Pendeli Childrens Hospital

Athens, Greece

Pendeli Childrens Hospital

Athens, Greece
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De Gucht V.,Leiden University | Papavasiliou A.,Pendeli Childrens Hospital | Maes S.,Leiden University
Epilepsy and Behavior | Year: 2015

The aim of this cross-sectional study was to explore the extent to which gender, epilepsy severity, and self-regulation concepts (illness perceptions, autonomous treatment regulation, perceived autonomy support by parents) predict psychological distress and quality of life (QoL) in young patients with epilepsy. Structured interviews were conducted in 100 patients (. Mage=. 13.9, SD=. 2.21, 41% girls), and data were analyzed by means of multiple hierarchical regression analyses. Seizures of most patients (91%) were well controlled by antiepileptics, 3% of the patients had infrequent seizures, and seizures in 6% were pharmacoresistant. At a multivariate level, it appeared that youngsters with epilepsy who expect that their disease will last for a long time, who believe that they have less personal control over their illness, and who expect the illness to have a high emotional impact reported higher levels of distress. In addition, a better QoL was reported by youngsters who believed that treatment did not control their illness and who thought that their epilepsy would not affect them emotionally. Findings indicate the importance of illness perceptions, and it is suggested that they should be targeted in future interventions in youngsters with epilepsy. © 2015 Elsevier Inc..

Nikaina I.,Pendeli Childrens Hospital | Papavasiliou A.,Pendeli Childrens Hospital
Toxin Reviews | Year: 2014

Botulinum toxin type A has been used extensively to treat spasticity in children with cerebral palsy. Although the effectiveness of the toxin in the lower limbs is well established, its effectiveness in upper limbs has not been proved yet. Many studies published so far report conflicting results in terms of spasticity, function, activity and participation improvement. The scope of this review is to present the evidence from published studies, focusing on the effectiveness and the safety of botulinum toxin A. © 2014 Informa Healthcare USA, Inc. All rights reserved: reproduction in whole or part not permitted.

Vlachou M.,Maternity and Childrens Hospital | Dimitriadis D.,Maternity and Childrens Hospital | Dimitriadis D.,Pendeli Childrens Hospital
Journal of Foot and Ankle Research | Year: 2010

Background: Overactivity of anterior and/or posterior tibial tendon may be a causative factor of spastic varus foot deformity. The prevalence of their dysfunction has been reported with not well defined results. Although gait analysis and dynamic electromyography provide useful information for the assessment of the patients, they are not available in every hospital. The purpose of the current study is to identify the causative muscle producing the deformity and apply the most suitable technique for its correction.Methods: We retrospectively evaluated 48 consecutive ambulant patients (52 feet) with spastic paralysis due to cerebral palsy. The average age at the time of the operation was 12,4 yrs (9-18) and the mean follow-up 7,8 yrs (4-14). Eigtheen feet presented equinus hind foot deformity due to gastrocnemius and soleus shortening. According to the deformity, the feet were divided in two groups (Group I with forefoot and midfoot inversion and Group II with hindfoot varus). The deformities were flexible in all cases in both groups. Split anterior tibial tendon transfer (SPLATT) was performed in Group I (11 feet), while split posterior tibial tendon transfer (SPOTT) was performed in Group II (38 feet). In 3 feet both procedures were performed. Achilles tendon sliding lengthening (Hoke procedure) was done in 18 feet either preoperatively or concomitantly with the index procedure.Results: The results in Group I, were rated according to Hoffer's clinical criteria as excellent in 8 feet and satisfactory in 3, while in Group II according to Kling's clinical criteria were rated as excellent in 20 feet, good in 14 and poor in 4. The feet with poor results presented residual varus deformity due to intraoperative technical errors.Conclusion: Overactivity of the anterior tibial tendon produces inversion most prominent in the forefoot and midfoot and similarly overactivity of the posterior tibial tendon produces hindfoot varus. The deformity can be clinically unidentifiable in some cases when Achilles shortening co-exists producing foot equinus. By identifying the muscle causing the deformity and performing the appropriate technique, very satisfying results were achieved in the majority of our cases. In three feet both muscles contributed to a combined deformity and simultaneous SPLATT and SPOTT were considered necessary. For complex foot deformities where the component of cavus co-exists, supplementary procedures are required along with the index operation to obtain the best result. © 2010 Vlachou and Dimitriadis; licensee BioMed Central Ltd.

Vlachou M.,Pendeli Childrens Hospital | Beris A.,Pendeli Childrens Hospital | Dimitriadis D.,Pendeli Childrens Hospital
Acta Orthopaedica Belgica | Year: 2010

Equinovarus hindfoot deformity is one of the most common deformities in children with spastic paralysis; it is usually secondary to cerebral palsy. Split tibialis posterior tendon transfer is performed to balance the flexible spastic varus foot and is preferable to tibialis posterior lengthening, as the muscle does not loose its power and therefore the possibility of a valgus or calcaneovalgus deformity is diminished. We retrospectively evaluated 33 consecutive ambulant patients (38 feet) with flexible spastic varus hindfoot deformity. Twenty-eight presented unilateral and five bilateral involvement. The mean age at operation was 10.8 yrs (range 6-17) and the mean follow-up was 10; yrs (4-14). There were 20 hemiplegie feet, 11 diplegic and 7 quadriplegic. Eighteen feet also presented an equinus position of the hindfoot, requiring Achilles tendon lengthening. The surgical technique applied was similar to the one described by Green et al, with four skin incisions, two on either side of the foot and ankle. The evaluation of the results was carried out using Kling and Kaufer's clinical criteria. Results were graded excellent or good for 34 out of 38 feet (89.5%). Twenty feet were graded excellent, indicating that the children managed to walk with a plantigrade foot without fixed or postural deformity and did not have callosities. Fourteen feet were graded good in children who walked with less than 5°,varus, valgus or equinus of the hindfoot and had no callosities. Four were graded poor, with recurrent equinovarus deformity. The feet with poor results presented a residual varus deformity due to intraoperative technical errors. © 2010, Acta Orthopædica Belgica.

Papavasiliou A.S.,Pendeli Childrens Hospital | Nikaina I.,Pendeli Childrens Hospital | Rizou J.,Pendeli Childrens Hospital | Alexandrou S.,Proseggisi Center for Children
European Journal of Paediatric Neurology | Year: 2011

There is great demand for effective management of children with Autistic Spectrum Disorders (ASD). This study aimed to investigate the effect of an individually tailored psycho-educational program for autistic children on the scores of the Childhood Autism Rating Scale (CARS) and the Short Sensory Profile (SSP). Methods: Forty children (36 males) were enrolled into an intervention program which consisted of occupational therapy including sensory integration techniques, speech therapy, social skills therapy and parent-directed approaches. Autism severity was assessed using CARS; sensory response capability with the SSP pre- and post-treatment. Results: Eight children were intellectually normal; 12 borderline and 20 of low intelligence. Pre-treatment CARS showed that 8 were mildly autistic, 32 moderately-severely autistic. Post-treatment, 24 children changed category; 11 were no longer autistic. The percentage of children performing in the definitive difference region, according to total SSP score, changed slightly (45% vs 32.5%). Comparison of the pre- and post-treatment values revealed that CARS decreased significantly (p < 0.001), whereas total SSP did not (p = 0.294). Tactile sensitivity and low energy/weakness sections, though, were significantly different pre- and post-treatment. Longitudinal analysis, taking into account other confounding factors besides time, further revealed a significant decrement for CARS score with time but not for SSP score (p < 0.001 and p = 0.288, respectively). Similarly, intelligence levels affected CARS but not SSP values (p < 0.001 and p = 0.813, respectively). Conclusion: Individually tailored psycho-educational therapy had a significant effect on autism severity according to CARS. Changes in the SSP scores were not significant. © 2011 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

Papavasiliou A.S.,Pendeli Childrens Hospital | Nikaina I.,Pendeli Childrens Hospital | Bouros P.,Pendeli Childrens Hospital | Rizou I.,Pendeli Childrens Hospital | Filiopoulos C.,Pendeli Childrens Hospital
European Journal of Paediatric Neurology | Year: 2012

This study assessed treatment consistency of botulinum toxin administration in spastic upper limbs under pragmatic conditions, as derived through stability of dosages and between injections intervals. Over a period of 8 years, 153 children (81 with bilateral spastic cerebral palsy, 72 with unilateral) were treated according to accepted, experience-based guidelines with Botox and Dysport. Treatment response was based on assessment of spasticity and attainment of pre-determined goals at 3, 6 and 12 months post each treatment. Mean age at treatment onset was 6y 4mo (SD: 4y 10mo), median F/U, 2.5 years (4 months-6 8/12 years). Number of injection sessions was 1-10; few had more than 6 sessions. In 106 (69.28%) children, more than one anatomic regions of the limb were injected. Most (56.2%), had at least two injection sessions; median time interval between the sessions was 9 months (IQR: 4-35 months, similar for unilateral and bilateral cerebral palsy, p = 0.874). Children >4 years old at the first treatment had longer intervals between sessions (25.8%) compared to younger ones (p = 0.010). The mixed effects models demonstrated that botulinum toxin dosage was stable over subsequent visits (p = 0.144) and that intermediate intervals for subsequent visits were similar to the first one (p = 0.279). © 2011 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

Papavasiliou A.S.,Pendeli Childrens Hospital | Nikaina I.,Pendeli Childrens Hospital | Foska K.,Pendeli Childrens Hospital | Bouros P.,Pendeli Childrens Hospital | And 2 more authors.
Toxins | Year: 2013

This retrospective study aimed to examine the safety of botulinum toxin A (BoNT-A) treatment in a paediatric multidisciplinary cerebral palsy clinic. In a sample of 454 patients who had 1515 BoNT-A sessions, data on adverse events were available in 356 patients and 1382 sessions; 51 non-fatal adverse events were reported (3.3% of the total injections number, 8.7% of the patients). On five occasions, the adverse reactions observed in GMFCS V children were attributed to the sedation used (rectal midazolam plus pethidine; buccal midazolam) and resulted in prolongation of hospitalization. Of the reactions attributed to the toxin, 23 involved an excessive reduction of the muscle tone either of the injected limb(s) or generalized; others included local pain, restlessness, lethargy with pallor, disturbance in swallowing and speech production, seizures, strabismus, excessive sweating, constipation, vomiting, a flu-like syndrome and emerging hypertonus in adjacent muscles. Their incidence was associated with GMFCS level and with the presence of epilepsy (Odds ratio (OR) = 2.74 - p = 0.016 and OR = 2.35 - p = 0.046, respectively) but not with BoNT-A dose (either total or per kilogram). In conclusion, treatment with BoNT-A was safe; adverse reactions were mostly mild even for severely affected patients. Their appearance did not necessitate major changes in our practice. © 2013 by the authors; licensee MDPI, Basel, Switzerland.

Gavatha M.,Pendeli Childrens Hospital | Ioannou I.,Pendeli Childrens Hospital | Papavasiliou A.S.,Pendeli Childrens Hospital
Epilepsy and Behavior | Year: 2011

The results of adjunctive lacosamide treatment in 18 pediatric patients with pharmacoresistant focal epilepsy are reported. All had severe forms of focal epilepsy with or without secondary generalization and were concurrently receiving one to three other antiepileptic drugs. Lacosamide was administered orally, and final dose, after slow titration, ranged between 1.7 and 10. mg/kg. Mean treatment duration was 8. months (range = 3. weeks-17. months). Treatment efficacy was assessed at two time points with a 1-year interval. The reported greater than 50% reduction in seizure frequency was 36% in the initial short-term and 20% in the following long-term assessment. Side effects, mostly somnolence and irritability, were reported by 39% of patients in both evaluations. Our data suggest that lacosamide treatment in pediatric patients is safe at doses up to 10. mg/kg/day without any major side effects, but studies in larger series are needed to validate and extend these findings. © 2011 Elsevier Inc.

Maria V.,Mitera Maternity and Childrens Hospital | Elias K.,Pendeli Childrens Hospital | Konstantinos F.,Pendeli Childrens Hospital
Journal of Pediatric Orthopaedics Part B | Year: 2011

Haemolymphangiomas are congenital malformations of the vascular system, benign in origin. They can be either defined at birth or in early childhood, but the recurrence rate is usually high and complete resection is difficult to be achieved. We report two cases of haemolymphangiomas present at the tibias. We used radiographic control, ultrasound and magnetic resonance to detect the nature of the tumour and the anatomical relation with the surrounding tissues providing the appropriate surgical treatment. The diagnosis was confirmed postoperatively by histopathology. The first case presented multiple recurrences because of insufficient draining and immobilization of the leg, whereas the second case had no complications or recurrence postoperatively. Both patients had no complications or recurrence in 24-month follow-up. Haemolymphangiomas are very challenging to be treated as they can grow slowly and remain asymptomatic for many years. Sometimes they can be very aggressive in growth without characteristics of malignancy. The choice of treatment is the complete surgical excision of the tumour, sufficient and long-lasting draining, and immobilization of the extremity to abolish the possibility of recurrence. Other methods of treatment did not show better results than surgical resection. Copyright © 2011 Lippincott Williams & Wilkins.

PubMed | Pendeli Childrens Hospital
Type: Journal Article | Journal: Neuropediatrics | Year: 2016

Demographic and clinical data were collected from three cross-sectional samples, from the headache and epilepsy clinics according to respective protocols. During structured interviews, we examined the co-occurrence of headaches and epilepsy in children and their families: (1) 172 children from the headache clinic, were questioned for the number and type of epileptic seizures and epilepsy diagnosis. (2) Around 70 children from the epilepsy clinic for the frequency and type of headaches and headache syndrome diagnosis. (3) A total of 149 parents of children with benign childhood epilepsy with centro-temporal spikes (BCECTS) and childhood absence epilepsy (CAE), for the relative frequency of headaches in first- and second-degree relatives.Out of 172, 84 (48.8%) children with headache had a migraine and 60 (34.9%) had tension headaches; 3 children (1.7%) had epilepsy or unprovoked seizures. Migraine and epilepsy, co-occurred in 2/84 (2.3%). Eight out of 70 patients with epilepsy had headaches (11.4%); none had migraine. Around 43% of patients with BCECTS or CAE had a family history of headache, more prevalent in first-degree relatives of children with BCECTS than CAE.Contrary to existing literature, migraine and epilepsy, co-occurred infrequently in these highly selected samples. Family history of headache was frequent in patients with BCECTS and CAE, without any significant difference between the two.

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