Post-Traumatic Headache in Children after Minor Head Trauma: Incidence, Phenotypes, and Risk Factors

Minor head trauma (MHT) is very frequent in children and post-traumatic headache (PTH) is one of its most common complications; however, its management is still a challenge. We aimed to assess the incidence and clinical characteristics of, and risk factors for, PTH among children referred to our pediatric emergency department (PED) for MHT. A total of 193 patients aged 3–14 years evaluated for MTH were enrolled and followed up for 6 months through phone calls and/or visits. PTH occurred in 25/193 patients (13%). PTH prevalence was significantly higher in school-aged (≥6 years) than in pre-school-aged children (21.6% vs. 4.9%, respectively, p < 0.009). Females were found to be more affected. The median time of onset was 4.6 days after MHT; resolution occurred in a median of 7 weeks. In 83.3% of patients, PTH subsided in <3 months, while in 16.7% it persisted longer. A total of 25% of children exhibited the migraine and 75% the tension-type variant. Our analysis indicates the presence of headache upon arrival in PED, isolated or associated with nausea and dizziness, as a factor predisposing the patient to the development of PTH. Our findings could be useful to identify children at risk for PTH for specific follow-up, family counseling, and treatment

Cefalee e sindromi correlate

La cefalea \ue8 il disturbo somatico riferito pi\uf9 frequentemente da bambini ed adolescenti. La prevalenza di cefalea in et\ue0 evolutiva \ue8 molto variabile compresa tra il 5.9% e l\u2019 82%. Le cefalee vengono distinte in primarie e secondarie. Nella stragrande maggioranza dei casi si tratta di cefalee primarie classificabili come emicranie o cefalee tensive.Il sistema di classificazione corrente \ue8 quello pubblicato dall\u2019International Headache Society (IHS) nel 2004, conosciuto come ICHD-II (International Classification of Headache Disorder). Il trattamento farmacologico delle cefalee in et\ue0 evolutiva consta di una terapia al bisogno ed una terapia profilattica da introdurre qualora la frequenza degli attacchi superi i 4 episodi al mese.L\u2019utilizzo di trattamenti non farmacologici in et\ue0 pediatrica nasce dall\u2019esigenza di avere una terapia scevra da effetti collaterali Tra le tecniche utilizzate va sicuramente annoverato il biofeedback una metodica attraverso cui il soggetto riceve informazioni sul suo stato biologico, che pu\uf2 modificare con il training.Un\u2019altra tecnica utilizzata \ue8 quella del relaxation training che comprende metodiche che si propongono il controllo della tensione muscolare o l\u2019induzione del rilassamento mentale. L\u2019ipnosi, analogamente alle tecniche di biofeedback, permette ai bambini una migliore gestione del dolore in situazione di emergenza

Levetiracetam in et\ue0 evolutiva

Viene presentata una casistica di 48 pazienti in et\ue0 pediatrica e adolescenziale che hanno utilizzati una recente molecola, il levetiracetam, nella terapia antiepilettica. Vengono riportati i risultati sulle crisi e la tollerabilit\ue0 del farmaco

Follow-up of bone mineral density and body composition in adolescents with restrictive anorexia nervosa: role of dual-energy X-ray absorptiometry

BACKGROUND/OBJECTIVES: Restrictive Anorexia nervosa (ANR) is an eating disorder (ED) characterized by a low bone mineral content (BMC) and by an alteration in body composition (reduction and abnormal distribution of fat mass\u2014FM and lean mass\u2014LM). The aim of our study was to address whether bone and body composition changes could be influenced by hormonal status and sport in female adolescents with restrictive anorexia nervosa-ANR. SUBJECTS/METHODS: Prospective study on 79 adolescents with ANR submitted to Dual Energy X-Ray Absorptiometry\u2014DXA at baseline-T0 and after 12 months-T12. Among the 46/79\u201458.2% patients that completed the study, we evaluated total and regional FM and LM%, as well as lumbar bone mineral density (BMD) and Z-score, linking them to clinical variables: menarche/amenorrhea/ hormonal therapy and physical activity. RESULTS: At T0: body mass index (BMI)\ubc16.4\ub11.4 kg/m2 with low levels of FM% (21.7\ub15.7) low BMC in 12/46\u201426.0% (mean Z-score: 1.21\ub11.27, with higher values related to physical activity\u2014P\ubc0.001). At T12: a significant increase in BMI\u2014P\ubc0.001, with LM reduction and FM increase (more evident in the trunk\u2014Po0.001); regarding bone, no significant changes were observed, though a tendency in terms of improvement associated with resumption of menses. CONCLUSIONS: After 1 year, weight recovery was not associated with a reestablishment of bone values; by contrast, it was associated with an increase and a distortion in FM distribution, more evident in trunk region (potential and adjunctive risk factor for the relapse of the psychiatric condition). The complexity of these clinical findings suggested DXA, a low-dose and low-cost technique, in long-term monitoring of ANR patients

Anorexia nervosa among first- and second-generation immigrant children and adolescents in Italy: treatment and clinical outcomes

PURPOSE: Cultural and environmental factors have frequently been implicated in the pathogenesis of Eating Disorders (ED). Although ED have been considered as "Western culture-bound syndromes", increasing rates of ED among non-Western groups are being documented. The present study aims to investigate treatment and clinical outcomes among first-generation immigrant children and adolescents (FGI) (patients born abroad) and second-generation immigrant youth (SGI, patients born in Italy) with Anorexia Nervosa (AN). METHODS: The study retrospectively compares treatment, hospitalizations, traumatic past events, clinical features, and treatment outcome (improvement in percentual body-mass index - %BMI) between FGI and SGI young patients with AN (10-18 years). Correlations were adjusted for age and severity (%BMI) at presentation. Treatments and outcomes were investigated at the baseline (T0), 2 weeks (T1), one month (T2), 3 months (T3), 6 months (T4), and 12 months (T5). RESULTS: Thirty-six patients (50% FGI) were enrolled. At T1 (F(1.26)=6.335, p=0.018), and at T2 (F(1.30)=18.752, p<0.001) FGI presented a significantly higher %BMI improvement than SGI. FGI required significantly less (OR=0.379, p=0.017), and shorter (F(1.32)=5.827, p=0.022) hospitalizations, when compared with SGI. CONCLUSIONS: When compared to SGI, FGI with AN required fewer and shorter hospitalizations and had a better early-treatment weight outcome. Larger nationwide studies should investigate the need for and access to treatment of immigrant populations with AN

Clinical features of benign infantile convulsions: familial and sporadic cases.

Objective: To give a contribution about the existence of non familial benign infantile convulsions during the first two years of life. Patients and Methods: We evaluated 58 patients (29 females and 29 males) with seizure onset ranging between 4 and 24 months of life, regular psychomotor development, unremarkable neuro-imaging studies and interictal electroencephalogram. We analyzed gender, age at onset, duration, manifestations and frequency of seizures, family history of febrile or infantile convulsions. Results: 17 patients had a family history of benign epilepsy, while 41 had not. Among the latter, 12 showed a family history of febrile seizures and the remaining 29 had an uncertain or fully negative familiarity with it. No clinical differences have been observed between the familial and the non familial groups. Nobody experienced seizures after the age of two and the psychomotor development remained normal in all patients, during follow-up. Conclusions: This study confirms the existence of non familial benign infantile convulsions and the benign outcome of this type of seizures either familial or non-familial. In addition to this, we also discuss the possibility to avoid anti-epileptic treatment

Audit of digestive complaints and psychopathological traits in patients with eating disorders: a prospective study

BACKGROUND: Esophago-gastrointestinal symptoms are frequently reported by patients with eating disorders. Scanty data exist on the relationship between psychopathological traits and digestive complaints. AIMS: To prospectively analyze (i) prevalence of digestive symptoms; (ii) psychopathological traits; (iii) relationship between symptom scores and psychopathological profiles. METHODS: Psychopathological and digestive symptom questionnaires were completed at baseline, at discharge, at 1 and 6 months' follow-up in 48 consecutive patients (85.4% female, median age, 15 years) hospitalized for eating disorders. RESULTS: The most frequently reported symptoms were postprandial fullness (96%) and abdominal distention (90%). Pooled esophageal (4; IQR 0-14) and gastrointestinal (34; IQR 19-53) symptoms significantly decreased at 6 months' follow-up (1; IQR 0-3 and 10; IQR 4-34; p<0.0001 and p<0.005, respectively). Pooled gastrointestinal symptoms significantly correlated with hypochondriasis (r=0.42, p<0.01). Both esophageal and gastrointestinal symptoms improved in patients with normal values of hypochondriasis and hysteria scales (p<0.05 and p<0.005, respectively) compared to those with pathological traits. CONCLUSIONS: Digestive symptoms are frequently reported by patients with eating disorders with their expression and outcome being influenced by psychopathological profiles. Hypochondriasis and hysteria traits are predictive factors for symptomatic improvement