[Training of executive function in preschool children with combined attention deficit hyperactivity disorder: a prospective, controlled and randomized trial]. / Entrenamiento de la función ejecutiva en preescolares con trastorno por déficit de atención/hiperactividad combinado: estudio prospectivo, controlado y aleatorizado.

INTRODUCTION: School-age children with attention deficit hyperactivity disorder, combined type (ADHD-C) have executive function (EF) alterations. ADHD-C and EF alterations improve with methylphenidate or after training of working memory. AIM: To determine EF training effect on ADHD-C and EF alterations in preschoolers. INCLUSION CRITERIA: randomly assigned, 2-4 years old with ADHD-C, from 7-1-2004 to 6-30-2005, normal neurological examination, no evidences of underlying chronic disorders, no taking long term medications and parents agree to train or no EF daily. Parents filled out DSM-IV diagnostic criteria form for ADHD-C and children were tested with the Standard Dimensional Change Card Sort Task at the first visit and once a year from 1 to 3 years. Inattention, hyperactivity/impulsivity and EF average scores were statistically analyzed by the t Student for significance. RESULTS: Of 25, 13 were trained. ADHD-C incidence went down to 16 (64%), 6 (24%) and 10 (40%) trained and untrained. Incidence was 50, 40 and 25% 100, and 66.66 y 100 after 1, 2 and 3 years with and without training. Inattention average score was 8.25, 8.4 and 7 before and 6, 5.8, and 5.5 before and after 1, 2 and 3 years of training. Hyperactivity/impulsivity average score was 8.5, 8.4 and 7.75 before and 5.75, 5.6, and 5.25 after 1, 2 and 3 years of training. EF average score was 5.2, 4.8, and 5.5 before and 8.5, 10 and 9.5 after 1, 2 and 3 years of training. Degree of improving of inattention, hyperactivity/impulsivity and EF were statistically significant for training of EF for 1, 2 and 3 years (p = 0.013, 0.002, 0.0249). CONCLUSIONS: Children with preschool ADHD-C and EF disorders should receive training of EF for at least 3 years from age of diagnoses to improve their condition.

Entrenamiento de la función ejecutiva en preescolares con trastorno por déficit de atención/hiperactividad combinado: estudio prospectivo, controlado y aleatorizado / Training of executive function in preschool children with combined attention deficit hyperactivity disorder: A prospective, controlled and randomized trial

Introducción. Los escolares con trastorno por déficit de atención/hiperactividad combinado (TDAH-C) presentan alteraciones de la función ejecutiva (FE) que mejoran mediante la administración de metilfenidato o con el entrenamiento de la memoria de trabajo. Objetivo. Determinar el efecto del entrenamiento de las FE sobre sus alteraciones y sobre el TDAH-C en preescolares. Sujetos y métodos. Criterio de inclusión: distribución aleatoria, niños de 2 a 4 años de edad, afectados de TDAH-C, incluidos entre el uno de julio de 2004 y el 30 de junio de 2005, con examen neurológico normal, sin enfermedades crónicas, que no estaban recibiendo tratamiento farmacológico a largo plazo y cuyos padres estaban de acuerdo en entrenar o no entrenar a sus hijos. Los padres completaron el cuestionario del DSM-IV para determinar la presencia o la ausencia de TDAH-C y las FE se evaluaron mediante la Dimensional Change Card Sort Task en la primera evaluación y una vez al año durante tres años. El promedio de puntuación de la inatención, hiperactividad/impulsividad y FE en los grupos entrenado o no entrenado se analizaron estadísticamente mediante la t de Student. Resultados. De 25 niños, 13 recibieron entrenamiento. La incidencia de TDAH-C descendió a 16 casos (64%), 6 niños (24%) con entrenamiento y 10 niños (40%) sin él. La incidencia de TDAH-C fue del 50, 40 y 25% y del 100, 66,66 y 100% después de uno, dos y tres años con entrenamiento o sin él. El promedio de puntuación de la inatención fue de 8,25, 8,4 y 7 antes del entrenamiento y de 6, 5,8, y 5,5 después de uno, dos y tres años. El promedio de la hiperactividad/impulsividad fue de 8,5, 8,4 y 7,75 antes del entrenamiento y de 5,75, 5,6 y 5,25 después de uno, dos y tres años, y el de las FE, de 5,2, 4,8 y 5,5 antes del entrenamiento y de 8,5, 10 y 9,5 después de uno, dos y tres años de entrenamiento. El grado de mejora de la inatención, de la hiperactividad/impulsividad y de las FE fue estadísticamente significativo con el entrenamiento de las FE durante uno, dos y tres años (p = 0,013, 0,002, 0,0249). Conclusiones. Los preescolares con TDAH-C y alteraciones de las FE deberían recibir entrenamiento de éstas durante, como mínimo, tres años desde el momento del diagnóstico para mejorar su condición (AU)

Introduction. School-age children with attention deficit hyperactivity disorder, combined type (ADHD-C) have executive function (EF) alterations. ADHD-C and EF alterations improve with methylphenidate or after training of working memory. Aim. To determine EF training effect on ADHD-C and EF alterations in preschoolers. Subjects and methods. Inclusion criteria: randomly assigned, 2-4 years old with ADHD-C, from 7-1-2004 to 6-30-2005, normal neurological examination, no evidences of underlying chronic disorders, no taking long term medications and parents agree to train or no EF daily. Parents filled out DSM-IV diagnostic criteria form for ADHD-C and children were tested with the Standard Dimensional Change Card Sort Task at the first visit and once a year from 1 to 3 years. Inattention, hyperactivity/impulsivity and EF average scores were statistically analyzed by the t Student for significance. Results. Of 25, 13 were trained. ADHD-C incidence went down to 16 (64%), 6 (24%) and 10 (40%) trained and untrained. Incidence was 50, 40 and 25% 100, and 66.66 y 100 after 1, 2 and 3 years with and without training. Inattention average score was 8.25, 8.4 and 7 before and 6, 5.8, and 5.5 before and after 1, 2 and 3 years of training. Hyperactivity/impulsivity average score was 8.5, 8.4 and 7.75 before and 5.75, 5.6, and 5.25 after 1, 2 and 3 years of training. EF average score was 5.2, 4.8, and 5.5 before and 8.5, 10 and 9.5 after 1, 2 and 3 years of training. Degree of improving of inattention, hyperactivity/impulsivity and EF were stadistically significant for training of EF for 1, 2 and 3 years (p = 0.013, 0.002, 0.0249). Conclusions. Children with preschool ADHD-C and EF disorders should receive training of EF for at least 3 years from age of diagnoses to improve their condition (AU)

[Treatment of herpes simplex encephalitis in children]. / Tratamiento de las encefalitis herpéticas en niños.

INTRODUCTION: Herpes simplex encephalitis (HSE) is a focal infectious disease of the central nervous system (CNS) acknowledged the world over as being severe. DEVELOPMENT: The epidemiology is well known in developed countries. It presents in patients over the age of 3 months. The mechanism by which the virus reactivates and penetrates into the CNS is still not fully understood. A timely diagnosis is crucial so that early treatment can be established within the first four days of the infectious process. By so doing, it becomes possible to raise the chances of survival by over 50%. The physician should have a strong suspicion when faced with a patient with symptoms of encephalitis, especially if he or she has focal neurological manifestations, including manifestations in the neuropsychiatric sphere. The non-invasive diagnostic method par excellence is high-sensitivity magnetic resonance imaging studies of the brain within the first 24-48 hours following the onset of the clinical signs and symptoms. Determination of viral DNA in cerebrospinal fluid by the polymerase chain reaction method is the technique with the highest degree of sensitivity and specificity available for carrying out the diagnosis. Effective treatment is intravenous acyclovir: 30 mg/kg/day in three doses. CONCLUSIONS: Encephalitis produced by the herpes virus is a disease that is dreaded because of the high mortality rate and the devastation it causes in the living conditions of survivors. Our aim is to stimulate the clinical suspicion of HSE so that pharmacological treatment can be established even while diagnostic tests are being carried out. We suggest early neuropsychological evaluation and follow-up of the manifestations of focal sequelae related to the frontotemporal regions.

[Cerebrovascular accidents in full-term newborn infants]. / Accidentes vasculares encefálicos en neonatos a término.

INTRODUCTION: The purpose of this paper is to review the role of the neurologist in the management of cerebrovascular accidents (CVA) (insults resulting from a sudden obstruction or rupture of an intracranial vessel). This was accomplished by reviewing the literature (PubMed) under the heading of stroke and term neonate. DEVELOPMENT: CVA in full-term neonates are classified as hematomas and infarcts. Hematomas are classified according to: location, structure (arterial, venous, or sinus), type of malformation (aneurysm, venous malformation, and telangiectasia), and cause of the bleed (vessel wall rupture or hypo-coagulation). Classification according to location is based on compartment supra or infratentorial; space -extra-axial (epidural, subdural, or subarachnoid) or intra-axial (parenchymal or ventricular)-; and region -parietal, temporal, thalamic, etc.-. Infarcts are classified according to vascular and parenchymal factors. The vascular factors are the structure, the cause of the obstruction -extramural, mural or intramural (thrombus or embolus)-. The parenchymal factors are type of damage (pale vs hemorrhagic) and location. Patients with suspected embolism should have ultrasound neck. Coagulation studies should be done in patients with hematomas and infracts. Multiple causes may be present in each case. Anticoagulation is only used in small pale infarcts of cardiac embolic origin. CONCLUSION: The neurologist roles in the management of CVA are to classify the event, select the appropriate investigation, and implement treatment.

[Executive function disorders]. / Trastornos de las funciones ejecutivas.

AIM: To review the development, anatomy and physiology of executive functions (EF) in normal and pathological conditions. DEVELOPMENT: EF consist of several internal mental process design to solve mental and environmental complex problems in an efficient and acceptable way to the person and the society. EF include inhibition of behavior and irrelevant information, nonverbal working memory, verbal working memory, self-regulation of affect, motivation and arousal, planning, decision making, self monitoring of the entire solving problem process and self evaluation of the results of the action taken. The anatomical substrate is at the prefrontal lobe cortex and its afferent and efferent structures. Neurotransmitters involved in activation of neurons at the prefrontal cortex are dopamine and norepinephrine and in less degree acetylcholine and serotonine. CONCLUSIONS: Disorders of one or more of the EF in children and adolescents are found in attention deficit/hyperactivity disorder, Tourette syndrome, bipolar disease, depression, obsessive-compulsive disorders, autism and traumatic brain injury.

Accidentes vasculares encefálicos en neonatos a término / Cerebrovascular accidents in full-term newborn infants

Introducción. El propósito de este artículo es revisar elpapel del neurólogo en el manejo de los recién nacidos a términocon accidentes vasculares encefálicos (AVE) (lesiones debidas auna súbita obstrucción o ruptura de un vaso intracraneal). Coneste fin se revisaron las fuentes bibliográficas (PubMed) mediantela búsqueda de los términos ‘stroke’ y ‘term neonate’. Desarrollo.Los AVE se dividen en hematomas e infartos. Los hematomas debenclasificarse de acuerdo con su localización; estructura vascularenvuelta (arteria, vena o seno), el tipo de anomalía vascular (aneurisma,malformaciones venosas, telangiectasia) y la causa de laextravasación de la sangre (ruptura de la pared vascular o hipocoagulación).La clasificación de acuerdo con la localización incluye:compartimentos (supra e infratentoriales), espacios –extraaxial(epidural, subdural o aracnoideo) o intraaxial (parénquima oventrículos)– y regiones –parietal, temporal, talámica, etc.–. Losinfartos se clasifican de acuerdo con factores vasculares y parenquimatosos;los factores vasculares son el tipo de estructura vascularenvuelta, causa de la obstrucción –extramural, mural o intramural(émbolo o trombo)–; los factores parenquimatosos son el tipode infarto –pálido o hemorrágico– y la localización de éste. Lospacientes con procesos embólicos requieren ecografía del corazóny del cuello. La posibilidad de causas múltiples debe sospecharse.Se deben realizar estudios de coagulación. La cirugía puede sernecesaria en determinados casos. En pacientes con cardioembolismose sugiere la anticoagulación en infartos pálidos y pequeños.Conclusión. La función del neurólogo en estos pacientes consisteen clasificar el evento, guiar las investigaciones y decidir el tratamiento

Introduction. The purpose of this paper is to review the role of the neurologist in the management of cerebrovascularaccidents (CVA) (insults resulting from a sudden obstruction or rupture of an intracranial vessel). This was accomplished byreviewing the literature (PubMed) under the heading of stroke and term neonate. Development. CVA in full-term neonates areclassified as hematomas and infarcts. Hematomas are classified according to: location, structure (arterial, venous, or sinus), typeof malformation (aneurysm, venous malformation, and telangiectasia), and cause of the bleed (vessel wall rupture or hypocoagulation).Classification according to location is based on compartment supra or infratentorial; space –extra-axial (epidural,subdural, or subarachnoid) or intra-axial (parenchymal or ventricular)–; and region –parietal, temporal, thalamic, etc.–.Infarcts are classified according to vascular and parenchymal factors. The vascular factors are the structure, the cause of theobstruction –extramural, mural or intramural (thrombus or embolus)–. The parenchymal factors are type of damage (pale vshemorrhagic) and location. Patients with suspected embolism should have ultrasound neck. Coagulation studies should be donein patients with hematomas and infracts. Multiple causes may be present in each case. Anticoagulation is only used in small paleinfarcts of cardiac embolic origin. Conclusion. The neurologist roles in the management of CVA are to classify the event, selectthe appropriate investigation, and implement treatment

Trastornos de las funciones ejecutivas / Executive function disorders

Objetivo. Revisar el desarrollo, la anatomía y la fisiologíade las funciones ejecutivas (FE) en condiciones normales y patológicas.Desarrollo. Las FE consisten en varios procesos mentalesdiseñados para resolver problemas mentales y medioambientalescomplejos con eficiencia y el beneplácito de la persona y lasociedad. Las FE incluyen inhibición de la conducta y la informaciónirrelevante, memoria de trabajo no verbal, memoria de trabajoverbal, autorregulación de las emociones, motivaciones y gradode alerta, planeamiento, tomar decisiones, automonitorización delproceso y autoevaluación de los resultados de la acción tomada.Las estructuras anatómicas involucradas incluyen la corteza prefrontaly sus áreas aferentes y eferentes. Los neurotransmisoresimplicados son la dopamina y la norepinefrina y, en menor grado,la acetilcolina y la serotonina. Conclusiones. Se han encontradoalteraciones de una o varias de las FE en niños y adolescentes contrastorno por déficit de atención e hiperactividad, síndrome deTourette, enfermedad bipolar, depresión, trastorno obsesivo-compulsivo,autismo y postraumatismo cerebral

Aim. To review the development, anatomy and physiology of executive functions (EF) in normal and pathologicalconditions. Development. EF consist of several internal mental process design to solve mental and environmental complexproblems in an efficient and acceptable way to the person and the society. EF include inhibition of behavior and irrelevantinformation, nonverbal working memory, verbal working memory, self-regulation of affect, motivation and arousal, planning,decision making, self monitoring of the entire solving problem process and self evaluation of the results of the action taken.The anatomical substrate is at the prefrontal lobe cortex and its afferent and efferent structures. Neurotransmitters involved inactivation of neurons at the prefrontal cortex are dopamine and norepinephrine and in less degree acetylcholine and serotonine.Conclusions. Disorders of one or more of the EF in children and adolescents are found in attention deficit/hyperactivitydisorder, Tourette syndrome, bipolar disease, depression, obsessive-compulsive disorders, autism and traumatic brain injury

Tratamiento de las encefalitis herpéticas en niños / Treatment of herpes simplex encephalitis in children

Introducción. La encefalitis herpética (EH) es una enfermedadinfecciosa focal del sistema nervioso central (SNC) reconocidamundialmente como grave. Desarrollo. La epidemiología estábien establecida en países desarrollados. Se presenta en pacientesmayores de 3 meses. No está bien determinado el mecanismo por elque el virus se reactiva y penetra en el SNC. El diagnóstico precozes determinante para la instauración temprana del tratamiento enlos primeros cuatro días del proceso infeccioso, con lo que se puedelograr aumentar en más de un 50% la posibilidad de supervivencia.Se insta tener una sospecha importante ante un paciente con síntomasde encefalitis, especialmente si presenta manifestaciones neurológicasfocales, incluidas las del ámbito neuropsiquiátrico. El métododiagnóstico no invasivo por excelencia es el estudio de resonanciamagnética cerebral con alta sensibilidad en las primeras 24-48 horas tras el inicio de las manifestaciones clínicas. La determinaciónde ADN viral en el líquido cefalorraquídeo por reacción encadena de la polimerasa es el método de mayor sensibilidad y especificidaddisponible para el diagnóstico. El tratamiento efectivo esaciclovir por vía endovenosa: 30 mg/kg/día en tres dosis. Conclusión.La encefalitis producida por el virus herpes es una temibleenfermedad por la alta mortalidad y devastación de las condicionesde vida de los supervivientes. Se propone estimular la sospecha clínicade la EH de manera que se inicie un tratamiento farmacológicoincluso mientras se realizan las pruebas diagnósticas. Planteamosla evaluación neuropsicológica temprana y el seguimiento delas manifestaciones de secuelas focales relacionadas con las regionesfrontotemporales

Introduction. Herpes simplex encephalitis (HSE) is a focal infectious disease of the central nervous system (CNS)acknowledged the world over as being severe. Development. The epidemiology is well known in developed countries. Itpresents in patients over the age of 3 months. The mechanism by which the virus reactivates and penetrates into the CNS is stillnot fully understood. A timely diagnosis is crucial so that early treatment can be established within the first four days of theinfectious process. By so doing, it becomes possible to raise the chances of survival by over 50%. The physician should havea strong suspicion when faced with a patient with symptoms of encephalitis, especially if he or she has focal neurologicalmanifestations, including manifestations in the neuropsychiatric sphere. The non-invasive diagnostic method par excellence ishigh-sensitivity magnetic resonance imaging studies of the brain within the first 24-48 hours following the onset of the clinicalsigns and symptoms. Determination of viral DNA in cerebrospinal fluid by the polymerase chain reaction method is thetechnique with the highest degree of sensitivity and specificity available for carrying out the diagnosis. Effective treatment isintravenous acyclovir: 30 mg/kg/day in three doses. Conclusions. Encephalitis produced by the herpes virus is a disease thatis dreaded because of the high mortality rate and the devastation it causes in the living conditions of survivors. Our aim is tostimulate the clinical suspicion of HSE so that pharmacological treatment can be established even while diagnostic tests arebeing carried out. We suggest early neuropsychological evaluation and follow-up of the manifestations of focal sequelaerelated to the frontotemporal regions

[Hyperbaric oxygen treatment for children with cerebral palsy]. / Tratamiento de los niños con parálisis cerebral con oxígeno hiperbárico.

AIMS: Demand from parents has made hyperbaric oxygenation (HO) inhalation the most popular and rapid growing therapy for children with cerebral palsy (CP). To review peer reviewed articles of HO in children with CP to determine its efficacy and risks, literature was searched on-line using PubMed indexed for MEDLINE (1996-2003) for articles under CP and HO headings. METHOD: We found 16 references: 5 articles (1 uncontrolled pilot study, 2 from a single controlled study, 1 case report of complications and 1 revision) and 11 letters to the editor. The control study showed significant improvements in the middle, at the end and 3 months after 40 treatments with OH (O2=100%/1.75 AA) and placebo (O2=21%/1.3 AA) in the gross motor function measure, (2.9% vs 3%), self-control, auditory attention and visual working memory. There were no significant differences between the groups. Side effects included barometric otitis media (48.2% and 22.2% in the OH and placebo groups). The authors and the Advisory Scientific Committee of the American Academy of Cerebral Palsy and Developmental Medicine agreed that the positive results in both groups were due to a participation effect. The Southern Africa Undersea and Hyperbaric Association discouraged the ongoing, widespread, and informal use of HO for children with CP in South Africa based on the results of this randomized controlled study. CONCLUSION: There are no scientific evidences for the use of HO in children with CP. Risks include barometric otitis media.

[Generalized neonatal hypotonia]. / Hipotonía neonatal generalizada.

Generalized neonatal hypotonia implies a pathologically decreased postural tone involving at least the extremities, trunk and neck occurring during the first month of life. The gestational age of the neonate, the behavioral state of the neonate at the time of the examination, and the possibility of pseudoparalysis (due to generalized pain) should be considered when evaluating a neonate for the possibility of generalized hypotonia. The evaluation of neonates with hypotonia should be guided by the characteristic of the muscular dynamic reflexes, primitive reflexes, the relation between the degree of hypotonia and weakness and findings during several maneuvers (traction, ventral and horizontal suspension, plantar response and response to forward displacement from a lying position). Possible sites of pathology in neonates with hypotonia include: (1) brain, (2) brain stem, (3) cervical spine, (4) cerebellum, (5) lower motor neurons in the brain stem and spine; (6) nerve, (7) myoneural junction, and (8) muscles.

Hipotonía neonatal generalizada / Generalized neonatal hypotonia

La hipotonía generalizada del recién nacido se caracteriza por un tono postural patológicamente disminuido que afecta, como mínimo, a las extremidades, el tronco y el cuello durante el primer mes de vida. La edad gestacional del recién nacido, su estado conductual en el momento del examen y la posibilidad de una seudoparálisis (debido al dolor generalizado) son factores que deben tenerse en cuenta al evaluar la posible existencia de una hipotonía generalizada en el neonato. La evaluación de los recién nacidos con hipotonía debe guiarse por las características ofrecidas por los reflejos dinámicos musculares, los reflejos primitivos, la relación entre el grado de hipotonía y debilidad y los resultados de algunas maniobras (tracción, suspensión ventral y horizontal, respuesta plantar y respuesta a un desplazamiento hacia adelante con el paciente en decúbito supino). Algunas de las posibles localizaciones de la patología en los recién nacidos con hipotonía incluyen: 1) el cerebro, 2) el tronco encefálico, 3) la médula cervical, 4) el cerebelo, 5) las neuronas motores inferiores del tronco encefálico y la médula espinal, 6) el nervio, 7) la unión neuromuscular, y 8) los músculos (AU)

Generalized neonatal hypotonia implies a pathologically decreased postural tone involving at least the extremities, trunk and neck occurring during the first month of life. The gestational age of the neonate, the behavioral state of the neonate at the time of the examination, and the possibility of pseudoparalysis (due to generalized pain) should be considered when evaluation a neonate for the possibility of generalized hypotonia. The evaluation of neonates with hypotonia should guided by the characteristic of the muscular dynamic reflexes, primitive reflexes, the relation between the degree of hypotonia and weakness and findings during several maneuvers (traction, ventral and horizontal suspension, plantar response and response to forward displacement from a lying position). Possible sites of pathology in neonates with hypotonia include: (1) brain, (2) brain stem, (3) cervical spine, (4) cerebellum, (5) lower motor neurons in the brain stem and spine; (6) nerve, (7) myoneural junction, and (8) muscles (AU)

Tratamiento de los niños con parálisis cerebral con oxígeno hiperbárico / Hyperbaric oxygen treatment for children with cerebral palsy

Objetivos. La terapia más popular y de mayor demanda entre los padres de los pacientes con parálisis cerebral (PC) es la inhalación de oxígeno hiperbárico (OH). En este trabajo nos propusimos revisar la bibliografía sobre OH en la PC para determinar su eficacia y riesgo. Revisamos las referencias en MEDLINE-PubMed (1996-2003) bajo los encabezamientos PC y OH. Desarrollo. Encontramos 16 referencias: cinco artículos (un estudio piloto no contro lado, dos de un sólo estudio controlado, un comunicado de complicaciones y una revisión) y 11 cartas al editor. El estudio controlado demostró una mejoría significativa similar en la escala de las funciones motoras groseras, autocontrol, atención auditiva y memoria visual de trabajo en niños con PC tratados con OH (O2 = 100 por ciento; 1,75 AA) y placebo (O2 = 21 por ciento; 1,3 AA). Las complicaciones fueron otitis media barométrica (OMB) en un 50 por ciento de los niños tratados con OH y un 25 por ciento del grupo placebo. Los resultados fueron interpretados por los autores y el Comité Científico de la Academia Americana de Parálisis Cerebral y Medicina del Desarrollo, debido al efecto de participación. La Sociedad de Medicina Submarina e Hiperbárica de Sudáfrica recomendó no emplear OH en niños con PC, en base a los resultados de este estudio controlado. Tres cartas al editor interpretaron los resultados como que ambos tratamientos fueron efectivos. Conclusiones. No encontramos evidencias científicas que justifiquen el empleo de OH en niños con PC. Los efectos indeseables fueron OMB (AU)

Aims. Demand from parents has made hyperbaric oxygenation (HO) inhalation the most popular and rapid growing therapy for children with cerebral palsy (CP). To review peer-reviewed articles of HO in children with CP to determine its efficacy and risks. Literature was searched on-line using PubMed-indexed for MEDLINE (1996- 2003) for articles under CP and HO headings. Method. We found 16 references: 5 articles (1 uncontrolled pilot study, 2 from a single controlled study, 1 case report of complications and 1 revision) and 11 letters to the editor. The control study showed significant improvements in the middle, at the end and 3 months after 40 treatments with OH (O2 = 100%/1.75 AA) and placebo (O2 = 21%/1.3 AA) in the gross motor function measure, (2.9% vs 3%), self-control, auditory attention and visual working memory. There were no significant differences between the groups. Side effects included barometric otitis media (48.2% and 22.2% in the OH and placebo groups). The authors and the Advisory Scientific Committee of the American Academy of Cerebral Palsy and Developmental Medicine agreed that the positive results in both groups were due to a participation effect. The Southern Africa Undersea and Hyperbaric Association discouraged the ongoing, widespread, and informal use of HO for children with CP in South Africa based on the results of this randomized controlled study. Conclusion. There are no scientific evidences for the use of HO in children with CP. Risks include barometric otitis media (AU)

[Cerebral malformation in the newborn: holoprosencephaly and agenesis of the corpus callosum]. / Malformaciones cerebrales en el recien nacido: holoprosencefalia y agenesia del cuerpo calloso.

OBJECTIVE: To review the embriology and clinical aspects of holoprosencephaly and agenesis of the corpus callosum. DEVELOPMENT: The rostral neuropore closes at 24 days of gestation. At 74 days of gestations axons cross through the dorsal region of the commissural plaque and start forming the corpus callosum. At 115 days of gestations the corpus callosum reaches its adult form. Holoprosencephaly occurs due to rostral mesodermal dysfunction. The etiology of holoprosencephaly is heterogenous. The risk of holoprosencephaly of neonates born to mother with gestational diabetes is 1 2 %. Agenesis of the corpus callosum not associated to holoprosencephaly is due to a disorder of telencephalic midline. Pyruvate dehydrogenase and non ketotic hyperglycinemia can produce agenesis corpus callosum. The prognosis of patients with agenesis of the corpus callosum is dictated by the associated central nervous system and none central nervous system anomalies. CONCLUSIONS: Knowledge of the embriology of holoprosencephaly and agenesis of the corpus callosum are necessary to understand their radiological appearance. The evaluation of a neonate with these conditions requires genetic and metabolic evaluations.

[The effect of interictal epileptiform discharges on cognitive function in children with idiopathic epilepsy]. / Efecto de las descargas epileptiformes interictales sobre las funciones cognitivas en niños con epilepsia idiopática.

INTRODUCTION: Transient cognitive disorders (CD) in benign rolandic epilepsy (BRE), the most common of idiopathic partial epilepsy (IPE), may be secondary to interictal epileptiform discharges (IED). OBJECTIVES: To determine incidence and risk factors for persistent TC in students with IE before, during and after antiepileptic (AE). INCLUSION CRITERIA: 6 12 years old, IPE, controlled for 2 years with AE, and follow up for 5 years. EVALUATIONS: intelligence (Wechsler III), learning (Wechsler), academic level (Woodcock Johnson) and attention/behavior (O Conners R). VARIABLES: sex, age of onset, seizure type, interval between first seizure and AE onset, EEG results and AE type. ANALYSIS: chi square. RESULTS: Fourteen children had decreased learning and attention span with impulsivity, hyperactivity, low tolerance and agressivity during remission; 12 (85,71%) with temporal lobe epilepsy: 6 (50%) with IED in the left dominant hemisphere, 2 (16,67%) with IED in the right temporal lobe in left dominant hemisphere children, 2 (16,67%) in both temporal lobes in left dominant hemisphere children and 2 (14,29%) with ERB and IED. MRI were normal. CONCLUSIONS: Children with idiopathic temporal lobe epilepsy and IED in the left dominant hemisphere are at higher risk for CD than children with other types of IPE. To control the seizures and to abolish the IED are recommended in an attempt to prevent these cognitive disorders

Efecto de las descargas epileptiformes interictales sobre las funciones cognitivas en niños con epilepsia idiopática / The effect of interictal epileptiform discharges on cognitive function in children with idiopathic epilepsy

Introducción. Los trastornos cognitivos (TC) transitorios en niños con epilepsia rolándica benigna (ERB), la más común de las epilepsias parciales idiopáticas (EPI), son secundarios a descargas epileptiformes interictales (DEI). Objetivos. Determinar la incidencia y factores de riesgo de los TC persistentes en escolares con EPI antes, durante y después de la administración de antiepilépticos (AE). Pacientes y métodos. Criterio de inclusión: edad de 6 a 12 años, EPI, control con AE durante dos 2 años y seguimiento durante cinco años. Evaluaciones: inteligencia (Wechsler-III), aprendizaje (Wechsler), nivel académico (Woodcock-Johnson) y atención/conducta (O'Conners-R). Variables: sexo, edad de comienzo, tipo de EPI, intervalo entre la primera crisis y comienzo del AE, resultado del EEG y tipo de AE. Análisis: ji cuadrado. Resultados. No se observaron TC antes de comenzar los AE ni durante los dos años con AE y sin crisis clínicas ni EEG. 14 pacientes tuvieron trastornos del aprendizaje, inatención, impulsividad, hiperactividad, baja tolerancia y agresividad durante la remisión; 12 (85,71 por ciento) con epilepsia del lóbulo temporal: seis (50 por ciento) con DEI en el lado izquierdo (hemisferio dominante izquierdo), dos (16,67 por ciento) con DEI en el derecho (hemisferio dominante izquierdo), dos (16,67 por ciento) en ambos lóbulos temporales y dos (14,29 por ciento) con ERB. La resonancia magnética cerebral fue normal. Conclusiones. Los niños con epilepsia del lóbulo temporal idiopática con DEI en el hemisferio dominante presentan mayor riesgo que el resto de los pacientes con EPI a sufrir TC. Se recomienda eliminar no sólo las cisis, sino también las DEI, para evitar estos trastornos (AU)

Introduction. Transient cognitive disorders (CD) in benign rolandic epilepsy (BRE), the most common of idiopathic partial epilepsy (IPE), may be secondary to interictal epileptiform discharges (IED). Objectives. To determine incidence and risk factors for persistent TC in students with IE before, during and after antiepileptic (AE). Patients and methods. Inclusion criteria: 6-12 years old, IPE, controlled for 2 years with AE, and follow-up for 5 years. Evaluations: intelligence (Wechsler-III), learning (Wechsler), academic level (Woodcock-Johnson) and attention/behavior (O’Conners-R). Variables: sex, age of onset, seizure type, interval between first seizure and AE onset, EEG results and AE type. Analysis: chi square. Results. Fourteen children had decreased learning and attention span with impulsivity, hyperactivity, low tolerance and agressivity during remission; 12 (85,71%) with temporal lobe epilepsy: 6 (50%) with IED in the left dominant hemisphere, 2 (16,67%) with IED in the right temporal lobe in left dominant hemisphere children, 2 (16,67%) in both temporal lobes in left dominant hemisphere children and 2 (14,29%) with ERB and IED. MRI were normal. Conclusions. Children with idiopathic temporal lobe epilepsy and IED in the left dominant hemisphere are at higher risk for CD than children with other types of IPE. To control the seizures and to abolish the IED are recommended in an attempt to prevent these cognitive disorders (AU)

Malformaciones cerebrales en el recién nacido: holoprosencefalia y agenesia del cuerpo calloso / Cerebral malformation in the newborn: holoprosencephaly and agenesis of the corpus callosum

Objetivo. Revisar la embriología y los aspectos clínicos de la holoprosencefalia y la agenesia del cuerpo calloso en el período neonatal. Desarrollo. A los 24 días de gestación, el neuroporo rostral se cierra. Alrededor de los 74 días de gestación, comienzan a cruzarse los primeros axones en la región dorsal de la placa comisural destinada a convertirse en el cuerpo calloso. Éste adquiere su configuración final (aunque no su tamaño final) a los 115 días de gestación. Los trastornos de diverticulación conducen a la holoprosencefalia, que ocurre por una disfunción del mesodermo rostral y cuya etiología es heterogénea. El riesgo de holoprosencefalia en neonatos de madres con diabetes mellitus gestacional es del 1 al 2 per cent. La agenesia del cuerpo calloso no asociada a holoprosencefalia constituye un trastorno del desarrollo del la línea media del telencefalo. Los trastornos metabólicos asociados con agenesia total o parcial del cuerpo calloso son la deficiencia de la dehidrogenasa pirúvica y la hiperglicinemia sin cetosis. El pronóstico de la agenesia del cuerpo calloso detectado durante el parto viene determinado por la presencia de anormalidades fuera del sistema nervioso central y la presencia de otras anormalidades en el mismo. Conclusiones. El conocimiento de la embriología del sistema nervioso central es necesario para entender las manifestaciones radiológicas de la holoprosencefalia y la agenesia de cuerpo calloso. La evaluación del neonato con estas malformaciones requiere estudios genéticos y metabólicos (AU)

[The effect of discontinuation of methylphenidate at adolescence onset on adult attention deficit hyperactivity disorder]. / Efecto de la discontinuación del metifenidato al comienzo de la adolescencia sobre el trastorno por déficit de atención en la edad adulta.

INTRODUCTION: The positive effect of methylphenidate on children and adults with ADHD is well known. However, the effect of discontinuation of methylphenidate at adolescence onset on adult s ADHD is unknown. Objective. To determine the effect of discontinuation of methylphenidate at adolescence onset on adult s attention deficit, hyperactivity, impulsivity and functional disabilities. PATIENTS AND METHODS: Adults and their parents, spouses and/or friends were requested to fill out the same criteria diagnosis form filled out by their parents and teachers before (7 years of age), during (7.5 years of age) and at the end of treatment (12 years of age). They took methylphenidate (0.1 0.5 mg/kg/day) from age 7 to 12 years because ADHD. Inattention, hyperactivity, impulsivity and functional disability were statistically analyzed by the paired sample method before, during at the end of treatment and at age 27 years. RESULTS: Methylphenidate used for 5 years (7.5 12 years of age) improved significantly (p< 0.001) the average score for inattention, hyperactivity, impulsivity and functional impairment compared to pre (7 year of age) and post (27 years of age) treatment. The discontinuation of methylphenidate for 15 years (12 27 year of age) deteriorate significantly the average score for inattention and functional impairment when pre adolescent and adult values were compared (p< 0.001). CONCLUSIONS: The results strongly suggest that methylphenidate must be used throughout the adulthood to avoid the degree of inattention and functional disability found in this study.

[Neurophysiological evaluation of children with peripheral neuropathy]. / Evaluación neurofisiológica de los niños con neuropatías periféricas.

OBJECTIVE: The purpose of this review is to demostrate the value and limitations of neurophysiological evaluation of children with peripheral neuropathy. DEVELOPMENT: The neurophysiological evaluation (NPE) is an extension of the neurologic examination. The NPE has a high diagnostic sensitiviy but lacks etiologic specificity. The NPE includes motor and sensory nerve conduction velocity studies (NCV), needle EMG, somatosensory evoked potential (SEP) and motor evoked potential (MEP). The NCV allows to determine the component of the peripheral nerve fiber involved (axon and/or myelin), type of fibers affected (motor and/or sensory), the location of the lesion (proximal and/or distal) and the pattern of the nerve involvement (segmental or continuos). The EMG allows to determine the presence and degree of denervation and reinervation. CONCLUSIONS: The combination of NCV, EMG, SEP and MEP allow: 1. To localize a lesion to the diferent regions of the peripheral nervous system (preganglionic and/or postganglionic segments of dorsal root, ventral root, spinal nerve, plexus and peripheral nerves); 2. To determine severity and prognosis; 3. To select candidates for reconstructive exploratory surgery; and 4. To determine treatment efficacy and/or natural course of the disease

Evaluación neurofisiológica de los niñoscon neuropatías periféricas / Neurophysiological evaluation of children with peripheral neuropathy

Objetivo. El propósito de esta revisión es demostrar el valor y las limitaciones de la evaluación neurofisiológica (ENF) en el estudio de pacientes con neuropatías periféricas. Desarrollo. La ENF es una extensión del examen neurológico; tiene una alta sensibilidad diagnóstica, pero carece de especificidad etiológica; incluye la determinación de la velocidad de conducción (VCN) de nervios motores y sensitivos, la electromiografía (EMG) con agujas, los potenciales evocados somatosensoriales (PES) y los potenciales evocados motores (PEM). La VCN permite determinar el tipo de lesión (axónica o desmielinizante), el tipo de fibra nerviosa involucrada (motora o sensitiva), la extensión (proximal o distal) y el patrón de alteración en el nervio (segmentaria o continua). La EMG permite determinar la presencia y el grado de desnervación y reinervación. Conclusión. La VCN, EMG, PES y PEM permiten: 1. Localizar la lesión (segmentos pre y posganglionar de la raíz dorsal, raíz ventral, plexos y nervios periféricos); 2. Establecer la gravedad y el pronóstico; 3. Seleccionar los candidatos a cirugía exploratoria reconstructiva; y 4. Determinar la eficacia del tratamiento o el curso natural del proceso (AU)

Efecto de la discontinuación del metilfenidato al comienzode la adolescencia sobre el trastorno por déficit de atenciónen la edad adulta / The effect of discontinuation of methylphenidate at adolescence onset on adult attention deficit hyperactivity disorder

Introducción. Se conoce bien el efecto positivo del metilfenidato sobre las manifestaciones del TDAH en niños y adultos. Sin embargo, se desconoce el efecto a largo plazo de discontinuar el metilfenidato al comienzo de la adolescencia. Objetivo. Determinar el efecto de discontinuar el metilfenidato al comienzo de la adolescencia sobre la inatención, hiperactividad, impulsividad y discapacidad funcional en la edad adulta. Pacientes y métodos. Se solicitó a los adultos, sus padres, esposos y amigos participantes del estudio, que llenaran el mismo cuestionario diagnóstico de TDAH que habían completado sus padres y maestros antes de comenzar (7 años de edad), durante (7,5 años) y al finalizar (12 años) el metilfenidato. A todos se les administró metilfenidato (0,1-0,5 mg/kg/día) desde los 7 hasta los 12 años de edad para tratar su TDAH. El grado de inatención, hiperactividad, impulsividad y discapacidad funcional se analizó estadísticamente por el método de muestras pareadas antes, durante y al final del tratamiento, y después de 15 años sin metilfenidato. Resultados. El metilfenidato administrado durante cinco años (7-12 años de edad) mejoró significativamente (p< 0,001) los valores promedio de inatención, hiperactividad, impulsividad y discapacidad funcional, comparado con los valores antes (7 años de edad) y después (27 años) del tratamiento. La discontinuación del metilfenidato durante 15 años (12-27 años de edad) deterioró significativamente (p< 0,001) los valores promedio de inatención y discapacidad funcional cuando los valores del adulto se compararon con los de la adolescencia . Conclusiones. Los resultados sugieren que el metilfenidato debería administrarse hasta la edad adulta para evitar el deterioro en la atención y discapacidad funcional encontrado en este estudio (AU)