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Light therapy as treatment of dyschronosis in brain impaired children
C Guilleminault1, C C McCann, M Quera-Salva
1Stanford University Sleep Disorders Clinic and Research Center, Palo Alto, CA 94304.
Insights
Light therapy effectively normalized sleep-wake cycles in five children with severe sleep disturbances. This treatment is promising for children unresponsive to other methods.
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Chronobiology
Background:
- Children with moderate to severe mental retardation and neurological issues often experience severe sleep disturbances.
- Abnormal day/night schedules and nocturnal sleep problems significantly impact affected children and their families.
- Previous treatments like hypnotic medications and behavioral therapies were largely ineffective.
Purpose of the Study:
- To evaluate the efficacy of light therapy in treating severe sleep-wake cycle disruptions in children with neurological impairments.
- To assess the long-term outcomes of light therapy for pediatric sleep disorders.
Main Methods:
- Fourteen children (9 months-4 years) with mental retardation and neurological lesions received light therapy (minimum 4000 lux).
- Treatment outcomes were monitored for 2-5 years post-intervention.
- Families' adherence to the prescribed regimen was noted.
Main Results:
- Five out of fourteen children achieved normal sleep-wake cycles after light therapy.
- Two families could not adhere to the treatment plan.
- Treatment failed in seven children; one showed spontaneous improvement later, and three experienced neurological worsening, with one fatality.
Conclusions:
- Light therapy is a viable treatment option for severe, treatment-resistant sleep-wake cycle disruptions in children with neurological conditions.
- Phototherapy demonstrates a favorable side-effect profile and potential for normalizing sleep patterns.
- Advancements in monitoring technology and light box availability facilitate future therapeutic trials.
Abstract:
Fourteen children aged 9 months-4 years with moderate to severe mental retardation and varying neurologic lesions were referred for severe and continuous nocturnal sleep disturbances and very abnormal day/night schedules. All children had previously been given hypnotic medications and behavioral treatments which had little or no effect on nocturnal sleep. The severity of the sleep disturbances significantly affected family life and was a major handicap to the children. All children were treated with light therapy (minimum 4000 lux). Five children responded to treatment and had normal sleep-wake cycles at the most recent post-treatment evaluation (2-5 years after the first treatment). Two of the patients' families were unable to follow the prescribed regimen. Treatment failed in 7 children. One of these seven children spontaneously improved 3 years later. In three of the failure children the neurologic problem progressively worsened, leading to death in one of them. Phototherapy is a treatment worth pursuing in children with very significant sleep/wake disruption which is unresponsive to behavioral or other treatments. It has few side-effects and may lead to normalization of the sleep-wake cycle. Recent improvement in the technology used to monitor the 24-h temperature rhythm over several days and the present commercial availability of "light boxes" should render these therapeutic trials easier than at the time of these initial investigations.