[Indications of electroencephalogram in the newborn]. / Indications de l'électroencéphalogramme en période néonatale. Recommandations du groupe de neurophysiologie clinique de l'enfant.

The electroencephalogram (EEG), an easy-to-use and non invasive cerebral investigation, is a useful tool for diagnosis and early prognosis in newborn babies. In newborn full term babies manifesting abnormal clinical signs, EEG can point focal lesions or specific aetiology. EEG background activity and sleep organization have a high prognostic value. Tracings recorded over long period can detect seizures, with or without clinical manifestations, and differentiate them from paroxysmal non epileptic movements. The EEG should therefore be recorded at the beginning of the first symptoms, and if possible before any seizure treatment. When used as a neonatal prognostic tool, EEG background activity is classified as normal, abnormal (type A and type B discontinuous and hyperactive rapid tracing) or highly abnormal (inactive, paroxysmal, low voltage plus theta tracing). In such cases, the initial recording must be made between 12 and 48 h after birth, and then between 4 and 8 days of life. Severe EEG abnormalities before 12 h of life have no reliable prognostic value but may help in the choice of early neuroprotective treatment of acute cerebral hypoxia-ischemia. During presumed hypoxic-ischemic encephalopathy, unusual EEG patterns may indicate another diagnosis. In premature newborn babies (29-32 w GA) with neurological abnormalities, EEG use is the same as in term newborns. Without any neurological abnormal sign, EEG requirements depend on GA and the mother's or child's risk factors. Before 28 w GA, when looking for positive rolandic sharp waves (PRSW), EEG records are to be acquired systematically at D2-D3, D7-D8, 31-32 and 36 w GA. It is well known that numerous and persistent PRSW are related to periventricular leukomalacia (PVL) and indicate a bad prognosis. In babies born after 32 GA with clinically severe symptoms, an EEG should be performed before D7. Background activity, organization and maturation of the tracing are valuable diagnosis and prognosis indicators. These recommendations are designed (1) to get a maximum of precise informations from a limited number of tracings and (2) to standardize practices and thus facilitate comparisons and multicenter studies.

Wavy film flows down an inclined plane: perturbation theory and general evolution equation for the film thickness.

Wavy film flow of incompressible Newtonian fluid down an inclined plane is considered. The question is posed as to the parametric conditions under which the description of evolution can be approximately reduced for all time to a single evolution equation for the film thickness. An unconventional perturbation approach yields the most general evolution equation and least restrictive conditions on its validity. The advantages of this equation for analytical and numerical studies of three-dimensional waves in inclined films are pointed out.

[Herpetic encephalitis: prognostic elements in adults and children (49 cases)]. / Encéphalite herpétique: éléments de pronostic chez l'adulte et l'enfant (49 cas).

In 49 cases (26 children, 23 adults) of proven Herpes simplex encephalitis, the authors studied the influence of age, disturbances of consciousness, time of diagnosis and therapy on patients' outcome, as well as the prognostic value of EEG data. Mortality was low in late childhood and young adulthood in spite of the constancy and depth of coma; it was very high in newborns and adults over 40 years of age and it was always correlated with the severeness of initial consciousness disturbances. The onset of periodic complexes (in 65% of the children and 78% of adults on the first EEG) does not systematically imply a poor outcome. Correlations between these EEG patterns and bioptic or surgical data tend to prove that these periodic complexes are already present in a prenecrotic state. Reversibility may be complete. On the other hand, the association between a contralateral focus or diffusion of initial abnormalities and an early coma imply a poor prognosis (12 deaths and 2 major sequellae in 14 cases). The importance of early presumptive diagnosis and therapeutical onset is stressed. The only cases of complete recovery are found among young adults treated early (surgery for older cases) thanks to an initial typical EEG. In young children, first clinical symptoms are often not evocative. Great importance should be attached to the onset of partial seizures and interictal loss of consciousness in a feverish child (24 out of 26 cases). Antiviral therapy should be started as soon as a Herpes simplex encephalitis is suspected, since the new antiviral drugs have a relatively low toxicity and do not interfere with the immunological diagnosis.

[Diagnoses to consider in newborn infants with inactive EEG tracings]. / Diagnostic à évoquer devant un tracé inactif du nouveau-né.

Thirty-one neonates without any electroencephalographic activity detectable on the first EEG before day 5 were studied. In the first group (20 neonates) the first EEG was performed on day 0. Signs of foetal and/or perinatal anoxia were observed. In the second group (11 neonates), the first EEG was performed between day 1 and day 4. In 7 cases, the neonate was considered normal during a period varying between a few hours and a few days. Various aetiologies other than foetal or perinatal anoxia were found: cardiac arrest, metabolic disease, polycystic encephalomalacia.

[Unilateral status epilepticus during the neonatal period]. / Les états de mal unilatéraux au cours de la période néonatale.

Twenty-one newborns displaying a strictly unilateral status epilepticus were studied. Three groups have been isolated according to the aetiology: neonatal anoxia (n = 5), postcardiac surgery (n = 8), cerebral hemispheric lesions confirmed by CT scan (n = 7). The authors relate in detail the clinical features and the EEG abnormalities, ictal and interictal in each group, and comment on their results. They show the importance of EEG in establishing or detecting a unilateral status epilepticus and in helping the aetiologic diagnosis.

[Prognostic value of EEG in pneumococcal meningitis in children]. / Valeur pronostique de l'EEG dans les méningites à pneumocoques chez l'enfant.

We studied the prognostic value of initial EEG in 36 children with a pneumococcal meningitis. The children were divided into 2 groups: infants under 1 year old, and children over 1 year old. The evolution was favourable in 5 cases out of 6 with normal or subnormal initial EEG. The evolution was unfavourable every time we recorded a status epilepticus. When the initial EEG is 'altered' or 'very altered' the prognosis is more difficult to determine but we did not find any sequelae after transitory localised abnormalities with a clinical neurological deficit. The EEG seems to be important for the surveillance and the prognosis of pneumococcal meningitis.

[Electroencephalographic aspects and thiopental in 4 cases of severe pneumococcal meningitis in children]. / Aspects électroencéphalographiques et thiopental dans quatre cas de méningites à pneumocoques graves chez l'enfant.

We present an electroclinical study of 4 severe pneumococcal meningitis cases with intracranial hypertension. In addition to classical anticerebral edema therapy thiopental infusion was used. The plasma thiopental level seems to be only an incomplete indicator of cerebral drug effect, but must be measured to avoid accumulation. EEG monitoring appears to be better in evaluating the clinical status and barbituric impregnation. The burst suppression in EEG recording is noted at variable periods (9-48 h) after the start of the treatment and disappears on discontinuation of infusion while the plasma drug levels remain high. Further, in two cases EEG changes preceded clinical deficits. Evolution of clinical and EEG status was good in the 4 children.

[Feasibility of increasing the high-speed response of the electromechanical drive in assisted circulation devices]. / Vozmozhnosti povysheniia bystrodeistviia élektromekhanicheskogo privoda v apparatakh vspomogatel'nogo krovoobrashcheniia.

The conditions in assisted circulation, especially with ballooned aorta, place high demands on the speed of the intraortal pump-balloon response. The salient feature of the described assisted circulation unit consists in that the intraortal pump-balloon is connected to the pneumotract via a commutative air-operated valve. A block diagram of the assisted circulation unit "Biopulso-4" based on the use of the electric drive, designed at the All-Union Scientific-Research Institute of Medical Equipment and Instruments, stress diagrams and a scheme explaining the operation of the apparatus, are described. The results obtained show the possibility of the balloon's resetting and opening in 70 ms, with the triggering synchronous pulse delay of 10 ms prior to response (with air use as power gas). These results are not any worse than those obtained with the pneumatic drive-based assisted circulation apparatus.