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1 ICNC-0353 Management of chronic headaches: obligatory bed-rest Chronic headaches are difficult to treat as their triggers are quite variable. Anxiety about missing a brain disorder and about recurring severe headaches perpetuate this issue. Parents also recognize some secondary gain by ongoing headaches.sorting out the triggers and associated factors is the main challenge. Over 20-years of practice, the author s observations led to the following algorithm:after mentioning various triggers and psychological factors, the families are to concentrate on severe headaches, which interfere even with pleasant activities of daily life. To ensure that, an obligatory bedrest of 20 minutes is ordered for each headache. Headaches warranting bed-rest are documented with triggers. Following study was designed to validate the long-term outcome: All patients with chronic headache applying to the author s practice enrolled in a one-year follow-up study. Initial evaluation included MRI if clinically relevant. The families were to determine the severity according to the need of bed-rest. The kids could use pain relief only after bed-rest. The families were contacted periodically about their documented episodes.the study is still enrolling. Results after three months is more than 90% decrease in headache frequency. A significant achievement is the families ability to control this subjective problem.conclusion: Chronic headaches are crowded by reporting episodes related to some secondary gain or illness-anxiety. These can be eliminated with obligatory bed-rest. Bed-rest is not an interesting activity for most kids and becomes a secondary loss or an opportunity for insight about the severity of their complaint. Relieved anxiety enables proper documentation of the triggers. Comu*, S.(1)*; (1)Private Practice, Turkey;

2 ICNC-0767 Long term outcomes and risk factors for chemotherapy induced peripheral neuropathy in the paediatric population Long term outcomes and risk factors for chemotherapy induced peripheral neuropathy in the paediatric populationintroduction: There has been a significant improvement in childhood cancer survival in the last twenty years and it is increasingly important to characterise, monitor and ultimately develop management strategies to mitigate potentially long lasting treatment related adverse effects such as chemotherapy induced peripheral neuropathy (CIPN). It is also necessary to identify risk factors that predispose to CIPN to enable individualisation of treatment. Methods: A cross-sectional study was undertaken to identify and evaluate peripheral neuropathy in long term survivors of childhood cancer. Children and adults who had completed cancer chemotherapy >5years ago were recruited for a single comprehensive neurotoxicity assessment comprising clinical, functional, quality of life and neurophysiological parameters including conventional nerve conduction studies as well as novel nerve excitability studies. Results: 54 patients aged between 6 and 36 years completed neurotoxicity assessments. Vincristine and Cisplatin were the most frequently used agents. Preliminary results demonstrate clinical signs or symptoms suggestive of peripheral neuropathy in 33 patients (61%). Abnormal sensory nerve conduction studies were seen in 5/29 (17.2%) patients tested, with an overrepresentation of patients who received cisplatin. There were also significant abnormalities in sensory and motor nerve excitability parameters in patients who received cisplatin (p<0.05). Conclusion: Symptoms and signs of peripheral neuropathy are common, with a spectrum of severity in long term childhood cancer survivors. Conventional nerve conduction studies may have limited sensitivity to detect mild neuropathy. The use of cisplatin may be one of the risk factors for long term CIPN. Tejaswi Kandula *(1)*;,2;Susanna B. Park(3,4);Matthew C. Kiernan(3);David Mizrahi(5);Kate Carey(1);Richard J. Cohn(5);Arun V. Krishnan(6);Michelle A. Farrar(1,2); (1)Discipline of Paediatrics, School of Women s and Children s Health, UNSW Medicine, The University of New South Wales;(2)Department of Neurology, Sydney Children s Hospital, Randwick, NSW 2031;(3)Brain & Mind Centre, University of Sydney, Australia;(4)Neuroscience Research Australia, UNSW Medicine, The University of New South Wales, Sydney;(5)Kids Cancer Centre, Department of Oncology, Sydney Children s Hospital, Randwick;(6)Prince of Wales Clinical School, UNSW Medicine, The University of New South Wales, Sydney;

3 ICNC-0924 KidsBrainIT: Using information technology to improve childhood brain trauma intensive-care management and patient safety Introduction: Physiological monitoring in minute-resolution is the routine standard in paediatric traumatic brain injury (TBI) intensive-care management, but many paediatric intensive care units (PICU) only use lower resolution data (e.g. end-of-hour summary) for quality assurance and research purposes. This discards vital information, reduces data fidelity, and potentially compromises patient safety, clinical management, and outcome. We, therefore, aim to establish a new multi-centre paediatric brain monitoring and information technology group (KidsBrainIT) to use high-resolution physiology data and information technology (IT) innovations to improve paediatric TBI patient care and safety. Methods: KidsBrainIT is modelled upon the successful adult BrainIT group ( Phase-1 is a proof-of-concept stage on the feasibility of linking 7 PICU to export anonymised prospectively-collected high-resolution physiological, clinical, and 6 month global outcome data to a central repository where abnormal physiology is quantified, using state of the art analytics such as intracranial pressure (ICP) dose-response, and its relationship to outcome determined. Results: Minute-resolution physiological data of 89 TBI children were successfully exported from 2 contributing PICU within KidsBrainIT to-date. Using colour-coded dose-response plot, children with ICP above 20 mmhg longer than 8 minutes were associated with worsened outcome. Furthermore, in a multivariate model, the cumulative ICP-time burden is independently associated with mortality. Conclusion: KidsBrainIT brings together clinician and scientists from multi-centres to use high-resolution physiological data and IT innovations to improve TBI patient care and safety. Further studies are required to determine its long-term impact on TBI patient care and outcome. T. Lo * (1); I. Piper (2) ; K. Morris (3); R. Levin (4) ; R. O'Kane (5); H. Krishnan (6); C. Park (7); R. Agbeko (8); P. Davies (9) ; J. Kandasamy (10) (1) Royal Hospital for Sick Children; (2) BrainIT, UK ; (3) Birmingham Children's Hospital, UK ; (4) Royal Hospital for Children of Glasgow, UK ; (5) Royal Hospital for Children of Glasgow, UK ; (6) Birmingham Children's Hospital, UK J. Weitz, Oxford Radcliffe Hospitals NHS Foundation Trust, UK ; (7) Alder Hey Childrens NHS Foundation Trust in Liverpool, UK ; (8) Great North Children's Hospital in Newcastle upon Tyne, UK ; (9) Nottingham University Hospitals NHS Trust, UK ; (10) Royal Hospital for Sick Children, UK

4 ICNC-0925 Prevalence of acute seizures and subsequent epilepsy among critically-ill children with acute ischemic stroke Background: Acute seizures are known to accompany pediatric stroke. We examined the prevalence of acute seizures and subsequent epilepsy among critically-ill children with acute stroke admitted to a tertiary children s hospital.methods: We studied children, including neonates, with radiographically confirmed ischemic stroke admitted to our ICUs and evaluated by our pediatric stroke service between Clinical details were abstracted from our institutional pediatric stroke registry and electronic medical records. Neuroimaging and EEG data were re-analyzed in a blinded fashion. Outcomes were assessed through follow-up in our pediatric stroke clinic.results:ninety-two patients (50% male; mean age 3.25y (IQR: ); 37 (40%) neonates) were included: 75 (82%) with acute ischemic stroke and 17 (18%) with cerebral sinovenous thrombosis. Seventy-four patients (80%) underwent EEG, including 38 (41%) who underwent continuous video-eeg monitoring (ceeg) (mean duration 37 hours (IQR: 18-48)). Acute clinical seizures were observed in 19 children (21%), all of whom subsequently underwent ceeg. EEG seizures were detected in 17 children (18%), 16 (94%) of which experienced subclinical seizures. The mean time to first EEG seizure was 13.5h (range: 0-110). Status epilepticus occurred in 5 children (5%). Survivors (n=85, 92%) were followed for an average of 26m (IQR: 12, 39). At last follow-up, 17 children (20%) remained on anti-epileptic medication, and 11 (13%) had active epilepsy. Discussion:Among critically-ill children with acute stroke, acute seizures and status epilepticus were common and frequently subclinical. Accurate assessment of seizures in this population requires ceeg monitoring. Whether seizure detection and treatment improves outcomes requires further study. Eric Payne *(1);Ivanna Yau(2);Mahendranath Moharir(2);Ann-Marie Pontigon(2);Elisa Wilson(2);Derek Liu(2);Helena Frndova(2);Jamie Hutchison(2);Gabrielle deveber(2);cecil Hahn(2); (1)Mayo Clinic, USA;(2)The Hospital for Sick Children, Canada;

5 ICNC-0361 Use of Ocular Coherence Tomography in children with Idiopathic Intracranial Hypertension- A single center experience Backgrounds: Idiopathic Intracranial Hypertension (IIH) is a disorder characterized by elevated intracranial pressure without identifiable cause of elevated intracranial pressure evident on imaging. Detection of papilledema is often challenging and leads to diagnostic uncertainty in evaluating a child for possible IIH. Ocular coherence tomography (OCT) has the potential to add accuracy to the diagnosis of IIH. Objective: The goal of the study is to determine if there was a relationship between severity of papilledema (as determined by direct ophthalmoscopy and confirmed by fundus photography) and measures of OCT in a pediatric population with IIH. Methods: 15 pediatric patients were recruited prospectively after diagnosis of either definitive IIH (with papilledema) or possible IIH (without papilledema) at Children's Hospital of Michigan between March 2014 and February Clinical data and results of initial OCT and Visual Field Test were collected and statistically analyzed. Results: The Frisén Scale of papilledema significantly correlated with average RNFL thickness of each eye (r=0.633, p=0.02 in right eye and r=0.868, p=0.001 in left eye). The average RNFL thickness was significantly higher in the definitive group than in the possible group (189 µm (SD 65) vs. 104 µm (SD 10) in right eye, 165 µm (SD 42) vs. 106 µm (SD 9) in left eye, p<0.01 in both eyes). Conclusion: OCT may be used as a supplementary method to aid in the reliable detection of papilledema in evaluating a child for IIH. Lee, Y.A.(1);Tomsak, R.(2);Sadikovic, Z.(3);Bahl, R.(4);Sivaswamy, L.(5,6)*; (1)Beaumont Children's Hospital, Pediatric Neurology,, U.S.A.;(2)Wayne State University School of Medicine Kresge Eye Institute, Department of Opthalmology and Neurology,, U.S.A.;(3)Kresge Eye Institute, Ophthalmic Photography Department,, U.S.A.;(4)Wayne State University School of Medicine Kresge Eye Institute, Department of Ophthalmology,, U.S.A.;(5)Children's hospital of Michigan, Pediatric Neurology,, U.S.A.;(6)Wayne State University School of Medicine, Pediatric Neurology,, U.S.A.;

6 ICNC-0795 Hydrocephalus in children less than five years of age : From diagnosis to short/middle/long term evolution Background and aims : The main aim of this study is to evaluate to prognosis of children diagnosed with hydrocephalus before the age of five.materials and methods : Inclusion criteria are diagnosis of hydrocephalus before the age of five, independently of etiology, and birth between 01/01/2000 and 31/12/2014.Results : 142 children have entered the study, divided into eleven etiological groups: postintraventricular hemorrhage in premature children (16.2%), brain tumours (16.2%), myelomeningocele (14.8%), postinfectious (8.5%), aqueductal stenosis (8.5%), posthemorrhagic (7.75%), Dandy-Walker malformation (6.3%), unknown origin (5.6%), arachnoid cysts (4.9%), diverse obstructive causes (3.5%) and of various causes (7.75%). 23 children died, most of them among the brain tumours group. Age of diagnosis and treatment are roughly to the type of hydrocephalus (congenital, neonatal or of later onset). Endoscopic third ventriculostomy (ETV) has been achieved for 40 patients and was successful for 20 (47.6%). 226 internal shunts have been placed in 99 children. 43 infectious complications occurred after internal shunt. Mechanical complications reached 54.8 % in ventriculostomies and 50.4 % in internal shunts. Aqueductal stenosis, arachnoid cysts, unknown and diverse obstructive causes show a better outcome. Postinfectious hydrocephalus has the largest amount of bad outcome.conclusions : Pure obstructive etiologies of hydrocephalus are more often treated efficiently by ETV. This keeps those children from complications related to internal shunt. Their evolution is more favourable. Children treated by shunt are more at risk of complications. Communicating hydrocephalus, e.g. myelomeningocele, postinfectious and posthemorrhagic causes, presents more often with associated abnormalities and neurological sequelae. Perdaens, O.(1)*;Koerts, G.(2);Nassogne *, M.C.(1); (1)Bruxelles, Service de Neurologie pédiatrique, Cliniques universitaires Saint-Luc, Belgium;(2)Bruxelles, Service de Neurochirurgie, Cliniques universitaires Saint-Luc, Belgium;

7 ICNC-0794 Diagnostic yield and clinical impact of brain biopsy in children presenting with neurological deterioration of unknown cause Introduction The role of brain biopsy in neurological deterioration of uncertain cause is controversial. The yield and value of diagnosis must be weighed against the risk of potentially catastrophic complications. We retrospectively reviewed indications for and outcomes of biopsy over a 25-year period at a UK quaternary Paediatric centre. Methods Patients were identified using computerised codes for the period December 1989 to November Case notes, MRI and pathology results were reviewed. All children (0-18 years) who presented with neurological deterioration and underwent biopsy after negative or inconclusive non-invasive diagnostics were included. Cases with a clear radiological diagnosis of tumour were excluded. We reviewed biopsy diagnosis to identify cases where histopathology influenced further management. Results Fifty-three stereotactic brain biopsies were performed in 25 years, 27/53 (50.9%) in Complete data were available for 43/53 (81.1%). The main indications for biopsy were a differential diagnosis including malignancy, or to exclude contraindications to immunosuppressive treatment. Brain histology was abnormal in 42/43 (97.7%) cases. Abnormal findings included unspecified encephalitis (28.6%), diffuse neoplasm (23.8%), specific infection (7.1%), granulomatous disease (7.1%), Rasmussen encephalitis (7.1%), non-specific changes (23.8%). Biopsy was diagnostic in 31/43 (72.1%). Histopathology altered clinical management in 36/43 (83.7%) cases. Short-term complications occurred in 6/43 (14%). There were no long-term complications. Conclusions Stereotactic biopsy was safe and effective with a diagnostic yield of 72.1%, clinical impact on management in 83.7% cases and short term complication rate of 14%. Clinicians and parents are often reluctant to undergo biopsy and this review may support decision making. Jane Hassell *(1) ; Patrick Grover (1) ; Charlotte Sayer(1) ; Kristian Aquilina(1) ; Cheryl Hemingway(1) (1) Great Ormond Street Hospital for Children, UK