Diagnostic des mouvements anormaux du nouveau-né

RésuméLe nouveau-né est prédisposé à des phénomènes moteurs de sémiologie apparemment proche mais dont les mécanismes sousjacents et les étiologies peuvent être radicalement différents. Une analyse sémiologique fine, aidée au besoin par un enregistrement EEG vidéo, doit permettre de distinguer trémulations, myoclonies et convulsions qui sont les plus fréquents. Il ne faut pas méconnaître des manifestations motrices plus rares comme l’hyperekplexie et la myotonie. Le contexte de survenue, le caractère isolé ou associé à d’autres mouvements anormaux ou à des anomalies de l’examen clinique sont les éléments essentiels de l’orientation étiologique. Une démarche diagnostique précise est nécessaire pour éviter le traitement abusif de manifestations bénignes. Summary The newborn infant is prone to motor phenomena of various physiological mechanisms and pathological significance whereas they can share close clinical patterns. A detailed clinical analysis, that should be supported by a video EEG recording, is necessary. That may help to distinguish myoclonus, jitteriness or seizures. Some rare phenomenom such as hyperekplexia or myotonia have also to be known. The pregnancy and birth history, the clinical examination and the search for association of various motor phenomena give essential clues for the diagnosis. Misdiagnosing non epileptic phenomona as seizures has to be avoided as it leads to unnecessary anticonvulsivant therapy with potential harmful effects

Low prevalence of coagulation F2 and F5 polymorphisms in mothers and children in a large cohort of patients with neonatal arterial ischemic stroke

International audienc

New insights (and new interrogations) in perinatal arterial ischemic stroke

With an incidence of 1/2800 to 1/5000 live-births, perinatal arterial ischemic stroke is the most frequent form of cerebral infarction in children. About 40% of the children do not have specific symptoms in the neonatal period, and are only recognized later with the emergence of motor impairment, developmental delay, specific cognitive deficiency or seizures. In the remaining 60%, children present with early symptoms, mostly recurrent focal seizures in the first 3 days of life. The diagnosis is easily confirmed by cranial ultrasounds and MRI. Early MRI has both a key role in the diagnosis, dating the injury, but also an important prognostic value to predict the motor outcome of the child. Indeed, although the infarct does not recur, the majority of children show subsequent sequels: cerebral palsy, epilepsy, cognitive or behavioural problems. Finding predictors of outcome regarding these latter concerns (and the way to prevent or alleviate them) is of major interest.The main etiological hypothesis for perinatal AIS is a cerebral embolus, originating from the placenta through the foramen ovale. Most of the established risk factors are indeed either determinants or biomarkers of vasculo-placental pathology. Injury to the cervico-cerebral arteries, giving rise to thrombus/embolus during the birthing process is also suggested. Both placento-embolic and traumatic theories are supported by a few, but well-analysed pathological or arteriographic reports. Nevertheless, their relative frequency, the implication of other mechanisms, and their repercussions to evidence-based preventive strategies remain to be determined. Moreover, the mechanism of stroke in the different groups of newborns with stroke (term vs. preterm; symptomatic neonates vs. those with a delayed presentation) is likely to be different, and there is a need for future studies to assess all populations as different entities. Neonatal supportive care remains important for all infants while there is no evidence for preventive anticoagulant use at present. In an effort to reduce neurological dysfunction, and in adjunction with ongoing physical therapy and pharmacological treatment, new rehabilitative interventions, such as constraint-induced movement therapy and mirror therapy, are increasingly being used

A Pilot Study of Continuous Limited-Channel aEEG in Term Infants with Encephalopathy

ObjectiveTo evaluate the accuracy, feasibility, and impact of limited-channel amplitude integrated electroencephalogram (aEEG) monitoring in encephalopathic infants. Study design Encephalopathic infants were placed on limited-channel aEEG with a software-based seizure event detector for 72 hours. A 12-hour epoch of conventional EEG-video (cEEG) was simultaneously collected. Infants were randomly assigned to monitoring that was blinded or visible to the clinical team. If a seizure detection event occurred in the visible group, the clinical team interpreted whether the event was a seizure, based on review of the limited-channel aEEG. EEG data were reviewed independently offline. Results In more than 68 hours per infant of limited-channel aEEG monitoring, 1116 seizures occurred (>90% clinically silent), with 615 detected by the seizure event detector (55%). Detection improved with increasing duration of seizures (73% >30 seconds, 87% >60 seconds). Bedside physicians were able to accurately use this algorithm to differentiate true seizures from false-positives. The visible group had a 52% reduction in seizure burden (P = .114) compared with the blinded group. Conclusions Monitoring for seizures with limited-channel aEEG can be accurately interpreted, compares favorably with cEEG, and is associated with a trend toward reduced seizure burden

Arterial ischemic stroke in non-neonate children: Diagnostic and therapeutic specificities

Pediatric arterial ischemic stroke (AIS) is a severe condition, with long-lasting devastating consequences on motor and cognitive abilities, academic and social inclusion, and global life projects. Awareness about initial symptoms, implementation of pediatric stroke code protocols using MRI first and only and adapted management in the acute phase, individually tailored recanalization treatment strategies, and multidisciplinary rehabilitation programs with specific goal-centered actions are the key elements to improve pediatric AIS management and outcomes. The main cause of pediatric AIS is focal cerebral arteriopathy, a condition with unilateral focal stenosis and time-limited course requiring specific management. Sickle cell disease and moyamoya angiopathy patients need adapted screening and therapeutics

Evaluation of automatic feature detection algorithms in EEG: application to interburst intervals

In this paper, we present a new method to compare and improve algorithms for feature detection in neonatal EEG. The method is based on the algorithm׳s ability to compute accurate statistics to predict the results of EEG visual analysis. This method is implemented inside a Java software called EEGDiag, as part of an e-health Web portal dedicated to neonatal EEG. EEGDiag encapsulates a component-based implementation of the detection algorithms called analyzers. Each analyzer is defined by a list of modules executed sequentially. As the libraries of modules are intended to be enriched by its users, we developed a process to evaluate the performance of new modules and analyzers using a database of expertized and categorized EEGs. The evaluation is based on the Davies–Bouldin index (DBI) which measures the quality of cluster separation, so that it will ease the building of classifiers on risk categories. For the first application we tested this method on the detection of interburst intervals (IBI) using a database of 394 EEG acquired on premature newborns. We have defined a class of IBI detectors based on a threshold of the standard deviation on contiguous short time windows, inspired by previous work. Then we determine which detector and what threshold values are the best regarding DBI, as well as the robustness of this choice. This method allows us to make counter-intuitive choices, such as removing the 50 Hz filter (power supply) to save time

The effect of video-guidance on passive movement in patients with cerebral palsy: fMRI study

In patients with cerebral palsy (CP), neuroimaging studies have demonstrated that passive movement and action–observation tasks have in common to share neuronal activation in all or part of areas involved in motor system. Action observation with simultaneous congruent passive movements may have additional effects in the recruitment of brain motor areas. The aim of this functional magnetic resonance imaging (fMRI) study was to examine brain activation in patients with unilateral CP during passive movement with and without simultaneous observation of simple hand movement. Eighteen patients with unilateral CP (fourteen male, mean age 14 years and 2 months) participated in the study. Using fMRI block design, brain activation following passive simple opening–closing hand movement of either the paretic or nonparetic hand with and without simultaneous observation of a similar movement performed by either the left or right hand of an actor was compared. Passive movement of the paretic hand performed simultaneously to the observation of congruent movement activated more “higher motor areas” including contralesional pre-supplementary motor area, superior frontal gyrus (extending to premotor cortex), and superior and inferior parietal regions than nonvideo-guided passive movement of the paretic hand. Passive movement of the paretic hand recruited more ipsilesional sensorimotor areas compared to passive movement of the nonparetic hand. Our study showed that the combination of observation of congruent hand movement simultaneously to passive movement of the paretic hand recruits more motor areas, giving neuronal substrate to propose video-guided passive movement of paretic hand in CP rehabilitation