Nogah C. Kerem

Primary headaches, attention deficit disorder and learning disabilities in children and adolescents

BackgroundPrimary headaches and Learning difficulties are both common in the pediatric population. The goal of our study was to assess the prevalence of learning disabilities and attention deficit disorder in children and adolescents with migraine and tension type headaches.MethodsRetrospective review of medical records of children and adolescents who presented with headache to the outpatient pediatric neurology clinics of Bnai-Zion Medical Center and Meyer Children’s Hospital, Haifa, during the years 2009–2010. Demographics, Headache type, attention deficit disorder (ADHD), learning disabilities and academic achievements were assessed.Results243 patients met the inclusion criteria and were assessed: 135 (55.6%) females and 108 (44.4%) males. 44% were diagnosed with migraine (35.8% of the males, 64.2% of the females, p = 0.04), 47.7% were diagnosed with tension type headache (50.4% of the males, 49.6% of the females). Among patients presenting with headache for the first time, 24% were formerly diagnosed with learning disabilities and 28% were diagnosed with attention deficit disorder (ADHD). ADHD was more prevalent among patients with tension type headache when compared with patients with migraine (36.5% vs. 19.8%, p = 0.006). Poor to average school academic performance was more prevalent among children with tension type headache, whereas good to excellent academic performance was more prevalent among those with migraine.ConclusionsLearning disabilities and ADHD are more common in children and adolescents who are referred for neurological assessment due to primary headaches than is described in the general pediatric population. There is an association between headache diagnosis and school achievements.

The cross- ethnic variations in the prevalence of headache and other somatic complaints among adolescents in Northern Israel

BackgroundHeadache is the most common cause for chronic or recurrent pain in childhood and adolescence. Chronic pain may have a long-term effect on adolescents. It might contribute to functional limitations, such as poor school attendance, and it may adversely affect development of healthy social relationships. The aim of our study was to examine the cross- ethnic variation in the prevalence of headache in a non- clinical sample of adolescents in Northern Israel and to learn about its association to other somatic complaints.MethodsA self-administered, anonymous questionnaire was presented to 2,088 tenth grade students attending 19 high-schools in Northern Israel (all the public high schools within two districts). Participants were Jews and Arabs, the latter including Muslim, Christians, and Druze, aged 15 to 16. Parental and student consent was obtained from all participants. The study was approved by the IRB of our institution.ResultsAll 2088 questionnaires were returned although only 2019 were usable and analyzed. Arab adolescents comprised 55% (1117) of the analyzed sample and Jews 45% (902), 56% of participants were girls. Of the Arab participants, 18.6% reported having frequent headaches (girls 25.3%, boys 9.1%, P<0.0001) much less than their Jewish peers (P<0.0001) among whom 27.9% reported having frequent headaches (girls 35.6%, boys 19% P<0.0001). Other somatic complaints such as abdominal pain, palpitations, disordered sleep and fatigue were more frequent in adolescents (Jews and Arabs, girls and boys) who suffered from headaches than in their peers who did not report having headaches (P<0.0001), the same pattern observed in the Jewish and the Arab group.ConclusionsHeadache is a frequent complaint among adolescents in Northern Israel. Jewish adolescents reported having headaches more frequently than their Arab peers. Those who suffered from frequent headaches also reported having significantly more other somatic complaints than adolescents without headaches. Girls had more somatic complaints then boys in the two ethnic groups.

Validation of a Novel Assay to Distinguish Bacterial and Viral Infections

A novel 3-protein host-assay’s diagnostic performance for distinguishing between bacterial and viral etiologies is validated in a double-blind, investigator-driven study in febrile children. BACKGROUND: Reliably distinguishing bacterial from viral infections is often challenging, leading to antibiotic misuse. A novel assay that integrates measurements of blood-borne host-proteins (tumor necrosis factor-related apoptosis-inducing ligand, interferon γ-induced protein-10, and C-reactive protein [CRP]) was developed to assist in differentiation between bacterial and viral disease. METHODS: We performed double-blind, multicenter assay evaluation using serum remnants collected at 5 pediatric emergency departments and 2 wards from children ≥3 months to ≤18 years without (n = 68) and with (n = 529) suspicion of acute infection. Infectious cohort inclusion criteria were fever ≥38°C and symptom duration ≤7 days. The reference standard diagnosis was based on predetermined criteria plus adjudication by experts blinded to assay results. Assay performers were blinded to the reference standard. Assay cutoffs were predefined. RESULTS: Of 529 potentially eligible patients with suspected acute infection, 100 did not fulfill infectious inclusion criteria and 68 had insufficient serum. The resulting cohort included 361 patients, with 239 viral, 68 bacterial, and 54 indeterminate reference standard diagnoses. The assay distinguished between bacterial and viral patients with 93.8% sensitivity (95% confidence interval: 87.8%–99.8%) and 89.8% specificity (85.6%–94.0%); 11.7% had an equivocal assay outcome. The assay outperformed CRP (cutoff 40 mg/L; sensitivity 88.2% [80.4%–96.1%], specificity 73.2% [67.6%–78.9%]) and procalcitonin testing (cutoff 0.5 ng/mL; sensitivity 63.1% [51.0%–75.1%], specificity 82.3% [77.1%–87.5%]). CONCLUSIONS: Double-blinded evaluation confirmed high assay performance in febrile children. Assay was significantly more accurate than CRP, procalcitonin, and routine laboratory parameters. Additional studies are warranted to support its potential to improve antimicrobial treatment decisions.

Headache and physical and sexual abuse among Jewish and Arab adolescents in Israel.

The purpose of the present study was to evaluate the relationship between headaches and physical and sexual abuse. A self-administered, anonymous questionnaire was presented to 2088 tenth grade students in Northern Israel. Participants were Jews and Arabs between the ages of 15 to 16 years. Arab adolescents comprised 55% of the analyzed sample and adolescent Jews 45%. With regard to gender, 56% of participants were females. Of the Arab participants, 18.6% reported having frequent headaches, less than that reported in the Jewish group (27.9%). Jewish girls who were physically abused during childhood had a higher prevalence of frequent headaches (55% vs 33% P < .001). Jewish students who reported being sexually abused had higher headache prevalence as well (44.4% vs 27.3% P = .05). In conclusion, adolescents who reported to have been physically or sexually abused report a higher prevalence of headache compared to their peers.

Primary Headache in Children and Adolescents: From Pathophysiology to Diagnosis and Treatment

Primary headaches are common disorders among children and adolescents; tension type headaches (TTH) and migraine being the most frequent types. This paper reviews the literature and summarizes the knowledge regarding the underlying pathophysiological mechanisms that cause headaches, mainly TTH and migraine, discusses the diagnostic criteria for primary headaches, and the different moralities for management of pain in children and adolescents. It is well accepted, that the pain experience holds bio-psychosocial components to it, therefore treatment strategies should be tailored according to the patient’s age, headache diagnosis, family structure, culture and beliefs, and according to the disability the headache imposes on the patient’s daily living. A multidisciplinary treatment, that includes counseling, education and reassurance combined with pharmacological and non-pharmacological treatment, was found to be the effective strategy to alleviate the symptoms of primary headaches in children and adolescents.

Respiratory acidosis in adolescents with anorexia nervosa hospitalized for medical stabilization: a retrospective study.

OBJECTIVE To examine the effect of malnutrition due to anorexia nervosa (AN) on venous blood gases of adolescents with AN hospitalized for medical stabilization. METHOD This retrospective study included 45 adolescents with recent onset (<1 year) AN diagnosed by DSM-IV criteria and excluded subjects with a history of lung disease. RESULTS Mean (± SD) age at hospitalization was 15.0 ± 2.0 years; time from onset of symptoms was 6.8 ± 3.0 months; body mass index (BMI) was 15.2 ± 1.5 kg/m(2) ; and minimal nocturnal heart rate (MNHR) was 39.8 ± 7.2 beats/min. On admission, pH was 7.32 ± 0.02, pCO(2) was 53.8 ± 4.6 mm Hg, and HCO(3) was 28.1 ± 2.1 mEq/l. Significant changes (p < .001) occurred during the relatively short hospitalization (9.7 ± 5.1 days): venous pH increased, pCO(2) decreased, HCO(3) decreased, MNHR increased, and heart rate orthostasis decreased. Mild respiratory acidosis (pH < 7.35 and pCO(2) > 45 mm Hg) was observed in 78% of the patients on admission and only in 35% at discharge (p = .0003). Positive correlations were found between % of weight loss and pCO(2) on admission and between BMI on admission and the delta pCO(2) during hospitalization. DISCUSSION Mild respiratory acidosis is common in adolescents with recently diagnosed AN, hospitalized for medical stabilization. Respiratory acidosis improves with bed rest and refeeding. The clinical significance of these findings should be further evaluated.

EHMTI-0013. The relations between attention deficit and hyperactivity disorder and different types of headaches in a non- clinical sample of adolescents

Stress is considered to be a major trigger for aggravation of headaches. In a previous study we demonstrated a high prevalence of ADHD among patients who were referred to a pediatric clinic due to headaches. In the present study we examined whether this is true for the general population of adolescents.