Intrathecal baclofen and deep brain stimulation are possibly effective in reducing dystonia. Current evidence does not support effectiveness of oral medications or botulinum toxin to reduce dystonia. Evidence is inadequate for pharmacological/neurosurgical interventions impact on improving motor function, pain/comfort, and easing caregiving. The majority of the care pathway rests on expert opinion.

Dystonia is readily identified in cerebral palsy (CP) using the Hypertonia Assessment Tool, regardless of the predominant motor type. Spasticity and dystonia frequently coexist in the CP population. Severity of dystonia is inversely related to motor function.

Asymptomatic VDD is common in East African immigrant children residing at a temperate latitude. Risk factors for VDD limit endogenous vitamin D production. Screening of immigrant children with increased skin pigmentation for VDD, anaemia, iron and vitamin A deficiency is appropriate. VDD in adolescent females identifies an increased risk of future infants with VDD.

There is some limited short-term evidence that intrathecal baclofen is an effective therapy for reducing spasticity in children with cerebral palsy. The effect of intrathecal baclofen on long-term spasticity outcomes is less certain.The validity of the evidence for the effectiveness of intrathecal baclofen in treating spasticity in children with cerebral palsy from the studies in the review is constrained by the small sample sizes of the studies and methodological issues in some studies.Spasticity is a impairment in the domain of body structure and function. Consideration must also be given to the broader context in determining whether intrathecal baclofen therapy is effective. The aim of therapy may be, for example, to improve gross motor function, to increase participation at a social role level, to improve comfort, to improve the ease of care by others or to improve the overall quality of life of the individual. Intrathecal baclofen may improve gross motor function in children with cerebral palsy, but more reliable evidence is needed to determine this.There is some evidence that intrathecal baclofen improves ease of care and the comfort and quality of life of the individuals receiving it, but again small sample sizes and methodological issues in the studies mean that these results should be interpreted with caution.Further evidence of the effectiveness of intrathecal baclofen for treating spasticity, increasing gross motor function and improving comfort, ease of care and quality of life is needed from other investigators in order to validate these results.The short duration of the controlled studies included in this review did not allow for the exploration of questions regarding whether the subsequent need for orthopaedic surgery in children receiving intrathecal baclofen therapy is altered, or the safety and the economic implications of intrathecal baclofen treatment when long-term therapy is administered via an implanted device. Controlled studies are not the most appropriate study design to address these questions, cohort studies may be more appropriate.

No abstract

The aim of this study was to assess trihexyphenidyl in reducing overall dystonia, improving upper limb function, and achieving goals in children with dystonic cerebral palsy. A randomized, double-blinded, placebo-controlled, crossover trial was conducted with 16 participants at a tertiary children's hospital. Assessments were performed at baseline, week 12, and week 28. The primary outcome measure was the Barry-Albright Dystonia scale for global assessment of dystonia. Secondary measures included the Quality of Upper Extremity Skills Test, Canadian Occupational Performance Measure, and Goal Attainment Scale. A total of 14 children (88%) completed the study. Mean baseline Barry-Albright Dystonia score was 18.4 (95% confidence interval, 15.5-21.2). There were no significant treatment effects as measured by change in outcome scores. There were significant order effects for both the Goal Attainment Scale and performance aspect of the Canadian Occupational Performance Measure. Side effects were common. Larger experimental trials with more narrowly defined functional levels are indicated.

Paediatric East African immigrants in Victoria are very likely to be inadequately immunised and parent-reported vaccination status does not predict serological immunity. Full catch-up immunisation is recommended where immunisation status is unknown and written records are unavailable. Consideration should be given to policy and program development to provide timely and complete immunisation coverage in this group after arrival in Australia.

The PEDI provides a useful measure of functional outcomes following paediatric stroke. Children in this study demonstrated reduced abilities across all domains. Further research to investigate the relationship between location of injury and functional outcome would assist understanding of paediatric stroke outcomes.