Radionuclear encephalo-angioscintigraphic studies in transitory disorders of brain circulation in childhood

Fifteen cases of transient cerebral ischaemia in children have been studied. Radionuclear encephaloangioscintigraphy (RNEAS) with Tc99 DTPA in combination with CT scanning, doppler sonography of extracranial head arteries and EEG were performed in all observed cases. For some children cerebral angiography was done. RNEAS study found out: stenosis of internal carotid artery or a. cerebri media in 5 cases; AV-malformations- 3; ischaemic area- 1, aneurysma- 1; increased blood permeability of the late static scintigraphy- 3. Positive correlation was established between the angioscintigraphic and sonographic findings in the cases with stenosis of internal carotid artery; between angioscintigraphic and CT results in the cases with ischaemia; between RNEAS and angiographic data in cases with AV-malformations, aneurysm and stenosis. In conclusion RNEAS could be considered as a useful, atraumatic screening method within the complex of laboratory examinations for vascular diseases in childhood.     

Troubles du langage et séquelles linguistiques dans l'épilepsie partielle rolandique

Partial rolandic epilepsy (PRE), a benign epilepsy of childhood having its onset between age 3 and 13, is characterized by the presence of epileptic activity localized in the central or midtemporal regions. In this study, we assessed language function in 27 children aged 7-16, currently affected by PRE or in remission: 41% of them showed language impairment. Moreover we found persistent language difficulties in children in remission. It is argued that these results are compatible with the hypothesis that an early epileptic disorder is likely to disturb language development, when it occurs during a critical period for language development.     

Natural sequence of recovery from child post-traumatic amnesia: A retrospective cohort study

The aim of this study was to determine the sequence of skills recovery during post-traumatic amnesia (PTA) in children with moderate to severe traumatic brain injuries (TBIs). Setting: Fifty children aged 8 to 15 years consecutively admitted to a children’s hospital with TBI and PTA>24 were tested in a retrospective cohort study where the main measure was the Westmead PTA Scale (WPTAS). The group analyses show that orientation to time took longer to recover than orientation to person and place, but not memory, while the individual analyses revealed that when orientation to time was grouped with memory, 94% of children recovered orientation to person and place before orientation to time and memory (examiner and pictures). Correlation coefficients between age and the number of days taken to recover skills were not found to be significant. It was established that, in terms of the natural sequence of skills recovery in children aged 8 to 15 years following moderate to severe TBI, recovery of orientation to time is more closely aligned to memory than to orientation to person and place. It was also established that WPTAS items are developmentally appropriate for children aged 8 to 15 years who have sustained TBI. These findings are clinically important because monitoring recovery from PTA both impacts the rehabilitation offered to individuals during acute care and aids discharge planning.     

Long‐Term Outcomes of Traumatic Brain Injury in Early Childhood

Mild traumatic brain injury (mTBI) is a leading cause of injury among children, with approximately 15% of children experiencing a TBI prior to 15 years of age. Acutely, mTBI has been associated with a range of cognitive, physical, emotional and behavioural impairments. However, few studies have examined outcomes beyond five years post injury, long before the developmental process is complete and the full extent of any deficits may manifest. Our group had the unique opportunity to use data from a longitudinal birth cohort of 1265 children (Christchurch Health and Development Study) to examine the long term outcomes of early injury (0–5 years). Information about these children, including mTBI events, had been collected at birth, 4 months and at yearly intervals until age 16, and again at ages 18, 21 and 25 years. We found that even after statistical control for a wide range of child and family confounds, children who had been hospitalized for an mTBI had increased inattention/hyperactivity and conduct as rated by mothers and teachers over ages 7–13 years. Increased rates of psychiatric disorders were over 14–16 years for those injured in the preschool, including symptoms consistent with Attention Deficit/Hyperactivity Disorder (ADHD), Odds Ratio = 4.6, Conduct Disorder (CD), Odds Ratio = 5.6 and Substance Abuse (Odds Ratio = 9.1). Over ages 21–25 ongoing behaviour problems were assessed using self‐reported arrests, violent offenses and property offenses. Compared to non‐injured individuals, mTBI groups were more likely to be arrested, involved in property, and violent offences. We controlled for a wide range of factors and there was still clear evidence of ongoing problems for individuals who had experienced a mTBI compared to their non injured counterparts. These findings provide compelling evidence of long term psychosocial and psychiatric outcomes following mTBI.     

Seizure episodes and death by drowning

473 cases of death by drowning were examined for evidence of previous neurological disorders linked with the occurrence of epileptic fits. It was found that 16 persons (3.4%) were undergoing medical treatment for epilepsy. In a further 10 cases there was evidence of the possibility of previous disorders in which epileptic fits and syncopal attacks played a dominant part. Besides the risks from the previous disorders, additional risk factors are discussed.     

The contribution of functional near-infrared spectroscopy (fNIRS) to the presurgical assessment of language function in children

Before performing neurosurgery, an exhaustive presurgical assessment is required, usually including an investigation of language cerebral lateralization. Among the available procedures, the intracarotid amobarbital test (IAT) was formerly the most widely used. However, this procedure has many limitations: it is invasive and potentially traumatic, especially for children. To overcome these limitations, neuroimaging techniques such as functional magnetic resonance imaging (fMRI) have been used. Again, these methods are difficult to use with children, who must remain motionless during data acquisition. Functional near-infrared spectroscopy (fNIRS) is a noninvasive functional imaging technique that is easily applied to pediatric and cognitively limited patients. It has been used recently in epileptic children for presurgical assessment of expressive and receptive language brain lateralization. The aim of this review is to present the contribution of fNIRS to the presurgical assessment of language function in children with neurological diseases.     

Larger brain and white matter volumes in children with developmental language disorder

Developmental language disorder (DLD) is predominantly a language disorder, but children with DLD also manifest non-language impairments, and neuroanatomical abnormalities have been found in multiple areas of the brain, not all language-associated. We therefore performed a whole brain general segmentation analysis of all major brain regions on MRI scans of 24 DLD subjects (16M, 8F) and 30 controls (15M, 15F), ages 5.7 to 11.3 years. Children with DLD showed increased total brain volume, driven predominantly by a substantial increase in the volume of cerebral white matter. Cerebral cortex and caudate were relatively but not absolutely smaller in DLD. These findings are discussed in relation to issues of specificity vs. generality as they arise in debates about (1) modular vs. general processing deficits and connectionist modeling in DLD, (2) language-specific vs. pervasive, non-specific deficits in DLD and (3) specificity of the disorder vs. overlap with other disorders, notably autism.     

Attentional skills in the acute phase following pediatric traumatic brain injury.

Only a limited number of studies have investigated attention following pediatric head-injury. The present study examined sustained attention and processing speed in a group of children who had sustained a mild (n = 27), moderate (n = 33) or severe (n = 16) traumatic brain injury (TBI). No significant differences were evident between the TBI groups on reaction time measures. Results did show that the severe TBI group exhibited greater deficits in the area of sustained attention, in comparison to children with mild and moderate injuries, in the acute stage following traumatic brain injury. This difficulty may impact on the future development of skills dependent on intact attentional capacity.     

Attentional Skills in the Acute Phase Following Pediatric Traumatic Brain Injury

Only a limited number of studies have investigated attention following pediatric head-injury. The present study examined sustained attention and processing speed in a group of children who had sustained a mild (n = 27), moderate (n = 33) or severe (n = 16) traumatic brain injury (TBI). No significant differences were evident between the TBI groups on reaction time measures. Results did show that the severe TBI group exhibited greater deficits in the area of sustained attention, in comparison to children with mild and moderate injuries, in the acute stage following traumatic brain injury. This difficulty may impact on the future development of skills dependent on intact attentional capacity.     

Social and affective impairments are important recovery after acquired stroke in childhood

Despite a congenital stroke, overall intelligence at school age is generally within the normal range. Language acquisition problems are more prominent when children are younger (<5 years of age) than when they are older. They are present after both right and left lesions, but appear to have different features. They are less apparent than in the child with a developmental language disorder. Acquired aphasia in childhood results in subtle and often persisting deficits. Children with congenital strokes are at risk for behavioral and psychiatric problems. Those with congenital right hemisphere strokes appear to be more difficult infants, but there is no clear side of lesion effect in older children. Children with congenital right hemisphere strokes have more prominent spatial difficulties than their left lesion counterparts. Evaluating both the process and the product highlights this. Increasing the difficulty of the task often brings out deficits in the right lesion group even when they seemingly recovered.     

An Investigation of Neuronal Integrity in Severe Paediatric Traumatic Brain Injury

Magnetic Resonance Spectroscopy (MRS) and its association with neuropsychological functioning was examined in the chronic injury phase of paediatric traumatic brain injury (TBI). Fifteen children, aged 10-16 years, with severe TBIs were compared with 15 controls, matched for age and gender. The TBI group was found to have significantly lower levels of N-acetyl aspartate (NAA) and Choline (Cho) in the right frontal lobe and generally displayed reduced performances on neuropsychological tests. A correlation between metabolites and reaction times was also obtained. Findings indicate a role of proton MRS as a measure of neuronal integrity following severe paediatric TBI and suggest a potential association of MRS with specific neuropsychological impairments.     

An investigation of neuronal integrity in severe paediatric traumatic brain injury.

Magnetic Resonance Spectroscopy (MRS) and its association with neuropsychological functioning was examined in the chronic injury phase of paediatric traumatic brain injury (TBI). Fifteen children, aged 10-16 years, with severe TBIs were compared with 15 controls, matched for age and gender. The TBI group was found to have significantly lower levels of -acetyl aspartate (NAA) and Choline (Cho) in the right frontal lobe and generally displayed reduced performances on neuropsychological tests. A correlation between metabolites and reaction times was also obtained. Findings indicate a role of proton MRS as a measure of neuronal integrity following severe paediatric TBI and suggest a potential association of MRS with specific neuropsychological impairments.     

2009年贵阳市住院儿童手足口病病原学及临床特点

为了解贵阳地区2009年4月~9月儿童手足口病的病原学及临床特点。从住院的820例手足口病患儿中采集部分伴有重症倾向的244例患儿的肛试子和咽试子标本进行RT-PCR技术检测,并进行临床观察。218例检测到肠道病毒,占89.34%,其中138例为EV71,占63.30%。72例为CA16,占33.02%,两者之比1.92:1。不同年龄组的病原构成差异有统计学意义(P0.01)。重症病例EV71感染明显高于轻症病例,两者在临床特征方面差异有统计学意义(P0.01)。2009年贵阳市住院儿童手足口病的主要病原是EV71和CA16;1岁~3岁的患儿EV71感染明显高于CA16,EV71比CA16更易引重症手足口病,重症病例与轻症病例在临床表现上有明显差异。     

A 2-year follow-up of bedwetters treated by dry-bed training and standard conditioning

Sixty nocturnally-enuretic children treated by Dry-Bed Training (DBT) and 35 children treated by standard conditioning were followed-up over a 2-yr period. Results showed that after achieving the initial success criterion of 14 consecutive dry nights, 39% of the DBT group and 41% of the standard-conditioning group relapsed during the follow-up period. Renewed bedwetting was arrested in 14 out of 15 cases re-treated by DBT and in all 10 cases re-treated by standard conditioning. Children who relapsed following initial treatment were compared with those who remained dry in respect of the child's age and sex, bedwetting frequency prior to treatment, the number of bedwets (and consequent conditioning trials) during treatments, a history of primary or secondary enuresis and a history of diurnal micturitional difficulty. Children who had a history of day-time wetting accidents beyond the age of 4 were found to be more likely to suffer a relapse in bedwetting following either DBT or standard conditioning. None of the other variables examined was found to be significantly associated with proneness to relapse.     

Sickle cell disease: primary stroke prevention

Stroke is an important and common complication of sickle cell disease (SCD), affecting children as well as adults. Clinically evident stroke, usually brain infarction, is usually associated with stenosis or occlusion of the intracranial arteries of the Circle of Willis, sometimes with formation of moyamoya (a Japanese word for "hazy" or "like a puff of smoke" that describes the appearance of a abnormal microvasculature on angiography believed secondary to internal carotid artery stenosis or occlusion and the resultant extensive collateralization). Several types of intracranial hemorrhage are observed but usually in older children and adults. Cerebrovascular diseases restricted to small vessels may go unrecognized but is associated with cognitive and learning problems. Prevention of recurrent stroke has been accomplished with chronic blood transfusion. A primary prevention strategy for clinical stroke, based on the Stroke Prevention in Sickle Cell Anemia Trial, has been tested in a randomized clinical trial. Over 2,000 young children with SCD were screened with transcranial Doppler ultrasound (TCD) to detect elevated blood flow velocity indicative of vessel disease and high risk of future stroke. Those randomized to standard care (no transfusion) had a 10%/year risk of stroke, which was reduced >90% with chronic transfusion. This approach is the only primary stroke prevention strategy so far tested in SCD in a randomized controlled trial. Silent lesions on magnetic resonance imaging are associated with an approximately 1.5%/year risk of clinical stroke and a trial is now starting in children with these lesions who do not meet Stroke Prevention in Sickle Cell Anemia Trial criteria for transfusion based on TCD. A controlled trial, based on intervention for nocturnal hypoxemia, is also underway. Hydroxyurea, bone marrow transplantation, antiplatelet, and antithrombotic agents may work but have not been tested in primary prevention in a systematic way. If early and repeated, TCD screening of children, as recommended by National Heart Lung and Blood Institute and the American Stroke Association, were implemented broadly the incidence of new strokes could be greatly reduced in these children.     

The epidemiology of the epilepsies in children

The epilepsies are a heterogeneous collection of neurological conditions and syndromes characterized by recurrent, unprovoked, paroxysmal seizure activity. There are several types of epileptic seizures and syndromes that are unique to children, including infantile spasms, Lennox-Gastaut syndrome and absence seizures. Febrile seizures and neonatal seizures, while not epilepsy, are relatively common types of seizures in infants and children and are likely markers of risk of later epilepsy. Thus, it is important to consider the epidemiological features of the epilepsies as they occur specifically in infants and children. The purpose of this review is to summarize what is currently known about the epidemiology of the childhood epilepsies and to identify promising areas for further population-based studies. The epilepsies are an important cause of neurological morbidity in children. The average annual rate of new cases (incidence) of epilepsy is approximately 5-7 cases per 10,000 children from birth to age 15 years, and in any given year, about 5 of every 1,000 children will have epilepsy. There is evidence that the incidence of the epilepsies in some populations of children may be decreasing over time, and this possibility merits further investigation. Factors that are known to increase risk of the epilepsies in children include congenital malformations of the central nervous system (CNS), moderate or severe head trauma, CNS infections, certain inherited metabolic conditions, and genetic factors. However, these account for only 25% to 45% of cases, and thus, the etiology of most cases of the epilepsies remains obscure. The paucity of well-controlled etiological studies is due largely to formidable methodological problems in conducting epidemiological studies of the epilepsies. The prognosis for seizure control is generally good, although children with remote symptomatic seizures and those with additional neurological disabilities do less well.     

Language in benign childhood epilepsy with centro-temporal spikes abbreviated form: rolandic epilepsy and language

Although Benign Childhood Epilepsy with Centrotemporal Spikes (BECTS) has a good prognosis, a few studies have suggested the existence of language disorders relating to the interictal dysfunction of perisylvian language areas. In this study, we focused on language assessment in 16 children aged 6-15 currently affected by BECTS or in remission. An important proportion of children showed moderate or more severe language impairment. The most affected domains were expressive grammar and literacy skills. We found linguistic deficits during the course of epilepsy but also persistent deficits in children in remission, suggesting possible long-term effects. Our results support the hypothesis that BECTS may be associated with impairment to language and suggest the possibility of a direct link between epileptic activity and language development, and the existence of long-term consequences.     

Incidence of infantile cerebral lesions in children with behavioral disorders]

The delimitation of behavioural disturbances predominantly due to organic brain lesions from those caused by reactions due to environmental factors has practical importance for drug therapy and pedagogic guidance. Figures on the incidence of infantile brain lesions among children with behavioural disorders range from between 20 to 90%. However, comparison of the results is difficult, because different authors followed different aspects for the evaluation of their material. The authors have collected data from 497 children from the 3 to 15 year-old age group who suffer from behavioural disturbances: history, neurological and psychological findings, electroencephalogram, native x-ray picture of the skull, pneumo-encephalogram and echoencephalogram were reviewed for signs and findings suggesting infantile brain damage. Certain signs of intantile brain lesion were found in 28.6% of the children. Among the apparative diagnostic procedures without impairment to the patients, the electroencephalogram proved particularly suited for the support of the diagnosis. The most accurate data on the localization and extent of the lesion are provided by the pneumo-encephalogram. However, its performance is not possible or justified in each child.     

Learner drivers and lay instruction – how socio-economic standing and lifestyle are reflected in driving practice from the age of 16

On September 1st 1993, a new law came into effect in Sweden, permitting instructor-supported driving practice from the age of 16 instead of 17 years and 6 months. The intention was to enable young people to gain more experience of driving a car before they acquire a driver's permit and thereby to reduce their accident risk.The study was conducted by means of a questionnaire posted to 601 17-year-olds throughout Sweden. The participants were analysed concerning gender, socio-economic standing (blue-collar and white-collar), and lifestyle (friend-oriented, externally-oriented and parent-oriented). The results show that men obtain a learner's permit more often than women (67.4% vs 57.2%) and that youngsters in white-collar families acquire a learner's permit in more cases than those in blue-collar families (67.4% vs 52.4%). One of the reasons for the latter group not acquiring a permit is that they cannot afford it, while children in white-collar families state that they have neither the time nor the desire. No significant difference was found between the three lifestyle groups.When it comes to the amount of practice, the men have been out on the road on average 39.9 h during their first 13 months, compared to 19.9 h for the women. In the lifestyle groups, those who belong to the so-called externally-oriented lifestyle have practised most. They have reported 39.2 h compared to the parent-oriented group with the least amount of training, 27.9 h on average. The friend-oriented group has 22.2 h of practice.When both lifestyle and socio-economic standing were considered, even greater differences were found. The white-collar group of the externally-oriented lifestyle reported as much as 51.5 h, compared to the blue-collar group of the parent-oriented lifestyle with only 18.4 h of practising.The above result is important because it is not in accordance with the intentions of the new driving practice system. The idea behind the new system was that all young people should have the opportunity for a longer period of driving practice in order to reduce the high accident risk during the first year with a driver’s license. If it is impossible for certain groups of youngsters to start their driving practice at the age of 16, the situation will become socially unjust and measures must be taken to remedy this situation.     

不同编码对听写困难儿童字形记忆的促进效应

听写困难是一种发生率较高的儿童学习障碍现象。实验考察笔画语音编码和动作编码对听写困难儿童字形记忆水平的影响。结果发现, 笔画语音编码对听写困难儿童的字形记忆成绩没有明显影响, 但却明显促进了正常儿童的字形记忆成绩; 与之相对, 动作编码对正常儿童的字形记忆成绩没有明显影响, 但却明显促进了听写困难儿童的字形记忆成绩。上述现象, 既可能源于编码加工阶段, 也可能源于字形表征的提取阶段。