The etiology and outcome of cerebrovascular diseases in Northeastern Thai children.

OBJECTIVE: To review the etiology and outcome of cerebrovascular diseases among children in Northeastern Thailand. STUDY DESIGN: Retrospective, descriptive study. SETTING: Srinagarind Hospital, Khon Kaen, Thailand. MATERIAL AND METHOD: The authors studied 109 pediatric patients admitted between April 1995 and 2006. RESULTS: The mean age was 11.6 years and the male-to-female ratio was 1.06:1. The ages at onset ranged from 6 months to 15 years, while the most commonly affected age group were children between 10 and 15 years. The authors identified 74 hemorrhagic strokes (65%) and 35 ischemic strokes (31%). The most common etiologic factor in hemorrhagic and ischemic strokes was arteriovenous malformations and cardiac diseases respectively. The five most common presenting symptoms were headache, alteration of consciousness, hemiparesis, vomiting, and seizures. The mortality rate was 22%. CONCLUSION: Knowledge of the etiologies and outcomes of cerebrovascular disease in children should improve diagnosis and management.

Treatment of infantile spasms with sodium valproate followed by benzodiazepines.

OBJECTIVE: To review the result of the infantile spasms' treatment with sodium valproate followed by nitrazepam or clonazepam. STUDY DESIGN: Descriptive retrospective study. SETTING: Srinagarind Hospital, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. MATERIAL AND METHOD: Twenty-four infantile spasms admitted between January 1994 and December 2003 were analyzed. The inclusion criteria were the patients with infantile spasms clinically diagnosed by the pediatric neurologist, having hypsarrhythmic pattern EEG, and receiving sodium valproate with or without nitrazepam or clonazepam. The patients who had an uncertain diagnosis, incomplete medical record, or that were incompletely followed up were excluded. Data were collected on sex, age at onset of seizure, type of infantile spasms, associated type of seizure, predisposing etiological factor, neuroimaging study, and the result of treatment including cessation of spasms, subsequent development of other seizure types, quantitative reduction of spasms, relapse rates of spasms, psychomotor development, and adverse effects of AEDs. RESULTS: The mean age at onset was 177 days. The male-to-female ratio was 1:1.2. There were 13 cryptogenic (54.2%) and 11 symptomatic (45.8%) infantile spasms. The most common predisposing etiological factors in symptomatic cases were hypoxic ischemic encephalopathy (45.5%) and microcephaly (36.4%), respectively. Ten patients received sodium valproate (41.7%), another 10 received sodium valproate with clonazepam (41.7%), and four received sodium valproate with nitrazepam (16.7%). Both, the complete cessation rate and the 50% reduction of spasms rate were 45.8%. The duration to complete cessation was 70 days. The relapse rate was 18.2%. The rate of delayed psychomotor development was 83.3%. The mean duration of follow-up was 49.6 months. CONCLUSION: The authors propose to use sodium valproate concomitantly with benzodiazepines, especially clonazepam, in situations such as unavailability, intolerability, or adverse effects of ACTH or vigabatrin, or in a patient who does not respond to ACTH or vigabatrin.

Brain abscess in infants and children: a retrospective study of 107 patients in northeast Thailand.

OBJECTIVE: To review the clinical manifestation, predisposing factor location of abscess, causative organism, treatment, and outcome of brain abscess. STUDY DESIGN: Descriptive retrospective study. SETTING: Srinagarind Hospital, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen. MATERIAL AND METHOD: One hundred and seven infants and children with brain abscess that admitted between 1985 and 2005 are analyzed retrospectively. RESULTS: The mean age was 8.4 years. The male-to-female ratio was 1.3:1. The most common predisposing factor was congenital heart disease. The most common organisms in congenital heart disease, chronic otitis media, and unknown source were Streptococci, Proteus, and Staphylococcus aureus respectively. Two very rare cases of Citrobacter freundii brain abscesses were reported. Only 9.4% had classic triad signs and symptoms of brain abscess. The overall mortality rate was 10.7%. CONCLUSION: The clinical features and outcomes of treatments of 107 infants and children with brain abscesses were reviewed. Congenital heart diseases and chronic otitis media were the most common predisposing factors. The common signs and symptoms were fever, headache, vomiting, alteration of consciousness, and focal neurologic deficit. The overall mortality rate was 10.7%.

Ocular myasthenia gravis and auto-immune thyroiditis in children.

A 7-year-old girl presented at a university hospital with ptosis of the left eye. This resolved spontaneously within 4 weeks but then the right eye became similarly affected but responded to prostigmine. Left hypertropia with restriction of the right inferior rectus, mild exophthalmos, non-tender diffuse enlargement of the thyroid, normal thyroid function tests, anti-thyroglobulin, and anti-microsomal antibodies indicated an association of autoimmune thyroiditis and ocular myasthenia. The ptosis was remedied with pyridostigmine and short-course oral prednisolone, but the hypertropia persisted.

Incidence of febrile seizures in thalassemic patients.

BACKGROUND: Febrile seizures are the most common seizures in children. Their incidence is 2-5% or 4.8/1000 person-years. To date, the pathophysiology of febrile seizures is unknown. But several hypotheses have been proposed that it may relate with plasma iron level. Such low incidence in thalassemic patients whose plasma iron level is high could give some clues to this hypothesis. PATIENTS AND METHOD: Four hundred and thirty thalassemic patients from the hematology clinic at two hospitals in Northeastern Thailand were consecutively enrolled between Febuary 2003 and January 2004. The authors reviewed all the medical records of the patients and interviewed their parents for occurrence of febrile seizures. RESULTS: The patients included 208 males and 222 females with an age ranged of 6 months to 10 years (mean = 6.36 years). Twenty patients (4.7%) had siblings who had febrile seizures. There were 3 episodes out of 2,734 person-years. The incidence was 1.10 per 1,000 person-years (95% CI: 0.23 to 3.20). This was statistically lower than that of the general population (p-value = 0.002). Therefore, the rate in thalassemic patients was 4.4 times less than that of the general population (95% confidence interval: 1.4 to 22.6). CONCLUSIONS: The incidence of febrile seizures in thalassemic patients was very low compared to that of the general children population. Thus, iron overload may be a major factor involving the brain metabolism that prevents febrile seizures.

A controlled trial of a new treatment for galactocele.

BACKGROUND: Needle aspiration, followed by excision should it recur, is the standard method of treating galactocele. Villagers in Northeast Thailand traditionally treat galactocele by probing the obstructed duct with double strands of pleated human hair. The aim of the study was to mimic this method in order to scientifically assess its effectiveness. PATIENTS AND METHOD: Sixteen patients were consecutively enrolled between 1995 and 2001. They elected either standard needle aspiration (Group A) or treatment by 6-0 nylon probing (Group B). The results were compared using the Fisher's exact and Mann-Whitney tests at p-value < 0.05. RESULTS: The two groups were similar regarding the children's age, first para, mass size, and duration of symptoms, but patients in the aspiration group were considerably younger than the nylon probing group. Both methods reduced the symptoms completely. Pain from treatment was reported by all patients in the aspiration method while there were none in the nylon probing method (p < 0.001). The aspiration method took 14.8 minutes less time than the nylon probing method (p < 0.001). Recurrence was found in 2 out of 5 patients in the aspiration method, whereas there was none in the 11 patients with the nylon probing method (difference = 40%; 95% CI: -3% to 83%; p = 0.083). CONCLUSIONS: The new treatment of galactocele by nylon probing took longer than aspiration but removed the protein plug that caused obstruction of the duct without pain and had a tendency to reduce the recurrence rate.