Sleep Problems in children with Down syndrome

Background:sleep problems are significant source of distress for families with a case of Down Syndrome [DS]. Parental perception of sleep problems is an important contributor to a family quality of life

Aim of the Work: the aim of the present work was to study the sleep problems in children with Down syndrome

Subjects and Methods: this study was carried out on 50 children with DS attending the neurology clinic in Alexandria University Children Hospital together with 50 apparently by healthy children with matched age and sex. Parents were interviewed in order to collect data using predesigned questionnaire. Sleep problems were assessed using the Children's Sleep Habits Questionnaire [CSHQ]

Results: total sleep score was significantly higher among children with DS than among those of the control group. The mean differences between case and control groups were significant regarding all subscales except that for sleep onset delay

Conclusion: sleep problems are more common among children with DS as compared with those in control group

Acute Guillain Barre Syndrome in childhood: clinical, electrophysiological and immunological study

Acute Guillain Barre Syndrome [acute GBS] is one of the leading causes of acute flaccid paralysis [AFP] in children. The syndrome has been recognized as a heterogeneous disorder with different subtypes, by clinical, electrophysiological and pathologic criteria. The disease may present with a wide variety of clinical presentations as well as prognostic outcome. The study was conducted on all children with acute GBS attending Alexandria University Children's Hospital during the period from September 2000 to September 2001 for the purpose of characterization of acute GBS in Egyptian Children and its relation to presumed infection with Cytomegalovirus [CMV] or Epstien-Barr virus [EBV]. All clinical, laboratory and electrophysiological data of the children with acute GBS who are admitted to the hospital during the period of the study were evaluated. Serum IgM titer against CMV and EPV were assessed and correlated with other patients'data. Thirty five children were admitted to the hospital during that period. Sixty age and sex matched healthy children were included as controls for studying IgM titre of EBV and CMV. Affected children were 22 boys and 13 girls. Their ages ranged between one and 10 years. Eight cases did not have preceding illness before the disease. The initial symptom was motor in 11 cases, sensory in 2 cases and mixed in 22 cases. Ascending paralysis was dominant in all cases except three who had descending paralysis. Only five cases did not exhibit severe pediatric GBS [grade 4 or 5] according to the functional grading system. Twenty nine cases exhibited the major electrophysiological type of acute inflammatory demyelinating polyneuropathy [AIDP]. Albuminocytologic dissociation was encountered in 25 cases. Two cases died in the acute phase, one was left with residual neurological deficit while the rest recovered completely. There was a statistically significant difference between cases and controls as regards the IgM titre against CMV virus [P < 0.05] while IgM titres against EBV were not statistically different from the control group. In addition children with presumed Prior CMV infection tended to be younger in their age significantly more than those with presumed EBV infection [r = 0.382, P = 0.003]. The only significant association was the relation between the type of initial symptoms versus the IgM titre against CMV and EBV where sensory symptoms were prominent more significantly among cases with presumed CMV infection than those with presumed EBV infection [P<0.005]. Acute GBS demonstrates diverse clinical, electrophsyiolgical and laboratory dilemma. Clinical and electrophysiological criteria remain the most important prognostic factors. Despite its initial grave presentation, early institution of therapy using intra-venous immunoglobulin [IVIG] or plasma exchange ensures dramatic recovery in most of cases. The underlying etio-pathologic mechanisms are still not properly understood. Their clarification might have its impact on better delineation of clinical presentations, outcome and prevention

Eye changes in cerebral palsy

This study was conducted to evaluate the different eye changes in cerebral palsied [cp] children. It included 70 CP children [45 boys and 25 girls] among those attending the Pediatric Neurology Outpatient Clinic at Alexandria University Children's Hospital with age range from 4 to 96 months. Cerebral palsy was due to perinatal causes in 57.1% of cases while postnatal and prenatal causes accounted for 28.6% and 5.7% respectively. The etiology of CP was unknown in 8.6% of cases. Most of the cases were of the spastic type [62.8%]. Dyskinetic CP accounted for 14.3%; ataxic CP for 14.3% and the mixed type accounted for 8.6%. The majority of cases were profoundly handicapped [55.7%]. Multiply handicapped CP children accounted for 92.9% while those with a single other deficit were 7.1%. Visual problems occurred in 64.3% of cases. These included bilateral cataract in 1.4%, ocular motility disorders in 51.4%, refractive errors in 58.6% and abnormal fundoscopy in 14.3%. Sixteen cases had examination of their visual evoked responses [VERs]. Abnormal VERs occurred in 43.7% of them. Visual problems were significantly higher in CP cases due to perinatal causes [P<0.05]. Also, visual problems were significantly higher among the spastic group [P<0.05]. Thorough ophthalmological assessment should be done as early as possible for all cases at high risk of CP or already having established CP and should be done periodically for early detection and proper management of the associated visual problems to limit their handicap. Visual evoked responses' examination is a valuable diagnostic tool for early detection of cortical visual impairment in CP cases

study of vitamin A blood level in children with lower respiratory tract infections

This work was done to study the serum vitamin A level in infants and children suffering from lower respiratory tract infections. It included 20 cases [12 males, 8 females] with a mean age of 14.5 months. A group of 10 healthy normal children of comparable age and sex served as a control. None of the cases suffered from malnutrition non had parasitic infestation. It was evident that the cases had significantly very low mean serum vitamin A level that may be due to the depressant effect of respiratory infections on the serum vitamin A. both forming a vicious circle. This study showed also that the clinical manifestations of vitamin A deficiency may not be evident inspite of laboratory evidence of hypovitaminosis A. No relation was found between the pattern of feeding and serum vitamin A level

Biochemical study of children with grand mal epilepsy treated with either carbamazepine or valproate sodium

The present study was conducted on 40 children with grand mal epilepsy attending the Pediatric Neurology Clinic of El-Shatby Children's Hospital [Alexandria]. They were divided into two groups Group [A]: those patients receiving valproate sodium as the sole drug therapy and Group [B]: those patients receiving carbamazepine as the sole drug therapy. Twenty patients from each group were investigated at three stages: Before starting treatment, after four weeks of treatment and after control of the attacks. Twenty healthy, age-matched children were studied as controls. Serum and CSF electrolytes,liver transaminases, alkaline phosphatase and lactic dehydrogenase were studied