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Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Nicotine exposure during prenatal to adolescent neurodevelopment causes morphologic changes in the CNS and persistent alterations of neurotransmission systems. Maternal smoking on the one hand and nicotine dependency and attention deficit hyperactivity disorder in the offspring on the other are significantly associated. There is even evidence that nicotine abuse during adolescence may result in deficits of the brain's attentional network. In contrast, any effects of nicotine exposure on the development of various psychiatric diseases are still unclear. The somatic consequences of smoking and the resulting economic problems are already well known, but the effects of nicotine on neurodevelopment are still underestimated. More public awareness training and medical education are required to avoid nicotine abuse in pregnant women, children, and adolescents.

A rare hyperkinetic syndrome in a child after premedication with Thalamonal has been known for some time. The triad: unconsciousness, opisthothonus and conjugate deviation should be considered by surgeon and anesthetist and it looks like the somnolent-ophthalmoplegic-hyperkinetic type of Economo's Encephalitis lethargica. The therapy is simple: 1 ml Biperiden i.v.