Cognitive dysfunction during anti-NMDA-receptor encephalitis is present in early phase of the disease

Anti-NMDA-receptor encephalitis is an autoimmune disorder with a well-defined set of clinical features including psychiatric changes (anxiety, agitation, bizarre behaviour, delusional or paranoid thoughts), epileptic seizures and cognitive disturbance followed by movement disorders including orofacial dyskinesias, alterations in the level of consciousness and dysautonomia. Although the cognitive changes are not always very clear at presentation, they can persist after recovery from the acute and often prolonged illness. However, there are few studies describing neuropsychiatric changes in depth, both in the early course of the disease and in long-term follow-up.

[A case of anti-NMDA-receptor encephalitis]

A clinical case of encephalitis caused by antibodies to NMDA-receptors is presented. This rare pathology is characterized by severe cognitive impairment and needs careful differential diagnosis.

Factor V Leiden and prothrombin 20210G>A [corrected] mutation and paediatric ischaemic stroke: a case-control study and two meta-analyses

AIM

To determine whether factor V Leiden (FVL) and prothrombin (PT) 20210G>A mutation are associated with paediatric ischaemic stroke.

METHODS

The study consisted of two parts. Case-control study included neuroradiologically confirmed paediatric ischaemic stroke patients from two tertiary children's hospitals in Estonia. For control group, DNA was obtained from 400 anonymous screening test cards of newborns born consecutively in all delivery departments of Estonia in January 2005. Meta-analyses was performed to assess the association between paediatric sinovenous thrombosis and FVL and PT 20210G>A.

RESULTS

A total of 75 children (45 boys, 30 girls) were included into the case-control study: 19 with childhood arterial ischaemic stroke, 49 with perinatal arterial ischaemic stroke and seven with cerebral venous thrombosis. Both FVL and PT 20210G>A occurred significantly more frequently among patients with sinovenous thrombosis compared with controls (OR = 12.9; 95% CI: 2.3-73.0 and OR = 11.9; 95% CI: 2.1-67.2, respectively). The difference was not significant between childhood/perinatal arterial ischaemic stroke and controls. Meta-analyses (including our study) revealed that both FVL and PT 20210G>A are associated with paediatric sinovenous thrombosis (OR = 3.1; 95% CI: 1.8-5.5 and OR = 3.1; 95% CI: 1.4-6.8, respectively).

CONCLUSION

FVL and PT 20210G>A are associated with paediatric sinovenous thrombosis.

Clean intermittent self-catheterization in persons with multiple sclerosis: the influence of cognitive dysfunction

Background

Bladder problems are very common in persons with multiple sclerosis (PwMS).

Objective

The aim of this study was to investigate the ability of PwMS to learn clean intermittent self-catheterization (CISC).

Methods

The physical disability of 23 PwMS was evaluated with the Expanded Disability Status Scale (EDSS), and cognitive status was evaluated with the Brief Repeatable Battery of Neuropsychological Tests (BRB-N). CISC was taught by the same continence advisor who was blinded to the cognitive test results. The ability to learn CISC was evaluated immediately after sessions and 3 months later. Twenty-three consecutive PwMS participated in the study.

Results

In all, 87% (20/23) of the PwMS successfully finished CISC training. The number of lessons needed to acquire CISC skills differed significantly depending on the EDSS (Spearman r = 0.682, P = 0.0003), but the total cognitive decline subscore did not influence the ability to learn CISC. Only 13% (3/23) of the PwMS failed to learn CISC. The ability to learn CISC depended on the number of lessons needed to acquire CISC ( r = −0.499, P = 0.0313) and the EDSS score ( r = −0.433, P = 0.0390) but not on the course of the disease ( r = 0.125, P = 0.5696) or on cognitive decline ( r = −0.311, P = 0.1480). After 3 months of follow-up, 30% (6/20) of the PwMS had ceased performing CISC. A follow-up indicated no statistically significant correlations among any of the subscores of the cognitive test battery, the EDSS score, the course of the disease, and the time required to learn CISC and effective bladder management.

Conclusions

Our study thus confirmed that most (87%) PwMS were able to learn CISC in spite of cognitive dysfunction and therefore to improve their quality of life.

One question as a screening instrument for depression in people with multiple sclerosis

OBJECTIVE

To evaluate how effectively one question 'Are you depressed?' works as a screening tool for depression in people with multiple sclerosis.

DESIGN

The results from a single question were compared with formal clinical diagnosis and the classification from a standard questionnaire.

SETTING

Estonian Multiple Sclerosis Centre, from October 2001 to April 2002.

SUBJECTS

One hundred and thirty-four consecutive inpatients with multiple sclerosis.

INTERVENTION

During two weeks of inpatient stay the mood disorder was analysed. On the basis of clinical interview and Beck Depression Inventory the diagnosis of depression was confirmed.

MAIN MEASURES

Beck Depression Inventory and structured clinical interview.

RESULTS

Fifty-seven per cent (77/134) of people with multiple sclerosis answered 'Yes' to the question 'Are you depressed?'. The diagnosis of depression was confirmed in 94% (72/77) of people with multiple sclerosis and not confirmed in 6% (5/77). Hence, the screening test sensitivity was 91%. Forty-three per cent (57/134) answered 'No'; 70% (40/57) did not have depression. In this case the sensitivity was 54%. In this group 30% (17/57) were actually depressed according to tests and clinical impression. The age, sex, duration of disease, cognitive abilities and physical disability did not influence consistency of the answers with test results and clinical opinion.

CONCLUSIONS

One-question interview is a useful tool for screening for depression in people with multiple sclerosis as it confirms existing depression (sensitivity 91%), but the results should be treated with caution if the person denies mood problems.

Prevalence and short-term outcome of juvenile idiopathic arthritis: a population-based study in Estonia

OBJECTIVES

To study the point prevalence of juvenile idiopathic arthritis (JIA) in children in Estonia on December 31, 2000. To examine the short-term clinical outcome of the disease.

METHOD

Identification of patients diagnosed with JIA between 1995-2000. Prospective follow-up of new cases diagnosed between 1998-2000 for two years. Retrospective analysis of the medical records of patients diagnosed between 1995-1997. The study was population-based.

RESULT

One hundred and ninety-seven (197) patients fulfilled the study criteria. On December 31, 2000, the point prevalence of JIA was 83.7 (95% CI: 72.4; 95.8) per 100 000 children aged 0-15 years, 90.7 (95% CI: 74.1; 108.9) for girls and 77.1 (95% CI: 62.2; 93.5) for boys. Prevalence was the highest among 11-15 year-old girls (132; 95% CI: 100.7; 167.4) and the lowest in 0-3 year-old girls (9.6; 95% CI: 1.2; 26.7). For 44 patients (22.3%), the disease was inactive after 2 years since the onset of the disease. For 76 patients (38.6%). the disease was active or stable after 2 years.

CONCLUSION

This is the first population-based study on the prevalence and outcome of JIA in Estonia in which the new ILAR criteria have been used. A longer follow-up of JIA patients is needed to have a better overview of the course of the disease. Good cooperation between family doctors and specialists is crucial for diagnosing JIA as early as possible.

Incidence of juvenile idiopathic arthritis in children in Estonia: a prospective population-based study

OBJECTIVE

To study the incidence rate of juvenile idiopathic arthritis (JIA) and its clinical subtypes in Estonia, to follow the course of the disease in newly diagnosed patients for 2 years, and to find the frequency of human leucocyte antigens (HLA) B27, DR1 and DR4 in JIA patients.

METHOD

A population-based study involving prospective registration of new cases of JIA in 1998-2000 and their clinical follow-up for 2 years.

RESULTS

In 1998-2000, 162 new cases of JIA were diagnosed. The mean annual incidence rate of JIA was 21.7 per 100 000 children aged 0-15 years (22.9 in girls and 19.3 in boys). During the investigation period, the incidence rate rose 3.5-fold. Oligoarthritis was the most frequent subtype (mean annual incidence rate of 11.7 per 100 000), followed by seronegative polyarthritis (4.4 per 100 000). HLA-DR1, B27 and DR4 were found respectively in 44.4, 28.6 and 11.1% of cases in which the analysis was performed. In HLA-B27-positive patients, inflammation markers of blood remained at a high level for a longer period compared with HLA-B27-negative patients.

CONCLUSIONS

This is the first population-based study on the epidemiology of juvenile arthritis in Estonia in which the new classification criteria defined by the International League of Associations for Rheumatology (ILAR) have been used. In addition to environmental factors, an increase in awareness among family doctors is a probable reason for the rise in incidence during the study period. HLA-B27 might have predictive value as a marker of chronicity of inflammation.

Cerebral blood-flow velocities in predicting outcome of asphyxiated newborn infants

AIM

To evaluate the role of early (up to 12 h) changes in cerebral blood-flow (CBF) velocity in predicting the severity of hypoxic-ischaemic encephalopathy (HIE) and long-term outcome in asphyxiated term infants.

METHODS

CBF velocities were investigated by colour Doppler ultrasonography in 81 healthy and 60 asphyxiated term infants at least three times during the first 5 d of life. The psychomotor development of infants was followed up to 18 mo.

RESULTS

No differences in CBF velocities were found at the age of 2-6 h between infants with severe and mild-moderate HIE, mean CBF velocity [mean (95% CI of mean CBF velocity)] in anterior cerebral artery [14.9 (1.4-28.4)cm/s] and [13.9 (11.1-16.7) cm/s], respectively, and between infants with poor outcome (death or severe disability) and with normal development/mild impairments. By the age of 12 h infants with mild-moderate HIE and infants with normal development/mild impairments had decreased CBF velocity in the anterior cerebral artery, and infants with severe HIE or poor outcome had increased mean CBF velocity in anterior, medial cerebral and basilar artery compared to the control group.

CONCLUSION

The value of CBF velocity changes to predict poor outcome in asphyxiated infants is low 2-6 h after asphyxia, but increases by the age of 12 ho.

Sudden death of a girl with Prader-Willi syndrome

We report on the sudden death of a 3.5-year-old girl with Prader-Willi syndrome (PWS) and 15q11-q13 deletion. She suffered from severe chronic breathing disturbances and recurrent bronchitis. During an episode of acute bronchitis she had a cardiac arrest and died two months later of the sequelae. Brain CT imaging three weeks after the arrest showed bilateral symmetrical haemorrhages in the basal ganglia region. The spatial distribution of the haemorrhages can possibly suggest that the basal ganglia in PWS may be especially susceptible to hypoxemia.

Four siblings with Hallervorden-Spatz disease

We reported four cases of Hallervorden-Spatz disease. All four siblings (three males and one female) in the family are affected. The first symptoms of the disease were spastic paraparesis and optic atrophy followed by trunkal dystonia and lower motor neurone involvement. The average age of the onset was 4.25 years. The diagnosis was made at the ages of 17, 14, 11 and 10 years. The diagnosis was confirmed clinically, electrophysiologically and by MRI. On MRI scans all patients demonstrated hypointense areas in globus pallidus. There is neither specific treatment nor prenatal diagnosis.

Neurocognitive development of children with congenital unilateral brain lesion and epilepsy

The aim of this study was to specify the neuropsychological deficits characteristic of children with unilateral non-progressive brain lesion. In order to assess these specific functions, we used a comprehensive model of congenital hemiparesis with partial epilepsy and newly diagnosed partial epilepsy without hemiparesis. The neuropsychological examination was performed using the NEPSY test battery on 44 children aged from 4 to 9 years. The children were divided into three groups: 18 children suffering from congenital hemiparesis with chronic partial epilepsy, 12 children with newly diagnosed partial epilepsy prior to anti-epileptic treatment, and 14 healthy controls matched by sex, age, and socioeconomic status. Children with congenital hemiparesis and epilepsy had a more clearly expressed cognitive dysfunction, especially in language, visuo-perceptual and memory tasks, than children with newly diagnosed partial epilepsy. The profile of cognitive weakness appears to be diffuse and quite similar in both groups, and it did not demonstrate a clear effect of lateralization, according to the side of epileptic electroencephalogram discharges. Children within both groups are likely to have a high risk of developing attention, phonological, visuo-perceptual, and memory deficits in their life. Especially interesting and surprising was the fact that the newly diagnosed epilepsy group demonstrated impairment not only in attention, visuo-perceptual and short-term memory skills, but also in auditory perception, lexical function, and the comprehension of speech. Therefore, it is recommended that children with epilepsy would undergo neuropsychological examination in order to assess their cognitive abilities.

The high frequency of coeliac disease among children with neurological disorders

In the present study we have explored antigliadin (AGA) and antireticulin (ARA) antibody tests for the serological screening for coeliac disease (CD) of 206 children with neurological disorders. IgA- or/and IgG-type AGA was discovered in 17 (8.3%) patients and IgA-type ARA in one (0.5%) patient. A small intestinal biopsy was performed in all 18 antibody-positive patients, and villous atrophy compatible with CD was revealed in three cases (patients with either epilepsy, retardation of psychomotor development or Down's syndrome). The CD prevalence rate of 14.6 per 1000 (95% CI 7.0-22.2) found in the present study was higher than could have been anticipated on the basis of the results of our previous population studies, which indicate that CD occurs more frequently among children with neurological disorders (OR = 37.6; 95% CI 9.7-146.9). Whether this finding reflects certain immunopathogenic links between CD and particular neurological diseases needs to be studied further. In this study, we were unable, using indirect immunofluorescence testing, to demonstrate the presence of autoantibodies against brain tissue in CD and AGA-positive patients.

Cognitive outcome of children with early-onset hemiparesis

The aim of this study was to examine the cognitive outcome of children with congenital and acquired early-onset unilateral brain lesions associated with hemiparesis. The neuropsychologic evaluation was done using the NEPSY test battery on 37 children with hemiparesis and 13 sex- and age-matched healthy controls. Compared to the controls, children with left-sided brain lesions had significant delay in phonologic and language functions, while children with right-sided brain lesions performed more poorly in visual and spatial skills and in somatosensory functions. There were more left-handed children in the former (6 of 23) than in the latter (1 of 14) group. There was no significant difference in cognitive outcome between children with congenital and acquired lesions. The cognitive outcome of boys and that of children with active epilepsy was more affected. Overall, the patients showed impairment in many cortical functions and diffuse cognitive delay compared to controls and the side of lesion, active epilepsy, and male gender were significant factors in predicting cognitive outcome.

Boy with celiac disease, malformations, and ring chromosome 13 with deletion 13q32-->qter

We describe a 2(1/2)-year-old boy with a ring chromosome 13 with distal deletion of 13q32-->qter and celiac disease.

Serum total magnesium and ionized calcium concentrations in asphyxiated term newborn infants with hypoxic-ischaemic encephalopathy

Total magnesium, ionized calcium, potassium and sodium concentrations in mixed umbilical cord blood and venous blood serum at a median (min.-max.) age of 33 h (24-48 h) were assessed colorimetrically in 46 asphyxiated and 35 healthy term infants. Asphyxiated infants without any signs or with signs of mild hypoxic-ischaemic encephalopathy (HIE) had significantly higher, and infants with severe HIE lower umbilical cord blood serum total magnesium (mean (95%CI) 0.81 (0.75-0.87) mmol/l and 0.64 (0.47-0.87) mmol/l, respectively, p < 0.05) compared with the control group (0.72 (0.69-0.76)mmol/l). An increase in serum total magnesium in spite of normalized acid-base status in asphyxiated infants suffering from severe HIE compared with the control group infants was found by the second day of life (0.97 (0.87-1.07) mmol/l and 0.86 (0.81-0.9) mmol/l, respectively, p < 0.05). At the age of 24-48 h hypermagnesaemia (>2 SD) was discovered in 36%, hyponatremia (<2 SD) in 38%, and hypocalcaemia (<2 SD) in 23% of asphyxiated infants. Derangements (>2 SD) in at least two electrolytes by the second day of life were significantly associated with poor outcome.

CONCLUSIONS

Magnesium, calcium and sodium derangements are a frequent finding in asphyxiated infants, and these abnormalities are significantly associated with poor outcome. For a better outcome prediction, the routine determination of magnesium in addition to other electrolytes in asphyxiated infants is recommended.

Prevalence of childhood epilepsy in Estonia

PURPOSE

To establish the prevalence rate (PR) and main characteristics of childhood epilepsy in Estonia.

METHODS

We performed a population-based case ascertainment of all the possible sources of medical care in seven counties of Estonia from January 1995 to December 1997. Only cases of patients from 1 month to 19 years of age with active epilepsy (i.e., at least one seizure during the last 5 years, regardless of treatment) were included. All patients were examined by a pediatric neurologist.

RESULTS

Five hundred sixty cases met the study criteria on the prevalence day, December 31, 1997. The total PR was 3.6 per 1,000 population (boy/girl ratio, 1.2:1.0). The PR was the highest-4.3 per 1,000-in the 5-to-9-year-old age group. The prevalence declined markedly in children age 14 years and on. The correlation between age and PR was negative (-0.542, p < 0.0001) by regression analyses. The most frequent seizure types in the total group were primarily generalized seizures-PR 2. 1/1,000 [rate ratio (RR) 1.4, 95% confidence interval (CI) 1.2, 1.6]. The predominance of generalized seizures was significant in those younger than 10 years. In 14.8% of cases, there was a history of epilepsy among first- and second-degree relatives. Benign rolandic epilepsy-PR 0.2/1,000-was the most frequent among idiopathic syndromes, and Lennox-Gastaut syndrome-PR 0.08/1,000-was the most frequent among cryptogenic ones. Perinatal factors-PR 0.8/1,000 were the most frequently found cause of epilepsy. In 304 cases (54.2%), additional medical problems existed.

CONCLUSIONS

The prevalence of childhood epilepsy was comparable with that found in developed countries. Generalized seizures predominated, and the main cause was perinatal factors.

Duchenne and Becker muscular dystrophies: an Estonian experience

The clinical and molecular features of 25 Duchenne (DMD), two intermediate (D/BMD) and three Becker (BMD) muscular dystrophy patients from 26 unrelated families were evaluated. Early psychomotor development was normal in patients with D/BMD and BMD. Learning to walk independently after 15 months of age was a risk sign of DMD in nine (36%) patients. Abnormality in crawling was seen in 13 (54%) patients with DMD. These boys demonstrated initial symptoms earlier than those who learned to crawl normally. Mental retardation was established in five (20%) patients with DMD. Deletions in the dystrophin gene were found in 11 families (48%). They were accumulated (9/11, 82%) in the distal region of the gene.

Incidence of childhood epilepsy in Estonia

The aim of this study has been to establish the incidence rate (IR) and main characteristics of childhood epilepsy in Estonia. A population-based prospective study was performed from January 1st 1995 to December 31st 1997 in seven counties (population of children 161202). Only cases occurring in the age range of 1 month to 19 years with active epilepsy were included. Two hundred and sixteen cases met the study criteria. The total age-adjusted IR was 45/100000. The IR was the highest, 73/100000, in the age group from 1 month to 4 years. The IR declined markedly after the age of 15 years. Primarily generalized seizures demonstrated a higher IR, 25/100000, than partial seizures, the IR of which was 20/100000. The IR of symptomatic epileptic syndromes was 16/100000, that of cryptogenic, 15.5/100000 and that of idiopathic, 13/100000. The cumulative incidence of epilepsy through age 19 was 0.13%. A family history of epilepsy was present in 13.9% of cases. In 40.7% of cases the cause of epilepsy was identified. Adverse perinatal events were the most frequent etiological factors: in 25%, IR 11/100000. In 103 cases (47.6%) additional medical problems were disclosed. Strong negative univariate association was noted between partial seizures and idiopathic etiology (OR 0.37, 95%CI 0.18, 0.72; P = 0.002) and between partial seizures and motor disability (OR 0.43, 95%CI 0.24, 0.78; P = 0.003). The incidence of childhood epilepsy in Estonia was comparable with developed countries. Generalized seizures predominated. Perinatal factors were the main causes. The idiopathic etiology and motor disability of cryptogenic and symptomatic cases were associated with generalized seizures.

Is the International League against Epilepsy classification of epileptic syndromes applicable to children in Estonia?

The concept of the epileptic syndrome has had a practical and research impact on the management of patients with epilepsy. The aim of the present study was to verify the applicability of the International Classification of Epilepsies and Epileptic Syndromes in children and adolescents in Estonia. A population-based study was performed between January 1995 and December 1997 in seven counties. Only cases involving children between the ages of 1 month and 19 years with at least two unprovoked seizures were included. In all, 560 children and adolescents were referred to the Children's Hospital of the University of Tartu. A syndrome diagnosis was made in 550 (98.2%) cases: (49.4%) were localization-related (6.4% idiopathic, 18.9% symptomatic, 24.1% cryptogenic). Benign childhood epilepsy with centrotemporal spikes was present in 33 (5.9%) and childhood epilepsy with occipital paroxysms in three (0.5%); 48.4% were generalized (28.8% idiopathic, 5.7% cryptogenic or symptomatic, 14% symptomatic). Childhood absence epilepsy was present in 6.4%, juvenile absence in 2.0%, juvenile myoclonic in 0.7% and epilepsy with generalized tonic-clonic seizures on awakening in 17.7%. West syndrome was diagnosed in 1.4%, Lennox-Gastaut syndrome in 2.9% of the cases. In 0.4% of the cases it was undetermined whether seizures were focal or generalized. In 8.8% of the cases there were atypical features so they were classified as 'other symptomatic generalized epileptic syndromes not defined above' and 1.8% of the cases were unclassified. Specific neurological diseases were diagnosed in 5.0% of cases. Thus, the International Classification of Epilepsies and Epileptic Syndromes was very applicable to children and adolescents in Estonia.

Changes in Doppler ultrasonography in asphyxiated term infants with hypoxic-ischaemic encephalopathy

Cerebral blood flow velocity was assessed by pulsed-Doppler ultrasonography in 39 asphyxiated and 35 healthy term newborn infants during the first days of life. Asphyxiated infants, investigated at the age of 12 +/- 2 h, with moderate stage hypoxic-ischaemic encephalopathy (HIE) (n = 7) had decreased (15.6 +/- 3.9 cm/s) and infants with severe stage of HIE (n = 8) increased (26.5 +/- 9.6 cm/s) mean cerebral blood flow velocity in medial cerebral artery compared to the control group (20.9 +/- 3.7 cm/s). Four out of six infants with severe stage of HIE and mean cerebral blood flow velocity of 3 SD above the mean for normal infants at the age of 12 h died and two developed multicystic encephalopathy during the neonatal period. We conclude that severe post-hypoxic increase of mean cerebral blood flow velocity at the age of 12 +/- 2 h is connected with development of severe stage HIE and poor prognosis.

Concentrations of magnesium and ionized calcium in umbilical cord blood in distressed term newborn infants with hypoxic-ischemic encephalopathy

Magnesium and ionized calcium in mixed umbilical cord blood was assessed colorimetrically in 38 distressed and 21 healthy term newborn infants. Distressed infants with a severe or moderate degree of hypoxic-ischemic encephalopathy (HIE) (n = 8) had significantly lower (p < 0.001) concentrations of magnesium (0.52 +/- 0.08 mmol/L) compared to the control group (0.69 +/- 0.06 mmol/L). No differences in concentrations of ionized calcium between distressed and control infants were detected.

Markers of oxidative stress before and after exchange transfusion for neonatal sepsis

Oxidative status before and after ET was assessed in eight septic newborns who received exchange transfusion (ET). Short-term elevations of conjugated dienes (CDs) and thiobarbituric acid reactive substances (TBARSs) (p < 0.05) and increased serum antioxidant capacity (AOC) (p = 0.06) were noted. Chromatographic migration of the red blood cells (CM RBCs), a measure of RBC deformability, also improved after ET. ET for neonatal sepsis does not cause significant oxidative stress; rather, it may help to restore the antioxidant depots and improve RBC deformability and microcirculation.

Creatine kinase isoenzyme BB concentrations in cerebrospinal fluid in asphyxiated preterm neonates

Creatine kinase isoenzyme BB was determined in cerebrospinal fluid (CSF) in 79 preterm neonates using an original enzyme-linked immunosorbent assay. The criterion for inclusion was an Apgar score of 7 or less at 5 min of life. Neurological examination was performed on day 2 and day 5 of life. CSF was obtained on the same days. Lumbar puncture was performed on 41 of these babies on day 2 and in 39 on day 5 of life (one baby underwent lumbar puncture twice). All babies had clinical features of hypoxic-ischemic encephalopathy (HIF) which was classified according to Sarnat and Sarnat. The control group consisted of 90 asphyxiated term babies and 30 adults without CNS pathology. The concentration of CK-BB in cerebrospinal fluid (mean +/- SD) was significantly higher (p < 0.0005) in preterm (168.0 +/- 2) than in term babies (29.0 +/- 3.1) and healthy adults (5.3 +/- 1.2). Our results demonstrate the possibility of using the classification system of Sarnat and Sarnat for assessment of the severity of brain damage not only in term, but also in preterm babies. Neonates with HIE stages II and III showed markedly higher CK-BB values than those with HIE I on day 2 (p < 0.025) and day 5 (p < 0.05) of life. CK-BB values were markedly higher in preterm babies with none of some primitive responses (head turning, Babkin's reflex, palmar grasp). The mean concentration of CK-BB was higher in neonates with retarded psychomotor development compared with those with normal development (p < 0.05) on day 3, and after 6 and 9 months. At 12 months of age no significant difference in median CK-BB concentration was detected between neonates with normal and developmental disturbances.

Enzymatic changes in the cerebrospinal fluid in patients with infections of the central nervous system

Enzymatic determinations in cerebrospinal fluid (CSF) of aspartate aminotransferase (AST), lactic dehydrogenase (LDH), gammaglutamyl transpeptidase (GGT), creatine phosphokinase (CPK) and creatine kinase BB (CK-BB) were performed in 16 patients with aseptic meningitis (AM), in 25 children with bacterial meningitis (BM) and in 15 patients with meningism. The activity of AST and GGT was significantly higher in patients with BM on admission compared with those with AM and meningism (p < 0.05 and p < 0.005, respectively) and decreased with therapy. The highest concentration of AST and LDH appeared in patients with poor outcome as well as in those with ventriculomegaly on neurosonography (p < 0.05). The concentration of CK-BB increased in all patient groups on admission and remained higher on termination of therapy. The present study confirms the high activity of AST and GGT in BM patients in the CSF whereas the increased activity of AST and LDH reflects the extent of brain injury. Nevertheless, the prognosis for individual patients cannot be established on the basis of enzyme activity alone, but depends on several factors.