First-episode schizophrenics show normal duration and topography of quasistationary EEG segments as compared to controls, during rest as well as during active tasks

In patients suffering from chronic schizophrenia, both altered temporospatial structure of the EEG and impaired activation during cognitive tasks have repeatedly been demonstrated. The present study evaluates whether similar abnormalities are present in drug-naive first-episode schizophrenics. The EEGs of 32 schizophrenic patients and of 52 healthy controls were recorded during a simple and a complicated motor task, a simple and a complicated auditory stimulus, and during resting periods between the tasks. The temporospatial characteristics were evaluated by adaptive segmentation of EEG, which decomposes an EEG into temporal segments of quasistationary activity. No differences in the temporal and topographic aspects of the EEGs were found between the first-episode schizophrenic patients and the controls, neither during the resting EEGs nor during active tasks. Moreover, the dynamic course of the EEGs, defined as the alternation between task-related changes of temporospatial patterns and the reappearance of resting patterns, was identical in patients and controls. The present findings suggest that while abnormal EEG power spectra seem a consistent finding in treated as well as in never-treated schizophrenics, altered temporospatial patterns and reduced task-related EEG changes are inconsistent signs.

Symptom dimensions in old-age schizophrenics. Relationship to neuropsychological and motor abnormalities

In most factor analytical studies of schizophrenic symptomatology, a three-factor solution was found. The aim of this study was to investigate symptomatological dimensions in old age and to clarify whether the dimensions correlate differently with neuropsychological and motor parameters. One hundred and thirty-one DSM-III-R chronic schizophrenics (mean age 68 years) were assessed using SANS, SAPS, a neuropsychological test battery and motor scales. Exploratory and confirmatory factor analyses yielded a model with three dimensions (negative, disorganized, paranoid), two of which (negative, disorganized) showed different correlations with neuropsychological and motor phenomena. Thus, three symptomatological dimensions could also be demonstrated in a chronic, old-age schizophrenic sample. The pathophysiological significance of the different correlations with neuropsychological and motor parameters should be clarified in neuroimaging and neuropathological studies.

Vestibular compensation in infants and children with congenital and acquired vestibular loss in both ears

In children with semicircular canal anomalies, vestibular compensation during their development and growth was studied. The damped rotation test elicited 'absence or poor per-rotatory nystagmus and absence of post-rotatory nystagmus in all cases. Development of gross motor and balance function was seriously delayed in each case during the first 2 or 3 years of life. Thereafter, during the pre-school age, all children could achieve most landmarks of motor development, such as head control, independent walking and running. However, balance functions at the age of entrance of the elementary school (6 years old) were variously impaired in each case. The better case could swim under water but the poor case could not maintain static balance with eyes closed. These motor skills due to vestibular compensation presumably depend on integration of the compensatory input from visual, somatosensory and proprioceptive senses, and the maturation of motor control systems in the cerebellum, basal ganglia and motor cortex.

[Syndrome of Ohtahara]

INTRODUCTION

A literature review using the term Ohtahara syndrome and early infantile epileptic encephalopathy revealed 51 cases.

DEVELOPMENT

The characteristics of these cases were: 1) early onset of seizures; 2) tonic seizures; 3) poor response to treatment; 4) mental retardation; 5) poor prognosis; 6) burst-suppression EEG pattern; 7) evolution to West syndrome, and 8) multiple causes. These characteristics are non specific. No cause was found in most cases. The onset of seizures was between 7 hours and 86 days of age. The most frequent brain imaging abnormality was diffuse atrophy. ACTH was effective in a few cases and hemispherectomy was successful in one case.

CONCLUSION

We believe that Ohtahara syndrome and early myoclonic encephalopathy are the same entity.

Neuropsychological functioning in depressed versus nondepressed participants with Alzheimer's disease

Differences in cognitive functioning between participants with Alzheimer's Disease (AD) reporting depressive symptomatology (AD-Dep; n = 37) and a control group of nondepressed participants with AD (AD-Con; n = 98) were investigated based on hypothesized impairments of attention/concentration, psychomotor speed, and simple motor speed. Groups did not differ in age, education, overall severity of dementia, auditory comprehension, or use of psychotropic medications. AD-Dep participants performed significantly more poorly than AD-Con participants on 3 of the 13 measures on which they were hypothesized to exhibit greater impairment (WAIS-R Block Design, WAIS-R Digit Symbol, and speeded motor programming); and there were trends toward poorer performance on four additional measures (WAIS-R Object Assembly, WAIS-R Picture Arrangement, WAIS-R Digit Span-backward, and letter fluency). There was only one significant effect for the 13 measures on which no group differences were hypothesized; the AD-Dep participants unexpectedly obtained better WMS-R Logical Memory delayed recall scores than the AD-Con participants. Finally, AD-Dep participants exhibited an unexpected pattern of greater right hand advantage on the Finger Tapping Test.

Neuropsychological subgroups of patients with Alzheimer's disease: an examination of the first 10 years of CERAD data

Neuropsychological CERAD data from 960 patients with Alzheimer's disease and 465 controls were subjected to separate yet identical classification procedures. Consistent with past research, three patient subgroups were reliably identified: Subgroup 1 (LAD; n = 312) was characterized by severe naming impairment yet borderline-normal figure-copying skills; Subgroup 2 (RAD; n = 247) displayed average naming ability but moderately-impaired copying performance; Subgroup 3 (GAD; n = 161) evinced profound anomia and constructional dyspraxia. LAD patients were older and less educated than those of the other subgroups. Control subgroups (n = 2) did not resemble the patient subgroups. Initial patterns of performance remained discernible across time for LAD and GAD, but were less consistent for RAD. Members from patient subgroups were present across disease stage.

Visuo-spatial and linguistic abilities in a twin with Williams syndrome

The present study reports a case of dizygotic twins, one boy with Williams syndrome (WS) and one typically developing girl, and compares their neuropsychological profiles. The goal of the present authors was to verify whether the child with WS displayed a cognitive profile which is unique to the syndrome. Several tests designed to assess visuo-perceptual, visuo-motor, linguistic and memory abilities were administered to both children when they were 10.9 years old. Compared to his sister, the boy with WS displayed a homogeneous developmental delay in both non-verbal and verbal abilities. He achieved a level of performance similar to his sister only in facial recognition, phonological word fluency and memory for phonologically similar words. Furthermore, despite the overall delayed performance of the boy, both the twins displayed a cognitive profile characterized by strength in lexical comprehension and relative weakness in visuo-motor abilities.

[Diagnosis of healthy and depressed patients based on their speech patterns]

Analysis of the speech signal allowed to propose methods for quantitative diagnosis of patients with psychogenic depression with overwhelming melancholy and anxiety, and the functional state of essentially healthy professional operators. The methods are based on evaluation of intonation, motor and ideational speech parameters. They were successfully demonstrated in a psychiatric clinic and during fulfillment of jobs by operators.

Depressed mood in multiple sclerosis: relationship to capacity-demanding memory and attentional functioning

Because it is theorized that depression results in reduced available attentional capacity that, in turn, can explain the impaired performance on capacity-demanding tasks in depressed individuals, the authors predicted that multiple sclerosis (MS) patients with depressed mood would have difficulty with these types of tasks. Twenty depressed mood MS participants were compared with 41 nondepressed mood MS participants and 8 nondepressed mood controls on 5 attentional capacity-demanding clinical memory and attentional tasks and 3 tasks with minimal capacity demands. Depressed mood MS patients performed significantly worse than both nondepressed mood groups on the 3 speeded capacity-demanding attentional measures but not on any of the tasks requiring few capacity demands, supporting the authors' predictions. The possibility that the impaired performance of depressed mood MS patients on speeded attentional tasks was mediated by reduced verbal working memory capacity, impaired deployment of executive strategies that access working memory capacity, or psychomotor slowing is explored.

'Putting your foot in it'! A window into clumsy behaviour

Intra-modal matching by 7-year-old children diagnosed as having hand-eye co-ordination problems (HECP) and a control group of children without such problems was tested using a target location and matching task. The 'foot-hand' task required the children to locate a target pin with the 'big-toe' (felt target) and match the located target position with the hand, without vision. There were four conditions: location via right foot-matching the located target with the right hand (RfRh) and left hand (RfLh) and location via left foot-matching the located target with the left hand (LfLh) and right hand (LfRh). Both groups demonstrated better performance in the intra- as compared to the inter-hemispheric conditions, suggesting that the corpus callosum is not yet fully mature at this age. The HECP children showed inferior performance to the control children in three of the four conditions, the conditions where the right hemisphere was involved and/or information had to be transported across the corpus callosum (RfLh; LfLh; LfRh). Two possible explanations of these findings are put forward and discussed: right hemisphere insufficiency with or without dysfunctional corpus callosum.

Early age of onset, brain morphological changes and non-consistent motor asymmetry in schizophrenic patients

Previous data suggest abnormalities in the consistence of motor dominance in schizophrenia (e.g. mixed-handedness, poor correlation between hand, eye and foot preferences and an increase of hand-eye crossed dominance). The aim of this work is to examine the clinical significance of hand-eye and hand-foot crossed dominance in a sample of 61 right-handed schizophrenic patients. The application of multivariate analysis revealed that 23 right-handed and non-right-eyed patients (crossed hand-eye dominant group) had a significant earlier clinical onset and smaller brain size, global and frontal area, than 38 right-handed and right-eyed schizophrenics (consistent hand-eye dominance group). These findings are discussed within the context of neurodevelopmental disorders.

[Neurophysiological examinations in Parkinson disease]

Electrodiagnostic examination is used relatively little for the assessment of central nervous system disorders. Nevertheless, it should provide useful information for the neurologists in their clinical evaluation of the patient. It could partly contribute to the correct diagnosis of the illness, its differential diagnosis with respect to diseases with smilar clinical presentation and, most of it all, to the identification of the pathophysiological abnormalities possibly responsible for the symptoms and signs characterizing the disease. Electrodiagnostic examination in Neurology enables us to design specific and customized methods for functional examination of mechanisms and circuits of the central nervous system, destined to enhance our understanding of pathophysiological mechanisms. This objective will be more readily accomplished from a common base of understanding and support between clinicians and electrodiagnostic specialists in which scientific curiosity and technical skills can complement each other effectively. In this article, we review some of the most relevant neurophysiological findings in patients with parkinsonian syndrome, with special focus on those that may contribute to the differential diagnosis between parkinsonisms.

Clinical evaluation of the driving ability in stroke patients

OBJECTIVES

Stroke often causes physical, cognitive and psychomotor dysfunction, which markedly decreases the driving ability of stroke patients. The aim of this study was to evaluate the driving ability of stroke patients using multidisciplinary clinical evaluation and driving-related laboratory tests.

MATERIALS AND METHODS

A neurologist evaluated the driving ability of 20 male stroke patients on the basis of his own clinical examination and the observations and measurements of a neurological multidisciplinary rehabilitation team. After that a traffic psychologist evaluated the patients' driving ability on the basis of the driving-related cognitive and psychomotor laboratory tests. The patients themselves also evaluated their driving ability, as did their spouses. All the evaluations were carried out independently using the same 10-point scale. The control group consisted of 20 healthy males, matched by age and driving experience, who went through the same laboratory test package as the patients did.

RESULTS

The stroke patients had more deficiencies in all tested driving related cognitive and psychomotor functions than the controls. The neurologist and the psychologist together evaluated 12 (60%) of the 20 stroke patients being unable to drive; 8 patients out of 11 with non-dominant hemisphere lesion and 4 in the dominant group. The patients themselves and their spouses had a clear tendency to overestimate driving ability compared to the estimates of the neurologist and the psychologist. The hit-rate of the evaluations of the neurologist and traffic psychologist (75%) was high.

CONCLUSION

Stroke patients form a risk group as drivers due to their decreased cognitive and psychomotor abilities, and driving ability should always be evaluated after stroke. The results suggest that multidisciplinary neurological teams are able to evaluate the driving ability of stroke patients reliably. A careful evaluation of driving ability without a driving test requires assessment of cognitive and psychomotor functions critical in driving, which is not feasible for physicians without the support of a multidisciplinary team and/or traffic-related laboratory tests.

Infantile encephalopathy associated with the MELAS A3243G mutation

MELAS syndrome is typically characterized by normal early development and childhood-onset recurrent neurologic deficits (stroke-like episodes), seizures, short stature, lactic acidosis, and ragged red fibers on muscle biopsy specimens. It is usually, but not invariably, associated with the A3243G point mutation in the mitochondrial DNA tRNALeu(UUR) gene. We report 3 unrelated children with the A3243G mutation who presented with severe psychomotor delay in early infancy. One patient's clinical picture was more consistent with Leigh syndrome, with apneic episodes, ataxia, and bilateral striatal lesions on brain magnetic resonance imaging (MRI). The second patient had generalized seizures refractory to treatment and bilateral occipital lesions on brain MRI. The third child had atypical retinal pigmentary changes, seizures, areflexia, and cerebral atrophy on brain MRI. All patients had several atypical features in addition to early onset: absence of an acute or focal neurologic deficit, variable serum and cerebrospinal fluid lactate levels, lack of ragged red fibers in muscle biopsy specimens. The proportion of mutant mtDNA in available tissues was relatively low (range, 5% to 51% in muscle; 4% to 39% in blood). These observations further extend the phenotypic expression of the A3243G "MELAS" mutation. Our findings confirm previous observations that there is poor correlation between abundance of mutant mtDNA in peripheral tissues and neurologic phenotype. This suggests that other factors contribute to the phenotypic expression of this mutation.

The Yale Children's Inventory--a screening tool for attention deficits and related disorders. Normative data for boys

Norwegian populated-based normative data on the Yale Children's Inventory (YCI) were provided for boys. All parents of boys aged 8 through 11 years in the county of Hammerfest received the YCI, and 77% responded. Mean scores on the YCI scales attention, activity, tractability, and fine motor were significantly lower in the Norwegian sample compared to the US normative data. Factor analysis of the 40 scale items yielded factors that corresponded generally well to the YCI scale constructs derived from US samples. We conclude that the scale constructs of the YCI seem to be transferable across these two cultures, but that restandardization is warranted. Further research is needed to establish cut-off values for clinical screening purposes. The Yale Children's Inventory has the potential to become a valuable screening tool for behavioral problems at school-age.

Catatonia as a psychomotor syndrome: a rating scale and extrapyramidal motor symptoms

BACKGROUND

Catatonia was first described by Kahlbaum as a psychomotor disease with motor, behavioral, and affective symptoms. In keeping with this concept, we developed a rating scale for catatonia (Northoff Catatonia Scale [NCS]) with three different categories of symptoms (i.e., motor, behavioral, affective). Furthermore, the question of the relationship among catatonic symptoms, extrapyramidal motor symptoms, and neuroleptics was addressed in the present study.

METHOD

34 acute catatonic patients and 68 age-, sex-, diagnosis-, and medication-matched psychiatric control subjects were investigated on days 0, 1, 3, 7, and 21 with the NCS, with other already validated catatonia rating scales by Rosebush, Bush (BFCRS), and Rogers (MRS), as well as with scales for hypokinetic (SEPS) and dyskinetic (AIMS) extrapyramidal motor features. Validity and reliability of the new scale, factor analysis, correlational analysis, and differences between catatonic patients and psychiatric control subjects were statistically calculated.

RESULTS

NCS showed high validity (i.e., significant positive correlations [p <0.0001] with the other scales, significant differences between catatonic and control subjects), high intra-and interrater reliabilities (r = 0.80-0.96), and high affective subscores. Factor analysis revealed four factors best characterized as affective, hypoactive, hyperactive, and behavioral. Catatonic scores in NCS correlated significantly with AIMS on day 0 and SEPS on days 7 and 21. There were no significant differences in catatonic (i.e., NCS, MRS, BFCRS) and extrapyramidal (i.e., AIMS, SEPS) scores between neuroleptically treated and untreated catatonic subjects.

CONCLUSIONS

The following conclusions were drawn: (1) the NCS has to be considered as a valid and reliable rating instrument for catatonia; (2) catatonia can be characterized by psychomotor symptoms encompassing motor, affective, and behavioral alterations; and (3) extrapyramidal hyperkinesias like dyskinesias are apparently closely related to catatonic symptoms which, in general, seem to be relatively independent of previous neuroleptic medication.

A model for the assessment and management of children with multiple disabilities

Children with multiple disabilities present complex management problems, both for their families and for the professionals involved in their care. For any one child, the list of functional and medical problems that need to be addressed is frequently reflected in an even longer list of involved professionals, leading to conflicting advice and problems in co-ordination of care. A hierarchical model for assessment and management is proposed, which highlights the interdependency of apparently different areas of functioning. The model aims to assist both parents and professionals in determining priorities, to improve interdisciplinary working, and to underpin staff training. Illustrative case studies indicate the importance of resolving issues in areas such as visual functioning, positioning and nutrition before integrated functions such as communication skills can be addressed successfully.

[Callosal dementia: behavioral disorders related to central and extrapontine myelinolysis]

We report the behavioral symptoms presented by a 57-year-old man as the first sign of a Marchiafava-Bignami syndrome and by a 44-year-old woman with centro and extrapontine myelinolysis. These observations define a clinical entity, that we named callosal dementia characterized by: 5) fronto-limbic signs with coarse interjections, repetitive and antisocial behavior, alternation of lack of incitation and agitation; 6) elements of a Balint syndrome (suggestive of a posterior callosal involvement), with a pseudo-hallucinated look and a gaze apraxia; 7) signs of callosal dysconnection and; signs of adjacent white matter involvement, with paucity of vocal and facial expression modulation. Early recognition of these features of callosal dementia may be very helpful for diagnosis of suspected myelinolysis, leading to a more careful research of clinical signs of callosal dysconnection and prompting neuroimaging with MRI. A rapid confirmation of the diagnosis may prevent progression to centro or extrapontine myelinolysis, that may sometimes still be lethal, by adequate supportive measures (slow correction of electrolytes imbalance, correction of deficiencies, total alcohol withdrawal).

Psychomotor performance and monoamine function in bipolar and unipolar affective disorders

BACKGROUND

Affective disorders are associated with prominent psychomotor abnormalities that may be related to changes in arousal or motivation due to altered catecholamine function.

METHODS

We investigated relationships between performance on psychomotor tests of motor speed (reaction time and tapping speed) and visual tracking (trail making and dot placement) and catecholamine system function including cerebrospinal fluid (CSF) or urinary concentrations of catecholamines or their metabolites. Subjects were medicine-free inpatients with unipolar depression or with manic, depressive, or mixed episodes of bipolar disorder, and healthy controls matched by gender and stratified by age.

RESULTS

Unipolar and bipolar depressed patients were impaired in motor speed, dexterity, and visual tracking, whereas manic and mixed patients did not differ from controls. Tapping speed correlated positively with CSF 3-methoxy-4-hydroxyphenylglycol in healthy controls and with CSF homovanillic acid in bipolar depressed subjects. Increased catecholamine function correlated with slowing in all other measures for patients with bipolar disorder. Relationships between catecholamines and psychomotor function were weaker in unipolar depressed subjects. Psychomotor function was related to severity of depression in bipolar, but not in unipolar, patients.

CONCLUSIONS

These data suggest that catecholamine systems are associated with increased arousal and psychomotor impairment in patients with bipolar disorder. Similar behavioral changes have different neurotransmitter relationships in unipolar disorder.

[Top of the basilar artery syndrome: clinico-radiological aspects of 25 patients]

INTRODUCTION, PATIENTS AND METHODS: We studied 25 patients, 16 women and 9 men (average age 64.8 years; SD 8.6; range from 36 to 79 years) admitted to our hospital with clinical findings compatible with obstruction at the level of the bifurcation of the basilar artery. The patients were selected on clinical and neuroradiological criteria.

RESULTS AND CONCLUSIONS

All patients included in the study had presented with two or more infarcts in the vertebro-basilar territory, related to pathology of the rostral region of the basilar artery. Diagnosis was confirmed on CT and MRI. Infarcts were found in the thalamus, brain-stem, cerebellum and parieto-occipital lobe. Infarct of the thalamus associated with another infarct in a different region was the most frequent lesion. The CT-MRI findings in the 25 cases were: 14 patients had unilateral thalamic infarcts associated with another infarct. There were 4 patients with bilateral thalamic infarcts and 5 with bilateral occipital infarcts. In 11 patients the occipital infarct was associated with another infarct at a different level, and 6 patients each had a cerebellar infarct together with a brain-stem infarct. In 12 patients the lesions were localized to three or more areas. The commonest clinical manifestations were: motor deficit (68%), abnormal eye movements (48%), cerebellar dysfunction (40%), alteration of the level of consciousness (32%), visual field defects (20%), pupil anomalies (16%). The risk factors most frequently associated were: arterial hypertension (64%), a history of cerebrovascular accident (28%), smoking (28%), diabetes mellitus (24%) and atrial fibrillation (20%). Mortality was 8%. Unlike the classical descriptions, motor deficit was the most frequent symptom in our series.

Neonatal type of nonketotic hyperglycinemia

Two infants with the neonatal type of nonketotic hyperglycinemia that had manifested as early neonatal consciousness disturbance are presented. Transient hyperammonemia had been detected in both initially. High levels of glycine in plasma and cerebrospinal fluid disturb the nervous system, causing variable manifestations of this disease. Both cases were complicated by intracranial hemorrhage, which has never before been reported. After treatment with sodium benzoate and dextromethorphan, some neurologic improvement was observed, although the glycine levels did not lower. Recent clinical trials are reviewed, and because of the unfavorable outcomes, the special need for prenatal diagnosis is highlighted.

Dexamethasone suppression test reversal in rapid transcranial magnetic stimulation-treated depression

OBJECTIVE

The aim of this paper is to report the effect of rapid transcranial magnetic stimulation (rTMS) on the mood and dexamethasone suppression test (DST) of a patient with major depressive disorder (DSM-IV).

CLINICAL PICTURE

A 36-year-old woman with a past history of prolactinoma and recurrent major depressive disorder presented with major depression on three separate occasions over a 3-month period. DST was positive on each occasion.

TREATMENT

During each episode, a course of rTMS was given. Courses varied from seven to 13 once-daily treatment sessions depending on clinical response. These treatment sessions were 20 trains of 10 Hz for 5 s at 100% of motor threshold.

OUTCOME

Remission was achieved, psychiatric rating scales improved and the DST status converted from positive to negative. There were no side effects.

CONCLUSION

DST status in major depressive disorder can be converted from positive to negative by rTMS. This so far unreported observation increases our knowledge of rTMS.

Microcephaly, colobomatous microphthalmia, short stature, and severe psychomotor retardation in two male cousins: a new MCA/MR syndrome?

We report on 2 male cousins with minor facial anomalies, microcephaly, colobomatous microphthalmia, psychomotor retardation, short stature, and skeletal malformations. The children belong to a highly inbred family. We conclude that these patients have a previously undescribed autosomal-recessive syndrome.

Testing a motor performance series and a kinematic motion analysis as measures of performance in high-functioning stroke patients: reliability, validity, and responsiveness to therapeutic intervention

OBJECTIVE

To assess measurement properties of motor performance tests when used with high-functioning stroke patients.

DESIGN

Test-retest reliability study with an interval of 2 days; responsiveness study with assessment before and after training; validity study assessing the tests' ability to discriminate between the high-functioning stroke patients and healthy subjects.

SETTING

Referral center for neurorehabilitation.

PARTICIPANTS

Twenty-nine high motor-functioning stroke patients and 20 healthy control subjects.

INTERVENTION

Two special training sessions per day on 5 consecutive days, plus regular therapy.

OUTCOME MEASURES

Scores on the motor performance series, a two-dimensional tracking test, and a kinematic task analysis.

RESULTS

All tests (except the bimanual test) were able to document performance deficits with these patients and showed a moderately high to high test-retest reliability without systematic trend from test to retest (intraclass correlation coefficients for main variables, .61 to .89). The kinematic task especially demonstrated changes after training (standardized response means for timing variables, .53 to .66). A subset of variables indicated a modifying effect of limb side, age, and gender.

CONCLUSION

All tests (except the bimanual test) can be used for both cross-sectional and follow-up group studies with high-functioning stroke patients. Measurement properties and the lack of comprehensive normative data limit their use with individual patients.

The Smith-Magenis syndrome: a new case with infant spasms

The Smith-Magenis syndrome (SMS) is characterized by congenital anomalies, mental retardation and the interstitial deletion of the 17p. 11.2 chromosome. The subjects affected by this syndrome show cranio-facial dysmorphias, brachycephalia, skeletal, ocular, cardiac, genitourinary and otolaryngological anomalies. The central nervous system is affected and this may be shown by psychomotor retardation, intellective deficit, electroencephalographic alterations (reduced/missing REM phase); the neuroradiological tests detect megacisterna magna, cerebellar hypoplasia, cortical dysplasia, ventricular asymmetry. Behavioural troubles are frequent and, among them, self-aggressive conducts (tearing out the nails). The syndrome is associated with the interstitial deletion of the 17p. 11.2 chromosome. The diagnosis can be made in the pre-natal period and a mosaic situation is possible. Even though the cases of SMS reported in the literature allow defining a characteristic phenotype, studies have been carried out to quantify the deletion of the chromosome 17 in order to identify the chromosomic tract which is responsible for the phenotypical induction. The deletion can either appear de novo or come from one of the parents. In addition, these subjects can show peripheral neuropathy, missing or reduced deep tendon reflexes and (rarely) epileptic crises. However, by reviewing the literature, no descriptions of patients affected by infant spasms are pointed out. This report refers to a new case of Smith-Magenis syndrome in a nine-month-old girl with spasms in extension.