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A Case of Thyrotoxic Periodic Paralysis in 17-Year-Old Adolescent.

Tae Hee CHO ; Soon Chul KIM ; Sun Jun KIM

Journal of the Korean Child Neurology Society.2013;21(2):68-72.

Thyrotoxic periodic paralysis (TPP) is a rare disease of muscle paralysis associated with hypokalemia and thyrotoxicosis. Hypokalemic periodic paralysis can be caused by potassium channelopathy or thyroid dysfunction. Thyrotoxic hypokalemic periodic paralysis is far more common in Asian males aged between 20 to 40 years and rare in children and adolescents. Clinical symptoms with motor paralysis were recovered just after treatment of potassium, propranolol, and methimazole. However, thyroid function tests were not normalized until 3 month treatment of methimazole and propranolol. We report a 17-year-old patient diagnosed with Graves' disease with TPP. Thyroid function test should including in periodic paralysis patient's evaluation.
Adolescent ; Aged ; Asian Continental Ancestry Group ; Channelopathies ; Child ; Graves Disease ; Humans ; Hyperthyroidism ; Hypokalemia ; Hypokalemic Periodic Paralysis ; Male ; Methimazole ; Muscles ; Paralysis ; Potassium ; Propranolol ; Rare Diseases ; Thyroid Function Tests ; Thyroid Gland ; Thyrotoxicosis

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Sleep Disturbances in Children Younger than 36 Months of Age with Iron Deficiency Anemia.

Hae Jung KIM ; Seon Kyeong RHIE ; Kyu Young CHAE ; Heui Seung JO ; Moon Kyu KIM

Journal of the Korean Child Neurology Society.2013;21(2):59-67.

PURPOSE: Iron deficiency anemia (IDA) and sleep problems are prevalent in infancy and early childhood and are more associated with poor cognitive, motor, and social-emotional development. The aim of this study was to access the relationship between IDA and sleep disorders in a population of Korean children <36 months. METHODS: One hundred and ninety six children, who visited the outpatient clinic for a routine check-up were consecutively enrolled from March 2011 to March 2012. All parents answered a questionnaire about sleep patterns of their children using a modified expanded version of the Brief Infant Sleep Questionnaire. Among the subjects, 93 children with strong evidence of sleep disordered breathing were excluded. Hundred three children were then divided into the IDA group (n=23) and the control group (n=80). Sleep-wake parameters and prevalence of sleep disturbances were compared between the two groups. A multivariate analysis was performed to determine the independent risk factors for sleep disturbances in children. RESULTS: Children with IDA had more frequent nocturnal waking, restless sleep, and inconsolable crying during sleep than those in the control. Children with IDA also had more inappropriate sleep onset associations. No difference in sleep-wake parameters was observed between the two groups. The presence of IDA in children and maternal anemia were significant independent risk factors for sleep disturbances in children <36 months. CONCLUSION: The results suggest that prevention, early detection, and treatment of IDA would be important for good sleep in young children <36 months.
Ambulatory Care Facilities ; Anemia ; Anemia, Iron-Deficiency ; Child ; Crying ; Humans ; Infant ; Iron ; Multivariate Analysis ; Parents ; Prevalence ; Surveys and Questionnaires ; Risk Factors ; Sleep Apnea Syndromes ; Sleep Wake Disorders

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Clinical Characteristics and Efficacy of Prophylactic Treatment of Pediatric Chronic Daily Headache.

Jeong Ho LEE ; Hunmin KIM ; Byung Chan LIM ; Jong Hee CHAE ; Jieun CHOI ; Ki Joong KIM ; Yong Seung HWANG ; Hee HWANG

Journal of the Korean Child Neurology Society.2013;21(2):53-58.

PURPOSE: The purpose of this study was to evaluate the clinical characteristics and efficacy of prophylactic treatment of pediatric chronic daily headache (CDH). METHODS: A retrospective medical-record review of patients who underwent the prophylaxis after a diagnosis of CDH was performed. Response to treatment was assessed by the total number of headache days/month. More than 50% reduction of headache frequency was classified as responders. RESULTS: Eighty patients with the diagnosis of CDH were included in the study. CDH was more prevalent in girls than in boys. It was classified into chronic migraine (81.2%), chronic tension-type headache (15.0%), or new-onset persistent daily headache (3.7%). None of the patient fulfilled the diagnostic criteria of hemicrania continua. The mean age of the patients was 11.8+/-1.2 years. The mean number of monthly headache episodes before treatment was 25.5+/-4.4. After prophylactic treatment, headache episodes were reduced to 8.7+/-9.5 episodes per month. The responder rate of prophylactic treatment was 70.2% (55/80 patients) for either topiramate or flunarizine. CONCLUSION: In our study, the most common type of CDH was chronic migraine. All patients with CDH had frequent, long lasting migraine attacks. This study also suggests that prophylactic treatment is effective in the treatment of pediatric CDH.
Fructose ; Headache ; Headache Disorders ; Humans ; Migraine Disorders ; Retrospective Studies ; Tension-Type Headache

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Clinical Presentations and the Bacterial Meningitis Score in Children with Cerebrospinal Fluid (CSF) Pleocytosis.

Hye Eun KWON ; Young Mock LEE ; Joon Soo LEE ; Heung Dong KIM ; Hoon Chul KANG

Journal of the Korean Child Neurology Society.2013;21(2):46-52.

PURPOSE: The differential diagnosis between aseptic meningitis and bacterial meningitis in children is often very difficult. The current study was performed to investigate the clinical presentations, cerebrospinal fluid (CSF) and the Bacterial Meningitis Score (BMS) in children presenting with CSF pleocytosis (> or =10 WBC/mm3). METHODS: We retrospectively analyzed medical records of children (age three months-15 years) with CSF pleocytosis between January 2012 to January 2013 at Gangnam Severance Hospital. RESULTS: The dominant clinical symptoms were fever (92.5%), headache (87.5%), and vomiting (75%). Neck stiffness was noted in 20% of the patients. Three patients who were younger than three years old could not properly present meningeal signs. The majority (36 patients, 90%) were hospitalized, with a median stay of three days. There was no one who had bacterial meningitis. The BMS was calculated for all patients. Among them, 27 patients (67.5%) showed a BMS of 0 which represents very low risk for bacterial meningitis and the remaining 13 patients (32.5%) showed a BMS of 1. CONCLUSION: The BMS may be helpful to guide clinical decision making for the management of children with CSF pleocytosis. Additional multicenter studies in Korea are now needed to evaluate whether the BMS can be used to safely reduce hospital admission and antibiotic use for children with aseptic meningitis.
Child ; Decision Making ; Diagnosis, Differential ; Fever ; Headache ; Humans ; Korea ; Leukocytosis ; Medical Records ; Meningitis, Aseptic ; Meningitis, Bacterial ; Neck ; Retrospective Studies ; Vomiting

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Relationship between Lifestyle and Headache in Korean Students.

Gi Youn SIM ; Young Il RHO ; Hee Jung CHUNG ; Kon Hee LEE ; Baik Lin EUN ; So Hee EUN ; Sang Ook NAM ; Won Seop KIM ; Young Ok KIM

Journal of the Korean Child Neurology Society.2013;21(2):39-45.

PURPOSE: Despite the high prevalence of headaches in students, their lifestyles have not been well examined. We examined correlation between lifestyle and headache in Korean students. METHODS: We conducted a cross-sectional, school-based study from a randomized and proportional sample of 5,360 male and female students. The questionnaires include demographic data, lifestyle, in addition to specific questions about headache according to International Classification of Headache Disorder II (ICHD-II) criteria. Valid questionnaires were returned by 94.1% (5,039, boys 2,405, girls 2,634) of the sample. Modified criteria changed the item 'duration' in migraine (>1 hour instead of 4 hours). We analyzed the data in terms of exercise, regular eating, sleep time, fluid intake, and caffeine intake. RESULTS: Students on regular exercise have less headache (P=0.03). Students who eat regularly have less recurrent headache (P<0.0001, odds ratio=0.5). Students sleep more have less headache (P<0.0001). Students take more fluid have less headache (P=0.0002). Students take more caffeine have more headache (P=0.0001). CONCLUSION: There seem to be a significant relationship between life style and headache in school children in South Korea. We suggest that changing the lifestyles or habits should be considered to manage and prevent headaches in school children.
Caffeine ; Child ; Eating ; Female ; Headache ; Headache Disorders ; Humans ; Life Style ; Male ; Migraine Disorders ; Prevalence ; Surveys and Questionnaires ; Republic of Korea

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Pediatric Narcolepsy: Diagnosis and Treatment.

Yang Weon BANG ; Kyu Young CHAE

Journal of the Korean Child Neurology Society.2009;17(2):107-117.

Narcolepsy is chronic devastating disease that characterized by excessive daytime sleepiness, cataplexy, which often precipitated by intense emotion or excitement, hypnagogic, or hypnapompic hallucinations, sleep paralysis and nocturnal disrupted sleep. In child onset narcolepsy, the presentations of narcolepsy can be very variable, making misdiagnosis as seizure disorders or delaying diagnosis as much as several years after disease onset. For the diagnosis of narcolepsy, overnight polysomnography(PSG) and multiple sleep latency test(MSLT) should be evaluated. Test for Cerebrospinal fluid hypocretin(orexin) concentration and human leukocyte antigens(HLA) would be great helpful to confirm the narcolepsy with cataplexy even in early stage of disease in children. The mainstays of treatment are that reducing the excessive daytime sleepiness, preventing the intrusion of the REM related phenomena including cataplexy and consolidating the nighttime sleep. Central nervous system stimulators such as methylphenidate or amphetamine decrease excessive daytime sleepiness and tricyclic antidepressant(TCA) or selective serotonin reuptake inhibitors(SSRI) can prevent cataplexy. Recently, new therapeutic agents such as modafinil and sodium oxybate are emerging in clinical practice with much effectiveness. Counseling for poor school performance, social isolation and depression should be provided. Early diagnosis and treatment can greatly improve the quality of life. Awareness of excessive daytime sleepiness in children or adolescent will allow pediatricians to effectively identify hypersomnia such as narcolepsy.
Adolescent ; Amphetamine ; Benzhydryl Compounds ; Cataplexy ; Central Nervous System ; Child ; Counseling ; Depression ; Diagnostic Errors ; Disorders of Excessive Somnolence ; Early Diagnosis ; Epilepsy ; Hallucinations ; Humans ; Leukocytes ; Methylphenidate ; Narcolepsy ; Quality of Life ; Serotonin ; Sleep Paralysis ; Social Isolation ; Sodium Oxybate

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Moyamoya Disease in Childen.

Hyun Jong CHIN ; Jun Su LEE ; Chang Jun COE

Journal of the Korean Child Neurology Society.1997;5(1):119-125.

PURPOSE: Moyamoya disease is a primary vascular disease characterized by stenosis that is followed by occlusion of the intracranial portion of the internal carotid artery and other vessels of the circle of Willis. Since there has not been any specific reports about clinical manifestation in children, we plan to study on clinical manifestation through these patients who have moyamoya disease. METHODS: We have reviewed our case of moyamoya disease in patients admitted to Yonsei University College of Medicine and analyzed their age & sex distribution as well as clinical manifestations, together with brain CT and angiographic findings. RESULTS: The results were as follows: 1) Fifty cases of moyamoya disease were encounted during a 10-year period. 2) The male to female ratio was 1:2.3 and mean age was 6.3 years old. 3) The most common chief complaint on admission was hemiparesis followed by convulsion. 4) 42 patients(84%) showed infarction on brain CT and only 5 patients(10%) showed hemorrhage. Most common lesion was frontal lobe. 5) Bilateral occlusion of the internal carotid arteries was most common site of lesions on cerebral angiography.
Brain ; Carotid Artery, Internal ; Cerebral Angiography ; Child ; Circle of Willis ; Constriction, Pathologic ; Female ; Frontal Lobe ; Hemorrhage ; Humans ; Infarction ; Male ; Moyamoya Disease* ; Paresis ; Seizures ; Sex Distribution ; Vascular Diseases

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Accuracy of Denver II in Developmental Delay Screening.

Min Cheol JEON ; Young Hoon KIM ; Seung Yun CHUNG ; In Goo LEE ; Jong Wan KIM ; Kung Tai WHANG

Journal of the Korean Child Neurology Society.1997;5(1):111-118.

PURPOSE : Developmental screening tests are in widespread use, but few reliable and valid tests are available. One of the oldest and best known developmental screening test was recently restandardized and revised as Denver II. Because the Denver II was published without evidence of its accuracy in developmental screening, we evaluate its accuracy in chidren with developmental delay to see whether it can be used on Korean children. METHODS : The Denver II was translated and was administered to 244 children attending the child development clinic in Kangnam St. Mary's Hospital to evaluated motor delay(Group I, n=68), language delay(Group II, n=84) or other problem(Group III, n=92). RESULTS : 1) The ratio of male to female and the mean age of the subject were 2.4:1 and 25.1 months overall, 1.6:1 and 11.8 months in Group I, 4.6:1 and 35.6 months in Group II, and 1.3:1 and 25.4 months in Group III. 2) The distribution of results(abnormal, normal and questionable) were 76%, 13% and 10% in Group I, 76%, 10% and 14% in Group II, and 38%, 53% and 9% in Group III. 3) The neurologic problems were determined 75%(cerebral palsy, central hypotonia, infantile spasm, myopathy etc.) in Group I, 74%(mental retardation, developmental language disorder, epilepsy, cerebral palsy etc.) Group II and 39%(mental retardation, epilepsy, cerebral palsy etc.) in Group III. 4) The sensitivity and the specificity of Denver II were 0.88 and 0.41 in Group 1, 0.90 and 0.27 in Group II, 0.81 and 0.77 in Group III, and 0.85 and 0.59 overall. CONCLUSION: Although the Denver II in identifying children at risk for developmental delay has a excellent sensitivity, it has a poor specificity, especially in identifying children at risk for language delay. These results demonstrate that the Denver fail to reliably identify children in need of developmental delay evaluation. So the Denver II should be standardized and modified to be used on Korean children with developmental delay.
Cerebral Palsy ; Child ; Child Development ; Epilepsy ; Female ; Humans ; Infant ; Infant, Newborn ; Language Development Disorders ; Male ; Mass Screening* ; Muscle Hypotonia ; Muscular Diseases ; Paralysis ; Sensitivity and Specificity ; Spasms, Infantile

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A Clinical Study of Recurrent Headaches in Children and An Application of International Headache Society Classification to Children.

Sang Su PARK ; Kwang Yeul BAE ; Tae Hong KIM ; Eun Jung KIM ; Kyu Geun HWANG

Journal of the Korean Child Neurology Society.1997;5(1):95-105.

PURPOSE: Headache is a frequent symptom in pediatric practice, but the prevalence of chronic recurrent headache was estimated in several studies with wide variations, because of inadequate expression and differences in case definition in children. Headache classification of International Headache Society is usually used in adults, but the application of it to children is uncommon, so we tried to diagnosis children with headache by using International Headache Society Classification. METHODS: We analyzed the clinical pictures, physical examinations including neurologic examination, PNS series, EEG and CT or MRI in 53 children with nonprogressing recurrent headache over than one month, who visited to pediatric department of Dong-A University hospital from January, 1995 to Feburary, 1996 and diagnosed them by using International Headache Society Classification. RESULTS: 1) The sex ratio between male and female was 1:1.2. 2) Diagnosed groups consisted of children with migraines in 22 cases(41.5%), tension-type headache in 19 cases(35.9%), coexisting migraine and tension-type headaches in 5 cases(9.4%), miscellaneous headaches not associated with structual lesion in 1 case(1.9%), headache associated with vascular disorders in 2 cases(3.8%), headache associated with nonvascular intracranial disorder in 1 case(1.9%), headache due to facial pain in 3 cases(5.6%). 3) Of 22 migraine cases, 13 cases(59.1%) had migraine with aura, 8 cases(40.9%) have migraine without aura and of 19 tension-type headache cases, 8 cases(42.1%) have episodic type, 11(57.9%) cases have chronic type. 4) Of 53 cases with recurrent headache, 3 cases(6%) had abnormal findings in CT or MRI. 5) Of 53 cases with recurrent headache, 9 cases(17%) had abnormal findings in EEG. CONCLUSIONS: International Headache Society Classifications are useful, but the diagnostic criteria are too strict for children, especially in migraine and tension type headache.
Adult ; Child* ; Classification* ; Diagnosis ; Electroencephalography ; Facial Pain ; Female ; Headache* ; Humans ; Magnetic Resonance Imaging ; Male ; Migraine Disorders ; Migraine with Aura ; Migraine without Aura ; Neurologic Examination ; Physical Examination ; Prevalence ; Sex Ratio ; Tension-Type Headache

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Benefits of High Dose Intravenous Gammaglobulin in Children with Severe Guillain-Barr Syndrome.

Geun Mo KIM ; Young Jong WOO

Journal of the Korean Child Neurology Society.1997;5(1):86-94.

To know the efficacy of intravenous gammaglobulin(IVGG) treatment and the resulting outcome at 18 months for acute Guillain-Barr syndrome (GBS) in children, clinical courses of 27 GBS patients who had been treated with IVGG in a dose of 1g/kg/day oyer 2 consecutive days were investigated. One died with respiratory failure and 8 patients received assisted ventilatory care with improvement. All consecutively treated patients responded well to IVGG. The mean plateau period in 26 recovered patients was 8.5 days. At the 6th month evaluation, only one failed to reach grade 2 on GBSSG scales. At the 18th month evaluation, minor motor symptoms such as easy fatigability or mild tremor on writing were remained in 9 patients. 9 patients showed mild to moderate febrile response to IVGG infusion, but no significant side effects were noted. IVGG can be chosen as an initial treatment for acute GBS in children because of its rapid effect, relative safety even in unstable patients and convenience of administration.
Child* ; Humans ; Respiratory Insufficiency ; Tremor ; Weights and Measures ; Writing

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