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.

[A short history of pediatric neurology in Jagiellonian University]

The author reminded preclinical years and the work of children's neu- rologists at that time. And next he de- scribed the work of people which from creating the Department of Pediatric Neurology in 1996 created structures of the Department, its 6 Laboratories and the Outpatients Clinic. From 2008 the Department was a part a Chair of Pediatric and Adolescent Neurology, from here the Author also checked teaching and scientific activity of the Chair, the Department, and 2 academic Laboratories of the Neurophysiology and the Clinical Electrophysiology. He pointed at effective efforts for financed research projects.

[Neurophysiological parameters in myasthena gravis in children in diagnostic and therapeutic view]

BACKGROUND

Myasthenia gravis (MG) is an autoimmunologic disorder. It is characterized by various clinical symptoms and their dependency upon the exertion and the rest as well.

MATERIAL AND METHODS

Between 2002-20014 in the Neurophysiology Laboratory at the Chair of Pediatric and Adolescent Neurology, Jagiellonian University in Krakow, the electrophysiological repetitive nerve stimulation study were performed in 44 children. The clinical picture and positive electrophysiological test were the ground to diagnose MG in 19 of them (12 girls and 7 boys). The mean age at onset of MG in the examined group was 12.8 years. In 5 patients the diagnosis was completed using edrophonium test. In 14patients the titer of AchRAb was also tested. In 18 patients with MG the radiological examinations of the chest were performed. In 14/19 patients with MG the control electrophysiological testing was performed 2 to 8 months after the first one.

RESULTS

The gen-ralized MG was diagnosed in 14 patients, and ocular in 2 of them. The amplitude of electro-physiological testing was normal during the first response in all patients, but the decrement of amplitude 4:1 in patients with MG was 26% to 88%. In 3 patients with MG the persisted thymus, while in 7 hypertrophy of thymus, in 2 thymoma nad inl thyinflammation of the thymus was detected. In 5 children the result of chest examination was normal. Among 5/8 patients (62.5%) with positive AChRAb, in one ocular MG was diagnosed, in the other 7 generalized MG. The titer of AChRAb was between 0.4 and 30.8 nmol/l (mean 9.44 nmol/l), and the decrement of amplitude 4:1 was 22% to 58%.. In the treatment pirydostygmine bromide (Mestinon) was used in all children, however in 4 of them together with azathioprine, and in 7 with steroids. In the treatment of myasthenic crisis in 5 patients plasmapheresis was performed. In 42% of patients thymectomy was performed during the first year after diagnosis. The clinical remission was succeed in 90,9% patients. The electrophysiological control examination detected the decrement of amplitude 4:1 in 1% to 80% (mean 36%). The electrophysiological remission, correlating with clinical remission was achieved in 2 patients. In 6/10 patients with clinical remission, the decrement of amplitude 4:1 in electrophysiological examination continued to be at the level similar to initial examination. In 1 patient remission was complete allowing significant reduction of doses of Mestinon, even though in the electrophysiological test the decrement was 80%.

CONCLUSIONS

(1) Among hospitalized children, the generalized myasthenia was the most common. (2) Neurophysiological studies plays still fundamental role in diagnostic methods in the diagnosis of myasthenia gravis in children. (3) The correlation of the clinical state and electrophysiological results was not established.

[The influence of cognitive-behavioral therapy on the P300 potential in children with psychogenic nonepileptic seizures and tension headache]

Explaining associations between neurophysiological and neuropsychological parameteres in children and improving the measurement methods would lead to a better understanding of the pathogenesis and course of psychosomatic disease. Goal: clinical assessment of the efficacy of cognitive-behavioral therapy in the treatment of psychogenic no- nepileptic seizures and tension type headaches in children. Determining the influence of cognitive behavioral therapy on the cognitive P300 potential and whether P300 parameters in children correlate with neuropsychological parameters.

MATERIAL AND METHODS

20 children with nonepileptic psychogenic seizures and 30 children with tension type headaches, aged 11.3 - 17.11 years. The final diagnosis was made in the Paediatric Neurology Clinic. The P300 examination was performed before/after therapy, with/without hyperventilation. A fixed structure therapy was implemented (10 sessions, 90 minutes each), during two weeks of hospitalization or in an outpatient clinic (9 children with tension type headache). The psychological assessment comprised of temperament questionnaires, auditory and visual memory trials, executive function and attention trials, and in some cases also intelligence testing.

RESULTS

More significant correlations were found in children with psychogenic seizures: attention parameters correlated negatively with reaction time, and this correlation tended to fade in the second examination, after psychotherapy. In children with tension type headache a statistically insignificant tendency was found of a positive correlation between those parameters. Medium P300 parameteres in this group were better. In 17/20 of children with psychogenic seizures a clinical improvement was observed, in 3 children the symptoms persisted in a 6 month follow up, but of a lower frequency. In 11/27 of chil- dren with tension headache the symptoms persisted, also with a lower frequency.

CONCLUSION

cognitive-behavioral therapy is effective in the reduction of symptoms in many cases of psychogenic seizures and chronic tension type headache.

[Neurophysiological methods in evaliuation of neurorehabiltation in children]

The authors reviewed neurophysiological methods, which are used in the evaluation of children referred for neurorehabilitation. Rehabilitation techniques which may stimulate or provoke pathological changes in EEG must be ruled out. Electrophysiological and clinical improvement allow for the extension and intensification of rehabilitation. Normal EEG pattern ensures the safe use of techniques consisting of neuromuscular re-education or passive verticalisation, electrotherapy and thermotherapy. Quantitative and qualitative assessment of cognitive impairment is based on neuropsychological tests and endogenous evoked potentials (most often P300). Presence of cognitive dysfunction needs the use of neuropsychological and neurologopedic therapy. Based on results of exogenous evoked potentials appropriate neurorehabilitation program (physiotherapy, kinezytherapy) can be determined and clinical outcome predicted. EMG allows appropriate usage of applications, patterns and principles in the PNF method (such as compression, stretching, resistance), adapting them optimally to the possibility of a child. ENG estimates conduction in motor and sensory nerves. Based on the results nerve impairment can be localized, severity and character of damage estimated (demyelinating, axonal or complex) and course of the disease and treatment monitored. Short characteristics of 37 children with Guillain-Barre syndrome referred for rehabilitation was presented. Special attention was drawn to floppy infants. Results of neuroelectrophysiological examinations determine suitable rehabilitation program adjusted to the course of central nervous system impairment.

[The links between neuropsychology and neurophysiology]

AIM

The aim of the study was to establish current scope of knowledge regarding associations between neurophysiological functioning, neuropsychology and psychoterapy.

MATERIAL AND METHODS

A systematic review was performed including 93 publications from Science Server, which contains the collections of Elsevier, Springer Journals, SCI-Ex/ICM, MEDLINE/PubMed, and SCOPUS. The works have been selected basing on following key words: 'neuropsychology, neurocognitive correlates, electrodermal response, event related potential, EEG, pupillography, electromiography' out of papers published between 2004-2015.

RESULTS

Present reports on the use of neurophysiological methods in psychology can be divided into two areas: experimental research and research of the practical use of conditioning techniques and biofeedback in the treatment of somatic disease. Among the experimental research the following have been distinguished: research based on the startle reflex, physiological reaction to novelty, stress, type/amount of cognitive load and physiological correlates of emotion; research on the neurophysiological correlates of mental disorders, mostly mood and anxiety disorders, and neurocognitive correlates: of memory, attention, learning and intelligence. Among papers regarding the use of neurophysiological methods in psychology two types are the most frequent: on the mechanisms of biofeedback, related mainly to neuro- feedback, which is a quickly expanding method of various attention and mental disorders'treatment, and also research of the use of conditioning techniques in the treatment of mental disorders, especially depression and anxiety. A special place among all the above is taken by the research on electrophysiological correlates of psychotherapy, aiming to differentiate between the efficacy of various psychotherapeutic schools (the largest amount of publications regard the efficacy of cognitive-behavioral psychotherapy) in patients of different age groups and different diagnosis.

[P300 potential in chldren with psychogenic nonepileptic events and tension headache]

INTRODUCTION

Psychotherapy is being used as the primary treatment in nonepileptic psychogenic seizures and tension headaches in children. Children's intelectual functioning is related to certain endogenous neurophysiological parameters.

AIM

The goal of this study was to establish whether the endogenous potential P300 is different in children with nonepileptic psychogenic events and with tension headaches, and whether it changes under the influence of the cognitive-behavioral psychotherapy.

MATERIAL AND METHODS

The study included a group of 47 children: 20 with nonepileptic psychogenic seizures (18 girls and 2 boys), aged 11.09-17.11 years, and 27 children with tension headache (25 girls and 2 boys), aged 10.11-17.11 years. The P300 potential was induced using an auditory stimulus. The reaction time, the amount of mistakes and the percentage of attention focus was measured in all children. All children attended 8-10 psychotherapy sessions. The P300 potential was registered before and after the course of therapy, and additionally in both cycles also after a 3 minutes hyperventilation.

RESULTS

Medium P300 parameters were closer to normal in the group of children with tension headaches rather than in the group with nonepileptic seizures. The shorter was the reaction time in the first measurement, the higher the attention score and the shorter the reaction time in the second measurement - this was visible in the results of children with nonepileptic seizures, in contrast to children with tension headaches. The use of hyperventilation caused a noticeable extension of the reaction time in the P300 measurement, with other components unchanged (mistake count and percentage of attention focus).

CONCLUSION

The endogenous potential P300 does vary, although on a statistically insignificant level, in groups of children with tension headaches and nonepileptic seizures.

[Bell's palsy in malopolska's children in 2010-2014 years]

BACKGROUND

Peripheral facial nerve palsy (Bell' palsy, BP) is a not rare diseases in children, being the most common acquired mononeuropathy.

AIM

The authors of this study wanted to determine whether the occurrence and course of paralysis changed in the past 5 years (2010-2014).

MATERIALS AND METHODS

The study involved Lesser Poland region, where the majority of children with paralysis are hospitalized at the Pediatric Neurology Department of University Children's Hospital in Krakow. These children in subsequent years were admitted to our department without any limitations. A review of clinical documentation of 125 patients, in terms of demographics, the coexistence of other diseases, seasonality, the degree of paralysis, location of paralysis, the prevalence of the recurrence was made. Changes in the structure of the nerve VII in MRI and CT, pharmacological treatment, applied rehabilitation, the degree of improvement and time of hospitalization were analyzed.

RESULTS

Similar distribution of occurrence and gender of children with BP in Lesser Poland region within 5 years were observed. The predominance of the girls resulted from demographic composition of the population. BP occurred most frequently in summer and winter. In more than half of children BP occurred in the course of acute systemic infection or craniofacial infection and in 5/125 BP followed head injury. Children with infections required antibiotic therapy. Left-sided paralysis was found in the majority of children and almost half of patients needed protection of the cornea of the eye (significant degree). In 12% of children structural changes within the facial nerve were found. In these children antiviral treatment was used and hospitalization time was more than 20 days while in the majority of children hospitalization lasted 15 days. In 8 (6.4%) children with recurrent BP kinezytherapy, electrical stimulation and laser therapy were applied. Steroid therapy was not used. Only 7/125 chil. dren had mild impairment of the eye closing at the discharge and the others received nearly complete recovery.

CONCLUSIONS

Inflammatory etiology is the most common in children with BP. BP occurs more often in the summer and winter. Severity of paralysis was significant in more than half of hospitalized children. Children with structural changes within the nerve VII required longer hospitalization and comprehensive treatment.

[Characteristics of ischemic stroke in children in the years 1968-1998 and 2010-2015]

BACKGROUND

Ischemic strokes in children are rare. The etiology and risk factors for ischemic stroke in children and adolescence differ from those typical in adults. Clinical symptoms depend on the location, extent of damage of the central nervous system and age. The aim of the study was to compare the clinical picture of ischemic stroke in children at two periods.

MATERIAL AND METHODS

The study included children who had a stroke: 32 children (group I) in the years 1968-1998 and 27 children (group II) in 2010-2015. In each case medical history, physical and neurological examination, laboratory tests and neuroimaging were taken. To determine the location of ischemia in children The Oxford Community Stroke Project classification was used. To determine the score of hemiparesis the Ashworth scale was used.

RESULTS

Pregnancy, delivery, neonatal period and neurological history in the majority of children enrolled to the study, was unbounded. Etiology of stroke in first group was found in 20 children. Diagnosis of ischemic stroke was made on the basis of angiography in 13 children, while the remaining 19 based on head CT. TACI were found in 11 children, while PACI had 21 children. In the Ashworth scale I score of paralysis was observed in 14 children; 2 score in 5 children. 3 score had 11 children and 2 children 4 score of paralysis. In the second group, the etiology of stroke was found in 6 children. Ischemic stroke in all children was diagnosed based on CT scans. Additionaly, 24 children had MRI, 4 children had CT angiography and in 5 children MRA. TACI was diagnosed in 3 children, in the next 21 children PACI and POCI in other 3 children. The Ashworth Scale score 1 paralysis were observed in 8 children and score 2 at 16. 2 children had paresis score 3, in 1 paralysis had score 4. No child in group I and II, had hemorrhagic stroke. In the pharmacological treatment of the acute phase of stroke steroidotherapy and diuretics were used, in children with infection antibiotic therapy was introduced. Antithrombotic therapy was administered in 2 children. Neuroprotective treatment (piracetam) and rehabilitation therapy was used. Children with ischemic stroke in group I were hospitalized an average of 80 days. Hospitalization time in group II was an average of 23 days.

CONCLUSIONS

1. In spite of dynamic development of laboratory diagnosis detection of the etiology of ischemic stroke in children has not improved. 2. Computed tomography is still a primary diagnostic tool in the diagnosis of stroke in children. 3. In both groups of children hospitalization in the years 1968-1998 and 2010-2015 clinical consequences after ischemic were observed. 4. Majority of children after ischemic stroke has a small degree of paralysis. 5. Better availability of outpatient multidisciplinary rehabilitation treatment enabled significantly shortened hospitalization of children in 2010-2015.

[Exogenous evoked potentials in adolesccents with muftiple sclerosis]

INTRODUCTION

Multiple sclerosis (MS) is a chronic inflammatory and demyelinating disease of the central nervous system. The disease usually affects young people, with a peak onset between the ages of 20 and 40, although it may also occur in early childhood. MS is one of the most common reasons of disability in young people. Aim of the study. The aim of the study was a neurophysiological characterisation of patients with relapsing-remitting MS (RRMS) eligible to receive an.

MATERIAL AND METHODS

In this study 23 patients have been included. According to initial symptoms two categories of patients were identified: in one group [group 1] (12123) there were patients with focal signs such as motor andlor sensory abnormalities while the second one [group 2] (11123) consisted of patients with retrobulbar optic neuritis.

RESULTS

There were no significant differences in VEP latencies and amplitudes in both I and 2 group. In both groups a significant latency prolongation as well as P100 amplitude decrease has been observed in comparison to the control group. Furthermore, the study has shown that the average latencies of N75 and N135 in group 2 were prolongated when compared to the control group. In BAEP examination no statistically relevant differences have been observed between average latencies and interlatencies in group I and group 2 as well as between the two test groups and control group. In SSEP examination group I has demonstrated a substantial latency prolongation of P14, NIB and N20 when compared to the control group, and the same result for P14, N20, P25 and CCT has been detected in group 2. The average amplitudes of all waves in group I were insignificantly lower than in the control group. In group 2 an insignificant decrease of amplitudes P9 and P18 from the control group has been noticed. In contrast, P25 amplitude was significantly lower.

CONCLUSIONS

I. Visual evoked potentials test is an effective neurophysiological method in a diagnosis of subclinical focal demyelination in CNS. 2. Auditory pathway is highly resistant to demyelination processes in CNS. 3. The presence of changes in somatosensory evoked potentials indicates a demand for further precise diagnosis of spinal location of MS.

Seizure-Precipitating Factors in Relation to medical Recommendations: Especially Those Limiting Physical Activity

Identification of factors precipitating epileptic seizures should always have practical implications and should always result in special recommendations given to patients. The purpose of our study is to analyze the relation between seizure-triggering factors and restrictive recommendations involving limitation of physical activity in particular. The research group consisted of 407 children hospitalized due to seizures. Their precipitants were identified in 27.5% of the patients. The most common included infection/fever, stress, and flashing lights. Although sport was documented as a precipitant in only 3.4% of all children, 8.1% of the investigated group were recommended to limit physical activity. As some episodes of epileptic seizures are reported to be provoked by sport, multiple restrictions are imposed on children. In the light of the worldwide academic literature and the present study, the recommendation of limiting sports activity is no longer supported.

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.

Epilepsy and electrophysiological findings in polish twins with glycogenosis type IIIb

Glycogen storage diseases are rare genetic disorders, mostly autosomal recessively inherited. Abnormal accumulation is because of the lack of one of the enzymes involved in glycogen metabolism. Neurological manifestation of the diseases involves muscle weakness and hypoglycemia-induced seizures. In this article, we present a history of twin sisters with unusual coincidence of glycogenosis type IIIb and epilepsy. Hypoglycemic background of seizures and organic changes of the central nervous system were excluded. Since the introduction of antiepileptic treatment, the patients have been seizure-free; however, paroxysmal electroencephalographic (EEG) changes have persisted. A high-protein and low-carbohydrate diet has protected them against hypoglycemia.

Alternating hemiplegia of childhood: new diagnostic options

A syndrome of alternating hemiplegia of childhood (AHC) is a rare disorder first presented in 1971. AHC is characterized by transient episodes of hemiplegia affecting either one or both sides of the body. Age of onset is before 18 months and the common earliest manifestations are dystonic or tonic attacks and nystagmus. Hemiplegic episodes last minutes to days and the frequency and duration tend to decrease with time. Motor and intellectual development is affected, deficits may also develop later. Epileptic seizures occur in some patients. Neuroimaging of the brain usually reveals no abnormalities. The variability of individual clinical presentations and evolution of symptoms have made diagnosis difficult. Therefore the problems of misdiagnosis could account for the low prevalence of this syndrome. This paper hopes to present actual data on AHC, especially of the results of genetic research and new diagnostic tools.

Dilatation of Virchow-Robin spaces in children hospitalized at pediatric neurology department

BACKGROUND AND PURPOSE

Dilated Virchow-Robin spaces (dVRs) have been revealed by magnetic resonance imaging (MRI) in patients with various neurological disorders. However, their etiology and clinical importance have not been discovered yet. The aim of the study was to estimate dVRs occurrence in hospitalized children and determine dVRs localization and their association with different nervous system diseases.

MATERIAL AND METHODS

Contrast-enhanced brain MRI examinations with the use of 1.5T GE device were performed in children with different diseases of nervous system, who were hospitalized at Pediatric Neurology Department, Chair of Children and Adolescent Neurology, Jagiellonian University in the years 2010-2011. The mean age of examined children was 11.58 years, and the studied group included 27 boys and 26 girls.

RESULTS

Within two years, MRI examinations of the brain were performed in 1348 children and dVRs were found in 53 of them (3.93%). Among children with dVRs, 15 were diagnosed with headache (28.3%) and 18 with epilepsy (33.96%). Other diagnoses were less frequent and occurred in 37.7%. Generalized dVRs and those localized in the subcortical nuclei were most frequently found.

CONCLUSIONS

Higher incidence of dVRs was found in children with headache and epilepsy. No association was found between localization of dVRs and symptomatology of different nervous system diseases except for large dVRs probably due to the pressure on the surrounding tissues.

Neurofeedback therapy in patients with non pain syndromes of chronic and paroxysmal character-literature review and own experience

Neurofeedback has been used in treatment of many other than pain clinical syndromes. This group includes chronic as well as paroxysmal syndromes previously treated pharmacologically. However due to non satisfactory results of this treatment introduction of non-pharmacological therapy has been examined. Observations from our 9-year experience of neurofeedback therapy used in children and adult patients with epilepsy, Asperger syndrome, depression, neurosis, personality disorders, drug addiction and other (not pain) syndromes have been presented in this paper. Positive influence of neurofeedback therapy on symptoms intensity, frequency, duration and social relations of treated patients has been confirmed by our own and other authors observations. Neurofeedback therapy has been tried by patients with other difficult life problems and has been effective in some of them. The effectiveness of the therapy has been confirmed by patients, their relatives and also by neurophysiological results. Additionally, preliminary results of neurofeedback therapy used in management of computer addiction in children and adolescents have been presented herein.

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.

[Influence of visual stimulation on cerebral blood flow and visual evoked potentials in children with migraine with visual aura]

BACKGROUND

Visual aura is the most common type of migrainous aura. It may occur as a single symptom or precede sensory or speech disturbances. Aura symptoms and order of their appearance may result from propagation of spreading depression phenomenon. Vascular disorders observed during migraine with aura attacks are probably secondary to neuronal changes. Simultaneous registration of cerebral bioelectric activation and changes evoked in cerebral circulation enables their objective estimation, detection of correlation and better understanding of migraine with aura pathogenesis. Studies with transcranial Doppler revealed impaired cerebrovascular response to various stimulations in migraine, especially migraine with aura patients. Combination of Doppler examination with registration of visual evoked potentials (VEP) enables estimation on neurovascular coupling.

AIM OF THE STUDY

Estimation of cerebrovascular response to visual stimulation in migraineurs with visual aura. Examination of correlation between cerebral blood flow and VEP parameters.

MATERIAL AND METHODS

50 children at the age range 8-18 years, 8 with migraine with visual aura, 9 with visual and sensory aura, 8 with visual, sensory and dysphasic aura and 25 children from control group. Examination of cerebral blood flow parameters was performed with transcranial Doppler, with the use of continuous monitoring, enabling performance of simultaneous record. ing from vessels of both hemispheres. Systolic (SV), end-diastolic (EDV), mean (MV) velocities and pulsatility (PI) and resistive indexes (RI) were analyzed. Parameters of cerebral blood flow were recorded in middle cerebral arteries, at rest (1 measurement), during visual stimulation (2, 3 measurement) and directly after the end of the stimulation (4 measurement). Black and white checkerboard pattern rebersal was visual stimulator and during stimulation VEP were registered. N75, P100, N135 latencies and N75/P100, P100/N135 amplitudes were analyzed. Moreover correlation between visually evoked changes in cerebral blood flow (2-1 measurement) and VEP values was examined.

RESULTS

Statistically significant differences in EDV and MV were found between controls and migraineurs with aura. In response to visual stimulation significant differences in cerebral blood flow velocities (SV, EDV, MV) were found and most often were observed direct after the beginning of the stimulation, however they did not differ significantly between the groups. Interactions between group and time was also not found in the following analyzed groups: migraine with visual, sensory and visual, sensory, dysphasic aura vs control, migraine with visual aura vs visual and sensory aura vs visual, sensory and dysphasic aura. Significant differences in P100 latencies and N75/P100 amplitudes were found between control and migraine with more than one aura symptom but no differences were found within migraine with aura subtypes. Moreover, in migraine with aura patients positive correlation between visually evoked changes in cerebral blood flow velocities and VEP amplitudes was detected.

CONCLUSIONS

Visual stimulation has significant influence on cerebral blood flow velocities in both migraine with aura patients and controls and these changes are most often observed direct after the beginning of the stimulation. However, no differences in vascular response to visual stimulation between the groups were observed. On the other hand positive correlation between visually evoked changes in cerebral blood flow velocities and VEP amplitudes was found in migraine with aura patients suggesting increased neurovascular coupling in this group when compared with controls.

[Familial epilepsy]

BACKGROUND

Epilepsy is a chronic disease, with heterogeneous etiology, clinical spectrum and prognosis. Among many causes of epilepsy genetic factors and hereditary diseases with different inheritance mechanisms manifesting with epileptic seizures play an important role. Analysis of genealogy of families burdened with epilepsy, development of molecular and genetic tests may contribute to better understanding of mechanisms of epileptogenesis and more effective treatment of epilepsy.

AIM OF THE STUDY

Research and analysis of epilepsy incidence in families of children hospitalized because of epilepsy.

MATERIAL AND METHODS

The study included 18 children with diagnosed epilepsy and positive family history of epilepsy, hospitalized in the Department of Pediatric Neurology Chair of Pediatric and Adolescent Neurology in the years 2007-2009. Apart from thorough pregnancy and delivery history, brain imaging examinations (MR, CT) and inter seizure EEG recording were performed.

RESULTS

Positive family history of epilepsy was found in children at the age range from 1 month to 11 years. In the examined group predomination of older children (over 2 years of age) and girls (10/18) was observed. Epilepsy with generalized seizures was found in majority of patients from examined group. The siblings of the patients were the most often affected with the epilepsy.

CONCLUSIONS

Positive family history of epilepsy in children with epilepsy is almost always associated with occurrence of generalized seizures. Even in twins different types of seizures may occur, which may result from structural brain lesions in one of them. In research of familial occurrence of epilepsy repetitive history taking and complementation is needed.

[Sleep paroxysmal events in children in video/polysomnography]

BACKGROUND

It is estimated that about 25% of children have sleep disorders, from short problems with falling asleep to severe including primary sleep disorders. Majority of these problems are transitory and self-limiting and usually are not recognized by first care physicians and need education.

AIM OF THE STUDY

Analysis of sleep structure at the developmental age and of sleep disorders associated with different sleep phases on the basis of video/polysomnography results.

MATERIAL AND METHODS

Literature review and illustration of fundamental problems associated with sleep physiology and pathology, with special attention to paroxysmal disorders. Additionally 4 cases from our own experience were presented with neurophysiological and clinical aspects.

RESULTS

Discussion on REM and NREM sleep, its phases and alternating share according to child's age was conducted. Sleep disorders were in accordance with their international classification. Parasomnias, occupying most of the space, were divided in two groups: primary and secondary. Among primary parasomnias disorders associated with falling asleep (sleep myoclonus, hypnagogic hallucinations, sleep paralysis, rhythmic movement disorder, restless legs syndrome) are important. Another disorders are parasomians associated with light NREM sleep (bruxism, periodic limb movement disorder) and with deeper NREM sleep (confusional arousals, somnabulism, night terrors), with REM sleep (nightmares, REM sleep behavior disorder) and associated with NREM and REM sleep (catathrenia, sleep enuresis, sleep talking). Obstructive sleep apnea syndrome and epileptic seizures occurring during sleep also play an important role. Frontal lobe epilepsy and Panayiotopoulos syndrome should be considered in the first place in such cases. Our 4 cases document these diagnostic difficulties, requiring video/polysomnography examination 2 of them illustrate frontal lobe epilepsy and single ones myoclonic epilepsy graphy in children is a difficult technique and requires special device, local and trained personnel. It is crucial in gathering objective data about sleep disorders.

SUMMARY

Correct diagnosis of paroxysmal disorders during sleep in children is possible thanks to video/polysomnography, and enables proper management and pharmacotherpy. It enables improvement or cure disorders during the sleep and moreover enables the obtainment of positive changes in child's every day life.

[Structural CNS abnormalities responsible for coincidental occurrence of endocrine disorders, epilepsy and psychoneurologic disorders in children and adolescents]

BACKGROUND

In the population of children and adolescents, epilepsy affects 0.5-1% of individuals; approximately 3% of general population suffer from non-epileptic seizures, while endocrine disorders are several times more frequent. All of the above factors result in a relatively common non-accidental occurrence of endocrine disorders, epilepsy and neuropsychiatric disorders. However, structural central nervous system (CNS) abnormalities that cause both endocrine and neurologic disorders seem to be markedly less common. No reports addressing this problem are available in the literature.

AIM OF THE STUDY

1) Assessment of the frequency of non-coincidental occurrence of epilepsy and endocrine disorders in inpatients and outpatients with structural CSN abnormalities managed in Department Endocrinology. 2) Presentation of diagnostic and therapeutic difficulties in these patients, and 3) An attempt at defining a common etiology of both disorders.

MATERIAL AND METHODS

A retrospective analysis of the medical records of the patients with coincidence of endocrine disorders and epilepsy and psycho-neurologic disorders (treated in Chair and Department of Children's and Adolescents Neurology, University Children's Hospital of Krakow or in another pediatric neurology center) and with organic CNS abnormalities (treated or followed up as inpatients and outpatient of Department of Pediatric Surgery, Children's University Hospital of Krakow, was performed. The patients were selected from among several thousands of children treated as inpatients and outpatients of the Department.

RESULTS

Various forms of symptomatic and idiopathic epilepsy and other psychoneurological disorders (disorders of behavior and emotions, obsession-compulsion syndromes, stereotypias, aggression, compulsive ideas and movements, anorexia or hypothalamic obesity) coincident with one or more endocrine disorders such as precocious or delayed puberty, multihormonal pituitary deficiency, panhypopituitarism and secondary hypothyroidism were detected in 42 patients with suprasellar arachnoid cyst (7 patients), septo-optic dysplasia (8 patients), craniopharyngioma (15 patients), glioma of the optic chiasm in neurofibromatosis type 1 (NF-1) (12 patients). There were no endocrine disorders in any of the ten patients with hamartoma of the hypothalamus and CPP. Endocrine and/ or neurological disorders did not resolve or were progressive after neurosurgery. Of 42 patients, a group of seven children representative for individual disorders was selected. In those patients, the etiology of both endocrine disorders, epilepsy and neuropsychiatric disorders was suspected to be common.

CONCLUSION

1. Various structural CNS abnormalities are the cause of concomitant epilepsy and endocrinopathy, although in some cases a direct impact of a genetic factor on the occurrence of both disorders or a mere coincidence cannot be ruled out. 2. Psychoneurological disorders usually precede the onset of endocrinopathy. 3. For this reason, MR or CT CNS imaging should be performed in any case of central neurological disorders, disorders of behavior, epilepsy, obsessive-compulsive syndrome, but also in patients with delayed psycho-motor development, delayed or accelerated growth and pubertal development. All of the above-mentioned manifestations may be symptoms of structural CNS abnormalities and their early treatment determines the child's future.

[Cytokines as a marker of the different paroxysmal sleep events in children]

BACKGROUND

Parasomnias in children manifest by unwanted behavior and various clinical picture. These disorders are associated with different sleep phases (REM, NREM) and sometimes threaten safety of children's sleep. They require differentiation with epileptic seizures because about 30% of epileptic seizures is associated with sleep. Some cytokines serum concentration changes were observed in sleep disturbances.

AIM OF THE STUDY

The search for peripheral markers of paroxysmal sleep disorders in children, which would be more simple method for differentiating between parasomnias and epileptic seizures.

MATERIAL AND METHODS

The study included 21 hospitalized children (17 with epilepsy and 4 with parasomnias) at the age range from 2 months to 14 years. Their 2,5-hour sleep was recorded with videoelectroencephalography. Blood samples were taken two times (before sleep and up to 30 minutes after seizure occurrence or after 2,5-hour registration without seizure). Cytokine concentration (IL-6 and IL-8) was determined in these samples. Statistical analysis of the obtained results was performed.

RESULTS

The arithmetic means of both cytokine concentrations did not differ significantly between both examined groups of children, before and after videoEEG performance. Statistically significant differences of mean cytokine concentrations were also not found in children from both groups, between samples after sleep registration and before videoEEG. Comparison of the arithmetic means of IL-6 and IL-8 concentrations after calculating all values before videoEEG and after sleep registration was also performed in children with epilepsy and parasomnias altogether. Similarly, these values did not differ significantly. Comparison of the means of all concentrations of both cytokines between groups of children with epilepsy and parasomnias was performed and also did not differ significantly.

CONCLUSION

IL-6 as well as IL-8 concentrations can not have practical use in diagnostics of children's paroxysmal sleep disorders because they do not differentiate basic types of these disorders such as epilepsy and parasomnias.

[Visual and auditory evoked potentials parameters in multiple sclerosis in children]

BACKGROUND

Evoked potentials (EP) visual (VEP) and auditory (BAEP) are used in diagnostics of demyelinating diseases, especially multiple sclerosis (MS). Elongation of the EP latencies and interlatencies has been found so far and sometimes change in the shape of the responses or decrease of their amplitudes has been registered as well.

AIM OF THE STUDY

Characteristics of VEP and BAEP parameters in Polish children with MS.

MATERIAL AND METHODS

Analysis included examination results of 10 patients with MS, at the age range from 13 to 17 years, 5 girls and 5 boys, hospitalized in the Department of Pediatric Neurology Chair of Pediatric and Adolescent Neurology Jagiellonian University Collegium Medicum in Krakow, in the years 2004-2010. Control group consisted of 10 children with similar age and sex distribution. VEP were registered during monocular stimulation with black and white checkerboard pattern reversal (pattern reversal VEP). Responses were registered from three active electrodes O1, O2 and Oz (according to the 10-20 International System of Electrode Placement). Latency of the maximal positive deflection P100, preceding N75 component, following N135 and N75/P100 amplitude were analysed. BAEP were evoked during alternating stimulation of the left and right ear, with the use of acoustic stimulus ("click") at 70 dB HL. The responses were registered from two receiving electrodes localized on the mastoid processes and from reference electrode Cz (according to the 10-20 International System of Electrode Placement). Latencies of I, II and V deflection and interlatencies: I-III, III-V, I-V were analyzed.

RESULTS

As far as VEP are concerned, significant elongation of P100 latencies was revealed in children from examined group when compared with control. N75/P100 amplitude differences were not statistically significant in both groups. BAEP analysis revealed significant elongation of III and V wave latencies and III-V, I-V interlatencies.

CONCLUSIONS

Evoked potentials, visual and auditory are important paraclinical tests used in MS diagnostics in children. They are used in identification of clinically silent demyelinating foci.

[The pineal cyst in children with different central nervous system diseases]

BACKGROUND

In the group of adult patients being diagnosed from different neurological complaints frequency of pineal cyst occurrence is estimated at 0,1-4,9%. Frequency of its occurrence in pediatric population is unknown, however it is regarded as a common lesion at this age, more frequent in girls and older children. This structural lesion is usually asymptomatic, without sequels and clinical complications. However, neoplastic lesions may also localize in pineal cyst.

AIM OF THE STUDY

Characterization of pineal cysts found in children diagnosed from different neurological diseases.

MATERIAL AND METHODS

45 children at the age range from 14 months to 17 years were hospitalized in the Department of Pediatric Neurology Chair of Pediatric and Adolescent Neurology in the years 2006-2010. MR examination with contrast (with the use of Siemens device 1,5 T) revealed lesions in pineal gland defined as pineal cysts. Predominance of girls was observed in the group (33/45). Additionally older children between 10 and 15 years of age were dominating (27/ 45). In 24/45 children serum tumor markers AFP and betaHCG were determined. Examined group of patients with clinical symptoms which indicated necessity of MR examination performance was very heterogenic.

RESULTS

The diameter of pineal cyst was between 3-10 mm in 40/45 children, 13 mm in 2 children and 11 mm in 3 children (most often 4-5 mm in 18 children). Usually this lesion accompanied other congenital or acquired CNS disorders. In 1/3 of children included to the study, headaches were cause of brain MR examination. In 15 children brain MR examination was performed due to epileptic paroxysmal events. No positive values of tumor markers were found in any of examined children.

CONCLUSIONS

1. Pineal cysts are common structural lesions in children hospitalized from different neurological symptoms. 2. Pineal cysts were usually found in children diagnosed because of headaches and epilepsy, and these were the most often final diagnosis. 3. In the examined group children over the age of 10 years and female sex predominate. 4. It is suspected that in majority of hospitalized patients pineal cyst was an incidental finding, with no association with clinical symptoms.

[Specific aspects of child's electroneurography and electromyography: literature and own experience]

BACKGROUND

Despite introduction of modern molecular diagnostics, electrophysiologic examinations still play an important role in the neuromuscular diseases diagnostics and in the disease course and convalescence process monitoring. EMG examination enables determination of location and character of peripheral impairment, establishment of neurogenic or myogenic impairment or neuromuscular transmission disorders and also determination if the process is acute or chronic, localized or generalized. EMG examination is also helpful in detection of subclinical pathology. In neurogenic processes it enables differentiation of spinal and peripheral nerve trunks impairment.

MATERIAL AND METHODS

Electrophysiological demyelinization criteria commonly used in adults have limited application in children. In the youngest children electrodes with smaller surface and distance between the poles are used in conduction examination. This cause difficulties in interpretation of the obtained results and requires the use of own norms considering values obtained with the use of smaller stimulating and receiving electrodes. Many technical factors have to be considered in the correct evaluation of electroneurographic and electromyographic recordings, which in adults have significantly lower influence on the results interpretation. Normal EMG result in a small infant does not exclude myopathy especially congenital myopathy. On account of child anxiety usually accompanying the examination the scheme of EMG examination should be elastic.

RESULTS

Authors illustrated specificity of these problems in children with own results.

Transcranial Doppler evaluation in migraineurs

Transcranial Doppler (TCD) enables indirect assessment of cerebral circulation by measurement of cerebral blood flow velocity. Stenosis and occlusion of cerebral vessels or cerebral vasospasm can be detected with this non-invasive method. Moreover, changes in cerebral blood flow velocity in response to hypercapnia or hypocapnia, exercise, temperature, orthostatic stress, visual and intellectual stimulation can be recorded and vasoreactivity or autoregulation mechanisms assessed. Migraine is considered to be a vasomotor disorder; its pathogenesis, however, is complex and requires further studies. TCD may help to detect mechanisms leading to migraine attack as well as during the attack and help to understand its pathophysiology. In this paper, the results of TCD examination in migraine patients in headache-free periods and during the attacks, in basal condition and during different stimulations, are presented. The influence of triptans on cerebral circulation is also described. Additionally, the role of TCD in diagnosis of patent foramen ovale in migraineurs is discussed.

[Children's sleep disturbances in videoelectroencephalography and polysomnography--preliminary data]

INTRODUCTION

Correlation between sleep and epilepsy is one of the most basic issues of pediatric neurology. VideoEEG nad polysomnography play an important role in diagnostic process of seizures occuring during sleep, epileptic seizures as well as parasomnic episodes.

AIM

In this paper videoEEG and polysomnography assessment in diagnosis paroxysmal sleep events in children was done.

MATERIAL AND METHODS

25 sleep registrations were performed, videoEEG was performed in 23 children with the age limit of 5 years, and two 8-years-old children underwent total polysomnographic examinations.

RESULTS

Examination during sleep time enabled to establish diagnosis of epilepsy in 18/25 children, in 2 children suspicion of epilepsy was made and in 5 epilepsy was excluded. Positive video results were found in 18/25 children and in 7 no clinical symptoms were recorded. Paroxysmal EEG activity was registered in 16 children, in 5 it was abnormal and in 4 it was within normal limits. Frontal epileptic seizures were observed in two children with simultaneous pathological changes in EEG, and in 1 of them in polysomnographic recording.

CONCLUSIONS

VideoEEG and polysomnographic examinations in children during sleep are helpful in defining seizure types and parasomnias.

[Rehabilitation outcome in children with cranial trauma and hypoxaemia of the brain]

BACKGROUND

Traumatic brain injury is one of the most common causes of children's disability and death.

AIM OF THE STUDY

The goal of this study was to present the effects of improvement treatment in patients who suffered various types of brain trauma, to discuss their motor functions as well as the emotional state and behavioural disturbances. One of the aims was also to present complications which took place reagardless of complex rehabilitation.

MATERIAL AND METHODS

In this study we describe the state of 5 patients. The patients were assessed with the Ashworth and RLAS scales before and after the complex rehabilitation. The programme of rehabilitation was designed individually for each patient depending on his RLAS score. The complications developed after 6 months of treatment are described.

RESULTS

In one case only- in a girl with hemiparesis- the state of nearly independent motor functioning was achieved. The other patients are bedridden or dependent on a second person when moving in a wheelchair. The girl with hempiparesis and another girl with spastic quadriparesis remain in the best verbal contact. Both of them however present with profound cognitive, emotional and behavioural deficits. The other patients are unable to reach any verbal communication. Because of swallowing problems some of the patients had feeding tube or tracheostomy performed. Each patient had an individually designed rehabilitation programme.

CONCLUSIONS

The outcome of rehabilitation treatment in patients with profound traumatic brain injury is very individual. The best outcome was achieved in a girl with hemiparesis who suffered brain injury in a car accident, and worse in children after brain hypoxaemia.

[Usefulness of electromyography in diagnostics of the neuro-muscular diseases]

INTRODUCTION

Electrophysiological examinations still play an important role in initial diagnostics of neuromuscular disorders and monitoring of the disease progress or recovery process.

AIM OF THE STUDY

Evaluation of neurophysiological examinations usefulness in differential diagnosis, indicating diagnostic and/or therapeutic management in patients with suspicion of neuromuscular disorders.

MATERIAL AND METHODS

109 patients were included, hospitalized at Department of Pediatric Neurology Jagiellonian University and treated at Neuromuscular, Neurologic, Orthopedic and Rehabilitation Outpatient Clinics of the Children's Hospital in Krakow. 6 groups of patients were indicated: I-11 patients with benign acute childhood myositis, BACM), II-18 children with gait disturbances, III-36 patients with suspicion of neuropathy, IV-11 patients hospitalized with suspicion of muscular disorders, V-18 children with SMA suspicion and V-15 patients with suspicion of myasthenia (MG). Neurophysiological examinations were conducted within 5 years (from May, 2004 to May, 2009) with Keypoint device from MedtronicDantec.

RESULTS

In the first group, EMG examination, performed in the acute phase of the disease, did not reveal any abnormalities. Indicators of inflammatory process were normal, however in 5 patients transient elevation of CK was found. Diagnosis of BACM in this group was established. Couple-month observation of children after BACM did not reveal deficits of muscular tone and strength, recurrence of the disease, or elevation of CK, despite consecutive respiratory tract infections. In 4/18 patients with gait disturbances EMG examination revealed abnormalities. In 1 patient myogenic injury of the muscles was found, in 3 conduction in motor fibers of examined peripheral nerves was disturbed. In 14/18 children EMG examination did not reveal any pathological changes. In 17/36 children from group III diagnosis of inflammatory neuropathy was established (Guillain-Barre Syndrome, GBS), in 2 chronic inflammatory demyelinating polyneuropathy, and in 2 others multifocal motor neuropathy with conduction block. In 7/36 patients familial sensory-motor polyneuropathy was diagnosed. Neuroboreliosis was cause of neuropathy in 2 children. In 1 child, segmental inflammation of anterior horns of the spinal cord evoked by Coxackie virus was revealed. Friedreich disease, Nieman-Pick disease, thoracic outlet syndrome was found in others. In 1 boy symptoms of polyneuropathy and encephaloptahy occurred in the course of tal intoxication. In group IV EMG examination showed myopathic injury of the muscles in 9 children. In 2 others the examination results were normal. Kearns-Syre syndrome was found in one of them and Duchenne disease in the second one, 16, 5 years old boy without pain complaints, Becker disease in 2 and in next 2 patients encephalopathy and in rare cases BaCM, congenital dystrophy and myotubular myopathy. SMA was diagnosed based on clinical manifestation and EMG examination in 18 patients. EMG examination showed lower motor neuron injury in every child with SMA type I and II. MG was diagnosed in 15 patients based on clinical manifestation and positive result of fatigability test. Ocular myasthenia was found in 2 patients, bulbar type of MG was found in 1 and systemic myasthenia in 12 children. In electrophysiological fatigability test amplitude of the first response was normal in every patient and decrease of amplitude in response 4:1 in patients with MG was from 26 to 88%.

CONCLUSIONS

Electromyographic examination remains important diagnostic tool of neuromuscular disorders. In order to limit extension of differential diagnostics EMG should be performed in its early stage.

[The type of involvement of the nervous system in multiple sclerosis in children and adolescents]

INTRODUCTION

The multiple sclerosis (MS) is characterized by variable clinical symptomatology, neuroradiological changes and neuropathological features, what influence the variable course of disease.

THE AIM

It was to describe the type of nervous system involvement in children with MS, considering the clinical manifestation and neuroradiological changes.

MATERIAL AND METHODS

9 children with multiple sclerosis hospitalized in the Department of Pediatric Neurology Chair of Pediatric and Adolescent Neurology, in 2006 and 2007 year were included. There were 5 girls aged 14-17 years and 4 boys aged 10-17 years. The history, clinical examination as well as head MRI were performed in all children, and in 2 children the spinal cord MRI as well. McDonald's criteria were employed. In 8 children oligoclonal bands in the cerebrospinal fluid were examined, in 6 children VEP and in 4 BAEP as well.

RESULTS

The most common clinical manifestations of MS were superficial sensory deficits, vertigo and diplopia. In 4 children with two attacks of symptoms disseminated in OUN, the head MRI revealed disseminated demyelination in the brain and in 1 child also demyelination in the cervical spinal cord. In 3 of patients oligoclonal bands were detected, and also in 3 children pathological VEP. In 2 other children only 1 attack was observed with symptoms disseminated in CNS, correlating with neuroradiological picture, within in 1 of them clinically silent progression of demyelination was revealed in the second MRI. In other children hospitalized after first attack with clinically isolated syndrome, demyelination was disseminated CNS, and in the youngest male patients oligoclonal bands were positive.

CONCLUSIONS

The most common clinical manifestations of MS were superficial sensory deficits, vertigo and visual disturbances, the least typical was organic based psychotic manifestation. The most common MR changes were located in the white matter of centrum semiovale and in corona radiata.

[Verbal fluency test--developmental aspects in health and illness]

INTRODUCTION

The Verbal Fluency Test is one of the easiest method in the neuropsychological evaluation of the frontal and temporal lobes' functioning. The amount of reasearch considering children's performance is still small compared to the adult population. The test lacks polish norms (as well as norms for children in other countries, except for unique cases).

AIM OF THE STUDY

it was to present possible methods of quality and quantity analysis of the Verbal Fluency Test, and the statistical interpretation of children's performance, depending on the general result, age and diagnosis.

MATERIAL AND METHODS

the research was done on a group of 80 children, aged 6-17, including 50 girls and 30 boys, who were hospitalized during the yeras 2007/2008 in the Department of Pediatric Neurology Chair of Pediatric and Adolescent Neurology Jagiellonian University in Krakow. The children were diagnosed with epilepsia (44 children) or headache (36 children). The Verbal Flunecy Test was used in the neuropsychological evaluation among other methods, such as Rey Osterrieth Compex Figure test, Clock test, and intelligence tests WISC-R and WAIS-R(PL).

RESULTS

the results confirm the charakter of the method, as a executive rather than memory function measure. The general result was influenced mainly by the ability to switch between specific subcategories. The general result correlated with age and gender, also children with headache performed better than children with epilepsia.

CONCLUSIONS

Apropriately interpreted, especially considering quality analysis, the Verbal Fluency test is a valuable tool in the differential diagnosis in children, and detection of subtle weakening in the development of certain cognitive abilities. It is crucial to gather appropriate normative data for the population of children in Poland, which would enable the test's use in more general practice, as one of the early detection methods in the diagnosis of developmental disorders.

[Neuroboreliosis with motoric disturbations in the developmental age]

BACKGROUND

Neurological symptoms develop in 10-20% of children suffered borreliosis (LD).

AIM OF THE STUDY

It was a presentation of motoric disturbances of neuroboreliosis in children.

MATERIAL AND METHODS

Children with neuroborreliosis and other neurological diseases were admitted to the University hospital during 2005-2007. Of these 13 patients, there were 9 males and 4 females, ranging in age between 3-17 years. Neurological diagnostic was performed using ELISA Biomedica kit and western blot bands. A 2-6 week sequential treatment with either iv ceftazidime or amoxicillin and oral doxycycline or amoxicillin was provided. Children were monitored regularly during the next 4-36 months.

RESULTS

The 13 children with neuroborreliosis constitute 0.5% of the pediatric neurology department's patients. The clinical manifestation of LD were usual and unusual from patient to patient. They included four cases of facial nerve paralysis (with bilateral paralysis in one case), in three cases transverse myelitis and in a single case, hemiparesis, and oculomotor nerve paresis. In 9/13 children motoric disturbances of neuroboreliosis was diagnosed indeed. The antibiotic treatment was successful in 6 patients and only partially effective in 3 children with facial nerve paralysis.

CONCLUSION

The most common symptoms of neuroborreliosis in children was motoric dysfunction.

[Diagnostics and treatment of myasthenia gravis in children]

BACKGROUND

Myasthenia gravis (MG) is an autoimmunologic disorder. It is characterized by various clinical symptoms and their dependency upon the exertion and the rest as well.

AIM OF THE STUDY

It was analysis of the diagnostic parameters in MG and also types and results of its therapy.

MATERIAL AND METHODS

Between 2002-2007 in the Neurophysiology Laboratory at the Department of Pediatric Neurology, Chair of Pediatric and Adolescent Neurology, Jagiellonian University in Krakow, the electrophysiological repetitive nerve stimulation study were performed in 44 children. The clinical picture and positive electro-physiological test were the ground to diagnose MG in 15 of them (11 girls and 4 boys). The mean age at onset of MG in the examined group was 12.93 years. In 5 patients the diagnosis was completed using edrophonium test. In 8 patients the titer of AchRAb was also tested. In 12 patients with MG the radiological examinations of the chest were performed. In 9/15 patients with MG the control electrophysiological testing was performed 2 to 8 months after the first one.

RESULTS

The generalized MG was diagnosed in 12 patients, ocular in 2, and bulbar in 1 of them. The amplitude of electro-physiological testing was normal during the first response in all patients, but the decrement of amplitude 4:1 in patients with MG was 26% to 88%. In 3 patients with MG the persisted thymus, while in 6 hypertrophy of thymus and in 2 thymoma was detected. Only in 1 child the result of chest examination was normal. Among 5/8 patients (62.5%) with positive AChRAb, in one ocular MG was diagnosed, in the other bulbar MG and in 3 generalized MG. The titer of AChRAb was between 0.4 and 30.8 nmol/l (mean 9.44 nmol/l), and the decrement of amplitude 4:1 was 33 to 58%. In 3/8 (37.5%) children the antibodies titer AChRAb was negative. In the treatment pirydostygmine bromide (Mestinon) was used in all children, however in 3 of them together with azathioprine, and in 6 with steroids. In the treatment of myasthenic crisis in 3 patients plasmapheresis was performed. In 40% of patients thymectomy was performed during the first year after diagnosis. The clinical remission was succeed in 88,9% patients. The electrophysiological control examination detected the decrement of amplitude 4:1 in 1% to 80% (mean 36%). The electrophysiological remission, correlating with clinical remission was achieved in 2 patients. In 6/9 patients with clinical remission, the decrement of amplitude 4:1 in electrophysiological examination continued to be at the level similar to initial examination. In 1 patient remission was complete allowing significant reduction of doses of Mestinon, even though in the electrophysiological test the decrement was 80%.

CONCLUSIONS

(1) Among hospitalized children, the generalized myasthenia was the most common. (2) Repetitve nerve stimulation is the fundamental diagnostic method to confirm myasthenia in children. (3) The correlation of the clinical state and electrophysiological results was not established. (4) Early simplify partial or total clinical remission.

[Significant neuropsychological impairment in children with normal MRI results]

The aim of the present work was to present significant cognitive impairment in 7 children with normal neuroimaging and electroencefalography results. In 6 children we observed difficulties in verbal auditory learning, in 3 visual memory impairment, and in 1 a disorder of visuo-spatial analysis and synthesis abilities. The clinical examinations performed during the diagnostic process (MRI, CT, Eeg) revealed no neurobiological correlates of the observed neuropsychological impairment. The authors used the cases described to remind, that even though current neuroimaging techniques seem excitingly promising in the diagnostic process, psychological and neuropsychological assessment remains the most sensitive method for the measurment and description of cognitive functions.

[The causes of symptomatic epilepsy in children aged 3-18 years hospitalized in the year 2006-2007]

BACKGROUND

Epilepsy can be one of symptoms of the damage to CNS in children with neurodevelopmental deficits, it is more difficult however to diagnose seizures if they are the first symptom of severe brain damage.

THE AIM

This retrospective research was conducted to study causes of symptomatic epilepsy in children aged 3-18 year hospitalized between 2006 and 2007 year in the Department of Pediatric Neurology.

MATERIAL AND METHODS

156 children with symptomatic epilepsy occurred after 2 years of life were included. The diagnosis of symptomatic epilepsy was established including clinical picture, neuro-radiological tests and EEG. The information from parents was helpful to analyze the type of seizures. The clinical state of children was analyzed, especially psychomotor development, focal deficits, as well as results of CT and/or MRI, in some children psychological testing was performed, molecular or serological.

RESULTS

156 children with epilepsy were hospitalized, within encephalopathy was diagnosed in 61 children. In 42 children static encephalopathy was associated with birth trauma, in 7 progressive encephalopathy was diagnosed, in 1 child CO intoxication caused encephalopathy, and in 11 cases the cause was not identified. Malformations of nervous system were associated with epilepsy in 37 children, geneticaly determined syndromes in 6, and the head trauma in other 6 children. Disorders of vascular origin caused epilepsy in 16 children, and neuroinfections in 9 children. In 2 children epilepsy was associated with ADEM, and in 11 children nonspecific de/dysmyelination was detected. The brain tumor was detected in 6 children with symptomatic epilepsy.

CONCLUSIONS

The most common disorder leading to epilepsy in children aged 3-18 years was encephalopathy, within hypoxic-ischemic encephalopathy. The other in sequence were malformations of nervous system and vascular diseases.

Pseudo-epileptic seizures in children are not associated with enhanced plasma level of allopregnanolone

Among neurosteroids, allopregnanolone is the most potent endogenous positive modulator of GABA(A) receptors, and disturbances in its release may play a role in pathomechanism of some neurological and psychiatric disorders. In contrast to a large body of evidence on allopregnanolone involvement in pathogenesis of epilepsy, no data are available on its role in pseudoseizures. Therefore, the aim of the present study was to find out whether pseudoseizures are associated with changes in plasma allopregnanolone level in pediatric patients. This study was carried out on 45 children with video EEG-diagnosed pseudoseizures, divided into three groups according to results of placebo test i.e: (I) children with pseudoseizures attacks without antiepileptic drug treatment; (II) children with pseudoseizures attacks and treated with antiepileptic drugs; (III) children without pseudoseizures attacks and no treatment. Allopregnanolone level was estimated by radioimmunoassay in blood samples collected before and after provoking pseudoseizures by placebo. No significant changes have been found in allopregnanolone level between all experimental groups. This suggests that in contrast to epileptic seizures, during pseudoseizures no compensatory increase in the endogenous antiepileptic and anxiolytic neurosteroid release occurs. The low level of allopregnanolone may have a detrimental effect on GABAergic inhibitory system in the brain aggravating stress response and promoting pseudoseizure occurrence. On the other hand, the clinical value of allopregnanolone plasma level as a biomarker distinguishing between epileptic and pseudoseizures remains questionable due to its high inter-individual differences.

Clinical and videoEEG findings in a girl with juvenile moyamoya disease

Moyamoya disease is present throughout the course of development, including juvenile development. Very careful EEG analysis may be a diagnostic method in such cases where clinical symptoms are not sufficient for diagnosis. Herein, we report a Polish case of moyamoya disease in a 13-year-old girl with polymorphic clinical symptoms. Even though her diagnosis was made late in the course of her disease, it was due to successful EEG analysis and not due to clinical symptoms that a diagnosis was made at all. Re-build up phenomenon was registered as well as an asymmetric slowing in background activity. High-voltage slow frontal and generalized activity was seen during hyperventilation.

Caudal regression syndrome associated with the white matter lesions and chromosome 18p11.2 deletion

Caudal regression syndrome (CRS) is a rare combination of congenital abnormalities characterized by caudal vertebral agenesis/dysgenesis that is usually associated with congenital anomalies of spinal cord, gastrointestinal and genitourinary organs. Although the exact teratogenic mechanism is not known, same environmental, e.g., hyperglycemia and genetic factors appears to play a crucial role in this fetopathy. Herein, we report an unusual case of CRS associated with unspecific white matter lesions and 18p-syndrome manifested by congenital ptosis, hypothyroidism, facial dysmorphy and chromosome 18p11.2 deletion.

[MRI brain imaging data in children with cavum septi pellucidi and vergae]

BACKGROUND

Cavum septum pellucidum (CSP) is commonly known marker of neurodevelopmental brain malformation. In MR imaging it is seen either as an isolated finding or with association of others developmental brain changes e.g. cavum vergae (CV).

AIM OF THE STUDY

was to assess the frequency of CSP and CV associated with others brain developmental malformations in children. We also classified clinical syndromes in children with these structural brain malformations.

MATERIAL AND METHODS

The study was performed on 55 children, hospitalised in the Department of Pediatric Neurology, Jagiellonian University in Krakow, between 1998-2006 with diagnosed CSP and/or CV in MRI. There were 29 girls and 26 boys aged 4 months-16 years old. Clinical history, clinical status and neurological findings in physical examination were main indication to perform brain MRI. MRI scans was done in SE T1, FSE T2, PD, FLAIR, IR T1 sequences, 3 and 5 mm depth, in vertical, frontal and axial surfaces, performed on 1,5 T machine Signa Horizon HiSpeed General Electric.

RESULTS

There were 38 children with CSP, 12 children with CSP and CV, and 5 with CV. In 18/55 children (33%) CSP was isolated, but in 37/55 children (67%) CSP was coexisted with other brain structural malformations. The average age of diagnosis in isolated CSP was 10 years old, in coexisting malformation was 5 years. In half of the children, the reason of neuroimaging was epilepsy, in this 6/18 patient with isolated CSP or CV. 58% of the study group had a normal mental development, but 35% of children with additional brain malformation and 11% of children with isolated CSP and CV were mentally retarded.

CONCLUSION

1. The majority of the children with CSP and CV had also coexisting brain malformations diagnosed in MRI. 2. CSP and CV coexisting with large brain malformation e.g. dysplasia septo-optica and agenesis of corpus callosum. were diagnosed earlier. 4. Mental retardation was diagnosed in 1/3 children with different structural brain malformation but also in 11% of children with CSP and CV as well.

[A pediatric neuropsychological evaluation]

BACKGROUND

Pediatric neuropsychology is currently one of the most expansive fields of psychology, developing between clinical neurology and other neurosciences.

THE AIM OF STUDY

This work presents the main possibilities of a pediatric neuropsychological evaluation in known clinical situations and the status of the neuropsychological profession.

DESCRIPTION

The necessity of evaluating the level of cognitive functioning in children from high risk groups, children with somatic, behavioural, emotional or developmental disorders was reminded. Clinical examples are described, when a neuropsychological evaluation of the child reveals important information, becoming a valuable part of the medical diagnosing process. Diagnostic methods most commonly used for assessing the level of cognitive functioning are presented, baring in mind its division into specific cognitive domains: executive functions, learning and memory, attention, visuo-motor and verbal skills. Most popular of the international and domestic IQ tests are described, including suggestions about testing children with various degrees of intellectual disability. Among the methods are tests for assessing children in age groups from 0-18. The authors described a neuropsychological interpretation of the evaluation results, including tests, behavioural observation, interviews and other diagnostic methods. Some limitations of the neuropsychological assessment methods are also mentioned, such as questionable ecological validity.

CONCLUSION

the knowledge of possibilities and the necessity of the neuropsychological evaluation in children should become much more common, especially in the medical environment. The status of the neuropsychologist in Poland need a precise legal regulation.