Benign childhood epilepsy with centrotemporal spikes (BECTS) and developmental co-ordination disorder

Background:- Benign epilepsy with centro-temporal spikes (BECTS) is a common childhood epilepsy syndrome also known as Rolandic Epilepsy (RE). Neurocognitive phenotypes have been described with greater focus on attention, reading and language domains but there have been far fewer studies focusing on motor functioning. This study included measures of motor, language and cognition in order to investigate the range, degree and pattern of difficulties associated with BECTS in a case series of children, but with a particular emphasis on motor skills. Method:- Twenty-one children aged between 8 and 16 years with a diagnosis of BECTS were asked to complete standardized assessments for language, cognition, motor functioning and handwriting. Results:- When measuring across language, cognitive and motor domains, 19 (90.48%) of the twenty-one children with a diagnosis of BECTS showed some difficulties on at least one area of functioning using standardized assessment tests. Of particular note nearly half (47.62%) of the children had some difficulties in one or more areas of motor functioning. Discussion:- Children with BECTS have a heterogeneous pattern of neurocognitive impairments. The presence of motor difficulties (DCD) should be considered in all children routinely seen in clinical settings with BECTS and included in any screening processes

Development of locally relevant clinical guidelines for procedure-related neonatal analgesic practice in Kenya: a systematic review and meta-analysis.

Background Increasing numbers of neonates are undergoing painful procedures in low-income and middle-income countries, with adequate analgesia seldom used. In collaboration with a multi-disciplinary team in Kenya, we aimed to establish the first evidence-based guidelines for the management of routine procedure-related neonatal pain that consider low-resource hospital settings. METHODS: We did a systematic review by searching MEDLINE, Embase, CINAHL, and CENTRAL databases for studies published from Jan 1, 1953, to March 31, 2019. We included data from randomised controlled trials using heart rate, oxygen saturation (SpO2), premature infant pain profile (PIPP) score, neonatal infant pain scale (NIPS) score, neonatal facial coding system score, and douleur aiguë du nouveau-né scale score as pain outcome measures. We excluded studies in which neonates were undergoing circumcision or were intubated, studies from which data were unextractable, or when pain was scored by non-trained individuals. We did a narrative synthesis of all studies, and meta-analysis when data were available from multiple studies comparing the same analgesics and controls and using the same outcome measures. 17 Kenyan health-care professionals formed our clinical guideline development panel, and we used the Grading of Recommendations, Assessment, Development and Evaluation framework and the panel's knowledge of the local health-care context to guide the guideline development process. This study is registered with PROSPERO, CRD42019126620. FINDINGS: Of 2782 studies assessed for eligibility, data from 149 (5%) were analysed, with 80 (3%) of these further contributing to our meta-analysis. We found a high level of certainty for the superiority of breastfeeding over placebo or no intervention (standardised mean differences [SMDs] were -1·40 [95% CI -1·96 to -0·84] in PIPP score and -2·20 [-2·91 to -1·48] in NIPS score), and the superiority of oral sugar solutions over placebo or no intervention (SMDs were -0·38 [-0·61 to -0·16] in heart rate and 0·23 [0·04 to 0·42] in SpO2). We found a moderate level of certainty for the superiority for expressed breastmilk over placebo or no intervention (SMDs were -0·46 [95% CI -0·87 to -0·05] in heart rate and 0·48 [0·20 to 0·75] in SpO2). Therefore, the panel recommended that breastfeeding should be given as first-line analgesic treatment, initiated at least 2 min pre-procedure. Given contextual factors, for neonates who are unable to breastfeed, 1-2 mL of expressed breastmilk should be given as first-line analgesic, or 1-2 mL of oral sugar (≥10% concentration) as second-line analgesic. The panel also recommended parental presence during procedures with adjunctive provision of skin-to-skin care, or non-nutritive sucking when possible. INTERPRETATION: We have generated Kenya's first neonatal analgesic guidelines for routine procedures, which have been adopted by the Kenyan Ministry of Health, and have shown a framework for clinical guideline development that is applicable to other low-income and middle-income health-care settings. FUNDING: Wellcome Trust Research Programme, and the Africa-Oxford Initiative

Ipsilateral cortical motor desynchronisation is reduced in benign epilepsy with centro-temporal spikes

Objective:- Magnetoencephalography (MEG) and a simple motor paradigm were used to study induced sensorimotor responses and their relationship to motor skills in children diagnosed with Benign Epilepsy with Centro-Temporal Spikes (BECTS). Methods:- Twenty-one children with BECTS and 15 age-matched controls completed a finger abduction task in MEG; movement-related oscillatory responses were derived and contrasted between groups. A subset of children also completed psycho-behavioural assessments. Regression analyses explored the relationship of MEG responses to manual dexterity performance, and dependence upon clinical characteristics. Results:- In children with BECTS, manual dexterity was below the population mean (p = .002) and three showed severe impairment. Our main significant finding was of reduced ipsilateral movement related beta desynchrony (MRBDi) in BECTS relative to the control group (p = .03) and predicted by epileptic seizure recency (p = .02), but not age, medication status, or duration of epilepsy. Laterality scores across the entire cohort indicated that less lateralised MRBD predicted better manual dexterity(p = .04). Conclusions:- Altered movement-related oscillatory responses in ipsilateral motor cortex were associated with motor skill deficits in children with BECTS. These changes were more marked in those with more recent seizures. Significance:- These findings may reflect differences in inter-hemispheric interactions during motor control in BECTS

Motor cortex oscillations, motor pathways and motor control in rolandic epilepsy

Aims:- There is increasing evidence that rolandic epilepsy, chara cterised by focal motor seizures arising from rolandic cort ex and interictal spiking activity over centro-temporal cortical regions, is associated with motor coordination disorders. This was investigated using psychobehavioral measures, diffusion weighted imaging (DWI) and neuromagnetic induced motor responses. Methods:- Children aged between 8 and 14 years with a diagnosis of rolandic epilepsy were assessed using the Movement-ABC (MABC-2,Henderson et al., 2007), DWI, and cued unilateral index finger movements in MEG. For each individual, cortical locations of MEG motor responses were identified using a beamforming approach. Mean magnitude and peak frequency were extracted from time-frequency windows of interest. Mean DWI fractionalanisotropy (FA) was computed for motor tracts in the dominant hemisphere between the following ROIs: supplementary motor area (SMA), M1, thalamus, cerebellum, basal ganglia. Results:- MABC-2 scores were variable but significantly below the popu lation mean and several children scored below the 5th percen tile. Greater magnitude of post-movement beta rebound activity (PMBR) and ipsilateral movement-related beta desynchrony(MRBDi) during movements of the dominant index finger predicted better scores on the MABC-2 aiming and catching sub-test.Greater PMBR and MRBDi were predicted by higher FA of thalamus to SMA tracts. Conclusion:- Smaller MRBDi and PMBR in patients with poorer motor co-ordi nation may reflect abnormal motor network activity. The magnitude of these induced beta band responses, believed to reflect inhibitory control (Engel & Fries, 2010, Curr. Op.Neurobio.), maybe partially determined by structural characteristics of specific motor pathways, reflected in their FA. Induced cortical oscillatory responses and DWI of motor pathways may provide markers of impaired motor skills during development