Interactions between Plagiotremus spp., Labroides dimidiatus and their clients: evidence for behavioural niche partitioning.

This study employed community analysis and behavioural field observations to explore the inter-specific interactions between fangblenny species (Plagiotremus spp.), the cleaner wrasse Labroides dimidiatus and their target species and found that the presence of Plagiotremus spp. did not affect the total amount that L. dimidiatus cleaned but it did reduce the amount L. dimidiatus cleaned key prey species of the Plagiotremus spp. The behavioural interactions between adult L. dimidiatus and their clients changed in response to the presence of Plagiotremus spp., but the results suggested the potential cost of Plagiotremus spp. on L. dimidiatus may be offset by behavioural niche partitioning.

Childhood secondary (symptomatic) epilepsy, seizure control, and intellectual handicap in a nontropical region of South Africa.

PURPOSE: To determine the prevalence of secondary (symptomatic) epilepsy and to ascertain levels of seizure control and intellectual function in a clinic population of children drawn from a poor community in a temperate region of South Africa. METHODS: Detailed review of the records of every child with recurrent seizures who attended a special epilepsy outpatient clinic during 1995. RESULTS: A total of 1,017 children was studied. In 432 (43%), there was historic, clinical, and radiologic evidence to suggest that epilepsy was symptomatic of underlying brain damage or defect. Acceptable seizure control was maintained with a single standard anticonvulsant drug (AED) in 65% of cases. In the 6 months preceding the study, 37% of the subjects had remained seizure free. Forty-seven percent of the study population were considered to be of subnormal intelligence. CONCLUSIONS: In a children's hospital outpatient population in the Western Cape region of South Africa, the prevalence of secondary epilepsy is higher than is found in developed countries. There is need within the community for preventive measures aimed at reducing the prevalence of perinatal insults, meningitis, tuberculosis, neurocysticercosis, and cerebral trauma.

Case report and molecular analysis of subacute sclerosing panencephalitis in a South African Child.

This is the first case of subacute sclerosing panencephalitis from South Africa in which the molecular characteristics of the causative measles virus were examined. The virus found is classified as genotype D3, which has not previously been found in Africa and was last circulating in the United States before 1992.

Experience with botulinum toxin in the treatment of cerebral palsy.

OBJECTIVES: To assess the effect of botulinum toxin on dynamic spasticity and dystonic posturing in children with cerebral palsy. DESIGN: Assessment and documentation of the motor disability of children with cerebral palsy followed by injection of botulinum toxin into selected muscle groups. Reassessment of motor function after injection. SUBJECTS: Fifteen children with cerebral palsy: 5 with dynamic spasticity, 5 with dystonia and 5 with a mixed picture. RESULTS: On a standard scoring system, 13 of the children showed improved function at reassessment. CONCLUSION: Intramuscular injection of botulinum toxin is effective in the treatment of selected children with spastic and dystonic forms of cerebral palsy. Improvement is not permanent, but the injection can be repeated.

Interventions for children with neurodevelopmental delay.

OBJECTIVES: To review studies in the scientific literature of five physical interventions commonly recommended for children with neurodevelopmental delay. DESIGN: A literature search for and a review of the results of controlled and other studies conducted in the course of the last 25 years. SETTING: Institute of Child Health, University of Cape Town. SUBJECTS: Patterning; neurodevelopmental therapy; sensory integrative therapy; optometric visual training; auditory integration therapy. OUTCOME MEASURES: Findings and conclusions drawn in the studies reviewed. RESULTS: Controlled studies fail to provide evidence to support claims made for the five interventions examined. CONCLUSIONS: In the absence of scientific evidence for efficacy patterning, neurodevelopmental therapy, sensory integrative therapy, optometric visual training and auditory integrative therapy cannot be recommended for children with neurodevelopmental delay.

A study of African children with prolonged focal seizure and a specific CT scan finding.

A prospective study was carried out on 25 children who presented with a focal seizure and had CT scan appearances identified as tuberculoma. Thirteen were treated for tuberculosis. The other 12 received no anti-tuberculous drug therapy. Follow-up scans showed resolution of the radiological lesions in all cases. It is postulated that anti-tuberculous drugs may safely be withheld in cases of this nature when there is no other evidence of tuberculosis.

Microcephaly-cardiomyopathy: a new autosomal recessive phenotype?

A distinctive phenotype of severe microcephaly and self-limiting dilated cardiomyopathy has been observed in two sibs suggesting autosomal recessive inheritance. Mental retardation, delayed developmental milestones, and minor dysmorphism were additional features.

Diencephalic syndrome with long-term survival.

Infants and young children with the diencephalic syndrome exhibit a normal activity level despite profound marasmus. Investigation reveals an intracranial tumour and evidence of endocrine dysfunction. The condition is easily missed in Third World countries with a high prevalence of nutritional marasmus. The advent of computer tomography and magnetic resonance imaging has simplified diagnosis. The syndrome was diagnosed in 1981 in a boy of 20 months who had a large hypothalamic tumour. Initial endocrine studies revealed very high growth hormone levels. After radiotherapy, these levels reverted to normal for a time but have subsequently declined in keeping with a state of hypopituitarism. The boy's long-term survival has afforded an opportunity for study over eight years. During this time, growth has been slow but sustained. There has been some fall off in intellectual capacity. Characteristic features of the diencephalic syndrome are normal activity and a state of euphoria in a profoundly marasmic child. Investigation reveals the presence of an intracranial tumour and evidence of endocrine dysfunction. Though there are earlier references, the condition first came to medical attention at the annual meeting of the British Paediatric Association in 1951 when Russell described the typical features. In Third World countries where childhood marasmus is common, the syndrome is easily overlooked. The present report concerns a boy who has been closely followed for more than eight years.

Adverse reactions in children. Special considerations in prevention and management.

Adverse reactions occur in only 2 to 5% of children for whom drugs are prescribed. Most of those which do occur are mild and transient in nature. Practitioners who treat children should be familiar with the adverse effects of every drug they use and be certain that every drug prescribed is strictly necessary. Antimicrobials and antipyretic/analgesics are the drugs most commonly prescribed for children. Serious adverse reactions such as aplastic anaemia (with chloramphenicol) are fortunately rare. Erythromycin prescribed for intercurrent infection may precipitate signs of toxicity in children receiving carbamazepine or theophylline. Anticonvulsants impair cognitive function and thereby affect school performance. Phenothiazines and metoclopramide prescribed as antiemetics may cause spectacular dystonic posturings, although this adverse reaction is rapidly reversed with intravenous biperiden. The duration of drug therapy in paediatric practice should be limited to the minimum time compatible with full recovery. The management of adverse reactions in childhood hinges on early recognition and prompt withholding of the offending drug. Urgent resuscitation is essential when anaphylactic collapse occurs, but in most instances of adverse reaction symptomatic treatment of discomfort is all that is necessary. It is important that parents of a child who has suffered an adverse reaction be aware of this and know the name of the drug responsible. Practitioners who encounter an unreported adverse reaction have an obligation to notify the appropriate drug monitoring authority.

Alexander's disease: a case report with brain biopsy, ultrasound, CT scan and MRI findings.

Alexander's disease is reported in a 6-month-old infant. The clinical course was characterized by hydrocephalus, irritability and psychomotor retardation, with subsequent seizures and spasticity. Findings on ultrasound examination, computerized tomography, magnetic resonance imaging and brain biopsy are presented. The glial nature of the Rosenthal fibers was confirmed by immuno-gold staining. Clinical classification and differential diagnosis are discussed.

The pattern of childhood poisoning in the western Cape.

An analysis of poisoning cases treated at the Red Cross War Memorial Children's Hospital during 1987 and of calls received on the poisons line is presented. Treatment of 1,116 children was undertaken and 922 telephone calls were logged. Of the patients treated, 60% had ingested a drug and 30% had drunk paraffin. The high prevalence of paraffin poisoning in the western Cape is examined. Constant vigilance must be maintained if childhood poisoning is to be prevented.

The prevalence of adverse reactions to anticonvulsants in children with epilepsy.

Sixty children on long-term treatment with anticonvulsant drugs were examined for evidence of adverse reactions. The prevalence of reported side-effects was extremely low. Adverse effects on haematopoiesis were not demonstrated, and only 2 children had alanine aminotransferase levels above the reference range. Nine children had biochemical evidence of altered calcium metabolism. The findings suggest that repeated routine laboratory monitoring of asymptomatic children on long-term anticonvulsant therapy is not essential.

Recurrent seizures in childhood. Western Cape profile.

In over 50% of children with recurrent seizures in a South African hospital population the onset of attacks was before the age of 2 years. In 32% of patients there was a history of perinatal complications and 11% had a history of meningitis; 38% of the children had abnormalities on physical examination and 55% were intellectually handicapped. Acceptable seizure control was achieved in 71% of patients and 68% were treated with a single anticonvulsant. Appropriate educational placement had not been achieved for 22%. It is concluded that a reduction in the incidence of epilepsy in the community can be achieved by improvements in obstetric/neonatal services and by the raising of living standards. The abolition of racial segregation at special schools and training centres will alleviate the present shortage of places for children with epilepsy who cannot cope at regular schools.

Improvement in brainstem function during treatment of intracranial tuberculosis. A report of 2 cases.

The auditory evoked response serves as a measure of brainstem integrity. Two cases are reported in which this investigation was used to monitor recovery from intracranial tuberculosis.