Wavelet Transform as a Helping Tool During EEG Analysis in Children with Epilepsy.

BACKGROUND: Epilepsy is a brain disorder characterised by unpredictable and excessive nerve cell activity that causes epileptic seizures. Epileptic seizures are more common in children and adolescents than in elderly population. Electroencephalography (EEG) is a diagram of electrical activity of the brain and it is used as a method of choice for diagnosing epilepsy. Despite the accurate EEG tracing of electrical activity in the brain, the disadvantage of this type of analysing is the doctor's skill to read the EEG correctly. OBJECTIVE: The aim of this study was ro represents further research presented in our pevious works with wavelet based EEG analysis after masuring a multiresolution as relation between time and frequency resolution. METHODS: Signal database set consist of 51 patients: a) healthy patient; b) 50 patients with a diagnosis of epilepsy. Additional characteristics of the analysed data: a) 19 signals-channels of EEG, b) Duration - 20 s or 2688 samples and. Nowadays, we can find dozens of EEG signal analysis papers using mathematical approach and with a focus on identification of epilepsy. RESULTS: This paper represents some results relating to the analysis of EEG in children using Wavelet Transform (WT). The signals was collected and analysed at the Department of neuropediatrics, Pediatric Clinic at the University Clinical Center, University of Sarajevo. CONCLUSION: Using this approach it is possible to clearly differentiate patients with a diagnosis of epilepsy from healthy ones.

Hand function in children with unilateral spastic cerebral palsy.

Aim To assess hand function and explore the relationship between hand function and neuroimaging findings in children with unilateral spastic cerebral palsy (US CP). Methods Hand function was assessed using Manual Ability Classification System (MACS, I-V). Brain lesions were divided into five groups: brain maldevelopment (MAL), periventricular white matter lesions (PV WM), cortical/subcortical gray matter lesions (C/SC GM), nonspecific and normal findings. Results Of 114 children with US CP (77 boys and 37 girls), 56 were with right-sided and 58 with left-sided involvement. MACS I was found in 49 (42.9%), MACS II in 19 (16.7%), MACS III in 19 (16.7 %), MACS IV in 9 (7.9%) and MACS V in 18 (15.8%) children (p=0.002). Computed tomography (CT) as the only neuroimaging has been done in 18 (15.8%), magnetic resonance imaging (MRI) at 94 (82.5%) children, whereas 2 (1.7%) children had neither CT nor MRI. The CT showed PV WM in eight (44.4%), C/SC GM lesions in 6 (33.3%), and normal findings in 4 (22.2%) children (p=0.709). The MRI showed MAL in 8 ( 8.5%), PV WM in 46 (48.9%), C/SC GM in 28 (29.8%), miscellaneous in 2 (2.1%), and normal finding in 10 (10.7%) children (p=0.0001). Mild hand dysfunction (MACS I and II) was assessed in 68 (59.7%) children, of which 33 had PV WM lesions (p=0.001). Conclusion Mild hand dysfunction in children with US CP has been significantly associated with PV WM lesions. The type of brain lesion may help to identify its timing and predict the level of hand dysfunction.

ESSENCE-Q: Slavic language versions for developmental screening in young children.

PURPOSE: The Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations - Questionnaire (ESSENCE-Q) was developed as a brief screener to identify children with developmental concerns who might have neurodevelopmental disorders (NDDs). This study aimed to translate the ESSENCE-Q into south Slavic languages, namely, Bosnian, Bulgarian, Croatian, Macedonian, Montenegrin, Serbian, and Slovenian, and to evaluate its psychometric properties for screening purposes in clinical settings. PATIENTS AND METHODS: In the study, the ESSENCE-Q was completed for 251 "typically developing" children and 200 children with 1 or more diagnosed NDDs, all aged 1-6 years. Internal consistency and construct validity were tested first, followed by generating receiver operating characteristic curves and the area under the curve. Optimal cutoff values were then explored. RESULTS: The Cronbach's α coefficients were 0.91, 0.88, and 0.86 for ESSENCE-Q parent-completed form, and the telephone and direct interview forms administered by trained nurse or specialist, respectively. The 3 versions produced area under the curve values (95% confidence interval): 0.96 (0.93-0.99), 0.91 (0.86-0.95), and 0.91 (0.86-0.97), respectively. An optimal cutoff for ESSENCE-Q parent-completed form was found to be ≥3 points, while for the telephone and direct interviews, it was ≥5 points. CONCLUSION: We found adequate measurement properties of the south Slavic languages versions of the ESSENCE-Q as a screener for NDDs in clinical settings. This study provided additional data supporting sound psychometric properties of the ESSENCE-Q.

Effects of Carbamazepine and Valproate on Serum Aspartate Aminotransferase, Alanine Aminotransferase and Gamma - Glutamyltransferase in Children.

INTRODUCTION: Epilepsy is one of the most common neurological diseases in childhood and adolescence. Carbamazepine (CBZ) and valproate (VPA) have been widely used as the first generation of antiepileptic drugs (AED). AIM: The aim of the study has been to evaluate and compare the effect of CBZ and VPA monotherapy on aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) serum levels in children. MATERIAL AND METHODS: The study has included 100 patients (boys 57/girls 43, age range 1 to 18 years), who have been treated with CBZ or VPA, as initial monotherapy, for at least 12 months. Patients with liver lesions or patients who have been treated with other drugs have been excluded from the study. The initial serum enzyme levels (AST, ALT and GGT) and after 12 months of treatment have been compared. RESULTS: 53/100 (53%) patients have been treated with CBZ and 47/100 (47%) patients have been treated with VPA.The initial level of enzymes were within the referece range. After one year-long treatment AST was elevated at 4/53 (7.5%) CBZ patients and 9/47 (19.15%) VPA patients (x2 test =3.965, p<0.05). ALT was elevated at 5/53 (9.4%) CBZ patients and 9/47 (19.15%) VPA patients (x2 test =6.953, p<0.05). GGT was elevated at 18/53 (34%) CBZ patients and 7/47 (14.9%) VPA patients (x2 test =4.831, p<0.05). CONCLUSION: The levels of enzymes AST and ALT have been elevated statistically significant in VPA group and GGT in CBZ group.

Anthropometric Parameters of Nutritional Status in Children with Cerebral Palsy.

INTRODUCTION: Patients with cerebral palsy (CP), besides the basic neurological damage, are also often undernourished. Adequate nutrition for children is very important during the period of intensive growth and development, which is of particular importance in patients with CP. GOAL: To evaluate the nutritional status of patients with CP who are treated at the Pediatric Clinic, Clinical Centre of Sarajevo University and causes of malnutrition in these patients. MATERIALS AND METHODS: Eighty patients with CP underwent anthropometric assessment (body weight, body height, body mass index, head circumference, subscapular skinfold thickness, triceps skinfold thickness and mid upper arm muscle circumference). Severity of CP was classified based on the Gross Motor Function Classification System (GMFCS). We compared the anthropometric parameters of our patients with normal values of healthy children, as well as with degree of motor impairment, oromotor dysfunction, feeding assistance, length of meals and daily feeding time. RESULTS: There were significant differences in all monitored parameters in relation to normal values, with 38 (47.5%) malnourished patients in the total group, out of which 29 (63.0%) with severe motor impairment and with 9 (11.3%) obese patients in the total group. The presence of oromotor dysfunction and other monitored parameters had a significant impact on the nutritional status of these patients. CONCLUSION: In severely disabled patients with CP there is a risk of profound malnutrition. Early identification and treatment of these patients is very important for their growth, development and health.

Brain Lesions in Children with Unilateral Spastic Cerebral Palsy.

INTRODUCTION: Unilateral spastic cerebral palsy (US CP) is the second most common subtype of cerebral palsy. AIM: The aim of the study was to analyze neuroimaging findings in children with unilateral spastic cerebral palsy. MATERIAL AND METHODS: The study was hospital based, which has included 106 patients with US CP (boys 72/girls 34, term 82/preterm 24). Neuroimaging findings were classified into 5 groups: Brain maldevelopment, predominant white matter injury, predominant gray matter injury, non specific findings and normal neuroimaging findings. RESULTS: Predominant white matter lesions where the most frequent (48/106,45.28%; term 35/preterm 13), without statistically significant difference between term and preterm born children (x2=0.4357; p=0.490517). Predominant gray matter lesions had 32/106 children, 30.19%; (term 25/preterm 7, without statistically significant difference between term and preterm born children (x2=0.902; p=0.9862). Brain malformations had 10/106 children, 9.43%, and all of them were term born. Other finding had 2/106 children, 1.89%, both of them were term born. Normal neuroimaging findings were present in14/106 patients (13.21%). CONCLUSION: Neuroimaging may help to understand morphological background of motor impairment in children with US CP. Periventricular white matter lesions were the most frequent, then gray matter lesions.

Association between high levels of stress and risky health behavior.

AIM: To determine the amount of stress to which young and adult persons were exposed during the last twelve months and relationship between stress levels and risky health behavior. METHODS: The study was conducted from November 2011 until January 2012 in the Sarajevo Canton. The study included 700 respondents divided into two groups: 350 young people aged 15- 27 years and 350 adults aged over 27 years. As an instrument for data collection a questionnaire was used to provide information on demographic characteristics of respondents and habits, as well as Holmes and Rahe stress scale to determine the level of stress. RESULTS: The average value of the stress scale score was 302.56±149.75 for the total sample, 331.7±165.7 for youth and 273.5±125.6 for adults. Respondents from the group of young people in the last twelve months had an average of 3.6 highly stressful events and 1.9 in the group of adults. In the group of young people there were more respondents with inadequate nutrition (p=0.023) and more smokers (p=0.128). In the group of adults more people were overweight (p=0.001) and had reduced physical activity (p=0.006). Both study groups had an equal number of respondents who consumed alcohol. People with high levels of stress consumed alcohol significantly more (p=0.03) and smoked (p=0.02) compared to those with low levels of stress. CONCLUSION: The respondents of both groups were exposed to large amount of stress that was associated with smoking and alcohol consumption. There is a need to design appropriate strategies for coping with stress and their implementation in lifestyle.

The effects of antenatal corticosteroid treatment on IVH-PVh of premature infants.

Intraventricular-periventricular hemorrhage (IVH-PVH) is the most frequent type of intracranial hemorrhage in premature infants and the major cause of neurodevelopmental disabilities in children too. The objective of this work is to evaluate the effects of prenatal corticosteroid treatment on the incidence of IVH-PVH in premature infants. The study enrolled 163 prematures of 26-34 weeks' gestation. They have been divided into two groups: the experimental group (80/163), who have been treated with corticosteroids prenatally and control group (83/163), who have not received such treatment. There is statistically significant difference in IVH-PVH incidence between the experimental group (18/80) and control group (32/83) (chi2 =5,616, p<0,05). There is no statistically significant difference in Apgar score after 5 minutes between the experimental group and control group of IVH-PVH prematures, t= 0,121. There is no statistically significant difference in mean gestation age between the experimental group (30,74 weeks) and control group (29,97 weeks) of IVH-PVH prematures, t= 1,299. There is no statistically significant difference in mean birth weight between the experimental group (1479,44 grams) and control group (1379,37 grams) of IVH-PVH prematures, t= 0,913. Antenatal corticosteroid treatment of premature infants reduced the incidence of IVH-PVH significantly. There is no statistically significant difference in Apgar score after 5 minutes, mean gestation age and mean birth weight between the experimental and control group of IVH PVH prematures.

Congenital malformations of the central nervous system: clinical approach.

Central nervous system (CNS) malformations represent important factor of morbidity and mortality in children. The aim of the study was to determine the incidence, type and clinical features of CNS malformations in children who were admitted at the Neonatal and Child Neurology Department, Neonatal Intensive Care Unit and Paediatric Intensive Care Unit of Paediatric Clinic, University of Sarajevo Clinics Centre, from January 1st, 2002 to December 31st, 2006. There were total of 16520 admissions at the Paediatric Clinic over the studied period. CNS malformations, solitary or multiple, have been diagnosed in 100 patients (0,61%). The total number of various CNS malformations was 127. Lethal outcome was established in 9/100 cases (9%). The most frequent CNS malformations were neural tube defects 49/127 (38,6%). Hydrocephalus was seen in 34/127 (26,8%), microcephaly in 24/127 (18,9%), agenesis of corpus callosum in 10/127 (7,9%), Dandy Walker malformation in 6/127 (4,7%) and other CNS malformations in 4/127 (3,1%). In 20/100 of patients neural tube defect was associated with hydrocephalus (20%). CNS malformations were prenatally diagnosed in 13/100 of patients (13%). Primary prevention of CNS malformations can be improved in our country by better implementation of preconceptional folic acid therapy for all women of childbearing age. Secondary prevention by prenatal diagnosis requires advanced technical equipment and adequate education of physicians in the field of foetal ultrasonography. In our circumstances, prenatal diagnostics of CNS malformations is still not developed enough.

[Infant walkers: the prevalence of use]. / Upotreba hodalica kod dojencadi.

UNLABELLED: Infant walkers are mobile wheeled seats that allow infants to move around with their feet on the floor. They enable precocious locomotion in very young, otherwise prelocomotor infants. Prelocomotor walker experience prevents visual access to the moving limbs. Infant walker use can be associated with delay in achievement of normal locomotor milestones. Besides delayed motor development, contractures of the calf muscles and motor development mimicking spastic diparesis may appear. In the case of infant walker's use for the infants at risk for development of cerebral palsy, multiple side effects can be produced: the persistence of positive support reflex, heel cord contractures, subluxation and dislocation of the hips or pronation contractures of the upper extremities. The use of infant walkers increases the risk of injuries. The study has enrolled 150 children and their mothers, from three big cities in Bosnia and Herzegovina (Sarajevo, Bihac, Zenica). All relevant data have been collected through the questionnaires. 130 children (86.6%) have used infant walkers. The mean age when the use of infant walker has started was 7 months. The mean time of daily use of infant walker was 1 hour 49 minutes. Twenty three children had various motor disturbances, 13 out of them (56.5%) have used infant walker. The mild injuries caused by using the infant walkers have been registered in 17 cases (11.3%). 83 mothers (55.3%) were aware of infant walker's nocuous effects. CONCLUSION: The use of infant walkers has been spread widely under our circumstances. There is significant discrepancy between mothers' knowledge about nocuous effects of infant walkers and their practice. The use of infant walkers for infants with motor disturbances is especially harmful. The main reason for using infant walker, despite of its harmfulness, was mother's preoccupation with everyday household activities. It is necessary to engage health professionals to support antiwalker campaign (warning labels on the infant walkers, public education programs, etc). We recommend safer alternatives for child daycare, like stationary activity centers (so called "fenced play gardens".

[Medical data warehousing as a generator of system component for decision support in health care]. / Skladistenje medicinskih podataka kao generator komponenti sistema za podrsku odlucivanju u zdravstvenoj zatiti.

Growth in role of data warehousing as strategic information for decision makers is significant. Many health institutions have data warehouse implementations in process of development or even in production. This article was made with intention to improve general understanding of data warehousing requirements form the point of view of end-users, and information system as well. For that reason, in this document advantages and arguments for implementation, techniques and methods of data warehousing, data warehouse foundation and exploration of information as final product of data warehousing process have been described.

[Ultrasound differentiation between benign enlargement of the subarachnoid space and brain atrophy]. / Ultrazvucna diferencijacija benignog prosirenja subarahnoidalnog prostora i atrofije mozga.

Fluid collections surrounding the brain (pericerebral fluid collections) in infants can be caused by a variety of conditions: benign enlargement of the subarachnoid space, passive dilatation of the subarachnoid space due to brain atrophy, subdural hygroma and subdural effusion as a result of meningitis or subdural haematoma. An enlarged frontal subarachnoid space and normal or minimally enlarged ventricular size, with normal or increase head circumference is relatively common finding in infancy. Without associated brain anomalies, this finding predicts normal development of the child. In our study, we have followed up psychomotor development of 22 children, with increased diameters of subarachnoid spaces, detected by ultrasound examination of the brain, without associated brain anomalies. The inclusion criterion for study was enlarged subarachnoid space, measured at the conventional coronal section at the level of the interventricular foramen. The upper limits of each measurements were: 3 mm for sinocortical width, 4 mm for craniocortical width and 6 mm for the interhespheric width. The patients have been followed up to the age of 24 months. Each of them had normal development. 16 of them had normal head circumference. 6 of them had head circumference above the 97th percentile and their head circumference measurements have been plotted for the next 6 months after the diagnosis, to be certain that growth is paralleling the normal curve. It is important to differ benign enlargement of subarachnoid space from brain atrophy, which is quite "serious" diagnosis, with poor neurodevelopmental prognosis. The brain atrophy has been presented with passive dilatation of subarachnoid space and ventriculomegaly, as well. In the case of benign enlargement of subarachnoid space normal or minimally enlarged ventricular size is present. For proper interpretation of this ultrasound finding, correlation with head circumference is necessary. We recommend the head circumference percentile chart to be enclosed to the each brain sonography finding. The algorithm of the further neurological evaluation differs significantly in the case of benign enlargement of subarachnoid space and brain atrophy. In the case of benign enlargement of subarachnoid space further neuroimaging procedures are not needed (in our study it has been done for 6 patients). If the brain atrophy is suspected, further complete neurological examination is necessary.