Tomoko Tando

EEG improvements with antiepileptic drug treatment can show a high correlation with behavioral recovery in children with ADHD

We investigated the relationship between neuropsychological disturbance, assessed using the global assessment of functioning (GAF) and the ADHD-rating scale (ADHD-RS), paroxysmal EEG abnormalities, and treatment with valproate sodium (VPA) in children with both attention deficit hyperactivity disorder (ADHD) and paroxysmal abnormality (PA). Participants with ADHD but without obvious epilepsy were recruited between April 1, 2003 and March 31, 2008. Paroxysmal abnormality was scored by measuring the spike frequency. Of 46 children, 16 showed PA; 3 of the 16 were excluded because no follow-up EEG was available. The EEG improved with VPA treatment in 5 of 8 patients with frontal PA and 3 of 5 patients with rolandic PA. While 83.3% of the patients with improvements in both assessments had frontal PA, only 16.7% had rolandic PA. The patients with frontal PA showed a significantly higher correlation between PA frequency and improvement in ADHD-RS compared with those with rolandic PA. In this study of children with ADHD, EEG improvement with antiepileptic drug treatment showed a high correlation with behavioral improvements as shown by ADHD-RS and GAF scores. However, this was not a population-based study, and the relative importance of detecting and treating PA in ADHD has yet to be determined.

Repeated seizures induce prefrontal growth disturbance in frontal lobe epilepsy

BACKGROUND The possible consequences of seizures in the immature brain have been the subject of much conjecture. We prospectively measured frontal and prefrontal lobe volumes using three-dimensional (3D) magnetic resonance imaging (MRI)-based volumetry in patients with frontal lobe epilepsy (FLE) presenting with the same seizure semiology. The pathogenesis of repeated seizure-induced brain damage is discussed herein. METHODS Serial changes in regional cerebral volumes were measured in two patients with FLE presenting with intractable clinical courses and cognitive impairments/behavioral problems (FLE(+)) and four FLE patients without cognitive impairments/behavioral problems (FLE(-)). Eleven normal subjects (4-13 years old) served as controls. Volumes of the frontal and prefrontal lobes were determined using a workstation, and the prefrontal-to-frontal lobe volume ratio was calculated. RESULTS Frontal and prefrontal lobe volumes revealed growth disturbance in FLE(+) compared with those of FLE(-) and control subjects. In addition, prefrontal-to-frontal lobe volume ratio increased serially in FLE(-) similarly to controls, but was stagnant or decreased in FLE(+). Prefrontal growth also revealed more rapid recovery in a FLE(+) patient with shorter active seizure period. CONCLUSION These findings suggest that repeated seizures may lead to prefrontal growth disturbance. The occurrence of frequent seizures in patients with FLE may be associated with prefrontal lobe growth retardation, which relates to neuropsychological problems and ultimate neuropsychological outcome.

Efficacy and safety of add-on levetiracetam in refractory childhood epilepsy

PURPOSE The purpose of the present study was to evaluate the efficacy and safety of levetiracetam (LEV) in refractory epileptic children. METHODS The study group included 61 outpatients (7 generalized, 48 localization-related, 3 undetermined, 3 unclassified) aged between 16 months and 18 years. LEV was given twice daily at a total dose of 10 mg/kg/day. The final mean dose was 50.7 mg/kg/day. The mean number of prior anti-epileptic drugs was 5.2. The entire treatment period was more than 6 months after LEV administration. RESULTS Fifteen children (24.6%) became seizure-free for 6 months after starting LEV, and 18 (29.5%) had a seizure reduction of more than 50% for the entire 6 months. The response rate was 33/61 (54.1%). Responders included 2/3 of patients (66.7%) with epilepsy with continuous spikes and waves during slow sleep and 13/19 (68.4%) with frontal lobe epilepsy. The effective dosage of LEV in the responders demonstrated a wide range (mean, 46.1 mg/kg/day; range, 19.4-59.1 mg/kg/day), and showed bimodal distribution. Adverse events occurred in only two patients who did not require LEV discontinuation. CONCLUSION LEV represents an important addition to the treatments available for refractory epileptic children.

Developmental changes in frontal lobe function during a verbal fluency task: A multi-channel near-infrared spectroscopy study

OBJECTIVE Near-infrared spectroscopy (NIRS) is commonly used to investigate continuous changes of brain activation and has excellent time resolution. Verbal fluency task (VFT) is widely used as a neuropsychological test of frontal lobe function. The aim of this study was to investigate normal developmental change in frontal lobe function during VFT performance using multi-channel NIRS, specifically focusing on oxygenation hemoglobin (oxyHb) changes. METHODS The subjects were 9 adults and 37 childrens who were all healthy right-handed volunteers. Children were divided into four age groups (group A, 6-8 years; group B, 9-11 years; group C, 12-14 years; group D, 15-18 years). The [oxyHb] changes were measured with 22 channels of NIRS during VFT. We defined the frontopolar region as the region of interest for analysis, and calculated the Z-score to compare the data between groups. RESULTS The task performance changed with age. There were significant differences between group A and other groups. The Z-score of [oxyHb] also significantly increased with age, when comparing adults to groups A and B. The task performances decreased with time in all groups. In contrast, [oxyHb] only continued to increase in the adult group. CONCLUSION The verbal retrieval functions begin to mature in early adolescence and continue to grow up to adulthood.

Parental thoughts and actions regarding their child's first febrile seizure

Little is known about what parents think and how they act when their child experiences febrile seizure (FS). This study therefore surveyed parents of 78 children who had experienced a first FS regarding their thoughts and actions.

57. Developmental changes of oxy-Hb concentration during “rock, paper, scissors” task assessed by multi-channel NIRS

Objectives: Here we to investigate cognitive impairments reflected by partial omission mismatch negativity (MMN) aberration in schizophrenia. Methods: We recorded EEG during event-related functional MRI (fMRI) followed by diffusion tensor imaging (DTI) in 13 healthy volunteers and 12 schizophrenic patients. The fMRI data was analyzed on SPM08 and blood oxygenation level-dependent signals (BOLD) signal changes were calculated in region of interest analysis using MarsBaR software. In DTI analysis, the areas significantly deteriorated in patients compared to controls were detected with tract-based spatial statistics. Fractional anisotropy (FA) in white matter fibers related to each area was compared between groups using tract-specific analysis. The clinical manifestation in the patients was evaluated using the Positive and Negative Syndrome Scale. Results: A significant correlation was founded among data for each recording modality: EEG, fMRI and DTI. In particular, a correlation between FA in the left anterior cingulate cortex (ACC) and EEG/fMRI data was significant. The correlation analysis with SPM revealed a significant correlation between FA of the left ACC and BOLD activity in the left Heschl gyrus. Conclusion: Dysfunction of the left ACC and temporal lobe may specifically contribute to the MMN aberration in schizophrenia.

28. The development of mind and the frontal lobe function

The aim of this study was to study interhemispheric inhibition (IHI) after bilateral (bil-task) and right finger extension tasks (rttask). Participants were 16 healthy adults. The IHI was studied before and after the finger extension tasks (bil-task and rt-task) by paired-pulse technique with transcranial magnetic stimulation (TMS). MEPs were recorded with surface electrodes placed over the right extensor digitorum communis (EDC). The intensities of both condition and test stimuli were set at 120% of the resting motor threshold. The condition stimulus was applied to the right M1, and the test stimulus was applied to the left M1.The condition-test interval was set at 10 and 15 ms. The IHI ratio was obtained by mean conditioned MEP amplitude/mean test MEP amplitude. The IHI ratio increased significantly after bil-task and the increment lasted for 30 min. The IHI ratio also increased after rt-task, however, the increment did not last for 30 min. Our results suggest that the IHI is more disinhibited after the bilateral finger movements than the unilateral finger movements.

12. The ERP findings during a Go/NoGo task with different Chinese characters

Magnetic round coil stimulation over the spinal enlargement activates the spinal nerves at the neuro-foramina level. However, the cauda equina in spinal canal has never been activated. The aim of this study is to activate the cauda equina using specially-devised round coil of diameter 20 cm named Magnetic Augmented Translumbosacral Stimulation coil (MATS coil). Total 40 healthy subjects were recruited. Magnetic stimulation was performed to obtain compound muscle action potentials (CMAPs) from abductor hallucis muscle placing the edge of coil over the L1 and L3 spinous processes. The CMAPs were compared with those elicited by high-voltage electrical stimulation. Cauda equina conduction time (CECT) between L1 and neuro-foramina levels was also measured. The CMAP latencies to L1 level MATS coil stimulation were identical to those evoked by electrical stimulation at the same level. The CMAP latencies to L3 level MATS coil stimulation were variable in each subject. L1 level MATS coil stimulation activates the cauda equina at the root exit site from conus medullaris. L3 level MATS coil stimulation activates some mid part of cauda equina or the distal cauda equina due to current spread. The MATS coil allows us to evaluate spinal nerve conduction in the cauda equina.