A group of clinicians from across Europe experienced in the use of botulinum toxin type A for the treatment of spasticity following acquired brain injury gathered to develop a consensus statement on best practice in managing adults with spasticity. This consensus table summarizes the current published data, which was collated following extensive literature searches, their assessment for level of evidence and discussion among the whole group. Published information is supplemented by expert opinion based on clinical experience from 16 European countries, involving 28 clinicians, who treat an average of approximately 200 patients annually, representing many thousand spasticity treatments with botulinum toxin per year.

To analyze the characteristics and treatment outcomes of pediatric orbital dermoid cysts. Chart review of consecutive pediatric biopsy-proven dermoid cysts surgically removed at the Department of Ophthalmology, Maggiore Hospital, between 2000 and 2007. We excised dermoid cysts from 30 children (30 eyes) whose mean age at the time of surgery was 24 months (range 6-84). The most common presentation of the cyst was a palpable or partially palpable mass (100%), followed by a superior lid ptosis (10%). Twenty patients (67%) had superficial cysts with margins well-definable by palpation, and 10 patients (33%) had deep cysts that extended beyond the orbital rim with an incomplete palpation of margins requiring imaging studies. The most frequent localization of the cysts was the superior temporal zygomatico-frontal suture (86.6%), followed by the superior nasal frontal suture (10%). Complete removal of the cysts was achieved and confirmed histopathologically, and there were no recurrences among the patients at a mean follow-up of 28 months (range 6-73). One child, however, developed a temporary orbital hematoma. The superficial cysts had an anatomic mean diameter of 10 mm (range 2.5-15), and the mean age of the patients at surgery was 19 months (range 6-31). The deep cysts had a larger diameter with a mean of 14 mm (range 10-30) (P = 0.008), and the children were older at presentation with a mean age of 34 months (range 15-84) (P = 0.03). There was a statistically significant difference (P < 0.05) between the two groups (superficial and deep) when comparing age and diameter. Cysts with palpably distinct margins (superficial) can be easily and completely excised with no recurrence. Cysts with indistinct margins need detailed computed tomography or magnetic resonance imaging investigation because they may require deep orbital dissection. Complete excision of the cyst's capsule may be difficult as a result. In our review we have not found cysts with intracranial extension.

A clinical motion analysis protocol was developed to measure the coordinated movements of shoulder-girdle and humerus (girdle-humeral rhythm--GD-H-R) during humerus flexion-extension (HFE) and ab-adduction (HAA), through an optoelectronic system. In particular, the protocol describes the GD-H-R with 2 angle-angle plots for each movement: girdle elevation-depression and protraction-retraction vs HFE, and vs HAA. Each of these plots is further divided in two subplots, one for the upward and one for the downward phases of the movement. By involving 11 participants and 2 operators, we measured the protocol's inter-operator reliability which ranged from very-good to excellent depending on the angle-angle plot (median values of the inter-operator coefficient of multiple correlation for the angle-angle plots higher than 0.94). We then computed the subjects' average control patterns, together with statistically meaningful prediction bands. +/-1SD confidence bands were also computed and their width ranged from +/-0.5 degrees to +/-4.6 degrees. Based on these results we could conclude that the method is robust and able to identify even limited differences in the GD-H-R.

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