| 1. |
- Källén, Kristina, et al.
(författare)
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Behandling av terapiresistent epilepsi - ett multiprofessionellt samarbete
- 2007
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Ingår i: Incitament : för en hälso- & sjukvård i förvandling. - 1103-503X. ; 16:1, s. 25-25
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Epilepsi är den vanligaste neurologiska sjukdomen efter stroke och huvudvärk, ca 60 000 personer har aktiv epilepsi i Sverige. Vi har idag tillgång till en rad mycket effektiva läkemedel, bara sedan 1989 har åtta nya epilepsimediciner registrerats. Trots den utvidgade behandlingsarsenalen bli bara två av tre patienter anfallsfria av läkemedel, för en tredjedel fortsätter anfallen att komma. Vid farmakologiskt terapiresistent epilepsi finns andra behandlingsalternativ.
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| 2. |
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| 3. |
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| 4. |
- Elfving, Maria, et al.
(författare)
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Ectopic recurrence of a craniopharyngioma in a 15-year-old girl 9 years after surgery and conventional radiotherapy: case report.
- 2011
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Ingår i: Child's Nervous System. - : Springer Science and Business Media LLC. - 1433-0350 .- 0256-7040. ; 27, s. 845-851
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Tidskriftsartikel (refereegranskat)abstract
- This 15-year-old girl was operated due to an ectopic recurrence of a craniopharyngioma along the previous surgical route. She presented with a sellar craniopharyngioma at the age of 4 years and underwent a right subfrontal craniotomy. Two and a half years later she had a local recurrence in the sella that was resected along the same surgical route. Postoperative cranial radiotherapy was administered with 50 Gy divided into 28 fractions. Nine years later, magnetic resonance imaging (MRI) revealed a local recurrence within the sella together with a supraorbital cystic mass. Both tumors were surgically removed. Microscopic examination revealed recurrence of an adamantinous craniopharyngioma at both localisations. Histopathological preparations showed a higher MIB-1 index at the simultaneous recurrences in the sella and in the frontal lobe and also an elevated focal p53 expression, compared to previous operations, suggesting a transformation to a more aggressive tumor. This is the first case report of ectopic recurrence in a child that had received conventional radiotherapy of 50 Gy to the sella. Careful intra-operative procedure is probably crucial for preventing ectopic recurrences. The future will reveal if the transsphenoidal surgical route will put an end to ectopic tumor recurrence in patients with a craniopharyngioma.
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| 5. |
- Hallböök, Tove, et al.
(författare)
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Beneficial effects on sleep of vagus nerve stimulation in children with therapy resistant epilepsy.
- 2005
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Ingår i: European Journal of Paediatric Neurology. - : Elsevier BV. - 1090-3798. ; 9:6, s. 399-407
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Tidskriftsartikel (refereegranskat)abstract
- The study purpose was to evaluate sleep structure following Vagus Nerve Stimulation (VNS) in 15 children with therapy resistant epilepsy and to correlate possible alterations with changes in epileptiform activity and clinical effects. Fifteen children were examined with ambulatory polysomnographic recordings initially, and after 3 and 9 months of VNS-treatment. Sleep parameters, all-night delta power activity and movement times (MTs), used to account for arousals were estimated. Epileptiform activity was evaluated by spike detection. Seizure frequency was recorded in a diary. The severity of the seizures was scored with the National Hospital Seizure Severity Scale (NHS3). Quality of life (QOL) was assessed by a visual analogue scale. Behaviour problems were quantified by using the total score of the Child Behaviour Checklist (CBCL). VNS induces a significant increase in slow wave sleep (SWS) and a decrease in sleep latency and in stage 1 sleep. The number and density of MTs during total night sleep were significantly increased. There was also a significant increase in the number of MTs immediately related to the VNS stimulation periods. Of the 14 children with increased MTs, 10 had a reduction in epileptiform activity, and in clinical seizures, all had an improvement in NHS3, and 11 in QOL. Of the 10 children with increased SWS, eight also improved in QOL and eight in behaviour. Our findings indicate that VNS counteracts known adverse effects of epilepsy on sleep and increases slow wave sleep. This possibly contributes to the reported improvement in well-being. We also see an increase in MTs. This arousal effect seems to be of minor importance for QOL and could possibly be related to the antiepileptic mechanisms in VNS.
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| 6. |
- Hallböök, Tove, et al.
(författare)
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Long term effects on epileptiform activity with vagus nerve stimulation in children.
- 2005
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Ingår i: Seizure. - : Elsevier BV. - 1532-2688 .- 1059-1311. ; 14:8, s. 527-533
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: We report tong-term effects of vagus nerve stimulation (VNS) on epileptiform activity in 15 children, and how these changes are related to activity stage and to clinical effects on seizure reduction, seizure severity (NHS3) and quality of life (QOL). Methods: Initially, and after 3 and 9 months of VNS-treatment, 15 children were investigated with 24 h ambulatory EEG monitoring for spike detection. The number of interictal epiteptiform discharges (IEDs) and the inter spike intervals (ISIs) were analysed during 2 h in the awake state, and 1 h of rapid eye movement (REM)-, spindle- and delta-steep, respectively. Total number and duration of electrographic seizure episodes were also analysed. Results: At 9 months the total number of IEDs was significantly reduced (p = 0.04). There was a tendency of reduction in all activity stages, and significantly so in delta-steep (p = 0.008). Total etectrographic seizure number was significantly reduced in the 24 h EEG at 3 and 9 months (p = 0.03, 0.05). There was a significant concordance in direction of changes in epileptiform activity and etectrographic seizures at 9 months (p = 0.04). Concordance in direction of changes was seen in 9 of 15 children between clinical seizures and IED (p > 0.3), in 10 of 15 children between QOL and IED (p = 0.3) and in 8 of 15 children between NHS3 and IED (p > 0.3). There was no direct correlation between the extent of improvement in these clinical data and the degree of spike reduction. Conclusion: This study shows that VNS reduces IEDs especially in REM and delta steep, as well as the number of electrographic seizures. It also shows a concordance between reduction in IEDs and etectrographic seizures.
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| 7. |
- Hallböök, Tove, et al.
(författare)
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Vagus nerve stimulation in 15 children with therapy resistant epilepsy; its impact on cognition, quality of life, behaviour and mood.
- 2005
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Ingår i: Seizure. - : Elsevier BV. - 1532-2688 .- 1059-1311. ; 14:Feb 19, s. 504-513
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Vagus nerve stimulation (VNS) is a neurophysiologic treatment for patients with refractory epilepsy. There is growing evidence of additional quality of life (QOL) benefits of VNS. We report the effects of VNS on seizure frequency and severity and how these changes are related to cognitive abilities, QOL, behaviour and mood in 15 children with medically refractory and for surgery not eligible epilepsy. METHODS: Initially, and after 3 and 9 months of VNS-treatment, 15 children were investigated with Bayley Scales of Infant Development (BSID), Wechsler Preschool and Primary Scale of Intelligence (WPPSI-R), Wechlser Intelligence Scales for Children (WISC-III) depending on the child's level of functioning, a Visual Analogue Scale for validating QOL, Child Behaviour Checklist (CBCL) for quantifying behaviour problems, Dodrill Mood Analogue Scale and Birleson Depression Self-Rating Scale, and the National Hospital Seizure Severity Scale (NHS3). A diary of seizure frequency was collected. RESULTS: Six of 15 children showed a 50% or more reduction in seizure frequency; one of these became seizure-free. Two children had a 25-50% seizure reduction. Two children showed increased seizure frequency. In 13 of 15 children there was an improvement in NHS3. The parents reported shorter duration of seizure and recovery phase. There were no changes in cognitive functioning. Twelve children showed an improvement in QOL. Eleven of these also improved in seizure severity and mood and five also in depressive parameters. CONCLUSION: This study has shown a good anti-seizure effect of VNS, an improvement in seizure severity and in QOL and a tendency to improvement over time regarding behaviour, mood and depressive parameters. The improvement in seizure severity, QOL, behaviour, mood and depressive parameters was not related to the anti-seizure effect.
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| 8. |
- Hesselgard, Karin, et al.
(författare)
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Morphine with or without a local anaesthetic for postoperative intrathecal pain treatment after selective dorsal rhizotomy in children
- 2001
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Ingår i: Paediatric Anaesthesia. - : Wiley. - 1460-9592. ; 11:1, s. 75-79
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Tidskriftsartikel (refereegranskat)abstract
- Selective dorsal rhizotomy is a surgical procedure with a selective division of posterior spinal nerve rootlets to treat spasticity in children. The extensive surgical procedure with multilevel laminectomies and the nerve root manipulation result in intense pain postoperatively. Two intrathecal (IT) regimes of pain treatment were compared in these children, concerning their pain relief and possible side-effects. In a prospective study, 12 children (3-6 years of age) with six in each group, received either intermittent IT morphine (5 microg x kg(-1) four times a day) or continuous infusion of a mixture of bupivacaine (40 microg x kg(-1) x h(-1)) and morphine (0.6 microg x kg(-1) x h(-1)). Pain score was lower in the bupivacaine/morphine group (0.2 +/- 1.1) compared to intermittent morphine (2 +/- 2.4) on a scale from 0 to 6 (P less than or = 0.0001). Bupivacaine/morphine resulted in a lower, but not significant, difference in pruritus and lower muscle spasm. Haemodynamic and ventilatory parameters did not differ between the groups. Intrathecal continuous infusion of bupivacaine and morphine was superior to intermittent morphine in the treatment of pain after selective dorsal rhizotomy operations.
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| 9. |
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| 10. |
- Hesselgard, Karin, et al.
(författare)
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Selective dorsal rhizotomy and postoperative pain management. A worldwide survey.
- 2007
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Ingår i: Pediatric Neurosurgery. - : S. Karger AG. - 1016-2291 .- 1423-0305. ; 43:2, s. 107-112
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Tidskriftsartikel (refereegranskat)abstract
- Background: Selective dorsal rhizotomy (SDR) is an operation method that decreases the degree of spasticity with long-lasting beneficial effects for children with spastic diplegia. Children undergoing SDR are postoperatively in severe pain, a pain related to both the extensive surgical exposure with multilevel laminectomy and the nerve root manipulation. Various pain management strategies for children undergoing SDR have been published. The postoperative pain treatment is a vital part of the management. The aim of this study was to estimate the number of centers performing SDR, the frequency of SDR surgery and to investigate pain management of the different centers. Methods: A questionnaire comprising 7 questions was sent by mail and/or e-mail to a total of 59 potential centers performing SDR, centers that have published material concerning SDR or centers that have been recommended. Forty-seven (80%) centers responded to the questionnaire; 11 of them do not presently perform SDR surgery, and the remaining 36 centers constitute the material of the present study. Results: 23 of the 36 centers use Peacock's operation technique and 8 centers use Park's technique. Continuous intravenous infusion of opioids for postoperative pain treatment is used by 17 (47%) of the centers. Seven (19%) centers use the epidural (ED) approach for treating postoperative pain and 6 (17%) centers use intrathecal (IT) pain treatment. The duration of intravenous ED or IT pain relief ranged from 24 h up to 7 days. To evaluate pain relief, 25 (70%) centers used some form of pain scale. Conclusion: The most common operation techniques in use today are described by Peacock or by Park, with an estimated number of procedures of more than 487/year in 36 centers. The majority of the centers seem to have a satisfactory pain management strategy. These centers administer continuous infusions of opioids, with an intravenous, ED or IT approach, and incorporate the use of a pain assessment tool to evaluate pain relief. Copyright (c) 2007 S. Karger AG, Basel
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