[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

[The effectiveness and tolerance of piribedil as adjunct therapy to levodopa in patients with Parkinson's disease: a nine month follow up]. / Eficacia y tolerancia del piribedil como terapia adjunta a la levodopa en pacientes con enfermedad de Parkinson: seguimiento de nueve meses.

INTRODUCTION: Piribedil is a D2 D3 dopamine agonist, which has been shown to be well tolerated and to improve Parkinsonian symptoms, particularly tremor. However, few studies have been published about this Dopamine Agonist as an adjunct to levodopa therapy in patients with Parkinson's disease (PD). This placebo controlled, parallel group study was undertaken to investigate the effects of piribedil in PD patients insufficiently controlled with levodopa in a nine months follow up. PATIENTS AND METHODS: We included 62 PD patients insufficiently controlled with levodopa and needed an increase in dopamine stimulation. Patients were randomized in two similar groups, one of them taking Piribedil and levodopa and the other group taking a placebo and levodopa. The primary efficacy measures were the items II and III of the UPDRS. The patients were evaluated prior to the start of therapy, and 3, 6 and 9 months after the start of the study. RESULTS: Patients taking Piribedil showed an average of improvement of 37,8% (p < 0.01) in the part II and 63,2% (p < 0.01) in the part III of the UPDRS at the end of the study. At 9 month evaluation, tremor at rest showed an average improvement of 68,6%, rigidity, fingers taps and legs agility improved substantially in their respective items of the UPDRS at the end of the study. CONCLUSIONS: We concluded that PD patients with functional worsening while on stable levodopa doses exhibit a steady improvement of the UPDRS part II and III with the adjunction of Piribedil 150 mg mean daily dose for 9 months.

[Autoimmune neuropsychiatric disorders associated to infection by streptococcus in the paediatric age: PANDAS]. / Trastornos neuropsiquiátricos autoinmunes asociados a la infección estreptocócica en la edad pediátrica: PANDAS.

INTRODUCTION: The acronym PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus) describes the neuropsychiatric disorders resulting from an autoimmune response to an infection by streptococcus in children. AIMS: The aim of this study was to clinically analyse 38 patients under the age of 16 with tics, Tourette syndrome (TS) or obsessive compulsive disorder (OCD) and their possible association to an infection caused by group A beta-haemolytic streptococcus (GABHS). METHOD: We reviewed the medical records at the Instituto Neurológico in Valencia (Venezuela) over a 12 year period (1988-2000). All the patients met the inclusion criteria set out by the National Institute of Mental Health in Bethesda (1997) and the DSM-IV. RESULTS: Onset of the symptoms was higher in the group of schoolchildren (n=24), followed by the group of preschool children (n=8) and adolescents (n=6). Males were predominant (n=33) (86.8%). 17 patients presented chronic tics (44.7%), 13 had transitory tics (34.2%) and there were eight cases of TS (21.1%). The most frequently related comorbid disorders were: difficulties in learning (n=30) (78.9%), ADHD (n=27) (71.1%), OCD 14 (36.8%), sleep disorders (n=14) (36.8%), behavioural disorders (n=12) (31.6%), language disorders (n=11) (28.9%), psychomotor disorders (n=10) (26.3%) and nocturnal enuresis (n=7) (18.4%). Electroencephalogram patterns were abnormal in 72.4% (n=12), and the disorganised pattern was the most frequently observed (n=12) (41.4%), followed by a slow diffuse pattern (n= 7) (24.1%) and the left centro-parieto-temporal focal paroxysmal specific pattern (n=7) (24.1%). Less frequently we found unspecific generalised paroxysmal patterns, in four cases (13.8%), and asymmetrical patterns (n=1) (3.4%). The association with an infection by streptococcus was shown in two cases, which amounted to 5.2% of the sample. CONCLUSIONS: The obtained are similar to those reported in the literature. Only 5.2% of the cases were linked to a prior streptococcus infection.

[Indications for neuroendoscopy]. / Indicaciones de la neuroendoscopia.

INTRODUCTION: In order to reduce intracerebral trauma in the diagnosis and treatment of intracranial lesions in children, neuroendoscopy is an important tool in current neurosurgery. Using this minimally invasive technique intraventricular objectives may be approached with little damage caused to adjacent structures. OBJECTIVES: There are two aspects to current indications for neuroendoscopy. Firstly, diagnosis is achieved by taking intraventricular biopsies of cystic lesions and tumours and for anatominical vigilance in microsurgical operations. Secondly, there is the therapeutic aspect, especially in operations to restore the circulation of cerebrospinal fluid (CSF), correct complex hydrocephaly, insert or remove intraventricular shunts, aspiration of cysts or haematomas, fenestration of cysts, resection of tumours within or near the ventricles. DEVELOPMENT: At the present time in neurosurgical paediatric management, neuroendoscopy is a tool used daily in common lesions such as hydrocephaly and the identification of intraventricular lesions. It may be safely used as a primary method of approach to the lesions or as a complement to open or guided surgery to the patient s advantage. We therefore reviewed the literature in the light of our own experience in neuroendoscopy since 1996. CONCLUSIONS: The formal indications for neuroendoscopy are greater in paediatric neurosurgery. In fact, the management of the CSF circulation, and disorders associated with this, together with the identification of tumours using minimally invasive methods, make this technique directly useful for solving these problems. This is most obvious in lesions such as multiseptate complex hydrocephaly, and intraventricular tumours and cysts where it is the first surgical option. In the short term, thanks to improvements in neuro navigation and frameless stereotaxis, its use will be wider and more precise

[Neuroendoscopy: diagnosis and therapeutic uses]. / Neuroendoscopia: utilidad diagnóstica y terapéutica.

Minimally invasive neurosurgical techniques permit improved ways of approaching problems which could previously only be solved by open surgery or microsurgery. In this field, neuroendoscopy offers a very efficient, clear means of diagnosis and a less aggressive form of treatment of lesions on the central nervous system. Particularly in paediatric neurosurgery, procedures such as implanting valves for ventriculo-peritonial derivations (DVP) may be carried out knowing the exacts anatomical site of the catheter tip, or allowing catheters adherent to structures such as the choroid to be removed. Ventriculoscopy permits review and biopsy of intraventricular and paraventricular structures. Myeloscopy allows intramedullary and paramedullary visualization together with the possibility of syringoscopy. The new option presented by neuroendoscopy, as a help in microneurosurgery, when studying structures which are not visible using a microscope, is particularly useful in vascular surgery and in surgery of the base of the skull. It also permits rapid, efficient drainage of subdural and intraventricular haematomas. This technique has become a useful tool in neurosurgical departments for solving problems and as a support for the classical techniques. Equally it requires practice and the study of neuroendoscopic anatomy.