Pediatric Reports

Background/Objectives: Drug-resistant epilepsy (DRE) is a significant health problem leading to cognitive impairment and reduced quality of life. This study aimed to investigate the incidence and etiology of DRE in children in Estonia. Methods: A retrospective, population-based study of childhood DRE was conducted in Estonia from 1 January 2013, to 31 December 2017. All cases were identified through the only two pediatric neurology departments in the country, both located at tertiary care hospitals (Tartu University Hospital and Tallinn Children’s Hospital), ensuring complete nationwide coverage. Epidemiological, magnetic resonance imaging (MRI), and genetic data (chromosomal microarray, single-gene tests, gene panels, and exome/genome sequencing) were collected. Results: The incidence rate of childhood epilepsy was 84.1 per 100,000. DRE developed in 10% of children with new-onset epilepsy, corresponding to an incidence rate of 8.5 per 100,000. Etiologically relevant MRI abnormalities were identified in 43% of patients with DRE, most commonly congenital brain malformations (19%). Pathogenic single-gene sequence variants were detected in 25 of 110 patients (23%), copy number variants in four patients (4%), and chromosomal aberrations in one patient (1%). Novel candidate disease genes of uncertain pathogenicity were identified in four patients (4%). The most frequent etiology of DRE was structural (29%), followed by genetic (19%), with combined etiologies (13%) also contributing significantly. Conclusions: Our study is the first epidemiological study of DRE in children in Estonia and the Baltic region. The relatively low incidence observed may reflect the comprehensive national ascertainment and centralized management of pediatric epilepsy in tertiary care centers.

This case report describes mandibular distraction osteogenesis (DO) in a six-year-old patient with first and second branchial arch syndrome and obstructive sleep apnea, in whom 3D surgical planning was combined with ultrasonography (US) for postoperative monitoring. The aim was to illustrate how patient-specific 3D modeling and a structured ultrasonography protocol can support safe mandibular advancement while limiting radiation exposure in a pediatric patient with complex craniofacial deformity. Preoperatively, a 3D-printed model of the mandible, generated from a cone beam computed tomography (CBCT) scan, was used to guide precise osteotomy planning and vector orientation. The surgical procedure was conducted using a Risdon approach and piezoelectric tools to ensure minimal trauma. Postoperative monitoring incorporated serial panoramic radiography and US at predefined time points to assess gap size, callus formation, and vascularity during distraction and consolidation. US identified early callus formation, progressive cortical bridging, and preserved callus vascularity, and, together with radiographic findings, guided the timing of distraction termination and distractor removal at 16 weeks. This case adds to the limited literature on pediatric mandibular DO by demonstrating the feasibility of integrating patient-specific 3D virtual planning with US-based follow-up to improve the safety, precision, and radiation-conscious management of DO in pediatric patients with complex craniofacial deformities.

Background: Procedural pain and anxiety are common phenomena among children hospitalized in pediatric wards; however, they are often under-recognized. These experiences frequently accompany patients during various diagnostic and therapeutic procedures. Assessing pain is particularly challenging in pediatric care, as children may have difficulty clearly expressing their pain experiences, which can result in the underestimation of their symptoms. Accurate assessment using an appropriately selected scale should be regarded as an essential component of high-quality healthcare. Methods: This narrative review summarizes standardized tools for assessing procedural pain and anxiety in pediatric patients, focusing on instruments adapted to different ages and cognitive abilities and on their applicability in everyday clinical practice. Results: Numerous standardized scales are available, ranging from behavioral to numerical instruments tailored to specific developmental stages. Despite this, the implementation of these tools in routine care remains inconsistent, largely due to organizational, educational, and communication barriers among healthcare professionals. Conclusions: Medical staff must not only receive adequate training but also exhibit the motivation and readiness to utilize available pain assessment methods. Education and increased awareness among staff regarding pain and procedural anxiety are crucial for improving patient comfort and safety.