Background: Self injurious behaviour (SIB), the deliberate, repetitive infliction of self harm, is present in a wide variety of neuropsychiatric disorders, including Tourette syndrome (TS). Although ...SIB occurs in up to 60% of individuals with TS, and can cause significant clinical impairment and distress, little is known about its aetiology. Objective: This study examined the relationship between SIB and other behavioural features that commonly co-occur with TS in nearly 300 subjects with TS participating in three genetic studies. SIB, obsessions, compulsions, tic severity, attention deficit hyperactivity disorder related impulsivity, risk taking behaviours, and rages were systematically assessed in all subjects. Methods: Using logistic regression, a best fit model was determined for both mild to moderate SIB and severe SIB. Results: Mild/moderate SIB in TS was correlated with the presence of obsessive and compulsive symptoms such as the presence of aggressive obsessions or violent or aggressive compulsions, and with the presence of obsessive−compulsive disorder and overall number of obsessions. Severe SIB in TS was correlated with variables related to affect or impulse dysregulation; in particular, with the presence of episodic rages and risk taking behaviours. Both mild/moderate and severe SIB were also correlated with tic severity. Conclusions: This study suggests that mild/moderate and severe SIB in TS may represent different phenomena, which has implications for clinical management of these symptoms.
Children with learning disabilities form a large pool of patients seen by neurologists for help in understanding the disability and deciding which forms of remediation are appropriate. Learning ...disabilities may accompany a large variety of other neurologic disabilities, but the usual child with such a problem is in excellent health. A thorough office evaluation for possible medical problems is always necessary, but most children do not require laboratory testing. All children with learning disabilities, whether or not they have accompanying neurologic problems, should be seen for psychological and/or educational evaluation. Some children may also benefit from an evaluation by a speech and language pathologist, occupational therapist, or ophthalmologist. The neurologist, alone or in association with a child psychologist, should also investigate the possible association of learning disabilities with attention deficit hyperactivity disorder. It is only for children with this component of learning problems that the possibility of medication arises. Working closely with the family, the child's school system, and other involved professionals becomes an important aspect of providing full and necessary help to children with learning disabilities. A caring physician can be a major help to the child and his family in understanding this disorder and supporting them during a difficult time.
The Committees on Substance Abuse and Children with Disabilities of the American Academy of Pediatrics statement on the effects, prevention and treatment of fetal alcohol syndrome and fetal alcohol ...effects are presented in this article
Three pediatric patients with generalized status epilepticus unresponsive to therapy with conventional anticonvulsants were successfully treated with moderate hypothermia (30 degrees to 31 degrees C) ...and barbiturate coma with thiopental. All 3 patients were treated with thiopental at doses producing burst suppression or an isoelectric tracing on the EEG and thiopental and barbiturate levels were followed sequentially in the plasma. Continuous thiopental infusion rates of 5 to 55 mg/kg X h maintained burst suppression and correlated with plasma thiopental levels of 25 to 40 mg/dl. Total doses of thiopental used to obtain and maintain burst suppression ranged from 15 to 50 g over 48 to 120 h. In all 3 patients, control of the status epilepticus was obtained. Moderate hypothermia and thiopental barbiturate coma are indicated in patients with generalized tonic-clonic status epilepticus which cannot be controlled with standard anticonvulsant drug therapy. This regimen has the advantage that the patient can be managed in an ICU without the need for general anesthesia with volatile anesthetic agents.
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