Abordaje médico, recuperación funcional y cambios en las imágenes en tres niños con síndrome de fosa posterior en un centro de neurorrehabilitación. Serie de casos / Medical approach, functional recovery, and imaging changes in three children with posterior fossa syndrome in a neurorehabilitation center. A case series

RESUMEN Introducción: El tratamiento del tumor de fosa posterior implica la resección quirúrgica, sola o en combinación con tratamientos coadyuvantes, como la radioterapia y quimioterapia. Luego de la resección quirúrgica, el 20-30% de los niños presentan síndrome de fosa posterior. En esta serie de casos, describimos el abordaje médico y la recuperación funcional de tres niños con síndrome de fosa posterior en una clínica de rehabilitación de Buenos Aires. Presentación de los casos: Se analizaron tres niños (dos de sexo masculino y uno femenino), de entre 5 y 15 años de edad, con síndrome de fosa posterior dentro de los 30 días postquirúrgicos e internados para neurorrehabilitación entre el 2016 y 2021. Se realizaron evaluaciones, previo y posterior a la rehabilitación, de los hallazgos en los estudios de imágenes, de las manifestaciones neurológicas mediante la escala para la evaluación y calificación de la ataxia (SARA) y de la movilidad funcional mediante la escala de movilidad funcional (FMS). Conclusión: Al alta del centro de rehabilitación, los tres niños evidenciaron mejoría en las manifestaciones neurológicas, la movilidad funcional y los hallazgos en las imágenes. Sugerimos la realización de estudios prospectivos con mayor tamaño mue stral y utilizando escalas validadas.

ABSTRACT Introduction: The treatment of posterior fossa tumors involves surgical resection, either alone or in combination with adjuvant treatments, such as radiotherapy and chemotherapy. After surgical resection, 20-30% of children experience posterior fossa syndrome. In this case series, we describe the medical approach and functional recovery of three children with posterior fossa syndrome in a rehabilitation center in Buenos Aires. Case presentation: Three children (two male and one female), between 5 and 15 years of age, with posterior fossa syndrome within 30 days after surgery, and hospitalized for neurorehabilitation between 2016 and 2021 were analyzed. We evaluated imaging findings, neurological manifestations with the scale for the assessment and rating of ataxia (SARA), and functional mobility with the functional mobility scale (FMS) before and after rehabilitation. Conclusion: Upon discharge from the rehabilitation center, all three children showed improvement in neurological manifestations, functional mobility, and imaging findings. We suggest conducting prospective studies on a larger sample size and with validated scales.

Beneficial effects of diphenhydramine in dystonia

The objective of this paper was to evaluate the efficacy of diphenhydramine hidrochloride (DPH) in dystonic patients. In 1995, Truong et al reported encouraging results in five patients with idiopathic torsion dystonia (ITD) treated with DPH, an H1 antagonist with sedative and anticholinergic properties. Five patients with generalized ITD, one with secondary generalized dystonia and one with idiopathic segmental dystonia were included in the prospective study, initialy the response to intravenous administration of DPH versus placebo in two sessions a week apart was evaluated. Two weeks later all patients started oral DPH in increasing doses (range 100-300 mg, mean 164 mg). The degree of dystonia was determined by a modified University of Columbia Scale evaluating the baseline score, after placebo and DPH I.V. administration then at one and six months after starting oral treatment. The results were analyzed by Friedman's test for repated measurements. On comparing scores for baseline severity, I.V. placebo and I.V. DPH presented a highly significant correlation (12.09; p = 0.00) as well as comparing baseline score with oral DPH at one and 6 months, treatment (12.78; p = 0.00). Functional score results were 9.5 p = 0.01 and 8.4 p = 8.4 p = 0.02 at one and 6 months respectively. The most common side effects were sommolence and dizziness. It can be concluded that DPH proved effective in our patients with mild to moderate adverse effects not requiring drug withdrawal in any case. However, I.V. challenge was unable to predict the long-term response to oral medication perhaps due to the limited number of cases.

Beneficial effects of diphenhydramine in dystonia

The objective of this paper was to evaluate the efficacy of diphenhydramine hidrochloride (DPH) in dystonic patients. In 1995, Truong et al reported encouraging results in five patients with idiopathic torsion dystonia (ITD) treated with DPH, an H1 antagonist with sedative and anticholinergic properties. Five patients with generalized ITD, one with secondary generalized dystonia and one with idiopathic segmental dystonia were included in the prospective study, initialy the response to intravenous administration of DPH versus placebo in two sessions a week apart was evaluated. Two weeks later all patients started oral DPH in increasing doses (range 100-300 mg, mean 164 mg). The degree of dystonia was determined by a modified University of Columbia Scale evaluating the baseline score, after placebo and DPH I.V. administration then at one and six months after starting oral treatment. The results were analyzed by Friedmans test for repated measurements. On comparing scores for baseline severity, I.V. placebo and I.V. DPH presented a highly significant correlation (12.09; p = 0.00) as well as comparing baseline score with oral DPH at one and 6 months, treatment (12.78; p = 0.00). Functional score results were 9.5 p = 0.01 and 8.4 p = 8.4 p = 0.02 at one and 6 months respectively. The most common side effects were sommolence and dizziness. It can be concluded that DPH proved effective in our patients with mild to moderate adverse effects not requiring drug withdrawal in any case. However, I.V. challenge was unable to predict the long-term response to oral medication perhaps due to the limited number of cases. (AU)