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Opp J, Schürmann M, Jenke A, Job B. Drawing the abdominal pain: A powerful tool to distinguish between organic and functional abdominal pain. J Pediatr Gastroenterol Nutr 2024; 78:846-852. [PMID: 38385706 DOI: 10.1002/jpn3.12165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/26/2024] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVES Abdominal pain (AP) in children imposes a large economic burden on the healthcare system. Currently, there are no reliable diagnostic tools to differentiate between organic and functional disorders. We hypothesized from previous research that the analysis of patients' graphic expression of subjective symptoms as well as their interactional behavior adds new ways to differentiate between functional and organic AP. METHODS Conversation analyses of physician-patient-encounters and graphical expression of AP-based pain were performed. RESULTS Twenty-two interactions were recorded and analyzed. Fifteen children were diagnosed with organic AP and seven with functional AP. We found marked differences between children with organic and functional AP. For example, all 15 children with organic AP saw the task of drawing a picture of the pain during the interview as a duty, whereas the seven children with functional AP took this as an opportunity to provide detailed descriptions about the nature of the pain, the circumstances, and how the AP impaired their quality of life. CONCLUSION Analysis of patients' interaction strategies in response to the painting task provides relevant clues as to whether AP is functional or requires further workup for organic causes.
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Affiliation(s)
- Joachim Opp
- Sozialpädiatrisches Zentrum, Evangelisches Krankenhaus Oberhausen, Oberhausen, Germany
| | - Mia Schürmann
- Leibniz-Institut für Deutsche Sprache, Mannheim, Germany
| | - Andreas Jenke
- Zentrum für Kinder- und Jugendmedizin, Klinikum Kassel, Universität Witten/Herdecke, Kassel, Germany
| | - Barbara Job
- Fakultät für Linguistik und Literaturwissenschaft, Universität Bielefeld, Bielefeld, Germany
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Thiel M, Bamborschke D, Janzarik WG, Assmann B, Zittel S, Patzer S, Auhuber A, Opp J, Matzker E, Bevot A, Seeger J, van Baalen A, Stüve B, Brockmann K, Cirak S, Koy A. Genotype-phenotype correlation and treatment effects in young patients with GNAO1-associated disorders. J Neurol Neurosurg Psychiatry 2023; 94:806-815. [PMID: 37225406 DOI: 10.1136/jnnp-2022-330261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 05/03/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Patients carrying pathogenic variants in GNAO1 often present with early-onset central hypotonia and global developmental delay, with or without epilepsy. As the disorder progresses, a complex hypertonic and hyperkinetic movement disorder is a common phenotype. A genotype-phenotype correlation has not yet been described and there are no evidence-based therapeutic recommendations. METHODS To improve understanding of the clinical course and pathophysiology of this ultra-rare disorder, we built up a registry for GNAO1 patients in Germany. In this retrospective, multicentre cohort study, we collected detailed clinical data, treatment effects and genetic data for 25 affected patients. RESULTS The main clinical features were symptom onset within the first months of life, with central hypotonia or seizures. Within the first year of life, nearly all patients developed a movement disorder comprising dystonia (84%) and choreoathetosis (52%). Twelve (48%) patients suffered life-threatening hyperkinetic crises. Fifteen (60%) patients had epilepsy with poor treatment response. Two patients showed an atypical phenotype and seven novel pathogenic variants in GNAO1 were identified. Nine (38%) patients were treated with bilateral deep brain stimulation of the globus pallidus internus. Deep brain stimulation reduced hyperkinetic symptoms and prevented further hyperkinetic crises. The in silico prediction programmes did not predict the phenotype by the genotype. CONCLUSION The broad clinical spectrum and genetic findings expand the phenotypical spectrum of GNAO1-associated disorder and therefore disprove the assumption that there are only two main phenotypes. No specific overall genotype-phenotype correlation was identified. We highlight deep brain stimulation as a useful treatment option in this disorder.
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Affiliation(s)
- Moritz Thiel
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Daniel Bamborschke
- Pediatric Neurology, University of Bonn, Faculty of Medicine, Bonn, Germany
| | - Wibke G Janzarik
- Pediatric Neurology and Muscle Disorders, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Birgit Assmann
- Department of General Pediatrics, Pediatric Neurology, Metabolic Diseases, Gastroenterology and Nephrology, University Hospital Heidelberg, Heidelberg, Germany
| | - Simone Zittel
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffi Patzer
- Department of Pediatrics, Krankenhaus St. Elisabeth und St. Barbara, Halle (Saale), Germany
| | - Andrea Auhuber
- Sozialpädiatrisches Zentrum, Celle General Hospital, Celle, Germany
| | - Joachim Opp
- Sozialpädiatrisches Zentrum, Evangelisches Krankenhaus Oberhausen, Oberhausen, Germany
| | - Eva Matzker
- Pediatric Neurology, Carl-Thiem Hospital Cottbus, Cottbus, Germany
| | - Andrea Bevot
- Pediatric Neurology and Developmental Medicine, Eberhard Karls University Tübingen, Faculty of Medicine, Tübingen, Germany
| | - Juergen Seeger
- Sozialpädiatrisches Zentrum Frankfurt Mitte, Frankfurt, Germany
| | - Andreas van Baalen
- Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Kiel University (CAU), Kiel, Germany
| | - Burkhard Stüve
- Pediatric Neurology, DRK-Kinderklinik Siegen gGmbH, Siegen, Germany
| | - Knut Brockmann
- Division of Pediatric Neurology, Department of Paediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Sebahattin Cirak
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Anne Koy
- Center for Rare Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Rinné S, Stallmeyer B, Pinggera A, Netter MF, Matschke LA, Dittmann S, Kirchhefer U, Neudorf U, Opp J, Striessnig J, Decher N, Schulze-Bahr E. Whole Exome Sequencing Identifies a Heterozygous Variant in the Cav1.3 Gene CACNA1D Associated with Familial Sinus Node Dysfunction and Focal Idiopathic Epilepsy. Int J Mol Sci 2022; 23:ijms232214215. [PMID: 36430690 PMCID: PMC9693521 DOI: 10.3390/ijms232214215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/04/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
Cav1.3 voltage-gated L-type calcium channels (LTCCs) are involved in cardiac pacemaking, hearing and hormone secretion, but are also expressed postsynaptically in neurons. So far, homozygous loss of function mutations in CACNA1D encoding the Cav1.3 α1-subunit are described in congenital sinus node dysfunction and deafness. In addition, germline mutations in CACNA1D have been linked to neurodevelopmental syndromes including epileptic seizures, autism, intellectual disability and primary hyperaldosteronism. Here, a three-generation family with a syndromal phenotype of sinus node dysfunction, idiopathic epilepsy and attention deficit hyperactivity disorder (ADHD) is investigated. Whole genome sequencing and functional heterologous expression studies were used to identify the disease-causing mechanisms in this novel syndromal disorder. We identified a heterozygous non-synonymous variant (p.Arg930His) in the CACNA1D gene that cosegregated with the combined clinical phenotype in an autosomal dominant manner. Functional heterologous expression studies showed that the CACNA1D variant induces isoform-specific alterations of Cav1.3 channel gating: a gain of ion channel function was observed in the brain-specific short CACNA1D isoform (Cav1.3S), whereas a loss of ion channel function was seen in the long (Cav1.3L) isoform. The combined gain-of-function (GOF) and loss-of-function (LOF) induced by the R930H variant are likely to be associated with the rare combined clinical and syndromal phenotypes in the family. The GOF in the Cav1.3S variant with high neuronal expression is likely to result in epilepsy, whereas the LOF in the long Cav1.3L variant results in sinus node dysfunction.
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Affiliation(s)
- Susanne Rinné
- Institute of Physiology and Pathophysiology, Vegetative Physiology, University of Marburg, 35037 Marburg, Germany
| | - Birgit Stallmeyer
- Institute for Genetics of Heart Diseases (IfGH), University Hospital Muenster, 48149 Muenster, Germany
| | - Alexandra Pinggera
- Department of Pharmacology and Toxicology, Center for Molecular Biosciences, University of Innsbruck, 6020 Innsbruck, Austria
| | - Michael F. Netter
- Institute of Physiology and Pathophysiology, Vegetative Physiology, University of Marburg, 35037 Marburg, Germany
| | - Lina A. Matschke
- Institute of Physiology and Pathophysiology, Vegetative Physiology, University of Marburg, 35037 Marburg, Germany
| | - Sven Dittmann
- Institute for Genetics of Heart Diseases (IfGH), University Hospital Muenster, 48149 Muenster, Germany
| | - Uwe Kirchhefer
- Institute of Pharmacology and Toxicology, University Hospital Muenster, 48149 Muenster, Germany
| | - Ulrich Neudorf
- Zentrum für Kinder-und Jugendmedizin, Klinik für Kinderheilkunde III-Bereich Kardiologie, University Hospital Essen, 45147 Essen, Germany
| | - Joachim Opp
- Ev. Krankenhaus Oberhausen, 46047 Oberhausen, Germany
| | - Jörg Striessnig
- Department of Pharmacology and Toxicology, Center for Molecular Biosciences, University of Innsbruck, 6020 Innsbruck, Austria
| | - Niels Decher
- Institute of Physiology and Pathophysiology, Vegetative Physiology, University of Marburg, 35037 Marburg, Germany
- Correspondence: (N.D.); (E.S.-B.); Tel.: +49-(0)6421/28-62148 (N.D.); +49-(0)251/83-55326 (E.S.-B.)
| | - Eric Schulze-Bahr
- Institute for Genetics of Heart Diseases (IfGH), University Hospital Muenster, 48149 Muenster, Germany
- Correspondence: (N.D.); (E.S.-B.); Tel.: +49-(0)6421/28-62148 (N.D.); +49-(0)251/83-55326 (E.S.-B.)
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Opp J, Job B. Dissoziative Anfälle frühzeitig erkennen. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01355-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
ZusammenfassungWenn dissoziative Anfälle, also psychogene, nichtepileptische Anfälle als epileptische Anfälle fehlgedeutet werden, führt dies zu frustraner medikamentöser Therapie und verzögert die Einleitung der erforderlichen psychotherapeutischen Maßnahmen. Folgende Anfallssymptome sollten an dissoziative Anfälle denken lassen: unrhythmisches, wildes Hin- und Herbewegen des Kopfes oder der Extremitäten, geschlossene Augen, lange Dauer und undulierender Verlauf. Ein unauffälliges Elektroenzephalogramm (EEG) spricht für dissoziative Anfälle, aber erst ein negativer EEG-Befund während eines Anfalls ist beweisend. Im Arztgespräch ist es entscheidend, dass die Betroffenen die Möglichkeit bekommen, frei zu schildern. Betroffene mit dissoziativen Anfällen zeigen dann Besonderheiten, die als Diagnosekriterien genutzt werden sollten: Sie fokussieren auf Begleitumstände und lassen in ihren Schilderungen den Moment des Bewusstseinsverlusts aus. Sie machen eher allgemeine Angaben und unterscheiden einzelne Anfälle kaum.
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Tacke M, Borggraefe I, Gerstl L, Heinen F, Vill K, Bonfert M, Bast T, Neubauer BA, Baumeister F, Baethmann M, Bentele K, Blank C, Blank HM, Bode H, Bosch F, Brandl U, Brockmann K, Dahlem P, Ernst JP, Feldmann E, Fiedler A, Gerigk M, Heß S, Hikel C, Hoffmann HG, Kieslich M, Klepper J, Kluger G, Koch H, Koch W, Korinthenberg R, Krois I, Kühne H, Kurlemann G, Mandl M, Mause U, Navratil P, Opp J, Penzien J, Prietsch V, Quattländer A, Rating D, Schara U, Shamdeen MG, Sprinz A, Wendker-Magrabi H, Stephani U, Muhle H, Straßburg HM, Töpke B, Trollmann R, Tuschen-Hofstätter E, Waltz S, Weber G, Wien FU, Wolff M, Polster T, Freitag H, Sönmez Ö, Reinhardt K, Traus M, Hoovey Z. Effects of Levetiracetam and Sulthiame on EEG in benign epilepsy with centrotemporal spikes: A randomized controlled trial. Seizure 2018; 56:115-120. [PMID: 29475094 DOI: 10.1016/j.seizure.2018.01.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/19/2017] [Accepted: 01/22/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE BECTS (benign childhood epilepsy with centrotemporal spikes) is associated with characteristic EEG findings. This study examines the influence of anti-convulsive treatment on the EEG. METHODS In a randomized controlled trial including 43 children with BECTS, EEGs were performed prior to treatment with either Sulthiame or Levetiracetam as well as three times under treatment. Using the spike-wave-index, the degree of EEG pathology was quantified. The EEG before and after initiation of treatment was analyzed. Both treatment arms were compared and the EEG of the children that were to develop recurrent seizures was compared with those that were successfully treated. RESULTS Regardless of the treatment agent, the spike-wave-index was reduced significantly under treatment. There were no differences between the two treatment groups. In an additional analysis, the EEG characteristics of the children with recurrent seizures differed statistically significant from those that did not have any further seizures. CONCLUSION Both Sulthiame and Levetiracetam influence the EEG of children with BECTS. Persistent EEG pathologies are associated with treatment failures.
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Affiliation(s)
- Moritz Tacke
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, University of Munich, Germany.
| | - Ingo Borggraefe
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, University of Munich, Germany; Epilepsy Center, University of Munich, Germany
| | - Lucia Gerstl
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, University of Munich, Germany
| | - Florian Heinen
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, University of Munich, Germany
| | - Katharina Vill
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, University of Munich, Germany
| | - Michaela Bonfert
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, University of Munich, Germany
| | - Thomas Bast
- Kork Epilepsy Center, Kehl-Kork, Germany; Faculty of Medicine of the University of Freiburg, Germany
| | | | - Bernd Axel Neubauer
- Department of Neuropediatrics, Justus-Liebig-University of Giessen, Germany; Children's Hospital, Rosenheim, Germany
| | | | | | | | | | | | - Harald Bode
- University Children's Hospital, Ulm, Germany
| | | | | | | | | | | | | | | | | | - Soeren Heß
- University Children's Hospital, Halle, Germany
| | | | | | | | | | - Gerhard Kluger
- Epilepsy Center, Vogtareuth, Germany; PMU Salzburg, Austria
| | | | | | | | | | | | | | | | - Ulrike Mause
- Hoechst Children's Hospital, Frankfurt am Main, Germany
| | | | | | | | | | | | - Dietz Rating
- University Children's Hospital, Heidelberg, Germany
| | - Ulrike Schara
- Pediatric Neurology, University of Duisburg Essen, Germany
| | | | - Andreas Sprinz
- Center for Interdisciplinary Pediatric Neurology, Kempten, Germany
| | | | | | | | | | | | | | | | | | | | - Frank U Wien
- University Children's Hospital, Magdeburg, Germany
| | - Markus Wolff
- University Children's Hospital, Tübingen, Germany
| | - Tilman Polster
- Pediatric Epileptology, Mara, Bethel Epilepsy Centre, Bielefeld, Germany
| | - Hedwig Freitag
- Pediatric Epileptology, Mara, Bethel Epilepsy Centre, Bielefeld, Germany
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Borusiak P, Biedermann H, Boßerhoff S, Opp J. Lack of Efficacy of Manual Therapy in Children and Adolescents With Suspected Cervicogenic Headache: Results of a Prospective, Randomized, Placebo-Controlled, and Blinded Trial. Headache 2010; 50:224-30. [DOI: 10.1111/j.1526-4610.2009.01550.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Opp J, Tuxhorn I, May T, Kluger G, Wiemer-Kruel A, Kurlemann G, Gross-Selbeck G, Rating D, Brandl U, Bettendorf U, Härtel C, Korn-Merker E. Levetiracetam in children with refractory epilepsy: A multicenter open label study in Germany. Seizure 2005; 14:476-84. [PMID: 16182573 DOI: 10.1016/j.seizure.2005.08.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2004] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the efficacy and tolerability of Levetiracetam (LEV) in a large pediatric cohort with drug-resistant epilepsy from a prospective multicenter observational study. METHODS We report the results of a multicenter observational survey of a cohort of 285 pediatric patients (mean: 9.9 years, range: 0; 6-17; 11) with refractory generalized and focal epilepsy who received Levetiracetam as an add-on open label treatment trial. The average duration of epilepsy was 6.0 years and the patients were treated with a mean of 7.0 antiepileptic drugs (AED) before LEV was introduced. RESULTS No serious persistent adverse events were reported. Reversible colitis and an apnoea syndrome in a child with phosphorylase-A-kinase-deficiency were noted. Mild to moderate side effects were reported in 128 patients (44.9%), consisting most frequently of somnolence (23.9%), general behavioral changes (15.4%), aggression (10.5%) and sleep disturbances (3.2%). In 209 patients, efficacy was analyzed over a treatment period of at least 12 weeks compared to a baseline of 2 weeks. Thirteen patients (6.2%) became seizure free, 39 (18.7%) responded with a seizure reduction of more than 50% following introduction of LEV. No response to LEV was reported in 65.1% (n=136). A decrease of initial treatment effect was seen in 37 patients (17.8%) while in 6.7% the seizure frequency doubled to the baseline (n=14). In seven patients (3.3%), the effect of LEV on seizure frequency could not be evaluated. A positive psychotropic effect was observed in 18 patients (8.6%). Mental retardation was associated with poor response and associated with more side effects and earlier discontinuation of LEV therapy. CONCLUSION LEV is a well-tolerated new AED that may effectively improve seizure control as an add-on drug in resistant epilepsy in childhood with good tolerability. However, neurologically handicapped children appear at increased risk for reversible neurocognitive side effects and have a poorer treatment response.
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Affiliation(s)
- Joachim Opp
- Evangelisches Krankenhaus, Department of Neuropediatrics, Oberhausen, Germany
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Holtmann M, Krause M, Opp J, Tokarzewski M, Korn-Merker E, Boenigk HE. Oxcarbazepine-induced hyponatremia and the regulation of serum sodium after replacing carbamazepine with oxcarbazepine in children. Neuropediatrics 2002; 33:298-300. [PMID: 12571784 DOI: 10.1055/s-2002-37081] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
While severe hyponatremia is reported to be more frequent in adults treated with oxcarbazepine (OXC) than with carbamazepine (CBZ), there is not sufficient data about the incidence of hyponatremia in childhood during treatment with OXC. We evaluated changes in serum electrolyte balance in 75 children with epilepsy before and during treatment with OXC and after replacing carbamazepine (CBZ) therapy with OXC therapy. All patients had normal sodium serum levels at the onset of OXC. During treatment with OXC we found hyponatremia (Na +< 135 mmol/l) without clinical symptoms in 26.6 % of the children (n = 20), sodium levels below 125 mmol/l were observed in 2 children (2.6 %). Clinically relevant hyponatremia occurred in one girl only (1.3 %). In a subgroup of 27 children, in whom CBZ was directly replaced with OXC, hyponatremia without symptoms was found in one child under CBZ (3.7 %) and in six children under OXC (22.2 %). Dosage of OXC, serum levels of the active metabolite of OXC, antiepileptic comedication or patients' age and gender were of no predictive value for the development of hyponatremia. Electrolytes should be measured before establishing OXC and if clinically relevant side effects occur.
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Affiliation(s)
- M Holtmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.
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Abstract
A new computer-based method for continuous gauging of momentary, visuomotor coordination under simultaneous EEG control proved both effective and suitable for children. Thirty-eight patients (age 4-17 years) who had different types of hypersynchronous activity were examined: None of the patients with focal discharges showed significant impairment in the test performance. Slight losses were evident in less than 3-s generalized, irregular spike-wave paroxysms. Deterioration was particularly evident in the bilateral synchronous 3-Hz spike-wave series, which lasted greater than 3 s.
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Affiliation(s)
- J Opp
- Neuropediatric Department, Erlangen University Pediatric Clinic, Germany
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