Lapsuuden aivokasvaimen myöhäisvaikutukset

Lapsena aivokasvaimen sairastaneilla esiintyy runsaasti myöhäishaittoja, joista yleisimpiä ovat kognitiiviset ja neurologiset ongelmat sekä aineenvaihdunnan sairaudet.Kognitiiviset vaikeudet eivät välttämättä näy yleisessä päättelyssä, vaan voivat kohdistua vain keskittymiseen, muistiin tai prosessointinopeuteen.Sosiaaliset ongelmat sekä oppimis- ja työllistymisvaikeudet heikentävät osan potilaista elämänlaatua merkittävästi.Myös fyysinen suorituskyky saattaa olla selvästi heikentynyt

Child neurology services for children with epilepsy in Finland

ObjectiveThe aim of the study was to describe healthcare organization, training of and needs for child neurologists, patient accessibility to services, and treatment paths of children with epilepsy in Finland.MethodsData were collected from all geographic healthcare areas over Finland on training capacity in child neurology, number and density of child neurologists, and availability and accessibility of child neurological services. Data sources included the National Physician Register, Central Register of Healthcare Professionals of National Supervisory Authority for Welfare and Health, and phone and email inquiries to the heads of public healthcare units.ResultsThe overall density of child neurologists in Finland was 11.9/100 000 children aged 0‐15 years or 8402 children per child neurologist (in 2018). There is a remarkable geographic variation, from 7.1 in northern Finland to 15.6 in the metropolitan area. However, waiting times for the treatment are virtually the same all over the country. According to the Finnish current practice recommendation from the year 2013 and again 2020, children with any first nonfebrile or complicated febrile epileptic seizure are invariably admitted to hospital for evaluation. Children with simple febrile seizures are recommended to be treated as outpatients by general practitioners or by experienced pediatricians.SignificanceChild neurology services are today well provided and organized in Finland. While there is geographic variation in the number of child neurologists, the accessibility is virtually the same all over the country. A gap between the numbers of specialists at near‐to‐retire age and those in training is a challenge.</p

Food allergy in a child with de novo KAT6A mutation

Crying combined with miscellaneous gastrointestinal symptoms are typical symptoms of infant with food allergy, but are also common among children with abnormal neurological development. Mutations in KAT6A gene is known to cause a syndrome characterized by developmental delay, hypotonia, cardiac defects, microcephaly, specific facial features and early feeding problems. However, these feeding problems have not earlier been specified. We present the first reported case of a DBPCFC confirmed food allergy in a child with KAT6A mutation whose feeding problems resolved with elimination diet. The present case does not establish proof of cause, but highlights the importance of careful clinical diagnostics despite other possible causes for feeding problems. Recognizing that early feeding problems these patients regularly have might be caused by food allergy is important for outcome and quality of life for these patients

Cognitive functions and symptoms predicting later use of psychiatric services following mild traumatic brain injury in school-age

Objective To investigate whether neuropsychological test performance or presence of some specific injury symptoms at 1-3 months following pediatric mild traumatic brain injury (mTBI) can help to identify the children at risk for developing post-traumatic psychiatric symptoms. Methods Data from 120 children and adolescents aged 7-15 years, treated at Turku University Hospital between 2010 and 2016 due to mTBI, and who had undergone neuropsychological evaluation at 1-3 months following injury, were enrolled from the hospital records. Neuropsychological test performancesand injury symptom reports were retrospectively retrieved from the patient files. Results Slow information processing speed (p = 0.044), emotion regulation deficit (p = 0.014), impulsivity (p = 0.013), verbal processing difficulties (p = 0.042) and headache (p = 0.026) were independent predictors for having later contact in psychiatric care. Conclusions Neuropsychological examination containing measure of information processing speed, injury symptom interview, and parental questionnaires on behavioural issues of the child at 1-3 months following mTBI seems to be useful in detecting children with risk for post traumatic psychiatric symptoms. Targeted support and guidance for this group of children and adolescents and their families are recommended to prevent the development of an unfavorable psychosocial outcome.Peer reviewe

Unenaikainen aivojen sähköinen purkaustoiminta lapsen kognitiivisen suoriutumiskyvyn heikkenemisen ja käytösoireiden syynä

TAUSTA : Jatkuva unenaikainen purkaustoiminta aivosähkökäyrässä (EEG) ja siitä johtuva CSWS-oireyhtymä ovat joskus lapsen epilepsiaan liittyvä ilmiö, jonka vaikutuksesta oppiminen, käytös, vireys ja tarkkaavaisuus huononevat huomattavasti. Tutkimme CSWS-oireyhtymän syitä, hoitoa ja tuloksia omassa potilasaineistossamme. POTILAAT JA MENETELMÄ : Tyksin aineistosta kerättiin ajalta 2006-2016 CSWS-potilaiden sairauskertomustiedot. Kriteerit täyttäneitä potilaita oli 17, ja heitä seurattiin 1,5-9 vuotta. TULOKSET : CSWS:n taustalla on geneettisiä ja hankinnaisia pre- ja perinataalisia syitä. Yhdeksällä potilaalla oli rakenteellisia aivomuutoksia, kuten polymikrogyriaa, talamushypoplasiaa, hydrokefalusta taikka aivoverenvuodon tai -infarktin jälkitila. Kahdeksalla potilaalla CSWS:n alkamista edelsi lääkitys natriumkanavan salpaajalla. Seurannassa todettiin kognitiivisen suoriutumiskyvyn heikkenemistä, ja kymmenen lasta suoriutui kehitysvammaisen tasolla. Kymmenestä potilaasta yhdeksän EEG normaalistui murrosiässä. ​​​​​​​PÄÄTELMÄT : Epilepsiaa sairastavan lapsen kognitiivisen suoriutumiskyvyn heikkenemisen ja käytösmuutosten taustalla tulisi osata epäillä CSWS-oireyhtymää.</p

Lasten ja nuorten krooninen väsymysoireyhtymä

Kroonista väsymysoireyhtymää pidetään toiminnallisena häiriönä. Etiologia on todennäköisesti monitekijäinen. Oikea-aikainen diagnoosi parantaa potilaan ennustetta ja kuntoutumista. Tutkitusti tehokasta hoitoa ei vielä ole. Hoidosta vastaa lasten ja nuorten hoitoon perehtynyt moniammatillinen tiimi. Tavoitteena on arjen toimintakyvyn tukeminen tai palauttaminen pitkäkestoisen, kuuntelevan ja luottamuksellisen hoitosuhteen avulla.Peer reviewe

Lasten ja nuorten krooninen väsymysoireyhtymä

Kroonista väsymysoireyhtymää pidetään toiminnallisena häiriönä. Etiologia on todennäköisesti monitekijäinen.Oikea-aikainen diagnoosi parantaa potilaan ennustetta ja kuntoutumista. Tutkitusti tehokasta hoitoa ei vielä ole.Hoidosta vastaa lasten ja nuorten hoitoon perehtynyt moniammatillinen tiimi.Tavoitteena on arjen toimintakyvyn tukeminen tai palauttaminen pitkäkestoisen, kuuntelevan ja luottamuksellisen hoitosuhteen avulla

Neurological and Cognitive Performance After Childhood Encephalitis

Background: Children with encephalitis have increased risk for long-term neurological sequelae. We investigated minor neurological dysfunction (MND) and cognitive performance as a measurement for long-term outcome of encephalitis in childhood.Materials and Methods: Children with encephalitis (n = 98) treated in Turku University Hospital during the years 1995–2016 were retrospectively identified. We included the patients without severe developmental delay before the encephalitis and without recorded neurological disability caused by encephalitis. MND was assessed using the Touwen examination. Age-appropriate Wechsler Intelligence Scale was used to determine the full-scale intelligence quotient (IQ). Residual symptoms in everyday life were evaluated using a questionnaire.Results: Forty-two subjects participated in the study and returned the questionnaire regarding residual symptoms. The median age was 4.3 years at the time of encephalitis, and 11.3 years at the time of the Touwen examination (n = 41) and the cognitive assessment (n = 38). The Touwen examination indicated MND in 29 of 41 participants (71%; simple MND in 16 and complex MND in 13 patients). The median full-scale IQ was lower in participants with MND compared with participants without MND (98 vs. 110, p = 0.02). Participants with IQ n = 5) had lower median age at acute encephalitis compared to participants with IQ ≥ 85 (n = 33) (1.8 vs. 5.3 years, p = 0.03). Problems in daily performance were reported in participant with MND (p = 0.2) and low full-scale IQ (p = 0.008).Conclusions: The prevalence of MND was high and it was related to lower cognitive performance after childhood encephalitis. Younger age at acute encephalitis was a risk factor for lower cognitive performance.</p

Neuroimaging and neurological outcome of children with acute encephalitis

Aim: To investigate the severity of acute phase magnetic resonance imaging (MRI) findings and severity of acute illness as risk factors for disability after recovery from encephalitis.Method: Children  with  encephalitis  (n  =  98;  median  age  6  years  10  months,  inter-quartile  range  3  years–11  years  6  months;  59  males,  39  females)  treated  in  Turku  University Hospital during the years 1995 to 2016 were identified in this retrospec-tive cohort study. The acute phase (1  year  from  discharge)  follow-up  was  as-sessed from medical records using the Glasgow Outcome Scale.Results: Long-term recovery was poor in 24 of 82 (29%) children with follow-up data. Two children died, eight had severe disability, and 14 had moderate disability. Acute phase MRI was available for re-evaluation from 74 of 82 patients with follow-up data. The increasing severity of MRI findings was associated with need for ventilator ther-apy and with poor recovery.Interpretation: The risk for poor recovery in paediatric encephalitis is high, and it is associated with the severity of MRI findings.</p

Cognitive functions and symptoms predicting later use of psychiatric services following mild traumatic brain injury in school-age

Objective: To investigate whether neuropsychological test performance or presence of some specific injury symptoms at 1-3 months following pediatric mild traumatic brain injury (mTBI) can help to identify the children at risk for developing post-traumatic psychiatric symptoms.Methods: Data from 120 children and adolescents aged 7-15 years, treated at Turku University Hospital between 2010 and 2016 due to mTBI, and who had undergone neuropsychological evaluation at 1-3 months following injury, were enrolled from the hospital records. Neuropsychological test performancesand injury symptom reports were retrospectively retrieved from the patient files.Results: Slow information processing speed (p = 0.044), emotion regulation deficit (p = 0.014), impulsivity (p = 0.013), verbal processing difficulties (p = 0.042) and headache (p = 0.026) were independent predictors for having later contact in psychiatric care.Conclusions: Neuropsychological examination containing measure of information processing speed, injury symptom interview, and parental questionnaires on behavioural issues of the child at 1-3 months following mTBI seems to be useful in detecting children with risk for post traumatic psychiatric symptoms. Targeted support and guidance for this group of children and adolescents and their families are recommended to prevent the development of an unfavorable psychosocial outcome.Keywords: Traumatic brain injury; adolescents; children; mild traumatic brain injury; pediatric; psychiatric.</p