Health-Related Quality Of Life In Intractable Paediatric Epilepsy: Using A New Measure To Improve Management
Funder
National Health and Medical Research Council
Funding Amount
$252,940.00
Summary
Until recently there was no adequate measure to assess the quality of life of children with epilepsy. Our Australian centre was the first to develop, validate and publish such an instrument; the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE). We now aim to collect more data using the QOLCE to gain further understanding of the effects of epilepsy and its treatment on the quality of life of children. We will determine if surgery in children stops seizures and improves quality of life. ....Until recently there was no adequate measure to assess the quality of life of children with epilepsy. Our Australian centre was the first to develop, validate and publish such an instrument; the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE). We now aim to collect more data using the QOLCE to gain further understanding of the effects of epilepsy and its treatment on the quality of life of children. We will determine if surgery in children stops seizures and improves quality of life. We also aim to find out if children with different types of epilepsies have unique quality of life issues. Finally, we aim to determine if the quality of a child's life depends on how well they are thinking and learning or how often they are having seizures. We will conduct this study in children with difficult epilepsy recruited from three major children's hospitals (Sydney Children's Hospital, the Children's Hospital, Westmead, Miami Children's Hospital, Florida USA) using a well designed methodology. Each child will have their particular type of epilepsy characterised using video and brain wave analysis. Each parent and older child will receive a quality of life package including the QOLCE to assess life function. In addition, all children will have an assessment of their thinking and learning by a child psychologist. At the completion of this project we will have established whether surgical treatment in children with epilepsy stops seizures and improves quality of life. This will allow clinicians and parents to better understand the effects of surgical treatment in this population. In addition, we will determine if problems in quality of life are associated with specific types of epilepsy. This information can be used to counsel families and tailor interventions and treatments. Finally, we will know whether a child's quality of life is determined by problems with thinking and learning and-or seizures.Read moreRead less
The Effect Of Adenotonsillectomy On Neurocognitive Functioning In Children With Upper Airway Obstruction
Funder
National Health and Medical Research Council
Funding Amount
$185,850.00
Summary
Upper airway obstruction during sleep affects up to 3% of all children and is very frequently unrecognised. If severe it causes growth failure, developmental delay and heart failure. However, there is little information on the effects of less severe degrees of upper airway obstruction in children but recent work suggests that reduced academic performance may also be present in children with relatively mild degrees of upper airway obstruction. In particular, the areas most affected appear to be i ....Upper airway obstruction during sleep affects up to 3% of all children and is very frequently unrecognised. If severe it causes growth failure, developmental delay and heart failure. However, there is little information on the effects of less severe degrees of upper airway obstruction in children but recent work suggests that reduced academic performance may also be present in children with relatively mild degrees of upper airway obstruction. In particular, the areas most affected appear to be intelligence, memory, behaviour and attentional capacity . Currently it is unclear whether these deficits are due to sleep disruption or reduced nocturnal oxygen levels. The treatment of upper airway obstruction is the removal of adenoids and tonsils, however, it is unknown whether or not this improves the child's intellectual capacity. This study aims to be one of the first to critically evaluate the impact of upper airway obstruction during sleep on children's intelligence, memory, behaviour and attentional capacity, and the improvements wrought by the removal of the child's tonsils and adenoids.Read moreRead less
Impact Of A Sleep Intervention In ADHD: Translational Randomised Trial
Funder
National Health and Medical Research Council
Funding Amount
$1,020,595.00
Summary
Up to 50% of children with ADHD experience sleep problems which worsen their ADHD symptoms, behaviour, quality of life and day to day functioning. In a previous trial, we showed that treating sleep problems in children with ADHD improves these outcomes. We now want to know if these benefits can be replicated when general paediatrcians and psychologists deliver the same sleep intervention in community settings.
Sleep Disordered Breathing And Neurocognitive Function In Children Post-adenotonsillectomy: Three Year Follow-up
Funder
National Health and Medical Research Council
Funding Amount
$266,536.00
Summary
Snoring is very common and affects at least 10% of children, or an estimated 0.25 million children in Australia. It is associated with deficits in a wide range of neurocognitive areas including intelligence, memory, reasoning, learning and behaviour. We have recently studied a group of 53 snoring children both before and six months after removal of their tonsils and adenoids, to treat suspected upper airway obstruction associated with their snoring. We found that prior to surgery, intelligence, ....Snoring is very common and affects at least 10% of children, or an estimated 0.25 million children in Australia. It is associated with deficits in a wide range of neurocognitive areas including intelligence, memory, reasoning, learning and behaviour. We have recently studied a group of 53 snoring children both before and six months after removal of their tonsils and adenoids, to treat suspected upper airway obstruction associated with their snoring. We found that prior to surgery, intelligence, memory, reasoning, language and behaviour were significantly reduced, by up to 10% compared to 53 non-snoring control children matched by age, gender, social class and area of residence. To our great surprise, at six months after surgery we found that although sleep and behaviour improves, intelligence, memory, reasoning and language development do not. We now wish to study these same children at 3 years after tonsils and adenoids removal, as we believe that if the deficits that we described at 6 months are still present, they are likely now to be permanent. Given the degree of deficit that we have found in snoring compared to non-snoring children, even 6 months after the snoring group of children have been treated, if still present at 3 years post-surgery then it is likely that these deficits will affect the children's future learning potential and academic success. In turn, this would suggest that early identification and treatment of sleep-related upper airway obstruction is critical in preventing long-term deficits in children's daytime functioning and behaviour.Read moreRead less
Frontal-striatal-parietal Activation In Children With ADHD, Combined Type: A Functional Magnetic Resonance Imaging Study
Funder
National Health and Medical Research Council
Funding Amount
$91,750.00
Summary
Attention Deficit Hyperactivity Disorder, combined type (ADHD-CT) is a common neuropsychiatric disorder that has serious consequences for affected children's educational and social development and success in later life. Despite a large investment in research investigating aetiology and therapeutic strategies that arise from these aetiological investigations, ADHD-CT remains poorly understood and it is often viewed with therapeutic pessimism. Understanding the neurobiological basis of ADHD-CT is ....Attention Deficit Hyperactivity Disorder, combined type (ADHD-CT) is a common neuropsychiatric disorder that has serious consequences for affected children's educational and social development and success in later life. Despite a large investment in research investigating aetiology and therapeutic strategies that arise from these aetiological investigations, ADHD-CT remains poorly understood and it is often viewed with therapeutic pessimism. Understanding the neurobiological basis of ADHD-CT is of tremendous importance for the development of more specific and targeted medication and-or psychological treatments and, ultimately, to obtain the best clinical outcome for individual children with ADHD-CT. We have previously examined the function of frontal-striatal-parietal brain networks in adolescent boys with ADHD-CT, showing dysfunction of brain systems important for the control of visuospatial attention. In this project, we aim to examine whether these changes in frontal-striatal-parietal brain function also occur in pre-pubertal 8-12 year-old boys with ADHD-CT. This is important for two major reasons: Firstly, adolescents and young adults examined in previous brain imaging studies of ADHD-CT, including our own, are not truly representative of the core of the disorder, as ADHD-CT has its peak prevalence from 8 to 12 years of age. Secondly, by now comparing pre-pubertal ADHD-CT and healthy control children we can determine whether the changes in brain function we have previously identified represent developmental stage independent brain dysfunction that is characteristic of ADHD-CT.Read moreRead less
The Effect Of Very Premature Birth On Brain Development
Funder
National Health and Medical Research Council
Funding Amount
$517,975.00
Summary
The neurological outcome of the premature infant is of major importance. Approximately 2,600 premature infants weighing less than 1500 grams are born annually in Australasia. Of the approximate 2,400 survivors between 5-15% will have a more major cerebral palsy, i.e. around 200 children per annum. A greater proportion of 25-50%, i.e., upto 1200 children will have a developmental disability that will adversely affect their school perfomance requiring special assistance or repeating grades. With a ....The neurological outcome of the premature infant is of major importance. Approximately 2,600 premature infants weighing less than 1500 grams are born annually in Australasia. Of the approximate 2,400 survivors between 5-15% will have a more major cerebral palsy, i.e. around 200 children per annum. A greater proportion of 25-50%, i.e., upto 1200 children will have a developmental disability that will adversely affect their school perfomance requiring special assistance or repeating grades. With an increasing number of very prematurely born infants surviving, the absolute number of affected children will continue to rise. Prevention of these disabilities will require an understanding of the cause. The educational and social implications of these high rates of neuro-developmental disability are enormous and the focus of wide international concern. Magnetic Resonance Imaging : It is a major challenge for neonatologists to be able to understand the impact of their therapies and managements on the developing brain. A window into the newborn brain can be seen utilising advanced magnetic resonance imaging techniques in-vivo to investigate these key issues: 1. What is the nature of brain injury in the prematurely born infant? 2. What are the risk factors for brain injury in the prematurely born infant - and are they able to be altered to reduce this risk - e.g. blood pressure management, steroid therapy 3. Is the brain of a prematurely born infant different from that of a full term born infant at TERM equivalent - if so, how is it different? 4. Are there certain postnatal therapies that relate to any alteration in brain structure and chemistry - e.g. postnatal nutrition, modes of ventilation, pharmacological therapies? 5. How does the brain structure relate to function on long term neuro-developmental follow up of our infants at 2 years?Read moreRead less
Improving The Outcome Of Premature Infants- A Randomised Trial Of Preventive Care At Home
Funder
National Health and Medical Research Council
Funding Amount
$633,375.00
Summary
The high rate of adverse neurodevelopmental outcomes of very premature infants is of major concern. In Australia there are approximately 2600 very low birthweight (VLBW, birthweight <1500 g) or very premature (<30 weeks' gestational age) survivors per annum. A large proportion of these infants (40%-50%) will later develop motor incoordination, cognitive impairment, attention deficits or behavioural problems (up to 1300 new cases per year). There is little research to test the efficacy of e ....The high rate of adverse neurodevelopmental outcomes of very premature infants is of major concern. In Australia there are approximately 2600 very low birthweight (VLBW, birthweight <1500 g) or very premature (<30 weeks' gestational age) survivors per annum. A large proportion of these infants (40%-50%) will later develop motor incoordination, cognitive impairment, attention deficits or behavioural problems (up to 1300 new cases per year). There is little research to test the efficacy of early preventive care programs geared to changing the infant's environment (physical management, behavioural regulation, maternal factors). In the proposed study we aim to use a low cost preventive care program at home conducted by physiotherapists and psychologists that has been shown to have utility and efficacy in pilot work, with follow up until 2 years of age. In subsequent studies we would aim to follow this cohort to school age, to determine if there are any lasting benefits of early intervention accompanied by measures of brain growth and structural development using advanced imaging techniques. Any new health care program should result not only in improvements in health, but should be affordable to implement so an economic evaluation will also be undertaken. This study will also utilise novel and advanced MRI brain imaging techniques to understand the complex interaction between brain injury and altered brain development in these infants with the risk and the repsonse to this program of care. In this way the changes in brain connectivity, structure and biochemistry can be formally defined to undertsnad the pathway of any potential benefit from this program.Read moreRead less