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

A systematic review of nonsurgical single-visit versus multiple-visit endodontic treatment

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Perceptions of single-visit and multiple-visit endodontic treatment: a survey of endodontic specialists and general dentists in Hong Kong

AIM: To study the preference of practice for single- and multiple-visit endodontic treatment by Hong Kong endodontists and general dental practitioners (GDPs), and to investigate their reasons for choosing single- or multiple-visit treatment in their practice. METHOD: An anonymous questionnaire was mailed to all 16 registered endodontists and 800 randomly selected GDPs in Hong Kong to explore their preference and reasons for selecting single- or multiple-visit endodontic treatment for their patients. Information on the use of magnifying loupes, microscopes and the number of years they have been in dental practice was also collected. RESULTS: Eight endodontists and 429 GDPs returned their questionnaires and the response rate was 50% and 53.6% respectively. Among the GDPs, 404 (94.2%) undertook endodontic treatment in their practices. For those performing endodontic treatment, the mean number of years of practice was 23.6 ± 4.8 for endodontists and 15.3 ± 9.1 for GDPs. Seven endodontists (87.5%) used a surgical microscope. For GDPs, only 25 (6.2%) used a surgical microscope and 123 (30.4%) used magnifying loupes during endodontic treatment. Seven endodontists (87.5%) and 375 GDPs (92.8%) predominantly performed multiple-visit treatment. The commonest reasons for choosing multiple-visit treatment for both endodontists and GDPs were the positive effects of interappointment medications (n = 3, 37.5%) and that the tooth to be treated had doubtful prognosis (n = 103, 25.5%). The commonest reason for choosing single-visit treatment for both endodontists and general dentists was that treatment could be completed in one visit (n = 4, 50%) and (n = 127, 31.4%). CONCLUSION: Most Hong Kong endodontists and GDPs preferred offering multiple-visit endodontic treatment.postprin

Oral health status and behaviours of children in rural districts of Cambodia

Objective: To describe the caries and periodontal status of children in rural Cambodia and to study their oral health habits. Method: Field examinations were conducted in Pailin, Kampong Thom and Kratie which are three rural districts in Cambodia. Children aged 6 and aged 12 were selected for report of caries status of primary and permanent teeth respectively. The periodontal status of the 12-year-old children in Kampong Thom and Kratie were assessed. A parental questionnaire survey was performed to study the children's tooth brushing habits, snacks habits and their diet. Results: A total of 120 6-year-old children and 196 12-year-old children were examined. The caries experience (dmft) of the 6-year-old children was 7.9±5.6. The caries experience (DMFT) of the 12-year-old children was 1.1±1.6 and all were untreated caries (DT). None of the surveyed 12-year-old children had healthy gums and 62% had calculus. A total of 316 questionnaires were collected. The result found 44% and 22% of the 6- and 12-year-old children had never brushed. Their meals were all mainly rice, soup and congee and snacks were not common. Conclusion: The caries experience of the 6-year-old children was high and most of the caries was untreated. The 12-year-old children had a mean score of 1.1 DMFT in their permanent teeth. They all had bleeding gums and more than half had calculus. Their oral health habits need to improve as many children never brushed their teeth. © 2008 FDI/World Dental Press.link_to_subscribed_fulltex

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

Treatment time for non-surgical endodontic therapy with or without a magnifying loupe

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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

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. METHODS: The paediatric epilepsy surgery programme ...published_or_final_versio

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

Prescribing trends and indications of antipsychotic medication in Hong Kong from 2004 to 2014: General and vulnerable patient groups

PURPOSE: Antipsychotic-prescribing patterns remain unclear in Asia. The aims of our study were to investigate prescribing trends of antipsychotic medication in the general population, children, and older patients by drug generation (first or second), the prescribing trend in pregnant women, the probable indication for antipsychotic prescription, and the prescribing trend by dosage form. METHODS: This descriptive study identified and included all patients prescribed with antipsychotic in Hong Kong from 2004 to 2014 using the Clinical Data Analysis and Report System. This study calculated and reported the prevalence of antipsychotic prescribing in patient groups of interest, the percentage with diagnoses of mental disorders were derived, and the prevalence of antipsychotic by dosage forms. RESULTS: The study included 10 109 206 prescriptions of any antipsychotics to 256 903 patients. Over the study period, the prevalence of antipsychotic prescribing increased from 1.06% to 1.54% in the general population, from 0.10% to 0.23% in children (3-17 years old), and from 2.61% to 3.26% in older patients (≥65 years old). The prevalence of second-generation antipsychotics increased, but the prevalence of first-generation antipsychotics did not. Prevalence of antipsychotic prescribing in prepregnancy, pregnancy, and postpartum timeframes varied from 0.18% to 0.38%. The percentage of incident prescriptions with a diagnosis of psychosis decreased from 54.1% to 47.5%. CONCLUSIONS: Antipsychotics have been increasingly prescribed in the general population, children, and older patients. There is an increase in second-generation antipsychotic prescribing. Over half of incident users had a recent diagnosis of a nonpsychotic mental disorder in 2014, suggesting that off-label prescribing of antipsychotics might be common. Copyright © 2017 John Wiley & Sons, Ltd