Overturned abusive head trauma and shaken baby syndrome convictions in the United States: Prevalence, legal basis, and medical evidence.

BACKGROUND: Media reports and the Innocence Network assert that wrongful Abusive Head Trauma (AHT)/Shaken Baby Syndrome (SBS) convictions pervade the United States (U.S.) criminal justice system. Yet, no empirical evaluation of overturned AHT/SBS convictions has been conducted. OBJECTIVE: To evaluate the prevalence, legal basis, and characteristics of appellate rulings of AHT/SBS convictions. PARTICIPANTS AND SETTING: U.S. appellate cases in a legal database, Westlaw. METHODS: Retrospective review of AHT/SBS convictions that had appellate rulings from January 2008 through December 2018. Multiple search terms ensured all potential AHT/SBS cases were included. A mixed-methods analysis was conducted on overturned AHT/SBS convictions. RESULTS: We identified a total of 1431 unique AHT/SBS criminal convictions that had appellate rulings since 2008. Of those, 49 convictions (3%) were overturned, and 1382 (97%) were affirmed/upheld. Of those overturned, 20 cases (1% overall) were overturned on medical evidence-related grounds. The most common themes from the medical evidence-related reversals were controversy over the AHT/SBS diagnosis (n = 12) and accidental injury mechanism (n = 11). After being overturned on appeal, upon retrial, 42% of defendants either re-plead guilty to or were convicted again of the same offense. CONCLUSION(S): AHT/SBS convictions are rarely overturned on medical evidence-related grounds. When overturned, medical evidence-related themes seldom reflect new scientific or clinical discoveries, but rather are alternative or differing medical opinions from those offered at the original trial. Our data tends to support the concerns of other authors regarding irresponsible communication of medical information in AHT/SBS cases.

Trigeminal nerve stimulation: short latency somatosensory evoked potentials.

We have devised a technique to measure trigeminal somatosensory evoked potentials, stimulating the mentalis nerve at the mandibular foramen and recording the evoked early potential on the scalp at 3.2 msec. The early potential was easily recognized in all normal subjects and on the asymptomatic side of patients with facial pain. The latency of the early potential in normals was 1 to 2 msec less than half the latency of the mechanically induced jaw jerk. The early potential appeared simultaneously on both sides after stimulation of either the right or left mentalis nerve and may have its origin in deep brainstem structures, the Gasserian ganglion, or the trigeminal nerve. The technique is useful in documenting the functional integrity of peripheral and central afferent pathways of the trigeminal nerve.

Juvenile muscular atrophy localized to arms.

Twenty-four patients from India, had juvenile muscular atrophy localized to the upper extremities. The condition characteristically affects young men and is not familial. Atrophy is limited to the hand and forearm muscles, with slow progression for two to three years after which it seems to be stationary. The condition is associated with "tremor-like" movements out of proportion to the weakness. Examination of muscle biopsy specimens shows group 2 fiber atrophy. This syndrome, for which no cause has been described, is benign and self-limiting, unlike most motor neuron diseases, and is distal in upper extremities, unlike Kugelberg-Welander disease. Asymmetrical muscle wasting and preceding febrile illness in some patients suggests an atypical poliomyelitis-like viral disease.

Juvenile parkinsonism treated with levodopa.

We describe three patients with early onset of parkinsonism. Two of these were sisters and showed a reduction in homovanillic acid (HVA), 5-hydroxytryptamine (5-HT), and 5-hydroxyindole acetic acid (5-HIAA) levels in the CSF. In the third patient, parkinsonism developed, which was probably related to chickenpox encephalitis. All three patients responed favorably to levodopa therapy.