Features of Primary Chronic Headache in Children and Adolescents and Validity of Ichd 3 Criteria.

Introduction: Chronic headaches are not a rare condition in children and adolescents with negative effects on their quality of life. Our aims were to investigate the clinical features of chronic headache and usefulness of the International Classification of Headache Disorders 3rd edition (ICHD 3) criteria for the diagnosis in a cohort of pediatric patients. Methods: We retrospectively reviewed the charts of patients attending the Headache Center of Bambino Gesù Children and Insubria University Hospital during the 2010-2016 time interval. Statistical analysis was conducted to study possible correlations between: (a) chronic primary headache (CPH) and demographic data (age and sex), (b) CPH and headache qualitative features, (c) CPH and risk of medication overuse headache (MOH), and (d) CPH and response to prophylactic therapies. Moreover, we compared the diagnosis obtained by ICHD 3 vs. ICHD 2 criteria Results: We included 377 patients with CPH (66.4% females, 33.6% males, under 18 years of age). CPH was less frequent under 6 years of age (0.8%; p < 0.05) and there was no correlation between age/sex and different CPH types. The risk to develop MOH was higher after 15 years of age (p < 0.05). When we compared the diagnosis obtained by ICHD 2 and ICHD 3 criteria we found a significant difference for the undefined diagnosis (2.6% vs. 7.9%; p < 0.05), while the diagnosis of probable chronic migraine was only possible by using the ICHD2 criteria (11.9% of patients; p < 0.05). The main criterion which was not satisfied for a definitive diagnosis was the duration of the attacks less than 2 h (70% of patients younger than 6 years; p < 0.005). Amitriptyline and topiramate were the most effective drugs (p < 0.05), although no significant difference was found between them (p > 0.05). Conclusion: The ICHD 3 criteria show limitations when applied to children under 6 years of age. The risk of developing MOH increases with age. Although our "real word" study shows that amitriptyline and topiramate are the most effective drugs regardless of the CPH type, the lack of placebo-controlled data and the limited follow-up results did not allow us to conclude about the drug efficacy.

Comorbidity prevalence and treatment outcome in children and adolescents with ADHD.

Although ADHD comorbidity has been widely studied, some issues remain unsolved. This multicenter observational study aims to examine comorbid psychiatric disorders in a clinical sample of newly diagnosed, treatment naïve children and adolescents with and without ADHD and, to compare treatment efficacy based on the type of comorbidity. We performed an analysis of the medical records of patients identified from the Regional ADHD Registry database, enrolled in 18 ADHD centers in the 2011-2016 period. 1919 of 2861 subjects evaluated (67%) met the diagnostic criteria for ADHD: 650 (34%) had only ADHD, while 1269 (66%) had at least one comorbid psychiatric disorder (learning disorders, 56%; sleep disorders, 23%; oppositional defiant disorder, 20%; anxiety disorders, 12%). Patients with ADHD of combined type and with severe impairment (CGI-S ≥5) were more likely to present comorbidity. 382 of 724 (53%) followed up patients improved after 1 year of treatment. ADHD with comorbidity showed greater improvement when treated with combined interventions or methylphenidate alone. Specifically, combined treatment showed significant superiority for ADHD with learning disorders (ES 0.66) and ODD (ES 0.98), lower for ADHD with sleep or anxiety disorders. Training intervention alone showed only medium efficacy (ES 0.50) for ADHD and learning disorders. This study was the first describing comorbidity patterns of ADHD in Italy, confirming, in a multicenter clinical setting, that ADHD is more often a complex disorder. Findings highlight important diagnostic, therapeutic, and service organization aspects that should be broadly extended to ensure an appropriate and homogenous ADHD management.

Comparison of macular thickness measurements between time-domain and spectral-domain optical coherence tomographies in eyes with and without macular abnormalities.

PURPOSE: To compare Stratus time-domain optical coherence tomography (OCT) with Cirrus spectral-domain HD-OCT for measuring macular thickness in eyes with and without macular abnormalities. METHODS: Seventy-five eyes of 48 patients were included in the study. Forty-one eyes of 29 patients had a normal macular thickness, and 34 eyes of 26 patients had an abnormal macular thickness. Macular scans were performed by 2 examiners (E1 and E2) with both OCTs. The agreement between the two OCT systems and interrater repeatability of each OCT system were determined using the Bland-Altman method. RESULTS: Mean agreement between the 2 OCTs as 1.96 × standard deviation of the mean difference between the measurements of central macular subfield was 21 µm in normal eyes and 36.8 µm in abnormal eyes. In five macular subfields, the agreement was significantly better in normal eyes. Cirrus HD-OCT repeatability was significantly better than Stratus in five macular subfields in normal eyes and in six macular subfields in abnormal eyes. The repeatability was significantly better in normal eyes in five macular subfields for Stratus and in three macular subfields for Cirrus HD-OCT. CONCLUSION: The agreement between the two OCTs is low and varies in each macular subfield. Cirrus HD-OCT has shown a better repeatability than Stratus OCT, especially when measuring eyes with a thickened macula.