Neuroplasticity during the transition period: How the adolescent brain can recover from aphasia. A pilot study.

BACKGROUND: Increasing clinical and scientific attention is given to the transition of neurological stages from child to adult. Data on brain plasticity during adolescence is interesting for providing adequate evidence-based medical attention to neurological conditions in this population. Acquired aphasia is well described in adults and children, but not in adolescence. OBJECTIVE: We describe a 5-year follow-up of language in three adolescent subjects with post-brain injury aphasia. METHODS: We analysed and scored formal aspects of language three times, language hemispheric dominance twice with dichotic listening test and functional magnetic resonance imaging (fMRI) brain activation patterns that supported expressive and comprehensive language during the recovery period. RESULTS: We found similarities to both paediatric and adult aphasia in these three adolescents. While the level of recovery resembled that of children with aphasia, a more efficient language rehabilitation occurred in those who remained with left hemispheric dominance in the chronic stage, as it is reported in adults. CONCLUSIONS: Our analysis and long-term follow-up provide data for a better understanding on how the injured brain matures during adolescence. More studies with larger samples will help to understand the function of the remaining networks and the recovery from injury in this particular age group.

Abnormal brain gamma oscillations in response to auditory stimulation in Dravet syndrome.

OBJECTIVE: To evaluate the capability of children with Dravet syndrome to generate brain γ-oscillatory activity in response to auditory steady-state stimulation. METHODS: Fifty-one subjects were included: 13 with Dravet syndrome with SCN1A gene alterations, 26 with non-Dravet epilepsies and 12 healthy controls. Responses to auditory steady-state stimulation elicited with a chirp-modulated tone between 1 and 120 Hz were collected in subjects and compared across groups. RESULTS: Subjects with Dravet syndrome showed weak or no responses in the 1-120 Hz frequency range. Healthy controls showed oscillatory responses following the frequency of the modulation that were maximal in the low (30-70 Hz) and high (80-120) γ-ranges both, in the power and inter-trial coherence estimates. Non-Dravet epileptic children showed differences in the auditory responses when compared with the healthy controls but were able to generate oscillatory evoked activities following the frequency-varying stimulation. CONCLUSIONS: The ability to generate brain γ-oscillatory activity of children with Dravet in response to a chirp-modulated auditory stimulus is highly impaired, is not due to epilepsy and is consistent with the Nav1.1 channel dysfunction affecting interneuron activity seen in Dravet mouse models. SIGNIFICANCE: The reported deficits in the brain oscillatory activity evoked by chirp modulated tones in children with Dravet is compatible with Dravet syndrome disease mechanisms and constitutes a potential biomarker for future disease-modifying interventions.

Virtual Reality-based Assessment and Rating Scales in ADHD Diagnosis / La evaluación mediante realidad virtual y las escalas de valoración en el diagnóstico del TDAH

The diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) is mainly based on structured scales, such as Conners' ADHD Rating Scale (EDAH in the Spanish version) and DSM interviews. The use of technologies in neuropsychological assessment, such as the AULA virtual reality based test leads to more accurate diagnosis. The current study presents findings from analyzing the external validity of AULA and its contribution to the diagnosis of ADHD. Four hundred and seven children (272 girls and 135 boys) from 6 to 16 years old (213 with ADHD diagnosis, 105 inattentive children, 108 combined-type, and 194 controls) were evaluated. First, a factor analysis of AULA variables was conducted in order to reduce data to factor and 5 factors or components that account for 82.37% of the total variance were obtained from 407 subjects, namely, sustained attention, impulsivity control, processing speed, response variability, and control of motor activity. Second, a discriminant analysis was then performed on data obtained by participants from whom the five factors were obtained, showing that AULA presents moderate levels of both specificity and sensitivity. Finally, in order to study whether AULA adds relevant information in the diagnosis of ADHD, a cluster analysis was carried out, showing 4 clusters in the analysis of conglomerates with the control group and 6 groups of clusters in the ADHD group. In summary, AULA test shows adequate external validity, allows correct classification of children with and without attentional problems, and confirms and provides additional ADHD diagnostic information that it is essential for the design of interventions

El diagnóstico del trastorno por déficit de atención y/o hiperactividad (TDAH) se basa principalmente en escalas estructuradas, como la escala de Conners (validada en España con el nombre de EDAH), y entrevistas basadas en los criterios recogidos en el DSM. El uso de las nuevas tecnologías en el proceso de evaluación neuropsicológica, como el Test de Atención de Realidad Virtual AULA, proporciona información rigurosa que conduce a diagnósticos más precisos. En este contexto, el objetivo del presente estudio es proporcionar evidencias acerca de la validez externa del test AULA, un test que mejora la precisión diagnóstica del TDAH. La muestra estuvo formada por 407 niños (272 niños y 135 niñas) de entre 6 y 16 años del norte de España (213 niños tenían un diagnóstico de TDAH, 105 desatentos, 108 de tipo combinado y 194 fueron niños controles). En primer lugar se realizó un análisis factorial exploratorio, que puso de manifiesto una estructura formada por cinco factores (atención sostenida, control de la impulsividad, velocidad de procesamiento, variabilidad de respuesta y control de la actividad motora), que son capaces de explicar el 82.37% de la varianza. En segundo lugar, se realizó un análisis discriminante, de acuerdo con el rendimiento obtenido por los participantes en los cinco factores obtenidos en el test AULA, que mostró niveles moderados de especificidad y sensibilidad. Finalmente, se llevó a cabo un análisis de conglomerados con el grupo control y seis grupos de clúster dentro del grupo de niños con TDAH. Los resultados muestran una adecuada validez externa del instrumento AULA, que permite realizar clasificaciones correctas de sujetos sanos y patológicos, confirmándose que proporciona información adicional para el diagnóstico de TDAH, esencial para el posterior diseño de intervenciones clínicas eficaces

Amnesia del desarrollo y daño cerebral temprano: neuropsicología y neuroimagen / Developmental amnesia and early brain damage: neuropsychology and neuroimaging

Objetivo. Contribuir a la descripción de la amnesia del desarrollo como síndrome específico en niños que sufrieron agresión temprana, pero no masiva, de ambos hipocampos. Sujetos y métodos. Muestra de 24 escolares de ambos sexos, de 6-16 años de edad. Se distribuye en tres grupos: pacientes afectos de encefalopatía hipóxico-isquémica perinatal, con parálisis cerebral espástica, inteligencia normal y fallos de memoria (n = 8); pacientes con similares características, pero sin quejas de memoria (n = 7); y escolares sanos sin antecedentes de riesgo (n = 9) como grupo control. Se aplican escalas y tests para comprobar la normalidad intelectual y atencional, y para medir el perfil de rendimiento en tareas de memoria. En todos los sujetos, mediante resonancia magnética, se estima la presencia y grado de atrofia hipocámpica con la escala de Scheltens, y se calcula el índice espectroscópico NAA/(Cho + Cr). Resultados. El perfil neuropsicológico de los ocho pacientes del primer grupo es claramente sugestivo de amnesia el desarrollo, que contrasta con la normalidad en los otros grupos. En siete escolares con amnesia se constata bilateralmente algún grado de atrofia bihipocámpica o disminución significativa del índice NAA/(Cho + Cr). Conclusiones. La amnesia del desarrollo se caracteriza por afectación de la memoria episódica con preservación del aprendizaje semántico y procedimental. Se explica por daño parcial bihipocámpico temprano. El correcto diagnóstico permite una intervención psicoeducativa específica. En el futuro cabría ensayar terapias farmacológicas asociadas a la intervención psicoeducativa (AU)

Aim. To contribute to neuropsychological profiling of developmental amnesia subsequent to bilateral damage to both hippocampi in early age. Subjects and methods. The total sample of 24 schoolchildren from both sexes is distributed in three groups: perinatal hypoxic-ischaemic encephalopathy and everyday complaints of memory in school age (n = 8); perinatal hypoxic-ischaemic encephalopathy without memory complaints (n = 7); and a group of typically developing (n = 9). All participants in every groups did have normal general intelligence and attention. Both clinical groups had, as another clinical consequence, spastic cerebral palsy (diplegia). Neuropsychological exam consisted on tests of general intelligence, attentional abilities, declarative memory and semantic knowledge. All participants had a brain magnetic resonance image and spectroscopy of hippocampi. Scheltens criteria were used for visual estimation of hippocampal atrophy. Parametric and non-parametric statistical contrasts were made. Results. Despite preservation of semantic and procedural learning, declarative-episodic memory is impaired in the first group versus the other two groups. A significant proportion of bilateral hippocampal atrophy is only present in the first group versus the other two non-amnesic groups using Scheltens estimation on MRI. Two cases without evident atrophy did have diminished NAA/(Cho + Cr) index in both hippocampi. Conclusions. Taken together, these results contribute to delineate developmental amnesia as an specific impairment due to early partial bihippocampal damage, in agreement with previous studies. After diagnosis of developmental amnesia, a specific sychoeducational intervention must be made; also this impairment could be candidate for pharmacological trials in the future (AU)

Anti-Basal Ganglia Antibodies and Streptococcal Infection in ADHD.

OBJECTIVE: Group A Streptococcus has been associated with ADHD, tic disorders (TD), and obsessive-compulsive disorder (OCD) through anti-basal ganglia antibodies (ABGA). METHOD: We investigated the association between ABGA and streptococcal exposure with behavioral, motor, and cognitive measures in 38 children with ADHD not comorbid to OCD or TD (nc-ADHD) and in 38 healthy children. An additional group of 15 children with TD and/or OCD was examined. RESULTS: ABGA titers were present in 3% of nc-ADHD patients and controls but in 27% of TD and/or OCD patients. Evidence of streptococcal exposure was similar between ADHD patients and controls living in the same urban area. Behavioral, motor, and cognitive measures were not associated with anti-streptococcal antibodies. CONCLUSION: ABGA do not distinguish nc-ADHD from controls. The differences in the frequency of streptococcal exposure in previous studies are determined by the dynamic nature of the infection rather than the behavioral phenotype of ADHD.

Acquisition of Motor and Cognitive Skills through Repetition in Typically Developing Children.

BACKGROUND: Procedural memory allows acquisition, consolidation and use of motor skills and cognitive routines. Automation of procedures is achieved through repeated practice. In children, improvement in procedural skills is a consequence of natural neurobiological development and experience. METHODS: The aim of the present research was to make a preliminary evaluation and description of repetition-based improvement of procedures in typically developing children (TDC). Ninety TDC children aged 6-12 years were asked to perform two procedural learning tasks. In an assembly learning task, which requires predominantly motor skills, we measured the number of assembled pieces in 60 seconds. In a mirror drawing learning task, which requires more cognitive functions, we measured time spent and efficiency. Participants were tested four times for each task: three trials were consecutive and the fourth trial was performed after a 10-minute nonverbal interference task. The influence of repeated practice on performance was evaluated by means of the analysis of variance with repeated measures and the paired-sample test. Correlation coefficients and simple linear regression test were used to examine the relationship between age and performance. RESULTS: TDC achieved higher scores in both tasks through repetition. Older children fitted more pieces than younger ones in assembling learning and they were faster and more efficient at the mirror drawing learning task. CONCLUSIONS: These findings indicate that three consecutive trials at a procedural task increased speed and efficiency, and that age affected basal performance in motor-cognitive procedures.

Prevalence of sleep disorders and their relationship with core symptoms of inattention and hyperactivity in children with attention-deficit/hyperactivity disorder.

OBJECTIVES: To determine the prevalence of sleep disorders in children with attention-deficit/hyperactivity disorder (ADHD) and in a control population. To examine the relationship between sleep disorders and symptoms of inattention, hyperactivity/impulsiveness and executive dysfunction. MATERIALS AND METHODS: We studied 126 children with ADHD and 1036 control children aged between 5 and 18 years old. Caregivers completed the Pediatric Sleep Questionnaire and the ADHD Rating Scale (ADHD-RS). Children with ADHD were subsequently assessed for executive function with the Conner's Continuous Performance Test (CPT) or with AULA Nesplora. RESULTS: Children with ADHD slept less at night and were more likely to display sleep-related rhythmic movements. Children in the ADHD group who were under 12 years old and who had total ADHD-RS scores over the 90th percentile had more difficulty falling asleep than other children; there was also a relationship between total ADHD-RS scores over the 90th percentile and certain parasomnias in the control population. There was a correlation between shorter duration of night-time sleep and omission errors in children who were 12 or older and who were under pharmacological treatment for ADHD. Bedtime resistance and difficulty falling sleep were more frequent in children with ADHD whose symptoms were not treated pharmacologically, than in children receiving treatment. INTERPRETATION: Symptoms of inattention and hyperactivity are correlated with impaired sleep duration and quality; specifically, there is an association between ADHD symptoms and problems falling asleep and parasomnias, however, the current study does not address the nature and direction of causality. Children with ADHD and receiving methylphenidate had fewer sleep disorders, suggesting that, at least in some children, stimulant treatment is associated with improvement of some aspects of sleep. Shorter sleep duration in adolescents under pharmacological treatment for ADHD tended to result in more errors of omission, suggesting that it is important to promote good sleep habits in this population.

La adaptación al castellano de la Children’s Communication Checklist permite detectar las dificultades en el uso pragmático del lenguaje y diferenciar subtipos clínicos / The Spanish adapted version of the Children’s Communication Checklist identifies disorders of pragmatic use of language and differentiates between clinical subtypes

Introducción. La Children’s Communication Checklist (CCC) de Bishop es una prueba útil para la valoración de la pragmática verbal en los escolares. El objetivo del trabajo es comprobar la fiabilidad y la validez de esta escala en castellano. Sujetos y métodos. Se analiza la CCC contestada por los padres de 360 niños/as de 4-12 años, con inteligencia normal, 160 controles y 200 de cuatro grupos clínicos: trastorno por déficit de atención/hiperactividad (n = 68), trastorno de aprendizaje no verbal procedimental (n = 77), trastorno de la comunicación social (n = 25) y trastornos del espectro autista de nivel 1 (n = 30). Se realizan análisis: factorial para agrupar los ítems del cuestionario, de fiabilidad de las nuevas escalas y discriminante para comprobar si clasifica bien a los afectos de dificultades en el uso del lenguaje. Resultados. Se obtienen siete factores (Kaiser-Meyer-Olkin: 0,852) con moderada similitud a las de la CCC original: relaciones sociales, intereses y otros cinco que constituyen pragmática (habilidades conversacionales, coherencia-comprensión, compenetración, comunicación no verbal y pertinencia). La correlación es significativa entre todos ellos, en el grupo control, y entre los cinco que configuran pragmática, en los grupos clínicos (r de Pearson). La fiabilidad de las escalas es buena (alfa de Cronbach: 0,914). El cuestionario clasifica bien al 98,9% de los casos agrupados con y sin trastorno pragmático; y al 78% de los participantes en sus correspondientes grupos clínicos. Además, permite diferenciar las patologías según la presencia e intensidad de los síntomas. Conclusiones. Esta versión española de la CCC es altamente válida y fiable. Los estadísticos aportados pueden utilizarse como valores de referencia (AU)

Introduction. The Children’s Communication Checklist (CCC) by Bishop is a useful scale for evaluation of pragmatic verbal abilities in school children. The aim of the study is to ascertain the validity and reliability of the CCC in Spanish. Subjects and methods. Answers to the CCC items by parents of 360 children with normal intelligence were analyzed. There were five groups: 160 control children; 68 children with attention deficit hyperactivity disorder, 77 with procedural non-verbal disorder, 25 children with social communication disorder and 30 with autism spectrum disorder. Investigations included: factorial analysis in order to cluster checklist items, reliability analyses of the proposed scales and discriminant analysis to check whether the scale correctly classifies children with pragmatic verbal abilities. Results. Seven factors were obtained (Kaiser-Meyer-Olkin: 0.852) with moderate similarity with those of the original scale: social relationships, interests, and five more that can be grouped into pragmatic verbal ability (conversational abilities, coherence-comprehension, empathy nonverbal communication and appropriateness). All factors are significantly correlated with each other in the control group, and the five that compose pragmatic verbal ability correlate with each other in the clinical groups (Pearson r). The scales have good reliability (Cronbach’s alpha: 0.914). The questionnaire correctly classifies 98.9% of grouped cases with and without pragmatic disorder and 78% of subjects in their appropriate clinical group. Besides, the questionnaire allows to differentiate the pathologies according to the presence and intensity of the symptoms. Conclusions. This Spanish version of the CCC is highly valid and reliable. The proposed statistics can be used as normativereference values (AU)

Procedural Learning in Children With Developmental Coordination, Reading, and Attention Disorders.

The aim is to assess repetition-based learning of procedures in children with developmental coordination disorder (DCD), reading disorder (RD) and attention-deficit hyperactivity disorder (ADHD). Participants included 187 children, studied in 4 groups: (a) DCD comorbid with RD and ADHD (DCD+RD+ADHD) (n = 30); (b) RD comorbid with ADHD (RD+ADHD) (n = 48); (c) ADHD (n = 19); and typically developing children (control group) (n = 90). Two procedural learning tasks were used: Assembly learning and Mirror drawing. Children were tested on 4 occasions for each task: 3 trials were consecutive and the fourth trial was performed after an interference task. Task performance by DCD+RD+ADHD children improved with training (P < .05); however, the improvement was significantly lower than that achieved by the other groups (RD+ADHD, ADHD and controls) (P < .05). In conclusion, children with DCD+RD+ADHD improve in their use of cognitive-motor procedures over a short training period. Aims of intervention in DCD+RD+ADHD should be based on individual learning abilities.

AULA virtual reality test as an attention measure: convergent validity with Conners' Continuous Performance Test.

The majority of neuropsychological tests used to evaluate attention processes in children lack ecological validity. The AULA Nesplora (AULA) is a continuous performance test, developed in a virtual setting, very similar to a school classroom. The aim of the present study is to analyze the convergent validity between the AULA and the Continuous Performance Test (CPT) of Conners. The AULA and CPT were administered correlatively to 57 children, aged 6-16 years (26.3% female) with average cognitive ability (IQ mean = 100.56, SD = 10.38) who had a diagnosis of attention deficit/hyperactivity disorder (ADHD) according to DSM-IV-TR criteria. Spearman correlations analyses were conducted among the different variables. Significant correlations were observed between both tests in all the analyzed variables (omissions, commissions, reaction time, and variability of reaction time), including for those measures of the AULA based on different sensorial modalities, presentation of distractors, and task paradigms. Hence, convergent validity between both tests was confirmed. Moreover, the AULA showed differences by gender and correlation to Perceptual Reasoning and Working Memory indexes of the WISC-IV, supporting the relevance of IQ measures in the understanding of cognitive performance in ADHD. In addition, the AULA (but not Conners' CPT) was able to differentiate between ADHD children with and without pharmacological treatment for a wide range of measures related to inattention, impulsivity, processing speed, motor activity, and quality of attention focus. Additional measures and advantages of the AULA versus Conners' CPT are discussed.

[Dysfunction of central coherence in schoolchildren with procedural learning disorder. Reply]. / Disfunción de la coherencia central en niños con trastorno de aprendizaje procedimental. Réplica.

TITLE: Disfuncion de la coherencia central en ninos con trastorno de aprendizaje procedimental. Replica.

[Dysfunction of central coherence in schoolchildren with procedural learning disorder]. / Disfunción de la coherencia central en niños con trastorno de aprendizaje procedimental.

INTRODUCTION: Children with coordination disorder -non verbal learning disorder, procedural learning disorder (PLD)- have difficulties in understanding complex simultaneous visual information. AIM: Validation of two different visual tasks to measure central coherence function of children with PLD. SUBJECTS AND METHODS: A chimeric image and a complex visual story are showed to 200 schoolchildren: 20 of them have PLD, 60 have PLD plus attention deficit/hyperactivity disorder (PLD + ADHD), 60 have non comorbid ADHD, and 60 subjects are typical control children. A chi square test and a discriminant analysis are used to study the performances of the different groups in verbal description of both images. RESULTS: Performance is lower in children with PLD and PLD + ADHD than in those with non-comorbid ADHD or controls. Moreover 93% and 92% of children with poor performance in, respectively, chimeric and complex images, have PLD or PLD + ADHD. Eighty seven per cent of subjects with PLD + ADHD fail in some of the tasks and, by contrast only 15% of children with ADHD do. CONCLUSIONS: Children with PLD have disability in quick understanding of simultaneous complex information and central coherence. The two tasks used in this research are useful to detect these difficulties, with high sensibility and specificity.

Disfunción de la coherencia central en niños con trastorno de aprendizaje procedimental / Dysfunction of central coherence in schoolchildren with procedural learning disorder

Introducción. Los niños con trastorno de aprendizaje procedimental (TAP) tienen dificultades para percatarse rápidamente de la coherencia o incoherencia de un material complejo y describirlo verbalmente. Objetivo. Estudiar la capacidad de escolares con TAP para percatarse de las incoherencias presentes en dos imágenes complejas. Sujetos y métodos. Se muestran el test de imagen quimérica y la escena visual incoherente a 200 escolares: 20 afectos de TAP, 60 con trastorno por déficit de atención/hiperactividad (TDAH), 60 con TDAH + TAP y 60 escolares típicos como grupo control. Se comparan las respuestas de todos los grupos mediante chi al cuadrado. Se calcula la sensibilidad, eficiencia y especificidad de cada prueba por separado y se realiza análisis discriminante según el rendimiento conjunto en ambas. Resultados. El rendimiento en los dos grupos con TAP es inferior al de los grupos control y TDAH, tanto en el test de imagen quimérica como en la escena visual incoherente. El 93 y el 92% de los niños que, respectivamente, rinden bajo en el test de imagen quimérica y en la escena visual incoherente están afectos de TAP (con o sin TDAH comórbido). El 87% de los sujetos con TDAH + TAP falla en una de las pruebas o en ambas, mientras que sólo lo hace el 15% de los niños con TDAH. Conclusiones. Las dificultades específicas para la comprensión rápida, simultánea y coherente de imágenes o escenas complejas, que forman parte del perfil neuropsicológico del TAP, son detectables mediante el test de imagen quimérica y la escena visual incoherente. Estos instrumentos se han revelado altamente sensibles, eficaces y específicos (AU)

Introduction. Children with coordination disorder -non verbal learning disorder, procedural learning disorder (PLD)- have difficulties in understanding complex simultaneous visual information. Aim. Validation of two different visual tasks to measure central coherence function of children with PLD. Subjects and methods. A chimeric image and a complex visual story are showed to 200 schoolchildren: 20 of them have PLD, 60 have PLD plus attention deficit/hyperactivity disorder (PLD + ADHD), 60 have non comorbid ADHD, and 60 subjects are typical control children. A chi square test and a discriminant analysis are used to study the performances of the different groups in verbal description of both images.Results. Performance is lower in children with PLD and PLD + ADHD than in those with non-comorbid ADHD or controls. Moreover 93% and 92% of children with poor performance in, respectively, chimeric and complex images, have PLD or PLD + ADHD. Eighty seven per cent of subjects with PLD + ADHD fail in some of the tasks and, by contrast only 15% of children with ADHD do. Conclusions. Children with PLD have disability in quick understanding of simultaneous complex information and central coherence. The two tasks used in this research are useful to detect these difficulties, with high sensibility and specificity (AU)

[Brain plasticity for language in children and adolescents]. / Plasticidad cerebral para el lenguaje en el nino y el adolescente.

INTRODUCTION: Plasticity makes possible adaptative modelling of the nervous system to experiences i.e. learning and development. AIM: To review current literature on clinical long term evolution and functional magnetic resonance imaging (fMRI) features of brain remodelling after focal stroke in left perisylvian regions involved in basic language processing during infancy and childhood. DEVELOPMENT: Each of the main neurocognitive subsystems develops with different timing, so altered plasticity and vulnerability are diverse, according with age at insult and its topography. Genetic programming makes human brain capable for installing basic formal linguistic abilities on an associative perisylvian subsystem, highly specialised. A focal lesion of this region leads to remodelling phenomena by disinhibition of contralateral frontal and perisylvian structures and by a more or less efficacious activation of neighboring homolateral cortex, as it has been shown by fMRI studies and DTI tractography. As a result, very early local stroke to language areas is generally well compensated in terms of linguistic behaviour. Meanwhile acquired aphasias into middle and late childhood, even if they have a better prognosis than in adults, they fail to resume without lexical access defaults and/or difficulties in written language. CONCLUSION: Brain plasticity can promote restoration and further development of language following a stroke in left peri-sylvian areas, specially when lesion occurs at perinatal to middle childhood.

Plasticidad cerebral para el lenguaje en el niño y el adolescente / Brain plasticity for language in children and adolescents

Introducción. La plasticidad posibilita el modelado estructural y funcional del sistema nervioso a lo largo de la vida por la experiencia, y fundamenta así los procesos de aprendizaje. Objetivo. Revisar la literatura clínica y de resonancia magnética funcional (RMf) referente al remodelado de los sistemas cerebrales específicamente implicados en el lenguaje tras una lesión focal ocurrida desde el período perinatal hasta la adolescencia temprana. Desarrollo. Cada uno de los grandes subsistemas neurocognitivos se desarrolla a diferentes ritmos; así, la plasticidad y la vulnerabilidad son diversas según la edad y el subsistema en los que ocurre una lesión cerebral focal. Al modificarse el programa genético local por lesiones, adquiridas durante el desarrollo, de áreas perisilvianas izquierdas, se ponen en marcha fenómenos de remodelado que desinhiben regiones homólogas contralaterales y activan, con mayor o menor fortuna, regiones vecinas homolaterales preservadas, según muestran los estudios con escucha dicótica, RMf y tractografía. Cuando la lesión focal ocurre en una edad prelingüística, o en la niñez temprana, el remodelado tisular permite un desarrollo lingüístico generalmente normal, a largo plazo. En las afasias por lesión adquirida a partir de los 5 años, la recuperación y el ulterior desarrollo del lenguaje son variables, con especial vulnerabilidad del acceso al léxico y de la lectoescritura. Conclusión. El funcionalismo neurolingüístico posee subsistemas de reserva que permiten diferentes formas de plasticidad tras lesiones focales de las áreas específicas en el niño (AU)

Introduction. Plasticity makes possible adaptative modelling of the nervous system to experiences i.e. learning and development. Aim. To review current literature on clinical long term evolution and functional magnetic resonance imaging (fMRI) features of brain remodelling after focal stroke in left perisylvian regions involved in basic language processing during infancy and childhood. Development. Each of the main neurocognitive subsystems develops with different timing, so altered plasticity and vulnerability are diverse, according with age at insult and its topography. Genetic programming makes human brain capable for installing basic formal linguistic abilities on an associative perisylvian subsystem, highly specialised. A focal lesion of this region leads to remodelling phenomena by disinhibition of contralateral frontal and perisylvian structures and by a more or less efficacious activation of neighboring homolateral cortex, as it has been shown by fMRI studies andDTI tractography. As a result, very early local stroke to language areas is generally well compensated in terms of linguistic behaviour. Meanwhile acquired aphasias into middle and late childhood, even if they have a better prognosis than in adults, they fail to resume without lexical access defaults and/or difficulties in written language. Conclusion. Brain plasticity can promote restoration and further development of language following a stroke in left perisylvian areas, specially when lesion occurs at perinatal to middle childhood (AU)

[Difficulties in the swift recognition of contradictions in procedural learning disorder: possible central coherence dysfunction]. / Dificultades en la percatacion rapida de incongruencias en el trastorno de aprendizaje procedimental: posible disfuncion de la coherencia central.

INTRODUCTION: Procedural learning disorder, or non-verbal learning disorder, affects the automation of perceptual motor and cognitive skills and routines. AIM: To further our knowledge of the neurocognitive dysfunction in this disorder and, more specifically, to analyse the difficulties experienced when going from recognition of the constituting elements of something to an understanding of the whole. DEVELOPMENT: Contrasting simultaneous visual information and the swift recognition of contradictions are especially difficult abilities for children with procedural learning disorder. CONCLUSIONS: These difficulties may reflect a central coherence dysfunction and can partly account for the deficient ability to adapt their social behaviour displayed by these children.