Circadian patterns of pediatric seizures

OBJECTIVE

To evaluate the relationship of sleep/wake and day/night pattern to various seizure subtypes and epilepsy localizations.

METHODS

Charts of 380 consecutive pediatric patients with epilepsy undergoing video-EEG (V-EEG) over 2 years were reviewed for seizure semiology, EEG localization, occurrence during the day (6 am-6 pm) or night, during wakefulness and sleep, 3-hour time blocks throughout 24 hours, and various epilepsy localizations, and etiology.

RESULTS

A total of 1,008 seizures were analyzed in 225 children (mean age 8.5 ± 5.7 years). Sleep and wakefulness predicted seizure semiology and localization more reliably than daytime and nighttime. Auras, gelastic, dyscognitive, atonic, hypomotor, and myoclonic seizures, and epileptic spasms occurred more often in wakefulness, while tonic, tonic-clonic, automotor, and hypermotor seizures occurred more frequently in sleep (p < 0.05). Clonic, atonic, myoclonic, and hypomotor seizures occurred more frequently during daytime. Hypermotor and automotor seizures occurred more frequently at night (p < 0.05). Generalized seizures (6 am-12 pm), temporal lobe seizures (9 pm-9 am), frontal lobe seizures (12 am-6 am), parietal lobe seizures (6 am-9 am), and occipital lobe seizures (9 am-noon and 3-6 pm) revealed specific circadian patterns (p < 0.05). In addition, generalized and temporal lobe seizures occurred more frequently in wakefulness, while frontal and parietal seizures occurred more frequently in sleep, independent of day or night pattern (p < 0.05).

CONCLUSION

Sleep and wakefulness, as well as time of day and night, are important considerations in proper characterization of seizure types and epilepsy localization. These findings may contribute to a better understanding of the mechanisms of nonrandom distribution of seizures, and may provide information for individualized treatment options.

The symptomatology of tic disorders and concomitant sleep habits in children

INTRODUCTION

The aim of study was to analyze the clinical symptoms of tic disorders (TG) and sleep habits in children. The sleep habits were compared with those of a control group (CG).

MATERIALS AND METHODS

The study included 84 children with TG. The diagnoses were verified according to DSM-IVR criterion. CG included 156 healthy children. The parents filled in a questionnaire developed by the authors--TG's parents filled in a part concerning the symptomatology of tic disorders and sleep habits, CG's parents only the second part.

RESULTS

There were 78.6% of male and 21.4% of female in TG respectively, and 53.8% and 46.2% in CG. The simple and complex motor tics were observed in 98.8% and 39.3% of patients, vocal tics--64.3%, sensory tics--20.2%. ADHD and OCD symptoms were noticed respectively in 73.8% and 35.7% of children. The most common simple and complex motor tics were respectively: blinking--9.0%, jumping and touching--20.2% of patients. Vocal tics were presented in 64.3%. 23.8% of TG slept together with another person in bed, and 69% of them in one room with other members of family; in CG it was respectively 58.1% and 19.2%. 33.3% of TG fell asleep and woke up in the same position in bed, in the CG 75.6% of children slept calmly. The bed-time stories were seldom read by the parents in TG--3.6% vs CG--31.4%.

CONCLUSIONS

Quote frequently TG are connected with other behavioral symptoms, in particular ADHD and OCD. Sleep habits are different in TG than in CG.

The sleep habits and sleep disorders in children with headache

PURPOSE

The study was conducted to examine the sleep habits and sleep disorders in children and adolescents with headache.

MATERIAL AND METHODS

Three hundred children with headache were qualified to a headache group (HG) and 284 children from schools and kindergartens without headache to a control group (CG).

RESULTS

In our study, 27.7% children of the HG slept together with other person in the bed; 18.7% of the CG. In the HG, 11.7% of children had physical contact with parents when falling asleep, in the CG 19.7%. In the HG, watching TV and listening to the radio when falling asleep occurred more frequently. About 20% of parents in the HG read aloud to children before putting them to sleep, in the CG 32.4%. Day naps occurred in 32.7% of the HG children and in 20.1% of the CG. Sleep disorders reported in the study group as parasomnia symptoms included: sleep talking 48.3% (CG 38.7%); bruxism 23.3% (CG 16.5%); leg movement 20.3% (CG 18.0%); nightmares 16.7% (CG 7.4%) and sleep breathing disorder symptoms like snoring 27.3% in the HG group (CG 19.0%) and breathing pauses 5.7% (CG 1.4%). Awakenings from the night sleep were observed in 43.7% children of the HG and in 36.4% children of the CG.

CONCLUSIONS

Sleep habits in children with headache were considerably different from sleep habits in the CG. The prevalence of sleep disorder symptoms like: snoring, sleep talking, bruxism, sleep terror, nightmares, breathing pauses and awaking from night sleep was higher in the HG group than in the CG.

Bilateral facial nerve palsy in the course of neuroborreliosis in children-dynamics, laboratory tests and treatment

PURPOSE

Presentation of four patients with bilateral peripheral facial nerve palsy as a clinical manifestation of neuroborreliosis in children--diagnostic, treatment and prognosis.

MATERIAL AND METHODS

In 2002-2004 in The Chair and Department of Developmental Neurology, 24 children from the Wielkopolska region were admitted with diagnosis of borreliosis. Among all the children with borreliosis, confirmed by serologic examination, 4 (16.7%) demonstrated bilateral peripheral facial palsy (PFP). We investigated the presence of IgM class and IgG class specific antibodies in the sera and cerebrospinal fluid (CSF) of 4 patients with bilateral PFP. (Detected by immunoenzymatic methods--ELISA.)

RESULTS

Before the occurrence of PFP all the children manifested unspecified systemic symptoms such as headaches, muscle and articulation pains, weakness and in two cases a mood depression. At first all patients demonstrated elevated IgM antibodies and proper levels of IgG antibodies. Control tests administered within 2-14 months later reduction of antibodies was indicated. Two patients demonstrated significant pleocytosis in CSF test, (without the meningeal symptoms). All children were treated with physiotherapeutic procedures and were administered antibiotic intravenously.

CONCLUSIONS

PFP is one of the most frequent neurological symptoms of borreliosis in children. In case of acute PFP and especially the bilateral form of PFP, neuroborreliosis is the most probable diagnosis. All children reported PFP at one side first and after several weeks the paresis of the facial nerve on the opposite side usually appeared. The clinical state of children started to improve after the introduction of physiotherapy and this process usually lasted several months.