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Background: Children with public insurance (Medicaid) have increased barriers to specialty care in the United States. For children with epilepsy, the relationship between public insurance and barriers to genetic testing is understudied.Methods: We surveyed a sample of US child neurology clinicians. We performed quantitative and qualitative analysis of responses.Results: There were 302 responses (of 1982 surveyed; response rate 15%) from clinicians from 46 states, the District of Columbia, and Puerto Rico, including board-certified child neurologists (82%), resident physicians (6%), nurses (3%), and nurse practitioners (3%). Clinicians felt it was more difficult to get genetic testing for patients with Medicaid insurance compared with commercial insurance, (43% vs 12%, P < 0.05), although many felt it was about the same degree of difficulty (25%) or were not sure (20%). Increased availability of testing was associated with less complex testing (P < 0.001), in-house testing (P < 0.001), and no preauthorization requirements (P < 0.001). Qualitative responses described barriers related to cost, clinician familiarity and comfort, commercial laboratories, health care organization, payer, and patient concerns. Descriptions of facilitators included lowered cost, availability of clinical genetics expertise, clinician knowledge, commercial laboratory assistance, health care organizational changes, improved payer coverage, and increased interest by parents.Conclusions: Pediatric Medicaid beneficiaries with epilepsy have barriers to genetic testing, compared with children with commercial insurance, particularly for more advanced testing. Potential strategies to improve access include broader coverage, lower co-pays, increased capacity for testing outside of specialty laboratories, fewer preauthorization requirements, improved clinician education, ongoing development and dissemination of guidelines, improved availability of clinical genetics services, and continued assistance programs from commercial laboratories. [ABSTRACT FROM AUTHOR]

The lay media and scientific literature have focused increasing attention on vitamin D deficiency and insufficiency in recent years. Low vitamin D levels confer increased an risk of abnormal bone mineralization, and are linked to poor bone health in epilepsy patients. However, vitamin D is not the only determinant of bone health in children with epilepsy. Anticonvulsant medications, in addition to features and comorbidities of epilepsy and coexisting neurologic diseases, are important factors in this complex topic. We review the basic metabolism of vitamin D in terms of bone health among children with epilepsy. We also discuss the literature regarding vitamin D and bone mineral density in this population. Finally, we suggest algorithms for screening and treating vitamin D insufficiency in these patients. [Copyright &y& Elsevier]

Abstract: Bronchial artery embolization with microspheres constitutes an effective, safe procedure for controlling hemoptysis. A 17-year-old girl with cystic fibrosis developed hemoptysis and underwent bilateral bronchial artery embolization with 300-500 μm and 500-700 μm microsphere particles. Afterward, she was delirious and complained of headache. On initial examination, she manifested altered mental status and diffuse hyperreflexia. Her left fifth digit was painful and cyanotic. Neuroimaging demonstrated multiple embolic infarcts in the cerebellum, thalamus, and cerebral hemispheres. An echocardiogram produced normal results. An evaluation of her thrombophilia revealed heterozygosity for a prothrombin 20210A mutation. Her functional neurologic recovery was complete. To our knowledge, this is the first pediatric case of cerebral and systemic embolism after bronchial artery embolization. Although this complication is not predictable, it should be suspected in patients with underlying chronic lung disease who develop acute neurologic signs after bronchial artery embolization, because these patients are prone to anomalous arterial-arterial shunt formation. [Copyright &y& Elsevier]

This cross-sectional study was designed to determine the prevalence of, and risk factors for, vitamin D insufficiency among children treated for epilepsy in a general pediatric neurology clinic. Included were 78 children with epilepsy, aged 3-17 years, treated by the authors between September 2008 and March 2009. Vitamin D levels and relevant risk factors were evaluated using multiple logistic regression. Of the 78 children, 41% were male and 81% were of European origin; the mean age was 11.64 ± 4.37 years. 25-hydroxyvitamin D levels of <20 ng/mL were observed in 25% of the children and levels considered to be normal (>32 ng/mL) were observed in only 25%. Girls and children with elevated body mass index were at increased risk for low 25-hydroxyvitamin D. The odds ratio for low 25-hydroxyvitamin D was 4.07 for girls versus boys, with a 95% confidence interval of 1.18-13.97; for each 1-unit increase in body mass index, the odds ratio was 1.179, with a 95% confidence interval of 1.047-1.329. Use of newer antiepileptic drugs was not associated with altered risk, compared with older enzyme-inducing drugs. Vitamin D insufficiency was highly prevalent in this unselected population of children with epilepsy. Female sex and increased body mass index were significant risk factors for low vitamin D levels, but antiepileptic drug regimen was not. [Copyright &y& Elsevier]

Objective: There are no evidence-based guidelines on the preferred approach to treating early-life epilepsy. We examined initial therapy selection in a contemporary US cohort of children with newly diagnosed, nonsyndromic, early-life epilepsy (onset before age three years).Methods: Seventeen pediatric epilepsy centers participated in a prospective cohort study of children with newly diagnosed epilepsy with onset under 36 months of age. Details regarding demographics, seizure types, and initial medication selections were obtained from medical records.Results: About half of the 495 enrolled children with new-onset, nonsyndromic epilepsy were less than 12 months old at the time of diagnosis (n = 263, 53%) and about half (n = 260, 52%) had epilepsy with focal features. Of 464 who were treated with monotherapy, 95% received one of five drugs: levetiracetam (n = 291, 63%), oxcarbazepine (n = 67, 14%), phenobarbital (n = 57, 12%), topiramate (n = 16, 3.4%), and zonisamide (n = 13, 2.8%). Phenobarbital was prescribed first for 50 of 163 (31%) infants less than six months old versus seven of 300 (2.3%) of children six months or older (P < 0.0001). Although the first treatment varied across study centers (P < 0.0001), levetiracetam was the most commonly prescribed medication regardless of epilepsy presentation (focal, generalized, mixed/uncertain). Between the first and second treatment choices, 367 (74%) of children received levetiracetam within the first year after diagnosis.Conclusions: Without any specific effort, the pediatric epilepsy community has developed an unexpectedly consistent approach to initial treatment selection for early-life epilepsy. This suggests that a standard practice is emerging and could be utilized as a widely acceptable basis of comparison in future drug studies. [ABSTRACT FROM AUTHOR]

Background: To assess and compare resident and practicing child neurologists' attitudes regarding recruitment and residency training in child neurology.Methods: A joint task force of the American Academy of Pediatrics and the Child Neurology Society conducted an electronic survey of child neurology residents (n = 305), practicing child neurologists (n = 1290), and neurodevelopmental disabilities specialists (n = 30) in 2015. Descriptive and multivariate analyses were performed.Results: Response rates were 32% for residents (n = 97; 36% male; 65% Caucasian) and 40% for practitioners (n = 523; 63% male; 80% Caucasian; 30% lifetime certification). Regarding recruitment, 70% (n = 372) attributed difficulties recruiting medical students to insufficient early exposure. Although 68% (n = 364) reported that their medical school required a neurology clerkship, just 28% (n = 152) reported a child neurology component. Regarding residency curriculum, respondents supported increased training emphasis for genetics, neurodevelopmental disabilities, and multiple other subspecialty areas. Major changes in board certification requirements were supported, with 73% (n = 363) favoring reduced adult neurology training (strongest predictors: fewer years since medical school P = 0.003; and among practicing child neurologists, working more half-day clinics per week P = 0.005). Furthermore, 58% (n = 289) favored an option to reduce total training to 4 years, with 1 year of general pediatrics. Eighty-two percent (n = 448) would definitely or probably choose child neurology again.Conclusions: These findings provide support for recruitment efforts emphasizing early exposure of medical students to child neurology. Increased subspecialty exposure and an option for major changes in board certification requirements are favored by a significant number of respondents. [ABSTRACT FROM AUTHOR]

Keywords: Genetic epilepsy; SCN1B; Sodium channel; Generalized epilepsy with febrile seizures plus EN Genetic epilepsy SCN1B Sodium channel Generalized epilepsy with febrile seizures plus 121 122 2 06/19/20 20200701 NES 200701 Patient Description This child experienced a febrile seizure at age 26 months. His cvEEG at 31 months demonstrated myoclonic seizures occurring two to three times per hour, atonic seizures occurring twice a day, and bilateral tonic seizures occurring once a day. Discussion SCN1B was the first gene identified for genetic epilepsy with febrile seizures plus,[1] which spans a range of phenotypes including epilepsy with myoclonic-atonic seizures. [Extracted from the article]