[Patient with fetal alcohol spectrum disorder]. / Patiënte met foetale alcoholspectrumstoornis.

FETAL ALCOHOL SPECTRUM DISORDERS (FASDS) IS A CONDITION THAT IS PROBABLY OFTEN MISSED. THIS SYNDROME IS BASED ON FEATURES IN FOUR DOMAINS: 1. REDUCED HEIGHT AND WEIGHT GROWTH, 2. SPECIFIC FACIAL FEATURES, 3. PREDISPOSED CENTRAL NERVOUS SYSTEM ABNORMALITIES (INCLUDING MICROCEPHALY) OR FUNCTION (NEUROLOGICAL, PSYCHOLOGICAL AND/OR BEHAVIORAL PROBLEMS) AND 4. (SUSPECTED) PRENATAL ALCOHOL USE BY THE MOTHER. DUE TO PSYCHIATRIC AND BEHAVIORAL PROBLEMS PATIENTS MAY ALSO BE SEEN IN SPECIALIZED MENTAL HEALTH CARE. TO INCREASE THE CHANCE THAT THESE PATIENTS WILL RECEIVE AN APPROPRIATE AND EFFECTIVE TREATMENT, AWARENESS OF THIS SYNDROME IS ESSENTIAL. WE DESCRIBE THE CLINICAL PICTURE ON THE BASIS OF A CASE DESCRIPTION, PROVIDE RECENT LITERATURE AND FORMULATE RECOMMENDATIONS FOR CLINICAL PRACTICE.

Reading performance in children with rolandic epilepsy correlates with nocturnal epileptiform activity, but not with epileptiform activity while awake.

OBJECTIVE: An association between language impairment and rolandic epilepsy is frequently reported. This impairment could be correlated with the amount of nocturnal epileptiform activity. METHODS: We retrospectively analyzed 26 children with rolandic epilepsy and/or rolandic spikes. All had undergone a 24-hour EEG and neuropsychological assessment within 2 weeks. Reading performance (reading words and sentences) and intelligence were measured. RESULTS: There was a significant negative correlation between amount of nocturnal epileptiform activity and reading sentences R=-0.525 (P=0.008). There was a trend in this correlation for reading words R=-0.398 (P=0.054). We found a negative correlation between amount of nocturnal epileptiform activity and Verbal IQ (R=-0.51 P=0.08). No correlation was found between reading performance or Verbal IQ and amount of diurnal epileptiform activity. CONCLUSIONS: Reading performance is impaired in children with rolandic epilepsy and is correlated with the amount of nocturnal epileptiform activity.

Impaired language performance as a precursor or consequence of Rolandic epilepsy?

OBJECTIVES: A correlation between language impairment and Rolandic epilepsy is frequently reported. It is unknown whether this language impairment develops gradually as a consequence of Rolandic epilepsy or precedes the onset of seizures. In the latter case both language impairment and Rolandic epilepsy may be symptoms of an underlying syndrome or both develop during the process of epileptogenesis. METHODS: Non-comparative clinical cohort study of 48 children with Rolandic epilepsy (children's mean age is 9 years, and 7 months; SD is 1 year, and 8 months). They were screened for previous and current language impairment and their reading skills were examined. RESULTS: 23% of children with Rolandic epilepsy had speech therapy in the past and 35% repeated a year on primary school, which is more often compared to the Dutch population of children. Their results on a reading task revealed lower scores. CONCLUSIONS: Language is impaired in children with Rolandic epilepsy. In some children this impairment of language may even be a precursor, for the Rolandic epilepsy. It is undecided however, whether the language impairment develops gradually after the onset of epilepsy, whether Rolandic epilepsy and language impairment are both symptoms of an underlying syndrome or both develop during the process of epileptogenesis as we observed in some children the onset of language impairment before the onset of epilepsy.

Nocturnal epileptiform EEG discharges, nocturnal epileptic seizures, and language impairments in children: review of the literature.

This review addresses the effect on language function of nocturnal epileptiform EEG discharges and nocturnal epileptic seizures in children. In clinical practice, language impairment is frequently reported in association with nocturnal epileptiform activity. Vice versa, nocturnal epileptiform EEG abnormalities are a common finding in children with specific language impairment. We suggest a spectrum that is characterized by nocturnal epileptiform activity and language impairment ranging from specific language impairment to rolandic epilepsy, nocturnal frontal lobe epilepsy, electrical status epilepticus of sleep, and Landau-Kleffner syndrome. In this spectrum, children with specific language impairment have the best outcome, and children with electrical status epilepticus of sleep or Landau-Kleffner syndrome, the worst. The exact nature of this relationship and the factors causing this spectrum are unknown. We suggest that nocturnal epileptiform EEG discharges and nocturnal epileptic seizures during development will cause or contribute to diseased neuronal networks involving language. The diseased neuronal networks are less efficient compared with normal neuronal networks. This disorganization may cause language impairments.