| 1. |
- Darin, Niklas, 1964, et al.
(författare)
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Clinical, serological and PCR evidence of cytomegalovirus infection in the central nervous system in infancy and childhood.
- 1994
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Ingår i: Neuropediatrics. - : Georg Thieme Verlag KG. - 0174-304X .- 1439-1899. ; 25:6, s. 316-22
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Tidskriftsartikel (refereegranskat)abstract
- Over a 3-year-period (Dec. 1990-Nov. 1993) 12 children were found PCR-positive for CMV-DNA in CSF and brain biopsies. Three of the patients were immunologically compromised. During the same period CSF samples from 10 shunt-operated children and 143 virological routine CSF samples were PCR CMV negative. Clinical association with positive PCR-CMV reaction was considered likely in 6 patients: two boys developed prolonged fever and meningoencephalitis following neurosurgery, one infant girl had a course compatible with congenital inclusion disease, and three had prolonged fever following transplantation. Clinical association was deemed probable in 3 infant girls: one had neonatal infection, meningitis and intraventricular haemorrhage, one had neonatal encephalitis and failure to thrive, and one with neonatal seizures and encephalitis developed brain atrophy. Clinical association was judged possible in 3 patients: one infant girl with no signs of encephalitis developed brain atrophy, one had an Aicardi Type 1 syndrome and one 2 1/2-year-old boy had an acute encephalitis with insufficient serological support for CMV but was 12 months later PCR positive for CMV. We conclude that CMV may be an overlooked infectious agent of the CNS also in immunocompetent children. PCR aids in rapid diagnosis of CMV infection in the immunocompromised. CMV may occasionally be disclosed with PCR in other conditions as a probably non-relevant observation.
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| 2. |
- Laegreid, Liv, et al.
(författare)
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Benzodiazepine amplification of valproate teratogenic effects in children of mothers with absence epilepsy.
- 1993
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Ingår i: Neuropediatrics. - : Georg Thieme Verlag KG. - 0174-304X .- 1439-1899. ; 24:2, s. 88-92
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Tidskriftsartikel (refereegranskat)abstract
- Valproate (VPA) is one of the most frequently used antiepileptic drugs (AEDs). Concern has recently been raised regarding VPA medication during pregnancy and teratogenic effects in the offspring. Both neural tube defects (5, 18, 34) and a constellation of signs termed the fetal valproate syndrome (1, 12) have been reported. Benzodiazepines (BZDs) are also widely used and sometimes as effective adjunctives in AED therapy. Both VPA and BZD have close connections to GABA transmission. Recently, clinical and epidemiological human studies (26, 27, 37, 39), supported by animal studies (17, 24, 40), have indicated that BZDs may act as human teratogens. We report on 7 children with congenital malformations, dysmorphism and abnormal neurological signs from birth. The mothers had well controlled primary generalized absence epilepsy without major seizures during pregnancy. Five children had been exposed to VPA monotherapy and two children to VPA and BZD combined during the first trimester. Those two infants had myelomeningoceles and the most pronounced dysmorphism in the group. We propose that these observations indicate a possible amplifying action of BZDs on VPA teratogenicity. Unrecognized BZD use during pregnancies exposed to VPA may be of importance when estimating the teratogenic risks of VPA therapy.
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| 3. |
- Hellström-Westas, Lena, et al.
(författare)
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Cerebral function monitoring during the first week of life in extremely small low birthweight (ESLBW) infants
- 1991
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Ingår i: Neuropediatrics. - 0174-304X. ; 22:1, s. 27-32
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Tidskriftsartikel (refereegranskat)abstract
- In order to evaluate the usefulness of early continuous EEG-monitoring in very preterm neonates, recordings with a Cerebral Function Monitor (CFM) were made prospectively in 31 ESLBW infants with birthweights below 901 grams, during their first week of life. The CFM background activity was, as expected from EEG studies, dominated by a suppression-burst pattern in 94% of the infants. Some infants had periods with more continuous EEG activity or suppression-burst changing into continuous. Patterns similar to sleep-wake cycling (SWC) were identified in infants with gestational ages as low as 24 weeks. The level of the CFM-background activity was mainly influenced by the presence and severity of intracranial hemorrhage (ICH), but also by medications such as phenobarbital. Epileptiform activity (EPA) was only found in infants with ICH, and was identified in 75% of these infants. Of the infants with EPA, 87% had periods with subclinical EPA, although 47% had both clinical and subclinical seizures. The presence of more continuous activity and SWC were indicators of a favourable outcome, whereas electrocerebral inactivity predicted an unfavorable outcome. The prognostic estimates of mortality and neurologic outcome were similar for early CFM recording (positive predictive value 69-100%) and cranial ultrasound scan (positive predictive value 71-100%). The monitoring of cerebral electrical activity also provided immediate and clinically useful information during the intensive care of these ESLBW infants. Further studies on the causal relation between EPA and the development of ICH should be performed before definite conclusions can be drawn concerning any preventive effect from anticonvulsive treatment of clinical/subclinical seizures.
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| 4. |
- Skov, L, et al.
(författare)
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Acute changes in cerebral oxygenation and cerebral blood volume in preterm infants during surfactant treatment
- 1992
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Ingår i: Neuropediatrics. - 0174-304X. ; 23:3, s. 126-130
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Tidskriftsartikel (refereegranskat)abstract
- Following administration of surfactant a marked depression in aEEG activity occurs for about 10 minutes; the mechanism of this depression is unknown. In view of this, twenty-nine preterm infants were investigated with near infrared spectroscopy (NIRS) to evaluate rapid changes in total cerebral haemoglobin concentration and cerebral oxyhaemoglobin concentration during rescue treatment with natural surfactant. During surfactant instillation there was a short-lasting hypoxaemia as demonstrated by pulseoximetry as well as a considerable fall in arterial blood pressure. With NIRS, tissue hypoxia was demonstrated by a drop in cerebral oxyhaemoglobin concentration. The marked drop in arterial blood pressure occurring immediately following surfactant was not matched by a drop in total cerebral haemoglobin concentration. This suggests that cerebral blood volume and hence cerebral blood flow was maintained. In the following minutes there was an improvement in cerebral oxygenation as indicated by the rise in cerebral oxyhaemoglobin concentration in nearly all the infants.
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| 5. |
- Uvebrant, Paul, 1951, et al.
(författare)
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Brain single photon emission computed tomography (SPECT) in neuropediatrics.
- 1991
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Ingår i: Neuropediatrics. - 0174-304X. ; 22:1, s. 3-9
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Tidskriftsartikel (refereegranskat)abstract
- The clinical value in neuropediatrics of [99mTc]HM-PAO brain single photon emission computed tomography was preliminary evaluated by the consecutive investigation of 79 children. Planned epilepsy surgery was the most common indication for the investigation. In 56 children investigated because of epilepsy, SPECT yielded relevant information in 79% of cases examined. The corresponding figures for magnetic resonance imaging and CT were 49% of 35 and 36% of 56 cases, respectively. All 22 children with an epileptic focus, ascertained by freedom from seizures after removal of the area or by consistent neurophysiological and neuroradiological findings, also had abnormal perfusion in the relevant area. Twenty-three children were examined because of neurological signs and symptoms other than epilepsy. SPECT findings were useful for elucidating neonatal brain impairments. Hypoperfused areas in the brain of asphyxiated infants and in posthemorrhagic hydrocephalus corresponded to neuroradiological and autopsy findings. SPECT was found to be an excellent tool when analysing cerebrovascular accidents. In cases with signs and symptoms of a diffuse severe encephalopathy, SPECT did not clarify the etiology but provided information on the distribution of the lesions and probable underlying pathophysiological mechanisms.
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| 6. |
- Uvebrant, Paul, 1951, et al.
(författare)
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Intractable epilepsy in children. The efficacy of lamotrigine treatment, including non-seizure-related benefits.
- 1994
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Ingår i: Neuropediatrics. - 0174-304X. ; 25:6, s. 284-9
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Tidskriftsartikel (refereegranskat)abstract
- Fifty children and adolescents with intractable epilepsy were treated with lamotrigine. Most of the children had other neuro-impairments, such as mental retardation, cerebral palsy and autism, added to their epilepsy. Five stopped lamotrigine treatment within four months because of side effects. In the 45 children who continued treatment for a mean of 14 months, five became seizure-free and in 16 the seizure frequency was reduced more than 30 percent. Absences and complex partial seizures responded best. In 24 of the 45 children, the parents reported an improvement in the mental state of their child, with better contact, longer attention span and improved alertness. In eight of 13 autistic children, the autistic symptoms decreased during lamotrigine treatment. This also occurred in children with an unchanged seizure situation, indicating a specific positive psychotropic effect of lamotrigine in mentally retarded and autistic children.
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| 7. |
- Uvebrant, Paul, 1951, et al.
(författare)
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The epidemiology of progressive encephalopathies in childhood. I. Live birth prevalence in west Sweden.
- 1992
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Ingår i: Neuropediatrics. - 0174-304X. ; 23:4, s. 209-11
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Tidskriftsartikel (refereegranskat)abstract
- Progressive encephalopathies in the west Swedish region were investigated in a population-based study. Cases were allocated to one of five main groups: 1) disorders covered by impairments in subcellular organelles, 2) disorders covered by deficiencies in the intermediate metabolism, 3) biochemically undefined neurometabolic disorders, 4) neuroimmunological disorders and 5) a symptom-orientated miscellaneous group. Progressive encephalopathies were identified in 76 of 132,138 children born alive in the study area during the 16-year-period 1970-85. This gives a live birth prevalence of 0.58 per 1000. In Sweden the size of the group corresponds to that of neural tube defects and that of congenital hydrocephalus. However, a vast number of different disorders are represented.
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| 8. |
- Wiklund, Lars-Martin, et al.
(författare)
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Computed tomography as an adjunct in etiological analysis of hemiplegic cerebral palsy. I: Children born preterm.
- 1991
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Ingår i: Neuropediatrics. - 0174-304X. ; 22:1, s. 50-6
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Tidskriftsartikel (refereegranskat)abstract
- Computed tomography (CT) of the brain has been used to evaluate potential etiologies of hemiplegic cerebral palsy in a population-based group of 28 children born preterm, in whom an obvious postnatal cause of hemiplegia could be excluded. The CT findings were classified according to a system so constructed to reflect the phase of brain maturation during which the insult causing hemiplegia likely had occurred. We found that 50% had evidence of periventricular leukomalacia the lesion typical of hypoxic-ischemic injury to the immature brain. However, it was not possible, neither from the CT scans nor from retrospective review of available clinical data, to date the injury more precisely to the pre- or perinatal period. Analysis of CT findings further showed that 18% of the children had cerebral maldevelopment, indicating an injury during early fetal life as the cause of hemiplegia, earlier than clinically suspected. The CT scans were normal in 25% of the children. It is concluded that the objective information obtained by studying the morphology of brain lesions using CT provides important information in addition to clinical data, and should be integrated with clinical assessment when attempts are being made to evaluate the etiology of cerebral palsy in children.
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| 9. |
- Wiklund, Lars-Martin, et al.
(författare)
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Computed tomography as an adjunct in etiological analysis of hemiplegic cerebral palsy; II: Children born at term.
- 1991
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Ingår i: Neuropediatrics. - 0174-304X. ; 22:3, s. 121-8
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Tidskriftsartikel (refereegranskat)abstract
- CT brain scans were used to evaluate the most likely etiology of hemiplegic cerebral palsy in a group of children born at term. The population based study group comprised 83 children. The CT findings were classified to reflect the phase of brain maturation during which the injury causing hemiplegia most likely had occurred. The most common finding (37%) was periventricular atrophy considered to represent periventricular leukomalacia (PVL). PVL is a form of hypoxic-ischemic damage typical of the immature brain and most commonly seen as a complication of preterm birth. As this lesion was found in children born at term it was considered to reflect a cerebral injury that had occurred in utero. Cerebral maldevelopment, due to a very early intrauterine lesion, was detected in 17%, while cortical-/subcortical lesions, previously considered to be of major importance in hemiplegia, were seen in just 16% of the children. Altogether the CT findings indicated a prenatal origin of hemiplegia in 57%. Assessing the time of injury based on clinical records concurred with prenatal origin in 32% of the children thought to have prenatal origin of hemiplegia by CT. The objective information available from careful review of imaging information such as CT brain scans, is an important adjunct to clinical data. We propose that assessment of brain morphology, by means of imaging, should be integrated with clinical assessment when evaluating the etiology of brain lesions in children with congenital motor impairment.
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