Cortical thickness and sulcal depth: insights on development and psychopathology in paediatric epilepsy.

BackgroundThe relationship between cortical thickness (CThick) and sulcal depth (SDepth) changes across brain regions during development. Epilepsy youth have CThick and SDepth abnormalities and prevalent psychiatric disorders.AimsThis study compared the CThick-SDepth relationship in children with focal epilepsy with typically developing children (TDC) and the role played by seizure and psychopathology variables.MethodA surface-based, computational high-resolution three-dimesional (3D) magnetic resonance image analytic technique compared regional CThick-SDepth relationships in 42 participants with focal epilepsy and 46 TDC (6-16 years) imaged in a 1.5 Tesla scanner. Psychiatric interviews administered to each participant yielded psychiatric diagnoses. Parents provided seizure-related information.ResultsThe TDC group alone demonstrated a significant negative medial fronto-orbital CThick-SDepth correlation. Focal epilepsy participants with but not without psychiatric diagnoses showed significant positive pre-central and post-central CThick-SDepth associations not found in TDC. Although the history of prolonged seizures was significantly associated with the post-central CThick-SDepth correlation, it was unrelated to the presence/absence of psychiatric diagnoses.ConclusionsAbnormal CThick-SDepth pre-central and post-central associations might be a psychopathology biomarker in paediatric focal epilepsy.Declaration interestNone.Copyright and usage© 2015 The Royal College of Psychiatrists. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence

Synergistic research synthesis enabling evidence based practice

Introduction Evidence based practice requires showing upon what we are basing medical opinions and guidelines, or recognising when evidence is absent that guidance is “expert opinion” and research is required to fill evidence gaps. Aerospace is one of the final medical fields to begin organising a critical summary, adapted periodically, of evidence underpinning operations, and the Aerospace Medicine Systematic Review Group is a new initiative to fill this gap. This group facilitates high quality, transparent synthesis of evidence, to inform operational medical guidelines in best practice, while simultaneously guiding future research by identifying research gaps. The group has (A) facilitated a second review with the European Space Agency Medical Office to inform human Lunar and Martian mission medical considerations and (B) developed and published, open access, new review methods to aid others to undertake aerospace medicine systematic reviews. Methods (A) Electronic databases were searched from the start of records to April 2016. Studies were assessed with the Cochrane risk of bias tool. Effect size analysis was used to assess the effect of various g loading on human biomechanical and cardiopulmonary systems. (B) A new rating scale to appraise technical principles of studies to simulate partial gravity was implemented. Additional method guides for developing questions, protocol drafting, data extracting, quantifying effects and scoring a bed rest study quality were also developed. Results (A) The review identified 43 studies that found partial gravity appears unable to protect against cardiovascular and biomechanical changes. (B) The group designed and developed a website (www.aerospacemed.rehab/systematic-review-group) to provide free access to methods developed by the group and provide links to wider resources. Discussion The systematic review informed medical considerations for future human exploration missions and demonstrates how systematic synthesis of the evidence base more strongly and better informs medical operations than expert opinion, basic reviews or disordered individual studies. Limitations in the current conduct and reporting of aerospace medicine research are also highlighted. Continuing development of review methods, published as open access guides on the group website and working with review teams globally, will help bring synergy to, and enable high quality summary, of the aerospace medicine evidence base

Childhood Schizophrenia: Diagnostic and Treatment Challenges

Abstract. This paper describes the developmental challenges involved in confirming the diagnostic criteria of schizophrenia in children, the disorders that should be included in the differential diagnosis of this disorder, and how to differentiate their symptoms from those of schizophrenia. It then reviews the psychopharmacological treatment of early-onset schizophrenia focusing mainly on the short-term and long-term adverse effects of first-and second-generation neuroleptics. The diagnostic challenges, together with the adverse effects of neuroleptics, emphasize the importance of accurate diagnosis and medical monitoring of children with schizophrenia

Cannabis use and family history in adolescent first episode psychosis in Durban, South Africa

Objectives: To investigate the clinical correlates of cannabis use in adolescents with first episode psychosis (FEP).Methods: Inpatient psychiatric records provided demographic, lifetime cannabis use, family history of mental illness, and clinical data on 45 FEP adolescents, aged 12–18 years, admitted to a psychiatric unit in Durban, KwaZulu-Natal, South Africa, over a 2-year period.Results: Thirty-one (68.8%) of the 45 FEP adolescents reported a history of lifetime cannabis use. The age of FEP presentation and pre-diagnosis symptom duration was not significantly different in cannabis users versus non cannabis users. Of the 15/43 (34.8%) FEP patients with family history of mental illness, 10 had a history of cannabis use. The 26 (57.8%) schizophrenia spectrum disorder patients did not differ significantly from the 19 (42.2%) with other psychoses in terms of cannabis use and family history of mental illness. They were, however, significantly younger at age of presentation and had a significantly longer duration of pre-diagnosis symptoms.Conclusions: These preliminary findings suggest a high prevalence of cannabis use in adolescents with FEP and highlight the public health concern of addressing substance abuse in the adolescent population.Journal of Child and Adolescent Mental Health 2013, 25(1): 61–6

A Comparison of Exercise Interventions from Bed Rest Studies for the Prevention of Musculoskeletal Loss

Musculoskeletal loss in actual or simulated microgravity occurs at a high rate. Bed rest studies are a reliable ground based spaceflight analogue that allow for direct comparison of intervention and control participants. The aim of this review was to investigate the impact of exercise compared to no intervention on bone mineral density (BMD) and muscle cross-sectional area (muscle CSA) in bed rest studies relative to other terrestrial models. Eligible bed rest studies with healthy participants had an intervention arm with an exercise countermeasure and a control arm. A search strategy was implemented for MEDLINE. After screening, eight studies were identified for inclusion. Interventions included resistive exercise (RE), resistive vibration exercise (RVE), flywheel resistive exercise, treadmill exercise with lower body negative pressure (LBNP) and a zero-gravity locomotion simulator (ZLS). Lower limb skeletal sites had the most significant BMD losses, particularly at the hip which reduced in density by 4.59% (p<0.05) and the tibial epiphysis by 6% (p<0.05). Exercise attenuated bone loss at the hip and distal tibia compared to controls (p<0.05). Muscle CSA changes indicated that the calf and quadriceps were most affected by bed rest. Exercise interventions significantly attenuated loss of muscle mass. ZLS, LBNP treadmill and RE significantly attenuated bone and muscle loss at the hip compared to baseline and controls. Despite exercise intervention, high rates of bone loss were still observed. Future studies should consider adding bisphosphonates and pharmacological/nutrition-based interventions for consideration of longer-duration missions. These findings correlate to terrestrial bed rest settings, for example, stroke or spinal-injury patients

Imaging and genetics of language and cognition in pediatric epilepsy

This paper presents translational aspects of imaging and genetic studies of language and cognition in children with epilepsy of average intelligence. It also discusses current unanswered translational questions in each of these research areas. A brief review of multimodal imaging and language study findings shows that abnormal structure and function, as well as plasticity and reorganization in language-related cortical regions are found both in children with epilepsy with normal language skills and in those with linguistic deficits. The review on cognition highlights that multiple domains of impaired cognition and abnormalities in brain structure and/or connectivity are evident early on in childhood epilepsy and might be specific for epilepsy syndrome. The description of state of the art genetic analyses that can be used to explain the convergence of language impairment and Rolandic epilepsy includes a discussion of the methodological difficulties involved in these analyses. Two junior researchers describe how their current and planned studies address some of the unanswered translational questions regarding cognition and imaging and the genetic analysis of speech sound disorder, reading, and centrotemporal spikes in Rolandic epilepsy