Indications for epilepsy monitoring in pediatric and adolescent health care.

Seizures present in childhood with infinite diversity. History alone may suffice for diagnosis in some cases; more often additional evidence is needed to clarify events of concern. Electroencephalography (EEG) is a primary methodology used for seizure identification and management. Pediatric and adolescent health care providers are increasingly asked to make decisions about when and how to refer patients for eventual monitoring and must then be able to confidently interpret any resulting report(s). Comprehensive literature review was undertaken to provide a succinct and up-to-date overview aimed at general and subspecialty non-neurologist pediatric and adolescent health care providers to not only convey a solid general understanding of EEG and what it entails for patients and their families, but also foster a deeper understanding of the indications for monitoring-and how to interpret documented findings. In plain language this resultant guide reviews EEG basics, provides a crash course in the various types of EEG available, discusses broad indications for epilepsy monitoring, guides counseling and management for patients and their families both before and after EEG, and ultimately aids in the interpretation of both findings and prognosis. This review should allow both primary and subspecialty non-neurologic pediatric and adolescent health care providers to better identify when and how to best utilize EEG as part of a larger comprehensive clinical approach, distinguishing and managing both epileptic and nonepileptic disorders of concern while fostering communication across providers to facilitate and coordinate better holistic long-term care of pediatric and adolescent patients.

Nocturnal events in children: When and how to evaluate.

Nocturnal events of wide variety and concern are frequently reported by patients and their caregivers. To evaluate suspected abnormal events, primary care physicians must first be familiar with normal behaviors, movements and breathing patterns. Abnormal nocturnal events can then be categorized as nocturnal seizure, parasomnia, sleep-related movement disorder or sleep-related breathing disorder. Diagnoses in the above categories can be made clinically; however, it is important to know when to refer for additional evaluation. Comprehensive literature review was undertaken of nocturnal and sleep-related disorders. This guide reviews nocturnal seizures, normal and abnormal nonepileptic movements and behaviors, discusses broad indications for referral for electroencephalography (EEG) or polysomnography (PSG), and guides counseling and management for patients and their families, ultimately aiding in interpretation of both findings and prognosis. Epilepsy syndromes can result in seizures during sleep or adjacent periods of wakefulness. Parasomnias and sleep-related movement disorders tend to also occur in childhood and may be distinguished clinically. Referral to additional specialists for specific studies including EEG or PSG can be necessary, while other times a knowledgeable and vigilant clinician can contribute to a prompt diagnosis based on clinical features. Nocturnal events often can be managed with parental reassurance and watchful waiting, but treatment or evaluation may be needed. Sleep-related breathing disorders are important to recognize as they present very differently in children than in adults and early intervention can be life-saving. This review should allow both primary and subspecialty non-neurologic pediatric and adolescent health care providers to better utilize EEG and PSG as part of a larger comprehensive clinical approach, distinguishing and managing both epileptic and nonepileptic nocturnal disorders of concern while fostering communication across providers to facilitate and coordinate better holistic long-term care of pediatric and adolescent patients.

Female pheromones stimulate release of luteinizing hormone and testosterone without altering GnRH mRNA in adult male Syrian hamsters (Mesocricetus auratus).

In many species chemosensory stimuli function as important signals that influence reproductive status. Neurons synthesizing the peptide gonadotropin-releasing hormone (GnRH) are critical mediators of reproductive function via their regulation of the hypothalamic-pituitary-gonadal (HPG) axis, and they are thought to be responsive to chemosensory information. In the present study, we sought to elucidate the effects of female chemosensory stimuli on the HPG axis in sexually naive adult male Syrian hamsters. In Experiment 1, serial blood samples were collected from catheterized male hamsters following exposure to female pheromones in order to characterize the luteinizing hormone (LH) response to this chemosensory stimulus. In Experiment 2, brains and terminal blood samples were collected from animals 0, 60, and 120 min following pheromone exposure. GnRH mRNA was measured in brain tissue sections using in situ hybridization, and plasma concentrations of LH and testosterone were measured using radioimmunoassay. Data from Experiment 1 indicated that female pheromones elicited a rapid rise in plasma LH that peaked at 15 min and returned to baseline 45 min after exposure. In Experiment 2, testosterone was elevated in terminal blood samples obtained 60 min, but not 120 min, after exposure to pheromones. LH levels were unaffected at both of these time points. The chemosensory-induced increases in LH and testosterone release were not accompanied by subsequent changes in GnRH mRNA over the time course studied. These data suggest that while activation of the male HPG axis by female pheromones involves release of GnRH, it does not involve increases in GnRH mRNA 1-2 h after pheromonal stimulation as a mechanism for replenishment of released peptide.