Cognitive-behavioral profiles in teenagers with Dravet syndrome

Aim: To investigate behavior and cognitive performances of teenage patients with Dravet syndrome (DS). Methods: We enrolled 20 teenage patients (12 females and 8 males) with DS, followed in the Child Neurology Unit of the Catholic University (Rome). Patients underwent a full clinical examination including behavioral and cognitive assessments (respectively, CBCL and Wechsler scales). Results: All patients showed behavior disorders and mental retardation, mild in six cases, moderate in seven and severe in the remaining seven. Among mildly retarded patients visual function, particularly visuo-motor abilities resulted mostly impaired in Wechsler subtests, whereas verbal skills were relatively preserved. In contrast, a general cognitive impairment was observed in moderately and severely retarded patients. Conclusions: Our teenage patients with DS compared with other series at different ages (young childhood, adulthood) suggest a progressivity of neurological and neuropsychological signs. A visuomotor default and a relative preservation of verbal skills, like what has been found in previous reports of younger patients, are still evident in mildly impaired cases. Therefore, the progression over time of these cases toward a generalized impairment may be suggested, but only longitudinal studies can confirm it.There was a possible responsibility of some epileptic disorders in worsening the neuropsychological outcome (early myoclonic seizures and atypical absences, as well as persistent EEG background slowness in the last 3 years)

Longitudinal assessments in discordant twins with SMA

We report longitudinal clinical and neurophysiological assessments in twins affected by spinal muscular atrophy (SMA) with discordant phenotypes. The boy had the homozygous deletion of SMN1, a typical type 1 SMA course, and died at the age of eight months. His twin sister, asymptomatic at the time of the diagnosis in her brother, had the same genetic defect but she developed clinical and electrophysiological signs of type 2 SMA. The reduction of tendon reflexes was the first clinical sign at the age of 4 months, followed within few weeks, by a mild decrement in the amplitude of the compound motor action potentials. After the age of 9 months, she showed a sudden clinical and electrophysiological deterioration. Among molecular tests, we determined SMN2 copy number, SMN2 and Plastin 3 transcript levels in peripheral blood, and observed no relevant differences between twins

6MWT can identify type 3 SMA patients with neuromuscular junction dysfunction

The aim of the study was to establish if the decrease in gait velocity on the 6 minute walk test relates to signs of neuromuscular junction dysfunction in spinal muscular atrophy type 3 patients. 6 minute walk test and low-rate repetitive nerve stimulation test were performed in fifteen ambulant patients with spinal muscular atrophy type 3 of age between 9 and 66 years. The 6 minute walk distance ranged between 66 and 575 m. The difference between the first and the 6th minute ranged between 0 and \ue2\u88\u9269%. The low-rate repetitive nerve stimulation test measured in % of loss ranged between \ue2\u88\u9231.7% to +4.2% to the axillary nerve. The correlation between 6 minute walk test changes and low-rate repetitive nerve stimulation test changes was 0.86. Our data suggest that the 6 minute walk test can identify fatigue in the ambulant type 3 patients who have a concurrent neuromuscular junction dysfunction. The identification of fatigue with a simple clinical test may help to target patients who may benefit from drugs that facilitate neuromuscular transmission

Sleep-potentiated epileptiform activity in early thalamic injuries: Study in a large series (60 cases)

OBJECTIVE: The study aims at a better definition of continuous spike-waves during sleep (CSWS) with an early thalamic lesion, focusing on various grades of sleep-potentiated epileptiform activity (SPEA). Their possible relationship with different clinical features was studied to try to define prognostic factors of the epileptic disorder, especially relating to behavior/cognitive outcome, in order to improve prevention and treatment strategies. METHODS: Sixty patients with early thalamic injury were followed since the first registration of SPEA with serial neurological, long term EEG monitoring and neuropsychological examinations, as well as neuroimaging and a detailed clinical history. They were classified in three different groups according to the sleep spike-waves (SW) quantification: electrical status epilepticus during sleep (ESES), more than 85% of slow sleep; overactivation between 50% and 85% and simple activation between 10 and 50%). Results were then examined also with a statistical analysis. RESULTS: In our series of CSWS occurring in early brain injured children with unilateral thalamic involvement there is a common neuropathologic origin but with various grades of SPEA severity. Statistical analysis showed that patients evolving toward ESES presented more commonly the involvement of the mediodorsal part of thalamus nuclei and a bilateral cortico-subcortical brain injury, epilepsy was more severe with a delayed onset; moreover, in the acute stage .ESES patients presented the worst behavior/cognitive performances. As to cognitive and behavior outcome, longer SPEA duration as well as bilateral brain injury and cognitive/behavior impairment in acute phase appear linked to a poor outcome; some particular neuropathology (ischemic stroke and haemorrhagic infarction) as well as hydrocephalus shunting are associated with behavior disorders. CONCLUSIONS: Discrete features seem to support different underlying mechanisms in ESES patients in comparison with less severe SPEA; they represent negative prognostic factors. Longer SPEA duration as well as bilateral brain injury and cognitive/behavior impairment in acute phase seem predictive of a worse cognitive/behavior outcome

Symptomatic and presumed symptomatic focal epilepsies in childhood: An observational, prospective multicentre study

none44noOBJECTIVE: To describe the clinical, neuropsychological, and psychopathologic features of a cohort of children with a new diagnosis of symptomatic or presumed symptomatic focal epilepsy at time of recruitment and through the first month. The selected population will be followed for 2-5 years after enrollment to investigate the epilepsy course and identify early predictors of drug resistance. METHODS: In this observational, multicenter, nationwide study, children (age 1 month-12.9 years) with a new diagnosis of symptomatic or presumed symptomatic focal epilepsy were consecutively enrolled in 15 Italian tertiary childhood epilepsy centers. Inclusion criteria were as follows: (1) diagnosis of symptomatic focal epilepsy due to acquired and developmental etiologies, and presumed symptomatic focal epilepsy; (2) age at diagnosis older than 1 month and 3 to 6 years, and >6 years. Clinical, electroencephalography (EEG), neuroimaging, and neuropsychological variables were identified for statistical analyses. RESULTS: Two hundred fifty-nine children were enrolled (116 female and 143 male). Median age: 4.4 years (range 1 month-12.9 years); 46.0% (n = 119) of children were younger than 3 years, 24% (61) from 3 to 6 years of age, and 30% (79) older than 6 years. Neurologic examination findings were normal in 71.8%. Brain magnetic resonance imaging (MRI) was abnormal in 59.9%. Children age ≤3 years experienced the highest seizure frequency in the first month after recruitment (p < 0.0001). Monotherapy in the first month was used in 67.2%. Cognitive tests at baseline revealed abnormal scores in 30%; behavioral problems were present in 21%. At multivariate analysis, higher chances to exhibit more than five seizures in the first month after epilepsy onset was confirmed for younger children and those with temporal lobe epilepsy. SIGNIFICANCE: In this prospective cohort study, an extensive characterization of epilepsy onset in children with symptomatic or presumed symptomatic focal epilepsies is reported in relation to the age group and the localization of the epileptogenic zone.noneVecchi, Marilena; Barba, Carmen; De Carlo, Debora; Stivala, Micol; Guerrini, Renzo; Albamonte, Emilio; Ranalli, Domiziana; Battaglia, Domenica; Lunardi, Giada; Boniver, Clementina; Piccolo, Benedetta; Pisani, Francesco; Cantalupo, Gaetano; Nieddu, Giuliana; Casellato, Susanna; Cappanera, Silvia; Cesaroni, Elisabetta; Zamponi, Nelia; Serino, Domenico; Fusco, Lucia; Iodice, Alessandro; Palestra, Filippo; Giordano, Lucio; Freri, Elena; De Giorgi, Ilaria; Ragona, Francesca; Granata, Tiziana; Fiocchi, Isabella; Bova, Stefania Maria; Mastrangelo, Massimo; Verrotti, Alberto; Matricardi, Sara; Fontana, Elena; Caputo, Davide; Darra, Francesca; Dalla Bernardina, Bernardo; Beccaria, Francesca; Capovilla, Giuseppe; Baglietto, Maria Pia; Gagliardi, Alessandra; Vignoli, Aglaia; Canevini, Maria Paola; Perissinotto, Egle; Francione, StefanoVecchi, Marilena; Barba, Carmen; DE CARLO, Debora; Stivala, Micol; Guerrini, Renzo; Albamonte, Emilio; Ranalli, Domiziana; Battaglia, Domenica; Lunardi, Giada; Boniver, Clementina; Piccolo, Benedetta; Pisani, Francesco; Cantalupo, Gaetano; Nieddu, Giuliana; Casellato, Susanna; Cappanera, Silvia; Cesaroni, Elisabetta; Zamponi, Nelia; Serino, Domenico; Fusco, Lucia; Iodice, Alessandro; Palestra, Filippo; Giordano, Lucio; Freri, Elena; De Giorgi, Ilaria; Ragona, Francesca; Granata, Tiziana; Fiocchi, Isabella; Bova, Stefania Maria; Mastrangelo, Massimo; Verrotti, Alberto; Matricardi, Sara; Fontana, Elena; Caputo, Davide; Darra, Francesca; Dalla Bernardina, Bernardo; Beccaria, Francesca; Capovilla, Giuseppe; Baglietto, Maria Pia; Gagliardi, Alessandra; Vignoli, Aglaia; Canevini, Maria Paola; Perissinotto, Egle; Francione, Stefan