Upstream Stimulating Factor 1 (USF-1) Gene Polymorphisms and the Risk, Symptoms, and Outcome of Pediatric Ischemic Stroke

BACKGROUND

Pediatric ischemic stroke is an important cause of morbidity and mortality. As previous studies of children after stroke showed, dyslipidemias were very common in Polish and other European populations. Thus, looking for genetic factors predisposing to pediatric stroke, its symptoms, and outcome, we have analyzed 2 polymorphisms of the upstream stimulating factor 1 (USF-1) gene.

MATERIALS AND METHODS

The study group consisted of 82 children with stroke, 156 parents, and 146 controls. We used 2 alternative methods: the case-control model and the analysis of families using the transmission disequilibrium test. The 2 polymorphisms, rs2516839 and rs3737787, were genotyped using the TaqMan Pre-Designed SNP Genotyping Assay. The Statistica 10.0 software was used in all statistical analyses.

RESULTS

We did not observe any statistical differences in genotype and allele frequencies between patients and controls. There were also no significant differences in the transmission of alleles from the parents to the affected children. However, we have observed that the TT genotype of the rs2516839 polymorphism was more common in patients with epilepsy and dysarthria, whereas the TT genotype of the rs3737787 polymorphism was more frequent in the group of patients with a decrease in intellectual functioning.

CONCLUSIONS

Our study did not show any associations between the 2 analyzed polymorphisms of the USF-1 gene and pediatric ischemic stroke. However, we have observed an influence of specific genotypes on the outcome of stroke, including epilepsy, dysarthria, and a decrease in intellectual functioning.

Associations between MDR1 C3435T polymorphism and drug-resistant epilepsy in the Polish population

Epilepsy is a common neurological disorder. About one-third of epileptic patients demonstrate multidrug resistance (MDR) phenotype and develop drug-resistant epilepsy (DRE). Single nucleotide polymorphism (SNP) C3435T (rs1045642), identified in the MDR1 gene, is associated with an increased intestinal expression of P-glycoprotein (P-gp) which affects the levels of anti-epileptic drugs in plasma. The reported study was designed to explore associations between the MDR1-C3435T gene SNP and the risk of DRE in the Polish population. The C3435T polymorphism of MDR1 gene was investigated by the PCR-RFLP technique in 74 patients with DRE and 70 age- and sex-matched non-DRE controls. Blood samples were obtained from patients with drug-resistant epilepsy, treated at the Department of Neurological Surgery, Medical University in Warsaw between the years 2011 and 2012. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated for each genotype and allele. Genotype distribution of C3435T polymorphism of MDR1 gene was compared between the DRE patients and controls with significant differences (p < 0.05) between the two investigated groups. A possible association was observed between DRE and the presence of 3435C allele. The 3435C allele was found in 69 % of DRE cases and in 48 % of the used controls. The variant 3435T allele of MDR1 decreased the risk of drug-resistant epilepsy [odds ratio (OR) 0.41; 95 % confidence interval (CI) 0.26-0.67]. The results indicate that the C3435T polymorphism of MDR1 gene may be associated with the incidence of DRE observed in the Polish population.

[The differential diagnosis of asymmetry in infants]

Asymmetry in infants is a clinical condition in which abnormal body shape, posture or mobility is observed. It is characterized by diverse etiology, localization and severity. The most frequently noted kind is idiopathic asymmetry. Symptomatic asymmetry is less frequent and a variety of structural or systemic disorders underlie this disease. The dynamics of child development in the first year of life makes it necessary for clinicians to give an early diagnosis of asymmetry, which has a significant impact on the expected course of its development and intervention strategies. The aim of the study is to present the definitions, classification and differential diagnosis of asymmetry in infants.

The effect of seizures on functional status of people with spastic forms of cerebral palsy

Background.Cerebral palsy (CP) is the most common childhood motor impairment. Epilepsy affects approximately one third of patients with CP. It is characterized by earlier disclosure, it is more severe and shows greater resistance than that of the general epilepsy treatment, associated with necessity for polytherapy. Its presence can result in gradual loss of function, loss of posture in non-ambulant individuals with severe disabilities and cognitive impairment risk, behavioural disorders and reducing probability of walking.

Aim.The aim of the study was to evaluate the functioning of people with CP with and without epilepsy.

Material and Methods.The study included 210 patients with a diagnosis of CP, aged 0–18 years. The study was conducted among the patients using the physiotherapy services in centres in southern Poland. The study used the Paediatric Evaluation of Disability Inventory (PEDI) and the classification systems: GMFCS, MACS, and CFCS.

Results.There were significant differences with regards to social functioning (53.7/67.4; W = 179, p = 0.006) and support in the social functioning (65.4/89.9; W = 185.5, p = 0.007) in patients with diplegia. However, mobility (19.55/29.00; W = 392, p = 0.018) and the social functioning (36.95/44.1; W = 418.5, p = 0.042) were lower in epileptic patients with tetraplegia. In patients with hemiplegia, there were no significant differences, although each domain with epilepsy subgroup had a lower rating than the subgroup without epilepsy.

Conclusion.The presence of epilepsy is associated with lower levels of social function in patients with cerebral palsy; particularly, with regard to mobility and selfservice.

Assessment of epilepsy impact on the level of social functioning of people with CP (diplegia, tetraplegia, hemi-plegia) is difficult because ambiguous relationship with mental retardation. The assessment should be undertaken separately for each group of spastic CP.

Fibrinogen alpha and beta gene polymorphisms in pediatric stroke--case-control and family based study

BACKGROUND/PURPOSE

Data on the role of the -455G > A polymorphism of the gene encoding β fibrinogen subunit (FGB) and the Thr312Ala polymorphism of the gene for the α fibrinogen subunit (FGA) in childhood ischemic stroke are insufficient. Therefore the aim of the study was to evaluate a possible association between these two polymorphisms and arterial ischemic stroke.

METHODS

The study group consisted of 85 children after ischemic stroke, 146 of their parents and 159 controls. Both polymorphisms were genotyped using the restriction fragment length polymorphism method. Two study designs were used: a case-control model and a family-based transmission-disequilibrium test. Statistica 7.1 and EpiInfo 6 softwares were used in all analyses.

RESULTS

In the TDT test, a tendency to a higher transmission of the 312Ala allele of the FGA gene and the -455A allele of the FGB gene was observed, however, it was statistically non-significant. The frequencies of alleles and genotypes of both FGA and FGB genes polymorphisms did not differentiate children from both groups also in the case-control model. Additive or synergistic effects between FGA and FGB genes polymorphisms were not observed.

CONCLUSION

An analysis of the results obtained in this study and a critical review of previously published data indicate that examined gene polymorphisms are not related to ischemic stroke in children.

Methylenetetrahydrofolate reductase gene A1298C polymorphism in pediatric stroke--case-control and family-based study

Moderate hyperhomocysteinemia is one of the risk factors of pediatric stroke. Methylenetetrahydrofolate reductase (MTHFR) is an important enzyme, which regulates homocysteine metabolism, and some polymorphisms of gene encoding this enzyme are associated with a decreased activity of the enzyme. The aim of the study was to assess an association between the A1298C polymorphism and pediatric stroke. We also evaluated a possible synergistic effect of A1298C and C677T polymorphisms of this gene. The study group consisted of 88 children after ischemic stroke, 142 of their parents and 111 controls. The A1298C polymorphism was genotyped using the restriction fragment length polymorphism method. We used 2 study designs: a case-control model and a family-based association test. The Statistica 7.1 and EpiInfo 6 softwares were used in all analyses. We did not observe any statistically significant differences either in the transmission of the A allele in the family-based test or in the frequency of the A allele in the patients group compared with the controls. We also did not notice any significant additive or synergistic effects between the A1298C and C677T polymorphisms. An analysis of the results obtained in this study and a critical review of previously published studies indicate that the A1298C polymorphism of the MTHFR gene is not related to ischemic stroke in children.

Impact of the -174G/C interleukin-6 (IL-6) gene polymorphism on the risk of paediatric ischemic stroke, its symptoms and outcome

OBJECTIVES

Ischemic stroke remains one of the top ten causes of death in children. There is evidence for the role of pro-inflammatory cytokines, such as IL-6 and the -174G>C promoter polymorphism of the IL-6 gene, in the occurrence and outcome of stroke in adults. The aim of the present study was to determine a possible association between the -174G>C IL-6 polymorphism and occurrence of paediatric stroke, its symptoms and outcome.

MATERIAL AND METHODS

The study group consisted of 340 individuals: 80 stroke children, 122 parents of patients and 138 controls. The -174G/C polymorphism was genotyped using the RFLP method. For the analysis of the relationship between genotypes and stroke we used two alternative methods: the case-control model and the transmission test for linkage disequilibrium using data from families.

RESULTS

We observed no differences in the transmission of alleles from parents to children. We also did not find any statistical differences in distribution of genotypes and alleles between patients and controls. However, the analysis showed that post-stroke epilepsy was genotype-dependent. All children with epilepsy were G allele carriers and none of them was a CC homozygote whereas about 25% of children without epilepsy had the CC genotype.

CONCLUSIONS

Our study did not show any associations between the IL-6 -174 G>C polymorphism and the occurrence of stroke but we observed a relation between post-stroke epilepsy and the G allele carrier-state.

The plasminogen activator inhibitor-1 gene polymorphism in determining the risk of pediatric ischemic stroke--case control and family-based study

Pediatric ischemic stroke, though relatively rare, remains an important medical problem since 20-40% of patients have recurrent strokes and 50-85% of them suffer from long-term neurological deficits. Approximately 20-50% of the affected children have prothrombotic disorders, therefore upon looking for possible genetic causes of the disease we focused on the plasminogen activator inhibitor (PAI-1)--the major inhibitor of fibrinolysis. The aim of the present study was to investigate a possible association between the -675_-674insG PAI-1 gene polymorphism and pediatric ischemic stroke. The study population consisted of 343 individuals: 70 children with ischemic stroke, 140 their biological parents and 133 control children. The PAI-1 gene polymorphism was genotyped using the restriction fragment length polymorphism and was visualized by AgNO₃ staining. The transmission/disequilibrium test showed exactly the same transmission of alleles from parents to the affected children (37:37). The case-control model also did not reveal any statistical significance in alleles and genotypes distribution between patients and control children. The obtained results suggest that the 4 G/5 G polymorphism of the PAI-I gene is not a risk factor of ischemic stroke in Polish children.

[Hypoxic-ischemic encephalopathy as a special form of head injury complication in battered child syndrome]

The battered child syndrome is increasingly more often described in literature. Head injuries experienced by battered children are the main cause of deaths and neurological complications. A special form of damage inflicted in battered children is vessel background brain injury. The objective of the article was to characterize central nervous system injuries and their results in children who were victims of physical violence. Medical records of three patients hospitalized in Department of Neurology of the Polish Mother Health Center Institute in Lodz, in whom the battered child syndrome had been diagnosed, were analyzed. The authors discussed three cases of children with central nervous system injuries caused by physical violence. All the children were treated pharmacologically, placed on parenteral nutrition and rehabilitated. Among typical central nervous system injuries caused by head trauma, particular attention of the authors was focused on hypoxic-ischemic encephalopathy, a complication of a still unclear etiology that occurred in two cases. Battered children are usually treated in surgical departments and the causes of injuries are not always correctly diagnosed. Brain damage is the reason for permanent neurological consequences in children who experienced physical violence. In medico-legal practice, it is essential to describe precisely all the visible injuries (bruises, abrasions, wounds) especially during the initial medical examination.

[Epilepsy and mental retardation. The school's functioning in children with epilepsy]

BACKGROUND

In 2009 Polish Society of Epileptology have conducted the survey of public opinion over the situation of the children suffering from epilepsy. Intellectual disability is a major indication for children with epilepsy to attend to special schools and learn in integrative classes. Neurodevelopmental disorders including intellectual disability, is associated with 5% of new-diagnosed cases of epilepsies and with 18% of all epilepsy cases in children.

METHODS AND RESULTS

Hereby author describes mechanisms that leads to cognitive impairments in the course of epilepsy, including influence of temporal and extratemporal seizures as well as school problems of children with epilepsy. From 5% to 50% of children suffering from epilepsy have problems in school and 30% require attending to special schools. School achievements of children suffering with epilepsy and normal IQ is similar to those without this disorder with IQ ranging from 71 to 85. The influence of biological factors (age of onset, number of seizures or antiepileptic drugs therapy) on school achievements is smaller than described by earlier authors. Nevertheless, even nowadays retardation in acquisition of reading, writing and calculating capacities can be noticed in 60% of children with epilepsy. Described risk can be increased by coexistence of attention deficit and emotional problems. The impairment decreases with age.

CONCLUSIONS

Children suffering from epilepsy require constant monitoring of school achievements and psychostimulation even in cases with normal IQ.

The T allele of the 677C>T polymorphism of methylenetetrahydrofolate reductase gene is associated with an increased risk of ischemic stroke in Polish children

Ischemic stroke is a very rare and multifactorial disease in children. The aim of the study was to analyze the relationship between the methylenetetrahydrofolate reductase (MTHFR) 677C>T polymorphism and stroke in Polish children and to observe whether there is any significant transmission of MTHFR alleles from heterozygous parents to their affected offspring. We analyzed 64 patients with stroke, 122 parents, and 59 healthy children. The MTHFR polymorphism was genotyped using polymerase chain reaction (PCR)-restriction fragment length polymorphism. The T allele was more frequent in the stroke group (38%) than in controls (25%, P = .029, odds ratio = 1.84). We also found higher frequency of T allele in male patients compared to male controls (46% vs. 25%, P = .009, odds ratio = 2.53). The number of T allele carriers was again more prevalent in boys with stroke (71%) than in healthy boys (45%, P = .023, odds ratio = 3.09). The T allele was significantly transmitted in male patients (P < .019). We conclude that the MTHFR 677C>T polymorphism may be considered as a genetic risk factor of childhood stroke, especially in boys.

Lack of obvious influence of PLLA nanofibers on the gene expression of BMP-2 and VEGF during growth and differentiation of human mesenchymal stem cells

Growth factors like bone morphogenetic protein 2 (BMP-2) and vascular endothelial growth factor (VEGF) play an important role in bone remodeling and fracture repair. Therefore, with respect to tissue engineering, an artificial graft should have no negative impact on the expression of these factors. In this context, the aim of this study was to analyze the impact of poly(L-lactic acid) (PLLA) nanofibers on VEGF and BMP-2 gene expression during the time course of human mesenchymal stem cell (hMSC) differentiation towards osteoblasts. PLLA matrices were seeded with hMSCs and cultivated over a period of 22 days under growth and osteoinductive conditions, and analyzed during the course of culture, with respect to gene expression of VEGF and BMP-2. Furthermore, BMP-2–enwoven PLLA nanofibers were used in order to elucidate whether initial down-regulation of growth factor expression could be compensated. Although there was a great interpatient variability with respect to the expression of VEGF and BMP-2, PLLA nanofibers tend to result in a down-regulation in BMP-2 expression during the early phase of cultivation. This effect was diminished in the case of VEGF gene expression. The initial down-regulation was overcome when BMP-2 was directly incorporated into the PLLA nanofibers by electrospinning. Furthermore, the incorporation of BMP-2 into the PLLA nanofibers resulted in an increase in VEGF gene expression. Summarized, the results indicate that the PLLA nanofibers have little effect on growth factor production. An enhancement in gene expression of BMP-2 and VEGF can be achieved by an incorporation of BMP-2 into the PLLA nanofibers.

[Lentigines as an important of Peutz-Jeghersa Syndrome]

Peutz-Jeghers syndrome is an autosomal dominant inherited disorder which is characterized by mucocutaneus melanocytic macules and intestinal hamartomatous polypus. The aim of our work is to underline the role of pigmented changes in the diagnostic process. Numerous lentigines should always lead to multiorgan investigations.

[Lentigines in different multiple organ defects syndromes]

The aim of our study is to introduce a larger number of doctors to the subject of lentigines. They may be a first syndrome coexistent with very rare multiple organ defects as syndrome Peutz-Jeghers, LEOPARD, LAMB and Carney syndrome.

[Pseudoatrophic macules as a additional skin sign of neurofibromatosis]

Pseudoatrophic macules are the infrequently mentioned skin symptom of neurofibromatosis. It may be the important diagnostic sign, especially, when other symptoms are absent or puerlly expressed.

[The diagnostic and therapeutic management in the first cerebral attack in childhood]

Cerebral attacks are the most frequent neurological problem in childhood. The diagnostic and therapeutic management in the first cerebral attack belongs to subjects often discussed in literature but currently it arouses some controversies concerning especially the notions "cerebral attack", "unprovoked seizures" and also the fact when epilepsy should be diagnosed after the first or the second unprovoked attack of seizures and when to start its treatment. The author presents in detail the principles of the management of cerebral attack and its differentiation in children. In relation to the neurological examinations (EEG, cerebrospinal fluid analysis, neuroimaging examination), the author demonstrates both the indications for their performance as well as limitations due to frequently obtained negative results. Among cerebral attacks, after exclusion of symptomatic attacks and febrile seizures, the first epileptic seizure can be diagnosed in 50% of children. The treatment of epilepsy after the first epileptic seizure decreases effectively the number of seizures within the first three years. However, the percentage of children who achieved 3-5-year remission is in these patients similar to that in the group treated after 2 successive attacks of unprovoked seizures. EEG and neuroimaging examinations (cerebral MR more beneficial than CT) belong to the diagnostic canon in the case of a cerebral attack. Changes in neurological examination and also the changes maintaining after focal attack, the age of children with cerebral attack up to 6 months and changes on EEG and in neuroimaging examinations increase the risk of another attack. The selection of the performed laboratory tests depends on an individual case and should be extended when symptomatic nature of cerebral attack is suspected (i.e. acute or chronic encephalopathies).

The assessment of comorbid disorders in ADHD children and adolescents

PURPOSE

The aim of these examinations undertaken by their authors was to run analysis concerning types and frequency of comorbid disorders occurrence in Attention Deficit Hyperactivity Disorders (ADHD) children and teenagers.

MATERIALS AND METHODS

Research, carried out from May 2005 to January 2007, in the area of the Lódź province, used a questionnaire, worked out by the above authors, addressed to parents of ADHD children and teenagers (research made in schools and among patients contacting the Clinical Psychology Institute of CZMP), and the study of medical documentation. 28 persons, 5 girls and 23 boys made the research group 7 to 13 years old (with an average age of 10.2), who had previously been ADHD diagnosed.

RESULTS

Out of disorders pointed out by parents, school problems of different degree of intensity appeared the most frequent ones, (39% of the examined) 18% with diagnosed dyslexia, head injuries (in 12 cases--26%), bed-wetting at 8 boys (17% of all registered diseases). Moreover tics disorder was diagnosed in 3 boys, epilepsy in 2 boys, habitual activity in one girl and one boy.

CONCLUSIONS

Head injuries, bed-wetting and dyslexia have most often been comorbid disorders. Boys with ADHD more often than ADHD girls, suffer from comorbid disorders. Desirable in the scope of ADHD diagnosis, further research on co-accompanying illnesses and its improvement.

[Cognitive disturbances in rolandic epilepsy--correlation with electoencephalographic patterns]

BACKGROUND

Up till now there have been many discussions in the epileptological literature concerning the occurrence of cognitive deficits in children with rolandic epilepsy (RE).

THE AIM OF STUDY

The aim of this study is to establish whether there exist any differences in general intelligence quotient or in particular cognitive functions in children with RE as compared to healthy children in the same age and if a correlation can be found between EEG and cognitive function in RE.

MATERIAL AND METHODS

The material comprised two groups: 38 children with RE (1-2 years after diagnosis establishing) and 15 children of the same age and sex - the control group. The study group was then subdivided into: 26 children with typical EEG patterns and 12 with atypical EEG acc. to Dalla Bernardina. The results of WICS, Benton, Raven's test, Bender-Koppitz and Bender-Gestalt test and 16-canal standard wake and sleep EEG were taken into account. Statistical analysis included: Student-test and Fisher exact test.

RESULTS

IQ of children with RE in all types of scores (full, verbal or non-verbal) did not differ from the control group. Some differences in particular cognitive functions were found: auditory memory (p<0.01), logical thinking (p<0.05). In the group of children with RE and atypical EEG pattern the full and non-verbal score was lower (p< 0.05) and we found in these children statistically significant deficit in analytic-synthetic thinking based on concrete material and hyperactivity (p< 0.05).

CONCLUSIONS

In spite of no difference in general IQ among children with RE and the control group, there are some cognitive deficits in this epilepsy particularly concerning auditory memory and logical thinking. The children with atypical changes in EEG are the risk group of lower full and nonverbal score analytic-synthetic thinking based on concrete material and hyperactivity.

[Bickerstaff's brainstem encephalitis -- an analysis of clinical and MRI findings]

BACKGROUND AND PURPOSE

Bickerstaff's brainstem encephalitis (BBE) is a very uncommon central nervous system disease. Its etiology remains unknown but it is postulated that BBE has an autoimmunologic origin. BBE is characterized by acute ophtalmoplegia, ataxia, pyramidal paresis and disturbance of consciousness. A special pattern of changes in magnetic resonance imaging (MRI) is characteristic of BBE. Lesions are located mainly in the brainstem. The aim of this paper is to analyze the clinical course and MRI changes in our own cases of BBE.

MATERIAL AND METHODS

We have analyzed medical records, clinical findings and MRI images of the patients with BBE diagnosis established in our Department of Neurology in the years 1998-2004.

RESULTS

During that period 4 cases of BBE were diagnosed with clinical sings of acute brainstem lesion and MRI imaging suggestive of BBE. In our patients we have observed ophtalmoplegia, ataxia, disturbances of consciousness and pyramidal signs. Two patients had a monophasic and 2 remitting-relapsing course of the disease. In all four cases we have seen on T2-weighted images large, irregular hyperintense lesions in the brainstem, especially in the pons, midbrain and medulla, but also in one case in the thalamus and vermis of the cerebellum. Patients were treated with steroids, plasmapheresis or acyclovir or a combination of these methods. We observed a complete recovery in two cases and significant improvement in the other two lasting more than two years confirming a relatively good prognosis in BBE.

CONCLUSIONS

BBE despite severe initial presentation usually has a good prognosis. MRI plays critical role in the diagnosis of BBE.

[Evaluation of brain activation by functional magnetic resonance in offspring of epileptic mothers and their parents in pathogenetic aspects of dyslexia]

PRINCIPLE

So far, the assessment of cerebral centres activity during fonological awareness test with functional magnetic resonance (fMRI) of families with dyslexia has not been carried out. The up till now published studies concern insignificant number of children or adults with dyslexia, whose results have not been unequivocal.

THE AIM

The general aim of the study is the explanation of the pathogenetic mechanisms of dyslexia in offspring of mothers with epilepsy and their family. Detailed aim is the evaluation of the influence of dyslexia occurrence in this particular population on activation of the brain in fMRI during phonological tests.

MATERIAL AND METHOD

Before fMRI, all the patients were subjected to classical cerebral MRI to estimate central nervous system structure excluding organic causes of lesions. Finally, the groups subjected to MRI included 7 children with dyslexia, 7 without dyslexia, 7 mothers with dyslexia, 10 women without dyslexia, 4 fathers with dyslexia, 10 fathers without dyslexia and 15 men without dyslexia. The examination was carried out during fonological awareness test. Mean quantities of activated pixels in the areas of interest--prefrontal cortex (1) and Broca's area (2) were compared in the investigated and control groups.

RESULTS

fMRI demonstrated significantly lower activity in both areas in frontal lobe in offspring of epileptic mothers with dyslexia as compared to offspring without dyslexia (p = 0.01, p = 0.02). Activity of Broca's area in epileptic mothers with dyslexia was significantly lower than in women with dyslexia from the control group (p = 0.05). Mothers with epilepsy and dyslexia, whose offspring also had dyslexia, had significantly lower Broca's area activity. The activity of frontal areas of fathers was on fMRI similar to the activity in control groups.

CONCLUSIONS

Epilepsy in mothers with coexisting dyslexia has a modifying effect on the activity of cerebral areas in frontal lobes during the fonological awareness test. Lower activity of Broca's area is a fonotypic trait transmitted to offspring with dyslexia.

[Linear nevus sebaceous syndrome with hemimegalencephaly diagnosed in child in neonatal period]

The aim of this study was to present the case of the child with linear nevus sebaceous syndrome (LNSS) and hemimegalencephaly, diagnosed in neonatal period. It is one of the five epidermal nevus syndromes. Etiology of this multiorgan disease is still unknown. Most often LNSS consists of central nervous system, skeletal and ocular abnormalities. In present case different epileptic non-responsive seizures began in second week of life. In image exams hemimegalencephaly was found. EEG pattern showed generally discharges. The fits responded to vigabatrin. Psychomotor retardation was observed. Sometimes the skin lesion may be only manifestation of the syndrome. It is very important to perform early image and EEG examinations in LNSS.

[Neurocutaneous melanosis and congenital gigantic pigmented nevi in the light of current knowledge]

The aim of this work is to approach the subject of neurocutaneous melanosis and to point out the necessity and precise neurological diagnosis in each case of gigantic pigmented nevi. It is necessary to remember about early planning of skin changes removal which is the cause of lowering risk of malignant melanoma.

[Photosensitivity in children with idiopathic headaches]

The occipital lobe involvement in the pathogenesis of the migraine aura, frequent occurrence of photogenic stimuli as the provoking factors of a migraine attack, still unsatisfactory explanation of the relation between migraine and epilepsy have drawn our attention to the photosensitivity in the idiopathic headaches, particularly in the developmental period. Photosensitivity is detected in EEG as a paroxysmal response to intermittent photic stimulation. This reaction called a photoparoxysmal response (PPR) has to be regarded as genetically determined EEG-symptom and occurs in 1.3-1.4% of healthy individuals aged 6-18. The aim of the study was to compare the frequency and identify the type of PPR in idiopathic headaches in children: with migraine with aura, without aura and with tension-type headache as well as to find the possible correlation between PPR and migraine photogenic triggering factors in children and adolescents aged 7-18. In years 2001-2003 263 EEG records were performed in patients hospitalized because of idiopathic headaches: 77 with the diagnosis of migraine with aura, 112 - migraine without aura, 74--in tension-type headache. The Fisher exact test was used to compare the number of patients with positive PPR and those with photogenic triggering factors of a migraine attack. The frequency of PPR did not differ significantly in three types of idiopathic headaches and accounts for 7.8% in migraine with aura, 8.9%--migraine without aura and 6.7%--in tension-type headache. PPR was most frequent (17.6%) in a group of children under 12 years of age with migraine with aura. In the migraine with aura PPR had the form of the general paroxysmal of the spike, polyspike and wave in 11.8%, localized changes in the temporal-parietal-occipital region only in 5.9%. In 7/17 patients with migraine and PPR, photogenic stimuli were most frequent provoking factors for the migraine attack (in controls without PPR 10/100) (p<0,01). Frequent coexistence of PPR and photogenic provocation of the migraine attack in children and adolescents supports the theory about general cortical hyperexcitability in migraine.

[Disorders of specific humoral immunological response in children with febrile seizures]

The aim of the study was to analyse a few recent aspects concerning the humoral immunological response deficiency in children with febrile seizures. 33 children were involved in the study: 16 with a single fit of febrile seizures and 17 with more than one fit. Children's average age was 37.6 months. The control group consisted of 14 healthy children chosen according to the age criterion. In the last three weeks there were no symptoms of infection. Blood for immunological tests was taken in the interictal period. In each case blood was taken for evaluation of B lymphocytes subpopulation (CD19/CD5, CD19/CD10, CD19/CD21), T lymphocytes (CD4/CD45RA, CD4/CD45RO) and the proliferative response to the action of PWM and PHA mitogens. The concentrations of released IgA, IgG, IgM and subgroups of IgG were also measured. In the children's group with single febrile seizures there were statistically higher levels of lymphocytes: CD19/CD5 and CD19/CD21, lower level of T lymphocytes: CD4/CD45RA and CD4/CD45RO, poorer lymphocyte response to the action of PWM and PHA mitogens. Moreover there were lower concentrations of the total IgG and IgG2 and IgG4 subgroups. In children who had only one fit of febrile seizures, abnormalities in the conducted tests were expressed much more than in the control group and the children's group with the multiple febrile seizures. The results suggest that there is a connection between the genetic factors and the dysfunction of immunological system and the course of febrile seizures.

[Evaluation of EEG after long-lasting focal febrile seizures during childhood: prospective study until adulthood]

The purpose of the study was to present differences in EEG in complicated (prolonged and/or focal) febrile seizures (FS) in relation to simple fs in the study conducted until adulthood.

METHOD

Material consisted EEG recordines: 1) 7-10 days after the seizures 2) in the age 3-5 years, 3) 8-12 years and 4) more than 17 years old.

RESULTS

The percentage of normal EEG after complicated FS increased with age: 30%, 42%, 59%, 70%, respectively. In each children group the number of normal EEG was significantly lower (p < 0.01), similarly in adults (p < 0.05). Focal changes (slow waves, sharp, spikes) were observed in 36-39% of the group during childhood (p < 0.01) but only in 23% in adults (ns). The number of paroxysmal changes was highest at the age of 5, but did not differ with simple FS in any studied group. Normal EEG after the seizure correlated positively with normal eeg in adults.

CONCLUSIONS

In some patients after complicated (focal, prolonged) FS abnormal EEG may be found from childhood to adulthood. Focal changes, which probably indicate preexisting pathology disappear in the majority before the 17th year of age.

Botulinum toxin treatment of spasticity in diplegic cerebral palsy: a randomized, double-blind, placebo-controlled, dose-ranging study

This study evaluated the efficacy and safety of three doses of botulinum toxin A (BTX-A; Dysport) in 125 patients (mean age 5.2 years, SD 2; 54% male)with dynamic equinus spasticity during walking. Participants were randomized to receive Dysport (10, 20, or 30 units/kg) or placebo to the gastrocnemius muscle of both legs. Muscle length was calculated from electrogoniometric measurements and the change in the dynamic component of gastrocnemius shortening at four weeks was prospectively identified as the primary outcome measure. All treatment groups showed statistically significant decreases in dynamic component compared with placebo at 4 weeks. Mean improvement in dynamic component was most pronounced in the 20 units/kg group, being equivalent to an increase in dorsiflexion with the knee extended at 19 degrees, and was still present at 16 weeks. The safety profile of the toxin appears satisfactory.

Botulinum toxin treatment of spasticity in diplegic cerebral palsy: a randomized, double-blind, placebo-controlled, dose-ranging study

This study evaluated the efficacy and safety of three doses of botulinum toxin A (BTX-A; Dysport) in 125 patients (mean age 5.2 years, SD 2; 54% male)with dynamic equinus spasticity during walking. Participants were randomized to receive Dysport (10, 20, or 30 units/kg) or placebo to the gastrocnemius muscle of both legs. Muscle length was calculated from electrogoniometric measurements and the change in the dynamic component of gastrocnemius shortening at four weeks was prospectively identified as the primary outcome measure. All treatment groups showed statistically significant decreases in dynamic component compared with placebo at 4 weeks. Mean improvement in dynamic component was most pronounced in the 20 units/kg group, being equivalent to an increase in dorsiflexion with the knee extended at 19 degrees, and was still present at 16 weeks. The safety profile of the toxin appears satisfactory.

Cavernous sinus thrombophlebitis in Nijmegen breakage syndrome

The aim of the study was to present rarely reported neurologic complications in Nijmegen breakage syndrome. A 13-year-old female was referred because of chronic progressive headaches. There were dysmorphic features on physical examination, which suggested a diagnosis of chromosomal instability syndrome. The results of genetic and immunologic examinations confirmed the diagnosis. Cerebral magnetic resonance imaging revealed an 8 mm thickening of the meninges over the left hemisphere, corresponding with a chronic inflammatory condition, and symptoms of left cavernous thrombophlebitis were detected. Cerebrospinal fluid examination and an infusion test demonstrated disorders in its absorption. Antibiotic, anticoagulant and cerebral edema treatment was given and after 1 week improvement was observed. Regression of symptoms occurred after 14 days.

[Open multicenter study of the effectiveness and safety of gabitril in epileptic patients with partial seizures]

The paper presents the results obtained by 53 investigators implementing the first Polish multicentre study of the effectiveness and safety of tiagabine (Gabitril). The study included 81 patients with refractory epilepsy with partial seizures. The duration of the study was 16 weeks. For the initial 6 weeks, Gabitril was gradually introduced till a dose of 30 mg/day was achieved. Within the subsequent 10 weeks the treatment effectiveness was observed and monitored, with the provision that the dose could be increased. The final analysis included 62 patients, while in 12 subjects the treatment was discontinued in less than 16 weeks. The results indicate a very beneficial effect of Gabitril on the frequency of seizures in patients with drug-resistant epilepsy. Almost 1 of the analyzed patients were seizure free. The most beneficial effects with respect to seizure number and intensity reduction were noted in subjects with partial complex and partial seizures with secondary generalization. The dynamic character of the decrease in seizure frequency was best observed between the first and third month of therapy. In 2/3 of patients the recommended dose was achieved and maintained. Less than 15% of subjects were excluded from the study, mainly due to lack of therapeutic effects. The number and character of adverse effects observed in the course of the present study did not differ from these noted in long-term Gabitril trials. The drug was demonstrated to exert no effect on vital functions and laboratory parameters. The results confirm the high effectiveness of Gabitril in treatment of patients with partial seizures and a good tolerance of this agent.

[Occurrence of epilepsy, its types and course during the first decade of life in progeny of mothers with epilepsy--prospective study]

On the basis of the prospective study, concerning 100 children of mothers with epilepsy, observed in the first decade, it was established that epilepsy appeared more often in this period than it was reported in the retrospective studies. The frequency of epilepsy amounted 7%. The pregnant-perinatal negative factors in mothers whose children suffered from epilepsy, weren't essentially larger than in other mothers with epilepsy. The occurrence of epilepsy in mothers till 10 year's of age increases the risk of early appearance of epilepsy in offspring essentially (p < 0.05). The epilepsy with absence seizures in mothers is related to the increased number of children with epilepsy in the first decade significantly more often than the epilepsy only with generalized tonic-clonic seizures (p < 0.012). Among the children with epilepsy, there were cases with the same type as in mothers epilepsy (absence), and with other generalized idiopathic epileptic syndromes (West syndrome, Dose syndrome, epilepsy with tonic-clinic seizures). The course of epilepsy in offspring of mothers with epilepsy was typical for the relevant epileptic syndroms appearing in childhood.

[Tiagabine in drug-resistant epilepsy in children: preliminary study]

The aim of the study was the presentation of our preliminary experiences and the data concerning the efficacy and safety of tiagabine in patients below the 12-th year of life. 4 cases of drug--resistant epilepsy--with partial complex attacks in 3 and simple in 1 (frontal epilepsy from supplementary motor area) with multiple seizures in the day were the subject of the study. Tiagabine add-one therapy to CBZ or to VPA was used. Initial period--the dose titration lasted 4 weeks. The stable dosis period amounted to 5 months. The effective dosis of tiagabine was 1 mg/kg/day. In 1 case the seizures completely disappeared and in 3 the frequency decreased to 2-4 times in comparison to frequency per day before the treatment. There were not any side-effects reported which would be the cause of the drug discontinuation.

IN CONCLUSION

Tiagabine appeared to be an effective and safe drug in resistant epilepsy in children below 12 years of age.

[Allergy effect on migraine course in older children and adolescents]

The interaction between allergy and migraine has been discussed since many years. The aim of the present study was the evaluation of: 1. allergy prevalence in the studied children with migraine, 2. allergy effect on the clinical course of migraine.

MATERIAL AND METHOD

The studied group comprised 30 children and adolescents aged 11-17 years with the diagnosis of migraine with or without aura by IHS criteria. In each case the migraine index was determined and symptoms of allergy were sought. Skin prick test and tests for immunoglobulin E in serum were done. The analysis of results showed the presence of allergy in 12 cases (40%), and on this basis two groups were isolated: with and without allergy. The allergic children were given antiallergic treatment for 6 months (pharmacological or diet restriction).

RESULTS

In the allergy group the migraine index decreased significantly from 2.45 to 0.33. Headache intensity decreased as well.

CONCLUSIONS

1. In 40% of cases migraine was associated with allergy. 2. Treatment results suggest that allergy and antiallergic treatment may influence the course of migraine attacks.

Krabbe disease: an ultrastructural study of globoid cells and reactive astrocytes at the brain and optic nerves

We report here a detailed ultrastructural study of a brain biopsy along with post-mortem brain and optic nerve specimens from a case of Krabbe disease, a relatively rare leukodystrophy caused by a mutation in the gene for galactocerebrosidase (GALC) mapped to the 14q31 region of chromosome 14. GALC is responsible for lysosomal hydrolysis of several galactolipids including galactosylceramide, a major sphingolipids of the white matter of the central nervous system, galactosylsphingosine (psychosine) and galactosyldigluceride. The main neuropathological features such as accumulation of globoid cells, loss of myelin and marked gliosis were observed in the white matter. The monocytic origin of globoid cells was confirmed by CD-68 and ferritin-positivity and periodic acid Schiff (PAS) positivity. Ultrastructural study of the globoid cells showed the accumulation of tubular crystalloids, which are highly specific for this disease. The differences with Gaucher's disease and the pathomechanism of neuropathological damage are discussed.

[Chorea gravidarum--case report]

A case of a 19 years old pregnant girl with chorea gravidarum is described, the diagnosis assuming rheumatic background to be the direct cause of the disease. Administered were: relanium, penicillin, solu-medrol and encorton with a positive therapeutic outcome.

[Alternating hemiplegia as a migraine equivalent in a small child]

The authors present the diagnostic criteria, clinical course and additional examinations in alternating hemiplegia (ah). According to International Headache Classification ah belongs to the syndromes which precede or accompany migraine. We give a description of the case which is the first published in Polish literature and discuss the etiology supporting the connection of ah with migraine.

[Neurological status and psychomotor development of infants with dilated pericerebral space]

Neurologic condition and psychomotoric development were analysed in infants up to 14 months of age with dilated pericerebral space detected by ultrasound scan performed between 2nd and 5th month of life. The good prognosis was stressed in children with mild degree of dilatation of the subarachnoid space.

[Case of subacute myelo-optico-neuropathy]

A 52-year-old female patient is reported in whom after taking of about 20 g Clioquinol blindness and paralysis of extremities with urinary incontinence developed. Complete cure ensued.