Lower fat and better quality diet therapy for children with pharmacoresistant epilepsy

The ketogenic diet (KD) is an established, effective, nonpharmacologic treatment for children with pharmacoresistant epilepsy. Although the KD is the most well-established dietary therapy for epilepsy, it is too restrictive and is associated with serious complications; therefore, alternative lower-fat diets, including a modified Atkins diet and low-glycemic index diet, have been developed. Recent ongoing clinical evidence suggests that other dietary therapies have an efficacy almost comparable to that of the KD. In addition, a diet rich in polyunsaturated fatty acids appears to increase the efficacy of diet therapy and reduce the complications of a high-fat diet. Here, we review the systematic information about lower-fat diets and better-quality dietary therapies and the current clinical status of each of these dietary approaches.ope

Screening for depression and anxiety disorder in children with headache

PURPOSE: The purpose of this study was to investigate the importance of initial screening tests for depression and anxiety disorders in children with headache. In addition, this study evaluated whether the Children's Depression Inventory (CDI) and Revised Children's Manifest Anxiety Scale (RCMAS) are suitable for screening symptoms of depression and anxiety. METHODS: A retrospective chart review was conducted of 720 children aged 7-17 years who had visited a pediatric neurology clinic for headaches and were referred to a pediatric psychiatric clinic for psychiatric symptoms from January 2010 to December 2011. All patients completed the CDI and RCMAS. Among them, charts of patients with clinically significant total scores (cutoff>15) for psychiatric symptoms, as defined by the CDI and RCMAS scoring scales, were reviewed. RESULTS: Nineteen patients had headaches and clinically significant total scores for psychiatric symptoms. The mean age at headache diagnosis was 11.7 years, and 57% were male. Mean duration of headache was 11.5 months. Two point eight percent of the patients were diagnosed with psychiatric disorders including major depression (1.7%), generalized anxiety disorder (1.1%), and bipolar disorder (0.1%). Four patients (0.6%) were diagnosed with attention deficit/hyperactivity disorder (ADHD). Total mean CDI and RCMAS scores of patients referred to the psychiatric clinic were 18.8 and 22.2, respectively. There was no correlation between CDI or RCMAS total scores and headache frequency, duration, or severity. CONCLUSION: We recommend that all patients with headache should be screened for depression and anxiety by CDI and RCMAS scores.ope

사물놀이 악기 중심으로

본 연구의 목적은 사물놀이 악기를 중심으로 한 음악활동이 자폐성 아동의 외부세계 인식 및 상호작용에 미치는 반응을 분석, 비교함으로써 민속적 음악요소의 치료적 효용성을 연구해 보는 것이다. 연구를 위하여 3명의 자폐성 아동을 대상으로 개별세션이 이루어졌으며 기간은 10주에 걸쳐 총 21회가 실시되었다. 이를 위한 음악활동은 오르프 음악치료의 다중 감각적 접근에 근거하여 구조화하였으며 외부세계 인식 및 상호작용의 반응은 정서(눈맞춤, 찡그림, 미소), 신체, 음악, 언어(발성적, 구어적 언어)적 영역별로 측정되었다. 이를 통하여 세션 진행에 따른 전체적 경향성과 초기, 후기 반응 빈도 평균을 비교, 분석하였다. 음악활동을 통한 자폐성 아동의 외부세계 인식 및 상호작용의 결과는 초기와 후기의 평균 반응 빈도 수의 차이가 통계적으로 유의미한 차이를 보였다(t=7.84, p<.0001). 또한 각 개인 아동에 있어서도 부정적 정서표현 이라 할 수 있는 찡그림과 구어적 언어를 제외한 각 영역별 반응의 증가를 나타냈다. 사물놀이 악기에 대한 반응은 타악기의 리듬요소에 의한 반응 뿐 아니라 악기자체의 신체적 접촉에 의한 촉감적 자극에 다양한 반응을 보였다. 이렇게 민속적 음악요소라 할 수 있는 사물놀이 악기를 이용한 구조화된 음악적 자극이 자폐성 아동의 외부세계 인식 및 상호작용에 효과적으로 작용한다는 것은 우리의 민속적 음악요소가 치료에 유용한 수단으로 기능 할 수 있음을 입증한 것이라 할 수 있다. 앞으로 자폐성 아동의 특성과 발달정도를 고려한 보다 구조화된 치료전략 하에 우리의 정서와 결부된 민속음악 사물놀이의 요소를 치료적으로 개발, 연구하여 활용한다면 이들에게 다양한 음악적 자극을 통하여 외부세계에 대한 인식력 향상과 함께 다양한 상호작용 경험을 통하여 사회성 발달까지 가져다 줄 것이다. ; The purpose of this study was to examine how musical environment using traditional Samulnori instruments can be used for children with autism to facilitate interactions with the environment and its awareness. Three children with autism participated and they were case-studied both qualitatively and quantitatively for 21 consecutive sessions. The main therapeutic model used was Orff music therapy with emphasis on its multi-sensory approach. The interactive behaviors measured were emotional (eye-contact, facial expression), physical(reaching, distancing), musical (imitating, dialoging), and communication(vocalizing, verbalizing). Each measurable behavior was defined with appropriate criteria for each case and the data were collected using frequency recording method. The results of the study indicated that the interactive behaviors significantly increased when musical instruments were provided in various interactive means when the first and the final session were compared(t=7.84, p<.0001). Both frequency and quality of children s interaction with musical environment increased by showing positive physical interaction with Samulnori instruments. The result of the study indicated that use of traditional Samulnori instruments were effective in facilitating interactions from the children in musical environment. Various physical features of instruments were effective for both physical and tactile stimulation. This further brought increase in children s cognitive and perceptive awareness of the environment. The results also implied that ethnic character of the instruments were effective in establishing familiarity and reinforcing participation and interaction in music therapy sessions.논문개요 I. 서론 1. 연구의 의의 = 1 2. 연구의 목적 = 5 3. 연구 문제 = 5 4. 용어의 정의 = 7 II. 이론적 배경 1. 자폐증과 음악 = 9 2. 음악의 치료적 개념 = 16 3. 즉흥연주의 치료적 개념과 Orff Music Therapy = 25 4. 민속음악의 치료적 개념과 사물놀이 = 32 5. 선행연구 = 38 III. 연구 방법 1. 연구대상 = 49 2. 연구설계 = 54 3. 연구도구 = 55 4. 연구절차 = 66 5. 자료처리 = 67 IV. 결과 1. 외부세계 인식 및 상호작용에 대한 반응결과 = 69 2. 외부세계 인식 및 상호작용의 영역별 반응결과 = 70 3. 아동별 외부세계 인식 및 상호작용에 대한 반응결과 = 78 4. 각 아동의 외부세계 인식 및 상호작용의 영역별 반응결과 및 음악활동 내용 = 80 V. 결론 및 제언 1. 결론 = 122 2. 연구의 제한점 = 127 3. 미래의 연구방향 = 128 4. 치료적 적용 = 128 참고문헌 = 129 ABSTRACT = 14

(A) research in to the necessity and effect of kindergarden's Dance education : Centered on teacher and parents

Dance education, which has subjective royality as a means to express human internal desire and feeling, contributes some roles that through which individuals can find and realize their values, and cultivate their adaptability and cooperative spirit. Also it makes people understand their own culture and other culture as well, and the historical background of human species. Thereby it makes people recognize and develop social, cultural values. In particular, in the dance education for children, dance is recognized as an art that expresses individual thoughts and feelings through their movement, and therefore dance education for children materializes not only children's physical development but also emotional purification and development of their initiative spirit and intelligence so that they can be grown to be a civilized person full of sensitivity. It is a reality that we are living in days when mechanism is extremely developed and egoism dances boisterously. However, in such society, since a science, dance, has an educational value and at the same time, it has an artistic nature, it not only makes any individual's internal world developed but also helps interrelations with others. Therefore, it is deemed that if the dance education having such advantages is sprouted early in childhood, the society which will include children who have been educated through dance will become a kind of abundant society, that is a kind of society all people are looking for. With that in mind, the present study is to review the effect of dance education and the necessity of it, and thereby considering the aspect of the educational value of dance and the characteristics of the development of dance according to age, review and find the steps through which the developmental area is changed according to age. Additionally in the study, the targets and curriculum of the dance education in kindergarten now in use were reviewed, and then the present conditions and contents of dance education, relationship between educational environment and teachers, and the importance of parental roles were studied. In such process, contents and results from the inspection through some questionnaires to __ teachers in 5 kindergartens located in Seoul and parents whose children attend one of the 5 kindergartens are as follows: First, regarding the recognition of the concept of dance education and its necessity, it appears that through dance children help their physical control and development of expressive power(95.8%), and dance education is a requisite for children's harmonious growth(50%). Second, as a general opinion on the present conditions and contents of dance education now in enforcement, it appears that the arrangement of dance education in kindergarten is poor as once or two times practices in a week(83.3%), the practical lesson is performed for 10 or 20 minutes(50%), and since in contents and methods(24%). learning of tones and rhythms(l9.4%) and learning of a kind of imitation are much utilized(15.67%), therefore more diversified educational materials and information are necessary(62.5%). Third, regarding the environment of dance education(58.3%), it appears that dance lessons are taken in the classroom, being treated same as other subjects(45.8%), and the literary exhibition is irregularly performed. And it appears that both teachers and parents want that dance education be practiced by professional dance teachers for putting more importance on dance education, and when the curriculum is composed, it is wanted that the same importance be put on dance education as on other courses. Fourth, regarding the teacher's role and the parental role, it appears and then is concluded that a new flow of audiovisual materials in necessary for the development of dance music, and more systematic, concrete contents of dance education to meet the speec of children's development should be materialized in kindergartens.;인간의 내면적 욕구와 감정을 표현하기 위한 수단으로써 무용교육은 무용을 통하여 사회 공동체 속에서 개인의 가치를 발견, 실현하게 하고 적응력과 협동심을 함양시킨다. 또 우리 자신과 다른 문화들 그리고 인류의 시대적 배경의 이해를 도모하는 사회적, 문화적 가치를 인식, 발달하게 한다. 특히 아동들에게 있어서의 무용교육은 올바른 움직임의 학습을 통해 무용을 개인의 사고와 느낌을 표현하는 예술로 인지하게 해주고 신체적 발달은 물론 보다 풍부한 감성의 문화인이 될 수 있도록 정서적 순화와 창의적 능력 그리고 지적발달을 키워준다. 오늘날 기계문명이 극도로 발달하고 이기주의가 난무하고 있는 것이 우리가 사는 사회의 현실이다. 그러나 무용이라는 학문은 교육적인 가치를 지님과 동시에 예술성을 지니고 있어 자기 자신의 내면세계의 발전뿐만아니라 타인과의 교류를 원활히 돕는다. 이러한 장점을 지니고 있는 무용교육이 일찍이 아동들에게서부터 싹튼다면 그 사회는 보다 풍요로운 사회가 될 것이며 모든 이들이 바라는 이상적인 사회가 될 것이다. 따라서 본 논문에서는 성장기의 아동에게 있어서 무용교육의 필요성과 효과를 살펴봄으로써 무용의 교육적 가치측면과 연령별 발달특징을 고려해 연령에 따른 발달 영역의 변화단계를 파악하였다. 그리고 현재 실행되고 있는 유치원 무용교육의 현황과 내용, 교육환경의 교사, 학부모의 역할에 대한 중요성과 인식도를 조사하기 위해서 서울시 5개 유치원의 교사 50명과 학부모 200명을 대상으로 설문지 조사를 통하여 분석해 본 내용과 결과는 다음과 같다. 첫째, 무용교육의 개념 및 필요성에 대한 인식에서는 무용교육을 통하여 아동의 신체조절 및 표현력 신장발달에 도움을 주고(95.8%), 아동의 원활한 성장을 위해 반드시 필요하다고(50%) 나타났다. 둘째, 무용교육의 내용과 방법에 대한 견해로써는 무용교육은 주 1회, 2회에 불과하고(83.3%) 실시 시간도 10분에서 20분 정도의 매우 적은 시간을 할애하는 것으로 나타났으며(50%), 내용과 방법에 있어서도 음률 활동(24%), 리듬학습(19.4%), 창의학습(15.67%)을 많이 사용함으로써, 보다 다양한 교육 자료와 정보가 필요로 하다는 의견(62.5%)으로 나타났다. 셋째, 무용교육의 환경에 대해서는 무용시간도 역시 타 교과목과 같이 교실에서 수업을 하고(58.3%), 장소의 넓이는 20평 이상(66.7%)이었다. 그리고 유치원에서의 무용학예발표회는 비정기적으로 실시(45.8%) 하는 것으로 나타났다. 넷째, 교사 및 학부모의 역할에 대해서는 교사가 아동들에게 원활한 무용수업을 제공하기 위해 사용하고 있는 방법으로는 동기부여 즉 이야기, 음악, 주제를 들려주는 것이 가장 많았고, (91.7%) 무용교육시간을 위하여 준비하는 사항으로는 도구마련으로 녹음기, 테이프 등을 준비한다(45.8%)는 것으로 나타났다. 학부모는 유치원에서나 과외활동으로 아동들에게 표현의 기회를 부여하며(48.3%) 수업시 실행하는 아동이 당황할 경우 신속히 안정시켜 주고(87. 4%), 참여와 격려 하는 것(99.9%)으로 나타났다.목차 = ⅰ 논문개요 = ⅲ Ⅰ. 서론 = 1 A. 연구의 필요성 및 목적 = 1 B. 연구방법 및 제한점 = 3 Ⅱ. 유치원 무용교육의 이론적 배경 = 5 A. 교육적 가치 = 5 B. 무용교육의 필요성 = 10 C. 교육환경과 교사, 학부모의 역활 = 14 D. 유치원 교육의 현황 = 16 Ⅲ. 연구 방법 = 26 A. 연구대상 및 도구 = 26 B. 기간 및 절차 = 27 C. 자료 처리 = 28 Ⅳ. 결과 분석 = 29 1. 무용교육의 필요성 = 29 2. 무용교육의 내용과 방법 = 32 3. 무용교육의 환경 = 39 4. 교사 및 학부모의 역활 = 42 Ⅳ. 결론 및 제언 = 47 참고문헌 = 50 부록 = 55 ABSTRACT = 6

Efficacy of the classic ketogenic and the modified Atkins diets in refractory childhood epilepsy

OBJECTIVE: We aimed to compare the efficacy, safety, and tolerability of a modified Atkins diet (MAD) with the classic ketogenic diet (KD) for the treatment of intractable childhood epilepsy. METHODS: From March 2011 to March 2014, 104 patients aged 1-18 years who had refractory epilepsy were randomly assigned to each diet group (ClinicalTrials.gov, number NCT2100501). A seizure diary record was used to compare seizure frequencies with the baseline prediet seizure frequency at the third and sixth months after diet therapy initiation. RESULTS: Fifty-one patients were assigned to the KD and 53 patients to the MAD. The KD group had a lower mean percentage of baseline seizures compared with the MAD group at 3 months (38.6% for KD, 47.9% for MAD) and 6 months (33.8% for KD, 44.6% for MAD), but the differences were not statistically significant (95% confidence interval [CI] 24.1-50.8, p = 0.291 for 3 months; 95% CI 17.8-46.1, p = 0.255 for 6 months). Instead, for patients aged 1-2 years, seizure outcomes were consistently much more favorable in patients consuming the KD compared with those consuming the MAD. The rate of seizure freedom at 3 months after diet therapy initiation was significantly higher (53% for KD, 20% for MAD, p = 0.047) in these patients. The MAD had advantages with respect to better tolerability and fewer serious side effects. SIGNIFICANCE: The MAD might be considered as the primary choice for the treatment of intractable epilepsy in children, but the classic KD is more suitable as the first line of diet therapy in patients <2 years of age.restrictio

Neuropsychological effects of levetiracetam and carbamazepine in children with focal epilepsy

OBJECTIVE: To prospectively evaluate the neuropsychological effect of levetiracetam (LVT) in comparison with carbamazepine (CBZ) and its efficacy and tolerability as a monotherapy in children with focal epilepsy. METHODS: A total of 121 out of 135 screened children (4-16 years) were randomly assigned to LVT or CBZ groups in a multicenter, parallel-group, open-label trial. The study's primary endpoints were defined as the end of 52 weeks of treatment, followed by analysis of changes observed in a series of follow-up neurocognitive, behavioral, and emotional function tests performed during treatment in the per protocol population. Drug efficacy and tolerability were also analyzed among the intention-to-treat (ITT) population (ClinicalTrials.gov, number NCT02208492). RESULTS: Eighty-one patients (41 LVT, 40 CBZ) from the randomly assigned ITT population of 121 children (57 LVT, 64 CBZ) were followed up to their last visit. No significant worsening or differences were noted between groups in neuropsychological tests, except for the Children's Depression Inventory (LVT -1.97 vs CBZ +1.43, p = 0.027, [+] improvement of function). LVT-treated patients showed an improvement (p = 0.004) in internalizing behavioral problems on the Korean Child Behavior Checklist. Seizure-free outcomes were not different between the 2 groups (CBZ 57.8% vs LVT 66.7%, p = 0.317). CONCLUSIONS: Neither LVT nor CBZ adversely affected neuropsychological function in pediatric patients. Both medications were considered equally safe and effective as monotherapy in children with focal epilepsy. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that in patients with pediatric focal epilepsy, LVT and CBZ exhibit equivalent effects on neuropsychological function.ope