ABSTRACT
Pediatric obstructive sleep apnea (OSA) represents a different entity from its adult counterpart and therefore requires a different therapeutic approach. Adenotonsillectomy (AT) is the primary treatment of pediatric OSA, and evidence shows it is very effective. However, there is a growing understanding that residual OSA is common, and next steps for patients who fail primary AT are less certain. This article reviews current methods of evaluating and treating these complex patients.
Subject(s)
Sleep Apnea, Obstructive , Tonsillectomy , Adenoidectomy/methods , Child , Humans , Polysomnography/methods , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/surgery , Tonsillectomy/adverse effects , Tonsillectomy/methodsABSTRACT
BACKGROUND: Insomnia is one of the most common nonmotor features of Parkinson's disease (PD). However, there are few practical guidelines for providers on how to best evaluate and treat this problem. METHODS AND FINDINGS: This review was developed to provide clinicians with a pragmatic approach to assessing and managing insomnia in PD. Recommendations were based on literature review and expert opinion. We addressed the following topics in this review: prevalence of insomnia in PD, sleep-wake mechanisms, theoretical models of insomnia, risk factors, assessment, pharmacologic and nonpharmacologic treatments. Insomnia treatment choices may be guided by PD severity, comorbidities, and patient preference. However, there is limited evidence supporting pharmacotherapy and nonpharmacologic treatments of insomnia in PD. CONCLUSIONS: We provide a pragmatic algorithm for evaluating and treating insomnia in PD based on the literature and our clinical experience. We propose personalized insomnia treatment approaches based on age and other issues. Gaps in the existing literature and future directions in the treatment of insomnia in PD are also highlighted.
Subject(s)
Disease Management , Sleep Wake Disorders/diagnosis , Sleep Wake Disorders/epidemiology , Age Factors , Child , Child, Preschool , Female , Humans , Incidence , Male , Narcolepsy/diagnosis , Narcolepsy/epidemiology , Narcolepsy/therapy , Nocturnal Myoclonus Syndrome/diagnosis , Nocturnal Myoclonus Syndrome/epidemiology , Nocturnal Myoclonus Syndrome/therapy , Parasomnias/diagnosis , Parasomnias/epidemiology , Parasomnias/therapy , Prognosis , Risk Assessment , Severity of Illness Index , Sex Factors , Sleep Wake Disorders/therapyABSTRACT
Primary vertebral Ewing sarcoma-primitive neuroectodermal tumor is uncommon. Although epidural extension has been seen in such tumors, cases with massive intraspinal involvement are decidedly rare. Here we present the case of a 4-year-old girl with back pain and difficulty walking. Magnetic resonance imaging showed a mass filling the spinal canal from T(11) to the L(3)/L(4) levels. Vertebral involvement with extension into the paraspinal soft tissue through neural foramina was seen. Histologically, a small-blue-cell tumor with strong membranous CD99 reactivity was noted. Molecular analysis revealed translocation t(11;22)(q24;q12), thus confirming the diagnosis of Ewing sarcoma-primitive neuroectodermal tumor. Our case emphasizes that vertebral Ewing sarcoma-primitive neuroectodermal tumor may present with massive intraspinal extension and should be included in the differential diagnosis of intraspinal lesions.
