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Tiivistelmä Lasten ja nuorten migreenin esiintyvyys ja ilmaantuvuus ovat lisääntyneet. Perusterveydenhuollossa on tärkeää selvittää migreenin taustasyitä ja esiintymistä. Migreenin diagnostiikassa tarvitaan lääkärin tutkimuksen lisäksi harvoin muita tutkimuksia. Lapsen ja nuoren on tärkeä saada tietoa päänsäryn hoito- ja itsehoitokeinoista. Estolääkitys voidaan aloittaa perusterveydenhuollossa, mikäli migreenikohtaukset ovat viikoittaisia. Abstract Migraine in children and adolescents Considering its increasing prevalence and incidence, paediatric migraine is a common condition requiring attention in primary care. When a child presents with a headache, it is crucial to survey his/her migraine background using a headache questionnaire and a symptom diary. These may also reveal individual migraine triggers, e.g. missed meals, lack of sleep or school related issues that should be addressed first of all. The website Terveyskylä (www.terveyskyla.fi/lastentalo/tietoa-lasten-sairauksista/päänsärky) provides a practical and family-friendly way to do this digitally. Children and their families need psychoeducation about headache and Terveyskylä offers reliable information about paediatric headache. A migraine diagnosis seldom needs more than a thorough history and clinical examination. If red flags exist, considering a brain MRI is appropriate. If a child or adolescent suffers from migraine on a weekly basis and common triggers have been excluded, a general practitioner, too, can consider preventive medication. If using propranolol fails to achieve a reduction in the number of headaches, the child should be referred to a specialist.

Tiivistelmä Lasten liikehäiriöt ovat etiologialtaan ja taudinkuvaltaan heterogeeninen ryhmä. Vaikeissa häiriöissä vaste lääkehoitoon on usein vähäinen. Syväaivostimulaatio voi merkittävästi auttaa osaa potilaista. Hoitopäätös vaatii moniammatillisen työryhmän arvion liikehäiriön laadusta, neurofysiologiset tutkimukset ja korkealaatuisen kuvantamisen. Lapsia ja nuoria hoitavien yksiköiden on tärkeää verkostoitua kansallisesti ja kansainvälisesti. Abstract Movement disorders are disabling conditions that can cause abnormal posture, torsion, repetitive movement or tremor via the disruption of regulatory areas in the brain. Among paediatric patients, generalised dystonia is the most common primary movement disorder, and dyskinetic CP the most common secondary phenotype, both with limited or unsatisfactory traditional treatment options. The prevalence of dystonia is suggested to be higher than reported since it is not always easy to recognise. Deep brain stimulation (DBS) is an established treatment method for movement disorders in adults, and it has emerged as a significant option for children as well. Treatment seems to be more beneficial when initiated early, since the time spent with dystonia is inversely correlated with the effectiveness of treatment. DBS modifies the basal ganglia-thalamocortical pathways, resulting in alleviation of symptoms. The careful selection of patients and accurate location of the electrodes are important contributors to treatment success. The most prevalent adverse effects are infections or hardware failure; however, these complications are not more prevalent in DBS than in other surgical procedures. DBS is an effective treatment option for severe paediatric movement disorders and it should be offered in a timely manner to patients with severe symptoms.