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International audience; Background: General Movement Assessment (GMA) is a powerful tool to predict Cerebral Palsy (CP). Yet, GMA requires substantial training challenging its broad implementation in clinical routine. This inspired a world-wide quest for automated GMA. Aim: To test whether a low-cost, marker-less system for three-dimensional motion capture from RGB depth sequences using a whole body infant model may serve as the basis for automated GMA.Study design: Clinical case study at an academic neurodevelopmental outpatient clinic.Subjects: Twenty-nine high risk infants were assessed at their clinical follow-up at 2-4 month corrected age (CA). Their neurodevelopmental outcome was assessed regularly up to 12-31 months CA.Outcome measures: GMA according to Hadders-Algra by a masked GMA-expert of conventional and computed 3D body model (“SMIL motion”) videos of the same GMs. Agreement between both GMAs was tested using dichotomous and graded scaling with Kappa and intraclass correlations, respectively. Sensitivity and specificity to predict CP at ≥12 months CA were assessed.Results: Agreement ofthe two GMA ratings was moderate-good for GM-complexity (κ=0.58; ICC=0.874 [95%CI 0.730;0.941]) and substantial-good for fidgety movements (FMs; Kappa=0.78, ICC=0.926[95%CI 0.843;0.965]). Five children were diagnosed with CP (four bilateral, one unilateral CP). The GMs of the child with unilateral CP were twice rated as mildly abnormal with FMs. GM-complexity and somewhat less FMs, of both conventional and SMIL motion videos predicted bilateral CP comparablyto published literature.Conclusions: Our computed infant 3D full body model is an attractive starting point for automated GMA in infants at risk of CP.

Objective The aim of the current study is to measure long‐term executive function, motor outcome, and QoL in children, adolescents, and young adults after VAD and Htx. Methods Patients were examined during routine follow‐up. Investigation tools were used as follows: Examination for MND of motor outcomes, Epitrack® for attention and executive functioning, and Kidscreen‐52 and EQ‐5D‐5L questionnaires for QoL. Additional data were retrospectively obtained by an analysis of patient medical records. Results Out of 145 heart transplant recipients at the department of pediatric cardiology of the University Hospital Munich, 39 were implanted with a VAD between 1992 and 2016. Seventeen (43.6%) patients died before or after Htx; 22 (56.4%) patients were included in our study. Mean age at transplant was 9.52 years (range: 0.58‐24.39 years, median 9), and the mean follow‐up time after Htx was 6.18 years (range: 0.05‐14.60 years, median 5.82). MND examination could be performed in 13 patients (normal MND: n = 11, simple MND: n = 1, complex MND: n = 1). Executive functioning was tested in 15 patients. Two (13.3%) patients had good results, six (40%) average results, three (20%) borderline results, and four (26.7%) impaired results. QoL (Kidscreen n = 7, EQ‐5D‐5L n = 8) was similar to a healthy German population. Conclusion Motor outcome, executive functioning and QoL in survivors of VAD bridging therapy and Htx can be good, though underlying diseases and therapies are associated with a high risk of cerebral ischemic or hemorrhagic complications.

Purpose To assess the impact of vertigo on health-related quality of life (HrQoL) of children/adolescents and to assess if the impact on HrQoL varies by age group, gender, and type of vertigo diagnoses. Methods A retrospective analysis was performed on the clinical and HrQoL data of children and adolescents referred to the German Center of Vertigo and Balance Disorders (n = 32; male = 17; female = 15; age range: 8–18 years), using the KIDSCREEN-52 questionnaire. For each scale, means of the Z-scores with 95% confidence intervals of the study and norm sample were compared. By nonparametric Kruskal–Wallis statistics differences between diagnostic groups were assessed. To assess the gender- and age-specific impact of vertigo on quality of life, Wilcoxon signed-rank test was used. Results The means of the physical well-being, psychological well-being, autonomy scale, and the general HrQoL index of patients were considerably lower than the means of the norm sample. The physical well-being seemed to be most affected by vertigo. The reduction of HrQoL was not related to gender and vertigo types but seemed to be higher in children suffering from vertigo aged 12 to 18 years than children aged 8 to 11 years. Conclusion These are the first data to demonstrate impaired HrQoL in children with chronic vertigo.

Zusammenfassung Hintergrund Begrenzte Zeit fur den Patienten und allgegenwartige administrative Verpflichtungen kennzeichnen das Arbeitsprofil von klinisch tatigen ArztInnen in der Erwachsenenmedizin. Ziel der Arbeit Pilotuntersuchung des arztlichen Arbeitsprofils in einer Universitatsklinik fur Kinder- und Jugendliche. Material und Methoden Befragung klinisch tatiger Kinder- und JugendarztInnen der Universitat Munchen an einem zufallig ausgewahlten Wochentag durch einen kurzen Fragebogen. Die Zeiterfassung fokussierte auf patientenbezogene Aufgaben einerseits und verwaltungsbezogenen Aufgaben andererseits. Die unterschiedliche klinische Erfahrung und die unterschiedlichen Arbeitsbereiche der Padiatrie (Station, allgemeine (Notfall-) Ambulanz, spezialisierte Hochschulambulanz, integriertes Sozialpadiatrisches Zentrum) wurden berucksichtigt. Ergebnisse Tagesarbeitszeiten von uber 8,5 Stunden wurden von 91,7% der Kinder- und JugendarztInnen angegeben. Der prozentuale Anteil patientenbezogener Zeit lag bei 31,2% (95%-KI = [25,2–37,1]). Die Zeit pro Patient im direkten Patientenkontakt variierte je nach Einsatzort von 14 Minuten pro Patient im stationaren Bereich bis zu 52 Minuten pro Patient im integrierten Sozialpadiatrischen Zentrum. Fur die korperliche Untersuchung (als der direkte klinische Zugang zum Kind) wurden 3 bis 10 Minuten pro Patient und Tag eingesetzt. Die unterschiedliche klinische Erfahrung der Kinder- und JugendarztInnen generierte keinen wesentlichen Unterschied fur die berichteten Zeitkontingente. Zusammenfassung Im realen Arbeitsalltag einer Universitatsklinik fur Kinder und Jugendliche werden ca. 30% der taglichen Arbeitszeit fur patientenbezogene Aufgaben eingesetzt. Daraus resultieren kurze Zeiteinheiten fur die korperliche Untersuchung und den direkten Arzt-Patientenkontakt.

Intrauterine Alkoholexposition kann zu einer toxischen Schadigung des kindlichen Gehirns und damit zur Fetalen Alkoholspektrumstorung („fetal alcohol spectrum disorder“, FASD) fuhren. Deren geschatzte Pravalenz betragt in Deutschland ca. 1 %. Die FASD persistiert lebenslang. Mit dem Krankheitsbild FASD werden neben Kinder-/Jugendarzten und Kinder-/Jugendpsychiatern auch Allgemeinarzte, Neurologen, Psychiater und Psychotherapeuten sowie Gynakologen (und weite Bereiche der Padagogik und Sozialarbeit) konfrontiert. Ausgehend von der systematisch recherchierten, methodisch bewerteten Literatur (2001–2015) konsentierte die multidisziplinare Leitliniengruppe Empfehlungen fur die Diagnose der FASD. In dieser Publikation werden die differenzierenden diagnostischen Kriterien fur das partielle Fetale Alkoholsyndrom (pFAS), die alkoholbedingte entwicklungsneurologische Storung („alcohol-related neurodevelopmental disorder“, ARND) und die alkoholbedingten angeborenen Malformationen („alcohol-related birth defects“, ARBD) dargelegt. Die Literaturrecherche zu pFAS, ARND und ARBD ergab 365 Treffer. Es wurden 58 Publikationen in die methodische Bewertung aufgenommen. Um das pFAS zu diagnostizieren, mussen 2 von 3 fazialen Auffalligkeiten (kurze Lidspalten, schmale Oberlippe und verstrichenes Philtrum), mindestens 3 Auffalligkeiten des Zentralnervensystems (ZNS) und ein wahrscheinlicher mutterlicher Alkoholkonsum vorhanden sein. Zur Diagnose der ARND werden mindestens 3 ZNS-Auffalligkeiten und eine gesicherte intrauterine Alkoholexposition gefordert. Alkoholbedingte angeborene Malformation wird als separate Diagnose verworfen. Evidenzbasierte und praktisch anwendbare Empfehlungen fur die Diagnose der FASD wurden bestimmt. Hinsichtlich der Versorgung und Sekundarpravention von Folgeerkrankungen besteht Forschungsbedarf.

Der Schlaganfall im Kindesalter ist ein Notfall mit hoher Mortalitat und Morbiditat. Er hat – in Abhangigkeit von der zugrunde liegenden Atiologie – ein klinisch bedeutsames Rezidivrisiko. Die Atiologie ist vielfaltig. Vaskulopathien, Infektionen, kardiale Probleme und Koagulopathien spielen pathophysiologisch eine wesentliche Rolle. Die atiologische Abklarung muss umfassend sein – der kindliche Schlaganfall ist eine „Multiple-Risk-Erkrankung“. Klassische Leitsymptome sind die akute Hemiparese, die faziale Parese und die Sprachstorung: Sie bestehen bei ca. 75 % der betroffenen Kinder. Aufgrund der mannigfaltigen, teils unspezifischen Symptome, der breiten Differentialdiagnosen und des fehlenden Bewusstseins fur den kindlichen Schlaganfall wird die Diagnose mittels Bildgebung oft erst nach einer erheblichen Zeitverzogerung gestellt (im Mittel nach 24 h). Die in speziellen Fallen moglichen Therapien wie die Thrombolyse oder die mechanische Thrombektomie konnen dabei grundsatzlich nur innerhalb weniger Stunden nach dem Ereignis eingesetzt werden – sie sind spezialisierten Zentren vorbehalten. Als neurologisches Residualsymptom steht die Hemiparese im Vordergrund, je nach betroffenem Infarktareal treten cerebrale Krampfanfalle, Sprachstorungen etc. auf. Die Auswirkungen auf Kognition und Verhalten werden in der Versorgungspraxis oft ubersehen und unterschatzt.

Aim For children with medical complexity, interdisciplinary treatment approaches are required to address the various aspects defined within the biopsychosocial model. Methods The present study identifies dimensions of the biopsychosocial model to generate a standardized visualized severity score for chronic neurological diseases in children. We demonstrate the score's applicability and usefulness in clinical practice among clinicians with and without pediatric board certification with the aid of illustrative patient cases. The results are compared by Spearman correlation coefficient. Results Nine dimensions were identified as the basis for the development of the score, which consists of five grades of severity for each of the selected neuropediatric subsections. All board-certified pediatricians would recommend the application of the severity score in clinical routine. Furthermore, a good correlation was revealed between direct and indirect (severity score) assessment. Interpretation The severity score developed in this study takes into account biopsychosocial aspects of chronic diseases while being comprehensible and easily applicable in clinical routine—a biopsychosocial signature serving as an excellent, striking communication basis within the interdisciplinary team. However, upcoming studies including more patient cases are needed for further refinement.

Der Schlaganfall bei Kinder und Jugendlichen tritt selten auf, ist aber immer ein kinderneurologischer Notfall. Fur das Outcome sind eine fruhzeitige Diagnostik und Therapieeinleitung, eine adaquate Rezidivpravention und speziell auf die Bedurfnisse jedes einzelnen Kindes und seine Entwicklung abgestimmte rehabilitative Masnahmen entscheidend.

BackgroundIn recent years, there has been increasing research interest in improving diagnostic and management protocols in childhood arterial ischaemic stroke (AIS). However, childhood stroke comprises, in approximately equal parts, both arterial ischaemic and haemorrhagic stroke (HS).ObjectiveThe aim of this study was to focus on the aetiology, clinical presentation, treatment and short-term outcome of children with spontaneous intracranial bleeding in a university hospital and elucidate differences to childhood AIS.DesignWe performed a retrospective analysis of electronic medical records of children (28 days–18 years) diagnosed with HS between 2010 and 2016.ResultsWe included 25 children (male child, n=11) with a median age of 8 years 1 month. The most common clinical presentations were vomiting (48%), headache (40%) and altered level of consciousness (32%). In more than half of the patients, HS was caused by vascular malformations. Other risk factors were brain tumour, coagulopathy and miscellaneous severe underlying diseases. Aetiology remained unclear in one child. Therapy was neurosurgical in most children (68%). Two patients died, 5 patients needed further (rehabilitation) treatment and 18 children could be discharged home.ConclusionsHS differs from AIS in aetiology (vascular malformations as number one risk factor), number of risk factors (‘mono-risk’ disease), clinical presentation (vomiting, headache and altered level of consciousness) and (emergency) therapy.

Hintergrund Die zeitliche Verzögerung zwischen Symptombeginn und Diagnose ist eine Herausforderung in der Behandlung von Kindern mit arteriell ischämischem Schlaganfall. Frühere Studien zur klinischen Präsentation beschäftigten sich v. a. mit kumulativen Symptomen. Zielsetzung Ziel dieser Studie ist es, mögliche Symptommuster aufzuzeigen. Methoden In einer aktiven Beobachtungsstudie zwischen 01/2015 und 12/2016 (ESPED-Studie) wurden Kinder mit Erstdiagnose eines arteriell ischämischen Schlaganfalls eingeschlossen. Isoliert auftretende Erstsymptome wurden verschiedenen Symptomkombinationen gegenübergestellt. Zudem wurde untersucht, inwieweit ein als „akut“ oder „progredient“ klassifiziertes Auftreten der Symptome Rückschlüsse auf die zugrundeliegende Ätiologie erlaubt. Ergebnisse Es wurden 99 Kinder in die Studie eingeschlossen. Unabhängig vom Alter traten überwiegend fokale Symptome auf (86%). Krampfanfälle als Initialsymptom wurden insbesondere bei Säuglingen beschrieben (67%), wohin-gegen diffuse, unspezifische Symptome vor allem bei Vorschulkindern (38%) und älteren Kindern (59%) auftraten. Isoliert traten fokale Symptome bei 37 Kindern auf, 48 Kinder zeigten zusätzlich unspezifische Symptome, darunter auch 9 Kinder mit Krampfanfällen. Isolierte unspezifische Symptome zeigten sich lediglich bei 7 Kindern, 2 Kinder wurden nur mit Krampfanfällen symptomatisch. Die Akuität des Symptombeginns wurde bei 53/78 als „akut“ und bei “25/78 Fällen als „progredient“ klassifiziert, lieferte jedoch keinen Hinweis auf die zugrundeliegende Ätiologie. Schlussfolgerung Jedes neue fokal neurologische Defizit sollte unabhängig vom Auftreten (isoliert oder kombiniert, akut oder progredient) an einen kindlichen Schlaganfall denken lassen. Background Time delay between onset of clinical symptoms and diagnosis is a challenge in childhood arterial ischemic stroke. Most previous studies reported cumulative symptoms. Objective We attempted to identify typical symptom patterns and assessed their emergence in childhood stroke. Methods Prospective active surveillance in ESPED, a hospital based Pediatric Surveillance Unit for rare diseases in Germany, between January 2015 and December 2016. Case definition: first diagnosis of a radiologically confirmed arterial ischemic stroke. Symptom patterns were identified as occurring in isolation or in combination. We distinguished acute vs. progressive onset. We ascertained risk factors to identify the possible etiology. Results 99 children with childhood arterial ischemic stroke were reported. Focal symptoms were the predominant presenting feature (86%), independent of age. Seizures were more often seen in infants < 1 year (67%), whereas diffuse symptoms were more present in pre-school children (38%) and older children (59%). 37 children had focal features alone and 48 additional non-specific features, including 9 with seizures. Isolated non-specific features accounted for 7 cases, and 2 children had (focal) seizures as the only symptom. In 77% of all cases at least one risk factor was identified. The emergence of symptoms was acute in 53/78 cases and progressive in 25/78 cases. The pattern of emergence was unrelated to the underlying etiology. Conclusions Any new focal neurological deficit in isolation, or associated with seizures or further non-specific symptoms should alert to childhood stroke.

Objective To assess the relative risk, predictive value and population attributable risk fraction of pre-school episodic syndromes for later migraine in primary school age children. Methods This retrospective cohort study used health insurance data on 55,035 children born in 2006 with no diagnosis of migraine up to the age of 5 years. The relative risk, probability and population attributable risk fraction of migraine prompting a physician visit at the age of 6–10 years in children with episodic syndromes included in the International Classification of Headache Disorders (benign paroxysmal torticollis, benign paroxysmal vertigo, cyclic vomiting syndrome, recurrent abdominal symptoms and abdominal migraine) and those not included in the International Classification of Headache Disorders (pavor nocturnus, somnabulism and bruxism) diagnosed up to the age of 5 years were determined. Results The period prevalence of individual episodic syndromes ranged between 0.01% and 1.40%. For episodic syndromes included in the International Classification of Headache Disorders (recurrent abdominal symptoms and abdominal migraine) and for the episodic syndromes not included in the International Classification of Headache Disorders (somnambulism), the risk for later migraine was increased by factors of 2.08, 21.87 and 3.93, respectively. The proportion of risk for migraine in primary school children explained by any episodic syndromes included in the International Classification of Headache Disorders was 2.18% and for any episodic syndromes not included in the International Classification of Headache Disorders it was 0.59%. Conclusion Several pre-school episodic syndromes are risk factors for migraine in primary school age children. The fraction of migraine in primary school age children explained by prior episodic syndromes, however, is below 3%. A probability to develop primary school age migraine above 50% was only observed for abdominal migraine.

Post-mortem studies reveal a high rate of cavum septi pellucidi (CSP) in chronic traumatic encephalopathy (CTE). It remains, however, to be determined whether or not the presence of CSP may be a potential in vivo imaging marker in populations at high risk to develop CTE. The aim of this study was to evaluate CSP in former professional American football players presenting with cognitive and behavioral symptoms compared with noncontact sports athletes. Seventy-two symptomatic former professional football players (mean age 54.53 years, standard deviation [SD] 7.97) as well as 14 former professional noncontact sports athletes (mean age 57.14 years, SD 7.35) underwent high-resolution structural 3T magnetic resonance imaging. Two raters independently evaluated the CSP, and interrater reliability was calculated. Within National Football League players, an association of CSP measures with cognitive and behavioral functioning was evaluated using a multivariate mixed effects model. The measurements of the two raters were highly correlated (CSP length: rho = 0.98; Intraclass Correlation Coefficient [ICC] 0.99; p

Soccer is the most popular sport in the world. Soccer players are at high risk for repetitive subconcussive head impact when heading the ball. Whether this leads to long-term alterations of the brain's structure associated with cognitive decline remains unknown. The aim of this study was to evaluate cortical thickness in former professional soccer players using high-resolution structural MR imaging. Fifteen former male professional soccer players (mean age 49.3 [SD 5.1] years) underwent high-resolution structural 3 T MR imaging, as well as cognitive testing. Fifteen male, age-matched former professional non-contact sport athletes (mean age 49.6 [SD 6.4] years) served as controls. Group analyses of cortical thickness were performed using voxel-based statistics. Soccer players demonstrated greater cortical thinning with increasing age compared to controls in the right inferolateral-parietal, temporal, and occipital cortex. Cortical thinning was associated with lower cognitive performance as well as with estimated exposure to repetitive subconcussive head impact. Neurocognitive evaluation revealed decreased memory performance in the soccer players compared to controls. The association of cortical thinning and decreased cognitive performance, as well as exposure to repetitive subconcussive head impact, further supports the hypothesis that repetitive subconcussive head impact may play a role in early cognitive decline in soccer players. Future studies are needed to elucidate the time course of changes in cortical thickness as well as their association with impaired cognitive function and possible underlying neurodegenerative process.

Several controlled studies have shown that in children with cerebral palsy, botulinum toxin A (BTX/A) can decrease muscular hyperactivity associated with spasticity and improve function. Studies have hitherto focused on the dimensions of impairment and functional limitations. In this pilot study with BTX/A in children with cerebral palsy, we used the Pediatric Evaluation of Disability Inventory (PEDI) to evaluate the effect of treatment. PEDI is a reliable and valid instrument that focuses on assessing disability in daily life. Patients with cerebral palsy (n = 17, median age 5.5 years, age range 2.5 to 16.5 years) were treated with BTX/A for pes equinus (n = 8) or adductor spasm (n = 9). PEDI assessment was carried out before and 1 month after the first treatment with BTX/A. Scaled scores were calculated according to the user’s manual for the Mobility domain with scores near „0” reflecting low capability and scores near „100” reflecting high capability. We found a significant improvement in the mobility domain-caregiver dimension from 52.3% ± 26.6% to 56.6% ± 26.7% (mean, standard deviation P < 0.05), as well as in the self care domain-functional skills from 63.6% ± 18.7% to 65.2% ± 19.6% (mean, standard deviation P < 0.05). Our data indicate that in young patients with cerebral palsy, BTX/ A therapy of the lower extremity can reduce the disability. For these patients PEDI is a valuable assessment instrument that reflects the effect of treatment with BTX/A on the disability. (J Pediatr Neurol 2003; 1(1): 29-34).

Active participation and the highest level of independence during daily living are primary goals in neurorehabilitation. Therefore, standing and walking are key factors in many rehabilitation programs. Despite inconclusive evidence considering the best application and efficacy of robotic tools in the field of pediatric neurorehabilitation, robotic technologies have been implemented to complement conventional therapies in recent years. A group of experienced therapists and physicians joined in an "expert panel." They compared their clinical application protocols, discussed recurring open questions, and developed experience-based recommendations for robot-assisted treadmill therapy (exemplified by the Lokomat, Hocoma, Volketswil, Switzerland) with a focus on children with cerebral palsy. Specific indications and therapeutic goals were defined considering the severity of motor impairments and the International Classification of Functioning, Disability and Health framework (ICF). After five meetings, consensus was found and recommendations for the implementation of robot-assisted treadmill therapy including postsurgery rehabilitation were proposed. This article aims to provide a comprehensive overview on therapeutical applications in a fast developing field of medicine, where scientific evidence is still scarce. These recommendations can help physicians and therapists to plan the child's individual therapy protocol of robot-assisted treadmill therapy.

In der Diskussion um den Nutzen der Heimmonitorversorgung insbesondere fur das Kollektiv fruhgeborener Kinder mit einem Apnoe-Bradykardie-Syndrom und/oder einer chronischen Lungenerkrankung spielt die Verkurzung des stationaren Aufenthaltes nicht nur unter soziookonomischen Gesichtspunkten sondern auch vor dem Hintergrund psychologischer und entwicklungsneurologischer Aspekte eine wichtige Rolle. Diesen Argumenten gegenuber stehen jedoch die Kosten dieser ambulanten Uberwachung sowie die fehlenden Standards fur die konsekutive Nachsorge dieser Kinder. Der folgende Artikel hat zum Ziel, die aktuelle Praxis der Heimmonitorverordnung und ihrer Nachbetreuung vor dem Hintergrund der Evidenzlage im Kontext der zu berucksichtigenden differenzialdiagnostischen Uberlegungen am Beispiel des etablierten Konzeptes der Neonatologie und des integrierten Sozialpadiatrischen Zentrums am Dr. von Haunerschen Kinderspital der Ludwig-Maximilians-Universitat in Munchen zu diskutieren.

Hintergrund Die meisten Falle von Kindesmisshandlung werden primar beim Kinderarzt oder in den Notfallambulanzen der Kinderkliniken vorstellig.

ZusammenfassungKopfschmerzen bei Kindern und Jugendlichen in Deutschland sind häufig und nehmen Richtung Jugendalter deutlich zu: Die Prävalenzen liegen zwischen 38% bei jüngeren Kindern und 84% bei Jugendlichen (Migräne: 6% bis 31%; Spannungskopfschmerz: 18% bis 51%; häufige Kopfschmerzen: 4% bis 10%). Dabei wird ein allgemeiner Anstieg der Kopfschmerzprävalenz bei Kindern und Jugendlichen in den letzten Jahren beschrieben, eine Aussage, die aber – bezogen auf alle Studien zu diesem Thema – inkonsistent bleibt. Stress, Rauchen, Koffeinkonsum und dysfunktionale muskuläre Anspannung und Schmerzen im Bereich von Schulter und Nacken wurden auch bei Kindern und Jugendlichen in allen Studien als Risikofaktoren für primäre Kopfschmerzen bestätigt.

Zusammenfassung80% der Schüler berichten über Kopfschmerzen im Laufe von 90 Tagen. Eine frühe Erkrankung an häufigen Kopfschmerzen bedingt eine höhere Wahrscheinlichkeit auch später im Erwachsenenalter an Kopfschmerzen zu leiden. Es ist deshalb sinnvoll, über Möglichkeiten einer Prävention von Kopfschmerzen im Schulalter nachzudenken. In der vorliegenden Übersicht werden die Ergebnisse von Studien, die die Umsetzbarkeit von meist psychologischen Interventionen wie Entspannungsübungen, Verhaltenstherapie oder Psychoedukation über Kopfschmerzen untersuchten, vorgestellt. Meist relativ kleine Studien weisen darauf hin, dass internetbasierte Verfahren oder Programme, die vorwiegend auf Selbststudium basieren, zu einer signifikanten Besserung führen. Vor diesem Hintergrund führten wir eine Studie zu dem Einfluss einer einstündigen Psychoedukation über Risikofaktoren, den Zusammenhang zu Muskelspannung der peri - kraniellen Muskulatur mit Demonstration von Dehnübungen und Wachheit gegenüber Stressoren durch. Diese bei 12 bis 19 Jahre alten Schülern durchgeführte Studie konnte zeigen, dass niedrigschwellige Intervention zur signifikanten Reduktion von Kopfschmerzen in der Gruppe führte, ein auch noch nach 7 Monaten nachweisbarer Effekt. Der Ansatz, über eine Gesundheitsaufklärung in der Schule, eine nachhaltige Besserung der Kopfschmerzen zu erreichen, wird mit unseren aktuellen Daten unterstützt.

Background The objective was to evaluate a supposed clinical interdependency of myofascial trigger points and migraine in children. Such interdependency would support an interaction of spinal and trigeminal afferences in the trigemino-cervical complex as a contributing factor in migraine. Methods Children ≤18 years with the confirmed diagnosis of migraine were prospectively investigated. Comprehensive data on medical history, clinical neurological and psychological status were gathered. Trigger points in the trapezius muscle were identified by palpation and the threshold of pressure pain at these points was measured. Manual pressure was applied to the trigger points, and the occurrence and duration of induced headache were recorded. At a second consultation (4 weeks after the first), manual pressure with the detected pressure threshold was applied to non-trigger points within the same trapezius muscle (control). Headache and related parameters were again recorded and compared to the results of the first consultation. Results A total of 13 girls and 13 boys with migraine and a median age of 14.5 (Range 6.3–17.8) years took part in the study. Manual pressure to trigger points in the trapezius muscle led to lasting headache after termination of the manual pressure in 13 patients while no patient experienced headache when manual pressure was applied to non-trigger points at the control visit (p

Objectives To assess potential risk factors for vertigo and dizziness in adolescents and to evaluate their variability by different vertigo types. The role of possible risk factors for vertigo and dizziness in adolescents and their population relevance needs to be addressed in order to design preventive strategies. Study design The study population consisted of 1482 school-children between the age of 12 and 19 years, who were instructed to fill out a questionnaire on different vertigo types and related potential risk factors. The questionnaire specifically asked for any vertigo, spinning vertigo, swaying vertigo, orthostatic dizziness, and unspecified dizziness. Further a wide range of potential risk factors were addressed including gender, stress, muscular pain in the neck and shoulder region, sleep duration, migraine, coffee and alcohol consumption, physical activity and smoking. Results Gender, stress, muscular pain in the neck and shoulder region, sleep duration and migraine were identified as independent risk factors following mutual adjustment: The relative risk was 1.17 [1.10 - 1.25] for female sex, 1.07 [1.02 - 1.13] for stress, 1.24 [1.17 - 1.32] for muscular pain, and 1.09 [1.03 - 1.14] for migraine. The population attributable risk explained by these risk factors was 26%, with muscular pain, stress, and migraine accounting for 11%, 4%, and 3% respectively. Conclusion Several established risk factors in adults were also identified in adolescents. Risk factors amenable to prevention accounted for 17% of the total population risk. Therefore, interventions targeting these risk factors may be warranted.

Objective The objective of our study was to evaluate the knowledge about fetal alcohol spectrum disorders (FASD) and the implementation of the German guideline for FASD among different professionals in the health and social system and among parents with children with FASD. Methods A questionnaire about FASD, containing 20 items, was sent by post to all children's hospitals (n = 287), all hospitals for child and adolescent psychiatry (n = 173), all social paediatric centres (n = 162), all neuropaediatricians (n = 129) and all youth welfare offices (n = 672) in Germany. Furthermore a link to the questionnaire as online version was put in the member's newsletter by 14 relevant professional societies. Besides, the questionnaire was distributed personally to the attendees of the annual national FASD conference (n = 363). Results Altogether 428 persons took part in the survey. 273 participants were professionals and 155 parents of children with FASD. More than 95% of the professionals and parents knew that alcohol consumption during pregnancy constitutes a risk for the child. The prevalence of maternal alcohol consumption and of FASD was underestimated. Although approx. 70% of the professionals knew which disorders belong to FASD just a few could tell their specific deficits. Questions regarding effective intervention for children with FASD and the long-term outcome were only partially answered correctly. Discussion Professionals in the German health and social system are aware of FASD but underestimate the level of damage and the impact on every day functioning of the affected people.

Mindestens 14 % der deutschen Frauen trinken Alkohol in der Schwangerschaft. Schatzungsweise 4/1000 Kinder zeigen das Vollbild eines fetalen Alkoholsyndroms (FAS). Mogliche Risikofaktoren fur mutterlichen Alkoholkonsum und fur die Entwicklung eines FAS sollen bestimmt werden. Eine systematische Literaturrecherche von 2001 bis 2013 wurde zur Evaluation der durch europaische Studien belegten Risikofaktoren fur mutterlichen Alkoholkonsum durchgefuhrt. Diese Recherche wurde auf europaische Studien beschrankt, da die darin beschriebenen gesellschaftlichen Rahmenbedingungen und Entwicklungen am ehesten mit denen der deutschen Gesellschaft vergleichbar sind. Eine weitere systematische Literaturrecherche wurde zur Evaluation der durch internationale Studien belegten Risikofaktoren fur die Entstehung eines FAS durchgefuhrt. Die sehr geringe Anzahl europaischer Studien hatte hier zu keinem aussagekraftigen Ergebnis gefuhrt; deswegen wurde diese Recherche auf amerikanische und kanadische Studien ausgeweitet. Vor allem gut ausgebildete und gut verdienende, altere Frauen konsumieren Alkohol in der Schwangerschaft. Allerdings trinken auch vermehrt Frauen Alkohol, in deren Umfeld Alkohol oder Drogen konsumiert werden oder die (andere) Drogen nehmen oder rauchen. Frauen, die unter einer psychiatrischen Krankheit leiden, haben ebenfalls ein hoheres Risiko, Alkohol in der Schwangerschaft zu trinken. Haufig liegt eine Kombination verschiedener Risikofaktoren fur Alkoholkonsum in der Schwangerschaft vor. Ob eine alkoholkonsumierende schwangere Frau tatsachlich ein Kind mit fetalem Alkoholsyndrom (FAS) oder fetaler Alkoholspektrumstorung (FASD) zur Welt bringt, scheint neben Zeitpunkt, Dauer, Haufigkeit und Menge des Alkoholkonsums von weiteren Faktoren wie Ernahrung, Alter, Ethnizitat und genetischer Disposition abhangig zu sein. Die Kenntnis von Risikofaktoren kann sowohl zur Primarpravention des FAS durch Aufklarung und Unterstutzung der betroffenen Mutter und ihrer Familien als auch zur fruhzeitigen Diagnose des FAS bei betroffenen Kindern beitragen.

Aim The aim of the present analysis is to confirm or refute the association of neck pain to migraine or tension-type headache and to assess whether this association is independent of other risk factors for headache. Methods Secondary school students were invited to complete a questionnaire on headache and lifestyle factors in a cross-sectional study. Neck pain was assessed via (a) a screening question concerning neck pain and (b) denoting affected areas in schematic drawings of the human body. Results Absolute increment in prevalence of headache with pain in the shoulder-neck region was between 7.5% and 9.6%. Gender, grade, stress and lifestyle factors were assessed as potential confounding factors. Nearly all factors were associated with shoulder-neck pain and most with headache. After adjustment for confounders, the association of neck pain with headache was almost completely confined to migraine (OR 2.39; 95% CI 1.48–3.85) and migraine + tension-type headache (OR 2.12; 95% CI 1.50–2.99), whereas the association with isolated tension-type headache was negligible (OR 1.22, 95% CI 0.87–1.69). Conclusion Neck pain is associated with migraine but not with tension-type headache. A possible link between migraine and neck pain may be the cervico-trigeminal convergence of neck and meningeal sensory afferents or a disturbed descending inhibition in migraine.

Objective To show non-inferiority of levetiracetam to sulthiame with respect to efficacy, tolerability and safety in benign epilepsy with centrotemporal spikes in a prospective, double-blinded randomized controlled trial. Methods A sample size of 60 subjects (treatment group) was calculated to show reliable statistical results for non-inferiority. A total of 44 patients could be randomly allocated to either (LEV or STM) treatment group. Explorative data analysis was performed to investigate differences in the number of treatment failure events (occurrence of a seizure during the observation period of 6 months) and total dropouts. In addition, information of the occurrence of adverse events was collected. Results 43 patients were analyzed. One patient had to be excluded due to protocol violation. Treatment failure events occurred in four patients (19.0%) in the LEV treatment group and in two patients (9.1%) in the STM treatment group, respectively, (p = 0.412). The number of dropouts due to adverse reactions was five in the LEV treatment group and one in STM treatment group (23.8% vs. 4.5%, respectively, p = 0.095). Severe adverse events occurred in patients treated with LEV (n = 2, 9.5%). The total number of dropouts due to either seizure recurrence or adverse events was significantly higher in the LEV group (n = 9, 42.9%) compared to the STM group (n = 3, 13.6%, p = 0.03). Interpretation The study results concerning non-inferiority were not conclusive, as the calculated sample size was not reached to support sufficient statistical power due to limited recruitment in a 26 months period. The rates of seizure free patients were [relatively] high in both groups. However, the results indicate that termination of drug treatment due to seizure recurrence or adverse events occurred more frequently in the LEV group compared to STM. Behavioral disturbances were the most common adverse event causing study termination.