Vaičienė-Magistris, Nerija

Objectives Visual snow syndrome (VSS) is a neurological (and neuro-ophthalmologic) disorder characterized by persistent positive visual disturbances. The proposed criteria consist of visual snow defined as constant flickering dots in the entire visual field and the presence of some additional visual phenomena. The disease is most likely related to dysfunctional central visual processing and/or hyperexcitability of the visual cortex. It has high comorbidity and shares several common features with migraine. Evidence for efficient pharmacological treatment remains insufficient. Although VSS is increasingly diagnosed by neurologists and ophthalmologists, it remains underrecognized and rarely described in pediatric patients. The objective of this presentation is to review the characteristics of VSS and to emphasize the importance of its recognition in children. Materials and Methods Analysis of case series. Results We present four patients – three boys and a girl who started to have or realized having VSS symptoms at different ages. All four complained of monochromatic and constant visual snow as well as other persistent visual phenomena such as bright flashes, colorful shapes, strong blue field entopic phenomenon, palinopsia, nyctalopia, and photophobia. One patient had migraine with visual and sensory aura. Ophthalmological and radiological findings were normal in all. Centro-temporo-parietal spikes on EEG without clinical seizures were observed in the girl, whose mother has VSS as well. Treatment with sulthiame markedly reduced epileptiform activity but had only a minor effect on some visual phenomena. Lamotrigine and acetazolamide attempted in two patients was without obvious effect. One patient chose not to receive a pharmacological treatment. Impact on daily and academic activities ranged from merely perceptible to bothersome. Recognition of the diagnosis of VSS enabled two patients to reduce anxiety and to better cope with their symptoms. Conclusions A detailed medical history and appropriate additional exams have to be performed in patients with persistent visual phenomena. Subjective origin of the symptoms, difficulty in depicting them in younger patients, and lack of awareness about VSS can mislead diagnosis and lead to unnecessary investigations and treatments. Reassuring and sharing the knowledge about this benign condition may provide efficient relief to both – patients and family members.

We recently showed headache to be common in children (aged 7–11 years) and adolescents (aged 12–17) in Lithuania. Here we provide evidence from the same study of the headache-attributable burden. Methods: Following the generic protocol for Lifting The Burden’s global schools-based study, this cross-sectional survey administered self-completed structured questionnaires to pupils within classes in 24 nationally representative schools selected from seven regions of the country. Headache diagnostic questions were based on ICHD-3 beta criteria but for the inclusion of undifferentiated headache (UdH; defined as mild headache with usual duration < 1 h). Burden enquiry was conducted in multiple domains. Results: Questionnaires were completed by 2505 pupils (1382 children, 1123 adolescents; participating proportion 67.4%), of whom 1858 reported headache in the preceding year, with mean frequency (±SD) of 3.7 ± 4.5 days/4 weeks and mean duration of 1.6 ± 1.9 h. Mean proportion of time in ictal state, estimated from these, was 0.9% (migraine 1.5%, probable medication-overuse headache [pMOH] 10.9%). Mean intensity on a scale of 1–3 was 1.6 ± 0.6 (mild-to-moderate). Symptomatic medication was consumed on 1.5 ± 2.8 days/4 weeks. Lost school time was 0.5 ± 1.5 days/4 weeks (migraine 0.7 ± 1.5, pMOH 5.0 ± 7.8) based on recall, but about 50% higher for migraine according to actual absences recorded in association with reported headache on the preceding day. More days were reported with limited activity (overall 1.2 ± 2.4, migraine 1.5 ± 2.2, pMOH 8.4 ± 8.5) than lost from school. One in 30 parents (3.3%) missed work at least once in 4 weeks because of their son’s or daughter’s headache. Emotional impact and quality-of-life scores generally reflected other measures of burden, with pMOH causing greatest detriments, followed by migraine and tension-type headache, and UdH least.

Background: While the Global Burden of Disease (GBD) study reports headache disorders as the second-highest cause of disability worldwide, the headache data in GBD come very largely from adults. This national study in Lithuania was part of a global schools-based programme within the Global Campaign against Headache contributing data from children (7-11 years) and adolescents (12-17 years). Methods: The methods followed the generic protocol for the global study. The basic study design was a cross-sectional survey. Self-completed structured questionnaires were administered, within classes, in 24 schools selected from seven regions of Lithuania to be nationally representative. Headache diagnostic questions were based on ICHD-3 beta criteria but for the inclusion of undifferentiated headache (UdH). Results: Of 3714 potential participants, 2505 (children 1382 [55.2%], adolescents 1123 [44.8%]; males 1169 [46.7%], females 1336 [53.3%]) completed the questionnaire. Adolescents and males were therefore relatively under-represented, with non-participation (32.6%) due in most cases to lack of parental consent. Observed lifetime prevalence of headache was 92.2%. Gender- and age-adjusted 1-year prevalence was 76.6% (migraine: 21.4%; tension-type headache [TTH]: 25.6%; UdH: 24.0%; all headache on ≥15 days/month: 3.9%; probable medication-overuse headache: 0.8%). All headache types except UdH were more prevalent among females than males, and among adolescents than children. UdH showed a complex relationship with age, but represented 38.0% of all reported headache in children, 27.4% in adolescents. Headache yesterday (HY) was reported by 17.5%, almost double the 9.8% predicted from prevalence and headache frequency to have headache on any day. The reason was unclear. Conclusions: Findings were not very different from those reported in Turkey and Austria, but with more TTH. Headache has, therefore, again been shown to be common in children and adolescents, [...].

Vadovėlis skirtas medicinos studijų programos studentams, studijuojantiems neurologiją. Pagrindinis dėmesys skiriamas neuroanatomijai, klinikiniam neurologiniam paciento tyrimui ir topinei neurologinei diagnostikai – pagrindams, be kurių neįmanoma neurologinių ligų diagnostika, paraklinikinių tyrimų ir gydymo taktikos pasirinkimas. Šie pagrindai buvo išdėstyti vadovėlyje "Nervų ligos", nuo kurio 2-ojo leidimo 1996 metais praėjo 20 metų, tačiau studentai vis dar jį studijuoja. Neurologijos studijas turėtų palengvinti informacija, pateikta lentelėse ir paveiksluose. Klinikinė vadovėlio dalis apima tik pagrindines ir dažniausias neurologines ligas, kurias turėtų žinoti medicinos gydytojas. Tikimės, kad šis vadovėlis bus naudingas ir pirmųjų metų neurologijos gydytojams rezidentams.

Pediatrics multiple sclerosis (MS) is a rare, life-long neurological condition associated with inflammation and degeneration in the CNS. About %5-3 of people with MS have their onset in childhood years. Pediatric MS indicating highly inflammatory process. In about 97% of cases the course of disease is relapsing-remitting with higher annualized relapse rate early in the disease. Pathological and radiological studies show more inflammatory white matter lesions with more extensive early acute axonal damage which correlates with earlier development of neuropsychological deficits and permanent disability. Diagnosis of pediatric MS should be established applying the most recent version of 2017 McDonald International diagnostic criteria as well as using guidelines proposed by International Pediatric MS Study Group. [...].

Anti-N-methyl-D-aspartatae (anti-NMDA) encephalitis is a rare but severe complication of Herpes Simplex Virus encephalitis (HSVE) in children. Recent data suggest that majority of relapses occurring in the weeks or months after primary infection are caused by secondary immune response to anti-NMDA antibodies. Clinical symptoms are age-dependent: young children more aften develop seizures, behavior changes, choreothetosis or decreased level of consciousness whereas adolescent more prone to present with behavior, psychiatric and cogntive changes. An increased awereness, early recognition and initiation of immunotherapy could reduce complications of the combination of these two potentially devastating diseases. Anti-NMDA antibodies should be searched in cerebrospinal fluid of patients with incomplete recovery or neurological relapse. Some data suggest that using immunotherapy during the viral phase of HSVE could possibly prevent the development of autoimmune encephalitis although further studies are needed. [...].

Recently developed and originally published in English, the Child and Adolescent HARDSHIP (headache-attributed restriction, disability, social handicap and impaired participation) questionnaire is valid and acceptable for the global assessment of the burden of headache in children and adolescents. The present study aimed to translate, adapt and validate a Lithuanian version of this questionnaire. A total of 22 volunteers from 7 to 17 years of age completed the questionnaire with 24 h test-retest and a representative sample of 2505 schoolchildren of the same age participated in the main study. Test-retest reliability of the HRQoL (Headache Related Quality of Life) scale in the translated questionnaire showed substantial agreement (kappa: 0.604). Reliability and validity of the translated HRQoL scale were acceptable (Cronbach's alpha: 0.749; test-retest kappa: 0.604, test for discriminant validity demonstrated that quality of life decreased by severity of headache). Factorial analysis revealed the two-dimensional structure of the HRQoL scale with indices of good model fit to the collected data. A total of 92.2% of the surveyed children had experienced headache in their lifetime, 74.2% during the last year. Girls and older children experienced headache more often than participants from the other groups. The translated Lithuanian version of the questionnaire seems to be a valid, feasible and acceptable instrument to measure the extent of the burden of headache in large populations.

"Visa ko pradžia, man atrodo, yra ten, toli vaikystėje, kur žmogus pirmą kartą supranta, kad pasaulyje jis gyvena ne vienas, kad jo rankos ir širdis privalo ką nors pridengti nuo skausmo, prievartos, melo, kad jis privalo būti žmogumi. Tai aukščiausia ir sunkiausia pareiga" (Just. Marcinkevičius). Vaikas – labiausiai pažeidžiama ir negalinti savęs apsaugoti visuomenės dalis. Siekiant užtikrinti vaikų sveikatos stiprinimą, ligų profilaktiką, efektyvią ligų diagnostiką ir gydymą, negalima pamiršti vienos pagrindinių vaiko teisės – vaiko teisė būti sveikam ir teisė į kokybišką sveikatos apsaugą, kurią vaikams garantuoja Jungtinių Tautų Vaiko teisių konvencija. Šių dienų galimybės gauti naujausią informaciją yra neribotos. Gyvename laikmetyje, kuriame greitis yra įprastas dalykas. Bendraujame ir naudojamės išmanaisiais telefonais, amžius kaupta intormacija pasiekiama akimirksniu. Begalinėje interneto erdvėje ne visi geba atsirinkti bazines ir teisingas žinias, kartais medikas pasiklysta medicininės informacijos lavinoje, o teisingą sprendimą reikia priimti čia ir dabar. Šis vadovėlis – tai Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų praktikos specialistų, mokslininkų ir pedagogų bendro darbo rezultatas. Praktikos gydytojui, bet kokioje grandyje jis bedirbtų, labai pravartu "po ranka" turėti lengvai prieinamą ir randamą informaciją viename šaltinyje. Paskutinis daugiatomis leidinys "Vaikų ligos" išleistas bendradarbiaujant Vilniaus universiteto Vaikų ligų klinikos ir tuometinio Kauno medicinos universiteto Vaikų ligų klinikos darbuotojams (I t. išleistas 2000 m., II – 2003, III -2004, IV – 2005, V – 2007). Šiame vadovėlyje aptariamos pagrindinės vaikų sveikatos problemos 17-oje skirtingų vaikų sveikatos priežiūros sričių, su kuriomis tenka susidurti bet kurios specialybės gydytojui, teikiančiam sveikatos priežiūros paslaugas ir vaikams.[...].