Efficacy of Nutritional Therapy in Children with Crohn Disease / 대한소아소화기영양학회지

PURPOSE: Crohn disease (CD) in children is frequently complicated by malnutrition and growth retardation. Conventional treatment with corticosteroid may also affect the growth of children, which may be alleviated by nutritional therapy. Therefore, we performed this study to evaluate the role of nutritional therapy in the treatment of CD in children. METHODS: The study cohort consisted of thirty children under the age of 17 years, admitted to the Asan Medical Center from 2001 to 2005. While 11 children received nutritional therapy (NT) with an elemental diet, 19 received conventional corticosteroid therapy (ST). Comparative analysis was performed for the rate of the induction of remission, recurrence, disease activity index of pre and post-treatment, and changes of the growth using mean standard deviation score for weight (zW) and height (zH). RESULTS: Ten of 11 children with NT and 18 of 19 children with ST completed the therapy. Two of them were lost to follow-up during the treatment. All 10 children with NT and 15 of 18 children with ST achieved remission. While there was no recurrence in children with NT, 7 with ST showed recurrence within 1 year. Pre- and post treatment Pediatric Crohn disease Activity Index (PCDAI) did not show a difference between the two groups. There were no differences in zW and zH between the two groups after 1 year of follow-up. CONCLUSION: This study showed that nutritional therapy could be considered instead of steroid therapy for treatment of children with CD. However, a long-term study will be needed to determine the long-term efficacy.

Clinical Indications and Efficacies of Video-Electroencephalographic Monitoring in the Diagnosis and Treatment of Childhood Epilepsy / 대한간질학회지

PURPOSE: The routine electroencephalography is a pivotal diagnostic study in the evaluation of patients with seizure disorders, but often proves incomplete. Video-Electroencephalographic Monitoring (VEM) is an important diagnostic innovation for intractable epilepsy. We performed this study to evaluate clinical indications and efficacies of VEM in childhood epilepsy. METHODS: The study group consisted of 231 children under the age of 15 year, admitted to the Asan Medical Center for VEM from November 1995 to February 2005. We classified the group on the basis of reasons for admission and did analyze the EEG, the change of diagnosis, treatment modality, and seizure control. RESULTS: Eighty seven (38%) patients underwent VEM for the exact classification of seizure types in patients who have epilepsy (Group I), 95 (41%) for presurgical evaluation (Group II) and 49 (21%) to confirm the diagnosis of a seizure disorder (Group III). The diagnosis was altered after VEM in 111 (48%) cases. The treatment modality was altered after VEM in 161 (70%) patients. In Group I, 53 (61%) had a changed treatment plan, 32 of whom had changes in antiepileptic drug and 7 underwent ketogenic diet. In Group II the treatment modality was changed in 82 (86%) cases, 68 of whom had done epileptic surgery and 6 had done VNS. In Group III, 26 (53%) changed the treatment modality. After VEM study, eventually 149 (65%) patients received changed modality of treatment and 91 (61%) patients of them showed improvement in the seizure control. CONCLUSIONS: VEM showed a high yield in changing diagnosis and management of childhood epilepsy in our study, and we confirmed it is effectively used in the treatment of the intractable childhood epilepsy.

Clinical Factors affecting Quality of Life in Children with Epilepsy

PURPOSE:Despite the worldwide interests in the quality of life issues in children with epilepsy, only few studies have been conducted in Korea yet. This study is aimed to analyze clinical factors related with the issues of life in children with epilepsy. METHODS:A total of 158 children(79 patients/79 control) were involved in the study from the Department of Pediatrics at Asan Medical Center and 79 normal children who completed the Korean Child Behavior Checklist(K-CBCL). We used the Korean version of the Quality of Life in Childhood Epilepsy Questionnaire(K-QOLCE) to evaluate the quality of life. The differences of the quality of life between the patients and the controls were compared and the influencing factors were evaluated. RESULTS:The scores of physical functions, well-being, cognition, social functions, behaviors, general health, and quality of life were lower in the patients than in the controls. We found higher scores of quality of life in the patients with epilepsy who were younger when diagnosed, had shorter disease period, took fewer drugs, and took drugs for a shorter time(P<0.05). Higher scores of physical restriction(P=0.017), self-esteem(P=0.006), cognition(P=0.02), and behaviors(P=0.019) were noted for the patients with partial seizures, compared to those with generalized seizures. CONCLUSION:We found that the quality of life in the pediatric epilepsy patients was lower than that of normal children and various factors associated with the treatment of epilepsy influenced the quality of life. The information obtained from this study will help us offer better epilepsy management.

A Case of Renal Osteodystrophy with Severe Bone Deformity

With the advent of hemodialysis, the success of renal transplants in the 1960s and the wide use of continuous ambulatory peritoneal dialysis at the end of the 1970s, children with renal failure now enjoy an extended life span. As a result, several children experience renal osteodystrophy and growth retardation. Renal osteodystrophy is induced by phosphorus retention, hypocalcemia, low vitamin D levels and hyperparathyroidism. The pharmacologic interventions are used to prevent bone deformities and to normalize growth velocity. But surgical intervention is required sometimes when osteodystrophy is severe and poorly controlled. We report an eight-year-old boy with chronic renal failure who developed severe bone deformities and needed osteotomy.