Newra Tellechea Rotta

Paralisia cerebral, novas perspectivas terapêuticas

Objective: to provide pediatrician with updated information about diagnoses and treatment of cerebral palsy. This articles aims at supplying pediatricians with tools that will help them diagnose and treat cerebral palsy. Sources: non-systematic review of literature combined with personal experience at the Neurology Unit of Pediatrics Service of Hospital de Clinicas de Porto Alegre - Universidade Federal do Rio Grande do Sul. Summary of the findings: the cerebral palsy diagnosis and treatment are based on multidisciplinary clinical exam, EEG, CT and MR. Conclusions: pediatricians are the first physician that see the patient with cerebral palsy. Thus, they should be able to diagnose an treat it.

Autism and pervasive developmental disorders

OBJECTIVE To review the current knowledge on neurobiological aspects of autism and pervasive developmental disorders, as well as to provide pediatricians with up to date information on diagnosis and treatment of autism. SOURCES OF DATA Review of MEDLINE and Internet. SUMMARY OF THE FINDINGS Autism is the 3rd developmental disorder, with an incidence of 40 to 130/100,000 individuals. Diagnosis is based on clinical findings, following DSM IV criteria. Neuroimaging, investigation of fetal neurological status, and genetic investigation contribute towards a better understanding of the neurobiology of autism. CONCLUSION Pediatricians are the first health professional to come in contact with patients with autism. Thus, they should be able to diagnose and to coordinate the multidisciplinary treatment of these patients.OBJETIVO: Revisar os aspectos neurobiologicos do autismo e das doencas invasivas de desenvolvimento. Oferecer ao pediatra informacoes atualizadas sobre diagnostico e tratamento. FONTES DOS DADOS: Revisao bibliografica, abordando o tema por meio do sistema MEDLINE e procura direta. SINTESE DOS DADOS: Conforme dados da literatura, o autismo e a terceira mais comum desordem no desenvolvimento, ocorrendo em 40 a 130 casos por 100.000. O diagnostico e clinico, baseado nos criterios do DSM-IV. Os exames de neuroimagem e neurofetologia e os estudos geneticos contribuem para o melhor entendimento da neurobiologia do autismo. CONCLUSAO: O pediatra e o primeiro medico a entrar em contato com o paciente autista e deve estar apto para reconhecer os desvios do desenvolvimento e orientar a investigacao e o tratamento multidisciplinar.

Prevalence of attention-deficit hyperactivity disorders in students: comparison between DSM-IV and neuropsychological criteria

Attention-deficit hyperactivity disorder (ADHD) is a common childhood condition, recognized as an important social-medical problem. The syndrome is characterized by motor system, perception, cognition and behavioral disturbances, compromising the learning of children with adequate intellectual potential. To investigate its prevalence in first grade pupils 484 children with DSM-IV diagnostic criteria and neuropsychological criteria were examined. The prevalence of ADHD was 18% when the diagnosis was made using DSM-IV criteria; 3.5% when neuropsychological criteria was used, including, in addition to behavioral and psychometric aspects, a discrepancy in the evolutionary neurological examination, and 3.9% when motor persistence was taken into account. The prevalence of ADHD was higher among older children (92.4 months) only when DSM-IV criteria were used. We conclude that the use of DSM-IV criteria probably overestimates the prevalence of ADHD, since it detects another behavioral disorders. In this context, they may be useful as screening, since they have adequate pre-testing performance.

Associação entre desempenho das funções corticais e alfabetização em uma amostra de escolares de primeira série de Porto Alegre

Cortical brain functions are the basis of the learning process and evolutionary neurological examination (ENE) provides the level of development of the brain. The purpose of this work was to study by means of the ENE the brain functions in a representative sample of first grade students of Porto Alegre, to investigate the learning performance. An observation, analytical and transversal delineated study was performed. The random sample had 484 children. It was observed: sex, age, race, weight, height, neurological examination, ENE, performance in the number sub-tests, completing figures and codes from WISC scale and literacy learning. The items of ENE were below the expected for the age in 11.4% and 38.2% of the children: the most affected ones were the sensitivity activity and gnosias (38.2%) and the least one was motor persistence (11.4%). In psychometric tests, 40.5% of the subjects had their development in numbers below the espected, 39.0% in accomplishing figures, 71.5% in codes. Concerning literacy, 94.4% of the children learned to read and write. The neuropsychological dysfunction and malestablished laterality were a risk factor for the learning process.

Avaliação do desenvolvimento neuropsicomotor em escolares de primeira série e sua relação com o estado nutricional

OBJECTIVE: to investigate the neurological performance of elementary school students from the city of Porto Alegre, state of Rio Grande do Sul, Brazil, in order to assess the association of neurological development and nutritional status. METHODS: we carried out an observational, analytical, and crosssectional study on a random and proportional population sample selected out of all first-grade students (n=35,521) in the city of Porto Alegre for a total of 484 children, out of which 64.7% were enrolled in state public schools, 11.9% in city public schools, and 23.4% in private schools. Our sample size allowed for a precision of ± 3% (95% confidence interval) for an estimated prevalence of 10% of cortical dysfunction. Children were submitted to individual examinations at the school. We collected data regarding sex, age, color of skin, nutritional status, and school of origin. An informed consent was obtained from the State and City Departments of Education and from the principals of the private schools. Statistical analysis was carried out using the chi-square test and ANOVA.. RESULTS: from 11.4% to 38.2% of children presented ENE results lower than expected according to their age. The most affected factors were sensory activity and gnosia (38.2%), and the least affected factor was motor persistence (11.4%). There were no statistically significant differences between boys and girls. We observed an association of children with low height-for-age and weight-for-age and cortical dysfunction. CONCLUSION: chronic malnutrition is a risk factor for brain function performance.

Aquisição da linguagem oral: relação e risco para a linguagem escrita

The present study relates the acquisition of oral language to the development of writing in 236 children of a private school in the city of Porto Alegre, Brazil. The objective of this research was to identify non-linguistic factors involved in phonological acquisition and to describe the relation of phonological acquisition with alterations of writing. At the age of 6 years, kindergarten students were divided into 2 groups, based on the test of Phonological Evaluation of Children. In the follow-up, at 9 years of age, students were evaluated by means of Balanced Dictation and textual production. The comparison of results from case and control groups showed statistically significant difference as to the number of mistakes made in writing, pointing to the acquisition of oral language as a predictive factor for the development of spelling.

Auditory hypersensitivity in children and teenagers with autistic spectrum disorder

OBJECTIVE To verify if the clinical behavior of auditory hypersensitivity, reported in interviews with parents/caregivers and therapists/teachers of 46 children and teenagers suffering from autistic spectrum disorder, correspond to audiological findings. METHOD The clinical diagnosis for auditory hypersensitivity was investigated by means of an interview. Subsequently, a test of the acoustic stapedial reflex was conducted, and responses to intense acoustic stimulus in open field were observed. RESULTS Of the 46 subjects, 11 (23.9%) were clinically diagnosed as oversensitive to sound and only 2 showed discomfort when exposed to intense acoustic stimulus in open field. There was no statistically significant difference for the test of the ipsilateral acoustic stapedial reflex between the groups. CONCLUSION Behavioral manifestations to sounds are not associated to hypersensitivity of the auditory pathways, but instead these are associated to difficulties in the upper processing, involving systems that usually are impaired in autistic spectrum patients, such as the limbic system.

Ischemic stroke in children: a study of the associated alterations

Arterial ischemic stroke (AIS) in children is a relatively rare disease, not yet clearly understood and with a multifactored etiology. It can cause a severe impact on the child and be the first manifestation of a systemic disease. Delayed diagnosis is still common and research on the subject in our field practically does not exist. Prothrombotic disorders have been described as important causative factors of the ischemic event in children. Forty-six patients from zero to 18 years of age diagnosed with AIS were studied in the period between March 2002 and September 2003. Laboratory tests were realised including coagulation proteins and echocardiogram. AIS of the newborn occurred in 37% of the cases. Focal seizures and hemiparesis were the most frequent symptoms; 40% of the patients presented prior pathologies. Abnormalities of the S and C proteins occurred in 22% and 17%. Associated alterations, particularly those that generate a hypercoagulability state, indicate more than one risk factor for this disease in childhood.

Neurological examination in the healthy term newborn

We carried out a cross-sectional study with a sample of 106 normal full-term newborns examined within 24 to 72 hours of birth. The following findings were evaluated: head and chest measurements, muscle strength, tone, tendon reflexes, superficial reflexes, primitive reflexes, and cranial nerves. All 106 newborns were considered neurologically normal. We found no differences in the neurological examination findings for newborns with different gestational ages. Primitive reflexes and appendicular tone in newborns examined at earlier postnatal ages tended to be less intense. We were able to determine the prevalence of certain neurological examination findings for the normal newborn and to discuss some differences between our results and those of other studies. Prevalence estimations for the different findings in our study may be valid for different populations as long as the same methodology is adopted.

Avaliação pelo P300 de crianças com e sem epilepsia e rendimento escolar

Learning disability is common in epileptic children. Epilepsy has been associated with disorders of intelligence. Cognitive potential (P300) is considered to be a clinical aid in the neurophysiological measurement of the cognitive process. Ninety-nine children between the ages of 10 years and 11 years and 11 months formed our sample, with good and poor school performance. Group I, non-epileptic, had 64 children of whom 32 had good and 32 poor school performance. Group II, epileptic, had 35 children, of whom 21 had good and 15 poor school performance. No significant difference in P300 latency was found between Groups I and II. When groups were stratified based on school performance, Group I children with good school performance had P300 latency of 336 ms, while the ones with poor school performance had latency of 382 ms. Group II children with good school performance had P300 latency of 363, while the ones with poor school performance had latency of 400 ms. There was a statistically significant difference between the non-epileptic children with good school performance and the children with poor school performance, epileptic or not.Dificuldade de aprendizagem e situacao comum em criancas com epilepsia. Disturbios da inteligencia tem sido associados com epilepsia. O potencial cognitivo (P300) e um adjunto clinico para mensurar neurofisiologicamente o processo cognitivo. Foram estudadas 99 criancas com 10 anos a 11 anos e 11 meses. Do Grupo I, sem epilepsia, faziam parte 64 criancas, das quais 32 com bom rendimento e outras 32 com mau rendimento escolar. Do Grupo II, com epilepsia, faziam parte 35 criancas, sendo 21 com bom rendimento escolar e 15 com mau rendimento escolar. Nao foi encontrada diferenca significativa na latencia do P300 entre os dois grupos. Quando foram estratificados segundo o desempenho escolar, as criancas do Grupo I, com bom rendimento escolar, apresentaram latencia do P300 de 336 ms e as com mau rendimento escolar, latencia de 382 ms; as criancas do Grupo II, com bom rendimento escolar, apresentaram latencia do P300 de 363 ms e as com mau rendimento escolar, latencia de 400 ms, com diferenca significativa. Essa diferenca estava localizada entre as criancas nao epilepticas com bom desempenho escolar e as com mau desempenho escolar, epilepticas ou nao.