RESUMEN
The purpose of this prospective, open-label pilot study was to determine whether treatment with levetiracetam improves neuropsychological functioning in children and adolescents who have evidence of subclinical spike production associated with attention and learning difficulties. Six participants (mean age 9.8 years) were treated with levetiracetam up to 40 mg/kg per day and evaluated using neuropsychological (Wide Range Assessment of Memory and Learning, Second Edition), academic (Wechsler Individual Achievement Test, Second Edition, Abbreviated), and electroencephalographic assessments at baseline and after 10 weeks of treatment. Statistically significant improvements on indexes of the Wide Range Assessment of Memory and Learning, Second Edition were observed in 4 participants after 10 weeks. No statistically significant differences were observed for the Wechsler Individual Achievement Test, Second Edition, Abbreviated. Concomitant spike suppression was observed. Levetiracetam was generally well tolerated. A subset of patients exists with attention and learning problems that have associated aberrant cortical electrical activity without clinical seizures and associated neuropsychological deficits that may improve after treatment with levetiracetam.
Asunto(s)
Anticonvulsivantes/uso terapéutico , Déficit de la Atención y Trastornos de Conducta Disruptiva/tratamiento farmacológico , Encéfalo/fisiopatología , Epilepsia/tratamiento farmacológico , Discapacidades para el Aprendizaje/tratamiento farmacológico , Piracetam/análogos & derivados , Adolescente , Atención/efectos de los fármacos , Déficit de la Atención y Trastornos de Conducta Disruptiva/fisiopatología , Encéfalo/efectos de los fármacos , Niño , Electroencefalografía , Femenino , Humanos , Discapacidades para el Aprendizaje/fisiopatología , Levetiracetam , Masculino , Memoria/efectos de los fármacos , Pruebas Neuropsicológicas , Proyectos Piloto , Piracetam/uso terapéutico , Estudios Prospectivos , Resultado del TratamientoRESUMEN
The concept of chronic sorrow has been used to describe the reaction of parents to the ongoing losses associated with caring for a child with chronic illness or disability. A middle-range theory of chronic sorrow provides a framework for further understanding of this phenomenon. This theory is applied to a case of a family burdened with the unrelenting stress of caring for 2 children with lissencephaly. With an understanding of chronic sorrow, nurses can plan interventions that recognize it as a normal reaction, promote healthy adaptation, and provide empathetic support.