Reappraisal of interictal electroencephalograms in infantile spasms

To delineate interictal electroencephalographic (EEG) features before treatment of patients with clinically defined infantile spasms, EEGs of 82 infants having tonic spasms in clusters were analyzed by type of paroxysmal abnormalities, continuity, interhemispheric synchrony, topography, and wave component of hypsarrhythmia during wakefulness and sleep. Hypsarrhythmia occurred less frequently in wakefulness than in non-rapid eye movement (NREM) sleep at any age, least frequently in wakefulness after 1 year of age, and disappeared in rapid eye movement (REM) sleep at any age. The continuity of hypsarrhythmia changed with states, but did not change with age, and was greatest in wakefulness and stage 1 and decreased in stage 2-3. Interhemispheric synchrony increased with increasing age but decreased with advancing sleep stage. The term modified hypsarrhythmia should be discarded, and unusual features, if present, should be specified.

[A study on ACTH dosage for treatment of West syndrome]

We conducted a retrospective study of 50 patients with West syndrome who had been treated with ACTH. The patients were classified into two groups; group I, receiving standard dose of ACTH (0.025 mg/kg/day); and group II, receiving low dose of ACTH (0.015 mg/kg/day). The short-term effect of treatment was evaluated. Each group was further divided into two subgroups; cryptogenic (I-C, II-C) and symptomatic (I-S, II-S). There was no significant difference in the control rate of clinical seizures, between the two dosage groups of cryptogenic etiology. In the symptomatic cases, a greater effectiveness was achieved in group II-S than I-S. None of the patients with cryptogenic etiology experienced any relapse of infantile spasms. Patients with symptomatic etiology had a higher incidence of relapse. The rate of clinical and EEG seizure control was lower, and the incidence of side effects was higher in group I-S patients. The poor short-term effect of treatment in group I-S patients may be due to a higher incidence of prenatal etiology.

[Atypical early infantile epileptic encephalopathy with suppression-burst]

We report an 8-month-old infant with tonic spasms that started at the age of 38 days and occurred in clusters. He had no myoclonic seizures, or erratic myoclonus. Repeated simultaneous video-EEG monitoring revealed abrupt flexion of the neck and extremities associated with high voltage slow waves preceded by multiple spikes and/or sharps, which resembled spasms seen in West syndrome. Interictal EEGs, before and after the onset of epilepsy, showed suppression-burst. The bursts consisted of irregular high voltage slow waves mixed with poorly developed spike before the onset of epilepsy. On the other hand, duration of suppression phase ranged from 1 to 27 seconds, and burst-burst interval from 2 to 30 seconds after the onset of epilepsy. He was considered as having an atypical early infantile epileptic encephalopathy with suppression burst.

Simultaneous EEG-VTR and transverse topographical analyses of absence seizures in children. Some prognostic implications

The clinical symptoms and electroencephalographic (EEG) features of typical absence seizures, including transverse topographical analysis (TTA), were studied retrospectively using a simultaneous EEG-VTR system in 36 children aged between 3 and 17 years. Complex absences were more common than simple, and oral automatisms were the most frequent complex symptoms. Occurrence of complex symptoms was directly proportional to the length of seizures. There was no association between lateral TTA type and simple absences. Prognosis was favorable in patients with long seizure duration (P < 0.01), bilaterally synchronous monomorphic spike-waves throughout the seizure discharges (BSMTSD) (P < 0.005) and lateral TTA type (P < 0.05). Two different mechanisms of origin for BSMTSD/non-BSMTSD and lateral/non-lateral TTA types are probably responsible for the difference in prognosis. Favorable prognosis in patients with long seizures is discussed in relation to the duration of the illness. EEGs with BSMTSD and lateral TTA type may indicate a favorable prognosis in children with absence seizures.

Benign epilepsy of children with complex partial seizures following febrile convulsions

Among the partial epilepsies with complex partial seizures (CPS) following febrile convulsions (FC), there is an idiopathic epilepsy with extremely benign outcome, characterized by: 1) no past history suggesting brain insult, no underlying brain lesions, no neurological abnormalities, no mental retardation; 2) a high incidence of a positive family history of FC or benign epilepsy; 3) no past history of prolonged febrile convulsions; 4) EEG spike foci other than anterior temporal ones; 5) CPS easily controlled with full recovery.

A histochemical and immunohistochemical study of extra-ocular sebaceous carcinoma

A histochemical and immunohistochemical study of five cases of extra-ocular sebaceous carcinoma was performed using formalin-fixed and paraffin-embedded tissue specimens. Histochemically, the clear cells of sebaceous carcinomas were negative with periodic acid-Schiff and alcian blue staining. Immunohistochemically, the tumour cells of sebaceous carcinomas showed positive reactions for epithelial membrane antigen, human milk fat globules subclass 1, human milk fat globules subclass 2 and Leu M1, but did not express carcinoembryonic antigen, breast carcinoma associated antigen, S-100 protein, gross cystic disease fluid protein-15 or Dako M1. These histochemical and immunohistochemical findings were compared with those of other skin cancers which must be distinguished histopathologically from sebaceous carcinoma. We conclude that sebaceous carcinoma can be distinguished from eccrine porocarcinoma, malignant clear cell hidradenoma, extramammary Paget's disease, malignant trichilemmoma, squamous cell carcinoma and basal cell carcinoma by histochemical and immunohistochemical techniques using formalin-fixed and paraffin-embedded tissue specimens.

Keratin specificity analyses of eight anti-keratin monoclonal antibodies, and their immunostaining patterns in normal skin using formalin-fixed and paraffin-embedded tissue specimens

Keratin specificity analyses of eight anti-keratin antibodies (34 beta B4 (K1), 35 beta H11 (K8), Ks 13.1 (K13), Ks 19.1 (K19), PKK1, LP34 (CK1), KL1 and AE1) using keratin protein derived from normal thigh epidermis, normal parotid gland and a human squamous cell carcinoma cell line (HSC-5) were performed, and compared with those described in the data sheets. The reactivities of LP34, KL1 and PKK1 were markedly different from those mentioned in the data sheets. The immunostaining pattern of these antibodies in normal skin using formalin-fixed and paraffin-embedded tissue specimens was also examined. The staining patterns of suprabasal keratinocytes (K1, K13, CK1 and KL1 positive), basal cells of the epidermis (PKK1 and AE1 positive), inner cells of the ducts (K8, K13, CK1, KL1 and AE1 positive) and secretory cells of sweat glands (K8, K19, PKK1, KL1 and AE1 positive), mature cells (K8 and KL1 positive) and peripheral cells (CK1, KL1 and AE1 positive) of sebaceous glands and outer root sheaths (PKK1, CK1, KL1 and AE1 positive) were specific. Thus, we conclude that the differentiation of epidermis and skin appendages is possible by immunostaining with these eight anti-keratin antibodies using formalin-fixed and paraffin-embedded tissue specimens with proper protease pretreatment.

Electrographic seizures in preterm and full-term neonates: clinical correlates, associated brain lesions, and risk for neurologic sequelae

Electrographically confirmed seizures in preterm and term neonates were compared with respect to clinical correlates, incidence, associated brain lesions, and risk for neurologic sequelae. Over a 4-year period, 92 neonates from a neonatal intensive care unit population of 4020 admissions at a large obstetric hospital with 40,845 livebirths had electrographically confirmed seizures. Sixty-two neonates were preterm and 30 were full-term for gestational age. Chi-square calculations were used to compare the two groups. While the incidence of seizures for all neonates admitted to a neonatal intensive care unit was 2.3%, outborn neonates were more likely to have seizures than inborn neonates. Preterm neonates of < or = 30 weeks gestational age had a seizure frequency of 3.9%, which was significantly higher than that of older preterm neonates and full-term neonates. Clinical criteria contemporaneous with electrographic seizures were noted in only 28 (45%) of 62 preterm, and 16 (53%) of 30 full-term neonates. Subtle seizures coincident with electrographically confirmed seizures were the most predominant clinical type for both term and preterm neonates (71% and 68%, respectively). The distribution of clonic, myoclonic, and tonic seizures was also similar for both groups. Autonomic signs coincident with electrographically confirmed seizures (ie, blood pressure, heart rate, oxygenation, respiration changes) were more frequently observed in preterm than full-term neonates with subtle seizures; 7 (37%) of 19 compared with 1 (6%) of 16. Electrical seizures without clinical correlates were noted more frequently than electroclinical seizures for both populations.(ABSTRACT TRUNCATED AT 250 WORDS)

[A steroid-effective case with "prolonged" cerebellar ataxia]

We reported a girl with "prolonged" cerebellar ataxia for whom steroid was effective. At the age of 9 months, she developed gait disturbance, tremor and abnormal eye movements following exanthema subitum. Her symptoms were prolonged for more than 4 months and she was admitted to our hospital. The symptoms were successfully suppressed with repeated ACTH treatment but recurred in a few weeks after cessation of the therapy. Steroid was also effective but reduction of the dosage resulted in worsening of symptoms. Immunological mechanism was suspected for her disorder because of her response to steroid and ACTH.

Organ culture of psoriatic skin: effect of TGF-alpha and TGF-beta on epidermal structure in vitro

Normal skin and uninvolved and involved psoriatic skin specimens were maintained in vitro in organ culture. The 3-4 mm punch-biopsied skin specimens were put freely into the culture medium with or without fetal calf serum, under an atmosphere of 95% O2 plus 5% CO2, and rotated at 60 rpm at 37 degrees C. In the serum-free culture medium (vitamin A-free) granular layers appeared in the involved psoriatic epidermis in culture. Addition of TGF-alpha caused normal skin and uninvolved and involved psoriatic skin specimens to become acanthotic and to degenerate easily almost to the full thickness of the epidermal layer in proportion to increasing concentrations of TGF-alpha as well as with the duration of the culture, but without disappearance of their granular layers. TGF-beta caused the normal skin and uninvolved psoriatic skin specimens to become thinned without disappearance of granular layers, but caused the involved psoriatic skin specimens to be thinned without appearance of granular layers in serum-containing medium or with their disappearance in the serum-free medium. TGF-beta also antagonized the acanthotic and degenerative effect of TGF-alpha. The results suggest that TGF-alpha and TGF-beta may partially be related to the induction of psoriatic epidermal lesions.

Organ culture of human hair follicles derived from different areas of the body

Whole human hair follicles derived from the scalp, chin, axilla, and pubis were organ cultured. The hair follicles were dissected from excised normal skin pieces and placed in 1.0 ml of incubation medium in a closed 5 ml glass tube under an atmosphere of air + 5% CO2. The tube was rolled at 15 rpm and 36 degrees C. The hair follicles from each area of the body grew linearly for about 6 days, both in serum-plus and serum-free media with or without fibroblast growth factor (FGF). The growth rates were slightly slower in serum-free media than in serum-plus media. No significant differences in the growth rates of hair follicles in organ culture were seen in different areas of the body. FGF did not affect the growth rate or the culture term of the hair follicles in vitro. This is the first report of human hair follicles derived from chin, axilla, and pubis growing well for about a week in organ culture.

Benign familial neonatal convulsions: generalized epilepsy?

A 3-year-old girl is presented with benign familial neonatal convulsions. She had seizures during the neonatal period and at age 3 months. Seizure manifestations and ictal electroencephalography indicated that she had not experienced generalized seizures but partial seizures, although international classifications of epilepsy define benign familial neonatal convulsions as generalized epilepsy.

Organ culture of psoriatic lesions: appearance of granular layers in vitamin A-free culture media

Some morphologic changes of the epidermis of psoriatic skin were observed in organ culture in the presence of absence of vitamin A. Normal and uninvolved and involved psoriatic skin areas, punch biopsied in 3-4-mm diameter specimens, were put in serum-free medium containing no vitamin A with or without delipidized fetal calf serum (FCS) and rotation cultured at 60 rpm under an atmosphere consisting of 95% O2 + 5% CO2. The involved psoriatic skin specimens showed well-developed granular layers after 1 d of culture. The values of labeling indices of 3H-thymidine (3H-TdR) incorporated into the epidermal layers of the cultured specimens of the psoriatic skin were nearly constant during culture for as long as 8 d, although the viable epidermal layer gradually became thinner. Addition of tretinoin to the culture caused uninvolved and involved psoriatic skin specimens to become parakeratotic at concentrations as low as about 2.0 x 10(-6) M and 4.0 x 10(-8) M, respectively, suggesting that the involved psoriatic epidermis is much more sensitive, in terms of keratinization, than uninvolved epidermis to the effect of tretinoin.

Usefulness of PET scan in a child with mesial frontal lobe epilepsy

Positron emission tomography (PET) scan with 18F-fluorodeoxyglucose (18F-FDG) was performed in a 14-year-old boy who had seizures suspected to have originated in mesial frontal lobe. The seizures occurred in clusters and were characterised by a change in the facial expression at seizure onset and complex motor manifestations consisting of kicking, swaying and screaming. Ictal EEG showed rhythmic alpha-waves in the left frontal area association with the ictus. Cerebral CT, MRI and SPECT revealed nothing of significance, but the PET brain scans showed frontal and parietal hypometabolism, which was most prominent in the left mesial frontal lobe. The present case suggests that FDG-PET scanning may be useful for the diagnosis of the mesial frontal epilepsy, when other imaging studies fail to show abnormalities.

Relapse of herpes simplex encephalitis in children

The polymerase chain reaction method was used to diagnose herpes simplex encephalitis in children. Initial samples of cerebrospinal fluid from 15 patients with herpes simplex encephalitis were all positive for the herpes simplex virus DNA by polymerase chain reaction assay. In terms of early diagnosis, polymerase chain reaction assay became positive significantly earlier than the detection of intrathecally produced anti-herpes simplex virus antibody using the enzyme-linked immunosorbent assay (4.4 vs 8.9 days after onset; P less than .01). Serial examinations showed that the presence of virus DNA in cerebrospinal fluid continued for 3 to 18 days after the neurologic onset (mean 10.1 days). Four of the 15 patients had a relapse of encephalitis after completing acyclovir therapy. The mean duration of initial acyclovir therapy in the recurrent group was significantly shorter than that in the nonrecurrent group. In recurring cases, herpes simplex virus DNA reappeared temporarily in the cerebrospinal fluid of two patients. These results show that polymerase chain reaction assay is a useful diagnostic tool for the early and noninvasive diagnosis of herpes simplex encephalitis in children. Results also suggest that a comparatively short duration of acyclovir therapy may be related to a relapse of herpes simplex encephalitis in some children.

Occurrence of differentiated keratin peptide(K1) in cultured human squamous cell carcinomas

To date, the largest keratin peptide(K1, 68 KD) has been absent in cultured human squamous cell carcinomas. Using a low salt aqueous solution, not containing high salt and Triton X-100, as a washing buffer for keratin extraction, followed by two dimensional polyacrylamide gel electrophoresis, immunological techniques and Northern blot analysis, we demonstrated K1 peptide in two kinds of cultured human squamous cell carcinomas. Until now keratin extraction has been done using high salt/Triton X-100 solution during which K1 peptide may be removed together developed an affinity with the buffer. Many investigators may have therefore overlooked K1.