Robert J. Baumann

A population-based study of neonatal seizures in Fayette County, Kentucky

Article abstract-This population-based, retrospective cohort study of neonatal seizures included all neonates born to residents of Fayette County, Kentucky, from 1985 to 1989. We ascertained potential cases by computer search of hospital-based medical record systems, Kentucky Center for Health Statistics birth certificate data files, and National Center for Health Statistics multiple-cause-of-death mortality data files. Medical records for potential cases were abstracted, and relevant portions were reviewed independently by three neurologists using prospectively determined case-selection criteria. Seizures occurred in 58 of 16,428 neonates (3.5/1,000 live births). An additional 15 neonates had possible seizures, for a combined risk of 4.4/1,000 live births. Neonatal seizure risk varied inversely with birth weight: 57.5/1,000 live births among very low birth weight infants (<1,500 grams) compared with 4.4/1,000 for infants with moderately low birth weight (1,500 to 2,499 grams), 2.8/1,000 for those with normal birth weight (2,500 to 3,999 grams), and 2.0/1,000 for those with high birth weight (4,000 or more grams). Risk varied among the four hospitals in the county with obstetric units, the university hospital having the highest risk. Risk did not differ by race or gender. A Cox proportional hazards model confirmed the results of the simpler univariate analyses. Differences in birth weight of the subpopulations served by each hospital accounted for much but not all the differences in hospital-specific risk. NEUROLOGY 1995;45: 724-732

Cigarette smoking and Parkinson disease: 1. A comparison of cases with matched neighbors

In previous studies, there were fewer cigarette smokers among persons with Parkinson disease than among other patients. We reinvestigated this phenomenon, using nonpatient controls. In home interviews with 237 Parkinson patients and 474 age-, sex-, and race-matched neighbors, we inquired about consumption of tobacco, coffee, tea, and alcohol. All Parkinson patients were diagnosed by a neurologist, had two or more cardinal features of parkinsonism, and had not received chronic phenothiazine therapy. One hundred fifty (63%) of 237 cases and 224 (47%) of 474 controls never smoked cigarettes (p < 0.0001). Significantly different smoking rates were also present at 10 and 20 years before the onset of parkinsonism.

Idiopathic intracranial hypertension (pseudotumor cerebri) in pediatric patients

Improved evaluation of visual features of idiopathic intracranial hypertension in pediatric patients has resulted in the demonstration of optic neuropathy which may be reversible. A wide variety of etiologic associations should be investigated to provide definitive therapy; however, nonspecific means often will be required to lower intracranial pressure. It is hoped that a double-blind controlled trial of medical therapies and another for surgical therapies will be conducted to elucidate optimum management of this condition.

Behavioral Treatment of Migraine in Children and Adolescents

Behavioral interventions, particularly biofeedback and relaxation therapy, have demonstrated their effectiveness in the treatment of both adults and older children with migraine in controlled trials. The physiological basis for their effectiveness is unclear, but data from one trial suggest that levels of plasma β-endorphin can be altered by relaxation and biofeedback therapies. The data supporting the effectiveness of behavioral therapies are less clear-cut in children than in adults, but that is also true for the data supporting medical treatment. This is due in part to methodological issues, especially the lack of a specific test for migraine, which has hampered research and helped lead to an inappropriate de-emphasis on care for childhood headache. In addition, migraine headaches in children are often briefer and have a higher rate of spontaneous remission than those experienced by adults, making it difficult to separate effective from ineffective treatments.While it is widely believed that stress is a major factor in childhood migraine, well-designed studies have had difficulty developing data to support this viewpoint. Many clinicians utilize ‘confident reassurance’, reassuring the family that the child is not seriously ill, in the belief that having migraine headaches can be stressful. They also modify behaviors that are believed to trigger migraine headaches, such as poor sleep habits or irregular meal times.Relaxation therapies use techniques such as progressive relaxation, self-hypnosis, and guided imagery. Several studies have found relaxation therapies to be as effective, or more effective, in reducing the frequency of migraine headaches than modest doses of a β-blockade medication, although one study found relaxation therapy to be no more effective than a control program. Several studies have demonstrated that these therapies can be taught to children in a low cost but effective manner.Biofeedback therapies commonly use an apparatus to demonstrate a physiological effect. Most commonly in pediatrics, children are taught to raise the temperature of one of their fingers. This can be done with or without a thermometer. Several groups have shown that these techniques can be taught to children and that their use is associated with fewer and briefer migraine headaches.People who experience migraines can also experience episodic headaches throughout life. An important consideration is preparing children to deal with future headaches, allowing them to feel in control of their health. Behavioral therapies have the potential to do this, giving the child access to a technique that can be easily resumed without a medical visit or prescription.

Epilepsy in rural Kentucky: prevalence in a population of school age children.

Seizure prevalence among school age children residing in a rural western Kentucky area (Hardin County) was determined utilizing a method designed to minimize false positives and to allow estimation of false negatives. The observed prevalence of epilepsy is 5.7/1,000 and of febrile seizures 17/1,000. Because of the high rate of false negative responses detected by random sample interview, the true rate of febrile seizures is believed to be closer to a projected rate of 31/1,000.

Use and monitoring of bromides in epilepsy treatment

Bromides are no longer a mainstay of epilepsy therapy because of the significant toxicity associated with their use and the availability of safer agents. However, bromides occasionally find a niche in the treatment of patients with refractory seizures, particularly in pediatrics. When the decision to utilize this therapy is made, the clinician may be frustrated by the lack of concise, current information regarding bromides. This review provides an update on the mechanism of action, efficacy, pharmacokinetics, dose, and adverse effects of bromides.

Acute disseminated encephalomyelitis after Rocky Mountain spotted fever

Although acute disseminated encephalomyelitis has been observed after a variety of viral infections and an occasional bacterial infection, it has not been reported in association with rickettsial infections. Reported is a 7-year-old male with magnetic resonance images and clinical manifestations suggestive of acute disseminated encephalomyelitis after a tick bite and serologically proven Rocky Mountain spotted fever.

Lafora progressive myoclonus epilepsy: narrowing the chromosome 6q24 locus by recombinations and homozygosities.

We thank the families whose members have carried the burden of LD; without their cooperation this study would not have been possible. We also gratefully acknowledge the cooperation and assistance of Joan Spellman, Bernadette Sakamoto, and Susan G. Pietsch-Escueta, who helped recruit families and coordinate family studies. Our study was approved by the Human Subjects Protection Committee at the UCLA School of Medicine and the West Los Angeles DVA Medical Center. Each participating patient or, in the case of minors or deceased relatives, the responsible adult, signed an informed-consent form. Our project was supported by NIH-NINDS program project 5PO1-NS21908 (to A.V.D.-E.), by special contributions from Mrs. A. Malenfant and the Quebec Laforas Disease Organization, and by Mrs. Vera Faludi of Sweden.

Magnetic resonance imaging of the brain in Aicardi's syndrome. Report of 20 patients.

Aicardis syndrome consists of multiple anomalies of the eye, brain, and axial skeleton in females, and is associated with early‐onset infantile spasms and severe developmental delay. For the present study, magnetic resonance images of 20 patients with Aicardis syndrome were obtained and the neuroimaging findings catalogued. These were compared to previously reported results and the findings correlated with current theories of fetal brain development. The results revealed a high frequency of cortical migration defects (94%) and a wide variability in the callosal defect, migrational abnormalities, and other findings in Aicardis syndrome.

Topiramate concentration in saliva: an alternative to serum monitoring.

This study examines the relationship between serum and saliva topiramate concentrations, and attempts to determine if saliva may be a useful alternative to serum for therapeutic monitoring. Saliva and blood specimens were collected from 31 epilepsy patients (mean age 10.5 +/- 6.0 years; range 2.5 years to 24.8 years), and topiramate concentrations were determined by fluorescence polarization immunoassay. One patients results were omitted because the saliva concentration was below the limit of quantitation of the assay. A strong correlation exists between serum and saliva topiramate concentrations (adjusted r(2) = 0.97, n = 30, P < 0.0001). The mean fraction of saliva to serum concentration is 89.8% +/- 12.1% (range 62.9% to 112.7%). The results of this study support the use of saliva as a viable alternative to serum for monitoring topiramate therapy. Topiramate concentration in saliva: an alternative to serum monitoring.