Botulinum Neurotoxin Injections in Childhood Opisthotonus

Opisthotonus refers to abnormal axial extension and arching of the trunk produced by excessive contractions of the paraspinal muscles. In childhood, the abnormal posture is most often related to dystonia in the setting of hypoxic injury or a number of other acquired and genetic etiologies. The condition is often painful, interferes with ambulation and quality of life, and is challenging to treat. Therapeutic options include oral benzodiazepines, oral and intrathecal baclofen, botulinum neurotoxin injections, and deep brain stimulation. Management of opisthotonus within the pediatric population has not been systematically reviewed. Here, we describe a series of seven children who presented to our institution with opisthotonus in whom symptom relief was achieved following administration of botulinum neurotoxin injections.

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Quality of Life after Laparoscopic Cholecystectomy for Biliary Dyskinesia in the Pediatric Population: A Pilot Study

The American Surgeon ◽

10.1177/000313481207800147 ◽

2012 ◽

Vol 78 (1) ◽

pp. 111-118 ◽

Cited By ~ 1

Author(s):

Damian Maxwell ◽

Stephanie Thompson ◽

Bryan Richmond ◽

Jillian McCagg ◽

Adam Ubert

Keyword(s):

Quality Of Life ◽

Laparoscopic Cholecystectomy ◽

Pilot Study ◽

Pediatric Population ◽

Symptom Relief ◽

Well Being ◽

Biliary Dyskinesia ◽

Gallbladder Ejection Fraction

This pilot study examined symptom relief and quality of life in pediatric patients who received laparoscopic cholecystectomy surgery at our institution for biliary dyskinesia. We used two validated questionnaires: the Child Health Questionnaire (CHQ-PF28), to assess general well-being, and the Gastrointestinal Quality of Life Index (GIQLI), to measure gastrointestinal-related health. After Institutional Review Board approval, all patients under the age of 18 years who underwent laparoscopic cholecystectomy for biliary dyskinesia between November 2006 and May 2010 received mailed questionnaires. Preoperative and postoperative data were retrospectively collected from respondents and included age, race, symptoms, gallbladder ejection fraction values, pathologic findings, and clinical course. Of 89 patients meeting inclusion criteria, 21 responded. Mean age at surgery was 13.08 years (range, 8 to 17 years). The most common preoperative symptoms consisted of nausea (100%), postprandial pain (90.5%), right upper quadrant pain (81.0%), and vomiting (66.7%). Mean long-term follow-up interval was 18.9 months (range, 7 to 40 months; SD 10.37). Patients with long-term symptom relief reported significantly higher GIQLI scores than those with enduring symptoms. Examination of the results from the CHQ-PF28 revealed significantly lower scores than a general U.S. pediatric sample in both the Physical and Psychosocial Summary Measures ( P < 0.05). Children experiencing long-term symptom cessation after laparoscopic cholecystectomy reported higher quality of life than those who had incomplete or only short-term relief. However, regardless of the degree of symptom relief, the degree of quality of life experienced by our study sample of patients with biliary dyskinesia is lower than that of a comparable U.S. pediatric sample.

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Deep Brain Stimulation Improves Medication Related Addictive Behavior and Associated Quality of Life

PsycEXTRA Dataset ◽

10.1037/e741342011-200 ◽

2009 ◽

Author(s):

Hunter Covert ◽

Pennie S. Seibert ◽

Caitlin C. Otto ◽

Missy Coblentz ◽

Nicole Whitener ◽

...

Keyword(s):

Quality Of Life ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Addictive Behavior ◽

Deep Brain

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Clinical outcomes of asleep vs awake deep brain stimulation for Parkinson disease

Neurology ◽

10.1212/wnl.0000000000004630 ◽

2017 ◽

Vol 89 (19) ◽

pp. 1944-1950 ◽

Cited By ~ 40

Author(s):

Matthew A. Brodsky ◽

Shannon Anderson ◽

Charles Murchison ◽

Mara Seier ◽

Jennifer Wilhelm ◽

...

Keyword(s):

Quality Of Life ◽

Deep Brain Stimulation ◽

Parkinson Disease ◽

Brain Stimulation ◽

Electrode Placement ◽

Microelectrode Recording ◽

Imaging Guidance ◽

Motor Outcomes ◽

Deep Brain

Objective:To compare motor and nonmotor outcomes at 6 months of asleep deep brain stimulation (DBS) for Parkinson disease (PD) using intraoperative imaging guidance to confirm electrode placement vs awake DBS using microelectrode recording to confirm electrode placement.Methods:DBS candidates with PD referred to Oregon Health & Science University underwent asleep DBS with imaging guidance. Six-month outcomes were compared to those of patients who previously underwent awake DBS by the same surgeon and center. Assessments included an “off”-levodopa Unified Parkinson’s Disease Rating Scale (UPDRS) II and III, the 39-item Parkinson's Disease Questionnaire, motor diaries, and speech fluency.Results:Thirty participants underwent asleep DBS and 39 underwent awake DBS. No difference was observed in improvement of UPDRS III (+14.8 ± 8.9 vs +17.6 ± 12.3 points, p = 0.19) or UPDRS II (+9.3 ± 2.7 vs +7.4 ± 5.8 points, p = 0.16). Improvement in “on” time without dyskinesia was superior in asleep DBS (+6.4 ± 3.0 h/d vs +1.7 ± 1.2 h/d, p = 0.002). Quality of life scores improved in both groups (+18.8 ± 9.4 in awake, +8.9 ± 11.5 in asleep). Improvement in summary index (p = 0.004) and subscores for cognition (p = 0.011) and communication (p < 0.001) were superior in asleep DBS. Speech outcomes were superior in asleep DBS, both in category (+2.77 ± 4.3 points vs −6.31 ± 9.7 points (p = 0.0012) and phonemic fluency (+1.0 ± 8.2 points vs −5.5 ± 9.6 points, p = 0.038).Conclusions:Asleep DBS for PD improved motor outcomes over 6 months on par with or better than awake DBS, was superior with regard to speech fluency and quality of life, and should be an option considered for all patients who are candidates for this treatment.Clinicaltrials.gov identifier:NCT01703598.Classification of evidence:This study provides Class III evidence that for patients with PD undergoing DBS, asleep intraoperative CT imaging–guided implantation is not significantly different from awake microelectrode recording–guided implantation in improving motor outcomes at 6 months.

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SYMPTOM RELIEF AND IMPROVED QUALITY OF LIFE IN ALLERGIC RHINITIS PATIENTS AFTER TRANSDERMAL ALLERGY IMMUNOTHERAPY

Annals of Allergy Asthma & Immunology ◽

10.1016/j.anai.2018.09.086 ◽

2018 ◽

Vol 121 (5) ◽

pp. S28

Author(s):

G. Plunkett ◽

H. Legere ◽

T. Smith ◽

P. Hurwitz ◽

J. Strader ◽

...

Keyword(s):

Quality Of Life ◽

Allergic Rhinitis ◽

Symptom Relief ◽

Allergy Immunotherapy

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Canadian Consensus Conference on the Management of Gastroesophageal Reflux Disease in Adults – Update 2004

Canadian Journal of Gastroenterology ◽

10.1155/2005/836030 ◽

2005 ◽

Vol 19 (1) ◽

pp. 15-35 ◽

Cited By ~ 136

Author(s):

David Armstrong ◽

John K Marshall ◽

Naoki Chiba ◽

Robert Enns ◽

Carlo A Fallone ◽

...

Keyword(s):

Quality Of Life ◽

Reflux Disease ◽

Symptom Relief ◽

Management Strategies ◽

Consensus Conference ◽

Optimal Management ◽

Barrett’S Epithelium ◽

Barrett's Epithelium ◽

Gerd Symptoms

BACKGROUND: Gastroesophageal reflux disease (GERD) is the most prevalent acid-related disorder in Canada and is associated with significant impairment of health-related quality of life. Since the last Canadian Consensus Conference in 1996, GERD management has evolved substantially.OBJECTIVE: To develop up-to-date evidence-based recommendations relevant to the needs of Canadian health care providers for the management of the esophageal manifestations of GERD.CONSENSUS PROCESS: A multidisciplinary group of 23 voting participants developed recommendation statements using a Delphi approach; after presentation of relevant data at the meeting, the quality of the evidence, strength of recommendation and level of consensus were graded by participants according to accepted principles.OUTCOMES: GERD applies to individuals who reflux gastric contents into the esophagus causing symptoms sufficient to reduce quality of life, injury or both; endoscopy-negative reflux disease applies to individuals who have GERD and a normal endoscopy. Uninvestigated heartburn-dominant dyspepsia -- characterised by heartburn or acid regurgitation - includes erosive esophagitis or endoscopy-negative reflux disease, and may be treated empirically as GERD without further investigation provided there are no alarm features. Lifestyle modifications are ineffective for frequent or severe GERD symptoms; over-the-counter antacids or histamine H2-receptor antagonists are effective for some patients with mild or infrequent GERD symptoms. Proton pump inhibitors are more effective for healing and symptom relief than histamine H2-receptor antagonists; their efficacy is proportional to their ability to reduce intragastric acidity. Response to initial therapy - a once-daily proton pump inhibitor unless symptoms are mild and infrequent (fewer than three times per week) - should be assessed at four to eight weeks. Maintenance medical therapy should be at the lowest dose and frequency necessary to maintain symptom relief; antireflux surgery is an alternative for a small proportion of selected patients. Routine testing for Helicobacter pylori infection is unnecessary before starting GERD therapy. GERD is associated with Barrett's epithelium and esophageal adenocarcinoma but the risk of malignancy is very low. Endoscopic screening for Barrett's epithelium may be considered in adults with GERD symptoms for more than 10 years; Barrett's epithelium and low-grade dysplasia generally warrant surveillance; endoscopic or surgical management should be considered for confirmed high-grade dysplasia or malignancy.CONCLUSION: Prospective studies are needed to investigate clinically relevant risk factors for the development of GERD and its complications; GERD progression, on and off therapy; optimal management strategies for typical GERD symptoms in primary care patients; and optimal management strategies for atypical GERD symptoms, Barrett's epithelium and esophageal adenocarcinoma.

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Gastrointestinal fistula with thigh extension and intractable pain

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2018-001748 ◽

2019 ◽

pp. bmjspcare-2018-001748

Author(s):

Ewa Deskur-Śmielecka ◽

Mateusz Sopata ◽

Michal Chojnicki ◽

Maciej Sopata

Keyword(s):

Quality Of Life ◽

Wound Care ◽

Rare Complication ◽

Enterocutaneous Fistula ◽

Symptom Relief ◽

Advanced Rectal Cancer ◽

Intractable Pain ◽

Gastrointestinal Fistula ◽

Selective Therapy

Spontaneous enterocutaneous fistulae are a rare complication in patients with cancer, especially following irradiation, chemotherapy or cytoreductive operations. They are associated with worse prognosis, higher costs of treatment and impaired quality of life. Proper recognition of the problem and fast implementation of selective therapy including water electrolyte resuscitation, infection control, nutritional support, control of output volume, proper wound care and, ultimately, surgical treatment in selected patients may result in better symptom relief and improved quality of life of patients. We describe a case of a patient with advanced rectal cancer and acute pain in the lateral aspect of thigh caused by the presumptive presence of an enterocutaneous fistula, in whom therapy with antibiotics and surgical incision enabled rapid pain relief and comfort of dying.

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Cochlear Implantation for Single-Sided Deafness: A New Treatment Paradigm

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1677482 ◽

2019 ◽

Vol 80 (02) ◽

pp. 178-186 ◽

Cited By ~ 8

Author(s):

Daniel Zeitler ◽

Michael Dorman

Keyword(s):

Quality Of Life ◽

Cochlear Implantation ◽

Pediatric Population ◽

Binaural Hearing ◽

Music Appreciation ◽

Speech Understanding In Noise ◽

Treatment Paradigm ◽

New Treatment ◽

Single Sided Deafness

AbstractUnilateral severe-to-profound sensorineural hearing loss (SNHL), also known as single sided deafness (SSD), is a problem that affects both children and adults, and can have severe and detrimental effects on multiple aspects of life including music appreciation, speech understanding in noise, speech and language acquisition, performance in the classroom and/or the workplace, and quality of life. Additionally, the loss of binaural hearing in SSD patients affects those processes that rely on two functional ears including sound localization, binaural squelch and summation, and the head shadow effect. Over the last decade, there has been increasing interest in cochlear implantation for SSD to restore binaural hearing. Early data are promising that cochlear implantation for SSD can help to restore binaural functionality, improve quality of life, and may faciliate reversal of neuroplasticity related to auditory deprivation in the pediatric population. Additionally, this new patient population has allowed researchers the opportunity to investigate the age-old question “what does a cochlear implant (CI) sound like?.”

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