An Infant With a Low-grade Brain Tumor Presenting With Atypical Epileptic Seizures / 日本農村医学会雑誌

Low-grade epilepsy-associated tumors (LEAT) are brain tumors that should be differentiated as a cause of symptomatic epilepsy in children. The most common initial symptom is epileptic seizure, particularly focal seizures. We present a case of LEAT in which an infant presented to our department with convulsive-like seizures that were observed from approximately 3 months of age. At the first visit, growth and development, including head circumference, were appropriate for age. The seizures were atypical, but ictal video electroencephalography showed abnormal waves indicative of left hemispheric epilepsy. The patient subsequently presented with somnolence and poor feeding, and a sudden increase in head circumference and hydrocephalus were observed. Thus, the patient was urgently admitted to the neurosurgery department of our hospital. Brain MRI showed a suspected brain tumor and elective craniotomy was performed. No epileptic seizures were observed postoperatively. When focal epileptic seizures are observed in infancy, a brain tumor should also be considered as a differential diagnosis, and further examination may be warranted.

Benign Partial Epilepsy in Infancy with Paternal Diagnosis of Paroxysmal Kinesigenic Dyskinesia: A Case Report of Familial Infantile Convulsions and Choreoathetosis Syndrome / 日本農村医学会雑誌

Benign partial epilepsy in infancy (BPEI) is a known cause of paroxysmal kinesigenic dyskinesia (PKD) in childhood. These two conditions have recently been grouped under the diagnosis of infantile convulsions and choreoathetosis (ICCA) syndrome, for which mutations in the proline-rich transmembrane protein 2 (PRRT2) gene have been shown to be responsible. Here, we report on a case of familial ICCA syndrome with an identical mutation in the PRRT2 gene. A 4-month-old infant developed BPEI, and this led to the diagnosis of PKD in his father. The father had been having exercise-onset rigidity of the upper and lower limbs since childhood and had been diagnosed with epilepsy but had not received proper treatment. Both BPEI and PKD are known to improve dramatically with low dose carbamazepine. Correct diagnosis and proper knowledge of ICCA syndrome is essential for providing adequate treatment and precise information on the genetic aspects of the disease to patients and their families.

Current Awareness Among Physical Therapists About Clinical Cooperation for Pediatric Patients with a Developmental Disorder / 日本農村医学会雑誌

　　In this study, to establish a system unique to our hospital, an awareness survey of physical therapists was conducted using a newly developed form to investigate the degree of anxiety about, and participation in supporting, pediatric patients with a developmental disorder, managing patients’ families, and interdisciplinary cooperative activities. The level of anxiety and the degree of participation were evaluated using a visual analog scale. The Mann-Whitney U test was used to compare cooperative activities with different professionals. The results showed that 20 (90.9%) of the physical therapists were anxious about supporting and handling pediatric patients with a developmental disorder and their families. No significant difference in the degree of anxiety was observed among different professionals, but the highest anxiety was observed when working in cooperation with physicians (Dr), followed by clinical psychotherapists (CP), nurses (Ns), medical social workers (MSW), occupational therapists (OT), and then speech therapists (ST). Physical therapists cooperated most frequently with Dr, followed by Ns, OT, MSW, ST, and then CP, with a significant difference between Dr and CP. The findings of this study, showing current awareness and challenges related to pediatric patients with a developmental disorder, provide information that is fundamental for the establishment of a system unique to our hospital.

Characteristics of Social Work Support in Neonatal and Pediatrics Departments / 日本農村医学会雑誌

　　We often experience difficulty supporting the pediatric social work because, under the present social welfare system, support services change as patients grow. Recently, studies aimed at establishing practice models have increased in the pediatric social work region. With a view to establishing practice models, we reviewed our experience in the neonatal and pediatrics departments.　　Our investigation found that almost all support requests in the neonatal cases were from our medical staff. For inpatients, request were mostly concerned with hospital discharge support. Requests in behalf of outpatients were consultation about physical examination. Most of the support processes ended up in liaison and coordination or providing information.　　In the pediatric department, the most common route of requests for inpatients was from our medical staff, but for outpatients, the requests came from public institutions and private facilities concerned. Most requests for inpatients were related to the use of the social welfare system. Meanwhile, requests in behalf of outpatients were centered on support of consultation about physical examination.　　From the above, we concluded that in the pediatric social work region, social workers should approach not only patients and their family members but also medical staff and community institutions. We deemed it necessary to coordinate social-welfare services based on a long-term plan, taking into account the growth of children.

Two Cases of Rotavirus-Related Acute Encephalopathy Which Made Different Clinical Progress / 日本農村医学会雑誌

We experienced two cases of rotavirus-related acute encephalopathy.  Each case followed a different clinical course.  The first case is 2-year and 11-month-old girl who had generalized tonic-clonic convulsion at onset. She was severe enough to a require respirator but she recovered without any sequelae.  The second case is 2-year and 2-month-old girl who had a vague symptom of continuous fretfulness. Her EEG showed a slow wave and her brain MRI detected abnormal signals in the cerebellum. Her motor function was recovered but higher brain dysfunction and light cerebellum symptoms remained.   There wene two types of clinical condition on rotavirus-related encephalopathy; Convulsion type and cerebellum lesion type.  Since the latter type is hard to diagnose and to treat, an effective therapeutic strategy should be established.

The Pediatric Emergency Care System Which Developed in Response to Changes in Regional Features and Demands / 日本農村医学会雑誌

We assessed the pediatric emergency care system of our hospital. A total of about 11,714 children were carried into the emergency room during 1998. Their age was young, 33.6% being less than 4 years old and 54.5% less than 7 years old. About half a number of them (50.8%) were received between 5 p.m. and midnight and 75.3% at night. They came to our hospital from two or three secondary medical care areas, the population of which was estimated at 800,000 including 120,000 children. Twenty-six percent of outpatients and 43% of inpatients were those who had first visited the emergency unit. During the year 110 persons entered into our pediatric ICU, 45 persons underwent mechanical ventilation therapy, and an average of 7.4 patients stayed in hospital per day.We also reviewed the changes of the pediatric emergency care system of our hospital for 20 years. This system has gradually developed. Chronologically, the neonatal intensive care unit was set up in 1983, followed by the opening of the pediatric intensive care unit in 1986, the start of the 24-hour emergency medical care by pediatricians in 1993, the home mechanical ventilation therapy in 1996 and the respite care since 1997. In other words, our system developed from intensive care to primary care and home care—from in-hospital to out-hospital. These changes were the result of our effort to cope with regional features and meet demands : increase of younger children, insufficiency of pediatricians, expansion of medical area in our change and parents’ request for rediatrician’s examination at any time.In summary, an increasing number of patients who need pediatric emergency care tend to concentrate into one central hospital in a large region. Pediatric emergency care developed into general pediatric medicine including primary care and intensive care and home care.