Prevalence of Sleep Disorders in Children with Cerebral Palsy; A Questionnaire-based Observational Study.

Background: Cerebral palsy (CP), the most common developmental disorder, has many comorbidities (epilepsy and behavioral issues). Sleep disturbances are common complaints of parents and are usually neglected in pediatric populations in comparison to other well-documented co-morbidities of CP but may have a significant effect on the quality of life of children and their parents. Objective: To study the prevalence and pattern of sleep disorders (SD) in children with CP. Study Design: Questionnaire-based observational study. Setting: Pediatric tertiary care center. The study was done over 6 months. Participants: In total, 200 children with CP between the ages of 1 year to 14 years were included in the study by convenience sampling. Co-morbid health problems involving cardiorespiratory system, other illness (e.g. epilepsy and gastroesophageal reflux disease), or children on anticonvulsant medications altering sleep patterns were excluded. Intervention: The Sleep Disturbance Scale for Children (SDSC) was administered to assess the presence of pathological sleep and type of SD ranging between Disorders of Initiation and Maintenance of Sleep (DIMS), Sleep Breathing disorders (SBD), Disorders of Arousal (DA), Sleep-Wake Transition Disorders (SWTD), Disorders of Excessive Somnolence (DES), and Sleep Hyperhydrosis (SHY). Main Outcome Measures: Sixty-two percentage of children (124) had a pathological total sleep score (score >39). Results: DIMS are the most common, occurring in 78.2% of subjects with a pathological sleep score (score >39). Quadriplegics [n = 96, mean score = 49.86(16.38)] and GMFCS V [n = 19, mean score = 58.00(17.10)] are most severely affected. Conclusion and Discussion: Children with CP have under-reported SD and DIMS is the most common type of SD. There is a linear correlation between the extent of topographical and motor afflictions and SD.

Duration of Pupillary Unresponsiveness to Light: A Physiological Adjunct to Electroencephalography and Motor Seizure Duration Monitoring During Electroconvulsive Therapy.

BACKGROUND: During electroconvulsive therapy (ECT) sessions, we observed that the time taken for the return of pupillary response to light (ROPL) outlasted both the electroencephalography (EEG) and the motor seizure duration after the delivery of the electrical stimulus to produce convulsions. OBJECTIVE: The objective of this study was to investigate whether ROPL can be used as a marker of cessation of seizure activity in the brain after ECT and also to study the effect of atropine premedication on seizure activity during ECT. METHODS: Forty-one patients underwent 82 sessions of ECT in a cross-over design study. The duration of motor seizure, EEG seizure, and time for ROPL was observed and compared. RESULTS: The ROPL consistently outlasted EEG and motor seizures; the difference in their mean durations was statistically significant P < 0.05. There was good correlation among the 3 parameters. Atropine premedication did not alter the seizure activity and ROPL after ECT. CONCLUSIONS: The ROPL after ECT stimulus is a good bedside monitor for termination of seizure activity and can be a valuable adjunct to surface EEG in monitoring the duration of epileptic activity after delivery of ECT.

Cerebral Oxygen Saturation During Electroconvulsive Therapy: A Secondary Analysis of a Randomized Crossover Trial.

BACKGROUND: Electroconvulsive therapy (ECT) causes acute changes in cerebral perfusion and oxygenation. Near-infrared spectroscopy is a novel, noninvasive technique to assess cerebral oxygen saturation (cSO2). We hypothesized that cSO2 increases during ECT and more so with atropine premedication and decreases when systemic desaturation (peripheral oxygen saturation <90%) occurs during ECT. METHODS: We performed a secondary analysis of a randomized trial of patients undergoing ECT for psychiatric illness during a 6-month period. During the second ECT session, patients were randomly assigned to receive either 0.01 mg/kg IV atropine or no atropine. During the third ECT session, patients were crossed over. Standard anesthetic management was performed. Data with regard to heart rate, blood pressure, peripheral oxygen saturation, and cSO2 were collected at baseline and continuously examined for 5 minutes from delivery of ECT stimulus. RESULTS: Forty-one patients underwent 82 ECT sessions. ECT resulted in significant increase in cSO2 during both the atropine and the no-atropine sessions (P<0.001 for both) but no between-session difference was observed (mean difference, 1.9±2.0; 95% confidence interval, -2.0, 5.9; P=0.337). The cSO2 values were lower in patients who developed systemic desaturation when compared with the cSO2 values in those who did not (mean difference, 5.0±2.6; 95% confidence interval -0.1, 10.2; P=0.054). However, the mean cSO2 was >60% at any measured time point, even in those with systemic desaturation. CONCLUSIONS: ECT increased cSO2 irrespective of atropine premedication. cSO2 was lower when systemic desaturation occurred. Future studies should explore the effect of cerebral oxygenation changes during ECT on outcome of psychiatric conditions.

Effect of Atropine Premedication on Cardiac Autonomic Function During Electroconvulsive Therapy: A Randomized Crossover Study.

OBJECTIVES: Electroconvulsive therapy (ECT) results in significant cardiovascular changes. The acute cardiac autonomic changes during ECT remain unexplored. The primary objective of this study was to compare autonomic dysfunction with and without atropine premedication during ECT and secondarily to evaluate dysautonomia across psychiatric diagnoses before and after ECT. METHODS: In this crossover study, 41 psychiatric patients were monitored during 82 ECT sessions. Patients were randomized either to receive atropine or not to receive atropine during their second ECT session and were crossed over during their third session. Heart rate, blood pressure, and oxygen saturation were continuously monitored from stimulus application until 300 seconds after ECT. Demographic characteristics and ANSiscope indices derived pre- and post-ECT were collected. RESULTS: Autonomic dysfunction (%) before ECT was similar between atropine and no-atropine sessions (32.4 ± 15.7 vs 32.8 ± 16.7; 95% confidence interval, -7.6 to 6.7; P = 0.90) but increased significantly after ECT to 60.9 ± 16.3 and to 47.0 ± 17.3, respectively, and this difference was significant (95% confidence interval, 6.5-21.3; P < 0.001). There was no difference in the autonomic function across psychiatric diagnoses both before (P = 0.07) and after ECT (P = 0.12). CONCLUSIONS: Cardiac autonomic dysfunction worsens after ECT in patients with psychiatric illnesses and to a significantly greater extent with atropine premedication. The degree of dysautonomia is similar across various psychiatric diagnoses both before and after ECT. Atropine premedication during ECT should be restricted to select patients susceptible to bradyarrhythmia and could be avoided in others.

Comparative study of fiberoptic guided versus intubating laryngeal mask airway assisted awake orotracheal intubation in patients with unstable cervical spine.

BACKGROUND: A safe airway technique minimizes intubation-associated cervical-spine movement and consequent neurological injury in patients with unstable cervical spine (UCS). Awake fiberoptic-guided intubation (FGI) is preferred in patients with UCS. Alternatively, intubating laryngeal mask airway assisted intubation (ILMA-AI) can be performed both during elective and emergency, requires less expertise and is cost-effective. This study evaluated cervical-spine movement during FGI and ILMA-AI in patients with UCS. METHODS: This was a parallel-group randomized controlled trial performed at a tertiary neurosciences hospital. Thirty-two patients with UCS scheduled for corrective surgery were allocated equally to receive FGI or ILMA-AI according to centralized computer-generated randomization. Primary outcome measure was cervical-spine movement as assessed using fluoroscopy at C1/2 level during intubation. Secondary outcomes were movement at C2/3 and new-onset motor deficit after intubation. RESULTS: All the sixteen patients in each group were successfully intubated and their data was analyzed. No significant difference in angles (indicating cervical spine movement) was observed at both C1/2 and C2/3 levels between FGI and ILMA-AI groups at various time points studied (P>0.05). No new-onset motor deficit was observed after intubation in both groups. One patient in FGI group developed desaturation during intubation while four patients in ILMA-AI group developed postoperative sore-throat. CONCLUSIONS: Similar degree of angulations was observed at various time-points during awake FGI and awake ILMA-AI at C1/2 and C2/3 spinal levels in patients with UCS. No patient developed new-onset motor deficits. ILMA can serve as a suitable alternative to fiberoptic-scope for awake intubation in cervical-spine instability.