THE JOURNAL OF PEDIATRICS
www.jpeds.com
24. McCausland AM, Holmes F, Schumann WR. Management of cord and placental blood and its effect upon the newborn. Calif Med 1949; 71:190-6. 25. Oh W. Cord milking at delivery improves the iron status of term infants at 6 weeks. Evid Based Med 2013;18:e58. 26. Upadhyay A, Gothwal S, Parihar R, Garg A, Gupta A, Chawla D, et al. Effect of umbilical cord milking in term and near term infants: randomized control trial. Am J Obstet Gynecol 2013; 208(120):e1-6.
Vol. 164, No. 5 27. Whipple GA, Sisson TR, Lund CJ. Delayed ligation of the umbilical cord; its influence on the blood volume of the newborn. Obstet Gynecol 1957; 10:603-10. 28. Lanzkowsky P. Effects of early and late clamping of umbilical cord on infant’s haemoglobin level. Br Med J 1960;2:1777-82. 29. Siddall RS, Richardson RP. Milking or stripping the umbilical cord; effect on vaginally delivered babies. Obstet Gynecol 1953;1:230-3. 30. Siddall RS, Crissey RR, Knapp WL. Effect on cesarean section babies of stripping or milking of the umbilical cords. Am J Obstet Gynecol 1952;63:1059-64.
50 Years Ago in THE JOURNAL OF PEDIATRICS Convulsive Equivalent Syndrome of Childhood Chao D, Sexton JA, Davis SD. J Pediatr 1964;64:499-507
C
hao et al described an entity they named the “convulsive equivalent syndrome of childhood” as “epilepsy characterized by paroxysmal attacks of autonomic disturbances.” Included in their list of autonomic disturbances were headaches, abdominal pain, nausea, vomiting, salivation, flushing, fever, epistaxis, chest pain, and itching. There were no electroencephalograms (EEGs) capturing these “attacks” to determine whether they were in fact epileptic. This article illustrates advances in pediatric neurology during the past 50 years while also illustrating the ground yet to be covered. Although EEG had been available clinically for about 30 years prior to the publication of the article by Chao et al, the use of continuous EEG monitoring to capture clinical events was not commonly used. The technique of leaving scalp electrodes on for days at a time to capture events in question is now routine in major medical centers and has helped distinguish epileptic from nonepileptic events. When it comes to “autonomic symptoms,” EEG monitoring during the events has shown that there are certainly cases of seizures with prominent autonomic symptoms, such as the vomiting, pallor, and hypersalivation in Panayiotopoulos syndrome. However, during paroxysmal events with “autonomic symptoms,” such as headache, flushing, and abdominal pain, more often than not continuous EEG monitoring shows no electrographic seizure activity. This leads us to diagnoses mentioned by Chao et al, including migraine, abdominal migraine, and cyclic vomiting, as were the alternate diagnoses 50 years ago. The article represented an attempt to converge diagnoses with similar features into one unifying diagnosis; patients with a variety of “autonomic symptoms” were diagnosed with “convulsive equivalent of childhood.” Since the publication of the article, the field has again diverged. Currently, depending on the specific set of symptoms, clinical context, and diagnostic test results, these symptoms can be attributed to various causes, including migraine headaches, abdominal migraines, cyclic vomiting, functional abdominal pain, seizures, dysautonomia, or anxiety. Undoubtedly, there will be further modifications to this classification system in the future, with unification of some categories and further subdivision of others, as progress in diagnostic techniques, basic science, and clinical research advance the field of pediatric neurology. Jane MacLean, MD Brenda Porter, MD, PhD Child Neurology Lucile Packard Children’s Hospital Stanford University Palo Alto, California http://dx.doi.org/10.1016/j.jpeds.2013.10.079
1050
Katheria et al
www.jpeds.com
24. McCausland AM, Holmes F, Schumann WR. Management of cord and placental blood and its effect upon the newborn. Calif Med 1949; 71:190-6. 25. Oh W. Cord milking at delivery improves the iron status of term infants at 6 weeks. Evid Based Med 2013;18:e58. 26. Upadhyay A, Gothwal S, Parihar R, Garg A, Gupta A, Chawla D, et al. Effect of umbilical cord milking in term and near term infants: randomized control trial. Am J Obstet Gynecol 2013; 208(120):e1-6.
Vol. 164, No. 5 27. Whipple GA, Sisson TR, Lund CJ. Delayed ligation of the umbilical cord; its influence on the blood volume of the newborn. Obstet Gynecol 1957; 10:603-10. 28. Lanzkowsky P. Effects of early and late clamping of umbilical cord on infant’s haemoglobin level. Br Med J 1960;2:1777-82. 29. Siddall RS, Richardson RP. Milking or stripping the umbilical cord; effect on vaginally delivered babies. Obstet Gynecol 1953;1:230-3. 30. Siddall RS, Crissey RR, Knapp WL. Effect on cesarean section babies of stripping or milking of the umbilical cords. Am J Obstet Gynecol 1952;63:1059-64.
50 Years Ago in THE JOURNAL OF PEDIATRICS Convulsive Equivalent Syndrome of Childhood Chao D, Sexton JA, Davis SD. J Pediatr 1964;64:499-507
C
hao et al described an entity they named the “convulsive equivalent syndrome of childhood” as “epilepsy characterized by paroxysmal attacks of autonomic disturbances.” Included in their list of autonomic disturbances were headaches, abdominal pain, nausea, vomiting, salivation, flushing, fever, epistaxis, chest pain, and itching. There were no electroencephalograms (EEGs) capturing these “attacks” to determine whether they were in fact epileptic. This article illustrates advances in pediatric neurology during the past 50 years while also illustrating the ground yet to be covered. Although EEG had been available clinically for about 30 years prior to the publication of the article by Chao et al, the use of continuous EEG monitoring to capture clinical events was not commonly used. The technique of leaving scalp electrodes on for days at a time to capture events in question is now routine in major medical centers and has helped distinguish epileptic from nonepileptic events. When it comes to “autonomic symptoms,” EEG monitoring during the events has shown that there are certainly cases of seizures with prominent autonomic symptoms, such as the vomiting, pallor, and hypersalivation in Panayiotopoulos syndrome. However, during paroxysmal events with “autonomic symptoms,” such as headache, flushing, and abdominal pain, more often than not continuous EEG monitoring shows no electrographic seizure activity. This leads us to diagnoses mentioned by Chao et al, including migraine, abdominal migraine, and cyclic vomiting, as were the alternate diagnoses 50 years ago. The article represented an attempt to converge diagnoses with similar features into one unifying diagnosis; patients with a variety of “autonomic symptoms” were diagnosed with “convulsive equivalent of childhood.” Since the publication of the article, the field has again diverged. Currently, depending on the specific set of symptoms, clinical context, and diagnostic test results, these symptoms can be attributed to various causes, including migraine headaches, abdominal migraines, cyclic vomiting, functional abdominal pain, seizures, dysautonomia, or anxiety. Undoubtedly, there will be further modifications to this classification system in the future, with unification of some categories and further subdivision of others, as progress in diagnostic techniques, basic science, and clinical research advance the field of pediatric neurology. Jane MacLean, MD Brenda Porter, MD, PhD Child Neurology Lucile Packard Children’s Hospital Stanford University Palo Alto, California http://dx.doi.org/10.1016/j.jpeds.2013.10.079
1050
Katheria et al
