1
|
Sansevere AJ, Keenan JS, Pickup E, Conley C, Staso K, Harrar DB. Ictal-Interictal Continuum in the Pediatric Intensive Care Unit. Neurocrit Care 2024:10.1007/s12028-024-01978-4. [PMID: 38671312 DOI: 10.1007/s12028-024-01978-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 03/08/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND The ictal-interictal continuum (IIC) consists of several electroencephalogram (EEG) patterns that are common in critically ill adults. Studies focused on the IIC are limited in critically ill children and have focused primarily on associations with electrographic seizures (ESs). We report the incidence of the IIC in the pediatric intensive care unit (PICU). We then compare IIC patterns to rhythmic and periodic patterns (RPP) not meeting IIC criteria looking for associations with acute cerebral abnormalities, ES, and in-hospital mortality. METHODS This was a retrospective review of prospectively collected data for patients admitted to the PICU at Children's National Hospital from July 2021 to January 2023 with continuous EEG. We excluded patients with known epilepsy and cerebral injury prior to presentation. All patients were screened for RPP. The American Clinical Neurophysiology Society standardized Critical Care EEG terminology for the IIC was applied to each RPP. Associations between IIC and RPP not meeting IIC criteria, with clinical and EEG variables, were calculated using odds ratios (ORs). RESULTS Of 201 patients, 21% (42/201) had RPP and 12% (24/201) met IIC criteria. Among patients with an IIC pattern, the median age was 3.4 years (interquartile range (IQR) 0.6-12 years). Sixty-seven percent (16/24) of patients met a single IIC criterion, whereas the remainder met two criteria. ESs were identified in 83% (20/24) of patients and cerebral injury was identified in 96% (23/24) of patients with IIC patterns. When comparing patients with IIC patterns with those with RPP not qualifying as an IIC pattern, both patterns were associated with acute cerebral abnormalities (IIC OR 26 [95% confidence interval {CI} 3.4-197], p = 0.0016 vs. RPP OR 3.5 [95% CI 1.1-11], p = 0.03), however, only the IIC was associated with ES (OR 121 [95% CI 33-451], p < 0.0001) versus RPP (OR 1.3 [0.4-5], p = 0.7). CONCLUSIONS Rhythmic and periodic patterns and subsequently the IIC are commonly seen in the PICU and carry a high association with cerebral injury. Additionally, the IIC, seen in more than 10% of critically ill children, is associated with ES. The independent impact of RPP and IIC patterns on secondary brain injury and need for treatment of these patterns independent of ES requires further study.
Collapse
Affiliation(s)
- Arnold J Sansevere
- Department of Neurology/Division of Epilepsy and Clinical Neurophysiology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA.
| | - Julia S Keenan
- Department of Neurology/Division of Epilepsy and Clinical Neurophysiology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Elizabeth Pickup
- Department of Neurology/Division of Epilepsy and Clinical Neurophysiology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Caroline Conley
- Department of Neurology/Division of Epilepsy and Clinical Neurophysiology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
- Department of Critical Care Medicine, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Katelyn Staso
- Department of Neurology/Division of Epilepsy and Clinical Neurophysiology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
- Department of Critical Care Medicine, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Dana B Harrar
- Department of Neurology/Division of Epilepsy and Clinical Neurophysiology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| |
Collapse
|
2
|
Morris EE, Howell MJ, Pickup E, Iber C, Wang SG. Pediatric sleep and pain: etiologies, consequences, and clinical considerations. J Clin Sleep Med 2022; 18:2281-2289. [PMID: 35499282 PMCID: PMC9435332 DOI: 10.5664/jcsm.10008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To examine current evidence of the relationship between sleep and pain from the neonatal period through adolescence. This review serves as a critical review of the literature and of the needs for future research on pediatric sleep and pain. METHODS The PubMed online database was queried from January 1, 1960, to March 1, 2020, producing 149 articles applicable to pain and sleep in the pediatric population. Of those, 97 articles were cited in this review with the key articles including over 3800 participants. RESULTS The pediatric literature supports the relationship between poor sleep (both sleep efficiency and nighttime awakenings) and subsequent risk for pain, especially among children with chronic disease. The reverse effect of pain on sleep is not yet well delineated. The key moderating factors explored in the literature are pharmacologic and nonpharmacologic therapies, psychologic health, and the etiology of pain. There is evidence that both altered sleep and pain early in life impact neurodevelopment, as seen by changes in sleep structure in clinical studies and alterations in brain development in animal models. CONCLUSIONS The complicated relationship between sleep and pain is critically important during pediatric development when alterations to a normal sleep structure can have a lifelong impact. It is becoming clear that sleep deprivation and poor sleep quality exacerbate pain. Further research is needed into the complex alterations of sleep in chronic pain conditions as well as treatments to improve sleep in pediatric care. CITATION Morris EE, Howell MJ, Pickup E, Iber C, Wang SG. Pediatric sleep and pain: etiologies, consequences, and clinical considerations. J Clin Sleep Med. 2022;18(9):2281-2289.
Collapse
Affiliation(s)
- Erin E. Morris
- Department of Pediatrics, University of Minnesota–Twin Cities, Minneapolis, Minnesota
| | - Michael J. Howell
- Department of Neurology, University of Minnesota–Twin Cities, Minneapolis, Minnesota
| | - Elizabeth Pickup
- Pediatric Neurology, Children’s National Hospital, Washington, DC
| | - Conrad Iber
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota–Twin Cities, Minneapolis, Minnesota
| | - Sonya G. Wang
- Department of Pediatrics, University of Minnesota–Twin Cities, Minneapolis, Minnesota
| |
Collapse
|
3
|
Bingham S, Beswick PJ, Bountra C, Brown T, Campbell IB, Chessell IP, Clayton N, Collins SD, Davey PT, Goodland H, Gray N, Haslam C, Hatcher JP, Hunter AJ, Lucas F, Murkitt G, Naylor A, Pickup E, Sargent B, Summerfield SG, Stevens A, Stratton SC, Wiseman J. The cyclooxygenase-2 inhibitor GW406381X [2-(4-ethoxyphenyl)-3-[4-(methylsulfonyl)phenyl]-pyrazolo[1,5-b]pyridazine] is effective in animal models of neuropathic pain and central sensitization. J Pharmacol Exp Ther 2004; 312:1161-9. [PMID: 15572651 DOI: 10.1124/jpet.104.075267] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The pathogenic form of the cyclooxygenase (COX) enzyme, COX-2, is also constitutively present in the spinal cord and has been implicated in chronic pain states in rat and man. A number of COX-2 inhibitors, including celecoxib and rofecoxib, are already used in man for the treatment of inflammatory pain. Preclinically, the dual-acting COX-2 inhibitor, GW406381X [2-(4-ethoxyphenyl)-3-[4-(methylsulfonyl)phenyl]-pyrazolo[1,5-b]pyridazine, where X denotes the free base], is as effective as rofecoxib and celecoxib in the rat established Freund's Complete Adjuvant model with an ED(50) of 1.5 mg/kg p.o. compared with 1.0 mg/kg p.o. for rofecoxib and 6.6 mg/kg p.o. for celecoxib. However, in contrast to celecoxib (5 mg/kg p.o. b.i.d.) and rofecoxib (5 mg/kg p.o. b.i.d.), which were without significant effect, GW406381X (5 mg/kg p.o. b.i.d.) fully reversed mechanical allodynia in the chronic constriction injury model and reversed thermal hyperalgesia in the mouse partial ligation model, both models of neuropathic pain. GW406381X, was also effective in a rat model of capsaicin-induced central sensitization, when given intrathecally (ED(50) = 0.07 mug) and after chronic but not acute oral dosing. Celecoxib and rofecoxib had no effect in this model. Several hypotheses have been proposed to try to explain these differences in efficacy, including central nervous system penetration, enzyme kinetics, and potency. The novel finding of effectiveness of GW406381X in these models of neuropathic pain/central sensitization, in addition to activity in inflammatory pain models and together with its central efficacy, suggests dual activity of GW406381X compared with celecoxib and rofecoxib, which may translate into greater efficacy in a broader spectrum of pain states in the clinic.
Collapse
Affiliation(s)
- Sharon Bingham
- Pain Research Department, Neurology and Gastrointestinal Centre of Excellence for Drug Discovery, GlaxoSmithKline Pharmaceuticals, 3rd Avenue, Harlow, Essex CM19 5AW, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Beswick P, Bingham S, Bountra C, Brown T, Browning K, Campbell I, Chessell I, Clayton N, Collins S, Corfield J, Guntrip S, Haslam C, Lambeth P, Lucas F, Mathews N, Murkit G, Naylor A, Pegg N, Pickup E, Player H, Price H, Stevens A, Stratton S, Wiseman J. Identification of 2,3-diaryl-pyrazolo[1,5-b]pyridazines as potent and selective cyclooxygenase-2 inhibitors. Bioorg Med Chem Lett 2004; 14:5445-8. [PMID: 15454242 DOI: 10.1016/j.bmcl.2004.07.089] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2004] [Revised: 07/26/2004] [Accepted: 07/26/2004] [Indexed: 11/23/2022]
Abstract
GW406381 (8), currently undergoing clinical evaluation for the treatment of inflammatory pain is a member of a novel series of 2,3-diaryl-pyrazolo[1,5-b]pyridazine based cyclooxygenase-2 (COX-2) inhibitors, which have been shown to be highly potent and selective. Several examples of the series, in addition to possessing favourable pharmacokinetic profiles and analgesic activity in vivo, have also demonstrated relatively high brain penetration in the rat compared with the clinically available compounds, which may ultimately prove beneficial in the treatment of pain.
Collapse
Affiliation(s)
- Paul Beswick
- Neurology and Gastrointestinal Diseases, Centre of Excellence for Drug Discovery, GlaxoSmithKline, New Frontiers Science Park, Third Avenue, Harlow, Essex CM19 5AW, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Larribe A, Leveque A, Muller A, Pauli E, Revel D, Tallini T, Litchfield P, Rangan L, Segar A, Smith J, Finney P, Fisher C, Pickup E. Test of C invariance in the 3π decay mode of the η meson. ACTA ACUST UNITED AC 1966. [DOI: 10.1016/0031-9163(66)91017-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
6
|
Haque N, Scotter D, Musgrave B, Blair W, Grant A, Hughes I, Negus P, Turnbull R, Ahmad A, Baker S, Celnikier L, Misbahuddin S, Sherman H, Skillicorn I, Atherton A, Chadwick G, Davies W, Field J, Gray P, Lawrence D, Loken J, Lyons L, Mulvey J, Oxley A, Wilkinson C, Fisher C, Pickup E, Rangan L, Scarr J, Segar A. K∗ resonances produced by 3.5 GeV / c K− interactions in hydrogen. ACTA ACUST UNITED AC 1965. [DOI: 10.1016/0031-9163(65)90230-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
7
|
|
8
|
|
9
|
|
10
|
|
11
|
|
12
|
|
13
|
|
14
|
Abstract
One of the more interesting features of cosmic ray stars is that [Formula: see text] nuclei are ejected occasionally in the nuclear disintegrations. Such nuclei are characterized by the fact that, at the end of their range, they suffer radioactive decay (τ = 0.9 sec.) into [Formula: see text], which immediately splits up into two oppositely directed α-particles, giving what is usually referred to as a hammer track. In this investigation numerous examples have been observed of the emission of such nuclei in stars in photographic emulsions, the stars having from 2 to 60 prongs. In particular, it has been shown that the energy spectrum of the α-particles forming the hammer tracks is in good agreement with that observed by other workers, and also with experiments made, using the cloud chamber technique, indicating that the [Formula: see text] in this disintegration is formed in the excited state. When an electron sensitive emulsion is used it is shown that the hammer track is accompanied by the [Formula: see text] disintegration electron. The energy spectrum of the [Formula: see text] nuclei is plotted, and the mechanism of the formation is discussed for both large and small stars.
Collapse
|
15
|
|
16
|
|
17
|
|