Therapy-resistant cluster headache in childhood: case report and literature review

The mean age of onset of cluster headache (CH) is in the late third decade. Only few cases of childhood-onset (<14 years) CH have been reported in the literature. We report the case of an 11-year-old boy who suffered from sudden attacks of shock-like, intense pain, localized in the right orbital region, with associated photophobia, phonophobia, conjunctival injection, lacrimation, nasal congestion, rhinorrhoea and psychomotor agitation. The episodes lasted 60–180 min, and the headache frequency was one to three per day. Physical and neurological examinations, magnetic resonance imaging and blood examinations were normal. The first bout lasted 8 months. Attacks were resistant to every symptomatic and partially to prophylactic treatment that has been tried. The second bout lasted approximately 2 months

Abilities of preschoolers: comparing different tools

<p>Abstract</p> <p>Background</p> <p>There is a strong need for studies evaluating tests in terms both of psychometric properties (i.e. their efficacy or ability to be helpful in reaching a diagnosis) and of their cost-effectiveness (i.e. their efficiency). These data are essential for planning a correct evaluation to identify children's needs (both educational and abilitative).</p> <p>Methods</p> <p>We evaluated 58 children attending for the first time the last year of the Scuola dell'Infanzia. Parental view was obtained with Child Behaviour Check-List and Conners' Rating Scales - Revised, and family socio-economic status was evaluated using Hollingshead's Four Factor Index; teacher compiled the IPDA questionnaire; children were administered Raven's Progressive Matrices, Modified Bell Cancellation Test, BVN 5-11 (a neuropsychological battery).</p> <p>Results</p> <p>A correlational analysis was conducted using Spearman's Rho (since variables were not normally distributed). These asymptomatic children show a good global cognitive functioning, but also a deficit of attention and of Executive Functions. Some of the tests used seem more cost-effective than others and there are some redundancies in information obtained.</p> <p>Conclusions</p> <p>Our data show that there are significant correlations between different neuropsychological and behavioural measures. It is therefore possible to rationalize diagnostic protocols without a significant information reduction. A deeper analysis will require a preliminary definition of the psychometric properties of used tools.</p

Terapia per mezzo del cavallo e terapia neuropsicomotoria: una possibile integrazione?

La Terapia per Mezzo del Cavallo (TMC) è un complesso di tecniche riabilitative che permette di superare danni sensoriali, cognitivi e comportamentali attraverso lo svolgimento di un’attività ludico-sportiva che ha come mezzo il cavallo. In questo lavoro viene proposta una possibile integrazione di questa tecnica con l’intervento neuropsicomotorio tradizionale, sulla base di obiettivi di intervento comuni (controllo posturale/equilibrio, carico/passaggi posturali, tono muscolare, attività selettiva/coordinazione, stimolazione propriocettiva/schema corporeo) e di una competenza specifica da parte dei terapisti coinvolti

Headache and Comorbidity in Children and Adolescents

Headache is one of the most common neurological symptom reported in childhood and adolescence, leading to high levels of school absences and being associated with several comorbid conditions, particularly in neurological, psychiatric and cardiovascular systems. Neurological and psychiatric disorders, that are associated with migraine, are mainly depression, anxiety disorders, epilepsy and sleep disorders, ADHD and Tourette syndrome. It also has been shown an association with atopic disease and cardiovascular disease, especially ischemic stroke and patent foramen ovale (PFO)

The 2q23.1 microdeletion syndrome: clinical and behavioural phenotype

Six submicroscopic deletions comprising chromosome band 2q23.1 in patients with severe mental retardation (MR), short stature, microcephaly and epilepsy have been reported, suggesting that haploinsufficiency of one or more genes in the 2q23.1 region might be responsible for the common phenotypic features in these patients. In this study, we report the molecular and clinical characterisation of nine new 2q23.1 deletion patients and a clinical update on two previously reported patients. All patients were mentally retarded with pronounced speech delay and additional abnormalities including short stature, seizures, microcephaly and coarse facies. The majority of cases presented with stereotypic repetitive behaviour, a disturbed sleep pattern and a broad-based gait. These features led to the initial clinical impression of Angelman, Rett or Smith–Magenis syndromes in several patients. The overlapping 2q23.1 deletion region in all 15 patients comprises only one gene, namely, MBD5. Interestingly, MBD5 is a member of the methyl CpG-binding domain protein family, which also comprises MECP2, mutated in Rett's syndrome. Another gene in the 2q23.1 region, EPC2, was deleted in 12 patients who had a broader phenotype than those with a deletion of MBD5 only. EPC2 is a member of the polycomb protein family, involved in heterochromatin formation and might be involved in causing MR. Patients with a 2q23.1 microdeletion present with a variable phenotype and the diagnosis should be considered in mentally retarded children with coarse facies, seizures, disturbed sleeping patterns and additional specific behavioural problems

SICOB-endorsed national Delphi consensus on obesity treatment optimization: focus on diagnosis, pre-operative management, and weight regain/insufficient weight loss approach

PurposeOverweight and obesity affects 60% of adults causing more than 1.2 million deaths across world every year. Fight against involved different specialist figures and multiple are the approved weapons. Aim of the present survey endorsed by the Italian Society of Bariatric Surgery (SICOB) is to reach a national consensus on obesity treatment optimization through a Delphi process.MethodsEleven key opinion leaders (KOLs) identified 22 statements with a major need of clarification and debate. The explored pathways were: (1) Management of patient candidate to bariatric/metabolic surgery (BMS); (2) Management of patient not eligible for BMS; (3) Management of patient with short-term (2 years) weight regain (WR) or insufficient weight loss (IWL); (4) Management of the patient with medium-term (5 years) WR; and (5) Association between drugs and BMS as WR prevention. The questionnaire was distributed to 65 national experts via an online platform with anonymized results.Results54 out of 65 invited panelists (83%) respond. Positive consensus was reached for 18/22 statements (82%); while, negative consensus (s20.4; s21.5) and no consensus (s11.5, s17) were reached for 2 statements, respectively (9%).ConclusionThe Delphi results underline the importance of first-line interdisciplinary management, with large pre-treatment examination, and establish a common opinion on how to properly manage post-operative IWL/WR