[The efficiency of carbamazepine in a case of post-streptococcal hemichorea]. / Eficacia de la carbamacepina en un caso de hemicorea posestreptocócica.

INTRODUCTION: Chorea is an infrequent disorder at the paediatric age which has a number of both hereditary and acquired causes. Post-streptococcal or Sydenham's chorea (SC) is still the main cause of chorea in children, in spite of the drop in prevalence of rheumatic fever in the last few years. SC is a benign, self-limiting disorder, but may last for several months and can be highly disabling. Several different types of symptomatic treatment have been proposed, for example corticoids, haloperidol, valproic acid, and carbamazepine. In each case, both the speed with which the clinical improvement is brought about, and the degree to which they are tolerated and the absence of side effects must be evaluated. CASE REPORT: We present a new case of SC that had been developing for three months. Carbamazepine was effective from the tenth day onwards and total remission of the symptoms was achieved in six weeks. Total follow-up time was nine months, and in this time no relapses or side effects were observed. CONCLUSIONS: This contribution offers new evidence supporting carbamazepine as another first choice medication in the treatment of this type of chorea.

[Clinical characteristics of migraine in childhood]. / Características clínicas de la migraña en la edad pediátrica.

INTRODUCTION: The clinical presentation and progression of childhood migraine has still not been clearly defined. However, major advances in prognosis and treatment would follow this. OBJECTIVE: To trace the clinical features and course of childhood migraine. PATIENTS AND METHODS: A prospective study, lasting 10 years, in a population of 284 children with migraine, seen at two hospitals. The data obtained were analysed using techniques of statistical significance and logistic regression. RESULTS: In 24.3% headaches started before the age of 6 years, and in 57% at between 6 and 10 years of age. In 77.5% of the patients there was a family history of migraine, this figure rose to 82.6% in the children whose headaches started before the age of 6 years. Characteristics such as duration, site and accompanying factors differed from those seen in adults. There was spontaneous improvement in 88.3%, who did not require prophylactic medication. CONCLUSIONS: Childhood migraine has some characteristics which distinguish it from adult migraine. This should be noted in classification. Most children with migraine have mild headaches which do not require prophylaxis. A genetic factor appears to play an important rol in phenotype expression of the disorder.

Natural history of migraine in childhood.

Epidemiological studies have shown that 3-7% of the paediatric population suffer from migraine. Despite this high prevalence little has been published about the natural history of migraine or of its prognosis. The objectives of this study were: (i) to outline the natural history of migraine in childhood; and (ii) to identify early predictors of an unfavourable clinical evolution. A prospective, longitudinal, 10-year follow-up study was conducted of the clinical evolution of 181 paediatric patients with migraine. Data analysis was performed by statistical significance and logistic regression tests. In our study 24.3% of children with migraine had their onset before age 6 years and another 57% between 6 and 10 years of age. A positive family history of migraine was recorded in 77.5%. Eighty-eight percent of patients followed a favourable clinical course. The remaining 12% of patients had to be placed on prophylactic treatment owing to the increasing of their headache. Of all parameters investigated, the age of onset was the only statistically significant predictor of an unfavourable clinical evolution. We conclude: (i) most patients with migraine headache starting in childhood do not require prophylactic treatment; (ii) the earlier the disease begins the more likely is an unfavourable clinical course; (iii) genetic factors play an important role in the phenotypic expression of the disease; (iv) our study suggests the existence, at least, of two different populations among childhood migraine patients.