Risk factors for neurological complications in children with Flavivirus infection.

This study aims to characterize the acute neurological manifestations caused by DENV, ZIKV, and YFV during hospitalization; identify the risk factors associated with persistent neurological complications after discharge; and evaluate the time to resolution during clinical follow-up. A prospective study evaluated 505 children, between March 2014 and July 2019, hospitalized with neurological manifestations and that doctors suspected infection of the central nervous system (CNS). Viral infection of collected cerebrospinal fluid (CSF) was confirmed by real-time reverse transcription-polymerase chain reaction (RT-PCR). Patients were clinically followed up after hospital discharge. Analysis of predictive factors and survival curves was performed. This study identified clinical symptoms and changes in the CSF laboratory, electroencephalogram (EEG), and CNS image as predictors of complications in children with confirmed infection in the CNS by DENV, ZIKV, or YFV. No statistical difference was found (p value 0.574) in the time to the resolution of complications in children after hospital discharge between the three types of flaviviruses. Children with YFV, detected in CSF samples, had a 53% higher risk of developing neurological complications. Performing etiological diagnosis by RT-PCR of CSF samples of children with neurological manifestations, especially during Flavivirus outbreaks, is an essential tool for improving the prognosis and clinical follow-up of these patients.

Neurological manifestations due to dengue virus infection in children: clinical follow-up.

The aim was to assess neurological complications in children with an invasive neurological disease by dengue virus (DENV) and the time to resolve symptoms after hospital discharge. A prospective study was conducted at a referral hospital for infectious diseases in Brazil between March 2014 and July 2019. All children hospitalized with neurologic manifestations and DENV RNA detected by real-time reverse transcription-polymerase chain reaction (RT-qPCR) in cerebrospinal fluid (CSF) were followed up until complete resolution of neurological complications. On average, they were followed up for 16 months. Among 56 DENV-positive children, 39% had some neurologic complications after hospital discharge and found that 19.6% were discharged with anticonvulsants due to seizures, 10.7% developed motor complications (e.g. muscle weakness, paresis, ataxia, and walking disability), 5.4% had headaches, and 14.3% had sleep disorders. Among the 56 children, only three had a clinical diagnosis of dengue because the symptoms are nonspecific and 35% showed no change in cerebrospinal fluid (CSF). The average time to resolve complications was 5.9 months (ranging from 1 m to 32 m). These results should alert physicians to the difficulties of a clinical diagnosis of an infection that causes neurological complications after discharge in a significant number of children. RT-qPCR's etiological diagnosis of DENV infection enabled better clinical follow-up for early intervention in children with neurological complications.

Neurologic Manifestations of Noncongenital Zika Virus in Children.

We evaluated neurologic complications following noncongenital Zika virus infection in 11 children who presented with central nervous system signs. Zika virus RNA was detected by real-time reverse transcription-polymerase chain reaction in cerebrospinal fluid. Approximately one-quarter of patients required antiepileptic medication in follow-up, and 2 children progressed to learning difficulties or developmental delay.

ADHD and epilepsy: contributions from the use of behavioral rating scales to investigate psychiatric comorbidities.

Children with epilepsy have a high incidence of psychiatric comorbidities, especially attention-deficit/hyperactivity disorder (ADHD). This observational cross-sectional study investigated the presence of ADHD in 30 children with idiopathic epilepsy. The Brazilian versions of the Child Behavior Checklist (CBCL), the Teacher Report Form (TRF), and the MTA-SNAP-IV questionnaire were used to assess comorbid psychiatric conditions. ADHD diagnosis was confirmed in 53.3% of children. The combined type was the most prevalent (43.7%), followed by the hyperactive-impulsive (37.5%) and inattentive (18.7%) types. Scores above the cutoff point on these scales were strongly correlated with the presence of ADHD. The high prevalence of ADHD in association with other psychiatric comorbidities in children with epilepsy justifies the use of behavioral rating scales as screening tests.

Herpes simplex neonatal recorrente: relato de caso / Neonatal recurrent Herpes simplex

Descrever um recém-nascido (RN) com Herpes simplex congênito recidivante, doença de alta morbimortalidade neonatal, principalmente se o sistema nervoso central (SNC) for acometido. A transmissão vertical ocorre principalmente em infecção primária materna. Além do SNC, a manifestação clínica pode ser localizada na pele e mucosas ou com infecção sistêmica (acometimento de múltiplos órgãos). Descrição: trata-se de recém-nascido de mãe com herpes genital e portadora do HIV, condições desconhecidas ao parto. Evoluiu com lesões cutâneas e encefalite na primeira manifestação do herpes. Foi tratado com aciclovir endovenoso por 28 dias. Posteriormente, apresentou duas recidivas cutâneas, novamente tratadas. Optou-se por profilaxia com aciclovir oral, que foi mantido até a criança completar um ano. Conclusão: a literatura descreve a importância do diagnóstico, prevenção e tratamento precoces do herpes materno, prevenindo ou reduzindo a morbidade para o RN, principalmente do SNC. O uso de aciclovir oral profilático não é bem estabelecido, mas foi eficaz nesse caso.

Describe a newborn with recurrent congenital herpes, disease with high mortality and morbidity, mainly when central nervous system is involved (CNS). Vertical transmission occurs mainly in primary maternal infection. Beyond CNS, clinical manifestations can be cutaneus and disseminated infection (multiple organs disease). Description: Newborn whose mother had genital herpes not diagnosed at labor. He presented cutaneous lesions and encephalitis at the first manifestation of herpes. Treatment was performed with endovenous acyclovir during 28 days. Thereupon, he had skin lesions that recurred twice, requiring new treatments. Prophylaxis with oral acyclovir was introduced and prescribed until the children attained one year old. Comments: Literature recognizes the importance of early diagnosis, prevention and treatment of maternal herpes, in order to minimize mortality and morbidity for the newborn, mainly related to CNS involvement. Prophylaxis with oral aciclovir is not well defined, but was successful in this case.

Possíveis interfaces entre TDAH e epilepsia / Possible interfaces between attention deficit hyperactivity disorder and epilepsy

OBJETIVO: Identificar na literatura elementos para explicar uma possível associação entre o transtorno de déficit de atenção e hiperatividade (TDAH) e a epilepsia e orientar quanto ao manejo clínico dos pacientes que compartilham esses transtornos. MÉTODOS: Realizou-se revisão da literatura dos últimos 10 anos nas bases de dados MedLine e Lilacs com a combinação dos descritores "attention deficit hyperactivity disorder", "ADHD" e "epilepsy". RESULTADOS: Sintomas de TDAH são frequentes em síndromes epilépticas idiopáticas. Vários fatores podem contribuir para a coexistência desses transtornos: 1) possibilidade de uma mesma propensão genética; 2) participação dos neurotransmissores noradrenalina e dopamina no TDAH e na modulação da excitabilidade neuronal; 3) anormalidades estruturais do cérebro evidenciadas em epilépticos portadores de TDAH; 4) influência dos efeitos crônicos das crises e das descargas epileptiformes interictais sob a atenção; 5) efeitos adversos das drogas antiepilépticas sob a cognição. CONCLUSÕES: As evidências atuais apontam que crises epilépticas e TDAH podem apresentar bases neurobiológicas comuns. Estudos que avaliam disfunções nas vias de sinalização das catecolaminas cerebrais e o papel das descargas epileptiformes interictais na geração dos sintomas são fundamentais na investigação desses mecanismos. Drogas psicoestimulantes são seguras e eficazes para o tratamento do TDAH na maioria dos portadores de epilepsia.

OBJECTIVE: To investigate in the literature elements that explain the association between the attention deficit hyperactivity disorder (ADHD) and epilepsy and to provide clinical guidelines for the management of patients that share these disorders. METHODS:Review of literature of the last 10 years in MedLine and Lilacs databases. The keywords used were "attention deficit hyperactivity disorder", "ADHD" and "epilepsy. RESULTS: Symptoms of ADHD are more frequent in idiopathic epilepsies. Several factors may contribute to this comorbidity: 1) common genetic environment; 2) participation of neurotransmitters norepinephrine and dopamine in ADHD and in neuronal excitability modulation; 3) the underlying brain structural abnormalities found in epileptic patients with ADHD; 4)the chronic effects of seizures and of the epileptiform interictal EEG discharges in attention; 5) the cognitive side effects of antiepileptic drugs. CONCLUSIONS: Recents evidences suggest that seizures and ADHD may have common neurobiological bases. Researches that investigate dysfunctions in cerebral cathecholamines pathways and the role of the interictal epileptiform discharges in the generation of the sintoms are essencial to understand these mechanisms. Treatment for ADHD with stimulant drugs are safe and effective in most epileptic patients.