This time it's a journal that was created to serve the purpose of marketing bogus treatments for children, and it's covered with a lot of science. I have taken you down this road before and I promise it is as annoying to you as it is to me. I am pretty sure this won't be the last time. There is a journal linked to above that is offending. Like the foundation that launched it, this particular waste of electrons and paper is dedicated to promoting a fictional entity that is often blamed for causing neck and back pain. The founder and president of the anti-vaccine National Vaccine Information Center is on the journal's editorial board. The director of research for the association is Alcantara. The ICPA believes that it is part of the multiverse and that it is focused on the spine. The development of educational degree programs for chiropractors is a way for them to fool parents into thinking they are experts in the field. He has made this happen by packing the literature with worthless case reports that are then used to promote the practice of chiropractic on practice websites around the globe. Case reports aren't bad. They don't need to be. Despite their low ranking, they can serve a useful purpose. They can inform plans for future research. Conditions that affect a small number of people might be the only guide for clinical management. An understanding of their limitations is required for proper evaluation. Even the most detailed report can never be relied upon to establish whether an intervention is safe or effective. In the legitimate medical literature, a treatment that has a reasonable degree of plausibility can be included in a case report. Over-reliance on case reports can result in false tracking, as there are too many variables that can't be accounted for. When written to support a belief system, case reports are not more useful than when your mom told you that her friend from college used a poultice of activated charcoal and ground flaxseed to treat her gout. It's possible she did. Maybe she thought it worked. Stories like that don't give information such as what other medical treatments a person is using, what lifestyle factors might have changed, what the natural course of a condition looks like, and how symptoms might be impacted by the plethora of non-specific factors we lump together as the " The case report should discuss its own weaknesses. The false impression that an intervention helped should be pointed out in a case report. It would be in the best interest of the case report to include input from a relevant expert. A high quality case report needs to be built on a foundation of basic science and add something to our understanding of a particular condition. The author of the case report is a fundamentalist private practice Chiropractor in Missouri who uses a bogus ICPA certification for marketing purposes. Dr. Nicole McCauley who is the only chiropractor within 250 miles of Springfield, MO who is a registered Pediatric Diplomate. This means she holds the highest level of education a chiropractor can receive in pediatric and perinatal care I am concerned that her practice website encourages parents of acutely ill children to visit the website of a medical doctor in New York who promotes a wide variety of unscientific treatment options and is aggressively anti-vaccine. This is an example of two of the most serious concerns I have about children's healthcare. If a patient has a serious illness, there is a risk of delays in care if the promoter is anti-vaccine. The report begins with a brief explanation of seizures. Seizures occur due to a disruption in the mechanisms responsible for balancing excitation and inhibition. Disrupting the mechanisms responsible for inhibition of firing or promotion of the mechanisms needed to facilitate excitation may both lead to seizures. Conversely, the opposite will usually bring about prevention of seizure activity. It isn't wrong, but it leaves a lot out I'm not arguing that the introduction to a case report should be able to substitute for a review article on a condition, but she doesn't mention that it is an electrical disturbance or what these mechanisms are. She wants to keep it vague because unscientific beliefs thrive in the gaps. It doesn't take much of an understanding of seizures and their numerous potential causes to grasp that there is zero plausibility behind claims thatChiropractors play a role A 15-month-old child is the patient in this report. The baby's birth was traumatic, but the description of the delivery is benign. The delivery was via C-Section at 37 weeks with an epidural administered. There was no fetal distress or meconium staining present. The infant cried strongly immediately, was pink all over, with arms and legs actively moving. The reason why his mother had a c-section was not mentioned. It's possible that the sign was a sign of fetal distress, but the baby did well. The term meconium refers to the material built up in the uterus. The passage of meconium can be a sign that a baby is in distress, and it can be harmful if swallowed. Nothing was said that made anyone feel distressed. The forces applied to the head and neck during delivery are what fundamentalist Chiropractor refer to when talking about birth trauma. They think that it doesn't have to be a forceps or vacuum-assisted delivery to be traumatic. Chiropractic evaluation of all newborns is a way to prevent a wide variety of future health issues. There is no evidence that pulling on the head during delivery can lead to seizure or any future health concern. The subluxations that were supposed to exist did not happen. Complicated delivery can cause injury to the brain and increase the risk of a child having a seizure. Hypoxic-ischemic encephalopathy is a condition in which the delivery of oxygen to the brain is reduced. It is said that the child had no problems until he had a number ofseizure-like episodes. These were not described and we don't know when they stopped happening. He began to have more troubling episodes eight months later. The mother reported events of unresponsiveness with associated limpness occurring upon waking from naps when diaper is changed after patient has had a bowel movement. He would also sometimes experience episodes consistent with
bowel movements every other day. Each episode lasted approximately 1-2 minutes and happened 2-3x/week but there was no loss of consciousness.What’s the deal with case reports?
A low quality case report: Resolution of Chronic Seizures in an Infant Undergoing Chiropractic Care for Vertebral Subluxation
He wouldn't be able to move parts of his body, even the lower limbs, because he became unreactive. The strength of his neck muscles diminished.
difficult time keeping his head up during an episode. His lips would become cyanotic during some of the episodes, but he did not appear to have any difficulty breathing.
There were no tonic-clonic movements or other movements of the body with these episodes. Mother said she checked his heart during the episode. He would sometimes have his lips turn blue.
The Brief Resolved Unexplained event is one of the most frustrating clinical scenarios faced by doctors. I have lost count of the number of infants I have admitted to the hospital after a parent noticed a change in their child's breathing, color, mental status, or muscle tone. The majority of them came into the emergency department by ambulance.
There are a lot of reasons why these cases are difficult. A dangerous condition with a long list of potential offenders is one of the things that can happen. The child's caregivers are scared because they think their child almost died. It is believed that some intervention done at home, such as blowing in a child's face or even performing what they think was effective rescue breaths or chest compressions, is what prevented death. They worry that their child will die suddenly. The evidence shows that these children are almost always fine, nothing dangerous actually happened, and their risk of death is the same as in any other healthy child.
This is where it gets really complex. A BRUE doesn't have any obvious red flags for serious pathology, such as when a child requires high qualityCPR performed by paramedics/ emergency department personnel, or the description of the event by caregivers is classic for a generalized tonic-clonic seizure The child has to look fine in the ED and can't have any historical risk factors such as prematurity or known medical conditions that puts them at risk for sudden death. A thorough physical exam and review of the child's personal and family medical history is necessary for these kids. It isn't a BRUE if something happens.
If there is a clear story from the caregivers that shows a benign event, like gagging during a feed, most of us feel comfortable giving reassurance, education, and discharge papers. Many babies are admitted to be watched on monitors for a day, despite the fact that labs, scans, and extended observation almost never reveal anything to be worried about. In many cases, this unnecessary evaluation doesn't even provide reassurance for caregivers, so it's frustrating as a hospitalist It can increase the likelihood that a child will be seen as vulnerable. The child will face more unnecessary medical interventions in the future as a result of this.
What's going on with these babies? We don't know because we rely on the observations of witnesses who weren't focused on taking notes I think I wouldn't have been worried if I'd been at the bedside. They happen at the child's home in the middle of the night and in a dark room. The baby is often the first baby of the family. Most of these are likely misinterpretations of normal infant behaviors, or a perception of reality altered by psychosocial factors.
There are a lot of frightening possibilities when it comes to BRUE evaluations. These aren't usually to blame. We need to communicate effectively with caregivers and hopefully guide them towards comfort with some amount of uncertainty while still counseling them on what red flags to look out for. We don't want them to believe that their child is at high risk of a bad outcome. Sometimes we are compelled to admit these babies after extensive evaluations that aren't likely to help. Many of us experience moral fatigue on a daily basis due to all of this.
I'm not sure what to say.
The description of the events provided in the case report matches that of a BRUE, at least initially. If a child is older than a year of age, the BRUE diagnosis doesn't apply. It is easier for parents to mistake normal behavior for pathology in babies than it is in toddlers.
This doesn't mean that toddlers are always in danger when their caregivers think they're dying. They don't have any serious pathology to worry about if they look good in the emergency room. The same concerns can be applied to the perception of caregivers. This is not a new diagnosis. Missed diagnoses and bad outcomes can be caused by assumptions.
The events in question do not fit into any known seizure category, even though the case report assumes they are. They are called atonic seizures but we don't know who they are. It is possible that the diagnosis is based on the caregivers understanding of the situation. It would be helpful to know the thoughts of the medical professionals involved in the care of this child.
There were no tonic-clonic episodes that caregivers saw. The grand mal seizure involves the jerking of muscles that most people are familiar with. Atonic seizures involve loss of muscle tone and are the closest to what is described, but the description is inconsistent with all other seizure types. It could have been something that the patient's caregivers applied after searching the internet awkwardly. The description of the child's medical evaluation is supported by this.
He had a number of medical tests performed including two EEG’s that were interpreted as normal. An MRI and ECG were also done and noted to be normal. He was examined for heart murmur, abnormal biventricular size and function,
abnormal valvular structure and function, and large intracardiac shunting due to an Aortic Arch Obstruction. All results were negative. There was no definitive medical diagnosis given.
When there is no apparent seizure activity at the time, it's normal to get a pheogram. Because of the suspicion that a seizure occurred and the movements of concern are not true seizures, a lot of times an EEG is ordered. Even if a patient ends up being diagnosed with a seizure disorder, they can still have a normal brain wave. It's not likely that a child at that age would have a normal brain wave if they had a seizure.
There is a sudden loss of muscle tone associated with atonic seizures and they start in childhood. They represent less than 1% of seizures and are usually associated with Dravet syndrome, which is very difficult to treat and can cause a lot of health issues. I would put this in the very unlikely category because I don't know if it ever had a seizure. After reading the report, the doctor agreed.
The child was found to have a few primitive reflexes, but you will be shocked to learn that they are related to the right S/I joint. After eight months and 17 adjustments of his spine and skull, as well as parent driven home therapy involving stimulation of his feet and cheeks to fix those primitive reflexes, the seizures gradually decreased in Frequency until they were gone for good. His parents were told to limit his food intake. This of course raises another concern, which is the potential for questionable or even harmful recommendations with case reports like this, as well as with other children's healthcare providers. We don't know what might have helped when there are more than one intervention.
After a discussion including the description of a few earlier case reports, each worthless, McCauley gets into potential limitations.
The author was unable to find cases in the scientific literature specifically describing the patient’s symptomatology. Further limitations included the use of a single case study design which cannot be generalized to the population, in addition to not having a control group to rule out maturation as a factor in improvement of chronic seizures. Moreover, further research is necessary to determine the effectiveness of chiropractic care in resolving chronic seizures in infants.
This section should have been added by me. What is most likely at play in this child's improvement is included. The people got older. There were a few frightening events when he was a baby. His caregivers could potentially see normal infant and toddler behavior, such as breath holding spells, as seizure activity. He had an extensive evaluation that was reassuring but not reassuring enough. The Chiropractor and their nonsense entered the picture. He outgrew the behaviors over the next 8 months and the care he received was not a factor. It's just time.
He came to a different conclusion.
The results of this case study and relevant research pertaining to chiropractic’s role in reduction and resolution of chronic seizures support the hypothesis that
subluxation reduction may have a positive impact on the symptoms associated with epilepsy.
The case reports are not completely useless. They can be taken with a grain of pink Himalayan salt. They are probably just trying to sell you something if they involve an intervention that is completely lacking in basic science support.
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