Различные исходы энцефалита, вызванного Herpes Simplex Virus (клинические и ЭЭГ наблюдения)

We followed clinical and EEG examinations of two patients with herpes simplex encephalitis (HSE) in acute condition along with monitoring their early and late outcomes. Patients: M. B., 23-year-old female, who completed home treatment as a severe organic psycho-syndrome, reliant on nursing care, and L. J., now 16-year-old female patient, whose HSE in the 3 rd year of her life went into auto-aggressive Rasmussen encephalitislike condition with epileptic status in the form of Epilepsia parcialis continua (EPC).The EEG signal was statistically processed using «power spectral analysis» with color maps 3D BM showing the performance of individual frequency bands topographically and the measurement of connectivity in longitudinal and transversal direction by means of the mean coherencies — indexes of connectivity.On the 9th year of L. J. life when she overcame varicella with a significant eruption of the skin and high temperature the highly active EEG patterns were attenuated both graphically and clinically with a significant reduction in focal epilepsy. The latter was affected by a total thiopentotal anesthesia and bolus corticotherapy, as well as amantadine sulphate.This patient exhibited central right lower limb mono-paresis in a selfstanding walk and 4–5 short myoclonic abduction cramps in arm joints associated with vocalized «hee-haw», deep inspiring and expiring in full consciousness. MRI proved hyperintense area parasagitally on the left side of the centromotor region and EEG with epileptogenic grapho-elements in adjacent scar. We compared the last sample of the EEG signal to the EEG patterns of her homozygous sister and found them identical with no pathological graphoelements.These patients survival was the result of continuing anti-viral treatment, intensive medical and nursing care aimed to protect neural cells in the brain, the effect of which was longitudinally monitored by classic and statistical EEG signal analysis.The late outcome of these patients was diametrically different. L. J. graduated from the 9-year primary school with good results. M. B. was progressively mobilized, despite the clinical signs of severe alterations of psychic sphere as a result of postencephalitic encephalopathy with insufficient response to neuroleptics and sedatives. After parents’ agreement received she was transferred to the regional hospital.Провели клинические и ЭЭГ-обследования 2 пациентов с острым энцефалитом, вызванным вирусом простого герпеса (ЭВВПГ): М. Б., 23-летняя женщина, получавшая лечение на дому по поводу тяжелого органического психосиндрома, постоянный уход за которой осуществляла медсестра, и Л. Й., 16-летняя пациентка, на 3-м году жизни перенесшая ЭВВПГ, который перешел в аутоагрессивную форму, напоминавшую энцефалит Расмуссена, с эпилептическим статусом в виде длительной парциальной эпилепсии. Проанализировали ранние и поздние исходы.Данные ЭЭГ статистически обработали с использованием «спектрального анализа мощности» и трехмерного цветного картирования, позволяющего выявить топическую локализацию отдельных диапазонов частот ЭЭГ-кривых и измерить межнейронные связи в продольном и поперечном направлениях с помощью определения средней когерентности (показателя межнейронных связей).На 9-м году жизни Л. Й. перенесла ветряную оспу с выраженными высыпаниями на коже и повышением температуры тела. При этом у нее выявили уменьшение высокоактивных изменений на ЭЭГ и клинической симптоматики, в том числе фокальной. Данное уменьшение произошло на фоне применения анестетика тиопентала и болюсного введения кортикостероидов, а также приема амантадина сульфата.При осмотре во время самостоятельной ходьбы у Л. Й. обнаружили центральный монопарез правой нижней конечности, а также — 4–5 коротких миоклонических спазмов в суставах рук при приведении, в сочетании с непроизвольными выкриками, напоминающими крик осла, глубокими вдохами и выдохами. Больная находилась при этом в полном сознании. По данным МРТ выявили область гиперинтенсивного сигнала парасагиттально на левой стороне двигательного центра, по данным ЭЭГ — признаки эпилептогенной активности в области прилежащего рубца. По результатам сравнения последней ЭЭГ пациентки Л. Й. с ЭЭГ ее гомозиготной сестры патологической активности не выявили — записи были схожи.Обе пациентки выжили на фоне длительного противовирусного лечения, интенсивной терапии, направленной на защиту нейронов головного мозга, эффект которой был доказан в динамике по данным классического и статистического анализа ЭЭГ.Поздние исходы у обследованных пациенток были диаметрально противоположными. Пациентка Л. Й. окончила 9-ти летнюю среднюю школу с хорошими результатами. Пациентка М. Б. была постепенно мобилизована, несмотря на клинические признаки постэнцефалитной энцефалопатии с недостаточным ответом на нейролептики и седативные средства. После получения согласия родителей ее перевели в областную больницу

Prenatal and Postnatal Serum PCB Concentrations and Cochlear Function in Children at 45 Months of Age

Background: Some experimental and human data suggest that exposure to polychlorinated biphenyls (PCBs) may induce ototoxicity, though results of previous epidemiologic studies are mixed and generally focus on either prenatal or postnatal PCB concentrations exclusively. Objectives: Our aim was to evaluate the association between pre- and postnatal PCB concentrations in relation to cochlear status, assessed by distortion product otoacoustic emissions (DPOAEs), and to further clarify the critical periods in development where cochlear status may be most susceptible to PCBs. Methods: A total of 351 children from a birth cohort in eastern Slovakia underwent otoacoustic testing at 45 months of age. Maternal pregnancy, cord, and child 6-, 16-, and 45-month blood samples were collected and analyzed for PCB concentrations. At 45 months of age, DPOAEs were assessed at 11 frequencies in both ears. Multivariate, generalized linear models were used to estimate the associations between PCB concentrations at different ages and DPOAEs, adjusting for potential confounders. Results: Maternal and cord PCB-153 concentrations were not associated with DPOAEs at 45 months. Higher postnatal PCB concentrations at 6-, 16-, and 45-months of age were associated with lower (poorer) DPOAE amplitudes. When all postnatal PCB exposures were considered as an area-under-the-curve metric, an increase in PCB-153 concentration from the 25th to the 75th percentile was associated with a 1.6-dB SPL (sound pressure level) decrease in DPOAE amplitude (95% CI: –2.6, –0.5; p = 0.003). Conclusions: In this study, postnatal rather than maternal or cord PCB concentrations were associated with poorer performance on otoacoustic tests at age 45 months. Citation: Jusko TA, Sisto R, Iosif AM, Moleti A, Wimmerová S, Lancz K, Tihányi J, Šovčíková E, Drobná B, Palkovičová L, Jurečková D, Thevenet-Morrison K, Verner MA, Sonneborn D, Hertz-Picciotto I, Trnovec T. 2014. Prenatal and postnatal serum PCB concentrations and cochlear function in children at 45 months of age. Environ Health Perspect 122:1246–1252; http://dx.doi.org/10.1289/ehp.130747

Different Fate of Herpes Simplex Encephalitis (Clinical and EEG Cases Report)

We followed clinical and EEG examinations of two patients with herpes simplex encephalitis (HSE) in acute condition along with monitoring their early and late outcomes. Patients: M. B., 23-year-old female, who completed home treatment as a severe organic psycho-syndrome, reliant on nursing care, and L. J., now 16-year-old female patient, whose HSE in the 3 rd year of her life went into auto-aggressive Rasmussen encephalitislike condition with epileptic status in the form of Epilepsia parcialis continua (EPC).The EEG signal was statistically processed using «power spectral analysis» with color maps 3D BM showing the performance of individual frequency bands topographically and the measurement of connectivity in longitudinal and transversal direction by means of the mean coherencies — indexes of connectivity.On the 9th year of L. J. life when she overcame varicella with a significant eruption of the skin and high temperature the highly active EEG patterns were attenuated both graphically and clinically with a significant reduction in focal epilepsy. The latter was affected by a total thiopentotal anesthesia and bolus corticotherapy, as well as amantadine sulphate.This patient exhibited central right lower limb mono-paresis in a selfstanding walk and 4–5 short myoclonic abduction cramps in arm joints associated with vocalized «hee-haw», deep inspiring and expiring in full consciousness. MRI proved hyperintense area parasagitally on the left side of the centromotor region and EEG with epileptogenic grapho-elements in adjacent scar. We compared the last sample of the EEG signal to the EEG patterns of her homozygous sister and found them identical with no pathological graphoelements.These patients survival was the result of continuing anti-viral treatment, intensive medical and nursing care aimed to protect neural cells in the brain, the effect of which was longitudinally monitored by classic and statistical EEG signal analysis.The late outcome of these patients was diametrically different. L. J. graduated from the 9-year primary school with good results. M. B. was progressively mobilized, despite the clinical signs of severe alterations of psychic sphere as a result of postencephalitic encephalopathy with insufficient response to neuroleptics and sedatives. After parents’ agreement received she was transferred to the regional hospital

Duration of breastfeeding and serum PCB 153 concentrations in children

Polychlorinated biphenyls (PCBs) are toxic, persistent, and bioaccumulative chemicals which, because of their lipophilic properties, are abundant in human breast milk. Breastfed infants are therefore at risk of being exposed to considerable amounts of PCBs. The commonly used exposure estimations, based solely on breast milk PCB levels and duration of breastfeeding, may lead to exposure misclassification. To improve assessments of exposure to PCBs, we determined PCB 153 serum concentration, as a model substance for PCBs, at the critical time of weaning for each child in 305 breastfed infants from 5 single time point concentration measurements spread over 7 years and data on duration of breastfeeding, using an earlier developed model of the system type. We approximated the dependence of PCB 153 serum concentration, Ctbf, adjusted to cord serum concentration, C0, on nursing period, by a polynomial function Ctbf/C0=0.596+0.278t-0.0047t(2) which reliably predicts exposure to PCB 153 of breastfed infants, important for assessment of dose-outcome relationships. Adjustment of current serum concentrations to cord serum concentration improved validity of exposure assessment

Ratio of cord to maternal serum PCB concentrations in relation to their congener-specific physicochemical properties

The aim was to characterize placental transfer of some congeners of polychlorinated biphenyls (PCBs) and to relate human in utero exposure to these pollutants to their physicochemical properties. We included into the study 1134 births during the period 2002-2003 from two highly PCB contaminated districts in eastern Slovakia. Concentrations of 15 PCB congeners (IUPAC No. 28, 52, 101, 123(+149), 118, 114, 153, 105, 138(+163), 167, 156(+171), 157, 180, 170, and 189) in umbilical cord (C) and maternal serum (M) were determined. The C/M ratios were significantly related, either positively or inversely depending on parameter, to the logarithm of partition coefficient octanol-water (KOW), to fusion enthalpy at the melting point, molecular weight, water solubility, total surface area of the molecule, solvent accessible surface area, melting point, molar volume, and molecular electronegativity distance vector. We found an inverse association between logKOW and lipid adjusted logC/M (const=1.078, b1=-0.179, p<0.001, R(2)=0.039). Parameters evaluated were interrelated except fusion enthalpy at the melting point and electron affinity vs. solubility. We discuss the possible role of cholesterol as a transplacental transporter of PCBs

Prenatal and postnatal serum PCB concentrations and cochlear function in children at 45 months of age.

BackgroundSome experimental and human data suggest that exposure to polychlorinated biphenyls (PCBs) may induce ototoxicity, though results of previous epidemiologic studies are mixed and generally focus on either prenatal or postnatal PCB concentrations exclusively.ObjectivesOur aim was to evaluate the association between pre- and postnatal PCB concentrations in relation to cochlear status, assessed by distortion product otoacoustic emissions (DPOAEs), and to further clarify the critical periods in development where cochlear status may be most susceptible to PCBs.MethodsA total of 351 children from a birth cohort in eastern Slovakia underwent otoacoustic testing at 45 months of age. Maternal pregnancy, cord, and child 6-, 16-, and 45-month blood samples were collected and analyzed for PCB concentrations. At 45 months of age, DPOAEs were assessed at 11 frequencies in both ears. Multivariate, generalized linear models were used to estimate the associations between PCB concentrations at different ages and DPOAEs, adjusting for potential confounders.ResultsMaternal and cord PCB-153 concentrations were not associated with DPOAEs at 45 months. Higher postnatal PCB concentrations at 6-, 16-, and 45-months of age were associated with lower (poorer) DPOAE amplitudes. When all postnatal PCB exposures were considered as an area-under-the-curve metric, an increase in PCB-153 concentration from the 25th to the 75th percentile was associated with a 1.6-dB SPL (sound pressure level) decrease in DPOAE amplitude (95% CI: -2.6, -0.5; p = 0.003).ConclusionsIn this study, postnatal rather than maternal or cord PCB concentrations were associated with poorer performance on otoacoustic tests at age 45 months

Pre- and postnatal polychlorinated biphenyl exposure and cognitive and behavioral development at age 45 Months in a cohort of Slovak children

Evidence of associations of pre- and postnatal exposure to polychlorinated biphenyls (PCBs) with cognitive development beyond early childhood is inconsistent. A previous report from this cohort observed adverse associations between early life PCB exposures and infant Bayley scores at age 16 months. The present study examines pre- and postnatal PCB exposures in relation to both behavior and cognitive development at age 45 months. Participants were 472 mother-child pairs residing in an area of eastern Slovakia characterized by environmental contamination with PCBs, which resulted in elevated blood serum concentrations. PCB-153 and PCB-118 concentrations were measured in maternal and in infant 6-, 16-, and 45-month serum samples. At age 45 months, children were administered five subtests of the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III), and mothers completed the Child Behavior Checklist (CBCL). Negative binomial and multiple linear regressions were used to estimate PCB-CBCL and PCB-WPPSI-III subtest score associations, respectively. Pre- and postnatal levels of PCB-153 and PCB-118 were not associated with cognitive performance on the WPPSI-III in this cohort. There was some suggestion that higher postnatal PCB concentrations were associated with more sleep problems and feelings of depression and anxiousness

A Birth Cohort Study of Maternal and Infant Serum PCB-153 and DDE Concentrations and Responses to Infant Tuberculosis Vaccination

BACKGROUND: Reasons for the highly variable and often poor protection conferred by the Mycobacterium bovis bacille Calmette–Guérin (BCG) vaccine are multifaceted and poorly understood. OBJECTIVES: We aimed to determine whether early-life exposure to PCBs (polychlorinated biphenyls) and DDE [1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene] reduces 6-month infant BCG vaccine response. METHODS: Data came from families participating in a prospective birth cohort in eastern Slovakia. At birth, maternal and cord blood were collected for chemical analyses, and infants were immunized with BCG. Blood was collected from infants for chemical analyses and to determine 6-month BCG-specific immunoglobulin (Ig) G and IgA levels. Multivariable linear regression models were fit to examine chemical–BCG associations among approximately 500 mother–infant pairs, with adjustment for confounders. RESULTS: The median 6-month infant concentration of the prevalent congener PCB-153 was 113 ng/g lipid [interquartile range (IQR): 37–248], and 388 ng/g lipid (IQR: 115–847) for DDE. Higher 6-month infant concentrations of PCB-153 and DDE were strongly associated with lower 6-month BCG-specific antibody levels. For instance, BCG-specific IgG levels were 37% lower for infants with PCB-153 concentrations at the 75th percentile compared to the 25th percentile (95% CI: –42, –32; p < 0.001). Results were similar in magnitude and precision for DDE. There was also evidence of PCB–DDE additivity, where exposure to both compounds reduced anti-BCG levels more than exposure to either compound alone. CONCLUSIONS: The associations observed in this study indicate that environmental exposures may be overlooked contributors to poorer responses to BCG vaccine. The overall association between these exposures and tuberculosis incidence is unknown. CITATION: Jusko TA, De Roos AJ, Lee SY, Thevenet-Morrison K, Schwartz SM, Verner MA, Palkovicova Murinova L, Drobná B, Kočan A, Fabišiková A, Čonka K, Trnovec T, Hertz-Picciotto I, Lawrence BP. 2016. A birth cohort study of maternal and infant serum PCB-153 and DDE concentrations and responses to infant tuberculosis vaccination. Environ Health Perspect 124:813–821; http://dx.doi.org/10.1289/ehp.151010