Paul Eunson

Consensus on the appropriate use of intrathecal baclofen (ITB) therapy in paediatric spasticity.

Among features of motor disorders in children, spasticity is associated with considerable morbidity and problems in care, particularly in severely affected patients. Intrathecal baclofen (ITB) has been increasingly used as a relatively specific treatment modality for spasticity. To date, most of the evidence for its use in paediatric patients has come from retrospective and uncontrolled studies, although randomised, controlled trials of screening ITB and ITB therapy itself have recently been published. This consensus statement on the use of ITB in paediatric patients with spasticity was developed on the basis of currently available evidence, with the aim of providing information for clinicians, promoting an expert opinion and a consistent approach to the management of these patients and emphasising the need for further prospective, large-scale studies.

The long-term health, social, and financial burden of hypoxic–ischaemic encephalopathy

Infants who suffer hypoxic–ischaemic encephalopathy (HIE) at term are at risk of dying or developing severe cerebral palsy (CP). Children with severe CP often have other neurodevelopmental disabilities, which may affect their quality of life as much as the CP itself. New treatments for HIE, such as cooling, may improve motor outcomes, but affected infants may still have significant cognitive or communication problems. Infants who have experienced HIE and develop CP will require significant medical input throughout childhood and adult life. The costs of this medical input are high, but the indirect costs to the child, his or her family, and the relevant social services and education systems are many times greater. When demonstrating the cost‐effectiveness of interventions aimed at preventing or treating HIE, these additional costs should be taken into account.

Spasticity in children and young people with non-progressive brain disorders: summary of NICE guidance

Spasticity is a form of hypertonia1 and is associated with conditions such as cerebral palsy, which affects 110 000 people in the United Kingdom.2 More than 2000 children born this year in the UK will develop spasticity, which, if unmanaged, will cause pain, affect quality of life, and may lead to complications requiring major surgery. Children and young people with spasticity need early referral to local services that will meet their individual needs and allow them access to the range of interventions that will encourage their motor development. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the management of spasticity in children and young people with non-progressive brain disorders, including those with cerebral palsy.3 NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. ### Principles of care #### Delivering care [ Both points based on the experience and opinion of the Guideline Development Group (GDG) ] #### Management programmes

Limbic encephalitis associated with elevated antithyroid antibodies.

Immune-mediated limbic encephalitis affects both adults and children. Patients typically present with seizures, memory problems, and imaging changes in the medial temporal lobes. Both paraneoplastic and nonparaneoplastic forms have been described in which the antibody to the voltage-gated potassium channel-complex associated protein, leucine-rich glioma-inactivated 1, is most commonly reported. Elevated antithyroid antibodies have also been reported in a range of neurological syndromes with encephalopathy, such as limbic encephalitis, often collectively termed Hashimoto encephalopathy, a condition whereby corticosteroids responsiveness with a complete recovery is commonly observed. Here we describe 3 children presenting with limbic encephalitis with elevated thyroid antibodies that did not respond to corticosteroids alone and required more aggressive immunotherapy, mirroring the slower treatment response that is more frequently seen in other immune-mediated forms of limbic encephalitis.

Manual oftropical pediatrics.

Manual of tropical pediatrics. Edited by Seear, MD. (Pp 480, hardback, £50.00) UK: Cambridge University Press, 2000. ISBN 0 521 65835 7 This is a handsome book, with hard, thick covers, quality printing, and superb illustrations. It will look just grand on a bookshelf, but how often will it come down from that bookshelf? This manual is a comprehensive textbook of child health. In 480 pages, it covers general paediatrics, as well as infective and nutritional disorders confined to developing countries. The quality of the illustrations is superb, and relative to the text. The x rays in particular enhance the teaching message. However, the microbiology illustrations seem designed …