•RGT increases balance children with hCP.•RGT increases walking speed and endurance of children with hCP.•RGT improves functional walking of children with hCP.•RGT increases muscle strength of lower ...limbs in children with hCP.•Aerobic exercises should be included in rehabilitation program of children with hCP.
The most prominent characteristics of hemiparetic cerebral palsy (hCP) children are structural and functional asymmetries. These children have low walking speeds, endurance and poor balance. The robotic walking devices repeat and experience symmetrical stepping at the corresponding speed and angles of the lower extremities.
Are robotic walking devices effective in the development of walking in hCP children who can walk?
How does the aerobic exercise experience with assisted and symmetrical movement affect the walking and local muscle, peripheral oxygenation of children with hCP?
This prospective, controlled study included 24 children with hCP. All children attended to a standard physiotherapy rehabilitation (PTR) program (three days a week for 12 weeks); those in the study group (n=12) also attended to an Robotic Gait Training (RGT) program three times a week. Evaluations performed before treatment, after treatment, and at the 3rd month after treatment included assessment of balance, functionality walking and measurements for oxygenation of vastus lateralis muscle and peripheral oxygenation.Results: The evaluations were similar for both groups before treatment. After treatment, walking speed, endurance and peripheral O2 saturation were increased and balance abilities and functional performances improved in the RGT group as compared with the pre-treatment evaluations; these improvements in balance and functional performance were generally preserved after 3 months of treatment. An increase in 6-min walking distance and a partial increase in gross motor functions and functional muscle strength were observed in the control group; however, these abilities were not preserved after the treatment.
RGT can provide a faster and higher effect on the development of functional muscle strength, balance, walking speed and endurance than the standard PTR program. It improves functional walking performance. RGT can be used for aerobic exercise training in children with walking hCP.
Recent literature suggests that goal-oriented and family-based interventions in enriched environment have a beneficial effect on neuromotor and cognitive development. We aimed to examine the ...short-term effects of SAFE (Sensory strategies, Activity-based motor training, Family collaboration, and Environmental Enrichment) early intervention approach on motor, cognitive, speech and language, and sensory development in preterm infants.
The study's sample population consisted of 24 preterm infants with corrected ages between 9 and 10 months. Infants in the control group participated in the family training program in accordance with the neurodevelopmental therapy principles (NDT). Infants in the treatment group were included in the family training program according to the principles of the SAFE Early Intervention Approach. Affordances in the Home Environment for Motor Development-Infant Scale (AHEMD-IS), Test of Sensory Functions in Infants (TSFI), Canadian Occupational Performance Measure (COPM), and Bayley Scales of Infant and Toddler Development III (Bayley III) were used to evaluate infants in both groups before and after 10 weeks of treatment (AHEMD-IS). The Depression, Anxiety, Stress Scale Short Form was used to assess the parents' mental health (DASS-SF).
The interaction effects (time × group) revealed significant differences for Bayley-III cognitive and language scores, TSFI total score, and AHEMD-IS total score in favor of the SAFE group (p < .05). However, there were no differences in Bayley-III motor composite score, COPM Performance score, and COPM Satisfaction score between the interaction effects (time × group) of the groups (p > .05).
SAFE early intervention approach improved cognitive, speech and language, sensory outcomes and provide enriched home environment in all domains when compared to NDT-based home program. SAFE is a promising novel early intervention approach for preterm infants.
Neuropsychiatric symptoms are common in multiple sclerosis (MS), but it is rarely associated with psychosis as the initial manifestation. Fourteen-year-old boy admitted with auditory hallucinations. ...His neurological examination was normal. Brain magnetic resonance imaging (MRI) showed multiple demyelinating lesions in the mesencephalon and periventricular regions. His IgG index was high and the oligoclonal band was positive. MS was diagnosed and pulsed corticosteroids were given and his psychotic symptoms regressed. After 22months, the patient presented with hemi-hypoesthesia, and repeated MRI showed new contrast enhancing lesion detected. His complaints completely resolved with pulse corticosteroid therapy. Increasing morbidity due to delay in MS treatment underlines the need to consider MS in the differential diagnosis of pediatric cases presenting with psychosis.
The use of neuroimaging, the General Movement Assessment (GMA), and the Hammersmith Infant Neurological Examination (HINE) to identify the risk of neurodevelopmental delay in early infancy is ...recommended.
The aim of this study was to examine the predictive power of neuroimaging, GMA and HINE for neurodevelopmental delay and cerebral palsy (CP) in infants with hypoxic ischemic encephalopathy (HIE) who were treated with hypothermia.
Retrospective cohort.
This retrospective study included 47 (18 female and 29 male) infants who were treated with hypothermia due to HIE. Neonates with a diagnosis of HIE were followed and assessed using neuroimaging, GMA, HINE and the Bayley Scales of Infant and Toddler Development-II (Bayley II) between 3 m and 2 years of age.
Out of the 47 infants with HIE, no fidgety movements were observed in 5 infants. The sensitivity and specificity in determining the psychomotor developmental index (PDI) score were 97% and 100%, respectively, for MRI; 92.9% and 100% for GMA; and 91.9% and 80% for the HINE. The sensitivity and specificity in determining the mental developmental index (MDI) score were 95% and 85.7%, respectively, for MRI; 90.5% and 80% for GMA; and 91.9% and 50% for HINE. The sensitivity and specificity in determining CP diagnosis at the age of 2 years were 83.3% and 95%, respectively, for MRI; 83.3% and 100% for GMA; and 83.3% and 87.8% for HINE.
The interpretation of MRI, GMA, and HINE that are performed within the early period of life may be the gold standard for the early detection of neurodevelopmental risks in 2-year-old infants with HIE. Clinical implementation of these methods in the early period in the follow-up of these infants offers useful information for the early identification of neurodevelopmental risk and for planning early intervention.
•The use of MRI, GMA, and HINE in infants with HIE who were treated with hypothermia has predictive value for motor outcomes.•The neuroimaging and GMA offer useful information in infants with HIE who were treated with hypothermia for later cognitive development.•It is recommended to use GMA and HINE in the early evaluation of infants with HIE who were treated with hypothermia.
Catatonia is a complex neuropsychiatric disorder involving stupor, waxy flexibility, and mutism lasting more than 1 hour. It has arisen mostly from mental and neurologic disorders. Organic causes are ...more prominent in children.
A 15-year-old female who had refused to eat and drink for 3 days, had not talked, and had stood in a fixed position for long periods was admitted to the inpatient clinic, and she was diagnosed with catatonia. Her maximum score on the Bush-Francis Catatonia Rating Scale (BFCRS) was 15/69 on day 2 of her stay. On neurologic examination, the patient`s cooperation was limited, and she was apathetic to her surroundings and stimuli and inactive. Other neurologic examination findings were normal. To investigate catatonia etiology, her biochemical parameters, thyroid hormone panel, and toxicology screening were conducted but all parameters were normal. Cerebrospinal fluid examination and autoimmune antibodies were negative. Sleep electroencephalography showed diffuse slow background activity, and brain magnetic resonance imaging was normal. As a first-line treatment for catatonia, diazepam was started. With her poor response to diazepam, we continued to evaluate the cause and found the transglutaminase levels were 153 U/mL (normal values, < 10 U/mL). The patient`s duodenal biopsies showed changes consistent with Celiac disease (CD). Catatonic symptoms did not benefit from a gluten-free diet or oral diazepam for 3 weeks. Then, diazepam was replaced with amantadine. With amantadine, the patient recovered within 48 hours, and her BFCRS retreated to 8/69.
Even without gastrointestinal manifestations, CD may present with neuropsychiatric symptoms. According to this case report, CD should be investigated in patients with unexplained catatonia, and that CD may only present with neuropsychiatric symptoms.
This observational study aimed to investigate the relationship between regional cerebral oxygen saturation (rSO
2
) during the 6-minute walk test (6-MWT) and the demographic/clinical features of ...patients with pulmonary arterial hypertension (PAH). Cerebral oxygenation was evaluated during the 6-MWT in 20 pediatric patients with PAH aged ≥ 7 years 13 male, 7 female; median age 12.25 (range 7–18) years. In all patients, regional cerebral oxygen saturation (rSO
2
), arterial oxygen saturation (SpO
2
), and heart rate (HR) were measured using near-infrared spectroscopy (NIRS) for 2 min before the test, during the 6-MWT test, and 2 min after the test. The relationship between the changes in rSO
2
, heart rate, and SpO
2
values and clinical and laboratory features was compared statistically. The mean pulmonary arterial pressure (mPAP) was 77 (range 25–126) mmHg, and the median 6-minute walk distance (6-MWD) was 427.5 (300–570) m. The changes in rSO
2
measurements ranged between 3.41 and 21.8%, and 70% of the patients had a greater than 10% decrease in rSO
2
during the test compared with baseline. Eight patients showed a decrease in rSO
2
without SpO
2
changes. The present study demonstrated a significant decrease in cerebral oxygenation in pediatric patients with PAH during the 6-MWT. We hypothesized that using a combination of the 6-MWT and regional cerebral oxygenation monitoring in pediatric patients with PAH in order to evaluate exercise capacity, as a reflection of reduced daily activities, would provide more precise predictive values than the 6-MWT alone.
Objective: The aim of the current study was to determine affective disorders (anxiety and depression) in children with epilepsy and assess the role of epilepsy type.
Methods: The study included 56 ...children with idiopathic generalized epilepsy (26 girls, 30 boys, aged 6-16), 47 children with self-limited focal epilepsy (22 girls, 25 boys, aged 6-16) and 78 healthy age-, gender-, and education matched children (31 girls, 47 boys). Seizure type, seizure frequency, and duration of epilepsy were recorded. All participants completed extensive baseline neuropsychological questionnaires that included Kovac Children’s Depression Inventory (CDI) and the State-Trait Anxiety Inventory for Children (STAIc).
Results: Children with idiopathic generalized epilepsy had higher depression, state and trait anxiety scores than healthy controls (depression scores: 9.07±7.01 vs 5.20±2.72, p=0.024, state anxiety scores: 37.53±9.34 vs 31.30±6.40, p=0.014, trait anxiety scores: 37.78±9.71 vs 33.23±5.67, p=0.032). Depression, state and trait anxiety scores were significantly higher in children with self-limited focal epilepsy than healthy controls (depression scores: 8.06±4.93 vs 5.20±2.72, p=0.028, state anxiety scores: 37.91±8.21 vs 31.30±5.67, p=0.009, trait anxiety scores: 36.74±9.703 vs 33.23±5.67, p=0.045). We found no significant differences in depression or anxiety scores between idiopathic generalized epilepsy and self-limited focal epilepsy groups. No correlation was found between seizure frequency and scale scores.
Conclusion: Our findings bring attention to the increased risks of affective disturbance in pediatric epilepsy. The presence of depression and anxiety in children with epilepsy had no association with epilepsy type and seizure frequency. Therefore, we did not identify epilepsy type as a predictor factor of affective disturbance.
Amaç: Dikkat eksikliği hiperaktivite bozukluğu (DEHB) okul çağı çocuklarında oldukça yaygın gözlenen bir nörogelişimsel bozukluktur ve erkek çocuklarında kızlara göre 2-10 kat daha sık görülür. ...Dikkat işlemleri farklı beyin bölgelerinin aralarında karşılıklı yoğun bağlantılar oluşturduğu sinir ağları sistemi tarafından yürütülmekte olup DEHB’de seçici dikkat, sürekli dikkat ve görsel-uzaysal dikkat bileşenlerin işlevlerinde yetersizlikler ve güçlükler gözlenmektedir. Bu çalışmada DEHB olan erkek çocuklarda görsel-uzaysal, seçici ve sürekli dikkati değerlendirmektir.
Yöntem: Çalışma çocuk psikiyatrisi ve çocuk nöroloji polikliniğine başvuran yaşları 6-10 arasında değişen DEHB tanılı 80 erkek olgu ve kontrol grubu olarak 73 erkek olgu ile yapılmıştır. Çocuk ve ailesi ile DSM-V’e göre yapılandırılmış bir görüşme yapılmıştır. Zekadan kaynaklanan karıştırıcı değişkenleri kontrol etmek amacıyla Wechsler Çocuklar İçin Zeka Ölçeği (WISC-R), analitik düşünme görsel, mekansal algılama becerilerini değerlendirmek için Raven Standart Progresif Matrisler Testi (RSPM), seçici ve sürekli dikkati değerlendirmek için İşaretleme Testi (İT) ve görsel-uzaysal dikkati incelemek için Çizgi Yönünü Belirleme Testi (ÇYBT) kullanılmıştır.
Bulgular: DEHB tanısı almış olan 80 erkek olgunun %41,25’i DEHB-DE, %30’u DEHB-HD ve %28,75’i DEHB-B olarak sınıflandırılmıştır. Yaş açısından incelendiğinde; tanı grubuyla (7.89±1.33 yaş) kontrol grubu (8.14±1.44 yaş) arasında anlamlı bir fark görülmemiştir (p>.05). WISC-R, RSPM, ÇYBT ve İT’den elde edilen puanlar değerlendirildiğinde tüm testler de kontrol grubunun puanlarının tanı grubundan daha yüksek olduğu görülmüştür (p<0.05).
Sonuç: Görsel dikkat bileşenlerinden seçici dikkat, sürdürülen dikkat ve görsel-uzaysal dikkat işlevselliğinin DEHB olan çocuklarda sağlıklı akranlarına göre etkilendiği görülmektedir. Bu nedenle DEHB olgularında hem yaşam kalitesi artırmak hem de tedavi izleminin değerlendirilmesinde nöropsikolojik testlerin kullanılması yararlı olacaktır.
Limbic encephalitis (LE) is an autoimmune, neurological
disorder characterized by confusion, memory disturbance,
and seizures. An association between type 1 diabetes mellitus
(T1D) and other ...autoimmune disorders is well-known.
However, the co-occurrence of T1D and LE is very rare.
To document the clinical and paraclinical features of pediatric multiple sclerosis (MS) in Turkey.
Data of MS patients with onset before age 18 years (n = 193) were collected from 27 pediatric ...neurology centers throughout Turkey. Earlier-onset (<12 years) and later-onset (≥12 years) groups were compared.
There were 123 (63.7%) girls and 70 (36.3%) boys aged 4–17 years, median 14 years at disease onset. Family history of MS was 6.5%. The first presentation was polysymptomatic in 55.4% of patients, with brainstem syndromes (50.3%), sensory disturbances (44%), motor symptoms (33.2%), and optic neuritis (26.4%) as common initial manifestations. Nineteen children had facial paralysis and 10 had epileptic seizures at first attack; 21 (11%) were initially diagnosed with acute disseminated encephalomyelitis (ADEM). Oligoclonal bands were identified in 68% of patients. Magnetic resonance imaging revealed periventricular (96%), cortical/juxtacortical (64.2%), brainstem (63%), cerebellum (51.4%), and spinal cord (67%) involvement. Visual evoked potentials (VEP) were abnormal in 52%; serum 25-hydroxyvitamin D levels were low in 68.5% of patients. The earlier-onset group had a higher rate of infection/vaccination preceding initial attack, initial diagnosis of ADEM, longer interval between first 2 attacks, and more disability accumulating in the first 3 years of the disease.
Brainstem and cerebellum are common sites of clinical and radiological involvement in pediatric-onset MS. VEP abnormalities are frequent even in patients without history of optic neuropathy. Vitamin D status does not appear to affect the course in early disease. MS beginning before 12 years of age has certain characteristics in history and course.
•This study confirms pediatric MS is a predominantly relapsing-remitting disease.•Brainstem-cerebellar or ADEM-like symptoms, facial paralysis, seizures are frequent.•Onset with sensorial symptoms is less likely compared to later-onset MS.•High rates of vitamin D deficiency and subclinical VEP abnormalities are of note.•First inter-attack interval is longer, disability accumulates faster in early-onset MS.
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