Sympatric shift in a male sexual ornament in the damselfly Calopteryx splendens.

Character displacement is a process by which interactions between two species that exhibit similar traits, results in geographical patterns of trait divergence in one or both species. These traits evolve to reduce costs of interspecific interactions in sympatry and thus differ from their condition in allopatry. In male damselflies Calopteryx splendens, large wing spots are sexually selected. However, in sympatric populations with Calopteryx virgo, wing spot size decreases as C. virgo abundance increases. The stability of this pattern is unclear, because previous studies have focused on sympatric populations with potentially fluctuating relative abundances. We studied the wing spot sizes of C. splendens in both sympatric and allopatric populations. Our data show that male C. splendens' wing spots are larger in allopatry than in sympatry with C. virgo. We suggest that both interspecific aggression and avoidance of interspecific reproductive interactions may result in this pattern, although their relative importance remains unclear.

Behavior problems in children at time of first recognized seizure and changes over the following 3 years.

OBJECTIVES: The purposes of this 36-month study of children with first recognized seizures were: (1) to describe baseline differences in behavior problems between children with and without prior unrecognized seizures; (2) to identify differences over time in behavior problems between children with seizures and their healthy siblings; (3) to identify the proportions of children with seizures and healthy siblings who were consistently at risk for behavior problems for 36 months; and (4) to identify risk factors for behavior problems 36 months following the first recognized seizure. Risk factors explored included demographic (child age and gender, caregiver education), neuropsychological (IQ, processing speed), seizure (epileptic syndrome, use of antiepileptic drug, seizure recurrence), and family (family mastery, satisfaction with family relationships, parent response) variables. METHODS: Participants were 300 children aged 6 through 14 years with a first recognized seizure and 196 healthy siblings. Data were collected from medical records, structured interviews, self-report questionnaires, and neuropsychological testing. Behavior problems were measured using the Child Behavior Checklist and the Teacher's Report Form. Data analyses included descriptive statistics and linear mixed models. RESULTS: Children with prior unrecognized seizures were at higher risk for behavior problems at baseline. As a group, children with seizures showed a steady reduction in behavior problems over time. Children with seizures were found to have significantly more behavior problems than their siblings over time, and significantly more children with seizures (11.3%) than siblings (4.6%) had consistent behavior problems over time. Key risk factors for child behavior problems based on both caregivers and teachers were: less caregiver education, slower initial processing speed, slowing of processing speed over the first 36 months, and a number of family variables including lower levels of family mastery or child satisfaction with family relationships, lower parent support of the child's autonomy, and lower parent confidence in their ability to discipline their child. CONCLUSIONS: Children with new-onset seizures who are otherwise developing normally have higher rates of behavior problems than their healthy siblings; however, behavior problems are not consistently in the at-risk range in most children during the first 3 years after seizure onset. When children show behavior problems, family variables that might be targeted include family mastery, parent support of child autonomy, and parents' confidence in their ability to handle their children's behavior.

Ischemic cerebrovascular complications of Haemophilus influenzae meningitis. The value of computed tomography.

In an effort to define the value of computed tomographic (CT) scanning in assessment of cerebral involvement in children with severe Haemophilus influenzae meningitis, we studied 12 children who had focal neurologic deficits on admission or within the early days of illness. The CT scan reliably excluded abscess and cerebritis and suggested ischemic cerebrovascular lesions in 11 of 12 children. Scans performed early in the hospital course generally showed low-density lesions occurring in a vascular distribution without detectable mass effect or enhancement. Later in the clinical course there was consistent enhancement of gray matter or diffuse enhancement in the area of the vascular lesion. The duration of symptoms of meningitis ranged from five to 21 days (mean, 13 days) and appeared to predispose to these vascular lesions. A CT scan consistent with infarction of brain parenchyma occurred predictably in patients with persistent focal neurologic deficits and was correlated with poor outcome.

CT in ceroid lipofuscinosis.

The diagnosis of the childhood forms of neuronal ceroid lipofuscinosis is considered when a child presents with seizures, dementia, and pigmentary change in the retina. A diagnosis is based on the result of skin or conjunctival biopsy. We report two children who had CTs obtained at the onset of seizures and prior to the occurrence of intellectual deterioration or retinal pigmentary changes. In both cases, the CT showed marked enlargement of the fourth ventricle and cerebellar atrophy without concomitant cerebral atrophy. We suggest that this cerebellar atrophy may be an early sign of ceroid lipofuscinosis and may be of particular note when seen on the CT scan of a child with a recent onset of seizures.

Behavioral issues in pediatric epilepsy.

Children with epilepsy have more behavioral and cognitive problems than children with other chronic illnesses and children in the general population. Risk factors are multiple, probably involving a combination of neurological, seizure, family, and child variables. Problems with attention and symptoms of depression occur frequently but may be unrecognized. Anxiety disorders and psychoses are less common. There are very few studies defining most effective therapies for behavioral problems in children with epilepsy. Education, group psychotherapy, and psychopharmacology have been used with success.

Peduncular hallucinations caused by brainstem compression.

Peduncular hallucinations are associated with intrinsic lesions of the midbrain. We report transient peduncular hallucinations due to extrinsic compression of the midbrain by a cystic craniopharyngioma. The peduncular hallucinations resolved promptly after drainage of the cyst.

Epidermal nevus syndrome: a neurologic variant with hemimegalencephaly, gyral malformation, mental retardation, seizures, and facial hemihypertrophy.

The epidermal nevus syndrome (ENS) is a sporadic neurocutaneous disorder that consists of epidermal nevi and congenital anomalies involving the brain and other systems. From among over 60 patients with ENS presenting with neurologic manifestations, we identified 17 who had hemimegalencephaly based on pathologic or radiologic studies. Associated brain and neurologic abnormalities included gyral malformations in 12 of 12, mental retardation in 13 of 14, seizures in 16 of 17 (including 9 with infantile spasms), and contralateral hemiparesis in 7 of 12. All had ipsilateral epidermal nevi of the head, and several had ipsilateral facial hemihypertrophy. We concluded that these abnormalities comprise a recognizable neurologic variant of ENS that we believe represents the full expression of primary brain involvement. Several patients also had evidence of acquired brain lesions such as infarcts, atrophy, porencephaly, and calcifications, which are best explained by prior ischemia or hemorrhage. Given repeated observations of blood vessel anomalies in ENS patients, we hypothesize that underlying vascular dysplasia predisposes to these acquired lesions. The same cause may be invoked to explain the wide variety of neurologic symptoms reported in ENS patients without hemimegalencephaly. While the cause of ENS remains unknown, several observations suggest a somatic mutation.

Normal SPECT thallium-201 bull's-eye display: gender differences.

The bull's-eye technique synthesizes three-dimensional information from single photon emission computed tomographic 201TI images into two dimensions so that a patient's data can be compared quantitatively against a normal file. To characterize the normal database and to clarify differences between males and females, clinical data and exercise electrocardiography were used to identify 50 males and 50 females with less than 5% probability of coronary artery disease. Results show inhomogeneity of the 201TI distributions at stress and delay: septal to lateral wall count ratios are less than 1.0 in both females and males; anterior to inferior wall count ratios are greater than 1.0 in males but are approximately equal to 1.0 in females. Washout rate is faster in females than males at the same peak exercise heart rate and systolic blood pressure, despite lower exercise time. These important differences suggest that quantitative analysis of single photon emission computed tomographic 201TI images requires gender-matched normal files.

Male mating preference for female survivorship in the seaweed fly Gluma musgravei (Diptera: Coelopidae).

The seaweed fly mating system is characterized by pre-mating struggles during which females exhibit a mate rejection response involving kicking, shaking and abdominal curling. Males must resist rejection until females become passive and allow copulation to take place. However, despite the vigorous nature of the struggle males frequently dismount passive females without attempting copulation. Here we show that rejected females suffered higher post-encounter mortality rates than those accepted by males in the seaweed fly Gluma musgravei. Furthermore, we show that males also preferentially mounted females with higher future longevity. We propose that this male mate choice for female survivorship has evolved as a result of females often having to survive for long periods after mating until suitable oviposition sites become available. Such male preferences for female survivorship may be common in species in which oviposition must sometimes be substantially delayed after mating.

The "muscular variant" of Pompe disease: clinical, biochemical and histologic characteristics.

We report on a 2-yr-old boy with progressive muscular weakness and respiratory failure. There was no clinical evidence of heart muscle involvement. Autopsy showed marked intralysosomal glycogen deposition in skeletal muscle and liver with no histological evidence of glycogen deposition in cardiac muscle. The activity of the lysosomal enzyme alpha-1,4-glucosidase was deficient in skin fibroblasts, skeletal muscle, cardiac muscle, and liver; however, the enzymatic activity in peripheral blood leukocytes was in the low normal range. The child's mother had normal enzymatic activity in leukocytes but heterozygote levels in skin fibroblasts.

Symptoms of depression in adolescents with epilepsy.

OBJECTIVE: To identify factors related to symptoms of depression in a sample of adolescents with epilepsy. METHOD: Cross-sectional data were collected on 115 adolescents aged 12 to 16 years who had epilepsy. Demographic (age, gender), seizure (severity, age of onset), family (stress, resources, relationships), mother (perceptions of stigma, depression), and child (attitude toward epilepsy, satisfaction with family relationships, coping, perceptions of control) variables were assessed by questionnaire and standardized scales. Depression was measured by the Children's Depression Inventory and the Anxiety/Depression subscale of the Youth Self-Report. Data were analyzed by using multiple regression with depression as the dependent variable. RESULTS: In this sample, 23% of subjects had symptoms of depression. Significant predictors of depression as measured by the Children's Depression Inventory (R2 = 0.53) were youth's attitude toward epilepsy, youth satisfaction with family relationships, and unknown locus of control or external locus of control for socially powerful others. CONCLUSIONS: Adolescents' attitudes, attributions, and satisfaction with family relationships are related to depression and should be assessed in the clinical setting. The relationship between locus of control and depression fits the learned helplessness model of depression and suggests the need for interventions to promote an internal locus of control in adolescents with epilepsy.

Status epilepticus in infancy and childhood.

Status epilepticus implies a prolonged seizure or recurrent seizures with persistent decreased consciousness, lasting at least 30 minutes. Both convulsive and nonconvulsive forms exist, either of which may lead to death or additional neurologic deficit. Therapy involves careful supportive care plus some combination of benzodiazepines, phenytoin, or phenobarbital. The outcome depends first on the etiology and second on the rapidity with which seizures are controlled.

Status epilepticus in children: etiology, clinical features, and outcome.

Between August 1984 and September 1986, data were gathered prospectively on 114 episodes of convulsive status epilepticus, defined as seizure duration longer than 30 minutes, affecting 97 children. Status epilepticus was symptomatic in 72% (chronic 59%, acute 13%) and idiopathic or febrile in 28%. We identified precipitating factors in 63% of episodes. The most common factors were inadequate blood levels of anticonvulsants (32 of 60 episodes in children with prior seizures) and febrile illnesses, excluding meningitis or encephalitis (38 of 114 episodes). There was an elevated peripheral white blood cell count in 60%, acidosis with a pH of less than 7.0 in 12.5%, and cerebrospinal fluid pleocytosis not due to meningitis or encephalitis in 8 of 64 episodes. Eight children died, three with severe pre-existing brain damage, two with meningitis, and two with a poorly defined encephalopathy. Eighteen children developed a new neurologic deficit. Outcome was associated with the etiology and duration of status epilepticus, with age at the time of status a minor factor. A permanent deficit occurred in only five children with idiopathic or febrile status epilepticus.

Vertebrobasilar occlusive disease and childhood migraine.

A nine-year-old girl developed a cerebellar infarct documented by computed tomography. This infarct occurred in association with a typical migrainous attack. Vertebrobasilar occlusive disease has been reported in adult migraineurs but has not been previously reported in children.

Brachial plexus palsy: intrauterine onset.

A newborn had a combination of brachial plexus palsy and phrenic nerve palsy associated with a small left arm, deformed ribs on the left, and an area of subcutaneous calcification on the left side of the neck. These lesions represent a deformation syndrome due to uterine constraint in a bicornuate uterus. Appropriate diagnosis can initiate management to avoid problems in subsequent pregnancies.

Behaviour problems in children with new-onset epilepsy.

Behaviour problems are common in children with epilepsy and it is not known when these problems begin. Some suggest that behaviour problems are caused by a neurological condition that also causes the seizures. Behaviour problems were investigated in 42 youths (23 girls and 19 boys) over a 4-month period beginning at the time of the initial seizure. Subjects were aged 4-15 years (mean, M = 8.4). Approximately 57% had partial seizure(s) and 43% had generalized seizure(s). The large majority (71%) were diagnosed with epilepsy. As a part of a larger study, parents rated their children's behaviour on the Child Behaviour Checklist immediately prior to the first seizure (time 1), and at 4 months after the first seizure (time 2). Seizure severity was rated as follows: high = 20%, moderate = 39%, and low = 41%. At time 1, 24% already had behaviour problems. Behaviour problems significantly decreased from time 1 to time 2 (P < 0.001) for the whole group. Within the epilepsy group (n = 40), differences were found in behaviour problems based on seizure severity from time 1 to time 2 as follows: low, time 1: M = 55, time 2: M = 45; moderate, time 1: M = 55, time 2: M = 51; and high, time 1: M = 61, time 2: M = 55. Results indicate that children should be assessed for behaviour problems at the time of the first seizure.

Children with epilepsy: quality of life and psychosocial needs.

In this chapter, research related to quality of life in children with epilepsy and their psychosocial needs is reviewed. Nursing and nonnursing research reports and descriptions of instruments developed between January 1994 and February 1999 are included. Most research reports described quality-of-life problems, especially psychological functioning in school-age children. Less attention was devoted to psychosocial needs. Major gaps included intervention studies and research on infants and young children. Conclusions include recommendations for future research.