John R. Hughes

EEG and seizures in autistic children and adolescents: further findings with therapeutic implications.

The goal of this study was to investigate the incidence of epilepsy and also the EEG findings among children with autism (A), a devastating disorder, and to compare these data to an EEG control group. EEGs were quantified as to the degree of epileptiform activity and also slow wave abnormalities. Abnormal EEGs were found in 75% of the 59 A children and 82% of their 151 EEGs; 46% had clinical seizures. Nearly all children with seizures had epileptiform activity, but almost 20% of those with spike discharges did not have clinical attacks. Slow wave abnormalities were more frequent and of a greater degree of severity in the A group, compared to controls. One new finding was that a greater variability of EEG abnormalities was found in the A group. Therapeutic implications, based on these latter findings, are discussed.

Adolescents who kill

From a sample of 1,956 adolescent delinquents referred to us by the court for physical, psychological, psychiatric, educational, and social examinations, 71 delinquents convicted of homicide were matched with 71 nonviolent delinquents by age, race, sex, and socioeconomic status (SES). These two groups were compared on the basis of these evaluations by stepwise discriminant analysis, matched pairs, two-tailed t-tests, and nonparametric tests. Adolescents who kill have a tetrad of symptoms: (1) criminally violent family members; (2) gang membership; (3) severe educational difficulties; and (4) alcohol abuse.

Premature temporal theta (PTθ)

Abstract A distinctive pattern called premature temporal theta (PTθ) was studied in 436 infants, ranging in age from 24 to 46 weeks. The pattern is seen in early prematurity, maximizes at 29–31 weeks and then diminishes and disappears near term. Usually the pattern is found independently on both temporal areas, but with a right-sided preference. Patients without PTθ or with a significantly low amount had either neurological or non-neurological (medical) conditions. With age there is a tendency for an increase in frequency and a decrease in amplitude. Five different peaks in the amount of this pattern are seen at approximately every month. Unilateral PTθ tends to be seen in older babies, more often on the right side and with an abnormal EEG. An abnormal EEG is usually associated with a delay in both the appearance and disappearance of this wave form. PTθ is also associated mainly with REM or active sleep. A polynomial rather than an exponential or power function best describes these data with changes of age. PTθ may arise from the inferior temporal gyrus and/or especially the transverse gyrus.

Homicidal adolescents: a replication.

30 homicidal delinquents were matched with 30 nonviolent delinquents on age, race, sex, and socioeconomic status. Both groups received physical, psychological, educational, psychiatric and social examinations. Data were evaluated using stepwise discriminant analysis. Previous research was replicated. Homicidal adolescents shared four symptoms: criminally violent families, gang participation, alcohol abuse, severe learning difficulties. In addition, when the sample and the original group of murderers were combined the contrast between groups became clearer. Juvenile murderers lived in criminally violent families learning aggression during early childhood. Cognitive and perceptual deficits associated with epilepsy and central nervous system (CNS) conditions led to difficulties in the school years. During adolescence, gang participation and alcohol abuse added to earlier risk factors.

The importance of phase of stimulus and the reference recording electrode in brain stem auditory evoked potentials

In normal subjects the phase of the stimulus and the reference electrode of the brain stem auditory evoked potential (BAEP) were investigated. Compared to condensation (C), rarefaction (R) clicks produced longer latencies, especially for peaks IN, IIIN and IV and lower amplitudes, mainly for IIN. The amplitude of the initial phase of R clicks was lower in the acoustical wave form (with piezoelectric phones) than the succeeding higher amplitude C phase, but damping characteristics varied with recording conditions. In comparing Ipsi vs. Contra ear reference the Ipsi showed a shorter latency for II and IIN, a longer latency for III, IIIN and IV and a higher amplitude, except for II. The relative contribution of the central vertex (Cz) and of each ear to the standard Cz-ear linkage was determined by referring each to an indifferent electrode. The activity at the Ipsi ear was out of phase with Cz up to peak IV, especially I, IN and III (but not II) with a resulting high amplitude in the Cz-ear linkage; in-phase relationships were noted between Cz and the Contra ear resulting in a relatively low amplitude in the Cz-Contra ear linkage. Discussion of the latter points included the complex, but significant changes of the amplitude and latency of Cz activity by an ear reference.

Correlations between EEG and chemical changes in uremia

This study investigated correlations between the EEG and 10 different chemical indices in 23 uremic patients, tested over long periods of time (up to 18 months). An abnormal EEG was recorded at least once in 70% of these patients, but among the 362 tracings from all patients, 36% were considered abnormal. Slow wave abnormalities, mainly mild in degree and frontal in location, were found in 97% of abnormal records and epileptiform patterns in the form of bilateral spike and wave complexes were seen in 14%. Patients with these EEG abnormalities had a significantly slower frequency of background rhythm than patients with normal EEGs. Compared to those with normal records, patients with abnormal EEGs had a significantly higher BUN and Cl and lower Ca, as determined by standard (absolute) mean values. With relative changes, based on the percentage change from the previous value, the BUN, Ca, Cl, K, PO4 and CO2 showed significant relationships with a deteriorating EEG and the Ca, Cl, K and CO2 with an improving record. A deteriorating EEG was usually associated with an increasing BUN, Cr, K, Cl and Na and a decreasing Ca, PO4, Hct, Alb and CO2. Significant absolute changes in the chemical indices were more often seen than relative ones, especially with a deteriorating EEG. With either absolute or relatives values, the BUN showed the closest relationship with EEG deterioration and the Cr, Cl and Hct with EEG improvement. Changes were often seen in a combination of chemical indices, most often involving the BUN and to a lesser extent the Cr. With combined changes the one with the greatest change was especially the BUN and PO4. Variations in the amount of epileptiform activity were most closely related to changes in the BUN. The main conclusions of this study are that the BUN correlated best with the EEG among the 10 different serum values using various indices, especially standard (absolute) values with a deteriorating recording. The second highest number of correlations were found with the Cl, especially absolute values with an improving EEG. The Ca and K showed the best correlation with relative changes. Thus, correlations of various chemical indices with electrographic changes in uremic patients depend upon whether absolute or relative values are used and whether EEGs are deteriorating or improving.

Two forms of the 6/sec spike and wave complex

In 3 decades 1550 patients showed 6/sec spike and wave complexes; 839 were chosen for computer-analyzed electroclinical correlations. Control groups (each 500) included patients (1) randomly selected from EEG files, (2) with normal EEGs, (3) with only slow wave abnormalities, and (4) with only spike abnormalities. In the experimental group more females and Caucasians were found with peak age distribution at 11--15 years. The major symptoms were seizures (53%), neurovegetative (51%) and psychological complaints (24%), all significantly different from control groups, except for seizures in control group 4. Seizures were mainly generalized motor attacks, neurovegetative symptoms included headaches, dizziness and blackouts and psychological symptoms were mainly behavior disorders. As a presumed etiology head injury was noted in over 25% with this complex, which was maximal either on the anterior or occipital areas. Further computer analysis shows that two extreme forms can be identified: (1) the WHAM form, seen mainly in waking records, high amplitude, anterior location, more males, and (2) the FOLD form, seen mainly in females, occipital location, low amplitude, in drowsy states. The WHAM form appears primarily in patients with seizures, and the FOLD form in patients with neurovegetative and psychological complaints.

Controlled examination of effects of progressive relaxation training on seizure reduction.

Summary: We determined the efficacy of progressive muscle relaxation in reducing seizure frequency. Subjects were 24 people with epilepsy attending an urban neurology clinic. The experimental design consisted of an 8‐week baseline period, a treatment period of six sessions of progressive relaxation training (PRT, n = 13) or quiet sitting (QS, n = 11) and an 8‐week follow up. In the PRT group, 11 subjects reported a decrease in seizure frequency (p < 0.01), and in the QS group, 7 reported a decrease (p > 0.05). The mean decrease in seizure frequency was 29% for the PRT group (p < 0.01) but only 3% for the QS group (p > 0.05). This is the fifth recent report of a controlled study documenting the success of progressive relaxation therapy in seizure reduction. PRT is inexpensive and noninvasive and facilitates patient participation. Such a technique should be incorporated into clinical practice.

Developmental and Disruptive Behavior Disorders among Delinquents

Medical histories, psychological tests, psychiatric examinations, and social investigations were reviewed to determine the frequency of independent diagnoses of retardation, attention deficit disorder with hyperactivity (ADD-H), and attention deficit disorder without hyperactivity (ADD). In a sample of 1,956 (384 females and 1,572 males) adjudicated delinquents with a mean age of 13.9 +/- 1.9 years, 9% had ADD-H, 15% were retarded, and 46% had ADD. The reliabilities of the diagnoses were 0.95 for retardation, 0.91 for ADD-H, and 0.94 ADD. Retarded delinquents had the greatest scholastic delays followed by the ADD-H and ADD-adolescent offenders.

EEG in dialysis encephalopathy

Electroencephalography (EEG) in dialysis encephalopathy (DE) was investigated by collecting 173 EEGs from 77 dialyzed patients; 26 had DE. An attempt was made to predict the DE patients, as opposed to the control group without DE, on the basis of EEG alone. Based on the presence or absence of bilateral spike and wave complexes, 91% of the patients along with 91% of their EEGs were correctly placed into the proper clinical category. Also, diffuse slow waves, usually seen in bursts maximal on the frontal areas, appeared in the DE group significantly more often and also with a greater degree of abnormality than in the non-DE group. Considerable variability was noted in the EEGs of these patients. The bilateral spike and wave complexes were discussed as an EEG marker of dialysis encephalopathy, which now seems to be related etiologically to aluminum toxicity.