Latent class analysis of attention and white matter correlation in children with attention-deficit/hyperactivity disorder.

This study aimed to explore attentional patterns among children with inattentive attention-deficit/hyperactivity disorder (ADHD-I) and children with typical development (TD), using a latent class analysis (LCA). Patterns of brain connectivity were also explored. The sample comprised 29 ADHD-I and 29 TD matched children. An LCA was conducted to reclassify subjects according to their attentional performance, considering cognitive measures of attention and behavioral symptoms, regardless of group of origin. The new clusters were then compared in respect to brain white matter measurements (extracted from diffusion tensor imaging). Participants were rearranged in 2 new latent classes, according to their performance in an attention task and the results of behavioral scales, resulting in groups with more homogeneous attentional profiles. A comparison of the 2 new classes using the white matter measurements revealed increased fractional anisotropy in the left inferior fronto-occipital fasciculus and left inferior longitudinal fasciculus for the class composed by participants with a higher risk of attentional problems. The findings indicated that it was possible to observe variability regarding neuropsychological profile, accompanied by underpinning neurobiological differences, even among individuals with the same disorder subtype - inattentive ADHD. This specific data-driven clustering analysis may help to enhance understanding of the pathophysiology of the disorder's phenotypes.

Latent class analysis of attention and white matter correlation in children with attention-deficit/hyperactivity disorder

This study aimed to explore attentional patterns among children with inattentive attention-deficit/hyperactivity disorder (ADHD-I) and children with typical development (TD), using a latent class analysis (LCA). Patterns of brain connectivity were also explored. The sample comprised 29 ADHD-I and 29 TD matched children. An LCA was conducted to reclassify subjects according to their attentional performance, considering cognitive measures of attention and behavioral symptoms, regardless of group of origin. The new clusters were then compared in respect to brain white matter measurements (extracted from diffusion tensor imaging). Participants were rearranged in 2 new latent classes, according to their performance in an attention task and the results of behavioral scales, resulting in groups with more homogeneous attentional profiles. A comparison of the 2 new classes using the white matter measurements revealed increased fractional anisotropy in the left inferior fronto-occipital fasciculus and left inferior longitudinal fasciculus for the class composed by participants with a higher risk of attentional problems. The findings indicated that it was possible to observe variability regarding neuropsychological profile, accompanied by underpinning neurobiological differences, even among individuals with the same disorder subtype - inattentive ADHD. This specific data-driven clustering analysis may help to enhance understanding of the pathophysiology of the disorder's phenotypes.

[Eletroencephalographic ambulatory monitoring in refractory epilepsies in childhood]. / Monitorização eletroencefalográfica ambulatorial na epilepsia de difícil controle da infância.

The objective of our study was, by means of continuous prolonged ambulatory electroencephalographic monitoring, to analyze the temporal distribution of paroxysmal discharges during sleep and awake in children and adolescents with refractory epilepsies. Twenty-one patients in the 4-to-17 year age bracket with refractory epilepsies, with 52.3% (n=11) male and 47.6% (n=10) female from the Discipline of Neurology of the Universidade Federal de São Paulo (Federal University of São Paulo). Cerebral Holter was carried out with Bioware EEG-2008 of prolonged ambulatory electroencephalographic monitoring equipment. We observed greater frequency of isolated and grouped epileptic discharges in day and in night sleep in relation to awake; day and night sleep led to activation of epileptic discharges, both isolated and grouped. The cerebral Holter was more effective in detecting epileptiform discharges than the routine EEG in 33.33% of the patients. The cerebral Holter proved a useful and precise method in detecting epileptic discharges, as an aid in the assessment of the fluctuations in frequency of paroxysmal activity in children with refractory epilepsies, both in relation to activities in daily life, and to the relation to the biological cycle of sleep and awake.

[Laterality of musical functions in partial epilepsy]. / Lateralização das funções musicais na epilepsia parcial.

Fourteen right handed patients with partial epilepsy (Epileptic Group) and with a median age of 31 years were divided into two groups (Right and Left), according the laterality of paroxystic activity in the electroencaphalogram. Of the 14 patients, 42.8% (6/14) presented a focus at the right side while the others 57.2% (8/14) presented a focus at the left. The Control Group consisted of 31 right handed individuals with a median age of 30 years and with no previous history of neurological disease or epileptic seizures. All the individuals had no musical skills. They carried out Music Abilities Tests including Spontaneous Rhythm, Elemental Music Functions Perception (tone color, duration, pitch, intensity and rhythm) and Complex Strutures Tests (recognition and reproduction of corporal rhythmic movements). We concluded that the focus at the right and the left cerebral hemisphere affect the development of the melodic recognition functions while in cases with focus at the left cerebral hemisphere, rhythmic reproduction and organization are more impaired when compared to the Control Group.

Epilepsias na infância: conceitos e classificaçäo / Seizures in childhood: definition and classification

O artigo reflete uma abordagem didática sobre as epilepsias que ocorrem na infância e na adolescência, enfatizando classificaçäo e quadro clinico das crises epilépticas e das sindromes epilepticas

[Surgical treatment of cerebral vascular pathologies in epileptic patients]. / Tratamento cirúrgico das patologias vasculares cerebrais nos pacientes epilépticos.

Surgery of arteriovenous malformations (AVM) and of cavernous angiomas (cavernoma) in the majority of cases is indicated subsequently to episodes of bleeding. With the development of techniques for diagnosis and surgery for epilepsy of difficult control, indication for surgery of these vascular lesions has become greater. We present nine patients with cerebral vascular lesions and very frequent crises in spite of adequate clinical treatment. Ages ranged from 12 to 42 years with an average of 25 years; there was a prevalence of the male sex (2:1). Surgery consisted of exercises of the lesion in all cases and in four there was also resection of the perilesional irritative area shown by electrocorticography. The pathologic study of lesions showed five cases of cavernoma, three cases of AVM, and one case of venous angioma. As to localization, we observed three lesions in the temporal lobe, four in the frontal, and two in the parietal region. Outpatient follow-up showed a reduction in crises in all of the patients, and seven evolved seizure free following surgery.

[Temporal lobe epilepsy. Surgical treatment]. / Epilepsia do lobo temporal. Tratamento cirúrgico.

The authors report the surgical management of 32 patients with medically intractable seizures. In all cases the epileptiform focus present in the temporal region was demonstrated by electroencephalography. Our report was made up of 14 male patients and 18 female patients. Their ages ranged from 9 to 62 years. The material was divided into two groups. The first, with eighteen patients with cerebral lesion (like gliomas, arteriovenous malformation, epidermoid tumor) demonstrated on the CT scan and MR imaging underwent to lesion resection: in some cases with adjacent irritative area (guided by electrocorticography) out of eloquent zone, the removal of this irritative area was done. The second, with fourteen patients without cerebral expansive lesion; the MR imaging showed mesial temporal sclerosis in eight cases; all the patients of this group underwent to temporal lobectomy; the histopathologic exam showed temporal sclerosis in nine cases and normal brain in five. The postoperative follow-up showed better results in the cases with expansive cerebral lesion (83.4% seizure free) than the cases without that lesion (71.4% seizure free).

Serotonina sérica e síndrome de Rett / Serum serotonin and Rett syndrome

A síndrome de Rett, uma patologia neurodegenerativa que afeta meninas, caracteriza-se por uma involuçäo neuropsicomotora do desenvolvimento. Sendo o diagnóstico desta síndrome exclusivamente clínico, o presente trabalho teve como objetivo o estudo do conteúdo de serotonina sérica em crianças normais e portadoras da síndrome de Rett. A metodologia empregada para a quantificaçäo de 5HT no soro foi a cromatografia líquida de alta eficiência acoplada a detecçao eletroquímica. Os resultados obtidos mostraram uma hiperserotonemia em 81 por cento das crianças com síndrome de Rett. Verificou-se também uma correlaçäo positiva entre níveis altos de serotonina no soro e a deambulaçäo independente, mostrando que pacientes sem marcha voluntária apresentam níveis séricos maiores deste neurotransmissor. O presente trabalho sugere que o nível sérico de serotonina pode vir a ser usado como um possível marcador biológico no diagnóstico de estadiamento da síndrome de Rett.

[Hemispheric functional specialization in motor aphasia. Neurophysiologic findings with computerized electroencephalographic brain mapping during musical and oral sound stimulation. Study of 2 cases]. / Especialização funcional hemisférica na afasia motora. Achados neurofisiológicos ao mapeamento eletrencefalográfico computadorizado sob estimulação sonora musical e verbal. Estudo de dois casos.

This study concerns about brain electrical activity during auditory stimulation in 2 aphasic patients, one with classical (left hemisphere lesion) and another with cross aphasia (right hemisphere lesion). Both cases were submitted to dichotic listening test (consonant-vowel-consonant task) and music audition (gregorian chant), during brain mapping examination. We found, in both cases, a great proportion in delta frequency and power in non-lesional hemisphere during dichotic and musical stimulation. Besides, increasing in frequency of alpha activity was observed only in the non-lesional hemisphere restricted to temporal lobe region. Such findings suggest an interesting field of research about measurements of neurophysiological correlates of auditory stimulation and brain electrical activity in aphasia.

Hemispheric specialization in partial epilepsy. Role of dichotic listening CV task and central audiological evaluation in the neuropsychological assessment.

We studied 49 patients with partial epilepsy divided into lesional cases (i.e. with lesions on CT scan) and non-lesional cases (i.e. without CT scan lesions), in relation to the Wechsler Intelligence Scale subtests (Coding, Digit span), dichotic listening CV task and Central Auditory Test (SSI, PSI). The aim of this paper was to study the hemispheric prevalence in dichotic listening task with regard to cognitive performance, as well as the presence or absence of central auditory dysfunction. Lesional cases presented a hemisphere prevalence in dichotic listening task with regard to cognitive performance, as well as the non-lesional cases tend to report the stimuli in the same side of EEG focus. Significant differences were found among the lesional and non lesional cases in relation to the digit span score and Coding subtest in right lesional cases versus right non-lesional cases. Both lesional and non-lesional group showed signs of central auditory dysfunction. We suggest that the dichotic listening and SSI and PSI test can be useful for a best comprehension of asymmetric neuropsychological performance in partial epilepsy.

[Analysis of functional hemispheric asymmetry in children with partial epilepsy and normal IQ by performance in WISC subtests]. / Análise da assimetria funcional hemisférica de criancas com epilepsia parcial e QI normal pelo desempenho nos subtestes do WISC.

We studied 87 normal IQ children, 26 partial epileptic (epileptic group) and 61 non-epileptic children (control group) with mean age of 9 years in relation to cognitive performance in Wechsler Infant Scale for Children (WISC) battery. The epileptic group showed lower score in IQ performance and in three verbal subtests (Information, Digit span, Arithmetic) and three performance subtests (Block Design, Object Assembly and Coding). Patients with right hemisphere EEG focus showed low score in subtests related to spatial ability and non-verbal attention, whereas patients with left hemisphere EEG focus showed low score only in Digit span subtest (related to immediate memory and verbal attention). The authors suggest that cognitive deficits in partial non-lesional epileptic children is related to the side of EEG interictal abnormalities, even in children with normal IQ.

[Sexual differences in functional hemispheric asymmetry: verbal tachistoscopic evaluation using microcomputers]. / Diferenças sexuais na assimetria funcional hemisférica. Avaliação taquistoscópica verbal utilizando microcomputador.

Study of sexual differences for the hemispheric prevalence on visual verbal stimuli using a microcomputer-based tachistoscope technic. Seventeen right-handed individuals, 10 males and 7 females (mean age 32 years old), without neurological or visual abnormalities were studied. The subjects performed a verbal trigram tachistoscope test, using a IBM PC microcomputer compatible. The trigram consists of 80 consonant-vowel-consonant pairs of stimuli presented randomly to right and left visual fields. The evaluation was made through two conditions: T1 and T2. In T1 Experiment stimuli exposition time was 260 ms, and in T2 Experiment the stimuli exposition time was 160 ms. In T1 Experiment 80% of females showed a Right Hemispherical Preference while 100% of males showed a Left Hemispherical Preference. In T2 Experiment, both sexes showed Left Hemispheric Preference. A close relationship between sexual difference and hemispheric preference was found. We point out the importance of stimuli exposition time in determination of sexual differences in lateral hemispherical asymmetry.

[Rolandic epilepsy: report of 53 cases]. / Epilepsia rolândica: relato de 53 casos.

The clinical and EEG features of 53 out-patients with benign partial epilepsy of childhood with rolandic spikes were studied. The age mean (years) of seizures onset was 5.5 +/- 3.2. Simple partial seizures with speech arrest were more frequent than other seizure types. In seven cases (13.2%) cognitive disabilities were present. In the left-side foci a expected correlation between the interictal EEG focus and clinical lateralization of seizure was observed; in the right-side foci, the right-side interictal focus was correlated with ipsilateral seizures.

[Sickle cell anemia: cerebral angiography changes]. / Anemia falciforme: alterações angiográficas cerebrais.

Two cases of sickle cell disease with neurological complications are described. Cerebral angiograms were performed and a characteristic moyamoya-like angiographic pattern was demonstrated. This pattern results from a compensatory vascularization which may follow occlusion of the arteries at the base of the brain in several diseases. The risks of angiography and appropriate precautions are emphasized.

Photoparoxysmal responses.

Sixty-five outpatients with photoparoxysmal response (PPR) during routine EEG were studied. The PPR showed prevalence in women (75.4%). Seizures were found in 66.1% of cases. The rest recordings were abnormal in 41.8% with prevalence of generalized paroxysm. Eight patterns of PPR were observed, being polyspike mixed to slow wave the most frequent (53%). The epileptic group showed a bimodal distribution in the several bands of photic stimulation, near 8 and 20-24 Hz. A sustained paroxysmal abnormality persisting after the photic stimulation was present in 6 epileptic patients.

Auditory extinction and dichotic listening CV task in cerebral infarction: preliminary report.

Six stroke patients were studied using a dichotic listening CV task, 4 with left hemisphere infarction, 2 with right hemisphere infarction. It was observed a "lesion-effect", a shift of hemisphere prevalence to the side opposite a brain lesion. The authors suggest that the lesion-effect can be explained by the auditory extinction phenomenon at the linguistic level.

Juvenile myoclonic epilepsy (JME): report of 12 cases

Juvenile myoclonic epilepsy is an idiopathic generalized epilepsy with age-related onset and characterized by myoclonic seizures, sometimes associated with other seizure types. We present the clinical and EEG characteristics of 12 cases out of 1,700 epileptic patients followed in the Epilepsy Section of a University Hospital. The mean age of seizure onset was 12.3 + 3.2 years (range 7-17), 8 females, 4 males; myoclonic and tonic-clonic generalized seizures were predominant (83.3 per cent). The circadian distribution of seizures was observed in 83.3 per cent (10/12). The complete seizure control occurred in 66.6 per cent (8/12) after valproate monotherapy. There was a positive family history of epilepsy in 50.0 per cent (6/12). In 50.0 per cent (6/12) of the cases the paroxysmal activity was precipitated by hyperventilation. Surprisingly we did not observe any pattern of photosensitivity in the interictal EEG recordings.

[Headache in childhood: diagnosis and therapy. A prospective study of 77 cases]. / Cefaléia na infância: diagnóstico e terapêutica. Estudo prospectivo de 77 casos.

Seventy seven cases of migraine in children were studied. Age average was 9 years +/- 2; there were any sex differences. The frontal localization was found in roughly 49% of cases, whereas hemicrania was just found in 9% of cases. The most frequent factors associated were nausea, vomiting and dizziness. The most common triggering factor was the stress. Family history of migraine occurred in 76.5%. Out of 36 patients suffering migraine, 31 underwent a prophylactic treatment with pizotifen or propranolol. There was satisfactory clinical responses in roughly 90% of cases.