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Syncope is a common phenomenon, well-known to all pediatricians: it is defined as a sudden transient loss of consciousness associated with inability to maintain postural tone that is incompatible with a seizure disorder, vertigo, dizziness, coma, shock or other states of altered consciousness. The purpose of this study are to analyse the multiple causes of syncope, to determine the characteristics of pediatric patients with syncope, to define the pathophysiologic mechanisms that result in neurally mediated syncope.

The cysticercosis is an infestation caused from the larva of Taenia solium, which is demoniated Cysticercus cellulosae. Infestation by the encysted forms occur within brain, muscle, cutis, eye and more rarely within kidney, liver, thyroid. The cysties cause inflammation, oedema and residual calcification. In the SNC they are responsible for seizures, usually of focal type, hydrocephalus, meningitis, endocranic hypertension, stroke. One case of neurocysticercosis in a 15 years old boy is described: the clinical pictures, the neuroradiologic images and the treatment are discussed.

Migraine has been recently defined a "central neuronal hyperexcitability state", maybe magnesium-dependent, and magnesium has been occasionally employed in the therapy of adult migraine. The Authors, on the basis of their personal experience (previous electromyographic studies), consider childhood migraine and periodic syndrome as a clinical equivalent of spasmophilia, in which an intracellular deficit of magnesium has been demonstrated, and have employed a magnesium salt in the prophylaxis of childhood migraine and migraine equivalents. 40 children with periodic syndrome (17 M and 23 F, aged 10.4 +/- 2.9 years) have been treated with magnesium pidolate, with doses ranging from 1.5 g/die to 4.5 g/die (corresponding to 122-366 mg Mg++):25 of them presented migraine as the main symptom, 12 recurrent abdominal pain, 3 fever of unknown origin, along with many other periodic symptoms. The first control visits have been done at 1 month, clinical follow-up lasted a mean period of 6.1 months. Therapy was stopped at 1 month visit if ineffective (of some other drug was added); otherwise, magnesium therapy was continued with the same dosage for another month, then gradually reduced. Clinical response was considered good if crises ceased completely or their frequency was reduced to less than 33%; partial if reduced to less than 67% of previous incidence; absent if only slightly or not at all reduced. Clinical response was good in 72.5% of cases at 1 month, in 77.5% later; partial in 12.5% and 10%; absent in 15% and 12.5% respectively. No side effects were observed. The compliance of children and their families was complete.(ABSTRACT TRUNCATED AT 250 WORDS)

The pathogenesis of periodic syndrome (recurrent abdominal pain, cyclic vomiting, headache and other equivalents of childhood migraine) is often related in the literature to a "neuro-vegetative dysfunction", by which occasional stimuli (environmental, metabolic, emotional) should find a particular somatic expression. The homeostatic role of the autonomic nervous system could be deficient in these cases, but systematic research has never been done to explore this hypothesis. We have evaluated the autonomic nervous function in 38 children (12 M, 26 F) with periodic syndrome, by cardiovascular autonomic function tests. They consist of ortho- and parasympathetic parameters obtained by ECG registration and pressure monitoring during deep breathing, Valsalva manoeuvre, lying to standing postural change, sustained handgrip. In the absence of adequate pediatric references values, we have previously standardized these tests in a population of 198 healthy children (94 M, 104 F), aged 8.3-15.7 years. Results have been compared with our standard reference values, matching them by t-test for independent data: in both sexes, significant differences have been found out in only one of 11 parameters (p < 0.05) of the autonomic tests performed. Children affected by periodic syndrome reveal a reduced heart rate variation in transition from the early orthosympathetic phase to the late parasympathetic one after lying to standing passage, showing a smaller fluctuation of autonomic feedback systems. The physiological meaning of this result is unclear. However, in children with periodic syndrome no prevalence of ortho- or parasympathetic systems is evident.

The study of cardiovascular autonomic reflexes is the most physiological and reliable test for the assessment of autonomic function: they consist of the analysis of variation of heart rate and arterial pressure provoked by many physiological stimuli. Up to now normal pediatric reference data were not available: we have standardized these tests in 198 normal children (94 M, 104 F), aged 8.3-15.7 years, without any symptom of possible autonomic dysfunction pathology. A complete auxological evaluation has been performed. Autonomic tests were performed by ECG recording and arterial pressure monitoring during normal and deep breathing, Valsalva manoeuvre, lying to standing postural change, isometric muscular contraction (sustained hand-grip and leg rising). Eleven autonomic parameters were obtained. Many statistical correlation between autonomic parameters and auxological features have been explored, without remarkable results. A significative difference emerged only between sexes. Normal reference values has been calculated. Their utility for the study of autonomic dysfunction is discussed.

Slight, moderate but also high rises in temperature, excluding other causes of fever, can be considered symptoms of periodic syndrome originating by hypothalamic centers as soon as headache, recurrent abdominal pains, growing pains, dizziness, kinetosis. These rises aren't uncommon, but often aren't considered important and this few statistics are available. The Authors present 16 case reports of fever as periodic symptom and discuss how common factors exist in the mechanism of hyperthermia and other clinical signs of periodic syndrome (ex. migraine) but they are generally modulated differently so that disturbance of temperature regulation predominates in the first case, pain in the second.

Two casual clinical observations here reported allow the Authors to discuss the possible relationships between periodic syndrome and spasmophilia. Particularly they stress how these common causes of recurrent symptoms (abdominal pain, headache, growing pains, anxiety, irritability) can be the same clinical entity. This suspicion is confirmed by EMG investigation: 25 children with periodic syndrome (8 males, 17 females; 8-13 years) and 10 normal subjects (6-11 years) participate in this study. Post-ischemic EMG shows signs of neuromuscular hyperexcitability as in spasmophilia in 21 children (84%) of the first group and only in 3 of the second group. Such findings should be regarded as the first step towards a better definition of the relationships between periodic syndrome and spasmophilia.

There has been a great dealt of discussion as to the clinical significance of E.E.G. 14-6 per second positive spikes (14-6 PS), a short burst lasting one second or less which occurs during light sleep in monopolar recordings, mainly in the posterior temporal regions and usually involving the parietal and occipital regions as well, for the most part in unsymmetrical fashion. Early interpretations stress the epileptic nature of vegetative attacks in patients with an inter-critical E.E.G. reading characterized by 14-6 P.S. Subsequently, however, this hypothesis has been refuted, mainly because E.E.G. intra-critical recordings have never shown evidence of any sort of paroxysmal activity. At present time expert think that the presence of 14-6 PS may be merely an indication of an electrical alteration associated with disorders in the neurovegetative area. In order to evaluate the possibility of using them as a diagnostic marker of migraine equivalents and periodic syndromes, we reviewed wake and sleep E.E.G. recordings, carried out consecutively and hence not selectively, in 617 children aged 5-16 years. 14-6 PS were present in 109 children (17.6%), 63 of whom showed evident symptoms of periodic syndrome (headache, recurrent abdominal pain, cyclic vomiting, kinetosis, etc.); hence 46 E.E.G. recording were false positive. 510 children were lacking in 14-6 PS, 91 of these presented symptoms of periodic syndromes (false negative). 14-6 PS are hence a marker 40.9% sensitive, 90.1% specific, with a predictable value of 57.7%. The search for 14-6 PS in children with periodic syndrome is not particularly sensitive as a test, but it is fairly specific: it may well constitute an useful element in diagnosis.

The case history in question refers to 94 high-risk babies, 24 of whom (25%) had neuromotor problems at some time during the first year. Of these, 15 have continued to be supervised up to the present time, i.e. to the age of four. Eight of them have had overall motor treatment and seven have had constant check-ups, advice on posture and active encouragement to move their bodies. All 15 infants developed normal neuromotor behaviour by the age of two (only one was retarded in speech). We therefore feel justified in not encouraging indiscriminate remedial therapy in all cases of abnormal development. It should be used only in those cases in which there are serious, persistent problems in the sphere of feeling and relating.