[Paediatric pseudotumour cerebri]. / Pseudotumor cerebral pediátrico.

INTRODUCTION: Paediatric pseudotumour cerebri or idiopathic intracranial hypertension syndrome is rare in the paediatric age and presents with clinical features that differ from the clinical picture seen in adults. It is not a benign condition in children and, although sometimes used to identify this syndrome, the term 'benign intracranial hypertension' must therefore be avoided. It is characterised by an increase in the intracranial pressure with analytically normal cerebrospinal fluid and the absence of expansive injuries detected by means of neuroimaging. DEVELOPMENT: It is a complex syndrome that causes intense headaches in children with acute loss of vision and, on occasions, optic atrophy. Its treatment has to be tailored to each patient and the use of different pharmacological or neurosurgical treatments must be considered to avoid permanent visual damage. We reviewed the case mix at our Institute over the last 10 years (1995-2005) and found 23 children (between 3 and 15 years of age) who fulfilled Dandy criteria confirming a diagnosis as suffering from paediatric pseudotumour cerebri, with no predominance of sex or associated obesity. CONCLUSIONS: Its treatment must be established on an individualised basis, as well as ongoing and multidisciplinary; fenestration of the optic nerve sheath or the implantation of lumboperitoneal shunts correct refractory syndromes, which in our case accounted for 35% of the total number. The rest were treated with acetazolamide, diet and steroids.

Pseudotumor cerebral pediátrico / Paediatric pseudotumour cerebri

Introducción. El pseudotumor cerebral pediátrico o síndromede hipertensión endocraneal idiopático; es infrecuente en laedad pediátrica y se presenta con características clínicas diferentesal cuadro visto en adultos. No es una condición benigna enniños y por ello debe evitarse el término ‘hipertensión endocranealbenigna’, algunas veces usado para identificar este síndrome, quese caracteriza por un aumento de la presión intracraneal con líquidocefalorraquídeo analíticamente normal y sin lesiones expansivasdetectadas mediante neuroimágenes. Desarrollo. Es un síndromecomplejo, una causa de cefalea intensa en niños, con pérdidavisual aguda y, eventualmente, atrofia óptica; su tratamiento debeser individualizado y las opciones de tratamiento farmacológico oneuroquirúrgico deben contemplarse para evitar daño visual permanente.Revisamos la casuística de nuestro instituto en los últimos10 años (1995-2005), donde encontramos 23 niños (entre los 3y 15 años) que cumplían con los criterios de Dandy para su diagnósticocomo pseudotumor cerebral pediátrico, sin predominio desexo, ni obesidad asociada. Conclusiones. Su tratamiento debe serindividualizado, continuo y multidisciplinario; la fenestración dela vaina del nervio óptico o el implante de derivaciones lumboperitonealescorrigen el síndrome refractario, que en nuestro caso estuvoen el 35%. El porcentaje restante se trató con acetazolamida,dieta y esteroides

Introduction. Paediatric pseudotumour cerebri or idiopathic intracranial hypertension syndrome is rare in thepaediatric age and presents with clinical features that differ from the clinical picture seen in adults. It is not a benign conditionin children and, although sometimes used to identify this syndrome, the term ‘benign intracranial hypertension’ must thereforebe avoided. It is characterised by an increase in the intracranial pressure with analytically normal cerebrospinal fluid and theabsence of expansive injuries detected by means of neuroimaging. Development. It is a complex syndrome that causes intenseheadaches in children with acute loss of vision and, on occasions, optic atrophy. Its treatment has to be tailored to each patientand the use of different pharmacological or neurosurgical treatments must be considered to avoid permanent visual damage.We reviewed the case mix at our Institute over the last 10 years (1995-2005) and found 23 children (between 3 and 15 years ofage) who fulfilled Dandy criteria confirming a diagnosis as suffering from paediatric pseudotumour cerebri, with nopredominance of sex or associated obesity. Conclusions. Its treatment must be established on an individualised basis, as wellas ongoing and multidisciplinary; fenestration of the optic nerve sheath or the implantation of lumboperitoneal shunts correctrefractory syndromes, which in our case accounted for 35% of the total number. The rest were treated with acetazolamide, dietand steroids

[Attention deficit hyperactivity disorder and sleep disorders]. / Trastorno por déficit de atención ehiperactividad y trastornos del sueño.

INTRODUCTION: The purpose of the present review was to analyse the comorbidity that exists between attention deficit hyperactivity disorder (ADHD) and sleep disorders in children and adolescents, together with their clinical characteristics, diagnosis and treatment regimens. DEVELOPMENT: ADHD and sleep disorders are a frequent cause of visits in neuropaediatric departments. Around 25% of children with ADHD have some kind of sleep disorder but, unlike the case of adults, these often remain undetected. We nearly always choose to improve hyperactivity, attention deficit and impulsiveness symptomatically and forget to treat the associated sleep disorder. CONCLUSIONS: There is a clear correlation between ADHD and sleep disorders and they are very common in visits to the neuropaediatric department. Diagnosis of these patients is clinical. Neurophysiological evaluation, especially using polysomnography, provides objective confirmation of the symptoms. Novel treatments such as melatonin and other drugs are now available to improve the sleep pattern. By improving these children's sleep, the symptoms of ADHD are diminished and thus avoid the need to administer psychostimulants, which have undesirable side effects that produce a great deal of anxiety in the parents of these children.

Trastorno por déficit de atención e hiperactividad y trastornos del sueño / Attention deficit hyperactivity disorder and sleep disorders

Objetivo. Analizar la comorbilidad existente entre el trastornopor déficit de atención e hiperactividad (TDAH) y los trastornosdel sueño en niños y adolescentes; sus características clínicas,diagnóstico y pautas de tratamiento. Desarrollo. El TDAH ylos trastornos del sueño son una causa frecuente de consulta enneuropediatría. Aproximadamente el 25% de niños con TDAH presentanalgún trastorno del sueño, pero, a diferencia de los adultos,muchas veces pasan desapercibidos. Casi siempre optamos pormejorar sintomáticamente la hiperactividad, el déficit de atencióny la impulsividad, y nos olvidamos de tratar el trastorno del sueñoasociado. Conclusiones. El TDAH y los trastornos del sueño tienenuna alta correlación y son muy frecuentes en una consulta de neuropediatría.El diagnóstico de estos pacientes es clínico. La evaluaciónneurofisiológica, especialmente la polisomnografía, corroboraobjetivamente los síntomas. Existen tratamientos novedososcomo la melatonina y otros fármacos que mejoran el patrón hípnico.Al mejorar el sueño de estos niños disminuyen los síntomas delTDAH y se evita la administración de psicoestimulantes cuyos efectossecundarios indeseables generan gran ansiedad en los padresde estos niños

Introduction. The purpose of the present review was to analyse the comorbidity that exists between attention deficithyperactivity disorder (ADHD) and sleep disorders in children and adolescents, together with their clinical characteristics,diagnosis and treatment regimens. Development. ADHD and sleep disorders are a frequent cause of visits in neuropaediatricdepartments. Around 25% of children with ADHD have some kind of sleep disorder but, unlike the case of adults, these oftenremain undetected. We nearly always choose to improve hyperactivity, attention deficit and impulsiveness symptomaticallyand forget to treat the associated sleep disorder. Conclusions. There is a clear correlation between ADHD and sleep disorders andthey are very common in visits to the neuropaediatric department. Diagnosis of these patients is clinical. Neurophysiologicalevaluation, especially using polysomnography, provides objective confirmation of the symptoms. Novel treatments such asmelatonin and other drugs are now available to improve the sleep pattern. By improving these children’s sleep, the symptomsof ADHD are diminished and thus avoid the need to administer psychostimulants, which have undesirable side effects thatproduce a great deal of anxiety in the parents of these children