[Neurofeedback therapy influence on clinical status and some EEG parameters in children with primary generalized epilepsy]. / Wplyw terapii neurofeedback na stan kliniczny i wybrane parametry zapisu EEG u dzieci chorych na padaczke z napadami pierwotnie uogólnionymi.

INTRODUCTION: Pharmacological treatment of epilepsy in some patients is ineffective and alternative methods of treatment are need. These include neurofeedback (EEG biofeedback, NF). The aim of this study was to evaluate the clinical and neurophysiological effectiveness of NF in children with epilepsy with primary generalized seizures. MATERIAL AND METHODS: The study involved a group of 63 children with primary generalized seizures, aged 6-16 years, including 39 girls and 24 boys. As the efficacy of pharmacotherapy was not satisfactory for them, they have been referred to Neuromedica Institute in Krakow for NF treatment. The evaluation of preliminary clinical and neurophysiological parameters was performed. Individual NF therapy protocols were elaborated and trainings were conducted for 0.5-4 years. Individual therapy protocols were prepared by biofeedback specialist and trainings were conducted by biofeedback therapists. The same specialist also made a comparison of selected elements of the EEG in children before and after NF therapy. RESULTS: The children enrolled into the study were diagnosed with epilepsy at the age of 6 months to the age of 16 years Tonic-clonic seizures and absence seizures were the most often seizure types in the examined group. Seizures occurred in 19 children every day. In 33/63 children clinical manifestation of seizures and EEG pattern when taken together allow the specific epilepsy syndrome diagnosis in 7 cases. In 27 children two or more antiepileptic drugs were used, and in 36 monotherapy was used. NF therapy had a significant impact on the clinical condition of the children, causing subsidence of seizures in most of them. In 23/63 children antiepileptic treatment was withdrawn and in 15 reduction of treatment was achieved. The impact of the NF therapy on the EEG parameters was beneficial, both in terms of the background activity and other parameters. Paroxysmal EEG pattern subsided in the vast majority of children (63 to 16) including a continuous paroxysmal activity from 12 to 4, interrupted from 51 to 12 and generalized from 63 to 21, with reduced susceptibility to photostimulation from 31 to 18 and hyperventilation from 39 to 17. CONCLUSIONS: In half of children with primary generalized epilepsy with a characteristic EEG pattern specific epilepsy syndrome was diagnosed. In half of children subsidence of epileptic graphoelements in EEG was observed after NF therapy. In % of children paroxysmal bioelectric pattern subsided and sensitivity of EEG to hyperventilation and photostimulation decreased significantly. NF therapy had a positive impact on all the parameters of background bioelectrical activity. In 1/3 of children treated with NF pharmacotherapy of epilepsy was discontinued and in 1/4 reduced.

[Clinical and neurophysiological data of neurofeedback therapy in children with ADHD]. / Wyniki kliniczne i neurofizjologiczne terapii neurofeedback u dzieci z zespolem ADHD.

INTRODUCTION: ADHD occurs in 3% of school-age children (and in 70% of them in adulthood) and represents an important medical and social problem. It is characterized by attention deficits, hyperactivity and impulsiveness. Neurofeedback therapy (EEG biofeedback, NF) is carried out based on the analysis of EEG. OBJECTIVE: To investigate the effect of NF therapy on clinical status and parameters of the EEG in ADHD. MATERIALS AND METHODS: In the years 2007-2014, 287 children (191 boys), aged 6-17 years were included into the study. Some children with ADHD had other coexisting disorders like: tics, dyslexia, emotional or behavior disorders. Visual analysis of EEG was made and 7 selected parameters of bioelectrical activity were assessed. EEG tracing before and after NF therapy were compared. NF therapy lasted from 9 months to 3 years (mean 1.5 years). 60-240 NF training sessions were performed with the use of NF device, video-games and 16-channel Elmiko devices. Statistical analysis of the results was made. RESULTS: Children with ADHD additionally presented low self-esteem, anxiety and sleep disorders. The baseline theta/beta ratio in children with ADHD and ADHD with cooccurring dyslexia was >4.0 and in children with ADHD and coexisting tics 3.0-3.8, with coexisting behavioral disorders 3.7-4.0 and emotional disorders 3.3-3.7. After therapy, this ratio decreased significantly in all groups, but most significantly in ADHD and ADHD with dyslexia group. In the group with dyslexia theta and alpha activity in the left fronto-temporo-parietal region (the speech centers) has been increased. In children with ADHD and behavior disorders right-sided paroxysmal changes in the form of slow and sharp waves in the temporo-centro-parietal regions were found. In emotionally disturbed children increased fast beta activity in the right hemisphere (anxiety, fear) was observed. Initially NF therapy reduced hyperactivity and impulsivity of children, subsequently improvement of attention was observed and eventually reduction of emotional and behavior disturbances was noticed. Noticeable improvement in the self-esteem was observed as well. The therapy had a positive impact on the spatial organization of EEG in each group. It proved to be particularly useful in children with ADHD and dyslexia. CONCLUSIONS: Neurofeedback therapy is a valuable tool with beneficial impact on children with ADHD and accompanying disorders. Characteristics of brain bioelectric activity provides a reliable basis to establish individual EEG bio-feedback protocols of therapy in children and monitor the effectiveness of treatment. In the last 4 years the number of children with ADHD and cooccurring tics who applied for neurofeedback therapy has increased significantly.

[Neurofeedback therapy influence on clinical status and some EEG parameters in children with localized epilepsy]. / Wplyw terapii neurofeedback na stan kliniczny i wybrane parametry zapisu EEG u dzieci chorych na padaczke z napadami czesciowymi.

UNLABELLED: Neurofeedback (EEG biofeedback, NF) is one of the methods of non-pharmacological instrumental therapy. In the treatment of epilepsy it is considered as a complementary method, reducing the number of seizures. The aim of this study was to investigate the effect of NF on the incidence of clinical attacks and bioelectrical activity of the brain in children with epilepsy with partial seizures and secondarily generalized seizures. MATERIAL AND METHODS: The study involved a group of 78 children with partial seizures, additionally 30 of them had second-ry generalized seizures. There were 35 girls and 43 boys ranging in age from 5 to 17.5 years. They were treated with NF in the Neuromedica Institute in Krakow, in the period 2005-2015. Treatment time ranged from 6 months to 3 years. We have evaluated the incidence of seizures before and after NF therapy. Visual analysis of EEG recordings with assessment of background activity, location of focal changes, presence of paroxysmal pattern and epileptic graphoelements. RESULTS: In 41/78 children seizures occurred 1-2 times a month, in 19/78 every day and 9 children were diagnosed with epileptic syndrome. During NF therapy 52/78 children experienced resolution of clinical seizures. NF therapy was ineffective in only one child. In 18 child withdrawal of antiepileptic treatment was achieved and in 22 reduction of drug doses. Epileptic graphoelements occurred in 46/78 children before treatment and in 21/78 children after treatment. Before NF therapy irregular bio-electrical activity was found in 51 children versus 27 children with regular bioelectric activity and in 27 children versus 51 children after the therapy. The amplitude of this activity returned to normal in 19 children, and in 29 children the frequency of background activity. Particularly surprising was to restore synchrony and symmetry of EEG pattern in 44 children (11 children before NF treatment to 55 children after the treatment). Even more significant effect of NF therapy was observed in EEG patterns, abolition of paroxysmal pattern and reduction of continuous, localized and generalized changes. NF therapy also advantageously reduced the number of localized changes and decreased sensitivity of EEG pattern to hyperventilation and photostimulation. CONCLUSIONS: During NF therapy in almost all children with epileptic partial seizures and secondarily generalized seizures resolution or reduction of clinical seizures was observed. In nearly 1/4 of children withdrawal of antiepileptic treatment was achieved and in higher number reduction of pharmacotherapy. All parameters of the background EEG bioelectric activity in these children have improved, especially synchrony and symmetry of EEG pattern and paroxysmal changes subsided.

Dilatation of Virchow-Robin spaces in children hospitalized at pediatric neurology department.

BACKGROUND AND PURPOSE: Dilated Virchow-Robin spaces (dVRs) have been revealed by magnetic resonance imaging (MRI) in patients with various neurological disorders. However, their etiology and clinical importance have not been discovered yet. The aim of the study was to estimate dVRs occurrence in hospitalized children and determine dVRs localization and their association with different nervous system diseases. MATERIAL AND METHODS: Contrast-enhanced brain MRI examinations with the use of 1.5T GE device were performed in children with different diseases of nervous system, who were hospitalized at Pediatric Neurology Department, Chair of Children and Adolescent Neurology, Jagiellonian University in the years 2010-2011. The mean age of examined children was 11.58 years, and the studied group included 27 boys and 26 girls. RESULTS: Within two years, MRI examinations of the brain were performed in 1348 children and dVRs were found in 53 of them (3.93%). Among children with dVRs, 15 were diagnosed with headache (28.3%) and 18 with epilepsy (33.96%). Other diagnoses were less frequent and occurred in 37.7%. Generalized dVRs and those localized in the subcortical nuclei were most frequently found. CONCLUSIONS: Higher incidence of dVRs was found in children with headache and epilepsy. No association was found between localization of dVRs and symptomatology of different nervous system diseases except for large dVRs probably due to the pressure on the surrounding tissues.

Neurofeedback therapy in patients with acute and chronic pain syndromes--literature review and own experience.

Pain management is based mainly on pharmacotherapy which has many limitations. Non-pharmacological techniques, like neurofeedback (EEG-biofeedback) are alternative methods of pain treatment. Data from literature confirm high efficacy of neurofeedback in pain syndromes treatment, chronic and acute as well. Neurofeedback plays an important role in management of post stroke, post traumatic headaches and in primary headaches like tension type headaches or migraine. Literature review and own experience indicate importance of number and frequency of performed neurofeedback trainings on treatment effectiveness. Satisfactory results have already been observed after 30 trainings however usually 40-60 training have to be performed. Effectiveness of such therapy in pain syndromes is usually good or less often acceptable (50% reduction of headaches). Children with tension type headaches (differently than adults) need reminder therapy every 6-12 months, otherwise recurrence of headaches is observed. Based on our own experience neurofeedback therapy seems to play role in neuropathic pain and cancer pain management.

Neurofeedback therapy in patients with non pain syndromes of chronic and paroxysmal character-literature review and own experience.

Neurofeedback has been used in treatment of many other than pain clinical syndromes. This group includes chronic as well as paroxysmal syndromes previously treated pharmacologically. However due to non satisfactory results of this treatment introduction of non-pharmacological therapy has been examined. Observations from our 9-year experience of neurofeedback therapy used in children and adult patients with epilepsy, Asperger syndrome, depression, neurosis, personality disorders, drug addiction and other (not pain) syndromes have been presented in this paper. Positive influence of neurofeedback therapy on symptoms intensity, frequency, duration and social relations of treated patients has been confirmed by our own and other authors observations. Neurofeedback therapy has been tried by patients with other difficult life problems and has been effective in some of them. The effectiveness of the therapy has been confirmed by patients, their relatives and also by neurophysiological results. Additionally, preliminary results of neurofeedback therapy used in management of computer addiction in children and adolescents have been presented herein.

Level of S100B protein, neuron specific enolase, orexin A, adiponectin and insulin-like growth factor in serum of pediatric patients suffering from sleep disorders with or without epilepsy.

BACKGROUND: Paroxysmal sleep disorders in children are important from both pathophysiological and clinical point of view. Correct diagnosis is crucial for further management. The aim of the present study was to identify peripheral markers of paroxysmal sleep disorders in children, which could improve diagnostics of these disorders. We compared serum levels of several putative biomarkers of neurological disorders, such as S100B protein, neuron specific enolase (NSE), orexin A, adiponectin, and insulin-like growth factor 1 (IGF-1) in pediatric patients suffering from sleep disturbances with those who additionally to parasomnia revealed also epilepsy. METHODS: Fifty six children from 1 month to 18 years of age hospitalized in the Pediatric Neurology Clinic, Chair of Children and Adolescent Neurology, participated in this study. Polysomnographic diagnostics was indicated due to sleep disturbances. Examination was performed with the use of polysomnography and videoelectroencephalography Grass device. Blood samples were taken before registration of sleep, after 2.5 h of sleep or 0.5 h after occurrence of clinical seizures. Concentrations of S100B protein, NSE, orexin A, adiponectin, and IGF-1 were measured by specific ELISA methods. RESULTS: The obtained data showed that serum S100B level was significantly increased in children with epilepsy and clinical seizure attacks as compared to patients with parasomnia only. Atendency to enhanced serum S100B level was also seen in epileptic children without clinical seizures during polysomnographic recording. The level of orexin A was significantly decreased in epileptic children without seizures as compared to the hormone level in parasomnic patients, but was elevated in patients who experienced seizures during polysomnographic examination. As S100B is regarded to be a marker of blood brain barrier leakage and astrocyte damage, the data suggest an increase in BBB permeability in epileptic children, especially during seizure fits. Furthermore, the enhanced S100B serum level without changes in NSE activity may be interpreted rather as an evidence of the elevated secretion of this protein during seizures than of the damage of brain tissue. In contrast to S100B and orexin A level, serum concentration of adiponectin and IGF-1 as well as NSE activity did not significantly differ between the studied groups. CONCLUSION: Out of the five putative biomarkers measured, blood concentration of S100B and orexin A may be helpful in differentiating parasomnic pediatric patients with and without epilepsy.

[Neurofeedback and personal development]. / Neurofeedback a rozwój czlowieka.

BACKGROUND: Development of neurofeedback was preceded by development of classical and quantitative EEG, construction of computer devices, programmes and individual medical protocols. METHODS: The basic rule of this method is to achieve effective change of rhythm and power of brain bioelectric activity based on knowledge of normal activity and identification of abnormalities of present activity. Various types of disturbed activity occur in many syndromes and brain development disorders. Training process is characterized by repetitive local activation of chosen brain structures as well as by general activation. Moreover, this method enables monitoring of emotional and social development. In accordance with disorders pathogenesis consecutive technical modules of this method are being introduced. RESULTS: Neurofeedback has been used in the treatment of post traumatic stress disorder, sequels of stroke and head trauma, emotional, anxiety disorders and depression. Good results of this neurotherapy have been also found in children with ADHD/ ADD, developmental dyslexia, tics and Tourette syndrome, learning difficulties and development disturbances and acquired speech disorders. It has been also used with a success in treatment of headaches, epilepsy and chosen disturbances in cerebral palsy. SUMMARY: Neurofeedback as a method of instrumental therapy of CSN is now undergoing thorough evaluation. New requirements that place further demands on the quantitative bioelectric activity estimation when qualification for the treatment is performed and on the elaboration of therapy results as a material for future meta analysis.

Clinical and videoEEG findings in a girl with juvenile moyamoya disease.

Moyamoya disease is present throughout the course of development, including juvenile development. Very careful EEG analysis may be a diagnostic method in such cases where clinical symptoms are not sufficient for diagnosis. Herein, we report a Polish case of moyamoya disease in a 13-year-old girl with polymorphic clinical symptoms. Even though her diagnosis was made late in the course of her disease, it was due to successful EEG analysis and not due to clinical symptoms that a diagnosis was made at all. Re-build up phenomenon was registered as well as an asymmetric slowing in background activity. High-voltage slow frontal and generalized activity was seen during hyperventilation.

CNS Lyme disease manifestation in children.

BACKGROUND: Neurological symptoms develop in 10-20% of children with borreliosis. AIM OF THE STUDY: It was a presentation of clinical manifestation of neuroborreliosis in children. MATERIAL AND METHODS: Children with neuroborreliosis and other neurological diseases were admitted to the University Hospital during 2005-2006 without any selection. Of these 9 patients, there were seven males and two females, ranging in age between 3-17 years. Neurological diagnostic was performed using ELISA Biomedica kit and western blot bands. A 2-6 week sequential treatment with either i.v. ceftazidime or amoxicillin and oral doxycycline or amoxicillin was provided. Children were monitored regularly during the next 4-24 months. RESULTS: The 9 children with borreliosis constitute 0.53% of the pediatric neurology department's patients. The clinical manifestation of LD were usual and unusual from patient to patient. They included three cases of facial nerve paralysis (with bilateral paralysis in one case). In two cases, they included transverse myelitis and in a single case, hemiparesis, meningitis and acute ataxia. Typically, other patients with early stage borreliosis first manifest focal seizures, raising the suspicion that borreliosis could be responsible for triggering seizures. The antibiotic treatment was successful in 7 patients and only partially effective in 2 children with facial nerve paralysis. CONCLUSIONS: The most common symptom of neuroborreliosis in children is motor dysfunction. Acute ataxia may be a clinical presentation of neuroborreliosis. It is probable that borreliosis_triggers seizures in children with EEG abnormalities.

[MRI brain imaging data in children with cavum septi pellucidi and vergae]. / Wyniki obrazowania MR mózgu u dzieci z jama przegrody przezroczystej i vergi.

BACKGROUND: Cavum septum pellucidum (CSP) is commonly known marker of neurodevelopmental brain malformation. In MR imaging it is seen either as an isolated finding or with association of others developmental brain changes e.g. cavum vergae (CV). AIM OF THE STUDY: was to assess the frequency of CSP and CV associated with others brain developmental malformations in children. We also classified clinical syndromes in children with these structural brain malformations. MATERIAL AND METHODS: The study was performed on 55 children, hospitalised in the Department of Pediatric Neurology, Jagiellonian University in Krakow, between 1998-2006 with diagnosed CSP and/or CV in MRI. There were 29 girls and 26 boys aged 4 months-16 years old. Clinical history, clinical status and neurological findings in physical examination were main indication to perform brain MRI. MRI scans was done in SE T1, FSE T2, PD, FLAIR, IR T1 sequences, 3 and 5 mm depth, in vertical, frontal and axial surfaces, performed on 1,5 T machine Signa Horizon HiSpeed General Electric. RESULTS: There were 38 children with CSP, 12 children with CSP and CV, and 5 with CV. In 18/55 children (33%) CSP was isolated, but in 37/55 children (67%) CSP was coexisted with other brain structural malformations. The average age of diagnosis in isolated CSP was 10 years old, in coexisting malformation was 5 years. In half of the children, the reason of neuroimaging was epilepsy, in this 6/18 patient with isolated CSP or CV. 58% of the study group had a normal mental development, but 35% of children with additional brain malformation and 11% of children with isolated CSP and CV were mentally retarded. CONCLUSION: 1. The majority of the children with CSP and CV had also coexisting brain malformations diagnosed in MRI. 2. CSP and CV coexisting with large brain malformation e.g. dysplasia septo-optica and agenesis of corpus callosum. were diagnosed earlier. 4. Mental retardation was diagnosed in 1/3 children with different structural brain malformation but also in 11% of children with CSP and CV as well.

[MRI and MRA data in children with migraine with aura]. / Wyniki badan MR i MRA u dzieci z migrenq z aura.

INTRODUCTION: One of indications to perform structural MRI and MRA is migraine with aura. Results may influence migraine management. THE AIM: THE AIM of this study was an assessment of MRI and MRA results in children with symptoms of migraine with aura and also the analysis if MR results influence migraine management. MATERIALS AND METHODS: During the year 2006, 20 children with migraine were hospitalized in the Department of Pediatric Neurology Jagiellonian University Krakow. There were 11 girls and 9 boys, aged 6-18 years (mean 13,7 years) with symptoms of migraine with aura. In 12 of them visual, in 9 sensory, in 6 dysphasic and in 3 motor aura was present. In 7 children two or more aura types coexisted. In 9 cases family history of migraine was positive. MRI was performed in all children, while additional MRA in 18 children and digital cerebral angiography in 1 of them. MRI was performed in SE T1, FSE T2, PD, FLAIR and IR T1 sequences with 3 or 5 millimetre thickness of slices, in the sagital, coronal and transversal plane, using a 1,5 T system (HiSpeed GE). 3D TOF techniques were used to perform MRA. RESULTS: Results of MRI were normal in 11/20. In other children brain pathology was detected, within lateral ventricular asymmetry (2), demyelination (2), dilatation of CSF spaces (2) and vascular malformation (2). Isolated pathology, such as a calcification of the pineal gland and focal demyelination of vascular origin were detected in individual children. MRA in 16 children did not revealed pathology, however in 2 other children slight asymmetry of distal insular branches of middle cerebral arteries was detected. Aneurysm of the right anterior communicans artery was suspected in one child and it was confirmed by MRA. In one case digital angiography confirmed described on MRI result left vertebral and cerebral posterior arteries hypoplasia and also revealed collaterals in the posterior skull cavity. CONCLUSIONS: Detection of vascular pathology in 20 % of patients with migraine with aura using MRI and MRA is an argument to perform both examinations in such patients.

[Brain MRI data in children with so called primary generalized seizures]. / Wyniki neuroobrazowania MR mózgu u dzieci z napadami padaczkowymi okreslanymi jako pierwotnie uogólnione.

INTRODUCTION: Diagnosis of primary generalised seizures may be not precise because difficulties exist with the assessment of information of focal onset of these seizures. THE AIM: The aim was to examine if the careful searching for partial component of seizures is necessary in children with so called primary generalized seizures. MATERIAL AND METHODS: The examined group included 45 children aged 6 month to 18 year (mean 11 year) within 19 girls and 26 boys, hospitalized during the year 2006 in the Department of Pediatric Neurology UJ CM in Krakow. The history indicated the primary generalized character of seizures. The tonic-clonic seizures were observed in 39 children, myoclonic in 3, infantile spasms in 1 and absence in other 2. In 6 patients familiar epilepsy was diagnosed in first-degree cousins. Neuropediatric examination was normal apart from 4 children with dysmorphic features of the face. Intellectual development was normal in 43 children, however it was close to the lower range in one and mildly delayed in the other one. Generalized paroxysmal bioelectric activity was detected in 43 children and in 2 children EEG pattern was normal. MRI was performed in SE T1, FSE T2, PD, FLAIR and IR T1 sequences with 3 or 5 millimetre thickness of layer in the sagital, coronal and transversal plane, using a 1.5 T signa horizon HiSpeed General Electric. These examinations were performed in the Voxel MR Laboratory in University Children's Hospital in Krakow. RESULTS: MRI results were normal in 14/45 children and in others pathological. In 9/45 MR revealed subarachnoidal cyst, in 8 lateral ventricles asymmetry, in 5 mild demyelination, in 9 subarachnoid space and lateral ventricles dilatation. In 2/45 children brain tumors (hamartoma of the hypothalamus and DNET of the temporal lobe), in 1 gliosis of the occipital lobe were revealed, however other insignificant changes were also observed. Dual or multiple MRI pathology was revealed in 14 children. In17/45 children abnormalities were localized. CONCLUSIONS: Existence of focal pathology in MRI of 38% children with the history of so called primary generalized seizures suggested the necessity of more careful searching for partial component of seizures.

Pseudo-epileptic seizures in children are not associated with enhanced plasma level of allopregnanolone.

Among neurosteroids, allopregnanolone is the most potent endogenous positive modulator of GABA(A) receptors, and disturbances in its release may play a role in pathomechanism of some neurological and psychiatric disorders. In contrast to a large body of evidence on allopregnanolone involvement in pathogenesis of epilepsy, no data are available on its role in pseudoseizures. Therefore, the aim of the present study was to find out whether pseudoseizures are associated with changes in plasma allopregnanolone level in pediatric patients. This study was carried out on 45 children with video EEG-diagnosed pseudoseizures, divided into three groups according to results of placebo test i.e: (I) children with pseudoseizures attacks without antiepileptic drug treatment; (II) children with pseudoseizures attacks and treated with antiepileptic drugs; (III) children without pseudoseizures attacks and no treatment. Allopregnanolone level was estimated by radioimmunoassay in blood samples collected before and after provoking pseudoseizures by placebo. No significant changes have been found in allopregnanolone level between all experimental groups. This suggests that in contrast to epileptic seizures, during pseudoseizures no compensatory increase in the endogenous antiepileptic and anxiolytic neurosteroid release occurs. The low level of allopregnanolone may have a detrimental effect on GABAergic inhibitory system in the brain aggravating stress response and promoting pseudoseizure occurrence. On the other hand, the clinical value of allopregnanolone plasma level as a biomarker distinguishing between epileptic and pseudoseizures remains questionable due to its high inter-individual differences.

[Paranasal sinus involvement in children with central nervous system disease]. / Zajecie zatok przynosowych u dzieci z chorobami osrodkowego ukladu nerwowego.

BACKGROUND: Paranasal sinus involvement in the developmental age can be clinically uncharacteristic, and therefore it is commonly diagnosed accidentally with other diseases. Not all cases of such sinusitis need otolaryngologic treatment. THE AIM OF THE STUDY: Was to assess the real prevalence of sinus involvement imaging in head MR scans diagnosed in children with neurological diseases and to describe the need of laryngological therapy in these cases. MATERIAL AND METHODS: During the period of 16 months (01.2005-04.2006) 393 MR imaging was done in children hospitalized in the Department of Child Neurology, Jagiellonian University. The study was performed in 77 children with MRI changes, aged between 1,5 to 18 years old. The MR imaging (SE T1, FSET2, PD, FLAIR, IR T1, 3 and 5 mm thickness of layers in frontal, horizontal, sagittal surfaces) were performed on 1.5 T Signa Horizon HiSpeed General Electric machine. EEG, videoEEG, ophtalmologic, laryngologic, dentist's, neuropsychologic, analytic, immunologic and biochemical assessment were done. The MRI results were analyzed by otolaryngologist, and they were compared with basic neurologic diagnosis and treatment. RESULTS: Sinus involvement was diagnosed in 20% of children with neurologic diseases. In 77 children were found 125 pathologic changes, predominated (91%) by mucosal edema. In over half of the study group there were no correlation of the sinus changes and neurologic diagnosis. In 62% of children in this group none type of treatment was used, in 20% of patients the antiinflammatory therapy and in 18% the sinusotomy was proposed. CONCLUSIONS: In most of the children with neurologic diseases and with paranasal sinus involvement diagnosed in MRI, the laryngologic treatment was not necessary, however 38% cases needed it.

[Assessment of EEG in children with partial epilepsy]. / Ocena znaczenia badania elektroencefalograficznego w padaczce czesciowej u dzieci.

INTRODUCTION: Diagnosis of the focal epilepsy is possible even based on the clinical history. More precise identification of bioelectrical focus, type of epileptic attack and type of epilepsy requires EEG or videoEEG analysis. AIM OF STUDY: The aim of the study was to assess clinical value of electro-encephalography and videoelectro-encephalography in diagnostics of partial epilepsy in children. MATERIAL AND METHODS: The study group consisted of 140 children with partial epilepsy hospitalized between 1998 and 2004 in Department of Pediatric Neurology, Jagiellonian University, Krakow. The group included 70 girls and 70 boys, aged from 2 months to 17 years. 38 of the children were older than 5 years, with mean age 8 years and 4 months. The mean time of the epilepsy course was 2 years and 4 months. Children with symptomatic partial epilepsy were the biggest group and children with idiopathic partial epilepsy were in minority. More than 50% of children suffered from complex partial seizures. Statistical correlation of the EEG results and pregnancy and birth period factors, results of neurological and psychological examination was performed. All children underwent MRI and 15 HMRS neuroimaging as well. All children underwent EEG examinations and 55 children videoEEG, recording time 60 minutes for each patient. Sleep recording in 40 children, awake EEG in 93 children and both type recordings in 8 children were performed. Stroboscope, hyperventilation and sleep deprivation stimulation tests were used. All EEG recordings were assessed by 2 physicians with the EEG license and final result was a mean of their assessment. T-student test, Mann-Whitney and bilateral Fisher test were used in statistical analysis. RESULTS: EEG pattern was abnormal in 139/140 children, and videoEEG in all 55 children. In the vast majority of the patients with partial epilepsy focal EEG changes were recorded (in 111/140), with a significant prevalence of unilateral changes observed in 48/111 patients. 34 children had focal EEG changes with one-site prevalence and 27/140 children had focal EEG changes in both hemispheres without any prevalence. Generalized EEG changes were revealed in 16/140 children. Hyperventilation revealed in 8 children paroxysmal bioelectric activity and in 43 enhanced abnormal EEG pattern. In all children with normal MRI imaging EEG/videoEEG methods revealed changes significant for localization of seizures onset and origin. CONCLUSIONS: (1) EEG patterns in children with partial epilepsy were dominated by localized and lateralized changes. EEG was crucial for localization of bioelectric foci especially in children with normal MRI. (2) Focal EEG changes were significantly more often in children with hippocampal sclerosis. (3) In terms of localization HMRS were more compatible with EEG than with MRI findings. HMRS examination is strongly indicated especially in children with EEG localized discharges and with normal brain MRI.

[Videoelectroencephalography in children with paroxysmal events]. / Wideoelektroencefalografia w stanach napadowych u dzieci.

The paper presents the crucial role of video EEG, modern diagnostic method, which allowed synchronized recording of clinical status and EEG pattern of the patient. This method gives the possibility to compare these two parameters in term of paroxysmal events. Video EEG allows to diagnosed clinical events associated with bioelectrical discharges (epilepsy), recording of bioelectrical events without clinical seizures, diagnosing clinical attacks without bioelectrical discharges (pseudoseizures) and nonepileptic events (without epileptic character in video and EEG). This method is very useful especially in children and adolescents because of huge polymorphism of clinical signs, more common ambiguous diagnosis in this age and due to heterogeneity of bioelectrical brain function in children. Video EEG monitoring gives the possibility for clinical and electro-physiological interpretation of paroxysmal events and plays a crucial rule in localizing of epileptogenic focus, classification of the seizure, epilepsy type or syndrome. The role of suggestion and placebo is important in diagnosing psychogenic pseudoseizures. The duration of video EEG recording is differentiated and much more shorter in diagnosing the type of the event. Prolonged monitoring is needed in children with drag resistant epilepsy and in pre-operation evaluation.

[The role of videoelectroencephalography in diagnostics of seizures in neonates and infants]. / Znaczenie wideoelektroencefalografii w diagnostyce stanów napadowych okresu noworodkowego i wczesnoniemowlecego.

OBJECTIVES: The clinical characteristic of attack is frequently difficult to unequivocal establishment by observation. It refers especially to seizures in youngest children, due to complicated attack morphology. VideoEEG as a diagnostic tool makes possible more precise establishment of seizures type and derivation. THE AIM: The aim of this analysis was to establish an importance of videoEEG for the differentiation of epileptic and non-epileptic attacks in neonates and youngest infants. MATERIALS: 20 children, 10 girls and 10 boys from the Neurological Division, the Neonatal Intensive Care Unit, the Intensive Care Unit, and the Division of Cardiology, admitted for examination between the 2000 and 2004 years in the Lab of Clinical Electrophysiology of the Department of Pediatric Neurology were included. The age of children, including 7 neonates, was at the moment of examination between 3 and 10 weeks. The first attack occurred between the first day of life and 7th week. In 15/20 of children features of encephalopathy were present. METHODS: The videoEEG recordings were provided in identical conditions, including place and personnel as well, using apparatus PL. 270 video option MedtronicDantec and camera Samsung with movable focus. The visual analysis was provided by two licensed in electrophysiology physicians and results were averaged. RESULTS: In 15/20 children clinical attacks were registered, including stereotypical seizures in 7 children and polimorphic seizures in 8 children. The most frequent attacks were apneic (11/ 20) and the registered seizures were generalised tonic (6/20) and focal (5/ 20). In 5 children attacks were not registered during examinations. In 2 children of this group the bioelectrical activity was also unchanged, whereas in 3 children the significant pathology was detected. Among 15 children with registered in videoEEG attacks, in 9 children ictal discharges were recorded, in 2 children burst-suppression discharges and in the remaining 4 children ictal changes of bioelectrical activity were not recorded. Interictal activity similar to ictal was detected in 2 children with burst-suppression discharges only, and in other cases it was differentiated. 2 of 4 children without discharges during attacks had also normal interictal activity, whereas in the remaining 2 children the immature low voltage flat activity was recorded. Among 9 children with ictal discharges, in 5 children interictal discharges were detected as well, whereas in 2 children only low-voltage activity with pathological features of sleep was detected, but in 2 children interictal activity was normal. The results of videoEEG and other tests allowed to recognized nn epileptic attacks in 5 children, probably epileptic in 1, epileptic seizures in 8 and epilepsy with genetic and hypoxic-ischaemic disorders in 6 children. CONCLUSION: The videoEEG allowed to register clinical seizures in the majority of youngest children with paroxysmal events, contributing to the diagnosis of tonic and polimorphic seizures and to the correct classification of apnoea. In 25% of children with and without registered clinical attacks, this examination allowed to diagnose non-epileptic attacks. To establish epilepsy, the ictal changes of bioelectrical activity were important and interictal as well.

[Proinflammatory cytokines in children with migraine with or without aura]. / Cytokiny prozapalne u dzieci z migrena z aura i bez aury.

OBJECTIVES: Migraine is an idiopathic headache of differential pathogenesis. THE AIM: The aim of this research was to establish whether the pathogenesis of migraine with or without aura is identical. In order to examine this, the differences in the level of interleukin-6 (IL-6), interleukin-1beta (IL-1beta), tumor necrosis factor (TNF) and soluble TNF receptor type I (sTNFRI) were established during a migraine attack with or without aura in children. MATERIALS AND METHODS: 30 children with migraine were included, 17 boys and 13 girls aged 10-17 (mean 13.5). In 14/30 children migraine without aura was diagnosed, in 16/30 with aura, visual in 12 and sensory in 4 children. The headache duration was in 23 children shorter and in 7 children longer than 6 hours. When the pain started during hospitalization, the blood was sampled in the first hour of the headache, then 3 hours and 6 hours since headache started (if headache persisted), and 6 hours after its termination. Two days after pain termination, the blood samples were collected, as the headache-free measurements. The levels of IL-6, IL-1 beta, TNF and sTNFRI were established using Biosource kits, all 146 samples were processed. The statistical assessment was conducted. RESULTS: The significant differences in cytokine levels were detected between children with migraine with or without aura. During headache-free interval in children without aura the level of IL1-beta was higher than with aura (p = 0.03), during 1st hour of migraine attack as well (p = 0.046). Higher, but non significant was IL-1 beta level 3 hours since headache started and 6 hours after its termination (p = 0.06). Type of migraine influenced also the TNF level (in children with migraine without aura higher 6 hours after pain termination, p = 0.046) and sTNFRI (p = 0.07 during the same period). The differences in IL-6 levels between children with migraine with or without aura were not significant. CONCLUSION: 1. The significant increase in IL-1beta level observed during headache-free interval and early stage of attack of migraine without aura as compared to migraine with aura may reflect differences in pathogenesis of both types of migraine in developmental age. 2. This dissimilarity may be suggested also by the increase in TNF and sTNFRI levels in children with migraine without aura as compared to children with migraine with aura after pain termination.

[Consequences of thallium poisoning in adolescent]. / Nastepstwa zatrucia talem u mlodocianego.

INTRODUCTION: Thallium poisoning appears very rare in developmental age and its consequences are quite different. The aim of this study was to characterised the course of thallium poisoning in adolescent and especially electroneurophysiological consequences of it. PATIENT AND METHODS: In a 15 year old boy with sensory-motor polyneuropathy thallium poisoning was recognised in the third week duration of the symptoms. Hemodialysis and hemodiaperfusion were used in the therapy. Data of the repeated electroneurographic and videoEEG examinations were collected. RESULTS: First electroneurographic data showed axonal motor polyneuropathy. Control after 1 year presented the largest form of the motor-sensory polyneuropathy. On videoEEG tape rejestered in the 5th month of clinical symptoms of poisoning, present were tonic seizures (although EEG pattern was flat with short low voltage theta activity). After next the 3 months of encephalopathy and phenobarbital therapy, voltage of the EEG pattern was slightly higher without any background and seizure activity. CONCLUSIONS: Thallium poisoning may result with catastrophic clinical consequences of polyneuropathy and encephalopathy. Electroneurographic and electroencephalographic changes 1 year after indicate that clinical consequences of the poisoning are un-remediable.