Language phenotypes in children with autism spectrum disorder, expressive language disorder, and typical language development.

The aim of this study was to compare language abilities in 4-6-year-old Georgian-speaking children with typical language development (TLD), expressive language disorder (ELD), and autism spectrum disorder (ASD). Language linguistic components, such as phonology, semantics, syntax, morphology, and pragmatics, were examined along with verbal behavior types like "mand," "tact," "echoic," and "intraverbal." Our sample comprised 148 children, with a gender distribution of 50 girls and 98 boys. Significant differences were observed in the application of various parts of speech across the three groups. Children with ELD were found to use pronouns more frequently compared to TLD and ASD groups. Conversely, children exhibiting typical language development displayed a greater usage of conjunctions and particles than the other groups. Notably, linguistic error patterns varied across groups: children with ELD predominantly committed errors in phonetics and morphosyntax, while children with ASD had more pragmatic errors and also struggled with morphosyntax. Moreover, the ASD group was found to use "mands" and "echoics" more frequently than both the TLD and ELD groups.

A six-year longitudinal study of neurocognitive problems in children with epilepsy.

INTRODUCTION: This study describes the specific neuropsychological abnormalities among children with epilepsy (CH-E) living in Georgia. METHODS: A cohort of CH-E and children without epilepsy (CH-NoE), aged 6-13 years, admitted to the epilepsy center of the Institute of Neurology and Neuropsychology from 1st January 2010 to 31st December 2015, was selected and investigated with a structured protocol. Neurological/epileptological assessments were made and neuropsychological testing was done on all study subjects. RESULTS: Abnormalities in praxis, verbal functions, verbal learning, visual-spatial matching, visual-motor ability, and fine motor skills, working memory, and phonological memory span were often revealed in CH-E as compared to CH-NoE. Early age of seizure onset, epilepsy duration, and anti-seizure medication (ASM) use, in combination with brain structural abnormalities on neuroimaging, and structural etiology were independent predictors of impaired functioning in various neuropsychological domains. DISCUSSION: More than half of children with epilepsy have a variety of cognitive impairments, which may increase with ASM therapy, especially when the cause of seizures is structural damage to the brain. Therefore, in the process of diagnosing epilepsy, evaluation of cognitive functions should become an integral part to ensure effective management of the disorder.

Cognitive functions in children exposed to antiepileptic drugs in utero - Study in Georgia.

OBJECTIVE: The cognitive teratogenicity of antiepileptic drugs (AEDs) has gained increasing attention in the last decade. The objective of the current study was to assess the effects of AED fetal exposure on the cognitive development of children of mothers with epilepsy from Georgia in a controlled study taking into consideration major confounding factors. METHODS: A prospective cohort group was formed from children and mothers registered in the Georgian National AED-Pregnancy Registry. The study group's age- and gender-matched control children without fetal AED exposure were selected retrospectively. The Intelligence Quotient (IQ) using the Wechsler Adult Intelligence Scale - revised (WAIS-R) was assessed in mothers. The Wechsler Preschool and Primary Scale of Intelligence (WPPSI-4) were used to assess intellectual functioning for children of both study and control groups. Linear regression analysis was performed to detect association of AED exposure on the cognitive performance of children. RESULTS: In total, 100 children aged 36 to 72months were evaluated. The IQ of WWE was significantly lower compared to women without epilepsy in all modalities. Exposure to valproate (VPA) (n=18) was associated with lowest cognitive performance regarding Full Scale IQ (FSIQ) (ß, -12.04; p=0.006) and verbal comprehension (VCI) (ß, -8.89; p=0.019). Maternal FSIQ, maternal performance IQ (PIQ), and child's age at first phrases were independent factors associated with the cognitive development of children. CONCLUSIONS: Multivariate analysis showed VPA to be an independent predictor for decreased cognitive performance. Maternal FSIQ, PIQ, and child developmental achievements were significant confounders for cognitive performance in children.

Bitemporal intractable epilepsy: could it be surgically treatable?.

BACKGROUND: The goal of this study is to retrieve the attention to the treatment opportunities for this cohort of intractable bitemporal epilepsy patients who in most cases are not considered optimal candidates for surgery. OBJECTIVES: The purpose of this study is to demonstrate that electrophysiologically guided precise surgeries on both temporal lobes can have a beneficial effect on seizures without additional cognitive decline. METHODS: Twenty-one intractable bitemporal epilepsy patients [13 men, 8 women, mean age 21 years (range 6-43), mean duration of illness 17 years (range 3-31), frequency of seizures 6-55 per month] underwent stereotactic cryosurgery on both temporal lobes guided by chronic and intraoperative depth electrode studies. RESULTS: Class I ('free of disabling seizures') outcome was achieved for 11/21 (52%), class II ('rare seizures') for 6/21 (29%), and class IV ('no worthwhile improvement') for 4/21 (19%) patients. No worsening of seizure or clinically significant cognitive or memory impairments were observed in this cohort of patients (follow-up 5-10 years). CONCLUSIONS: The minimally invasive precise surgeries on both temporal lobes confined to the removal/lesion of just the brain tissue that exhibited epileptic activity can have a beneficial effect on seizure frequency and severity without additional devastating declines in intelligence, learning and memory.

Electrophysiological effects and clinical results of direct brain stimulation for intractable epilepsy.

OBJECTIVE: Epilepsy can be considered as a result of the imbalance of the excitatory and inhibitory processes. Therefore, the artificial enhancement of the activity of brain inhibitory mechanisms might lead to a beneficial therapeutic effect for intractable epilepsy patients. MATERIAL AND METHODS: Studies of the inhibitory effects of electrical stimulation of the head of the caudate nucleus (HCN), cerebellar dentate nucleus (CDN), thalamic centromedian nucleus (CM), and neocortical and temporal lobe mesiobasal epileptic foci were performed on 150 patients with implanted intracerebral electrodes. Chronic brain stimulation with implanted neurostimulators was performed on 54 patients. Sixteen were followed up to 1.5 years (mean 1.2 years). RESULTS: The study demonstrated that 4-8 Hz HCN and 50-100 Hz CDN stimulation suppressed the subclinical epileptic discharges and reduced the frequency of generalized, complex partial, and secondary generalized seizures. CM stimulation (20-130 Hz) desynchronized the EEG and suppressed partial motor seizures. Direct subthreshold 1-3 Hz stimulation of the epileptic focus may suppress rhythmic afterdischarges (ADs). Seizures were eliminated for 26 of 54 patients (48%), worthwhile improvement was achieved for 23 of 54 patients (43%), and no improvement was observed in 5 of 54 patients (9%). CONCLUSION: The artificial increase of the activity of brain inhibitory system may suppress the activity of epileptic foci, and, in long run, stabilize this epileptic foci activity at a lower, perhaps normal, level. Therapeutic direct brain stimulation, therefore, might serve as a useful tool in the treatment of intractable and multifocal epilepsy, and might be combined with ablative surgical methods.