Brazilian Portuguese Childhood Autism Spectrum Test: an investigation of the factor structure of autistic traits in school-aged children

Objective: There is limited evidence about the cross-cultural validity of autistic symptoms in school-aged children in Brazil. We used data from a large school survey to evaluate the factor structure of autism symptoms in community-dwelling children and adolescents. Methods: We translated the Childhood Autism Spectrum Test to Brazilian Portuguese and performed factor analyses to investigate the factor structure of parent-reported autistic symptoms in a large sample (n=8,571) of children/adolescents from a school survey in the metropolitan area of São Paulo. Results: Autistic symptoms were best conceptualized under a correlated-factors model with two factors: one predominantly characterized by social-communication symptoms and the other by symptoms of inflexible/restricted language, behaviors, and interests. Conclusions: These findings provide evidence that the structure of autistic symptoms in Brazil is similar to that described in other countries, indicating the cross-cultural validity of autism in Brazil.

Assessment of motor skills and school performance in children diagnosed with attention deficit hyperactivity disorder

Abstract This study was designed to analyze the association between motor skills and school performance in elementary school children with attention deficit hyperactivity disorder (ADHD). Two groups of children were evaluated. The experimental group contained 55 students of both sexes, age 7 to 10, who had been clinically diagnosed with ADHD; the control group consisted of 55 children with typical motor development. The results showed no association between motor skills and school performance in the experimental group, although there was a statistically significant difference between manual dexterity and writing performance in the control group. Although we found no relationship between motor skills and school performance in children with ADHD, we believe that having specialized professionals monitor these children may be beneficial. Early diagnosis of impaired motor skills and poor school performance may lead to better developmental opportunities and a better quality of life.

Attention deficit and hyperactivity disorder in people with epilepsy: diagnosis and implications to the treatment / Transtorno de déficit de atenção e hiperatividade em pessoas com epilepsia: diagnóstico e implicações para o tratamento

The association between attention deficit and hyperactivity disorder (ADHD) and epilepsy can cause significant impact on the social life of affected individuals and their families. Clinical studies suggest that 30-40 percent of people with epilepsy also have ADHD. There are no studies which demonstrate that short or long-term treatment with methylphenidate increases the risk of seizures. Some studies attempt to relate drug interactions between methylphenidate and antiepileptic drugs, but adverse effects of methylphenidate have not been shown clearly. This review presents some neurobiological and physiopathogenic aspects, common to ADHD and epilepsy, from recent research studies, related to pharmacology, neuroimaging and electroencephalography. Possible risk of occurrence of seizures associated with the use of methylphenidate are also discussed.

A associação entre transtorno de déficit de atenção / hiperatividade (TDAH) e epilepsia pode causar importante impacto na vida social dos indivíduos afetados e seus familiares. Estudos clínicos sugerem que 30-40 por cento das pessoas com epilepsia também apresentam TDAH. Não existem publicações que evidenciem que o tratamento a curto ou longo prazo com metilfenidato aumente o risco de ocorrência de crises epilépticas, e alguns estudos procuram relacionar as interações medicamentosas entre o metilfenidato e as drogas antiepilépticas, porém não foram demonstrados os possíveis efeitos do metilfenidato de uma maneira clara. Apresenta-se a seguir, revisão sobre os aspectos neurobiológicos e fisiopatogênicos comuns ao TDAH e epilepsia, a partir de pesquisas recentes relacionadas a estudos de farmacologia, neuroimagem e eletroencefalografia, e discuti-se os possíveis riscos da ocorrência de crises epilépticas associadas ao uso de metilfenidato.

Encefalopatia necrotizante aguda: paciente com evolução recidivante e letal / Acute necrotizing encephalopathy: patient with a relapsing and lethal evolution

A encefalopatia necrotizante aguda foi descrita inicialmente em crianças japonesas e se caracteriza por rápida evolução e lesões simétricas no tronco encefálico, cerebelo e especialmente nos tálamos. Avaliamos uma menina de 7 meses de idade, que apresentou dois episódios de depressão da consciência de rápida instalação e paresias, sem alterações metabólicas. Houve uma rápida melhora na primeira crise, porém o segundo episódio foi fulminante, tendo evoluído para estado de morte encefálica em dois dias. Os estudos de ressonância magnética mostraram lesões simétricas nos tálamos e acometimento também do tronco encefálico e cerebelo.

Acute necrotizing encephalopathy was initially reported in Japanese children. The rapid evolution and symmetrical brain lesions seen in the brainstem, cerebellum and specially in the thalamus characterize the disease. We studied a 7-month-old-girl, who presented with two episodes of rapid loss of consciousness and paresis without metabolic disturbances. At the first time she had a rapid improvement, but at the second episode the course was fulminant and in two days she lapsed into a clinical state of brain death. The magnetic resonance studies showed symmetrical lesions in the thalamus and additional lesions involving the brainstem and the cerebellum.

Inter-relações entre distúrbios respiratórios do sono, respiração bucal e distúrbios do comportamento na infância / Relationships between sleep-disordered breathing, oral breathing and behavioral disorders in childhood

A caracterização atual dos distúrbios respiratórios do sono compreende desde a síndrome de apnéia do sono até a síndrome de resistência das vias aéreas superiores. A fisiopatologia dos distúrbios respiratórios do sono na infância mantém complexas correlações com a respiração bucal. Com freqüência, crianças com distúrbios respiratórios do sono podem desenvolver alterações comportamentais, tais como déficit de atenção e hiperatividade, bem como manifestar sonolência ou, ainda, apresentar complicações sistêmicas cardiovasculares e déficit pôndero-estatural. Com base na literatura recente sobre o tema, são apresentadas as correlações entre os distúrbios respiratórios do sono e o transtorno do déficit de atenção/hiperatividade.

The recent concept of sleep disordered-breathing ranges from the sleep apnea syndrome to the upper airways resistance syndrome. The physiopathology of sleep-disordered breathing includes complex relations with oral breathing. Children with sleep-disordered breathing often present behavioral disorders, such as attention deficit and hyperactivity, excessive daytime sleepiness as well as systemic cardiovascular or growth. Based on recent references, we discuss the correlations between sleep-disordered breathing and attention deficit/hyperactivity disorder.

Neonatal seizures: the overlap between diagnosis of metabolic disorders and structural abnormalities. Case report

Inborn metabolic errors (IME) and cortical developmental malformations are uncommon etiologies of neonatal seizures, however they may represent treatable causes of refractory epilepsy and for this reason must be considered as possible etiological factors. This case report aims to demonstrate the importance of neuroimaging studies in one patient with neonatal seizures, even when there are clues pointing to a metabolic disorder. CASE REPORT: A previously healthy 14 day-old child started presenting reiterated focal motor seizures (FMS) which evolved to status epilepticus. Exams showed high serum levels of ammonia and no other abnormalities. A metabolic investigation was conducted with normal results. During follow-up, the patient presented developmental delay and left side hemiparesia. Seizures remained controlled with anti-epileptic drugs for four months, followed by relapse with repetitive FMS on the left side. Temporary improvement was obtained with anti-epileptic drug adjustment. At the age of 6 months, during a new episode of status epilepticus, high ammonia levels were detected. Other metabolic exams remained normal. The child was referred to a video-electroencephalographic monitoring and continuous epileptiform discharges were recorded over the right parasagittal and midline regions, with predominance over the posterior quadrant. A new neuroimaging study was performed and displayed a malformation of cortical development. Our case illustrates that because newborns are prone to present metabolic disarrangement, an unbalance such as hyperammonemia may be a consequence of acute events and conduct to a misdiagnosis of IME

Vaccine-associated paralytic poliomyelitis: a case report of domiciliary transmission

Poliomyelitis associated with live strain vaccine is defined as the paralytic form of the acute anterior poliomyelitis related to the vaccine strain. Since these strains behave similarly to the wild-type virus, we can differentiate, epidemiologically, two types of vaccine-associated poliomyelitis: cases in which the patient was vaccinated and cases in which the patient had had contact with vaccinated individuals. We herein present the case of an unvaccinated child, with a clinical picture of an acute anterior poliomyelitis associated with the live strain vaccine, whose brother received the Sabin vaccine 20 days before the onset of the symptoms. Vaccine strain of the type 3 poliovirus was isolated in fecal culture and a presented mutation in nucleotide 472 (C(r)U) in the 5' non-coding region, which is strongly related to the higher strain virulence