Use of Complementary and Alternative Medicine Practices in Patients Admitted to The Pediatric Neurology Outpatient Clinic

Introduction: Despite the developments in pharmacologic treatments, traditional and complementary therapies have recently gained popularity in our country, as well as around the world. Aim: To question complementary and alternative medicine practices CAMP during clinical visits of pediatric neurology patients, to raise awareness of families and patients about the use of complementary and alternative medicine, and to prevent possible negative interactions. Methods: This prospective survey study was conducted with the parents of 300 pediatric patients aged between 6 months and 18 years, who were being treated at the Child Neurology Clinic between March 1st and May 30th, 2020. For the study, 360 patients’ parents who came to the Pediatric Neurology clinic for treatment were randomly selected, and a face-to-face survey lasting 2 minutes was conducted with 300 patients’ parents who agreed to participate in the study. This study was approved with the decision number E-20-12-62 at the meeting dated 21.12.2020 of the Clinical Research Ethics Committee of SBU Ankara Dr Sami Ulus Gynecology and Childhood Health and Diseases Training and Research Hospital. Results: Three hundred parents (56% women) participated in the study. Just over half (55.3%) of the patients were followed up with a diagnosis of epilepsy, 56.6% of the parents stated that they had used traditional and complementary therapy methods before, 43.4% stated that they did not use it, 46.54% stated that they used prayer and 23,9% used vitamin methods, respectively. Conclusion: In neurologic diseases, parents use traditional and complementary therapies as treatment methods, creating an alternative to modern medicine. Families and patients should be informed by investigating the reasons and frequency of using traditional and complementary therapies, raising the awareness of parents, and determining the possible harm caused by traditional and complementary therapies

Çocuk Acil Servisine Zehirlenme Nedeniyle Başvuran Olguların Değerlendirilmesi

Amaç: Bu çalışmada Selçuk Üniversitesi Meram Tıp Fakültesi ÇocukAcil Servisi'ne başvuran zehirlenme olgularının epidemiyolojik ve demografik özelliklerinin incelenmesi amaçlanmıştır.Gereç ve Yöntem: Çalışmaya 1 ay-18 yaşları arası zehirlenme ile başvuran hastalar alındı. Hastaların tıbbi verileri geriye dönük olarak incelendi. Yaş, cinsiyet, alım zamanı, alınan etken madde,zehirlenme nedeni, mevsimsel dağılımı, klinik bulguları, tedavileri değerlendirildi.Bulgular: Beş yıllık dönemde çocuk acil servisine başvuran 1027 hasta vardı; bu süre içinde zehirlenme olguları tüm başvuruların %1,66’sını oluşturmuştu. Hastaneye yatırılarak takip edilen 513zehirlenme olgusu çalışmaya alındı. Hastaların ortalama yaşları 7,8±5,6 yıl (5 ay-17 yıl) olan, 294 (%57,3)’ü kız, 219 (%42,7)’u erkek idi. Hastaların %86'sında tek ilaç zehirlenmesi tespit edildi.Zehirlenmelerin %64,5'i kaza sonucu ve%35,5'i öz kıyım amaçlı idi. Kaza sonucu zehirlenmeler 2-6 yaş grubunda en yaygın neden iken, öz kıyım amaçlı zehirlenmeler en sık 10-17 yaş grubunda görüldü. Öz kıyım amaçlı zehirlenmelerde kızların oranı belirgin şekilde yüksekti. En sık zehirlenme nedeni ilaç¬lar (%70,2) olup, en sık ilaç grubu amiritiptilin grubu trisiklik antidepresanlardı (%42,2). İkinci en yaygın etken farmakolojik olmayan ajanlardı ve bunların çoğunu insektisid ve organofosfatlar oluşturdu. Başvuru anında hastaların %71,7'i semptomatikti. En sık görülen semptom letarji (%34) idi. Hastaların %77’sine mide yıkama ve aktif kömür, %35,7’sine mide yıkama, %11,1’ine alkali diürez, %9,7’sine antidot tedavisi uygulandı. Hastanede kalış süresi ortanca 2 gün (1-10 gün) idi. Hastaların %50,9'u yoğun bakım ünitesinde takip edildi. Mortalite oranı %0,5 idi.Sonuç: İlaçlar ve organofosfat/insektisid zehirlenmeleri bölgemizde en sık görülen zehirlenme etkenleri idi. Önleyici tedbirlerin alınması, kamu ve sağlık personelini eğitilmesi açısındanher bölgenin kendi zehirlenme özelliklerini belirlemesinin önemli olduğunu düşünüyoruz

Evaluation of Visual Evoked Potentials in Children with Neurofibromatosis Type 1 and Comparison With Radiological Findings

Amaç: Nörofibramotozis Tip 1 (NF tip 1)’li çocukların desen görsel uyarılmış (pattern visual evoked potentials; P-VEP) potansiyellerini değerlendirmek ve P-VEP sonuçlarının, optik gliom ve NF Tip 1 ilişkili bilinmeyen parlak objeler (unidentified brigtht objects; UBO) ile korelasyonunu irdelemek amaçlanmıştır. Gereç ve Yöntem: 2017-2020 yılları arasında XXXXXXXXXXXXX Çocuk Nöroloji Polikliniği’nde NF Tip 1 tanısı ile takip edilen, yaş ortalaması 9,61±3,7 yaş olan, 16 (%57)’sı erkek, 28 çocuk hastanın P-VEP P 100 latans değerleri, yaş ve cinsiyeti benzer 28 sağlıklı çocuktan oluşan kontrol grubunun P100 latansları ile karşılaştırıldı. Sonuç: Hastaların %82’sinde beyin magnetik resonans görüntülemede UBO, %21’inde optik gliom saptandı. Hasta grubunda P100 latansları kontrol grubuna göre anlamlı olarak daha uzun idi (p=0.013, p=0.043). Optik gliomu olan hastaların P100 latanslarının, optik gliomun anotomik lokalizasyonu ile uyumlu şekilde, optik gliomu olmayan hastalara göre anlamlı olarak daha uzun olduğu görüldü (p=0.042, p=0.025). Sonuç: Bu çalışma ile P-VEP testinin NF Tip 1’li çocuklarda görme yollarının fonksiyonel değerlendirmesinde kullanılabilecek objektif bir elektrofizyolojik test olduğu gösterilmiştir. NF Tip 1’li çocukların klinik takibinde P-VEP testinin kullanılmasının özellikle optik gliomların erken dönem tespitinde yararlı olabileceğini düşünmekteyiz

Türkiye’de üçüncül bir merkezden duchenne ve becker müsküler distrofili hastaların klinik özellikleri ve yaşam kalitesi

Introduction: Duchenne Muscular Dystrophy (DMD) and Becker Muscular dystrophy (BMD), are chronic and progressive and rare genetic disorders that cause systemic involvement such as progressive muscle deterioration, motor disability, cardiomyopathy, and respiratory problems, with an increased risk of cognitive decline and psychological problems They are a group of neuromuscular diseases in which psychological problems affect negatively on quality of life (Qol) not only patients but also caregivers. This study demonstrates the clinical features of patients with DMD/BMD and their caregivers and compares controls with respects to psychological and social aspects. Materials and Methods: A total of 20 patients (3 with BMD and 17 with DMD), aged between 8 and 18 years, and 20 age-matched healthy children were included in this descriptive and cross-sectional study. The patients were evaluated by the pediatric neurology, cardiology, and psychiatry departments at the study time. Their demographic and clinical features were recorded. The Wechsler Intelligence Scale for Children-Revised (WISC-R), Pediatric Quality of Life Inventory (PedsQL) and its parent form, and the Strengths and Difficulties Questionnaire (SDQ) were applied to all of the participants. Results: The QoL scores were lower in patients with moderate and severe DMD/ BMD and their caregivers. In patients with DMD and in both groups, emotional symptoms, peer problems and prosocial behavior scores were higher in the subsets of the SDQ. The PedsQL child-parent scores were lower in all of the subsets with statistical significance. Conclusions: DMD and BMD comprise a group of chronic diseases with multiple complications that are difficult to manage. A QoL equal or close to that of the healthy children should be targeted. Today, proposed or experimental treatments for this disease group are assessed based on their ability to enhance QoL. Inquiring into the QoL and counseling should become routine.Giriş: Duchenne ve Becker musküler distrofi (DMD,BMD); progresif kas güçsüzlüğü, motor beceriksizlik, kardiyomiyopati ve r solunumsal problemler, artmış bilişsel kayıp riski ve psikolojik problemler gibi sistemik bulgularla seyreden kronik, progresif seyirli, nadir genetik bozukluklardır. Bu nöromusküler hastalık grubunda yalnızca hastaların değil bakım verenin de yaşam kalitesinin negatif yönde etkilendiği psikolojik problemlerin eşlik ettiği durumlardır. Bu çalışmada; DMD/BMD hastalarının klinik özellikleri yanı sıra hastalar ve bakım verenlerin psikolojik ve sosyal etkilenimleri ortaya konulmaya çalışılmıştır. Gereç ve Yöntem: 3’ü BMD, 17’si DMD tanılı, 8-18 yaş aralığındaki 20 hasta ile age-matched 20 sağlıklı kontrol çalışmaya dahil edilerek tanımlayıcı ve kesitsel bir çalışma planlanmıştır. Hastalar; çocuk nörolojisi, çocuk kardiyolojisi ve çocuk psikiyatrisi tarafından eş zamanlı değerlendirilmiştir. Demografik ve klinik özellikleri kaydedilmiştir. Çocuklar için revize edilmiş Wechsler zeka ölçeği,Çocuklar ve ebeveynler için yaşam kalitesi ölçeği ve Güç ve Güçlükler Anketi hasta ve kontrol grubuna uygulanmıştır. Bulgular: Klinik ciddiyeti orta ve ciddi olan DMD/BMD hastalarında sağlıklı kontrollerle karşılaştırıldığında hem hasta hem bakım verenin QOL skorları oldukça düşük saptandı. SDQ’ya göre ise alt içerikler açısından hem tüm grupta hem de DMD tanılı hasta grubunda emosyonal symptoms, peer problems ve social behavior açısından sağlıklı kontrollere göre yüksek skorlar elde edildiği başka bir deyişle bu alanlarda negatif yönde belirgin etkilenme olduğu görüldü. PedsQL child-parent skorları tüm alt başlıklarda sağlıklı kontrollere göre istatistiksel önemlilik ile birlikte düşük saptanmıştı. Sonuç: DMD/BMD yönetmekte güçlük yaşanan çok sayıda komplikasyonu olan bir grup kronik hastalıktır. Yaşam kalitesinin sağlıklı çocuklar kadar veya onlara yakın bir düzeyde tutulması hastalık yönetiminin ana hedefi olmalıdır. Günümüzde bu hastalık grubundaki önerilen veya henüz deneme aşamasındaki tedaviler de yaşam kalitesinin arttırılması ön koşulu ile değerlendirilmektedir. Bu nedenle; klinik pratikte sağlık hizmetleri yanı sıra yaşam kalitesinin sorgulanması ve arttırıcı önerilerin verilmesi bir rutin olmalıdır

Pediatric-Onset Chronic Inflammatory Demyelinating Polyneuropathy: A Multicenter Study

Background: To evaluate the clinical features, demographic features, and treatment modalities of pediatric-onset chronic inflammatory demyelinating polyneuropathy (CIDP) in Turkey. Methods: The clinical data of patients between January 2010 and December 2021 were reviewed retrospectively. The patients were evaluated according to the Joint Task Force of the European Federation of Neurological Societies and the Peripheral Nerve Society Guideline on the management of CIDP (2021). In addition, patients with typical CIDP were divided into two groups according to the first-line treatment modalities (group 1: IVIg only, group 2: IVIg + steroid). The patients were further divided into two separate groups based on their magnetic resonance imaging (MRI) characteristics. Results: A total of 43 patients, 22 (51.2%) males and 21 (48.8%) females, were included in the study. There was a significant difference between pretreatment and post-treatment modified Rankin scale (mRS) scores (P 0.05); however, a significant decrease was found in the mRS scores of both groups with treatment (P < 0.05). The patients with abnormal MRI had significantly higher pretreatment mRS scores compared with the group with normal MRI (P < 0.05). Conclusions: This multicenter study demonstrated that first-line immunotherapy modalities (IVIg vs IVIg + steroids) had equal efficacy for the treatment of patients with CIDP. We also determined that MRI features might be associated with profound clinical features, but did not affect treatment response

Re-examining the characteristics of pediatric multiple sclerosis in the era of antibody-associated demyelinating syndromes.

Background: The discovery of anti-myelin oligodendrocyte glycoprotein (MOG)-IgG and anti-aquaporin 4 (AQP4)-IgG and the observation on certain patients previously diagnosed with multiple sclerosis (MS) actually have an antibody-mediated disease mandated re-evaluation of pediatric MS series. Aim: To describe the characteristics of recent pediatric MS cases by age groups and compare with the cohort established before 2015. Method: Data of pediatric MS patients diagnosed between 2015 and 2021 were collected from 44 pediatric neurology centers across Turkiye. Clinical and paraclinical features were compared between patients with dis-ease onset before 12 years (earlier onset) and >= 12 years (later onset) as well as between our current (2015-2021) and previous (< 2015) cohorts. Results: A total of 634 children (456 girls) were enrolled, 89 (14%) were of earlier onset. The earlier-onset group had lower female/male ratio, more frequent initial diagnosis of acute disseminated encephalomyelitis (ADEM), more frequent brainstem symptoms, longer interval between the first two attacks, less frequent spinal cord involvement on magnetic resonance imaging (MRI), and lower prevalence of cerebrospinal fluid (CSF)-restricted oligoclonal bands (OCBs). The earlier-onset group was less likely to respond to initial disease-modifying treatments. Compared to our previous cohort, the current series had fewer patients with onset < 12 years, initial presentation with ADEM-like features, brainstem or cerebellar symptoms, seizures, and spinal lesions on MRI. The female/male ratio, the frequency of sensorial symptoms, and CSF-restricted OCBs were higher than reported in our previous cohort. Conclusion: Pediatric MS starting before 12 years was less common than reported previously, likely due to exclusion of patients with antibody-mediated diseases. The results underline the importance of antibody testing and indicate pediatric MS may be a more homogeneous disorder and more similar to adult-onset MS than previously thought

Characteristics of pediatric multiple sclerosis: The Turkish pediatric multiple sclerosis database

Objective To document the clinical and paraclinical features of pediatric multiple sclerosis (MS) in Turkey. Methods Data of MS patients with onset before age 18 years (n = 193) were collected from 27 pediatric neurology centers throughout Turkey. Earlier-onset (<12 years) and later-onset (?12 years) groups were compared. Results There were 123 (63.7%) girls and 70 (36.3%) boys aged 4–17 years, median 14 years at disease onset. Family history of MS was 6.5%. The first presentation was polysymptomatic in 55.4% of patients, with brainstem syndromes (50.3%), sensory disturbances (44%), motor symptoms (33.2%), and optic neuritis (26.4%) as common initial manifestations. Nineteen children had facial paralysis and 10 had epileptic seizures at first attack; 21 (11%) were initially diagnosed with acute disseminated encephalomyelitis (ADEM). Oligoclonal bands were identified in 68% of patients. Magnetic resonance imaging revealed periventricular (96%), cortical/juxtacortical (64.2%), brainstem (63%), cerebellum (51.4%), and spinal cord (67%) involvement. Visual evoked potentials (VEP) were abnormal in 52%; serum 25-hydroxyvitamin D levels were low in 68.5% of patients. The earlier-onset group had a higher rate of infection/vaccination preceding initial attack, initial diagnosis of ADEM, longer interval between first 2 attacks, and more disability accumulating in the first 3 years of the disease. Conclusion Brainstem and cerebellum are common sites of clinical and radiological involvement in pediatric-onset MS. VEP abnormalities are frequent even in patients without history of optic neuropathy. Vitamin D status does not appear to affect the course in early disease. MS beginning before 12 years of age has certain characteristics in history and course