Pilot project of integration of Chinese medicine (acupuncture) and Western medicine for neurohabilitation of children with acquired brain injury: a study of 2 cases

PURPOSE: To demonstrate if there is any efficacy of integration of Chinese medicine (acupuncture) and western medicine for rehabilitation for two children with acquired brain injury (ABI). METHODS: Two children (M/1 year, with dystonic cerebral palsy, cortical visual impairment and global developmental delay due to acute encephalitis; and M/12 years, with spastic tetraplegia, cortical visual impairment, and severe mental retardation due to hypoxic-ischaemic encephalopathy related to hypertrophic cardiomyopathy) were enrolled into our pilot programme which had started as the ‘First Integrated Chinese Medicine and Western Medicine for Neurorehabilitation of Children with Traumatic or Acquired Brain Injury under the Hospital Authority’ in June 2008. Both of them received daily acupuncture treatment and conventional neurohabilitation programme for 4 months. Pre- and post-assessment were performed for both cases. Deoxyglucose PET scan of the brain, parental daily reports for any change after each acupuncture session were monitored. Objective outcome measures were performed by the Neurohabilitation Team with allied health disciplines including physiotherapist, occupational therapist, optometrist, audiologist, speech therapist and clinical psychologist in pre- and post-acupuncture treatment using objective outcome measures including Modified Ashworth Spasticity Scale, CVI assessment, Video Fluoroscopic Swallow Study (VFSS) and Functional Independence Measure of Children (WeeFIM). Videos were taken by blind assessors. RESULTS: PET scan of the brain showed mild-to-moderate increase in glucose uptake for both cases. Videos and clinical outcome measures showed improvement in vision and other parameters. CONCLUSIONS: A short and intensive course of acupuncture can be effective in improving visual and functional outcome for children with ABI. Further research is underway to assess the practicability of organising this model of integration of Chinese medicine (acupuncture) and western medicine for neurohabilitation of children with ABI in Hong Kong.published_or_final_versio

Posterior Reversible Encephalopathy Syndrome: paediatric heart transplant with cyclosporine neurotoxicity

Posters: no. P8Posterior reversible encephalopathy syndrome (PRES) is associated with a specific disorder of cerebrovascular autoregulation. Clinical features of PRES consisted of headache, decreased consciousness, altered mental functioning, seizures, visual loss or cortical blindness. Characteristic findings on neuroimaging included high signal intensity on T2-weighted as well as diffusion-weighted imaging MRI in the posterior cerebral hemispheres, indicative of vasogenic subcortical oedema without infarction. Cyclosporine neurotoxicity had been described following bone marrow and organ transplantation; however, there are few reports of PRES in children especially post-paediatric heart transplantation. We report a case of cyclosporine-related PRES in a paediatric heart transplant recipient. She made a good recovery with no residual neurological deficits after withdrawal of cyclosporine, control of possible risk factors as well as symptomatic control of seizure.published_or_final_versionThe 1st Hong Kong Neurological Congress cum 22nd Annual Scientific Meeting of the Hong Kong Neurological Society, Hong Kong, 6-8 November 2009. In Hong Kong Medical Journal, 2009, v. 15 n. 6, suppl. 7, p. 42, abstract P

Paediatric Epilepsy Surgery Programme in Hong Kong: experience in Queen Mary Hospital / Duchess of Kent Children's Hospital

Poster: no. P6BACKGROUND: Surgery is a well-established treatment for adults with intractable seizures. Increasingly, infants and children are being considered for epilepsy surgery. In a growing child, epilepsy surgery has the additional benefit of aborting cognitive decline and improving development and behaviour ...published_or_final_versio

Electroacupuncture for children with autism spectrum disorder: Pilot study of 2 cases

Objective: The objective of this study was to observe for efficacy, safety, and compliance of electroacupuncture for autism spectrum disorder (ASD). Methods: Two (2) children with ASD received electroacupuncture for 24 sessions over 8 weeks and were assessed pre- and postacupuncture. We defined a positive or negative change as an improvement or deterioration of 25%, respectively, in total score or any subscales of Aberrant Behavioral Checklist (ABC), Ritvo-Freeman Real Life Scale (RFRLS), WeeFIM,® and as a rating of much improved or much worse on the Clinical Global Impression-Improvement (CGI-I) scale. Results: For ABC, positive changes in "Irritability" and "Stereotypy" was noted in case 1 but no changes occurred for case 2. For RFRLS, positive changes were found for both cases in "Sensory motor," "Sensory response," and "Total score," although negative change was noted for case 2 in "Affectual response." For WeeFIM®, there were no positive or negative changes in both cases. For CGI-I, positive change in case 1 with much improved in "Social relatedness, Communication, and Stereotypy behavior" was reported. Conclusions: A short intensive course of electroacupuncture might improve some core features of children with ASD. © 2008 Mary Ann Liebert, Inc.published_or_final_versio

Double-blind randomized control trial of acupuncture for autistic spectrum disorder

Free Paper Presentations: no. FP3OBJECTIVE: To study the efficacy, safety, and compliance of short-term electro-acupuncture (EA) for children with autism spectrum disorder (ASD). METHODS: This was a randomised, double-blind, sham-controlled, clinical trial. Children with ASD were randomly assigned to EA group (n=30) or sham electro-acupuncture (SEA) group (n=25) matched by age and severity of autism. The EA group received EA for selected acupoints while SEA group received sham EA to sham acupoints. A total of 12 acupuncture sessions over 4 weeks were given. Primary outcome measures included WeeFIM, Pediatric Evaluation of Disability Inventory (PEDI), Leiter International Performance Scale–Revised (Leiter-R), Clinical Global Impression–Improvement (CGI-I) scale. Secondary outcome measures consisted of Aberrant Behavior Checklist (ABC), Ritvo-Freeman Real Life Scale (RFRLS), Reynell Developmental Language Scale (RDLS), and standardised parental report. Data were analysed by Mann-Whitney test. RESULTS: There was significant improvement in language comprehension domain of WeeFIM (P=0.02), self-care caregiver assistant domain of PEDI (P=0.028), and CGI-I (P=0.003) in the EA than SEA group. As for parental report, the EA group also showed significantly better social initiation (P=0.01), receptive language (P=0.006), motor skill (P=0.034), coordination (P=0.07), and attention span (P=0.003). More than 70% children with ASD adapted acupuncture easily, while 8% had poor acupuncture compliance. Mild side-effect with minor superficial bleeding or irritability during acupuncture was found. CONCLUSION: A short 4 weeks (12 sessions) course of EA is useful to improve the specific function in children with ASD, especially for language comprehension and self-care ability.published_or_final_versionThe 1st Hong Kong Neurological Congress cum 22nd Annual Scientific Meeting of the Hong Kong Neurological Society, Hong Kong, 6-8 November 2009. In Hong Kong Medical Journal, 2009, v. 15 n. 6, suppl. 7, p. 29, abstract FP

Risk factors associated with refractory epilepsy in children

Posters: no. P7BACKGROUND: There is a lack of consensus about the definition of intractable or refractory epilepsy in children. Medically intractable epilepsy occurred in 10 to 20% of epilepsy with childhood onset. Patients with medical intractability had immense resource implication and lifelong disability/disabilities. Early identification of risk factors for refractory epilepsy offers a chance of appropriate and timely treatment thus affecting prognosis. METHODS: A retrospective study was performed for our cohort of 505 children aged below 18 years with new-onset epilepsy, diagnosed between 1979 and 2006, and actively managed at the Comprehensive Epilepsy Clinic, Department of Paediatrics and Adolescent Medicine of the University of Hong Kong. We arbitrarily defined refractory epilepsy as those who had never been seizure-free for more than 12 months despite receiving anti-epileptic drug (AED) treatment. Responders were arbitrarily defined as those who had at least been seizure-free for consecutive 12 months. All patients had been on one or more AEDs and were followed up for at least 24 months after AED initiation. The demographic, clinical, diagnostic, investigative, management and seizure outcome at 2 years were analysed. RESULTS: At 2 years’ follow up, 42% (n=212) had refractory epilepsy. Risk factors significantly correlated with refractory epilepsy included history of status epilepticus (P<0.001), symptomatic aetiology (P<0.001), use of two or more AEDs (P=0.001), abnormal neurological co-morbidities including mental retardation (IQ<70) [P<0.001], learning disabilities (IQ=70-90) [P=0.009], cerebral palsy (P=0.011), abnormalities in EEG (P<0.001) and neuroimaging (P<0.001). CONCLUSIONS: Early identification of risk factors to predict possible medical intractability is important in improving treatment strategies especially in the selection of traditional versus newer AEDs, mono- versus poly-pharmacy or even earlier alternative epilepsy management decision plans including evaluation for possible surgical therapies.published_or_final_versionThe 1st Hong Kong Neurological Congress cum 22nd Annual Scientific Meeting of the Hong Kong Neurological Society, Hong Kong, 6-8 November 2009. In Hong Kong Medical Journal, 2009, v. 15 n. 6, suppl. 7, p. 42, abstract P

Anti-NMDA-R encephalitis: an encephalitis lerthargica-like illness

Posters: no. P14A girl of 3 years and 9 months with a 3-day history of fever and upper respiratory tract infection (URTI) was admitted with a generalised tonic-clonic convulsion, and delirium with screaming, non-sense talking, and agitation. For the first week after admission, she was lethargic with fluctuating awareness and mutism during the day but poor sleep at night. Workup for acute encephalopathy including autoimmune, infective, toxicology, metabolic and vasculitic screening showed negative findings. Erythrocyte sedimentation rate was markedly elevated and ...published_or_final_versionThe 1st Hong Kong Neurological Congress cum 22nd Annual Scientific Meeting of the Hong Kong Neurological Society, Hong Kong, 6-8 November 2009. In Hong Kong Medical Journal, 2009, v. 15 n. 6, suppl. 7, p. 47, abstract P1

Increased CSF levels of aromatic amino acids in hip fracture patients with delirium suggests higher monoaminergic activity

textabstractBackground: To examine whether delirium in hip fracture patients was associated with changes in the levels of amino acids and/or monoamine metabolites in cerebrospinal fluid (CSF) and serum. Methods: In this prospective cohort study, 77 patients admitted with an acute hip fracture to Oslo University Hospital, Norway, were studied. The concentrations of amino acids in CSF and serum were determined by high performance liquid chromatography. The patients were assessed daily for delirium by the Confusion Assessment Method (pre-operatively and post-operative day 1-5 (all) or until discharge (delirious patients)). Pre-fracture dementia status was decided by an expert panel. Serum was collected pre-operatively and CSF immediately before spinal anesthesia. Results: Fifty-three (71 %) hip fracture patients developed delirium. In hip fracture patients without dementia (n = 39), those with delirium had significantly higher CSF levels of tryptophan (40 % higher), tyrosine (60 % higher), phenylalanine (59 % higher) and the monoamine metabolite 5-hydroxyindoleacetate (23 % higher) compared to those without delirium. The same amino acids were also higher in CSF in delirious patients with dementia (n = 38). The correlations between serum and CSF amino acid levels were poor. Conclusion: Higher CSF levels of monoamine precursors in hip fracture patients with delirium suggest a higher monoaminergic activity in the central nervous system during delirium in this patient group