QEEG findings in nonsyndromic sagittal craniosynostosis.

Despite the undertaken treatment, children with nonsyndromic sagittal craniosynostosis (NSC) are burdened with problems with speech development, visuospatial and other cognitive deficits. The electroencephalographic assessment has not influenced the diagnostics and treatment strategy of craniosynostosis so far but the introduction of quantitative EEG (QEEG) protocols renewed an interest in the functional aspect of this disease. In this study we retrospectively assessed the QEEG records of 25 children with NSC aged 1-18 months (mean age 9.62 months) before and after surgery. In each case, the amplitude, interhemispheric (ICoh) and intrahemispheric (HCoh) coherence indices were calculated. Obtained data were compared to age-matched control group of 25 normocephalic children. Children with NSC presented significantly lower values of amplitudes and intrahemispheric coherence in occipital, posterior parietal and posterior temporal regions than normocephalic children. The values of amplitudes, ICoh and HCoh in pre- and postoperative QEEG records mostly remained unchanged, with a slight improvement in HCoh in centro-parietal area. These findings suggest that NSC children present their own QEEG profile. The operative treatment improves an intrahemispheric connectivity, but there still exists a significant difference in the occipitotemporal, frontotemporal and centro-frontal areas, which may be considered as a functional substrate of reported speech and neurocognitive problems. QEEG findings in nonsyndromic sagittal craniosynostosis.

Photo-Dependent Reflex Seizures-A Scoping Review with Proposal of Classification.

Children and adolescents are the largest at-risk group for the appearance of reflex seizures or epilepsy syndromes with a photoparoxysmal response. The aim of this study was to present an overview of the literature regarding photo-dependent reflex seizures. Epilepsy with seizures provoked by intermittent light stimulation is a distinct group of epilepsies; therefore, we focused on reflex seizures provoked by different factors whose common feature is the patient's response to intermittent photic stimulation. A qualitative search of PubMed/MEDLINE, Scopus, EBSCO, and Cochrane Library electronic databases for selected terms was carried out for scientific articles published up to May 2020 outlining the outcomes of control, observational, and case studies. This scoping review was developed and followed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The review of the qualitative evidence for the synthesis of photosensitive epilepsy allowed us to distinguish the following categories: light-induced seizures and light-deprived seizures. Differentiating between intermittent photic stimulation-related epilepsy syndromes and seizures is essential in order to determine the length of appropriate treatment. Photo-dependent reflex seizures make up the majority of this type of disorder among reflex seizures. Since there are many seizures provoking factors in the world around us, it is important to distinguish amongst them in order to be able to protect the patient exposed to this factor. It is recommended that the photostimulation procedure be performed during a routine electroencephalogram study.

Terrorism's Impact on Mental Health Outcomes among Directly and Indirectly Exposed Victims and the Development of Psychopathology.

After the events of 9/11, many police-responders developed post-traumatic stress disorder (PTSD) and were potentially vulnerable to developing depression and/or anxiety; in addition, nearly half of police with probable PTSD had comorbid depression and anxiety. Having in mind that victims who experience the effects of terrorism are exposed to high levels of psychological damage, we thus aimed to determine how sequelae of a terrorist act directly and indirectly affect victims. Quantitative synthesis findings were concluded on the basis of 200 records that met the inclusion criteria out of a total of 650. We grouped the patients according to their level of exposure to the WTC terrorist attack on 11 September 2001. The Level I group included individuals who had experienced the traumatic event and/or those who had observed the attack. The Level II group consisted of rescuers and/or persons who cleaned up debris in the area after the attack. The Level III group comprised the victims' families. Our research enabled us to create a profile for those who were most vulnerable to mental disorders after the WTC terrorist attack. Patients who had survived the terrorist attack and/or those who had observed the incident exhibited fewer traumatic symptoms and a lower percentage of suicidal thoughts in comparison to individuals who had worked as rescuers or cleaning staff in the area after the attack. The number of symptoms rose along with increased contact time with the stressor. The dominant symptom was the triad of intrusion, avoidance, and hyperarousal. The findings may confirm the positive effect of protracted court cases in legal proceedings for compensation on the maintenance and development of psychopathology. Our research may contribute to a better understanding of the consequences of terrorism outcomes on the human psyche and be used in the development of standards for dealing with victims of terrorism's impact.

Adverse Mental Health Sequelae of COVID-19 Pandemic in the Pregnant Population and Useful Implications for Clinical Practice.

The COVID-19 pandemic has increased risk of disturbances in the functioning of everyday life, directly or indirectly has influenced the risk of mental disorders in the most vulnerable populations, including pregnant women. The aim of this study was to analyze adverse mental health effects in the pregnant population during the COVID-19 pandemic, investigate risk factors for adverse mental health outcomes, identify protective factors, and create practical implications for clinical practice, bearing in mind the need to improve perinatal mental healthcare during such pandemics. Qualitative research was conducted in the electronic databases PubMed and Web of Sciences for the keywords COVID-19, pregnancy, depression, anxiety, and telemedicine for relevant critical articles (n = 3280) published from 2020 until October 2021, outlining the outcomes of control studies, meta-analysis, cross-sectional studies, face-to-face evaluation survey studies, remotely administered survey studies, and observational studies regarding the main topic; all were evaluated. Mental health problems among pregnant women linked to the COVID-19 pandemic, in most cases, show symptoms of depression, anxiety, insomnia, and PTSD and may cause adverse outcomes in pregnancy and fetus and newborn development, even at later stages of life. Therefore, useful implications for clinical practice for improving the adverse mental health outcomes of pregnant women associated with the COVID-19 pandemic are highly desirable. Our research findings support and advocate the need to modify the scope of healthcare provider practice in the event of a disaster, including the COVID-19 pandemic, and may be implemented and adopted by healthcare providers as useful implications for clinical practice.

The quantitative effect of blue lenses on pediatric photoparoxysmal response - An electroencephalographic cohort study.

PURPOSE: To determine and quantify the effect of blue lenses (Z1) on photosensitivity (PS) suppression in patients aged 5-18 years with and without epilepsy. METHODS: The retrospective cohort study was carried out in 100 pediatric patients aged 5-18 years with grade 4 PS assessed with EEG for medical indications. All EEG procedures were carried out and recordings assessed by two independent researchers. The study cohort was divided into groups with and without the diagnosis of epilepsy. The overall effect of the Z1 lenses on photoparoxysmal response (PPR) was determined by directly comparing the maximum discharge values in each patient without and with Z1 lenses in a within-subject design yielding the index of overall improvement (IOI). The differences in PS suppression by brain region and side were assessed by an additional between-subject comparison of age groups (below and above 14 years). Then, overall findings were compared with the PPR change criteria developed in 2006 by Capovilla (PPR disappearance, persistence, or attenuation) which warranted another subset analysis. Finally, in a between-subject design, we assessed whether the presence of epilepsy affects the intensity of PPR in children with PS, compared to non-epilepsy children. RESULTS: The IOI in the entire cohort was 66.1±2.5% (P<0.001). There were no significant differences in IOI between the left and right hemispheres, between the age groups, and between the epilepsy and non-epilepsy groups, despite some qualitative variation. With reference to literature findings, whereas median IOI were comparable in PPR disappearance and attenuation subsets, they differed significantly from the median IOI in the PPR persistence subset. CONCLUSION: Using Z1 lenses results in neither a complete PPR disappearance, nor a complete lack of effect. However, the correlation between the quantified PS suppression and the Z1 filter may be expected to become a valuable piece of information for both clinicians and manufacturers.

Vigabatrin - new data on indications and safety in paediatric epilepsy.

INTRODUCTION: Vigabatrin (VGB), a second-generation antiepileptic drug, is effective for the treatment of infantile spasms and focal seizures, primarily in tuberous sclerosis complex (TSC) patients. However, reports of adverse events of VGB, including VGB-associated visual field loss and brain abnormalities in neuroimaging, have raised concerns about the broader use of VGB and thus significantly limited its application. AIM OF THE STUDY: The goal of this review was to summarise the recent therapeutic guidelines, the use of VGB in focal seizures and new VGB applications as a disease-modifying treatment in TSC patients. Moreover, we discuss the current opinions on potential VGB-associated toxicity and the safety of VGB.

Symmetry and interhemispheric propagation of paediatric photoparoxysmal response.

AIM OF THE STUDY: To investigate the speculated interhemispheric symmetry and the pattern of propagation of paediatric photoparoxysmal response. CLINICAL RATIONALE FOR THE STUDY: Quantitative analysis of the photoparoxysmal response (PPR) to intermittent photic stimulation is a promising method of assessing photosensitivity (PS). The pattern of PPR propagation underlies the model used for calculations. The generalisation of a discharge should correspond with the parameters objectively characterising the PPR in both cerebral hemispheres. However, to date no evidence of a postulated symmetry has been demonstrated. MATERIALS AND METHODS: Our analysis was performed by comparing the EEG amplitude and interhemispheric coherence (ICoh) in both hemispheres in 100 non-epileptic individuals of both sexes, aged 5-18 years, with PS grade IV (the PPR group) and without PS (the control group). The amplitude and ICoh values were recorded and analysed statistically. RESULTS: The distribution of amplitude values between the hemispheres was comparable in both groups, but was significantly different between the PPR group and the control group. Individual tracks of propagation revealed hemispheric symmetry. Interhemispheric coherence values were significantly higher in occipital, temporal and fronto-polar areas in children with PS. CONCLUSIONS AND CLINICAL IMPLICATIONS: This study provides objective evidence of interhemispheric symmetry in paediatric PPR, which supports the link with generalised seizures. Interhemispheric propagation is facilitated in children with PS, and propagation is more likely in the occipital and temporal regions.

[Evaluation of renal lesions in children with tuberous sclerosis - summary of the first year of follow-up program]. / Ocena zmian w nerkach u dzieci chorych na stwardnienie guzowate ­ podsumowanie pierwszego roku programu opieki.

Tuberous sclerosis complex (TSC) is a genetic disease that leads to formation of tumors i.e. in brain kidneys, heart, lungs, and skin. AIM: The aim of the study was to summarize center's experience in the first year of program of nephrologic follow-up in patients with TSC. MATERIALS AND METHODS: During 12 months 30 children with TSC (14 boys and 16 girls aged from 3 months to 17 years 11 months, mean 7.57±5.02 years) were hospitalized. Following parameters were evaluated: genetic and biochemical tests, blood pressure in ambulatory blood pressure monitoring (ABPM), kidney lesions in ultrasonography (30 patients) and in magnetic resonance (14 patients). RESULTS: Genetic tests were performed in 6 children - in 5 TSC2 mutation was found, in one boy with TSC and numerous renal cysts only PKD1 mutation was revealed. Mean GFR was 130.81±23.23 mL/ min/1.73 m2. Four children (13.3%) had arterial hypertension. Renal lesions were found in 28 (93.3%) children: 18 patients had angiomyolipomas (AML) (mean diameter 15.4±12.5, max 38 mm), 23 patients had renal cysts (mean diameter 7.6±7.0, max 30 mm); 13 patients had AMLs and cysts. A dysplastic lesion (39x26x15 mm) in right kidney was found in one girl. Children with AML were older than remaining patients (10.08±4.55 vs. 4.25±3.50 [years], p<0.001). Children with cysts were characterized by higher systolic (p=0.017), diastolic (p=0.027) and mean (p=0.014) arterial pressure, and mean arterial pressure Z-score (p=0.025) in ABPM. Maximal kidney cyst diameter correlated positively with systolic, diastolic, mean arterial pressure, mean arterial pressure Z-score, and diastolic blood pressure load in ABPM (r = 0.61-0.75, p = 0.033-0.005). Two children with numerous AML with diameter >30 mm were treated with sirolimus. CONCLUSIONS: Because of common focal lesions in kidneys children with TSC should be kept under regular nephrologic follow-up. Presence of large renal cysts may predispose children with TSC to arterial hypertension.

Long-term Outcome of Intravenous Lidocaine in Pediatric Cluster Seizures: A Preliminary Study.

BACKGROUND: Cluster seizures are life-threatening conditions. They may easily evolve into status epilepticus and are reported in up to 20% to 30% of patients with epilepsy. Sometimes cluster seizures become drug resistant, leading to the use of unconventional therapies. One of these unconventional approaches may be the use of lidocaine, which is a sodium-channel-blocking drug mostly known as a local anesthetic and antiarrhythmic agent. METHODS: We describe the outcome of four children who were treated with continuous intravenous infusion of 2% lidocaine due to drug-resistant focal cluster seizures. Lidocaine was administered as an initial dose of 1 mg/kg/hour and, subsequently, was increased to 2 to 4 mg/kg/hour. The therapy was continued for five to 10 days. Patients remained under careful cardiological surveillance during the treatment. RESULTS: Complete seizure remission was achieved in all four children. None of the patients experienced adverse events. Although seizures recurred in all patients within an average time of 2.4 months, they appeared with reduced frequency, and within the follow-up period (mean 7.5 months) no additional cluster seizures occurred. CONCLUSIONS: Treatment with lidocaine in pediatric cluster seizures may be useful and may be considered as a therapeutic option. Our patients encountered no side effects and experienced prolonged seizure remission, possibly resulting from the effect of lidocaine on sodium channels or from its anti-inflammatory properties. However, more studies are required to confirm the safety and long-term effectiveness of this approach. Clinicians should be aware of possible adverse effects and necessity of sustained cardiological surveillance during the treatment.

Current concepts on epilepsy management in tuberous sclerosis complex.

Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous disease affecting approximately 1 in 6,000 people, and represents one of the most common genetic causes of epilepsy. Epilepsy affects 90% of the patients and appears in the first 2 years of life in the majority of them. Early onset of epilepsy in the first 12 months of life is associated with high risk of cognitive decline and neuropsychiatric problems including autism. Prenatal or early infantile diagnosis of TSC, before the onset of epilepsy, provides a unique opportunity to monitor EEG before the onset of clinical seizures, thus enabling early intervention in the process of epileptogenesis. In this review, we discuss the current status of knowledge on epileptogenesis in TSC, and present recommendations of American and European experts in the field of epilepsy.

A case of symmetric retrograde thromboembolic cerebral infarction in an 8-year-old child due to arterial thoracic outlet syndrome.

Arterial type of thoracic outlet syndrome belongs to the most unusual mechanisms of stroke in children in the first decade of life. We present a case diagnosed for bilateral and symmetric changes due to retrograde thromboembolic phenomenon. Regarding the age of the patient, the appropriate diagnostics and management are still a matter of debate in pediatric and neurological literature.

Patterns of intrahemispheric propagation in pediatric photoparoxysmal response.

PURPOSE: The photoparoxysmal response (PPR) is the most important EEG indication of photosensitivity (PS). It may be elicited by intermittent photic stimulation (IPS). PS mostly affects young individuals, with adolescent females at greatest risk. The diagnosis of PS is based on visual EEG assessment. To date, no objective test of PS has been established. METHOD: Here we describe 89 individuals of both sexes, aged 5-18 years, epileptic and non-epileptic, in whom a PPR was elicited by IPS during a standard EEG procedure. The distribution of amplitude and intrahemispheric coherence indices were analyzed and, in each case, revealed a unique pattern of PPR propagation. RESULTS: A lateral (occipito-temporo-frontal) track was found in 52% of recordings, and 55% of individuals tested showed symmetric patterns. A bilateral pattern dominated in all age groups, all grades of PS, and across epileptic and non-epileptic groups. CONCLUSION: A symmetric, bilateral pattern is the most common type of PPR across genders and all ages, regardless of grade of PS and the presence of epilepsy. The results of this study show the current PPR classification in a new light and provide a basis for the concept of PPR lateralization based on objective, quantitative findings.

[Efficiency of the photostimulation in activation of the EEG paroxysmal disorders in children depending on frequency spectrum of the luminous stimulus--preliminary report]. / Efektywnosc próby fotostymulacji w aktywacji zmian o charakterze napadowym w zapisie EEG u dzieci w zaleznosci od widma czestotliwosci bodzca swietInego--doniesienie wstepne.

INTRODUCTION: Photostimulation is considered as a factor that may induce epileptic seizures, hence it has been implemented to neurological diagnostics in children as a component of electroencephalographic examination. The response to light stimulus is called photosensitivity. The impact of elimination of red light on the response to photostimulation has been widely discussed in current papers. However, there is no report concerning the Polish population. AIM: The aim of this study was to evaluate the efficacy of blue-filtered lenses (Z1) in children with photosensitivity. MATERIAL AND METHODS: The study was based on the analysis of EEG records in 61 patients aged 5-18 years (21 M, 40 F) diagnosed with photosensitivity. The EEG studies were performed according to the standard protocol, according to clinical indications. CONCLUSIONS: Epilepsy was diagnosed in 30 cases (49%), the remaining 31 patients (51%) presented with other symptoms. A positive response to Z1 lenses was observed in 40 cases (66%), including 18 children with the diagnosis of epilepsy (60% of this group) and 22 patients from the second group (71%). The use of blue-filtered lenses may support the treatment of epilepsy. This method is characterized by safety, efficiency over 50% and relatively low cost. The use of blue-filtered lenses may help to reduce symptoms in children with photosensitivity.

A comparative study of vigabatrin vs. carbamazepine in monotherapy of newly diagnosed partial seizures in children.

Carbamazepine (CBZ) is a drug of choice for the treatment of simple or complex partial seizures and secondary generalized seizures in adults and children. Vigabatrin (VGB) is a relatively new second line antiepileptic drug and was first registered for use in Poland more than ten years ago. Few reports have been published on the comparison of efficacy of VGB in children with epilepsy. The objective of this study is to evaluate the safety, efficacy and EEG effects of initial VGB monotherapy compared with initial CBZ monotherapy in children with newly diagnosed epilepsy. We present results of a prospective, outpatient and open study carried out in the University Hospital Center in Bialystok. Twenty-six children with partial epilepsy treated with VGB and 28 patients treated with CBZ were studied. The evaluation of the efficacy of the two drugs did not reveal any significant differences. Very good (reduction > 75%) seizure control was achieved in 22 out of 26 patients (84.6%) in the VGB group. One patient had a 50-75% decrease of seizures (good effect), similarly one child had a 25-50% reduction of seizures (mild effect). In two patients, we observed increased seizures (myoclonic jerks). Very good seizure control was achieved in 17 out of 28 patients (60.7%) in the CBZ group. Good seizure control was achieved in 5 out of 28 patients (17.8%) and mild control was seen in two children. No improvement was observed in 4 (14%) of the patients. The EEG background activity was improved in VGB-treated patients. No effect on the EEG background activity was observed in CBZ-treated children. VGB seems to be a safe and effective antiepileptic drug as primary monotherapy for epilepsy in children with similar proportion of side effects as CBZ.