Autism - 2014 Lancet review

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What is autism?

Autism is a set of heterogeneous neurodevelopmental conditions, characterised by:

- early-onset difficulties in social communication
- unusually restricted, repetitive behavior and interests

How common is autism?

The worldwide population prevalence is 1%. Autism affects more males than females. Comorbidity is common (more than 70% have concurrent conditions).

Individuals with autism have atypical cognitive profiles:

- impaired social cognition, social perception, and executive dysfunction
- atypical perceptual and information processing

These profiles are underpinned by atypical neural development at the systems level.

Is it hereditary?

Genetics has a key role in the etiology of autism, in conjunction with developmentally early environmental factors. Large-effect rare mutations and small-effect common variants contribute to risk.

What is the treatment?

Early detection is essential for early intervention. Early comprehensive and targeted behavioral interventions can improve social communication and reduce anxiety and aggression.

Drugs can reduce comorbid symptoms, but do not directly improve social communication. Creation of a supportive environment that accepts and respects that the individual is different is crucial.

References:

Autism - The Lancet http://bit.ly/1h1TpyN

Pediatric concussions: 69% by boys, 30% sports-related

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This is a cross-sectional study of children 0 to 19 years old diagnosed with concussion from the National Hospital Ambulatory Medical Care Survey.

There were 144 000 concussions annually.

69% of concussion visits were by males. 30% were sports-related.

69% of patients diagnosed with a concussion had head imaging.

28% of patients were discharged without specific instructions to follow-up with an outpatient provider for further treatment.

References:

Pediatric Concussions in United States Emergency Departments in the Years 2002 to 2006. William P. Meehan III, MDab, Rebekah Mannix, MD, MPHa. The Journal of Pediatrics.
Chronic traumatic encephalopathy (CTE): Brain bank examines athletes' hard hits - CNN, 2012.
Image source: Illustration of the human brain and skull. Wikipedia, Patrick J. Lynch, medical illustrator, Creative Commons Attribution 2.5 License 2006.

Evaluation of a Child With a Febrile Seizure

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Clinical Practice Guideline for Neurodiagnostic Evaluation of the Child With a Simple Febrile Seizure:

Find the cause

Clinicians should identify the cause of the child's fever.

Meningitis is the biggest danger

Meningitis should be considered in the differential diagnosis for any febrile child, and lumbar puncture should be performed if there are concerns.

When to do a lumbar puncture?

For any infant between 6 and 12 months of age who presents with a seizure and fever, a lumbar puncture is an option when the child is considered deficient in Haemophilus influenzae type b (Hib) or Streptococcus pneumoniae immunizations (ie, has not received scheduled immunizations as recommended), or when immunization status cannot be determined. This group of children is at an increased risk of bacterial meningitis.

A lumbar puncture is an option for children who are pretreated with antibiotics.

Additional tests may not be needed in a simple febrile seizure

In general, a simple febrile seizure does not usually require further evaluation, specifically electroencephalography, blood studies, or neuroimaging.

References:
Clinical Practice Guideline: Neurodiagnostic Evaluation of the Child With a Simple Febrile Seizure. PEDIATRICS Vol. 127 No. 2 February 2011, pp. 389-394 (doi:10.1542/peds.2010-3318)