Browsing by Author "Van Toorn, R."

Now showing 1 - 7 of 7
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    Characteristics of children with pervasive developmental disorders attending a developmental clinic in the Western Cape Province, South Africa
    (Health & Medical Publishing Group, 2013-09) Springer, P.; Van Toorn, R.; Laughton, Barbara; Kidd, M.
    Background. Little has been published on autism in Africa, and it is not known whether South African children present with the same characteristics and challenges as described internationally. Objectives. To describe the demographics, history, clinical features, co-morbidity and yield of aetiological investigations in children diagnosed with a pervasive developmental disorder (PDD). Methods. This was a retrospective review of medical records of children fulfilling Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) criteria for a PDD who attended a tertiary developmental clinic at Tygerberg Hospital, Western Cape, South Africa, over a 2-year period (2008 - 2010). Results. Fifty-eight children were included. The median age at diagnosis was 42 months (range 15 - 106 months), and 45 (77.6%) were boys. Forty per cent had complex autism (dysmorphism with or without microcephaly), and 12.1% were macrocephalic. Most children (72.4%) were non-verbal (using fewer than 10 non-echoed words), and 89.0% had behavioural problems as reported by caregivers. The diagnostic yield of investigations was low. Conclusion. The profile of children with PDD attending a tertiary hospital developmental clinic in the Western Cape revealed that a high proportion had severe language impairment, behavioural problems and complex autism.
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    The characteristics of juvenile myasthenia gravis among South Africans
    (Health and Medical Publishing Group (HMPG), 2012-06) Heckmann, J. M.; Hansen, P.; Van Toorn, R.; Lubbe, E.; Janse Van Rensburg, E.; Wilmshurst, J. M.
    Objectives. To report the characteristics of juvenile-onset (<20 years) myasthenia gravis (MG) in Africa. Subjects and methods. Six South African centres collected data which included acetylcholine receptor-antibody (AChR-ab) status, delay before diagnosis, MG Foundation of America grade at onset, maximum severity and severity at last visit, therapies, outcomes and complications. Results. We report on 190 individuals with a 4-year median follow-up (interquartile range (IQR) 1 - 8). The median age at symptom onset was 7 years (IQR 4 - 14). Ocular MG (26%) occurred among younger children (mean 5.1 years) compared with those developing generalised MG (74%) (mean 10.2 years) (p=0.0004). Remissions were obtained in 45% of generalised and 50% of ocular MG patients, of whom the majority received immunosuppressive treatment, mainly prednisone. Children with post-pubertal onset had more severe MG, but deaths were infrequent. Thymectomies were performed in 43% of those with generalised MG who suffered greater maximum disease severity (p=0.002); there was a trend towards more remissions in the thymectomy group compared with the non-thymectomy group (p=0.057). There was no racial variation with respect to AChR-ab status, maximum severity, or use of immunosuppression. However, 23% of children of African genetic ancestry developed partial or complete ophthalmoplegia as a complication of generalised MG (p=0.002). Conclusion. Younger children developed ocular MG and older children generalised MG. Persistent ophthalmoplegia developing as a MG complication is not uncommon among juveniles of African genetic ancestry. A successful approach to the management of this complication that causes significant morbidity is, as yet, unclear.
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    MRI findings in children with tuberculous meningitis: a comparison of HIV infected and non-infected patients
    (2010) Dekker, G.; Andronikou, S.; Van Toorn, R.; Ackermann, C.
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    Use of phenobarbitone for treating childhood epilepsy in resource-poor countries
    (Health & Medical Publishing Group, 2005) Wilmshurst, J. M.; Van Toorn, R.
    [No abstract available]
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    White matter lesions in children with HIV encephalopathy: correlating with Griffiths mental scale
    (2010) Ackermann, C.; Andronikou, S.; Laughton, Barbara; Dobbels, Els; Innes, S.; Taliep, R.; Cotton, M.; Van Toorn, R.
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    White matter signal abnormalities on MRI in children with HIV encephalopathy
    (2010) Ackermann, C.; Andronikou, S.; Laughton, Barbara; Van Toorn, R.; Dobbels, Els; Innes, S.; Taliep, R.
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    Withdrawal of parenteral phenobarbitone : implications for resource-poor countries
    (Health & Medical Publishing Group, 2005) Wilmshurst, J. M.; Van Toorn, R.; Newton, C. R. J. C.
    Parenteral phenobarbitone is an integral part of the management of status epilepticus, especially in the context of resource-poor countries. It is highly effective at controlling seizures. It is safe, cheap, can be given by rapid intravenous push or intramuscular route, boluses can be repeated, and it is recommended as part of the Advanced Paediatric Life Support guidelines. The proposed alternatives lack efficacy, practicality and/or place the child in status epilepticus at risk of respiratory compromise. The impact of the loss of parenteral phenobarbitone would be increased cardiac complications, lack of early seizure control, prolonged seizures resulting in brain damage and systemic complications. Increased numbers of patients will require artificial ventilation in centres without facilities, and centres with facilities will be unable to cope with the load of ventilated patients because of lack of safe transport systems and bed space.