Consequences of the Covid-19 pandemic in children and adolescents with attention deficit hyperactivity disorder - a systematic review

Abstract Objective In this systematic review (SR), the authors aimed to identify the possible impact of the social restriction imposed by the Coronavirus Disease-19 (COVID-19) pandemic on children/adolescents with Attention Deficit Hyperactivity Disorder (ADHD). Data sources This SR was registered on PROSPERO CRD42021255569. Eligible articles were selected from PubMed, Embase, and LILACS, according to the following characteristics: ADHD patients < 18 years old, exposed to the COVID-19 pandemic, and the outcomes, medications, relationships, sleep, media use, remote learning, and comorbidities such as depression/sadness, inattention, anxiety, and irritability/aggressiveness. Newcastle-Ottawa Scale (NOS) for cohort, cross-sectional and case-control studies was used to assess methodological quality and the risk of bias. Summary of findings Of the 222 articles identified, 27 were included, with information on 7,235 patients. Most studies (n = 22) were cross-sectional and received a mean NOS 4.63/10 followed by longitudinal (n = 4) with 3.75/8 points and case-control (n = 1), with 3/9 points. The pandemic affected patients' access to treatment, behavior, and sleep. Difficulties in remote learning and increased use of social media were described, as well as significant and positive changes in relationships with family and peers. Conclusion Although the studies were heterogeneous, they indicated that the pandemic-related issues experienced by patients with ADHD were mostly manifested affecting their behavior and sleep patterns.

Consequences of post-weaning sleep deprivation on behaviour and oxidative stress parameters in rat plasma and brain.

Sleep is essential for health: Adequate sleep is essential for healthy development and sleep deprivation results in several consequences. Indeed, sleep deprivation early in life is associated with poor behaviour and cognition, as well as impaired mental and physical health. Preclinical studies have shown that sleep deprivation alters several physiological functions later in life such as the cardiovascular, immune and endocrine systems, resulting in altered oxidative states. Most of the preclinical literature is focused on adult animals, and little is known about oxidative alterations during development, especially in the context of sleep deprivation. Hence, we adapted a classic and well-documented model of sleep deprivation, paradoxical sleep deprivation using multiple platforms, for juvenile rats and explored central and peripheral oxidative parameters, as well as the behavioural consequences of sleep deprivation post-weaning. We showed that 96 h of paradoxical sleep deprivation induced a significant reduction in body weight, decreased sucrose preference-a behaviour suggestive of anhedonia-and increased glucose and decreased cholesterol in the plasma. In the brain, we observed a decrease in reduced glutathione levels in the medial prefrontal cortex and an increase in thiobarbituric acid reactive substance levels in the hypothalamus, indicating oxidative damage in these regions. Taken together, our findings suggest that paradoxical sleep deprivation during development induces anhedonic behaviour and promotes central and peripheral alterations in oxidative parameters.

Motor and cognitive outcomes of neonates with low birth weight in Brazil: a systematic review and meta-analysis / Desfechos motores e cognitivos de recém-nascidos com baixo peso ao nascer no Brasil: uma revisão sistemática e metanálise

Abstract Background Data on the outcomes of preterm newborns in South American countries are scarce. Given the great effect of low birth weight (LBW) and/or prematurity on children's neurodevelopment, it is extremely necessary to conduct studies on these phenomena in greater depth in more heterogeneous populations such as those ones from countries with limited resources. Methods We conducted a comprehensive literature search on databases including PubMed, the Cochrane Library, and Web of Science for articles published in Portuguese and English up to March 2021 involving children born and evaluated in Brazil. The analysis of the risk of bias was adapted from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and used to evaluate the methodology of the included studies. Results From the eligible trials, 25 articles were selected for qualitative synthesis, and 5 of those, for quantitative synthesis (meta-analysis). The meta-analyses showed that children born with LBW presented lower scores on motor development when compared with controls (standardized mean difference: -1.15; 95% confidence interval [95%CI]: -1.56--0.73]; I2: 80%) and also scored lower in terms of cognitive development (standardized mean difference: -0.71; 95% CI: -0.99--0.44; I2: 67%). Conclusion The results of the present study reinforce that impaired motor and cognitive functions can be a significant long-term outcome of LBW. The lower the gestational age at delivery, the higher the risk of impairment in those domains. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database under number CRD42019112403.

Resumo Antecedentes Dados sobre desfechos de recém-nascidos prematuros em países da América do Sul são escassos. Dado o grande efeito do baixo peso ao nascer (BPN) e/ou da prematuridade no neurodesenvolvimento das crianças, é extremamente necessária a realização de estudos que investiguem esses fenômenos com maior profundidade em populações mais heterogêneas. Métodos Realizou-se uma busca da literatura em bases de dados, incluindo PubMed, Cochrane Library e Web of Science, por artigos publicados em português e inglês até março de 2021 envolvendo crianças nascidas e avaliadas no Brasil. A análise de risco de viés foi adaptada da declaração de Fortalecimento do Relato de Estudos Observacionais em Epidemiologia (Strengthening the Reporting of Observational Studies in Epidemiology, STROBE), que foi utilizada para avaliar a metodologia dos estudos. Resultados Dos estudos elegíveis, 25 artigos foram selecionados para síntese qualitativa, e 5 desses 25, para síntese quantitativa (metanálise). As metanálises mostraram que crianças nascidas com BPN apresentaram pontuação menor em desenvolvimento motor quando comparadas aos controles (diferença média padronizada, -1,15; intervalo de confiança de 95% [IC95%]: -1,56--0,73]; I2: 80%) e pontuação também menor em termos de desenvolvimento cognitivo (diferença média padronizada, -0,71; IC95%: -0,992-0,44; I2: 67%). Conclusão Os resultados deste estudo reforçam que o comprometimento das funções motoras e cognitivas pode ser um desfecho significativo de longo prazo do BPN. Quanto menor a idade gestacional no momento do parto, maior o risco de prejuízo nesses domínios. O protocolo do estudo foi registrado no banco de dados International Prospective Register of Systematic Reviews (PROSPERO) sob o número CRD42019112403.

Sleep quality among parents and their children during COVID-19 pandemic

Abstract Objective: To evaluate sleep characteristics of parents and their children during the COVID-19 pandemic and predictors for sleep disturbances. Methods: Cross-sectional web-based study using an online survey made available for dyads of parents and their children during the 7th week of quarantine in southern Brazil. Parents' and adolescents' sleep were characterized using the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale. For children aged 0-3 years parents completed the Brief Infant Sleep Questionnaire, for those aged 4-12 years the Sleep Disturbance Scale for Children. Parents also informed, subjectively, their perception about sleep habits during social distancing. Multiple regression was run to predict sleep disturbances in adults using independent variables: sex, income, education, children age, and children with sleep disturbances. Results: Data from 577 dyads showed sleep alterations in 69,8% of adults, in 58,6% of children aged 0-3 years, 33,9% in the 4-12 years range (with a predominance of disorders of initiating or maintaining sleep), and 56,6% in adolescents. Sex (female) and children with sleep disturbances were significant predictors of a sleep problem in parents (p < 0.005). Subjective perception revealed complaints related to emotional concerns such as anxiety and fear in adults and due to alterations in routine in children and adolescents. Conclusion: The present study's data showed an increased rate of sleep problems among families during quarantine both measured by validated instruments and also based on personal perception.

Social and environmental effects of the COVID-19 pandemic on children

Abstract Objective: This study aimed to review the literature, summarizing the existing evidence on the effects of the pandemic on children, adolescents and parents, with an emphasis on the psychological, emotional, and sleep quality consequences. Source of data: Empirical studies identified in the following databases: MEDLINE, ISI Web of Knowledge/Web of Science, and preprint servers. Synthesis of data: The findings point to a wide range of consequences for children and adolescents resulting from the COVID-19 pandemic, which mainly includes an increase in depressive mood symptoms. There is also an increase in anxiety symptoms, suicidal ideation, as well as potential delays in language and motor development resulting from deprivation of social interaction and the closing of schools. These effects are more severe due to previous neuropsychiatric conditions. For parents, there is an increase in anxiety, depressive and post-traumatic symptoms, which are more accentuated in those who suffered socioeconomic damage due to the pandemic. There was an important increase in situations of violence towards children by parents and caregivers during the pandemic. Also, changes in routine and fear of the pandemic have negatively impacted sleep quality, globally. Conclusions: It is noteworthy that most studies published to date used a cross-sectional design and applied online screening questionnaires. The few studies with a longitudinal design suggest that these changes may have been transitory and more prevalent at the beginning of the pandemic.

Sleep and weight-height development / Sono e desenvolvimento pondero-estatural

Abstract Objectives: To describe the association between sleep duration and weight-height development in children and adolescents. Source of data: A non-systematic search in the MEDLINE database was performed using the terms anthropometry, body composition, overweight, obesity, body mass index, growth, length, short stature, sleep, children, and infants and adolescents, limited to the last 5 years. The references cited in the revised articles were also reviewed, when relevant. Synthesis of data: Sleep disorders are prevalent in the pediatric population. Among them, insomnia, which leads to a reduction in total sleep time, is the most prevalent disorder. Evidence found in the current literature allows the conclusion that sleep time reduction has a role in the current pandemic of overweight and obesity. Studies associating sleep deprivation and deficit in height growth are still insufficient. Conclusions: The association between shorter sleep duration and risk of overweight and obesity is well established for all pediatric age groups. However, more evidence is needed to establish an association between insufficient sleep duration and height growth deficit. Pediatricians should include the encouragement of healthy sleep habits in their routine guidelines as an adjuvant in the prevention and management of excess weight.

Resumo Objetivos: O objetivo deste artigo é descrever a associac¸ão entre a durac¸ão de sono e o desenvolvimento pondero-estatural entre crianc¸as e adolescentes. Fontes de dados: Foi realizada uma busca não-sistemática na base de dados MEDLINE utilizando os termos antropometria, composic¸ão corporal, sobrepeso, obesidade, índice de massa corporal, crescimento, comprimento, baixa estatura, sono, crianc¸as, lactentes e adolescentes, limitadas aos últimos cinco anos. As referências citadas nos artigos revisados também foram, conforme relevância, revisados. Síntese dos dados: Distúrbios do sono são prevalentes na população pediátrica. Dentre eles, a insônia, que cursa com redução do tempo total de sono, é a mais prevalente. Evidências presentes na literatura atual permitem apontar que a redução do tempo de sono tem um papel na pandemia atual de sobrepeso e obesidade. Os estudos que associam a privação de sono com déficit no crescimento estatural ainda são insuficientes. Conclusões: A associação entre menor duração de sono e risco para sobrepeso e obesidade está bem estabelecida para todas as faixas etárias da pediatria. Entretanto, maiores evidências são necessárias para que se possa estabelecer uma associação entre duração insuficiente de sono e déficit no crescimento estatural. O médico pediatra deve incluir nas suas orientações de rotina o estímulo a hábitos de sono saudáveis como coadjuvante na prevenção e manejo do excesso de peso.

The uptake of safe infant sleep practices by Brazilian pediatricians: a nationwide cross-sectional survey.

OBJECTIVE: Sudden infant death syndrome (SIDS) is a major cause of death among children aged <1 year. Campaigns to educate physicians have been effective to reduce its incidence. We assessed the knowledge of Brazilian pediatricians' regarding risk factors for SIDS, their familiarity with the first Brazilian SIDS campaign launched in 2009, and self-reported changes in practices following this campaign. METHODS: Active members of the Brazilian Society for Pediatrics who had been in practice for at least two years at the time of the campaign were invited. Pediatricians answered an online survey including eight multiple-choice questions and one open-ended question. Invitees were chosen by chance draw to reflect the geographic distribution of pediatricians in the five regions of the country. RESULTS: The survey was answered by 1654 pediatricians (mean [SD] age: 46 [11.5] years; mean [SD] professional practice time: 20.2 [11.52] years). Bedding items (77.7%), prone sleeping position (72.9%), bed sharing (66.3%), and smoking (59.2%) were recognized as risk factors for SIDS. Most pediatricians (88.2%) were familiar with the campaign, and 84.7% were aware of the current recommendation of supine sleeping position to prevent SIDS. The effectiveness of the first Brazilian SIDS campaign could be measured by a change in practice; before the campaign, 67.5% recommended lateral position and 23.1% the supine, and after the campaign, 76.2% recommended supine and 10.4% lateral. However, 12.8% still recommend prone position. CONCLUSIONS: The majority of pediatricians changed their advice to parents after the educational campaign and became familiar with risk factors for SIDS. Continuous educational campaigns focusing on physicians resistant to changing practices should be provided.

Microcephaly and Zika virus: a clinical and epidemiological analysis of the current outbreak in Brazil / Microcefalia e vírus Zika: um olhar clínico e epidemiológico do surto em vigênciano Brasil

Abstract Objective: This study aimed to critically review the literature available regarding the Zika virus outbreak in Brazil and its possible association with microcephaly cases. Sources: Experts from Instituto do Cérebro do Rio Grande do Sul performed a critical (nonsystematic) literature review regarding different aspects of the Zika virus outbreak in Brazil, such as transmission, epidemiology, diagnostic criteria, and its possible association with the increase of microcephaly reports. The PubMed search using the key word “Zika virus” in February 2016 yielded 151 articles. The manuscripts were reviewed, as well as all publications/guidelines from the Brazilian Ministry of Health, World Health Organization and Centers for Disease Control and Prevention (CDC – United States). Summary of findings: Epidemiological data suggest a temporal association between the increased number of microcephaly notifications in Brazil and outbreak of Zika virus, primarily in the Brazil's Northeast. It has been previously documented that many different viruses might cause congenital acquired microcephaly. Still there is no consensus on the best curve to measure cephalic circumference, specifically in preterm neonates. Conflicting opinions regarding the diagnosis of microcephaly (below 2 or 3 standard deviations) that should be used for the notifications were also found in the literature. Conclusion: The development of diagnostic techniques that confirm a cause–effect association and studies regarding the physiopathology of the central nervous system impairment should be prioritized. It is also necessary to strictly define the criteria for the diagnosis of microcephaly to identify cases that should undergo an etiological investigation.

Resumo Objetivos: O objetivo deste estudo foi realizar uma revisão crítica da literatura sobre o surto de vírus Zika no Brasil e sua possível associação com casos de microcefalia. Fonte de dados: Especialistas em áreas afins do Instituto do Cérebro do Rio Grande do Sul realizaram uma revisão crítica (não sistemática) da literatura sobre o vírus Zika, suas formas de transmissão, a epidemia no Brasil, critérios diagnósticos e a possível associação com os casos crescentes de microcefalia. O uso da palavra chave “Zika virus” na base de dados do PubMed em fevereiro de 2016, retorna 151 publicações. Estes textos foram revisados assim como todas as publicações e recomendações do Ministério da Saúde, Organização Mundial da Saúde e Centro de Controle de Doenças (CDC – USA). Síntese dos dados: Os dados epidemiológicos sugerem uma relação temporal entre aumento da notificação de casos de microcefalia e o surto de vírus Zika, principalmente no Nordeste do Brasil. Agentes virais comprovadamente podem ser causadores de microcefalia congênita adquirida. Não existe um consenso sobre a melhor curva de perímetro cefálico a ser utilizada, principalmente nos prematuros. Assim como também existem divergências sobre a definição de microcefalia (abaixo de 2 ou 3 desvios padrões) a ser padronizada nas notificações. Conclusão: Deve-se priorizar o desenvolvimento de técnicas diagnósticas que confirmem uma relação causa–efeito e estudos sobre mecanismos da patogênese da infecção pelo Zika no sistema nervoso central. Também é necessário definir e universalizar os critérios diagnósticos para a identificação dos casos de microcefalia que devem ser submetidos à investigação etiológica.

Insônia na infância e adolescência: aspectos clínicos, diagnóstico e abordagem terapêutica / Insomnia in childhood and adolescence: clinical aspects, diagnosis, and therapeutic approach

Resumo Objetivos: Revisar as características clínicas, as comorbidades e o manejo da insônia na infância e adolescência. Fonte dos dados: Revisão não sistemática da literatura feita na base dados PubMed, na qual foram selecionados artigos publicados nos últimos cinco anos, com o uso da palavra-chave insônia e o filtro faixa etária pediátrica. Adicionalmente foram incluídos artigos e livros-texto clássicos da literatura sobre o tema. Síntese dos dados: Na infância existe predomínio da insônia comportamental na forma de distúrbio de início do sono por associações inadequadas e/ou distúrbio pela falta de estabelecimento de limites. Na adolescência a insônia está mais associada a problemas de higiene do sono e atraso de fase. Transtornos psiquiátricos (ansiedade, depressão) ou do neurodesenvolvimento (transtorno do déficit de atenção, autismo, epilepsias) ocorrem com frequência em associação ou como comorbidade do quadro de insônia. Conclusões: A queixa de insônia nas crianças e nos adolescentes deve ser valorizada e adequadamente investigada pelo pediatra, que levará em consideração a associação com diversas comorbidades, que também devem ser diagnosticas. As causas principais de insônia e fatores desencadeantes variam de acordo com a idade e o nível de desenvolvimento. A abordagem terapêutica deve incluir medidas de higiene do sono e técnicas comportamentais e em casos individualizados tratamento farmacológico.

Abstract Objectives: To review the clinical characteristics, comorbidities, and management of insomnia in childhood and adolescence. Sources: This was a non-systematic literature review carried out in the PubMed database, from where articles published in the last five years were selected, using the key word “insomnia” and the pediatric age group filter. Additionally, the study also included articles and classic textbooks of the literature on the subject. Data synthesis: During childhood, there is a predominance of behavioral insomnia as a form of sleep-onset association disorder (SOAD) and/or limit-setting sleep disorder. Adolescent insomnia is more associated with sleep hygiene problems and delayed sleep phase. Psychiatric (anxiety, depression) or neurodevelopmental disorders (attention deficit disorder, autism, epilepsy) frequently occur in association with or as a comorbidity of insomnia. Conclusions: Insomnia complaints in children and adolescents should be taken into account and appropriately investigated by the pediatrician, considering the association with several comorbidities, which must also be diagnosed. The main causes of insomnia and triggering factors vary according to age and development level. The therapeutic approach must include sleep hygiene and behavioral techniques and, in individual cases, pharmacological treatment.

Cognition, behavior and social competence of preterm low birth weight children at school age

OBJECTIVE: The aim of this study was to assess the cognitive and behavioral development of preterm and low birth weight newborns living in a disadvantageous socioeconomic environment at school age. METHODS: This cross-sectional study included children aged 6-7 from a historical birth cohort of preterm (gestational age <37 weeks) and low birth weight (<2,500 g) infants. The Wechsler Intelligence Scale for Children III (WISC-III) was administered by a psychologist while the parents completed the Child Behavior Checklist. The results were compared to the test's reference. The perinatal information and follow-up data were collected from the hospital files. The demographic data were collected from the parents. The current performance was compared with the results from the Denver II and Bayley II tests, which were administered during the first years of life. RESULTS: The total intelligence quotient varied from 70 to 140 (mean 98.7±15.8). The borderline intelligence quotient was observed in 9.3% of the children. The Child Behavior Checklist indicated a predominance of social competence problems (27.8%, CI 19.2 to 37.9) compared with behavioral problems (15.5%, CI 8.9 to 24.2). Both the Child Behavior Checklist domains, such as schooling, social and attention problems, and the cognitive scores were significantly associated with maternal education and family income. The results of the Denver and Bayley tests were associated with the cognitive performance (p<0.001) and the Child Behavior Checklist social profile, including aggressive and externalizing behavior (p<0.001). CONCLUSIONS: Our data suggest that even low-risk preterm newborns are at risk for developing disturbances in early school age, such as mild cognitive deficits and behavioral disorders. This risk might increase under unfavorable socioeconomic conditions. .

An 18-year follow-up of seizure outcome after surgery for temporal lobe epilepsy and hippocampal sclerosis.

OBJECTIVES: To evaluate the very long-term clinical outcome of surgery for mesial temporal lobe epilepsy and unilateral hippocampal sclerosis (MTLE/HS) without atypical features. The impact of surgical technique and postoperative reduction of medication on this outcome was investigated. DESIGN: Prospective longitudinal cohort follow-up study for up to18 years. SETTING: Epilepsy surgery centre in a university hospital. PATIENTS: 108 patients who underwent unilateral MTLE/HS. INTERVENTION: Surgery for MTLE/HS. MAIN OUTCOME MEASURE: Engel classification (I). Clinical evaluations were based on systematic interviews in person or by phone. Kaplan-Maier survival curves estimated the probability of remaining seizure free. The impact of medication management in the postoperative outcome was analysed using Cox regression. RESULTS: The probability of remaining completely seizure-free at 12 and 18 years after MTLE/HS surgery was 65% and 62%, respectively. The risk of having any recurrence was 22% during the first 24 months and increased 1.4% per year afterwards. Type of surgical technique (selective amygdalohippocampectomy vs anterior temporal lobectomy) did not impact on outcome. Remaining on antiepileptic drugs and history of generalised clonic seizure diminished the probability of remaining seizure free. CONCLUSIONS: MTLE/HS surgery is able to keep patients seizure free for almost up to two decades. Removal of the neocortex besides the mesial portion of the temporal lobe does not lead to better chances of seizure control. These findings are applicable to the typical unilateral MTLE/HS syndrome and cannot be generalised for all types of TLE. Future longitudinal randomised controlled studies are needed to replicate these findings.

Impacto das crises convulsivas neonatais no prognóstico neurológico durante os primeiros anos de vida / Impact of neonatal seizures in the neurological outcome during the early years of life

Objetivos: Avaliar o prognóstico clínico-neurológico de crianças que apresentaram crises convulsivas no período neonatal, verificando a incidência e o impacto da ocorrência de epilepsia pós-neonatal em relação ao desenvolvimento neuropsicomotor e qualidade do sono.Métodos: Realizou-se um estudo transversal em uma coorte histórica de recém-nascidos que apresentaram crises convulsivas confirmadas por observação clínica e eletroencefalograma ou vídeo-eletroencefalograma, durante internação na Unidade de Terapia Intensiva Neonatal do Hospital São Lucas da PUCRS, em Porto Alegre/RS, entre janeiro de 2004 e dezembro de 2009. As crianças foram avaliadas quanto ao desenvolvimento neuropsicomotor (teste de Denver II), hábitos do sono (Inventário dos Hábitos de Sono para Crianças Pré-escolares) e ocorrência de epilepsia pós-neonatal.Resultados: O grupo com seguimento foi constituído por 12 meninos e 10 meninas com idade variando entre 2 e 6 anos. Dez pacientes (45,5%) apresentavam epilepsia pós-neonatal. Todas as crianças com epilepsia apresentaram resultado anormal ou questionável no teste de Denver II. As médias do escore total do Inventário do Sono e das suas subescalas demonstraram um predomínio de bom padrão de sono em ambos os grupos (com e sem epilepsia). Os escores variaram de 5 a 59 (média 34,84±14,61), sendo que as crianças com epilepsia apresentaram os escores mais baixos no Inventário do Sono, sugerindo melhores hábitos de sono. A diferença do escore de sono entre os dois grupos foi de 13.25 (intervalo de confiança 95% 1,39 a 25,11; p=0,030).Conclusões: O estudo evidenciou alta incidência de epilepsia após crises convulsivas neonatais e associação de epilepsia com indicadores de atraso no desenvolvimento neuropsicomotor. A qualidade do sono apresentou-se de forma regular na amostra estudada.

Aims: To evaluate the clinical and neurological outcome of children who had seizures in the neonatal period, checking the incidence and impact of the occurrence of postnatal epilepsy in relation to neuropsychomotor development and quality of sleep.Methods: A cross sectional study was carried out in a historical cohort of infants who had seizures confirmed by clinical observation and electroencephalogram or video electroencephalogram, during hospitalization in the Neonatal Intensive Care Unit of São Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, in Porto Alegre/RS, Brazil, from January 2004 to December 2009. Children were evaluated for neuropsychomotor development (Denver II test), sleep habits (Inventory of Sleep Habits for Preschool Children), and occurrence of post neonatal epilepsy.Results: Group with follow-up consisted of 12 boys and 10 girls aged between 2 and 6 years. Ten patients (45.5%) had post-neonatal epilepsy. All children with epilepsy showed abnormal or questionable Denver II test. The means of total score on the Inventory of Sleep and its subscales showed a predominance of good sleep pattern in both groups (with and without epilepsy). The scores ranged from 5 to 59 (mean 34.84±14.61). Children with epilepsy had the lower scores in the Inventory of Sleep, suggesting better sleep habits. The difference in the sleep score between the two groups was 13.25 (95% confidence interval 1.39 to 25.11, p=0.030).Conclusions: The study showed high incidence of epilepsy after neonatal seizures and association with indicators of delayed neuropsychomotor development. Quality of sleep presented a regular pattern in the study sample.

Perfil epidemiológico e estratégias para o diagnóstico de SMSL em um país em desenvolvimento / Epidemiological profile and strategies for diagnosing SIDS in a developing country

OBJETIVO: Descrever o perfil epidemiológico, os fatores de risco e as melhores estratégias para diagnosticar a síndrome da morte súbita do lactente (SMSL) em um país em desenvolvimento. MÉTODOS: Estudo caso-controle populacional com crianças nascidas entre 01/01/2001 e 31/12/2003 em Porto Alegre (RS), divididas em três grupos: casos de SMSL (33) e controles - óbitos esclarecidos (192) e crianças vivas (192) -, que foram pareados por idade e sexo aos casos. As famílias com casos de lactentes menores de 1 ano que faleceram em casa foram identificadas, e as informações das certidões de óbito e autópsias foram comparadas para confirmar a SMSL. Os óbitos esclarecidos foram os ocorridos em hospitais, e os controles vivos foram selecionados na vizinhança dos casos de SMSL. Os pais foram entrevistados para obter informações sobre a saúde e os hábitos de sono da criança. Realizou-se uma análise multivariada para identificar fatores de risco na população estudada. RESULTADOS: A incidência da SMSL na população avaliada foi de 0,55/1.000 nascidos vivos. A análise revelou os seguintes fatores de risco: etnia (autorreferida como negra), prematuridade, baixo peso ao nascer, mãe adolescente, tabagismo na gravidez e renda familiar abaixo de um salário mínimo. Além disso, 94 por cento dos casos de SMSL foram mal-diagnosticados na certidão de óbito. CONCLUSÕES: Embora a SMSL tenha sido mal-diagnosticada, seu perfil epidemiológico é semelhante ao da literatura, assim como os fatores de risco, que poderiam ser reduzidos com campanhas preventivas. Investigar a SMSL em países em desenvolvimento requer estratégias especiais para evitar erros de diagnóstico.

OBJECTIVE: To describe the epidemiological profile, risk factors and best strategies for diagnosing sudden infant death syndrome (SIDS) in a developing country. METHODS: Population-based, case-control study with children born between January 1st, 2001, and December 31st, 2003, in Porto Alegre, southern Brazil, who were allocated into three groups: SIDS cases (33), explained death controls (192), and living controls (192). Children in the latter two groups were age- and sex-paired with SIDS cases. Families in which an infant had died at home within the first year of life were identified, and the information available on death certificates and autopsy reports was compared to confirm the diagnosis of SIDS. Explained death controls consisted of infants who had died at city hospitals, and living controls were selected in the same neighborhood as SIDS cases. All parents were interviewed to obtain information on children’s health and sleep habits. Multivariate analysis was performed to identify risk factors in the study population. RESULTS: The incidence of SIDS in the population assessed was 0.55/1,000 live births. The analysis revealed the following risk factors: ethnicity (characterized by self-reported black skin color), prematurity, low birth weight, adolescent mother, smoking during pregnancy, and family income of less than one minimum wage. Ninety-four percent of SIDS cases were misdiagnosed in the death certificate. CONCLUSIONS: Although SIDS was misdiagnosed in official death certificates, the epidemiological profile is similar to the literature, as well as risk factors, which could be reduced with preventive campaigns. Investigating SIDS in developing countries requires special strategies to avoid misdiagnosis.

Epidemiological profile and strategies for diagnosing SIDS in a developing country.

OBJECTIVE: To describe the epidemiological profile, risk factors and best strategies for diagnosing sudden infant death syndrome (SIDS) in a developing country. METHODS: Population-based, case-control study with children born between January 1st, 2001, and December 31st, 2003, in Porto Alegre, southern Brazil, who were allocated into three groups: SIDS cases (33), explained death controls (192), and living controls (192). Children in the latter two groups were age- and sex-paired with SIDS cases. Families in which an infant had died at home within the first year of life were identified, and the information available on death certificates and autopsy reports was compared to confirm the diagnosis of SIDS. Explained death controls consisted of infants who had died at city hospitals, and living controls were selected in the same neighborhood as SIDS cases. All parents were interviewed to obtain information on children's health and sleep habits. Multivariate analysis was performed to identify risk factors in the study population. RESULTS: The incidence of SIDS in the population assessed was 0.55/1,000 live births. The analysis revealed the following risk factors: ethnicity (characterized by self-reported black skin color), prematurity, low birth weight, adolescent mother, smoking during pregnancy, and family income of less than one minimum wage. Ninety-four percent of SIDS cases were misdiagnosed in the death certificate. CONCLUSIONS: Although SIDS was misdiagnosed in official death certificates, the epidemiological profile is similar to the literature, as well as risk factors, which could be reduced with preventive campaigns. Investigating SIDS in developing countries requires special strategies to avoid misdiagnosis.

Incidência de epilepsia e distúrbios convulsivos na infância e sua associação com determinantes sociais: um estudo de coorte de nascimento / Incidence of epilepsy and seizure disorders in childhood and association with social determinants: a birth cohort study

OBJETIVO: Investigar a incidência e prevalência de epilepsia e distúrbios convulsivos na infância e sua relação com os determinantes sociais escolhidos. MÉTODOS: Estudo de coorte de nascimento de base populacional, com crianças nascidas entre 1/01 e 31/12/2003 na cidade de Passo Fundo (RS). Os dados foram coletados prospectivamente em duas etapas. Na primeira, foi aplicado o Questionário de Rastreamento Neurológico para Epilepsia (QRN-E) durante uma visita à casa das crianças, juntamente com a avaliação dos determinantes sociais da saúde. Foram analisados construtos de posição social (classe econômica, escolaridade, estado civil e ocupação da mãe), fatores biológicos e comportamentais (consumo de álcool, tabaco e medicamentos na gravidez, e consultas pré-natais) e fatores psicológicos (participação em cerimônias religiosas). Na segunda etapa, as crianças cujos QRN-E apresentaram resultado positivo foram submetidas a avaliação neuroclínica para confirmação do diagnóstico. RESULTADOS: Foram identificados 11 casos de epilepsia, 27 de convulsões febris, 10 de convulsões neonatais, 8 de crise única, além de 26 pacientes com eventos paroxísticos não epilépticos. A incidência de epilepsia foi de 7/100.000 crianças, e a prevalência de 65,2/10.000 crianças. Nove crianças apresentaram epilepsia ativa, resultando em uma prevalência pontual de 53,3/10.000 crianças. Após análise multivariada, nenhum determinante social esteve significativamente relacionado à epilepsia. CONCLUSÕES: Neste estudo, foi relatada uma baixa incidência de epilepsia, em contraste com a incidência de convulsões febris e eventos paroxísticos não epilépticos, que foi quase duas vezes maior. Além disso, a realização de um diagnóstico preciso de epilepsia ainda é um desafio nos países em desenvolvimento, a fim de se evitarem diagnósticos incorretos.

OBJECTIVE: To investigate the incidence and prevalence of epilepsy and seizure disorders during childhood, and their relationship to selected social determinants. METHODS: Population-based birth cohort study, with children born between January 1st and December 31st, 2003 in the city of Passo Fundo (RS), Brazil. Data was prospectively collected in two stages. In the first one, the Questionnaire of Neurologic Tracking for Epilepsy (QNT-E) was applied at the children’s homes, together with the assessment of social determinants of health. Constructs of social position (economical class, mother’s educational level, marital status and occupation), biological and behavioral factors (alcohol and tobacco consumption during pregnancy, number of prenatal appointments, and use of medicines during pregnancy), and psychosocial factors (religious meetings attendance) were analyzed. In the second stage, children with a positive QNT-E were submitted to neuroclinical assessment for diagnostic confirmation. RESULTS: Eleven cases of epilepsy, 27 of febrile seizures, 10 of neonatal seizures, 8 of single seizures, besides 26 patients with non-epileptic paroxysmal events, were identified. The incidence rate of epilepsy was 7/100,000 children and the prevalence 65.2/10,000 children. Nine children had active epilepsy, giving a point prevalence of 53.3/10,000 children. After multivariate analysis, no social determinants could be significantly related to epilepsy. CONCLUSIONS: In this study, a low incidence rate of epilepsy was reported in contrast to almost a double incidence of febrile seizures and non-epileptic paroxysmal events. Moreover, the achievement of an accurate diagnosis of epilepsy in developing countries is still a challenge, in order to avoid misdiagnosis.

Incidence of epilepsy and seizure disorders in childhood and association with social determinants: a birth cohort study.

OBJECTIVE: To investigate the incidence and prevalence of epilepsy and seizure disorders during childhood, and their relationship to selected social determinants. METHODS: Population-based birth cohort study, with children born between January 1st and December 31st, 2003 in the city of Passo Fundo (RS), Brazil. Data was prospectively collected in two stages. In the first one, the Questionnaire of Neurologic Tracking for Epilepsy (QNT-E) was applied at the children's homes, together with the assessment of social determinants of health. Constructs of social position (economical class, mother's educational level, marital status and occupation), biological and behavioral factors (alcohol and tobacco consumption during pregnancy, number of prenatal appointments, and use of medicines during pregnancy), and psychosocial factors (religious meetings attendance) were analyzed. In the second stage, children with a positive QNT-E were submitted to neuroclinical assessment for diagnostic confirmation. RESULTS: Eleven cases of epilepsy, 27 of febrile seizures, 10 of neonatal seizures, 8 of single seizures, besides 26 patients with non-epileptic paroxysmal events, were identified. The incidence rate of epilepsy was 7/100,000 children and the prevalence 65.2/10,000 children. Nine children had active epilepsy, giving a point prevalence of 53.3/10,000 children. After multivariate analysis, no social determinants could be significantly related to epilepsy. CONCLUSIONS: In this study, a low incidence rate of epilepsy was reported in contrast to almost a double incidence of febrile seizures and non-epileptic paroxysmal events. Moreover, the achievement of an accurate diagnosis of epilepsy in developing countries is still a challenge, in order to avoid misdiagnosis.

Incidence of SUDEP in a cohort of patients with refractory epilepsy: the role of surgery and lesion localization / Incidência de SUDEP numa coorte de pacientes com epilepsia refratária: papel da cirurgia e da localização da lesão

OBJECTIVE: The aim of this study was to verify incidence and characteristics of sudden unexpected death in patients (SUDEP) with refractory epilepsy and its relation to previous surgery and lesion localization. METHOD: A cross sectional study was carried out in a cohort of 550 patients with refractory epilepsy followed up by the Epilepsy Surgery Program of the University Hospital of PUCRS, Porto Alegre, Brazil, between January, 1992 and July, 2002. Patients were allocated in two groups (operated and non operated). Seizure type, distribution of interictal spikes and MRI findings were correlated with the SUDEP outcome. RESULTS: The estimated incidence of probable SUDEP amounted to 29:1000 individuals. Probable SUDEP occurred in 1.2 percent of the 166 patients of the non operated group and in 3.7 percent of the 384 patients who were operated (OR=3.02, 95 percent CI 0.69-13.16) (p=0.11). Comparing patients who died to patients alive in the operated group a significant difference was observed concerning the following variables: SUDEP patients had a predominance of generalized seizures (p=0.002), extratemporal lesion on MRI (p<0.001) and epileptiform activity over extratemporal regions (p=0.001). CONCLUSION: In surgically treated patients with refractory epilepsy, an extratemporal location of the lesion and of the epileptiform discharges significantly correlated to SUDEP. Thus it is possible that in those patients; the underlying disease may play a role in the pathogenesis of SUDEP.

OBJETIVO: O objetivo deste estudo é avaliar a incidência e características de morte súbita em pacientes com epilepsia refratária (SUDEP) e sua relação com cirurgia prévia e localização da lesão. MÉTODO: Estudo de Coorte realizado com 550 pacientes com epilepsia refratária seguidos no Programa de Epilepsia do Hospital Universitário da PUCRS, Porto Alegre, Brasil, entre Janeiro, 1992 e Julho, 2002. Os pacientes foram distribuídos em dois grupos (operados e não operados). Tipo de epilepsia, distribuição das descargas interictais e achados em RNM foram correlacionados com SUDEP. RESULTADOS: A incidência estimada de SUDEP foi 29:1000 indivíduos. A incidência de provável SUDEP nos 166 pacientes do grupo de não operados foi 1,2 por cento e nos 384 pacientes no grupo operado 3,7 por cento (OR=3,02, 95 por cento IC 0,69-13,16) (p=0,11). Comparando os pacientes que morreram com os sobreviventes do grupo operado houve diferença significativa nas seguintes variáveis: pacientes com SUDEP apresentam uma predominância de crises epilépticas generalizadas (p=0,002), lesões extratemporais na RNM (p<0,001) e atividade epileptiforme na região extratemporal (p=0,001). CONCLUSÃO: A localização da lesão e as descargas extratemporais em pacientes tratados cirurgicamente com epilepsia refratária correlacionaram-se significativamente com SUDEP. Então, é possível que nestes pacientes uma doença sobrejacente possa estar envolvida na patogênese da SUDEP.

O valor do eletroencefalograma na avaliação de suspeitas de atraso no desenvolvimento neuropsicomotor em crianças com epilepsia / Value of the electroencephalogram in the assessment of suspected neuropsychomotor developmental delay in children with epilepsy

OBJETIVOS: avaliar o desempenho do Eletroencefalograma (EEG) na predição de suspeitas de atraso no desenvolvimento neuropsicomotor em crianças menores de cinco anos de idade com triagem positiva para epilepsia. MÉTODO: uma amostra de 1687 (73,8 por cento) crianças de uma coorte de nascidos vivos no ano de 2003 em Passo Fundo/RS foi rastreada nos domicílios para detecção de crises convulsivas. Os casos identificados foram encaminhados para a Entrevista Neurológica para Epilepsia, avaliação do desenvolvimento neuropsicomotor com o Teste de Denver II e exame eletroencefalográfico. Calculou-se a sensibilidade, a especificidade e valor preditivo do EEG, tomando-se como padrão-ouro a avaliação clínica. RESULTADOS: das 541 (32 por cento) crianças com rastreamento positivo, 59 apresentaram crises convulsivas e 37 realizaram o Teste de Denver II e EEG. Constatou-se 68,9 por cento de EEG alterados e 84,8 por cento de suspeitas de atraso de desenvolvimento, com associação significativa (p<0,03) entre os dois exames. A sensibilidade do EEG foi de 69 por cento e a especificidade de 75 por cento, com VPP de 91 por cento. CONCLUSÃO: O estudo demonstrou que o EEG se associa ao diagnóstico precoce de alterações no desenvolvimento neuropsicomotor, ampliando a detecção de casos suspeitos