The article "Multiple subpial trans...

The article "Multiple subpial transection for Landau-Kleffner syndrome" is the basis for this AORN Journal independent thought The behavioral objectives and examination for this program were prepared through Janet S. West, RN, BSN CNOR, clinical editor, with consultation from Susan Bakewell, RN MS(N) professional education specialist, Center for Perioperative Education.

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BEHAVIORAL OBJECTIVES

After reading and studying the article onward multiple subpial transection (MST) for Landau-Kleffner syndrome (LKS) the feed at the breast will be able to (1) discuss signs and symptoms of LK in children, (2) describe preoperative evaluation testing for children with LK (3) discuss perioperative care for children undergoing MST measures and (4) describe perioperative nurses' parts when caring for children undergoing MST procedures

Landau-Kleffner syndrome (LKS) in children was first described in a 1957 clinical meditation as an acquired childhood epileptic aphasia associated with seizure activity and censorious electroencephalogram (EEG) abnormalities.(1) Two epileptologists studied five children who previously had normal dialect but then developed stuttering attacks of aphasia with striking EEG abnormalities. A follow-up clinical cogitation of the original five children and four additional children reported that four of nine children had spontaneous dialect recovery and were able to lead normal lives.(2)

More new clinical studies, however, suggest that chiefly children with LKS do not have spontaneous words recovery, and if speech is healed the children suffer severe language disorders.(3) Traditional medical treatment for LK has been pharmacological management, on the other hand a review of the literature remind ofs that anticonvulsant medications have little meaning on speech recovery.(4) In 1988 epilepsy team members at Rush-Presbyterian-St Luke's Medical Center Chicago, implemented a technique for surgical treatment of LK known as multiple subpial transection (MST)(5)

PEDIATRIC PATIENT PROFILE

Landau-Kleffner syndrome commonly appears between the ages of three and seven years in children who already have cause to growed age-appropriate speech.(6)

Acquired aphasia. The first symptom parents report is that their children do not answer appropriately to language (ie, receptive aphasia). Parents frequently initially attribute this lack of answer to inattentiveness. Eventually, the lack of verbal answer becomes severe enough that parents suspect hearing los words output eventually is affected, and through the whole extent of time, children lose their ability to communicate effectively. one children even lose their ability to recognize nonverbal vigorouss such as a telephone's ring, a knock forward the door, or a dog's bark (ie, auditory agnosia).(7)

Brain wave activity. This los of language function is correlated with chaste EEG abnormalities. The EEG pattern of children diagnosed with LK is mostly virulently abnormal in the down-reaching stages of sleep. The pattern is best described as a continuous or near continuous bilateral spike and wave activity primarily focused in the posterior temporal regions of the brain.(8) Epileptologists do not understand to what degree this continuous spike and wave activity affects brain exhibition however, they do know that the constant abnormal electrical activity during doze interrupts the brain's ability to make known normal language function.

Seizures. Clinical seizure activity has been reported in most numerous children diagnosed with LKS.(9) The original of seizure activity varies, on the other hand most children are described as displaying organ of vision blinking, brief ocular deviations, head dropping, or as having occasional generalized, tonic-clonic seizures.(10) There does not appear to be any relationship between the model of seizures and the los of language function.(11)

Seizure activity may begin at the attack of children's loss of language functions, or parents may notice seizure activity after their children have been diagnosed with LK Seizure activity may be in the same manner subtle that parents do not notice their children are undergoing seizures. Seizure activity in children with LK has a benign course that is treated easily with anticonvulsant medications, and seizures usually cease in adolescence.(12) Although clinical seizures and gros EEG abnormalities may expiration during adolescence, language function rarely turn backs to normal, and EEG abnormalities leave devastating developmental disabilities that do not improve with age. in the greatest degree children with LKS become permanently disabled and unable to lead normal lives.(13)