SUMMARYThe diagnosis, evaluation, and management of infantile spasms (IS) continue to pose significant challenges to the treating physician. Although an evidence-based practice guideline with full literature review was published in 2004, diversity in IS evaluation and treatment remains and highlights the need for further consensus to optimize outcomes in IS. For this purpose, a working group committed to the diagnosis, treatment, and establishment of a continuum of care for patients with IS and their families-the Infantile Spasms Working Group (ISWG)-was convened. The ISWG participated in a workshop for which the key objectives were to review the state of our understanding of IS, assess the scientific evidence regarding efficacy of currently available therapeutic options, and arrive at a consensus on protocols for diagnostic workup and management of IS that can serve as a guide to help specialists and general pediatricians optimally manage infants with IS. The overall goal of the workshop was to improve IS outcomes by assisting treating physicians with early recognition and diagnosis of IS, initiation of short duration therapy with a first-line treatment, timely electroencephalography (EEG) evaluation of treatment to evaluate effectiveness, and, if indicated, prompt treatment modification. Differences of opinion among ISWG members occurred in areas where data were lacking; however, this article represents a consensus of the U.S. approach to the diagnostic evaluation and treatment of IS.

The observed point-prevalence is higher than previous US estimates. More inclusive survey questions, increased population awareness, and improved screening and identification by providers may partly explain this finding.

Lamotrigine was an effective and well-tolerated treatment for seizures associated with the Lennox-Gastaut syndrome.

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Recommendations are made for both minimizing the likelihood of serious rash and for management of rash in patients taking LTG. Risk of serious rash may possibly be lessened by strict adherence to manufacturer's dosing guidelines, particularly in patients who are at higher risk: those on concurrent VPA and in the pediatric population.

http://hyper.ahajournals.org/ Downloaded from Dong et al Effects of Air Pollution on Blood Pressure 579pollution on BP in different parts of the world are unclear but may result from spatial and temporal variability in pollution sources and composition. 17,18 Compared with short-term effects of air pollution, there is little information on the relation between chronic exposure to air pollution and prevalent hypertension. Inconsistent results have also been reported on the association between incident hypertension and air pollution. For instance, Coogan et al 19 showed in a 10-year follow-up for incident hypertension and diabetes mellitus of black women from Los Angeles that NO X (but less PM 2.5 ) borderline increased the risk of becoming hypertensive. However, Sørensen et al 20 reported that longterm exposure (1 and 5 years) to NO X was not associated with incident self-reported hypertension in a Danish cohort. We hypothesized that at the population level, long-term exposure to ambient air pollution is associated with higher BP and higher prevalence of hypertension among humans. In this study, we tested this hypothesis in the 11 Districts Chinese Study, a cross-sectional study of air pollution and adult health in a large, well-characterized population-based sample, residing in northeast China, where there are wide differences in inter-and intracity gradients and ambient pollutant levels, offering a valuable opportunity to assess the associations between exposure and response. Methods Study Cities Selection and Subject RecruitmentMore than 20 million people reside in 14 cities in Liaoning province in northeast China. To maximize the inter-and intracity gradients of the pollutants of interest and minimize the correlation between district-specific ambient pollutants, in April 2009, we selected 3 cities (Shenyang, Anshan, and Jinzhou) based on the results of air pollution measurements between 2006 and 2008. There are 5, well-identified geographic districts in Shenyang, and 3 districts in Anshan and Jinzhou, respectively. Three communities within 1 km of air-monitoring sites were randomly chosen from these districts resulting in 33 locales, and from each of these, 700 to 1000 households were randomly identified. One participant, aged 18 to 74 years, was selected from each household without replacement. Our entry criterion was that the subject should have lived at that place for at least 5 years. The design and conduct of this investigation was reviewed and approved by Human Studies Committee of China Medical University. Before data collection, a written informed consent form was obtained from each participant. Ambient Air PollutionIn each of the selected study districts, there was only 1 municipal air pollution monitoring station, which was located 1 mile from the participants' homes. Measurements of PM 10 , SO 2 , NO 2 , and O 3 concentrations from 2006 to 2008 were obtained at the stations. The measurements were subject to uniform criteria for monitoring, siting, instrumentation, and quality assurance. Thes...

Summary: Purpose:To determine the population-based epidemiology of infantile spasms (IS) among Atlanta children.Methods: By using data from a cross-sectional, populationbased surveillance system that included 21 EEG laboratories, we identified children born in 1975-1977 in metropolitan Atlanta with IS.

Summary:Purpose: To determine the prevalence and descriptive epidemiology of Lennox-Gastaut Syndrome (LGS) among metropolitan Atlanta children.Methods: We conducted a population-based study of LGS as part of the Metropolitan Atlanta Developmental Disabilities Study (MADDS) using a multiple-source surveillance system for epilepsy and developmental disabilities. Children were defined as having LGS if they had onset of multiple seizure types before age 11 years, with at least one seizure type resulting in falls, and an EEG demonstrating slow spike-wave complexes (<2.5 Hz). Mental retardation (MR) was not used as a diagnostic criterion.Results: The lifetime prevalence of LGS at age 10 years was LGS accounts for only 4% of all childhood epilepsy, yet is a significant contributor to childhood morbidity.