g/dL, mean corpuscular volume levels from 45 to 56 fL, and platelet counts from 248,000 to 586,000/μL. Magnetic resonance imaging and magnetic resonance venography revealed thrombosis of the straight sinus and internal cerebral veins in all three children, with the addition of the vein of Galen, left transverse and sigmoid sinuses, and upper left internal jugular vein in one child. Recovery ranged from excellent to poor in 3 months to 3 years of follow-up. Four additional cases, ages 6 to 22 months, were found in the English-language literature. Evaluation for prothrombotic disorders was negative in all children, including the current cases. Treatments have included thrombectomy, corticosteroids, mannitol, heparin, low-molecular-weight heparin, warfarin, aspirin, blood transfusion, and iron supplementation, but there is no consensus regarding therapy, other than to correct the anemia and treat iron deficiency. Iron deficiency anemia, a preventable cause of cerebral sinovenous thrombosis, deserves consideration when cerebral sinovenous thrombosis is detected in young children. ( J Child Neurol 2004;19:526—531).
    Type of Medium: Online Resource
    ISSN: 0883-0738 , 1708-8283
    URL: Article
    DOI: 10.1177/08830738040190070901
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2004
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