Salivary alpha-amylase: a new non-invasive biomarker for assessment of pain perception in epileptic children.

The aim of this study was to evaluate pain perception in epileptic children during an invasive procedure as the collection of venous blood through salivary alpha-amylase (sAA) activity determination, and to compare it with that of healthy children. In the study 23 children, 12 with epilepsy and 11 healthy controls were enrolled. From all children of both groups, one sample of saliva was collected through a non-invasive device, 15 min before (t 0), during (t 1), and 15 min later (t 2) blood withdrawal, and sAA activity was then determined through a kinetic-colorimetric assay. A statistically significant difference (p < 0.001) was found at t 2 between the sAA activity in the two groups, suggesting that epileptic children have an increased sensitization to pain, while at t 0 the difference was at the limit of statistical significance and at t 1 no statistically significant difference was found indicating that in both groups the venipuncture equally induced a state of stress. Our data suggest that sAA activity could represent a new objective and non-invasive biomarker for the assessment of pain perception in epileptic children.

Neuropsychological development in children with Dravet syndrome.

PURPOSE: Aim of this study is to report a detailed profile of neuropsychological development in children with Dravet syndrome. METHODS: Twelve children with Dravet syndrome were longitudinally assessed using a detailed clinical and neuropsychological evaluation. Six had typical features of severe myoclonic epilepsy in infancy (SMEI) whereas the other six resulted borderline. All twelve underwent serial neuropsychological assessments with neurodevelopmental scales and further assessment of specific cognitive abilities. RESULTS: Our results reported an apparent normal development before disease onset, a general evolution in two main stages, more active the first one and with a general trend towards a clinical stabilization afterwards. The onset of cognitive decline was generally later than what is reported in other series; furthermore, the impairment of cognitive development is less severe, especially in borderline cases. As to specific cognitive competence, attention, visual motor integration, visual perception as well as executive functions are the most impaired abilities; language appears less involved, with a predominance of phonological defects. CONCLUSIONS: In our cohort the global development of patients appear less affected than in previous studies. Furthermore, our study points out an impairment of several specific cognitive skills even in patients with a developmental quotient apparently in the normal range. Language and other cognitive skill impairment such as attention, visuo-spatial organization, working memory and executive function appear consistent with what is usually found in cerebellar disorders.

The Italian version of the Zarit Burden interview: a validation study.

BACKGROUND: Caregiving experiences in dementia may have adverse effects on the caregiver's own physical and mental health. The Zarit Burden Interview (ZBI) is the most widely used instrument for assessing family carer burden and the purpose of the present study was to evaluate the psychometric properties of the Italian version of the ZBI (I-ZBI). METHODS: I-ZBI was administered to a non-randomized sample of 273 caregivers related to consecutively attending outpatients with a previously established primary diagnosis of dementia, according to DSM-IV criteria. Measurements used for the construct validity of the instrument were the General Health Questionnaire (GHQ-12), Hospital Anxiety and Depression Scale (HADS) and the Symptom Checklist-90-Revised (SCL-90-R). Validity and reliability were evaluated, as well as the factor structure of the instrument. RESULTS: Most caregivers were children (65%), female (72%) and living with the patient (53%), with quite a high level of burden. The I-ZBI demonstrates good reliability with high internal consistency (α = 0.90) and split-half correlation of 0.78, and good concurrent validity with other assessment tools. A five-factor solution was obtained for the I-ZBI and the original bi-factorial structure of the ZBI was not confirmed. CONCLUSIONS: The Italian version of the Zarit Burden Interview is valid, reliable and useful for use in clinical contexts and in future studies that could lead to a better understanding of carer burden in dementia. Clarifying the factorial structure of the ZBI would help to further the understanding of the large body of research using it and would also help to advance the understanding of subjective burden.