Tiina Talvik

The incidence of childhood traumatic brain injury in Tartu and Tartu County in Estonia.

Background: Traumatic brain injury (TBI) is a major health problem in childhood. Estonia and other Baltic states have the highest trauma-related mortality in the European Union. There are no data on the incidence and causes of TBI for children in Estonia. The aim of this study was to estimate the incidence, structure and main causes of TBI in Tartu and Tartu County. Methods: The study was carried out at Tartu University Hospital, between January 1, 2001, and December 31, 2005. For inclusion in the study the following criteria had to be fulfilled: age 0–14 years, documented brain trauma and neurological symptoms and residency in Tartu or Tartu County. Over the study period the inclusion criteria were fulfilled in 478 cases [272 boys (57%) and 206 girls (43%)]. Results: The incidence of TBI in childhood in Tartu and Tartu County was 369:100,000 (405:100,000 for boys, 330:100,000 for girls). The incidence was highest among children from 0 to 4 years of age – 566:100,000. The main cause of TBI in all age groups was falling – 63.6%. According to severity, 82% of the cases were mild and 18% were moderate and severe. Conclusions: There is an urgent need for governmental prevention programs for TBI in children in Estonia.

Outcome of infants with inflicted traumatic brain injury (shaken baby syndrome) in Estonia

This is a population‐based prospective study to identify the long‐term outcome of children with inflicted traumatic brain injury (ITBI).

Newly-diagnosed pediatric epilepsy is associated with elevated autoantibodies to glutamic acid decarboxylase but not cardiolipin

Glutamic acid decarboxylase autoantibodies (GADA) and anti-cardiolipin autoantibodies (ACA) have been detected in adult subjects with epilepsy, though the functional implications of these findings are a matter of debate. This study aimed to determine the prevalence of GADA and ACA and to investigate their clinical significance in pediatric subjects with newly-diagnosed epilepsy. For this purpose GADA and ACA were assessed by enzyme-linked immunosorbent assays in 208 pediatric patients with newly-diagnosed epilepsy and 128 controls. The clinical data (results of electroencephalography, magnetic resonance imaging, 6-month outcome etc.) was compared to antibody test results. Our study revealed GADA in 14 (6.7%) patients with epilepsy and in 1 (0.8%) control, which was a statistically significant difference (P=0.010; Chi-square test). The GADA-positive and -negative patients had similar clinical characteristics. The prevalence of ACA in patients with epilepsy (6.3%) was not significantly different than controls (2.6%). These results suggest that GADA is associated with epilepsy in a subgroup of newly-diagnosed pediatric patients. Further studies are required to determine the prognostic significance and pathogenic role of GADA among pediatric subjects with epilepsy.

Response to Letter by Temesvári

Response:nnWe thank Professor Temesvari for his comments regarding our recent article about the epidemiology of perinatal stroke (PS) in Estonia.1 The hypothesis of pneumothorax with subsequent air-embolism as a possible cause of neonatal ischemic stroke is interesting and has been demonstrated in piglet experimental model by professor Temesvari and his group.2 However, epidemiological studies of PS risk factors in term and near-term infants have not identified this association.3,4 Though intrapartum complications including the need for resuscitation and positive pressure ventilation are more common in infants with perinatal stroke,3 case-control studies have failed to identify these variables as independent risk-factors for PS suggesting a different cause-result relationship.5 A recent case-control study on risk factors of PS in preterm infants failed to show any difference in the use of positive pressure ventilation between …

Vastsündinu insult – haigestumus Eestis

Insult vastsundinueas on raske tusistus, mis on senini olnud aladiagnoositud, kuid tanu radioloogiliste uurimismeetodite taiustumisele on selle diagnoosimine koikjal sagenenud. Neonataalse insuldi kliinilisele pildile on iseloomulik fokaalsete krampide, apnoehoogude ja teadvushairete esinemine, hiljem avalduvad lastel hemiparees, epilepsia ning kognitiivsete funktsioonide haired. Eestis tehtud epidemioloogilise uuringu senised tulemused naitavad, et vastsundinuea isheemilise insuldi esmashaigestumus oli aastatel 1998–2002 uks juht 2000 ja 2003. aastal 1 juht 1200 elussunni kohta. Artiklis on kasitletud neonataalse insuldi epidemioloogiat, tekkepohjusi, riskitegureid ja diagnoosimist. nn nEesti Arst 2004; 83 (5): 296–303