Archives ofDisease in Childhood 1992; 67 302-306Narcoleps.docxrossskuddershamus
Archives ofDisease in Childhood 1992; 67: 302-306
Narcolepsy
M R Allsopp, Z Zaiwalla
Abstract
The symptom of excessive sleepiness in
children and adolescents does not necessarily
cause great concern to families and profes-
sionals involved in their care. Children may
deny the symptom and minimise the adverse
effects. These factors contribute to an under-
diagnosis of narcolepsy in this age group when
clinical diagnosis is difficult as associated
symptoms may not have appeared or are hard
to elicit. In this paper three children whose
difficult behaviour contributed to the presen-
tation of their sleep disorder are described.
Park Hospital for
Children, Oxford
M R Allsopp
Z Zaiwalla
Correspondence to:
D)r M R Allsopp,
Child and Family Guidance
Centre, Wvvern House,
'T'heatre Square, Swindon,
Wiltshire SNI IQN.
Accepted 22 November 1991
The narcolepsy syndrome comprises sleep dis-
turbance, cataplexy, sleep paralysis, and
hypnagogic hallucinations, although all four
symptoms occur only in a minority.' 2 The
sleep disturbance involves excessive daytime
drowsiness with intermittent, irresistible naps
and a disrupted pattern of nocturnal sleep.
Estimates of the prevalence of the condition
suggest that between two and nine per 10 000 of
the general population are affected.3 There is a
strong link with HLA-DR2.4 The condition is
rarely diagnosed in childhood or early puberty,
although single cases have been reported.5 6 In a
large series of patients only 4% of400 adults had
been diagnosed before the age of 15 years,7 yet
Navelet et al reported that the families of more
than half of adult patients recalled that
symptoms had begun by that age.8
The apparent under identification of narco-
lepsy in children and young adolescents is given
added significance by the increasing evidence
that patients with narcolepsy suffer significant
psychosocial adversity and the possibility that
early intervention may reduce this.9 10 Kales et
al detail the retrospectively self reported psy-
chosocial adverse consequences of excessive
sleepiness in childhood or adolsecence. " Many
patients had school problems and reported that
their teachers misinterpreted symptoms as
laziness, indifference, or malingering. The
authors suggest that these consequences,
together with a lack of emotional expressivity
cultivated by patients to prevent cataplexy,
contribute to the high rate (50%) of minor
psychopathology found in this and other studies
of adult populations.'2 13
In this paper we describe three consecutive
cases of narcolepsy in childhood presenting to
the Park Hospital for Children, Oxford, a
specialist centre for childhood epilepsy, sleep
disorders, and behavioural disturbance. They
illustrate some of the diagnostic issues and
management problems that may be encountered.
Case reports
CASE 1
A boy aged 8 years was referred with a history of
daytime sleepiness, irritability, and difficult
behaviour. He had become increasingly sensi-
tive, surly, and irritable after the .
get the sleep you need sleep soundly.pdfPaulClaybrook
When you don’t get enough sleep, you lose out. For example, focus, concentration, losing your temper are all tougher to manage. Furthermore, sleep deprivation makes you more irritated, anxious and cranky, which in turn makes it harder to get to sleep at night. It’s a vicious cycle that Neural Balance TM can break!
Archives ofDisease in Childhood 1992; 67 302-306Narcoleps.docxrossskuddershamus
Archives ofDisease in Childhood 1992; 67: 302-306
Narcolepsy
M R Allsopp, Z Zaiwalla
Abstract
The symptom of excessive sleepiness in
children and adolescents does not necessarily
cause great concern to families and profes-
sionals involved in their care. Children may
deny the symptom and minimise the adverse
effects. These factors contribute to an under-
diagnosis of narcolepsy in this age group when
clinical diagnosis is difficult as associated
symptoms may not have appeared or are hard
to elicit. In this paper three children whose
difficult behaviour contributed to the presen-
tation of their sleep disorder are described.
Park Hospital for
Children, Oxford
M R Allsopp
Z Zaiwalla
Correspondence to:
D)r M R Allsopp,
Child and Family Guidance
Centre, Wvvern House,
'T'heatre Square, Swindon,
Wiltshire SNI IQN.
Accepted 22 November 1991
The narcolepsy syndrome comprises sleep dis-
turbance, cataplexy, sleep paralysis, and
hypnagogic hallucinations, although all four
symptoms occur only in a minority.' 2 The
sleep disturbance involves excessive daytime
drowsiness with intermittent, irresistible naps
and a disrupted pattern of nocturnal sleep.
Estimates of the prevalence of the condition
suggest that between two and nine per 10 000 of
the general population are affected.3 There is a
strong link with HLA-DR2.4 The condition is
rarely diagnosed in childhood or early puberty,
although single cases have been reported.5 6 In a
large series of patients only 4% of400 adults had
been diagnosed before the age of 15 years,7 yet
Navelet et al reported that the families of more
than half of adult patients recalled that
symptoms had begun by that age.8
The apparent under identification of narco-
lepsy in children and young adolescents is given
added significance by the increasing evidence
that patients with narcolepsy suffer significant
psychosocial adversity and the possibility that
early intervention may reduce this.9 10 Kales et
al detail the retrospectively self reported psy-
chosocial adverse consequences of excessive
sleepiness in childhood or adolsecence. " Many
patients had school problems and reported that
their teachers misinterpreted symptoms as
laziness, indifference, or malingering. The
authors suggest that these consequences,
together with a lack of emotional expressivity
cultivated by patients to prevent cataplexy,
contribute to the high rate (50%) of minor
psychopathology found in this and other studies
of adult populations.'2 13
In this paper we describe three consecutive
cases of narcolepsy in childhood presenting to
the Park Hospital for Children, Oxford, a
specialist centre for childhood epilepsy, sleep
disorders, and behavioural disturbance. They
illustrate some of the diagnostic issues and
management problems that may be encountered.
Case reports
CASE 1
A boy aged 8 years was referred with a history of
daytime sleepiness, irritability, and difficult
behaviour. He had become increasingly sensi-
tive, surly, and irritable after the .
get the sleep you need sleep soundly.pdfPaulClaybrook
When you don’t get enough sleep, you lose out. For example, focus, concentration, losing your temper are all tougher to manage. Furthermore, sleep deprivation makes you more irritated, anxious and cranky, which in turn makes it harder to get to sleep at night. It’s a vicious cycle that Neural Balance TM can break!
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Pathophysiology Across The Lifespan Week 9 Discussion.docx
1. Pathophysiology Across The Lifespan Week 9 Discussion
Pathophysiology Across The Lifespan Week 9 DiscussionPathophysiology Across The
Lifespan Week 9 DiscussionMake sure all of the topics in the case study have been
addressed.Cite at least three sources—journal articles, textbooks or evidenced-based
websites to support the content.All sources must be within five years.Do not use .com,
Wikipedia, or up-to-date, etc., for your sources.Case Study 1Organization and Control of
Neural FunctionRiku is a 19-year-old college student. One morning, after a long night of
studying, Riku woke up and made himself a hot cup of coffee and toast.Much to his surprise,
when he brought the cup to his mouth to drink, the coffee spilt onto the table. Riku went to
the bathroom mirror and noticed the left side of his face seemed to droop. He quickly got
dressed and ran to the medical clinic on the college campus. As he ran, his left eye began to
feel scratchy and dry, but he could not blink in response. The physician at the clinic listened
to Riku’s story and then did a careful cranial nerve examination. She concluded that Riku
had Bell palsy, an inflammatory condition of the facial nerve most likely caused by a
virus.ORDER NOW FOR CUSTOMIZED, PLAGIARISM-FREE PAPERSWhat are an afferent
neuron and efferent neuron? What are efferent components of the facial nerve and their
actions?Under certain circumstances, axons in the peripheral nervous system can
regenerate after sustaining damage. Why is axonal regeneration in the central nervous
system much less likely?At a healthy myoneural junction, acetylcholine is responsible for
stimulating muscle activity. What mechanisms are in place to prevent the continuous
stimulation of a muscle fiber after the neurotransmitter is released from the presynaptic
membrane?Case Study 2Somatosensory Function, Pain, and HeadacheRamandeep is an
active 23-year-old. She works as a part-time nurse during the day and is studying for a
postgraduate certificate in the evening. Ramandeep started to wear a bite plate at night
after she began to experience jaw pain and headaches. Sometimes the pain radiated to her
ear, and she would apply a hot water bottle to it to ease the discomfort. Her husband
mentioned to her that he heard her grinding her teeth at night while she was sleeping. She
knew then that her headaches might be from temporomandibular joint syndrome, and she
went to her dentist to confirm her thoughts. In addition to the bite plate, the dentist also
recommended she should continue with the application of heat, use NSAIDs when needed,
and incorporate regular relaxation exercises throughout her stressful days.What effect does
heat have on nociceptors so that it makes a good nonpharmacologic treatment for
pain?Heat and cold treatment are both hypothesized to have an effect on the release of
endogenous opioids. What are these chemicals, and why are they hypothesized to be
2. beneficial in the body?Using your knowledge of physiology, how do NSAID analgesics
function in the management of pain? Pathophysiology Across The Lifespan Week 9
DiscussionCase Study 3Disorders of Motor FunctionJohn is 63 years old and receives home
care by an occupational therapist twice a week. His therapist is currently working with John
on maintaining joint flexibility and balance. John demonstrates resting tremor, so his
therapist is also working on adaptive techniques, so John can continue to use his hands to
write, use the computer, and cook simple meals. John’s wife assists with his mobility and
walks slowly beside him, holding his arm. Sometimes she needs to help him open his
prescription bottles, so he can take his medicine, a combination of levodopa and
carbidopa.What motor disease does John demonstrate? One of his signs is resting tremor.
What is the difference between a resting tremor and an intention tremor?What is the
advantage of combining levodopa with carbidopa? What is the benefit of anticholinergic
drugs in the management of Parkinson disease?Parkinson disease involves the destruction
of the substantia nigra and the nigrostriatal pathway. Where are these structures
anatomically?The patient with Parkinson disease typically presents with a masklike facial
expression. Why does he or she have a masklike facial expression? How are the eyes, mouth,
and laryngopharynx affected by this disease?Case Study 4Disorders of Brain
FunctionBonnie is a 70-year-old woman who lives alone. One evening, she felt light-headed
and dizzy. When her head began to ache, she decided to take an analgesic and go to bed
early. The following morning, upon awakening, she was unable to move the bed sheets with
her right arm. At this point she was experiencing tingling sensations in her limbs, and she
had difficulty keeping her balance. She dialed 911 for help, and by the time the ambulance
arrived, she was confused and unable to articulate her words although she knew what
information he was asking of her. In the hospital, she was examined and treated for
ischemic stroke.Stroke, or brain attack, involves brain tissue injury. Describe ischemic
penumbra and what factors contribute to the survival of the neurons involved. What
happens if the cells of the penumbra are unable to be preserved?Compare and contrast
hypoxia and ischemia. What condition is more dangerous to the brain? Explain your
answer.Knowing what you do about the effects of ischemia on the brain, why would
someone with ischemic stroke develop cerebral edema?What type of aphasia was Bonnie
exhibiting when talking to her caregivers? Explain your answer.Case Study 5Sleep and Sleep
DisordersJessica is six years old. Her parents recently saw her pediatrician because they
were concerned about the sleeping difficulties Jessica has been having. Often she would
scream out loud in her sleep. Her parents would rush to her room and find her sitting
upright in bed, panting heavily in a state of panic. Jessica would not respond to her parent’s
words of consolation, and the next morning she would have no memory of the incident at
all. Her parents were worried about the anxiety their daughter was experiencing and asked
the pediatrician what they could do about her nightmares. The pediatrician explained
Jessica was likely suffering from sleep terrors and carefully described what that
meant.What are the similarities and differences between nightmares and sleep
terrors?What are the characteristics of motor, sensory, and autonomic function during REM
sleep? What is thought to be the importance of this stage of sleep?Jessica’s pediatrician said
that the careful management of sleep hygiene may help to decrease the incidence of her
3. sleep terrors. What is included in an overview of the general features that demonstrate
good sleep hygiene? Pathophysiology Across The Lifespan Week 9 DiscussionCase Study
6Disorders of Thought, Emotion, and MemoryElla is 88 years old and was living at home
until very recently. Her children, who visited her regularly, noticed she was becoming more
forgetful. At first, she mislaid objects, and then she began to forget her doctor’s
appointments. With time, her personality changed and she became withdrawn. At home she
would forget to turn off the stove or leave the kettle on until it boiled dry. After seeking
advice from a gerontologist and social worker, Ella’s children placed her in a nursing home
with a unit equipped for patients with Alzheimer disease.What is dementia? Why is
Alzheimer disease based on a “diagnosis of exclusion”?What are the macroscopic and
microscopic features of the brain that are typical in Alzheimer disease?One of Ella’s children
brought her a new pair of slippers to wear in the nursing home. A minute after she received
them, Ella could not remember the exchange and asked what they were doing on her bed.
What part of the brain has largely been affected to produce this behavior, and what is the
pathophysiology involved?To view the Grading Rubric for this Assignment, please visit the
Grading Rubrics section of the Course Home.