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Porte M.,Nimes University Hospital Center | Porte M.,Institute Saint Pierre Palavas les flots | Chaleat-Valayer E.,CMCR des Massues Lyon | Patte K.,Institute Saint Pierre Palavas les flots | And 3 more authors.
European Journal of Paediatric Neurology | Year: 2014

Background After the age of 4 years, drooling becomes pathological and impacts the quality of life of children with cerebral palsy. Intraglandular injection of Botulinum toxin is one of the treatments available to limit this phenomenon. Aims The objectives of this review were to validate the efficacy of Botulinum toxin injections for drooling in children with cerebral palsy, determine recommendations and identify potential side effects.Methods We conducted a literature review from 2001 in the following databases: Embase, Pubmed and Cochrane using the keywords: sialorrhea, drooling, hypersalivation, Botulinum toxin, cerebral palsy and children. Only the articles evaluating the efficacy of Botulinum toxin in children with cerebral palsy over the age of 4 were researched.Results Eight studies were found: 2 case studies, 3 open and non-controlled studies and 3 randomized controlled trials. Efficacy results in this indication are quite encouraging and the use of BTX injections is safe but the overall level of evidence of these studies was quite low.Conclusion However, intraglandular injection of Botulinum toxin has a place among the therapeutic array available for the management of sialorrhea in this population even if no standardized protocol is available yet. © 2014 European Paediatric Neurology Society.


PubMed | Pediatric Orthopedic Surgery Unit, Institute Saint Pierre Palavas les flots, Montpellier University Hospital Center, Nimes University Hospital Center and 2 more.
Type: Journal Article | Journal: European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society | Year: 2014

After the age of 4 years, drooling becomes pathological and impacts the quality of life of children with cerebral palsy. Intraglandular injection of Botulinum toxin is one of the treatments available to limit this phenomenon.The objectives of this review were to validate the efficacy of Botulinum toxin injections for drooling in children with cerebral palsy, determine recommendations and identify potential side effects.We conducted a literature review from 2001 in the following databases: Embase, Pubmed and Cochrane using the keywords: sialorrhea, drooling, hypersalivation, Botulinum toxin, cerebral palsy and children. Only the articles evaluating the efficacy of Botulinum toxin in children with cerebral palsy over the age of 4 were researched.Eight studies were found: 2 case studies, 3 open and non-controlled studies and 3 randomized controlled trials. Efficacy results in this indication are quite encouraging and the use of BTX injections is safe but the overall level of evidence of these studies was quite low.However, intraglandular injection of Botulinum toxin has a place among the therapeutic array available for the management of sialorrhea in this population even if no standardized protocol is available yet.


Trivedi R.,Sanjay Gandhi Post Graduate Institute of Medical Sciences | Agarwal S.,Indian Institute of Technology Kanpur | Shah V.,Pediatric Orthopedic Surgery Unit | Goyel P.,Sanjay Gandhi Post Graduate Institute of Medical Sciences | And 3 more authors.
Neuroradiology | Year: 2010

Introduction: The purpose of this study was to determine whether tract-specific diffusion tensor imaging measures in somatosensory and motor pathways correlate with clinical grades as defined using the Gross Motor Function Classification System (GMFCS) in cerebral palsy (CP) children. Methods: Quantitative diffusion tensor tractography was performed on 39 patients with spastic quadriparesis (mean age=8 years) and 14 age/sex-matched controls. All patients were graded on the basis of GMFCS scale into grade II (n=12), grade IV (n=22), and grade V (n=5) CP and quantitative analysis reconstruction of somatosensory and motor tracts performed. Results: Significant inverse correlation between clinical grade and fractional anisotropy (FA) was observed in both right and left motor and sensory tracts. A significant direct correlation of mean diffusivity values from both motor and sensory tracts was also observed with clinical grades. Successive decrease in FA values was observed in all tracts except for left motor tracts moving from age/sex-matched controls to grade V through grades II and IV. Conclusion: We conclude that white matter tracts from both the somatosensory and the motor cortex play an important role in the pathophysiology of motor disability in patients with CP. © 2010 Springer-Verlag.


Nikomarov D.,Rambam Healthcare Campus | Zaidman M.,Pediatric Orthopedic Surgery Unit | Katzman A.,Pediatric Orthopedic Surgery Unit | Keren Y.,Rambam Healthcare Campus | Eidelman M.,Pediatric Orthopedic Surgery Unit
Journal of Pediatric Orthopaedics Part B | Year: 2013

Sclerosing osteomyelitis of Garré continues to be a puzzling entity, with a nonspecific clinical description and course, an obscure pathogenesis, and no consensus on a predictable and helpful method of treatment. The proposed treatment options according to the literature are observation, analgesics and NSAIDs, and bone curettage. Here we present a 15-year-old girl treated by resection of a 12 cm-long lesion after failed conservative treatment, followed by bone transport using a circular external fixator. This treatment method has not been described previously for this condition. The duration of bone transport was 3 months, and the total duration of the frame treatment was 12 months. After hardware removal, and at 2.5-year follow-up, the patient was asymptomatic and achieved good functional results. To the best of our knowledge, this is the first description of bone resection and transport for the treatment of this condition, even though it is well described for the treatment of chronic osteomyelitis and other conditions necessitating bone resection. On the basis of this case we suggest that resection and bone transport using a circular external fixator for the treatment of sclerosing osteomyelitis of Garré might be an effective and safe method. Of course, being a rare entity, large cohorts are difficult to obtain, and more data and longer follow-up are required to form a convincing recommendation. Level IV evidence. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Kotlarsky P.,Rambam Health Care Campus | Shavit I.,Rambam Health Care Campus | Kassis I.,Pediatric Infectious Disease Unit | Eidelman M.,Rambam Health Care Campus | Eidelman M.,Pediatric Orthopedic Surgery Unit
American Journal of Emergency Medicine | Year: 2016

Background A pediatric septic hip is a serious condition that must be recognized and treated as early as possible. We describe the clinical course of children with septic hip that were treated with aspiration of the hip joint in the emergency department (AHED). Methods This was a retrospective case series analysis. Results Between January 1, 2007, and December 31, 2014, 17 children with septic hip were diagnosed by emergency physicians using point-of-care ultrasonography. All were treated with AHED. During hospital admission, a median of 2 (interquartile range [IQR], 2-3) follow-up sonographic examinations per patient was performed; 10 (59%) patients did not have another hip aspiration, and 7 (41%) had a median of 1 (IQR, 1-3) hip joint aspiration under sedation. Median length of antibiotic treatment was 28 days (IQR, 21-40). No patient underwent arthrotomy, and all recovered without disability in up to 4 years of follow-up. Conclusions The results of this cohort suggest that AHED with repeated aspirations as needed is an effective treatment for children with septic hip. © 2015 Elsevier Inc. All rights reserved.


Eidelman M.,Pediatric Orthopedic Surgery Unit | Keren Y.,Rambam Health Care Campus | Norman D.,Rambam Health Care Campus
Journal of Pediatric Orthopaedics Part B | Year: 2012

The treatment of distal femoral valgus deformities in skeletally mature patients might be a challenging surgical problem with significant morbidity. Treatment options are various and include osteotomy and external fixation, intramedullary nailing, and plating using standard and locking plates. We describe technical notes of minimally invasive technique of fixator-assisted plating using a supracondylar locking plate. During a period of 3 years, we operated on six patients (seven femurs) with distal femoral valgus deformities of different etiologies. All patients achieved correction of the deformities and started full weight bearing with radiographic evidence of union 6 weeks after correction. We believe that fixator-assisted locking plating has advantages over correction using external fixation and intramedullary nailing. This method of correction can be performed by a minimally invasive technique, precisely, and with minimal morbidity. Copyright © Lippincott Williams & Wilkins.


PubMed | Pediatric Orthopedic Surgery Unit, Rambam Health Care Campus and Pediatric Infectious Disease Unit
Type: Journal Article | Journal: The American journal of emergency medicine | Year: 2016

A pediatric septic hip is a serious condition that must be recognized and treated as early as possible. We describe the clinical course of children with septic hip that were treated with aspiration of the hip joint in the emergency department (AHED).This was a retrospective case series analysis.Between January 1, 2007, and December 31, 2014, 17 children with septic hip were diagnosed by emergency physicians using point-of-care ultrasonography. All were treated with AHED. During hospital admission, a median of 2 (interquartile range [IQR], 2-3) follow-up sonographic examinations per patient was performed; 10 (59%) patients did not have another hip aspiration, and 7 (41%) had a median of 1 (IQR, 1-3) hip joint aspiration under sedation. Median length of antibiotic treatment was 28 days (IQR, 21-40). No patient underwent arthrotomy, and all recovered without disability in up to 4 years of follow-up.The results of this cohort suggest that AHED with repeated aspirations as needed is an effective treatment for children with septic hip.


PubMed | Pediatric Orthopedic Surgery Unit
Type: Journal Article | Journal: Journal of pediatric orthopedics. Part B | Year: 2012

The treatment of distal femoral valgus deformities in skeletally mature patients might be a challenging surgical problem with significant morbidity. Treatment options are various and include osteotomy and external fixation, intramedullary nailing, and plating using standard and locking plates. We describe technical notes of minimally invasive technique of fixator-assisted plating using a supracondylar locking plate. During a period of 3 years, we operated on six patients (seven femurs) with distal femoral valgus deformities of different etiologies. All patients achieved correction of the deformities and started full weight bearing with radiographic evidence of union 6 weeks after correction. We believe that fixator-assisted locking plating has advantages over correction using external fixation and intramedullary nailing. This method of correction can be performed by a minimally invasive technique, precisely, and with minimal morbidity.

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