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Transient loss of consciousness (TLOC) is spontaneous loss of consciousness with complete recovery; there is temporary impairment of brain function associated with loss of awareness, loss of responsiveness, and loss of memory. Syncope is the most common cause of transient loss of consciousness in children. Whilst syncope is potentially easy to understand using applied physiology, therapeutic opportunities are often missed, leading to avoidable morbidity and disability. In this article we will discuss the causes of TLOC and focus on the evaluation and management of syncope and orthostatic intolerance in children and young people. [ABSTRACT FROM AUTHOR]

Purpose: In response to continuing concerns regarding the quality and equality of care for children and young people, the British Paediatric Neurology Association (BPNA) has supported the development of practical and meaningful audit to support quality improvement. Method: In 2006, the Children's Epilepsy Workstream in Trent (CEWT) coordinated a retrospective multi-service audit of paediatric epilepsy care against NICE and SIGN guidelines. This aimed to both facilitate quality improvements for participating services and act as a pilot for future potential national audits. Results: The audit was achieved in 4 hospital services using prospective and retrospective ascertainment methods. 12 performance indicators were applied to each cohort. Overall 54% (12/22) of children with epilepsy had input from a paediatrician with "expertise" and 23% (5/22) had input from an epilepsy specialist nurse. Conclusion: Audit can be developed for epilepsies that delivers standardised quality metrics against national recommendations. As well as supporting local quality improvement initiatives, comparative and aggregate data can be produced to potentially give regional and national perspectives. The results and experience describe the journey towards the 2009-2012 Epilepsy12 UK multicentre epilepsy audit. [ABSTRACT FROM AUTHOR]

Ambulatory electroencephalogram has been used for differentiating epileptic from nonepileptic events, recording seizure frequency and classification of seizure type. We studied 100 consecutive children prospectively aged 11 days to 16 years that were referred for an ambulatory electroencephalogram to a regional children's hospital. Ambulatory electroencephalogram was clinically useful in contributing to a clinical diagnosis in 71% of children who were referred with a range of clinical questions. A diagnosis of epileptic disorder was confirmed by obtaining an ictal record in 26% and this included 11 children that had previously normal awake and or sleep electroencephalogram. We recommend making a telephone check of the current target event frequency and prioritising those with typical events on most days in order to improve the frequency of recording a typical attack. [ABSTRACT FROM AUTHOR]

Head-up tilt testing (HUTT) is the gold standard investigation for adults with transient loss of consciousness (TLOC), but it is controversial in children and young people, because of a lack of systematic investigation and because the test can be uncomfortable. As it was introduced recently for children attending our hospital, we undertook a retrospective registered clinical audit of its usefulness. The medical records of 100 consecutive patients aged less than 18 years undergoing HUTT from October 2001 to December 2008 were reviewed. Information about their episodes, prodromes, triggers, previous tests, indications for the HUTT, the HUTT and clinical outcomes was extracted. Children were 6-17 years old; 68/100 were female. In 32/100, no trigger was reported. The most reported triggers included standing up (20%) and prolonged standing (18%). Dizziness (64%) and altered vision (39%) were the most experienced prodromal symptoms. Twenty-eight of 100 had a positive test, with reproduction of symptoms in 24. Seventeen of 100 tests were negative but symptomatic; 55/100 had a negative asymptomatic test. In 17/28 positive HUTTs, the tilt confirmed the suspected diagnosis and elucidated the mechanism. Two of 28 were started on medication. However, in 9/28, neither was the diagnosis clarified nor was therapy instigated. Potentially useful information about the TLOC was obtained in 45/100 cases. The 17/100 with negative but symptomatic results may have had medically unexplained TLOC or emotional attacks, although without concurrent electroencephalogram, some uncertainty remains. Therefore, a new protocol with video-electroencephalogram-polygraphy and beat-to-beat finger blood pressure recording, and more explicit clinical reporting is being developed. [ABSTRACT FROM AUTHOR]

Summary: Purpose: Epilepsies in children are complex diseases. Guidelines are needed on the appropriate use of newer versus older anti-epileptic drugs (AEDs). This paper presents an individual patient-sampling model to assess the cost-effectiveness of using newer AEDs as add-on therapy in line with UK prescribing guidance. Methods: Identification of the relevant parameters and treatment pathways for the model were achieved by a systematic review of the literature and discussions with clinical experts. Data were obtained from the literature and supplemented with data elicited from paediatric neurologists. The model considered paediatric patients over the period of childhood from the age of diagnosis to 18 years. Results: The results suggest that the older and newer AEDs are similar in terms of drug retention rates and the average time in ‘good’ treatment outcomes. In terms of cost, the results indicate a consistent increase in cost (compared to older AEDs) when all of the newer AEDs are considered. The decision analysis results indicate that there are no important health benefits from the use of newer AEDs when used as add-on therapy. However, the analysis also reveals that the uncertainties in the model are greater than the differences between the drug strategies. Conclusions: To develop guidelines on the appropriate use of newer AEDs, better information is required from randomised controlled trials as there is insufficient data available in the public domain to accurately estimate the nature of the trade off between older versus newer AEDs. [Copyright &y& Elsevier]

Summary: Objective: To assess the quality of clinical care at first clinic attendance in children with suspected epilepsy from a defined geographical population. Method: All hospital- and community-based consultant paediatricians in Nottingham City region, UK, were asked to collaborate with a retrospective clinical audit identifying children seen between January 2001 and March 2002. The British Paediatric Neurology Association (BPNA) audit tool (Appleton R, Besag F, Kennedy C, et al. An audit of children referred with suspected epilepsy. Seizure 1998;7(6):489–95) was used to analyse the initial outpatient assessment. Results: All consultants agreed to participate. A total of 147 children were identified as meeting the inclusion criteria. The sequence of events during the episodes was well recorded (91%). Other aspects of the history were less well recorded. Twelve percent were given a diagnosis of epilepsy, 26% non-epileptic and 62% uncertain. Documentation of early development and school performance was low (41%). Twenty-four percent of the children had no written documentation confirming physical and neurological examination. Documentation describing referral to an epilepsy nurse or support group was seen in 11%. Drug treatment and doses and follow-up plans were recorded in nearly all cases where applicable. Discussion: A managed clinical network for children with epilepsy in Nottingham and the surrounding Trent region is currently being discussed which will consider alternative models of care for children with epilepsy. A revision of the BPNA audit tool has been produced with the BPNA Audit group and is available for other centres via the BPNA website''s ‘clinical toolbox’ ( http://www.bpna.org.uk/audit ). [Copyright &y& Elsevier]

We evaluate the value of an internet-based educational animated video designed to prepare children for MRI scans, and whether this video reduces scan-related anxiety in children with a neurological disorder, and healthy controls. Participants completed a pre- and post-scan questionnaire evaluating participant online viewing behaviour, understanding of the MRI procedure, anxiety regarding the MRI, impact of animation in preparing the child and whether the child's expectation of the MRI scan matched their experience. 21 children were recruited (12 healthy controls) ranging in age from 6.5 to 11.5 years. The animation was successfully accessed by participants on a range of digital devices and had high levels of approval. Children who viewed the animation had a good understanding of the MRI procedure and low anxiety levels prior to the scan, and reported that their expectations broadly matched the real-life MRI experience. Children reported that the animation positively impacted on their preparation with similar ratings before and after the scan, and the impact on preparation was rated greater by younger children. There were no group differences between healthy children and those with the neurological disorder for ratings of anxiety, impact on preparation and expectation of the experience. This evaluation demonstrates accessibility, acceptability and relevance of internet-based educational animation for typically developing children, and children with a neurodisability aged 6 to 11 years, with positive impact on preparation for MRI. The internet-based educational animation provides a widely accessible tool to support preparation of children for non-sedated MRI. [ABSTRACT FROM AUTHOR]