Sleep Quality in Children and Adults with Rett Syndrome.

BACKGROUND: Over 80% of individuals suffering from Rett syndrome (RTT) are affected over their life period by sleeping disorders. Little is known about the impact of those on the quality of life and a clinical approach to the treatment of sleep disturbances is lacking. AIMS: Primary aim was to assess sleep quality in children and adults. Secondary aim was to assess behavioral disorders and their relationship to sleep quality. The medication taken by the subjects was also included. METHODS: Sleep quality and medication were assessed using the sleeping questionnaire for children with neurological and other complex diseases (SNAKE). Behavioral disorders were assessed by the Rett Syndrome Behavior Questionnaire (RSBQ). Questionnaires were sent to the 700 members of the Elternhilfe für Kinder mit Rett Syndrom in Deutschland e.V. (Rett Aid) of which 287 were included. Questionnaires were filled out by the primary caregivers. RESULTS: Sleep quality was rated as very good to good by over 60% of caregivers in contrast to data available in the literature. Behavioral disorders related to regression such as loss of acquired hand skills (p = 0.046) and isolation (p = 0.002) were found to be associated with sleep quality. Melatonin showed a significant association (p = 0.007) with sleep quality. CONCLUSION: Our study showed sleep dysfunction to be less prevalent in RTT-affected individuals than evidence from past studies has suggested. Nevertheless, this remains a subjective assessment of sleep quality and therefore the need to find objective, disorder-specific parameters that measure sleep quality in RTT patients persists.

Interception of comet Hyakutake's ion tail at a distance of 500 million kilometres

Remote sensing observations and the direct sampling of material from a few comets have established the characteristic composition of cometary gas. This gas is ionized by solar ultraviolet radiation and the solar wind to form 'pick-up' ions, ions in a low ionization state that retain the same compositional signatures as the original gas. The pick-up ions are carried outward by the solar wind, and they could in principle be detected far from the coma (Sampling of pick-up ions has also been used to study interplanetary dust, Venus' tail and the interstellar medium.) Here we report the serendipitous detection of cometary pick-up ions, most probably associated with the tail of comet Hyakutake, at a distance of 3.4 AU from the nucleus. Previous observations have provided a wealth of physical and chemical information about a small sample of comets, but this detection suggests that remote sampling of comet compositions, and the discovery of otherwise invisible comets, may be possible.

Detection of interstellar pick-up hydrogen in the solar system.

Interstellar hydrogen ionized primarily by the solar wind has been detected by the SWICS instrument on the Ulysses spacecraft at a distance of 4.8 astronomical units from the sun. This "pick-up" hydrogen is identified by its distinct velocity distribution function, which drops abruptly at twice the local solar wind speed. From the measured fluxes of pick-up protons and singly charged helium, the number densities of neutral hydrogen and helium in the distant regions of the solar system are estimated to be 0.077 +/- 0.015 and 0.013 +/- 0.003 per cubic centimeter, respectively.

Energetic particles at venus: galileo results.

At Venus the Energetic Particles Detector (EPD) on the Galileo spacecraft measured the differential energy spectra and angular distributions of ions >22 kiloelectron volts (keV) and electrons > 15 keV in energy. The only time particles were observed by EPD was in a series of episodic events [0546 to 0638 universal time (UT)] near closest approach (0559:03 UT). Angular distributions were highly anisotropic, ordered by the magnetic field, and showed ions arriving from the hemisphere containing Venus and its bow shock. The spectra showed a power law form with intensities observed into the 120- to 280-keV range. Comparisons with model bow shock calculations show that these energetic ions are associated with the venusian foreshock-bow shock region. Shock-drift acceleration in the venusian bow shock seems the most likely process responsible for the observed ions.

Plasma Composition in Jupiter's Magnetosphere: Initial Results from the Solar Wind Ion Composition Spectrometer.

The ion composition in the Jovian environment was investigated with the Solar Wind Ion Composition Spectrometer on board Ulysses. A hot tenuous plasma was observed throughout the outer and middle magnetosphere. In some regions two thermally different components were identified. Oxygen and sulfur ions with several different charge states, from the volcanic satellite lo, make the largest contribution to the mass density of the hot plasma, even at high latitude. Solar wind particles were observed in all regions investigated. Ions from Jupiter's ionosphere were abundant in the middle magnetosphere, particularly in the highlatitude region on the dusk side, which was traversed for the first time.

Electron beams and ion composition measured at Io and in its torus.

Intense, magnetic field-aligned, bidirectional, energetic (>15 kiloelectron volts) electron beams were discovered by the Galileo energetic particles detector during the flyby of Io. These beams can carry sufficient energy flux into Jupiter's atmosphere to produce a visible aurora at the footprint of the magnetic flux tube connecting Io to Jupiter. Composition measurements through the torus showed that the spatial distributions of protons, oxygen, and sulfur are different, with sulfur being the dominant energetic (> approximately 10 kiloelectron volts per nucleon) ion at closest approach.

Proton MRS of a child with Sandhoff disease reveals elevated brain hexosamine.

Sandhoff disease (gangliosidosis type 0) is a lysosomal storage disorder with a deficiency of hexosaminidases A and B. After an initially normal development the clinical course of affected children is severe and rapidly progressive leading to spastic tetraparesis, epileptic seizures and early death. In a 10-month-old girl with enzymatically established diagnosis of Sandhoff disease MRI of the brain showed signal changes in the periventricular white matter, pyramidal tract, basal ganglia, and cerebellar hemispheres. Proton MR spectroscopy (MRS) at the age of 13 months revealed a reduction of total N-acetylaspartate (neuroaxonal marker) as well as strongly elevated inositol (glial marker) in white matter, gray matter, and basal ganglia. A new resonance at 2.07 ppm was detected in all regions and ascribed to N-acetylhexosamine with highest concentrations in white matter and thalamus. While conventional MRS findings are in line with neuroaxaonal damage and pronounced astrocytosis, the observation of N-acetylhexosamine appears as a specific marker of Sandhoff disease indicating accumulation of hexosamine-containing oligosaccharides. This interpretation is supported by a recent in vitro MRS study of a Sandhoff mouse model. In conclusion, proton MRS of cerebral metabolites offers specific insights into the pathopysiologic processes of children with Sandhoff disease and may prove to represent another disease specific MRS pattern of the brain.

Chronic relapsing opsoclonus-myoclonus syndrome: combination of cyclophosphamide and dexamethasone pulses.

Opsoclonus-myoclonus syndrome (OMS) is a rare and debilitating disorder of unknown etiology affecting children and adults. Outcome is unfavourable; approximately 80% of children with OMS suffer from mild to severe neurological handicaps, mainly cognitive impairment. A standard therapy does not exist. Due to the possible immune-mediated mechanisms, treatment with steroids, ACTH, plasmapheresis and immunoglobulins can be successful. However, some children become steroid dependent and symptoms may reoccur after treatment has been finished. We present two girls with OMS, who had a prolonged clinical course lasting 4 and 9 years with many relapses. Both children developed symptoms around the age of two years. Diagnostic work-up to exclude neuroblastoma was negative. Several treatment modalities including oral steroids, dexamethasone pulses, immunoglobulin and cyclosporine were used without lasting success. In addition, cognitive impairment developed in both children. In order to prevent further clinical and mental deterioration, 6 pulses of cyclophosphamide in combination with dexamethasone pulses every 4 weeks were administered. Both children showed significant improvement of OMS symptoms. One girl is still symptom free 18 months after treatment, mild ataxia developed in the other after 12 months. Both children are mentally handicapped and in special need schools. We conclude that combination of cyclophosphamide pulses and dexamethasone pulse therapy is a therapeutic option even after a long clinical course to improve symptoms of OMS.

Slowly progressive hemiparesis in childhood as a consequence of Rasmussen encephalitis without or with delayed-onset seizures.

Five young children developed slowly progressive hemiparesis as the initial manifestation of Rasmussen encephalitis (RE). Three have remained seizure free over an observational period of 1.3-1.9 years. In the remaining two patients, seizures occurred after 0.5 and 0.6 years respectively. We suggest that RE might be presently underdiagnosed and should be suspected in cases of new onset hemiparesis. In this series, three out of five patients showed oligoclonal bands on examination of cerebrospinal fluid (CSF) which represented additional diagnostic hints towards an immune-mediated condition. According to recently published formal diagnostic criteria, evidence of progressive cerebral hemiatrophy or bioptic identification of RE-typical inflammation confirms the diagnosis in such cases. Long-term immunotherapy is recommended in order to prevent further tissue loss and functional decline.

Hyperphagia in children with craniopharyngioma is associated with hyperleptinaemia and a failure in the downregulation of appetite.

Patients with craniopharyngioma frequently suffer from severe obesity. Leptin induces an inhibition of appetite via hypothalamic receptors. This study was undertaken to investigate whether a relationship exists between serum leptin levels and pituitary/hypothalamic lesions in craniopharyngioma patients. Serum leptin levels were evaluated by RIA in 14 patients (age 7-21 years; 7 females, 7 males) after they had undergone neurosurgical treatment for craniopharyngioma. Normal controls had a positive correlation between leptin levels and body mass index (BMI) with higher levels in the females than in the males. Significantly elevated leptin levels with respect to BMI were found in 11 craniopharyngioma patients who had been affected by a suprasellar tumour, whereas 3 patients with an intrasellar tumour had lower, almost normal serum leptin levels. Our data suggest that craniopharyngioma patients develop hypothalamic obesity because their hypothalamic structures are insensitive to endogenous leptin. The elevated serum leptin concentrations found only in patients with a suprasellar tumour may be explained by a disturbed feedback mechanism from the hypothalamic leptin receptors to the adipose tissue.

Aminophylline modulation of the mouse respiratory network changes during postnatal maturation.

Aminophylline is a respiratory stimulant commonly used for the treatment of central apnea. Experiences from clinical practice, however, revealed that aminophylline is not reliably effective in preterm infants, whereas it is normally effective in infants and mature patients. In an established animal model for postnatal development of respiratory control mechanisms, we therefore examined the hypothesis that the clinical observations reflect a developmental change in the sensitivity of the central respiratory network to methylxanthines. The medullary respiratory network was isolated at different postnatal ages (postnatal days 1-13; P1-P13) in a transverse mouse brain stem slice preparation. This preparation contains the pre-Bötzinger complex (PBC), a region that is critical for generation of respiratory rhythm. Spontaneous rhythmic respiratory activity was recorded from the hypoglossal (XII) rootlets and from neurons in the PBC by using the whole cell patch clamp technique. Bath-applied aminophylline [20 microM] increased the frequency (+41%) in neonatal animals (P1-P6) without affecting the amplitude of respiratory burst activity in XII rootlets. The same concentration of aminophylline did not have any significant effect on the frequency of respiratory XII bursts but increased the amplitude (+31%) in juvenile animals (P7-P13). In the same age group, aminophylline also augmented the amplitude and the duration of respiratory synaptic drive currents in respiratory PBC neurons. The data demonstrate that augmentation of the respiratory output is due to direct enhancement of central respiratory network activity and increase of synaptic drive of hypoglossal motoneurons in juvenile, but not neonatal, animals. This indicates a developmental change in the efficacy of aminophylline to reinforce central respiratory network activity. Therefore, we believe that the variable success in treating respiratory disturbances in premature infants reflects maturational changes in the expression of receptors and/or intracellular signal pathways in the central respiratory network.

Anoxic ATP depletion in neonatal mice brainstem is prevented by creatine supplementation.

BACKGROUND: Sufficient ATP concentrations maintain physiological processes and protect tissue from hypoxic damage. With decreasing oxygen concentration, ATP synthesis relies increasingly on the presence of phosphocreatine. AIM: The effect of exogenously applied creatine on phosphocreatine and ATP concentrations was studied under control and anoxic conditions. METHODS: Pregnant mice were fed orally with creatine monohydrate (2 g/kg body weight/day). Brainstem slices from these mice pups were compared with those from pups of non-creatine supplemented pregnant mice. Measurements were performed under normoxic and anoxic conditions. In addition, brainstem slices from non-creatine treated mice pups were incubated for 3 hours in control artificial cerebrospinal fluid (CSF) (n = 10) or in artificial CSF containing 200 microM creatine (n = 10). ATP and phosphocreatine contents were determined enzymatically in single brainstem slices. RESULTS: ATP concentrations were in the same range in all preparations. However, there was a significant increase of phosphocreatine in the brainstems from pups of creatine fed mice when compared with the brainstems of pups from non-creatine treated mice or in non-incubated brainstems of control animals. After 30 minutes anoxia, ATP as well as phosphocreatine concentrations remained significantly higher in creatine pretreated slices compared with controls. CONCLUSION: The data indicate that exogenous application of creatine is effective in neuroprotection.

Quantitative proton magnetic resonance spectroscopy of focal brain lesions.

The diagnostic value of single-voxel proton magnetic resonance spectroscopy (2 T, stimulated echo acquisition mode, TR = 6,000 ms, TE = 20 ms, 4-5 mL volumes-of-interest) was assessed for a differentiation of focal brain lesions of unknown etiology in 17 patients 1-14 years of age. Absolute metabolite concentrations were compared with age-matched control subjects and an individual control region. Most of the brain tumors were characterized by strongly reduced total N-acetylaspartyl compounds and marked increases of myo-inositol and choline-containing compounds, consistent with a lack of neuroaxonal tissue and a proliferation of glial cells. Lactate was elevated in only four patients. When using this pattern for a metabolic discrimination of brain tumors from other focal lesions, proton spectroscopy correctly identified 14 of 17 abnormalities, as confirmed by histologic examination after neurosurgical intervention. One false-positive tumor diagnosis was a severe reactive gliosis mimicking a typical tumor spectrum. Two inconclusive cases comprised an astrocytoma with moderately elevated myo-inositol but reduced choline-containing compounds and a patient with an abscess leading to a marked reduction of all metabolites but strong contributions from mobile lipids. In summary, quantitative proton spectroscopy has considerable clinical value for preoperative characterization of focal brain lesions.

Use of a modified needle in antegrade transfemoral arterial approach for diagnostic and interventional procedures.

A modified needle for the antegrade transfemoral approach in diagnostic and interventional procedures is described that simplifies access to the superficial femoral artery, and that can easily be manufactured from standard puncture needles.

New magnetic electron spectrometer with directional sensitivity for a satellite application.

Design and test of a new magnetic electron spectrometer with excellent angular and rather small energy resolution is described. The system is specifically designed for a space flight application to analyze the angular distribution of energetic electrons. Incident electrons with energies between 15 and 270 keV are focused with respect to the direction of incidence. Reasonable directional focusing is obtained over an angular range of 60 degrees with a resolution of 5 degrees. This magnetic electron spectrometer is part of the energetic particle instrument (EPI) developed for the European Space Agency (ESA) GEOS program. GEOS-1 was launched on April 20, 1977, and injected into a 12-h orbit. The instrument has worked successfully since the switch-on-phase in the beginning of May 1977.

Active transport and mediated diffusion of glucose and other monosaccharides in Endomyces magnusii.

After growth on sucrose or glucose, Endomyces magnusii possess a monosaccharide uptake which resembles that of Saccharomyces cerevisiae (a high KT of uptake, preference for alpha-anomers of D-xylose and D-glucose, enhanced uptake during anaerobiosis, attainment of a diffusion equilibrium). The uptake is inhibited by other monosaccharides and especially strongly by D-galactose. In the absence of high concentrations of metabolizable sugars. E. magnusii develops a capacity to accumulate 3-O-methyl-D-glucose and D-xylose against a concentration gradient the new system displaying a high affinity for glucose (KT less than 0.1 mM), repression by glucose, mannose or galactose. Cycloheximide (0.2%) blocks the formation of the active system.

The present status of highly selective vagotomy.

Peptic ulcer has been the subject of extensive investigation in the search for a curative operation free of complications. Highly selective vagotomy is an elegant physiological approach to the problem, and has excited widespread interest. The reported results in uncomplicated duodenal ulcer disease indicate an almost nil mortality, a very low incidence of recurrent ulceration, a marked reduction in basal and stimulated acid secretion, and little or no interference with gastric emptying, hormone metabolism, or pancreatic and biliary function. The good clinical results at one year appear to be maintained at five years. Its use in the management of gastric ulceration and the complications of peptic ulcer disease also appears promising.