Pediatric Annals

editorial 

Of Topics Neurologic, Surgical, and Pharmacologic

Stanford T Shulman, MD

Abstract

Much on the spectrum of pediatric neurologic problems is covered by the articles in the current issue of Pediatric Annals, edited by Dr. Ed Conway. One of the areas of real progress in this field is the neurosurgical therapy of seizures that are truly refractory to medical therapy. Although the only such patient that I have seen personally developed a post-operative infection problem, this complication is quite rare. I recall being amazed at how intact this teenager appeared following an almost total hemispherectomy procedure and how much her life had improved. These interventions, including resection of a small focal seizure generator area, are made possible by newer and highly sophisticated tools to locate with great precision the anatomic source of the seizure. It does appear that epilepsy surgery, a new field, can provide remarkable benefits for a highly select population of pediatric patients.

Other topics of interest in this issue include a review of pediatric stroke, an update on childhood headaches, new medical and surgical therapies for childhood spasticity, and a detailed review of the approach to craniosynostosis.

I would like to make the readership aware of two short perspectives published in the April 6, 2006, issue of the New England Journal of Medicine. Of direct relevance to pediatricians is a perspective on the cardiovascular risks associated with the use of ADHD medications. These risks led to the Food and Drug Administration's Drug Safety and Risk Management Advisory Committee to vote in early February 2006, to recommend a "black-box" warning about the risks of stimulant drugs to treat ADHD (Nissen SE. New Engl J Med. 2006;354(14):1445). This advisory committee reviewed 25 reported cases of sudden death in children and adults possibly related to this class of medication.

In addition, and quite separately, another perspective reviews the changing face of teenage drug abuse in the United States and emphasizes the trends of decreased illicit drug use by teens but notes the increased (and unauthorized) use of prescription drugs (Friedman RA. New Engl J Med. 2006; 354(14): 1448). Apparently, calming prescription agents, rather than stimulating drugs, have become more popular among adolescents, and their availability via many unauthorized routes is well-known. I urge you to review these two perspectives that affect substantial proportions of our patient populations.…

Much on the spectrum of pediatric neurologic problems is covered by the articles in the current issue of Pediatric Annals, edited by Dr. Ed Conway. One of the areas of real progress in this field is the neurosurgical therapy of seizures that are truly refractory to medical therapy. Although the only such patient that I have seen personally developed a post-operative infection problem, this complication is quite rare. I recall being amazed at how intact this teenager appeared following an almost total hemispherectomy procedure and how much her life had improved. These interventions, including resection of a small focal seizure generator area, are made possible by newer and highly sophisticated tools to locate with great precision the anatomic source of the seizure. It does appear that epilepsy surgery, a new field, can provide remarkable benefits for a highly select population of pediatric patients.

Other topics of interest in this issue include a review of pediatric stroke, an update on childhood headaches, new medical and surgical therapies for childhood spasticity, and a detailed review of the approach to craniosynostosis.

I would like to make the readership aware of two short perspectives published in the April 6, 2006, issue of the New England Journal of Medicine. Of direct relevance to pediatricians is a perspective on the cardiovascular risks associated with the use of ADHD medications. These risks led to the Food and Drug Administration's Drug Safety and Risk Management Advisory Committee to vote in early February 2006, to recommend a "black-box" warning about the risks of stimulant drugs to treat ADHD (Nissen SE. New Engl J Med. 2006;354(14):1445). This advisory committee reviewed 25 reported cases of sudden death in children and adults possibly related to this class of medication.

In addition, and quite separately, another perspective reviews the changing face of teenage drug abuse in the United States and emphasizes the trends of decreased illicit drug use by teens but notes the increased (and unauthorized) use of prescription drugs (Friedman RA. New Engl J Med. 2006; 354(14): 1448). Apparently, calming prescription agents, rather than stimulating drugs, have become more popular among adolescents, and their availability via many unauthorized routes is well-known. I urge you to review these two perspectives that affect substantial proportions of our patient populations.

The stamps chosen for this month's issue are rather varied. Morocco honored the 13th World Congress of Neurosurgery in 2005 with the mostly blue stamp that is illustrated by the cerebrum. The yellow and pink 2005 stamp from Israel (which includes a digital thermometer) honors pediatricians. The US stamp, also from 2005, portrays Barbara McClintock (1902-1992), who was awarded the 1983 Nobel Prize in Physiology or Medicine for her pioneering genetic studies. Her research studies with maize plants led to the discovery of genetic transposition, clarifying the movement of genetic material within and between chromosomes.

10.3928/0090-4481-20060501-01

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