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Wernicke like Encephalopathy in a Child: A Reversible Cause

Posted by Dr. Akio Hiura on 03 Dec 2012 02:52:25 AM GMT

What are the main claims of the paper and how important are they?
This is a case report. A 12 year old boy was diagnosed as Wernicke encephalopathy with the typical clinical signs of drowsy (lethargy), afebrile, ptosis of right eye and ataxis. Intravenous thiamine application (2mg/kg) dramatically rescued the symptoms.
Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.
NA
Are the claims properly placed in the context of the previous literature?

No
Do the results support the claims? If not, what other evidence is required?

Yes
If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

NA
Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

NA
Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

NA
Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?
NA
Other Comments:
In the Text, "Abstract" is changed to "Results". References should be added for the reader to know how many studies on this subject are present uo to now.
Competing interests:
None
Invited by the author to review this article? :
No
Have you previously published on this or a similar topic?:
No
References:
None
Experience and credentials in the specific area of science:

Capsaicin and pain
How to cite: Hiura A .Wernicke like Encephalopathy in a Child: A Reversible Cause[Review of the article 'Wernicke Like Encephalopathy in a Child: A Reversible Cause ' by Syed R].WebmedCentral 2012;3(12):WMCRW002366

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Wernicke Like Encephalopathy in a Child: A Reversible Cause

Posted by Dr. Richard A Rison on 02 Dec 2012 06:40:20 AM GMT

What are the main claims of the paper and how important are they?
That WE or a similar syndrome can occcur in an otherwise previous healthy individual after fasting.
Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.
No (please see below).
Are the claims properly placed in the context of the previous literature?

Yes.
Do the results support the claims? If not, what other evidence is required?

Yes.
If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

NA
Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

NA
Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

NA
Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?
It is an interesting topic and reminds clinicians to be aware of this entity.
Other Comments:
This in an interesting single case report on a previously heatlhy pre-teenage boy who developed a Wernicke-like encephalopathy following a first time religious fast. While the intact EOM's are unusual, the ataxia and thiamine levels along with the positive response to thiamine (I would have given IV thiamine) argue in favor of the diagnosis. Ptosis has been reported before: Bilateral ptosis in Wernicke's disease. Neurology. 1967 Jan;17(1):85-6. One should also note as this manuscript shows that not all patients with WE are overtly previously sick or malnourished: Acute bilateral ophthalmoplegia in a young woman. Surv Ophthalmol. 2000 May-Jun;44(6):513-7. I would have liked to have seen an MRI instead of the reported CT (but perhaps this was unavailable); an MRI is not need for the diagnosis though. I don't see a reference section at the end of the paper (though the author seems to cite reference numbers within the text). I recommend the following articles for further reading:

Wernicke-korsakoff-syndrome: under-recognized and under-treated.
Isenberg-Grzeda E, Kutner HE, Nicolson SE. Psychosomatics. 2012 Nov;53(6):507-16. doi: 10.1016/j.psym.2012.04.008.

AND Wernicke's encephalopathy and Korsakoff's syndrome revisited.

Sullivan EV, Fama R. Neuropsychol Rev. 2012 Jun;22(2):69-71. doi: 10.1007/s11065-012-9205-2. Epub 2012 May 16.
Competing interests:
No
Invited by the author to review this article? :
No
Have you previously published on this or a similar topic?:
No
References:
None
Experience and credentials in the specific area of science:

General Neurology.
How to cite: Rison R A.Wernicke Like Encephalopathy in a Child: A Reversible Cause[Review of the article 'Wernicke Like Encephalopathy in a Child: A Reversible Cause ' by Syed R].WebmedCentral 2012;3(12):WMCRW002364

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