Chronic impact of topiramate on acid-base balance and potassium in childhood

Topiramate, which is commonly prescribed for seizure disorders and migraine prophylaxis, sometimes causes metabolic acidosis and hypokalemia. Since the effects of topiramate on acid-base balance and potassium levels have not been well explored in children, acid-base balance, anion gap and potassium were assessed in 24 patients (8 females and 16 males) aged between 4.6 and 19 years on topiramate for more than 12 months and in an age-matched control group. Plasma bicarbonate (21.7 versus 23.4 mmol/L; P<0.03), carbon dioxide pressure (39.7 versus 43.2mm Hg; P<0.05), and potassium (3.7 versus 4.0 mmol/L; P<0.03) were on the average lower and chloride (109 versus 107 mmol/L; P<0.03) higher in patients treated with topiramate than in controls. Blood pH, plasma sodium and the anion gap were similar in patients on topiramate and in controls. In patients on topiramate no significant correlation was observed between the dosage of this agent and plasma bicarbonate or potassium as well as between topiramate blood level and the mentioned electrolytes. In conclusion long-term topiramate treatment is associated with a mild, statistically significant tendency towards compensated normal anion gap metabolic acidosis and hypokalemia.

The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy

An interdisciplinary European group of clinical experts in the field of movement disorders and experienced Botulinum toxin users has updated the consensus for the use of Botulinum toxin in the treatment of children with cerebral palsy (CP). A problem-orientated approach was used focussing on both published and practice-based evidence. In part I of the consensus the authors have tabulated the supporting evidence to produce a concise but comprehensive information base, pooling data and experience from 36 institutions in 9 European countries which involves more than 10,000 patients and over 45,000 treatment sessions during a period of more than 280 treatment years. In part II of the consensus the Gross Motor Function Measure (GMFM) and Gross Motor Function Classification System (GMFCS) based Motor Development Curves have been expanded to provide a graphical framework on how to treat the motor disorders in children with CP. This graph is named "CP(Graph) Treatment Modalities - Gross Motor Function" and is intended to facilitate communication between parents, therapists and medical doctors concerning (1) achievable motor function, (2) realistic goal-setting and (3) treatment perspectives for children with CP. The updated European consensus 2009 summarises the current understanding regarding an integrated, multidisciplinary treatment approach using Botulinum toxin for the treatment of children with CP.

Cavernous malformations of the central nervous system in children: presentation, treatment and outcome of 20 cases

Cavernous malformations (CM) of the central nervous system are vascular malformations responsible for symptoms such as seizures, headache, and neurological deficits: 25% of cases already present in childhood.

Non-traumatic spinal cord ischaemia in childhood - Clinical manifestation, neuroimaging and outcome

Spinal cord ischaemia is rare in childhood and information on clinical presentation and outcome is scarce.

Pontocerebellar hypoplasia type 2: variability in clinical and imaging findings

We report 24 children (14 girls) who presented with the typical neuroimaging findings of pontocerebellar hypoplasia (PCH) to describe the clinical spectrum of type 2. Twenty-one presented with the classical form described by Barth; characteristic features (15/21) were breathing and/or sucking problems during neonatal period and early onset hyperkinetic movement disorder. Eighteen were normocephalic at birth, but all developed microcephaly during infancy. Development was severely affected with none of the children being capable of sitting, walking, or talking. Social contact and visual fixation were persistently poor. Dyskinetic movement disorder was present in all, in some together with mild spasticity. Seizures occurred in 14 (in 7 as neonates). Eight children died (age 1 day-6 years). Neuroimaging showed an absent or severely flattened pons, different degrees of vermian hypoplasia, with cerebellar hemispheres (wing-like structures) being equally or more affected. Three (all girls) were less severely affected clinically and did not develop the dyskinetic movement disorder, motor and cognitive development were somewhat better. Microcephaly was also a prominent sign. Severity of pontocerebellar neuroimaging findings did not differentiate between the typical and atypical clinical group and did not correlate with clinical outcome.

A paradoxical rise of neonatal seizures after treatment with vitamin B6

We report the case of a newborn with intractable epileptic seizures developing a paradoxical rise of seizure frequency and electroencephalogram alterations after administration of vitamin B6. We have been unable to determine the aetiology of this disorder. In a newborn presenting with drug-resistant epileptic seizures, the first therapeutic option remains the application of intravenous pyridoxine, but the physician should be aware of the risk of an increase in seizure frequency.

An economic assessment of drought effects on three grassland systems in Switzerland

This paper analyzes the economic impacts of summer drought on Swiss grassland production. We combine field trial data from drought experiments in three different grasslands in Switzerland with site-specific information on economic costs and benefits. The analysis focuses on the economic implications of drought effects on grassland yields as well as grassland composition. In agreement with earlier studies, we found rather heterogeneous yield effects of drought on Swiss grassland systems, with significantly reduced yields as a response to drought at the lowland and sub-alpine sites, but increased yields at the wetter pre-alpine site. Relative yield losses were highest at the sub-alpine site (with annual yield losses of up to 37 %). However, because income from grassland production at extensive sites relies to a large extent on ecological direct payments, even large yield losses had only limited implications in terms of relative profit reductions. In contrast, negative drought impacts at the most productive, intensively managed lowland site were dominant, with average annual drought-induced profit margin reductions of about 28 %. This is furthermore emphasized if analyzing the farm level perspective of drought impacts. Combining site-specific effects at the farm level, we found that in particular farms with high shares of lowland grassland sites suffer from summer droughts in terms of farm-level fodder production and profit margins. Moreover, our results showed that the higher competitiveness of weeds (broad-leaved dock) under drought conditions will require increasing attention on weed control measures in future grassland production systems. Taking into account that the risk of drought occurrence is expected to increase in the coming years, additional instruments to cope with drought risks in fodder production and finally farmers’ income have to be developed.

Buffer capacity: capturing a dimension of resilience to climate change in African smallholder agriculture

Building resilience to climate change in agricultural production can ensure the functioning of agricultural-based livelihoods and reduce their vulnerability to climate change impacts. This paper thus explores how buffer capacity, a characteristic feature of resilience, can be conceptualised and used for assessing the resilience of smallholder agriculture to climate change. It uses the case of conservation agriculture farmers in a Kenyan region and examines how their practices contribute to buffer capacity. Surveys were used to collect data from 41 purposely selected conservation agriculture farmers in the Laikipia region of Kenya. Besides descriptive statistics, factor analysis was used to identify the key dimensions that characterise buffer capacity in the study context. The cluster of practices characterising buffer capacity in conservation agriculture include soil protection, adapted crops, intensification/irrigation, mechanisation and livelihood diversification. Various conservation practices increase buffer capacity, evaluated by farmers in economic, social, ecological and other dimensions. Through conservation agriculture, most farmers improved their productivity and incomes despite drought, improved their environment and social relations. Better-off farmers also reduced their need for labour, but this resulted in lesser income-earning opportunities for the poorer farmers, thus reducing the buffer capacity and resilience of the latter.

Adaptation options under climate change for multifunctional agriculture: a simulation study for western Switzerland

Besides its primary role in producing food and fiber, agriculture also has relevant effects on several other functions, such as management of renewable natural resources. Climate change (CC) may lead to new trade-offs between agricultural functions or aggravate existing ones, but suitable agricultural management may maintain or even improve the ability of agroecosystems to supply these functions. Hence, it is necessary to identify relevant drivers (e.g., cropping practices, local conditions) and their interactions, and how they affect agricultural functions in a changing climate. The goal of this study was to use a modeling framework to analyze the sensitivity of indicators of three important agricultural functions, namely crop yield (food and fiber production function), soil erosion (soil conservation function), and nutrient leaching (clean water provision function), to a wide range of agricultural practices for current and future climate conditions. In a two-step approach, cropping practices that explain high proportions of variance of the different indicators were first identified by an analysis of variance-based sensitivity analysis. Then, most suitable combinations of practices to achieve best performance with respect to each indicator were extracted, and trade-offs were analyzed. The procedure was applied to a region in western Switzerland, considering two different soil types to test the importance of local environmental constraints. Results show that the sensitivity of crop yield and soil erosion due to management is high, while nutrient leaching mostly depends on soil type. We found that the influence of most agricultural practices does not change significantly with CC; only irrigation becomes more relevant as a consequence of decreasing summer rainfall. Trade-offs were identified when focusing on best performances of each indicator separately, and these were amplified under CC. For adaptation to CC in the selected study region, conservation soil management and the use of cropped grasslands appear to be the most suitable options to avoid trade-offs.

The new Southeast Asian goblin spider genus Aposphragisma (Araneae, Oonopidae): diversity and phylogeny

The new genus Aposphragisma (Araneae, Oonopidae, Oonopinae) comprising the new species A. baltenspergerae, A. borgulai, A. brunomanseri, A. confluens, A. dayak, A. dentatum, A. draconigenum, A. hausammannae, A. helvetiorum, A. kolleri, A. menzi, A. monoceros, A. nocturnum, A. retifer, A. rimba, A. salewskii, A. scimitar, A. sepilok and A. stannum is described. It is characterised by very hard bodied, strongly sclerotized species with completely armoured prosoma and strongly sclerotized ventral and dorsal abdominal scuta. Aposphragisma gen. nov. is placed within the Gamasomorpha-group sensu Saaristo (2001). Descriptions and illustrations are given for all new species. A phylogenetic analysis based on 40 characters using Prethopalpus fosuma, Gamasomorpha asterobothros, G. cataphracta, G. seximpressa, Xestaspis biflocci, X. kandy and X. paulina as outgroup-taxa and Cortestina thaleri (Oonopidae, Sulsulinae) as the root is presented and discussed. Furthermore it is shown that females of Aposphragisma gen. nov. possess complex internal genitalia. The members of the new genus are ground-dwelling litter inhabitants restricted to Southeast Asian lowland and montane forests, with more than 60% of the species only known from single localities. They are presumed to be negatively affected by the massive destruction of pristine forest habitats within their range. This work has been conducted within the framework of the Planetary Biodiversity Inventory (PBI) of Oonopidae (see http://research.amnh.org/oonopidae).

Late diagnosis of fucosidosis in a child with progressive fixed dystonia, bilateral pallidal lesions and red spots on the skin

Fucosidosis is a rare lysosomal storage disease. A 14-year-old girl is presented, with recurrent infections, progressive dystonic movement disorder and mental retardation with onset in early childhood. The clinical picture was also marked by mild morphologic features, but absent dysostosis multiplex and organomegaly. MRI images at 6.5 years of age were reminiscent of pallidal iron deposition ("eye-of-the-tiger" sign) seen in neurodegeneration with brain iron accumulation (NBIA) disorders. Progressively spreading angiokeratoma corporis diffusum led to the correct diagnosis. This case extends the scope of clinical and neuroradiological manifestations of fucosidosis.