Infantile Spasms and Injuries of Prematurity: Short-Term Treatment-Based Response and Long-Term Outcomes

The association of infantile spasms and periventricular leukomalacia and/or intraventricular hemorrhage is well documented. Data regarding early treatment-based and long-term outcomes are limited. A retrospective chart review identified children with infantile spasms born prematurely (<37 weeks) with diagnoses of periventricular leukomalacia and/or intraventricular hemorrhage. Thirteen children were included. Median gestational age was 30 weeks and age of onset of infantile spasms was 8 months. Nine children had intraventricular hemorrhage, 10 had periventricular leukomalacia, and 6 children had both. Twelve of 13 children had resolution of spasms. In responders, the successful medication was adrenocorticotropic hormone (ACTH) in 7, topiramate in 3, and vigabatrin in 2. Follow-up after a median of 7.1 years found that all patients had developmental delay but only 1 had refractory epilepsy. Standard therapies (ACTH and vigabatrin) appeared to be more effective than other treatments. Developmental delay is common in children with periventricular leukomalacia / intraventricular hemorrhage and infantile spasms, but refractory epilepsy might be less frequent.

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The Natural History of Back Pain after a Randomised Controlled Trial of Acupuncture Vs Usual Care – Long Term Outcomes

Acupuncture in Medicine ◽

10.1136/aim.25.4.121 ◽

2007 ◽

Vol 25 (4) ◽

pp. 121-129 ◽

Cited By ~ 6

Author(s):

Stephanie L Prady ◽

Kate Thomas ◽

Lisa Esmonde ◽

Simon Crouch ◽

Hugh MacPherson

Keyword(s):

Back Pain ◽

Randomised Controlled Trial ◽

Usual Care ◽

Controlled Trial ◽

Bodily Pain ◽

Care Group ◽

Long Term Outcomes ◽

Short Term Treatment ◽

Randomised Controlled

Introduction There is growing evidence about the effectiveness of acupuncture in the short term treatment of chronic low back pain but little is known about long term outcomes. To address this question we followed up participants of a past randomised controlled trial of acupuncture to assess outcomes after 5.5 to 7 years. Methods A postal questionnaire assessing pain, quality of life, disability, experience with back pain and healthcare resource use was sent to all 239 participants of the York Acupuncture for Back Pain trial. Results Response to the survey was low at 43.9%. Pain measured by the SF-36 Bodily Pain dimension was maintained in the acupuncture group since the last follow up 3.5 to 5 years previously. The usual care group had improved over the intervening years and there was now no evidence of a difference between the groups (difference −0.4 points, 95% confidence interval −10.1 to 9.7). The results were unchanged on sensitivity analysis using multiple imputation. In both groups back pain had not completely resolved and worry about back health was moderate. Physiotherapy and acupuncture were used at similar rates for continuing treatment. Discussion We theorise that exposure to a short course of acupuncture speeds natural recovery from a back pain episode, but improvements plateau after two years. Acupuncture is often accessed privately for long term management of back pain but is rarely available within the health service. While our study methods were robust, the low response rate means that our findings should be interpreted with caution.

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Visualization of immature brain lesions: MR patterns of long-term outcomes. Case reports

L.O. Badalyan Neurological Journal ◽

10.46563/2686-8997-2021-2-2-94-99 ◽

2021 ◽

Vol 2 (2) ◽

pp. 94-99

Author(s):

Anatoly V. Anikin ◽

Milana A. Basargina ◽

Eugeniya V. Uvakina

Keyword(s):

White Matter ◽

Premature Infants ◽

Periventricular Leukomalacia ◽

Brain Magnetic Resonance Imaging ◽

Brain Lesions ◽

Gestation Period ◽

Long Term Outcomes ◽

Immature Brain ◽

The Brain

The periventricular and deep white matter of the immature brain of premature infants has an increased vulnerability to various, primarily ischemic injuries. The leading mechanism of selective vulnerability of the white matter of the large hemispheres in children with a low gestation period is the lack of formation of adjacent blood circulation zones between the main arteries of the developing brain. Magnetic resonance imaging has a high sensitivity to detect damage to the brain substance, both in the acute period and in the period of long-term outcomes. Periventricular leukomalacia (PVL) is one of the variants of brain damage in premature infants and the most common term in the conclusions of diagnostic doctors (ultrasound, CT, MRI). Considering the pathomorphological criteria, not always detected changes in the white matter of the large hemispheres are PVL. Diffuse (telencephalic) gliosis and diffuse leukomalacia are ordinary and typical variants of damage to the white matter of the large hemispheres in extremely premature infants, with a gestation period of up to 30-32 weeks. In the first variant, atrophic changes predominate with a pronounced decrease in the volume of white matter and a secondary expansion of the lateral ventricles. Diffuse leukomalacia is most often mistaken for PVL, but the localization of the white matter lesion of the large hemispheres is extensive and extends beyond the peri- and paraventricular region. Clinical examples show various variants of primary non-hemorrhagic brain lesions in prematurely born children in the long-term period. The analysis of the revealed changes is carried out, taking into account current data on developing the brain and pathomorphological criteria.

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West syndrome: ethiology, management, long-term outcomes

Bulletin of Siberian Medicine ◽

10.20538/1682-0363-2009-4(2)-137-141 ◽

2009 ◽

Vol 8 (4(2)) ◽

pp. 137-140

Author(s):

L. S. Krayeva ◽

V. M. Alifirova ◽

O. V. Grebenyuk

Keyword(s):

Hormone Therapy ◽

Antiepileptic Drugs ◽

Age Of Onset ◽

Neurological Status ◽

West Syndrome ◽

Long Term Outcomes ◽

Long Term Observation

The article is based on long-term observation of 27 patients with West syndrome, age of onset, etiology of symptomatic forms, neurological status, efficiency of hormone therapy and antiepileptic drugs.

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Similar Long-Term Outcomes in Children Presenting With Abscess vs Phlegmon at Diagnosis of Crohn Disease

Crohn's & Colitis 360 ◽

10.1093/crocol/otaa060 ◽

2020 ◽

Vol 2 (3) ◽

Author(s):

Andrew W Fondell ◽

Maua H Mosha ◽

Ross M Maltz ◽

Brendan M Boyle ◽

Barbara Joanna Niklinska-Schirtz ◽

...

Keyword(s):

Crohn Disease ◽

Chart Review ◽

Pediatric Patients ◽

Retrospective Chart Review ◽

Limited Data ◽

Long Term Outcomes ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

Disease Present

Abstract Background Limited data are available for long-term outcomes of pediatric patients with abdominal abscess or phlegmon at diagnosis of Crohn disease. Methods We performed a retrospective chart review of such children over a recent 6-year period at 5 pediatric inflammatory bowel diseases. Results Fifty-two patients (mean age 15.9 ± 1.8 years) were reviewed. Thirty-six had an abscess and 27 (75%) required resectional therapy compared to 16 with phlegmon which 10 (63%) requiring surgery. Overall (37/52) 71% had surgery which was performed within 6 months in 32 (86%). Conclusions A similar high surgical rate exists whether pediatric patients with Crohn disease present with abscess or phlegmon.

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Intermediate and Long-term Outcomes Following Surgical Decompression of Neurogenic Thoracic Outlet Syndrome in an Adolescent Patient Population

Hand ◽

10.1177/1558944719901319 ◽

2020 ◽

pp. 155894471990131

Author(s):

Erin F. Ransom ◽

Heather L. Minton ◽

Bradley L. Young ◽

Jun Kit He ◽

Brent A. Ponce ◽

...

Keyword(s):

Thoracic Outlet Syndrome ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Patient Reported Outcome ◽

Long Term Outcomes ◽

Neurogenic Thoracic Outlet Syndrome ◽

Patient Reported ◽

Data Points

Background: Although the diagnosis of thoracic outlet syndrome (TOS) is often missed, outcomes from surgical intervention significantly improve patient satisfaction. This article seeks to highlight patient characteristics, intraoperative findings, and both short and long-term outcomes of thoracic outlet decompression in the adolescent population. Methods: A retrospective chart review of patients between the ages of 13 and 21 years with a clinical diagnosis of neurogenic thoracic outlet syndrome (NTOS) who were treated surgically between 2000 and 2015 was performed. Data points including preoperative patient characteristics and intraoperative findings were collected. In addition, patient-reported outcome scores, including Visual Analog Scale (VAS), Single Assessment Numeric Evaluation (SANE), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire, Cervical Brachial Symptom Questionnaire (CBSQ), and NTOS index, were obtained for a cohort of patients with follow-up ranging from 2 to 15 years. Results: The study population consisted of 54 patients involving 61 extremities. The most common procedures included neurolysis of the supraclavicular brachial plexus (60, 98.4%), anterior scalenectomy (59, 96.7%), and middle scalenectomy (54, 88.5%). First rib resection (FRR) was performed in 28 patients (45.9%). Long-term outcomes were collected for 24 (44%) of 54 patients with an average follow-up of 69.5 months (range, 24-180 months). The average VAS improved from 7.5 preoperatively to 1.8 postoperatively. The average SANE increased from 28.9 preoperatively to 85.4 postoperatively. The average postoperative scores were 11.4 for the QuickDASH, 27.4 for the CBSQ, and 17.2 for the NTOS index. Subgroup analysis of patients having FRR (28, 45.9%) demonstrated no difference in clinical outcome measures compared with patients who did not have FRR. Conclusion: Surgical treatment of NTOS in adolescent patients has favorable intermediate and long-term outcomes.

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Rural Secondary School Athletic Trainers’ Recognition and Management of Acute Lateral Ankle Sprains: A Retrospective Chart Review

International Journal of Athletic Therapy & Training ◽

10.1123/ijatt.2017-0106 ◽

2018 ◽

Vol 23 (5) ◽

pp. 200-204

Author(s):

Robert Vallandingham ◽

Zachary Winkelmann ◽

Lindsey Eberman ◽

Kenneth Games

Keyword(s):

Test Performance ◽

Chart Review ◽

Point Of Care ◽

Athletic Trainers ◽

Management Strategies ◽

Retrospective Chart Review ◽

Ankle Sprains ◽

Long Term Outcomes ◽

Lateral Ankle

The management of an acute lateral ankle sprain (LAS) affects long-term outcomes, which highlights the need for assessment of practice at the point of care. The purpose of this retrospective chart review was to examine the management strategies for acute LAS as documented in a secondary school’s electronic medical records (EMR) over 2 years. Patient charts noting a LAS diagnosis (n = 107) were identified from the EMR. Most charts indicated palpation and anterior drawer test performance. Cryotherapy (82%) and compression (55%) varied in use. Therapeutic rehabilitation and return-to-activity testing were underreported. Overall, clinical management of acute LAS may not align with best available evidence.

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Long-Term Outcomes and Aggressiveness of Hereditary Medullary Thyroid Carcinoma: 40 Years of Experience at One Center

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2019-00516 ◽

2019 ◽

Vol 104 (10) ◽

pp. 4264-4272 ◽

Cited By ~ 5

Author(s):

Friedhelm Raue ◽

Thomas Bruckner ◽

Karin Frank-Raue

Keyword(s):

Thyroid Carcinoma ◽

Medullary Thyroid Carcinoma ◽

Age Of Onset ◽

Risk Groups ◽

Tumor Stage ◽

Long Term Outcomes ◽

Term Survival ◽

Medullary Thyroid ◽

Tertiary Referral Center

Abstract Context Recent data on long-term outcomes and aggressiveness of medullary thyroid carcinoma (MTC) are lacking for patients with multiple endocrine neoplasia type 2 (MEN2). Objectives To analyze the long-term outcomes in MEN2 and compare MTC aggressiveness in three defined RET mutation-risk categories: moderate risk (MOD), high risk (H), and highest risk (HST). Design, Setting Retrospective study of 263 operated patients with MEN2 from one German tertiary referral center from 1979 to 2017 comparing demographic, biochemical, genetic, and outcome parameters Intervention None (observational study) Main Outcome Measure Long-term survival and outcomes in three risk groups Results Surgery was performed at a mean age of 35.3 ± 18.8 (MOD, n = 122), 23.0 ± 15.7 years (H, n = 120), and 14.9 ± 9.3 (HST, n = 21) years (P < 0.05). The mean follow-up was 12.9 ± 9.8 years. Age and tumor stage at diagnosis differed among the three risk groups (P < 0.0001). Multivariate analysis of disease-specific survival (DSS) showed that increasing age [hazard ratio (HR), 1.06; 95% CI, 1.02 to 1.09], stage III/IV at diagnosis (HR, 7.39; 95% CI, 2.39 to 22.8), and HST group (HR, 14.4; 95% CI, 3.32 to 62.6) were significantly associated with worse DSS; the H group was not (P = 0.175). The DSS rates and outcomes were not different between the MOD and H groups (P = 0.179 and P = 0.893, respectively) but were significantly inferior in the HST group (P < 0.0008 and P < 0.0001, respectively). Conclusion MTC in patients with MEN2 showed a clearly different age of onset in the different risk groups. DSS and outcomes after MTC diagnosis were similar in the MOD and H groups, suggesting similar tumor behavior. The HST group had inferior outcomes and survival vs the MOD and or H groups.

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Optimized Treatment for Infantile Spasms: Vigabatrin versus Prednisolone versus Combination Therapy

Journal of Clinical Medicine ◽

10.3390/jcm8101591 ◽

2019 ◽

Vol 8 (10) ◽

pp. 1591

Author(s):

Hahn ◽

Park ◽

Kang ◽

Lee ◽

Kim ◽

...

Keyword(s):

Combination Therapy ◽

Initial Treatment ◽

Dose Group ◽

Treatment Initiation ◽

Infantile Spasms ◽

Second Line ◽

Long Term Outcomes ◽

First Line ◽

Optimized Treatment

Hormone therapies and vigabatrin are first-line agents in infantile spasms, but more than one-third of patients fail to respond to these treatments. This was a retrospective study of patients with infantile spasms who were treated between January 2005 and December 2017. We analyzed the response rates of initial treatment and second-line treatment. Responders were defined as those in whom cessation of spasms was observed for a period of at least one month, within 2 weeks of treatment initiation. Regarding the response rate to initial treatment, combination therapy of vigabatrin with prednisolone showed a significantly better response than that of vigabatrin monotherapy (55.3% vs. 39.1%, p = 0.037). Many drugs, such as clobazam, topiramate, and levetiracetam, were used as second-line agents after the failure of vigabatrin. Among these, no antiepileptic drug showed as good a response as prednisolone. For patients who used prednisolone, the proportion of responders was significantly higher in the higher-dose group (≥40 mg/day) than in the lower-dose group (66.7% vs. 12.5%, p = 0.028). Further studies of combination therapy to assess dosage protocols and long-term outcomes are needed.

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