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Mitsea, A., A. Karidis, C. Donta-Bakoyianni, and N. Spyropoulos. "Oral health status in Greek children and teenagers, with disabilities." Journal of Clinical Pediatric Dentistry 26, no. 1 (2002): 111–18. http://dx.doi.org/10.17796/jcpd.26.1.705x15693372k1g7.
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Nowadays there is a sharp increase of population with disabilities. The aim of this investigation was a) to survey the dental health status, estimate the treatment requirements of children and adolescents with cerebral palsy, mental retardation and visual disorders and b) to compare the oral health status of these groups of individuals. The investigation entailed the clinical examination of 170 individuals, between 6 and 15 years old, who were attending four special schools in Athens, Greece. In conclusion, our investigation documented the following: The treatment needs regarding both dentitions are extremely high in all groups of individuals. The oral hygiene status is in general, moderate to low-grade, especially in the individuals with mental retardation. The highest rate of malocclusion is observed in the group of individuals with cerebral palsy.
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Raina, Sunil Kumar, Shailja Sharma, Ashok Bhardwaj, Mitasha Singh, Sanjeev Chaudhary, and Vipasha Kashyap. "Malnutrition as a cause of mental retardation: A population-based study from Sub-Himalayan India." Journal of Neurosciences in Rural Practice 07, no. 03 (2016): 341–45. http://dx.doi.org/10.4103/0976-3147.182776.
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ABSTRACT Background: Mental retardation is one of the most common disabilities of childhood. The research on childhood malnutrition and its relationship with cognitive functioning suggests that malnutrition alone does not cause mental retardation. Objective: To identify the relation between malnutrition and cognition among children from a Sub-Himalayan state in North India. Materials and Methods: A two-phase cross-sectional study was conducted in the rural, urban, and slum area of district Kangra. A 30-cluster sampling technique was used to screen a population of children 1–10 years of age from five randomly selected panchayats (village government units) of district Kangra. The screening was based on a modified version of the ten questions screen, adapted to the local population. In the first phase, a door-to-door survey was done to identify suspects of mental retardation. In the second phase, the children found positive in the first phase were called for clinical examination to confirm mental retardation. Anthropometric assessment of all study children was done by measuring weight and height. The nutritional assessment was done by categorizing them according to Waterlow classification for malnutrition. Results: Out of the total 5300 children, 1.7% were diagnosed as mentally retarded. No positive association was reported with different types of malnutrition and mental retardation. A weakly positive association existed between nutritional status and mental retardation (correlation coefficient-0.04). Children who were both wasted and stunted had the highest risk (odds ratio, 95% confidence interval - 5.57, 2.29–10.36) of mental retardation as compared to normal. Conclusion: Malnutrition may be one of the causes but certainly not the only cause of mental retardation. Other causes may be contributing more significantly toward it.
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Sharma, Shailja, Sunil Kumar Raina, Ashok Kumar Bhardwaj, Sanjeev Chaudhary, Vipasha Kashyap, and Vishav Chander. "Socio demography of mental retardation: A community-based study from a goitre zone in rural sub-Himalayan India." Journal of Neurosciences in Rural Practice 6, no. 02 (2015): 165–69. http://dx.doi.org/10.4103/0976-3147.153220.
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ABSTRACT Introduction: Mental retardation is one of the most common disabilities of childhood which can be prevented by timely identification of the causative agent and an adequate management accordingly. District Kangra lies in the sub-Himalayan belt and forms a part of the 2400 km long goitre belt along the southern slopes of the Himalayas. Objective: To study the prevalence of mental retardation among children (1-10) years of age. Materials and Methods: A two-phase cross-sectional study was conducted in the rural area of district Kangra. A 30-cluster sampling technique was used to screen a population of children 1-10 years of age from five randomly selected panchayats (village government units) of district Kangra. The screening was based on a modified version of the ten questions screen, adapted to the local population. In the first phase a door to door survey was done to identify suspects of mental retardation. In the second phase, the children found positive in the first phase were called for examination by the pediatrician to confirm mental retardation. Results: A total of 2420 children were screened in the first phase of which 95 tested positive. About 52 of these children were found to be mentally retarded in the second phase giving a prevalence of 2.15%. The 69% of these children belonged to the lower middle class and 28.3% belonged to middle class families using the Uday Parekh scale for assessment of the socio-economic status. Conclusion: Prevalence of mental retardation is high in district Kangra of Himachal Pradesh in comparison to other states of India. This could be attributed to the good primary health care in Himachal Pradesh where institutional deliveries are about 70%. This may have led to better survival of children with congenital disorders and those that suffer perinatal trauma.
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Soleimani, Robabeh, Zahra Gol, and Seyede Melika Jalali. "The Association Between Ginseng and Mania: A Case Report and Literature Review." Caspian Journal of Neurological Sciences 6, no. 1 (2020): 66–70. http://dx.doi.org/10.32598/cjns.6.20.217.1.
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Background: Ginseng has long been used as a tonic and panacea, a dietary supplement, or a therapeutic agent in different countries. Among many common side effects for this herbal, the affective disorder is one of the rare ones. Case presentation and Intervention: We present a case of mania with psychotic features. The patient was an 18-year-old male who consumed Asian red ginseng for five months to treat his overweight. His physical examination was normal except for mild mental retardation. Mental status examination revealed increased psychomotor activity, anxious mood, unstable affect, irritability, aggression, pressured speech, grandiosity, auditory hallucinations, and persecutory delusions. After the admission, he was ordered to stop ginseng taking and supportive care and treatment with risperidone, lorazepam, and valproate sodium started. After 15 days, all symptoms were treated. Conclusion: Despite the widespread use of herbal and dietary supplements, physicians and health care providers should be concerned about the side effects of these products, such as mania and psychosis.
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Savic-Stankovic, Tatjana, Milica Jovanovic-Medojevic, and Slavoljub Zivkovic. "Dental status of institutionalized persons with special needs who live in Special institution “Srce u jabuci” in Pancevo." Serbian Dental Journal 58, no. 1 (2011): 16–22. http://dx.doi.org/10.2298/sgs1101016s.
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Introduction. Dental status of most people with special needs is not satisfactory. Many of them are edentulous or toothless, with acute extensive caries lesions present, high DMFT index and severe periodontal disease. The objective of this study was to examine the dental status of mentally impaired persons who live in the special institution ?Srce u jabuci? in Pancevo. Material and Methods. Clinical examination was performed on 114 institutionalized patients (68 male and 46 female), age 22 to 71 years. Patients were divided in two groups; the first group consisted of 71 persons who had a moderate mental disorder (F71), while the second group included 43 respondents with severe mental retardation (F72). Oral examination revealed: the number of present teeth, caries lesions, the presence of restorations, the number of extracted teeth, the presence of residual roots, fractures and the presence and number of fixed restorations. Results. The mean DMFT of total examined teeth was 20.33?7.63. The greatest percentage found for extracted teeth (63.76%): in the first group 63.23%, and in the second 64.06%. The percentage of teeth that had caries lesions of all examined teeth was 33.48%, while the lowest percentage was for restored teeth (2.76%). In majority of examined people, initial caries, deep caries, or tooth with the exposed pulp (K1 - 51.74% K2 - 40.35%, K3 - 51.75%) were not found. A high percentage of examined people had more than 10 extracted teeth (52.63%). Most of them did not have any restoration in the mouth (81%) and only three persons had fixed denture. Conclusion. Dental status of institutionalized mentally impaired persons showed high prevalence of extracted teeth, significant presence of carious lesions and small percentage of restored teeth with inadequate oral hygiene.
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Survilaite, A. "Forensic Psychiatric Assessment of Individuals with Mental and Behavioral Disorders Due to Use of Alcohol, who Committed Homicide." European Psychiatry 41, S1 (2017): S154. http://dx.doi.org/10.1016/j.eurpsy.2017.01.2016.
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IntroductionThe rate of pure alcohol consumption per capita in Lithuania is reported to be one of the highest in Europe Union. Many studies illustrate the relationship between alcohol and violent crimes. Though dual diagnosis of severe mental disorder and alcohol dependency is common.AimTo evaluate peculiarities of mental status of individuals with mental disorders due to use of alcohol, who had committed homicide.MethodsForensic psychiatry examination reports in alcohol consumption cases and homicide acts (n 110) were taken from archive of national service of forensic psychiatry in Lithuania, 2010–2014.ResultsIn total, 93% (n 91) men and 100% (n 12) women at the time of homicide act were under the influence of alcohol. A total of, 83% (n 91) of cases reported impulsiveness, emotional lability and personality degradation due to long term of alcohol consumption; 52% (n 57) of cases motives for violence remained unclear: offenders indicated they remember nothing because of alcohol intoxication, also possible malingering was evaluated. In total, 100% women (n 12) and 97% men (n 95) were criminally responsible. Only 2 individuals committed homicide as a result of psychosis due to paranoid schizophrenia and 1 individual had significant intellectual deficiency due to moderate mental retardation, which lead them to inability to appreciate the dangerous nature of their acts and to control their behavior. Compulsory medical treatment was recommended to all three of them.ConclusionImpulse control deficiency and emotional lability are prevalent amongst homicide offenders with mental disorders due to use of alcohol. Only 3 individuals were irresponsible for their criminal acts as a result of severe mental disorders.
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Gajic, Zoran, Jovan Milatovic, Boris Golubovic, Josip Dadasovic, Sladjana Ralevic, and Jagos Golubovic. "Sociodemographic and psychiatric characteristics among homicide offenders in Serbia - the province of Vojvodina (1996-2005)." Medical review 69, no. 7-8 (2016): 224–29. http://dx.doi.org/10.2298/mpns1608224g.
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Introduction. Recent studies have shown a growing correlation between violence and mental illness, but there is a higher risk of violent crimes only in certain cases of mental disorders. This study presents sociodemographic and psychiatric characteristics of homicide offenders in Serbia, in the Province of Vojvodina in a 10-year period (1996-2005). Material and Methods. The obtained data are based on performed forensic and psychiatric expert investigations of 154 homicide offenders in preceding period, considering sociodemographic data, personal history and current psychiatric status. Data were analyzed using the statistical John?s Macintosh programe. Results. The male offenders were in the great majority (92%) as well as a low level of education (87%). A positive history of criminal acts was found in 24% of the subjects. Minority of subjects (21%) consumed alcohol on a daily basis. At the time of committing the crimes, 57% of homicide offenders were under the influence of alcohol, and just 2% of other psychoactive substances. Among the offenders who had previously received psychiatric treatment (31.2%), the most frequent diagnosis was alcohol addiction (25%) and anxiety disorders (22.9%). During the psychiatric examination 70.8% of the subjects were diagnosed with mental disorder: personality disorders (41%), alcohol addiction (84%), neurotic disorders (65%), schizophrenic psychosis (5.2%), affective disorders (3.2%), paranoid psychosis (2.6%), organic disorders (19%), psychoactive drug addiction (13%) and mental retardation (0.6%). Emotionally unstable personality disorder was dominant among personality disorders (55.6%). Diminished mental competency was established in 77.9% of subjects at the time of the homicide, being rather sever in most of them. All those diagnosed to have a psychotic disorder were mentally incompetent. Conclusion. Emotionally unstable disorders were the most common among the offenders who underwent forensic evaluation. A relatively low presence of psychotic disorders imposes the need for destigmatization particularly of the patients suffering from major mental illnesses.
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Orsolini, L., A. Valchera, R. Vecchiotti, M. Panichi, and D. De Berardis. "Psychosis and polydrug abuse in a patient with Dandy-Walker variant." European Psychiatry 33, S1 (2016): S310. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1061.
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Background and purposeDandy Walker “syndrome” (DWS) was firstly defined by Dandy and Blackfan, and then described by Hart et al. [1] as a series of neurodevelopmental anomalies in the posterior fossa, including Dandy-Walker (DW) malformation, DW variant (cerebellar hypoplasia/aplasia of the cerebellar vermis and cystic dilatation of the fourth ventricle), mega-cisterna magna and posterior fossa arachnoid cyst. Mental symptoms have been associated with DWS in previous reports, but the spectrum of mental symptomatology widely varies between clinical cases, ranging from psychotic/schizophrenia-like to mood/cognitive symptoms [2].MethodsHere we describe a case of psychosis and polydrug abuse in a 27-year-old man with DW variant a 4-year history of polydrug abuse, sporadic alcohol abuse, epilepsy and psychotic symptoms including delusions of reference/persecution, suspiciousness, associated with obsessive thoughts, mood lability and persistent anxiety.ResultsHe was recovered for a 28-day program of detoxification from drug addiction/stabilization of psychiatric symptoms. Family history of Bipolar Disorder, gambling disorder (father) and depression (mother). The mental status examination at baseline revealed slowness of thought, psychomotor retardation, aboulia/anhedonia/apathy/hypomimic facies/asthenia/social withdrawal/deflected mood/poor thought content/blunted affect/self-neglect/poor insight, cognitive impairment and oppositive and partially collaborative attitude and behaviour. Borderline intelligence activity was found on WAIS-R (IQ = 79). At the baseline, he was taking carbamazepine 400 mg BID (baseline serum level: 6.720 μg/ml), gabapentin (400 mg BID), paroxetine (20 mg/d), olanzapine (10 mg/d) and methadone (70 ml/d), with a poor response/control both on psychotic and seeking drug symptomatology.References not available.ConclusionsFurther DWS clinical cases should be evaluated in order to better investigate the role of this variant to addictive and psychotic symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Goodey, C. F. "“Foolishness” in Early Modern Medicine and the Concept of Intellectual Disability." Medical History 48, no. 3 (2004): 289–310. http://dx.doi.org/10.1017/s002572730000764x.
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The texts by Paracelsus, Felix Platter and Thomas Willis under consideration here have two things in common, despite their separate historical and cultural settings. First, they describe people who seem to relate both to their own world and to the external world in problematical ways which the authors variously call stultitia, fatuitas or stupiditas: “foolishness”. My translation is intentionally imprecise and will, I hope, restrain the reader from jumping to the conclusion that it signifies any clinical concept recognizable in modern medicine; it is, rather, an algebraic x whose content needs further investigation. The second common factor is that these are precisely the texts which some commentators do indeed believe to contain “early” diagnoses of a modern concept of intellectual disability (“mental retardation”, “learning disability” etc.). This belief, of axiomatic status, presupposes that some such concept has existed across different historical periods in a more or less mutually recognizable form, and therefore that “foolishness”, in the medical writers discussed here, just is, if primitively, our “intellectual disability”. However “foolishness” needs closer examination, which I attempt to provide here.
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Herrera Ortiz, Andrés Felipe, and Héctor Eduardo Ortiz Sandoval. "Open Lip Schizencephaly: A Case Report." Revista Cuarzo 26, no. 2 (2021): 27–29. http://dx.doi.org/10.26752/cuarzo.v26.n2.510.
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Schizencephaly is an extremely rare congenital structural disorder presented in 1.54/100,000 births. In this article, we present one of the few cases of schizencephaly reported in Colombia, in which the linguistic barrier and the lack of resources made the differential diagnosis a challenge. The patient presented to the emergency department with focal impaired-awareness seizures associated with an inability to speak since birth. On physical examination, it was evident the loss of cephalic support, mental retardation, and left- sided hemiparesis for which a non-contrast brain computed tomography was performed showing findings that are in relation to open- lip schizencephaly (right frontoparietal brain cleft lined by gray matter which is connecting the subarachnoid space to the ventricular system, polymicrogyria and absence of septum pellucidum). Neuro-rehabilitation and antiseizure therapy were established with good outcomes. It is important to understand that nowadays does not exist any curative procedure, the mainstay of treatment is based on neuro- rehabilitation which should be initiated as soon as possible because it improves the cognitive and motor status of patients.
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Chernov, D. A., and V. I. Evdokimov. "Comparison of indicators of mental disorders among army conscripts and 18–19 year old men in the Republic of Belarus in 2003–2015." Medicо-Biological and Socio-Psychological Problems of Safety in Emergency Situations, no. 2 (June 17, 2020): 44–54. http://dx.doi.org/10.25016/2541-7487-2020-0-2-44-54.
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Relevance. The mental health status of military personnel is an important factor in the combat readiness and combativity of the armies of the countries of the world. Intention. Analysis of the mental disorders among army conscripts and 18–19 year old men in Republic of Belarus in 2003–2015.Methodology. We studied the indicators of the general and primary morbidity of the personnel of the Armed Forces of the Republic of Belarus based on 3/MED reports from military units, where about 80% of the total number of conscripts served. The indicators of mental disorders in the population of Belarus are obtained from «1-psychiatry» and «1-narcology» state statistical forms (Ministry of Health). The incidence rate was determined per 1000 people.The indicators of mental health disorders were classified according to the groups (blocks) of Class V «Mental and behavioral disorders» of the International Classification of Diseases and Behavioral Disorders, 10th revision (ICD-10).Results and Discussion. The conducted medical and statistical studies showed that average annual levels of the general and primary morbidity among the conscripts with mental disorders in the Armed Forces in 2003–2015 were statistically significantly lower compared to 18–19 year old civilians in the Republic of Belarus. The overall incidence rates of mental disorders were (34.05 ± 1.05) and (111.98 ± 4.58)‰ (p < 0.001), the primary incidence rates were (17.26 ± 1.02) and (28.51 ± 1.26)‰, respectively (p < 0.001). Polynomial trends in the general and primary morbidity among military conscripts with mental disorders with different determination coefficients showed a decrease and among 18–19 year old men – an increase. In the structure of the studied medical and statistical types of mental morbidity among military conscripts from the Armed Forces of the Republic of Belarus, neurotic, stress-related, and somatoform disorders (group 5, F40–F48 according to ICD-10) and personality and behavior disorders in adulthood (7th group, F60–F69) were most common. Their total contributions were 85.4 and 78.5%, respectively, for the structure of the general incidence rate and the primary incidence rate. In military conscripts in 2003–2015, there was a decrease in the level and percentage of neurotic, associated with stress, and somatoform disorders in the overall structure of incidence of mental disorders. In the structure of the analyzed medical and statistical types of mental disorders among 18–19 year old men in the Republic of Belarus, mental and behavior disorders associated with the use of psychoactive substances (2nd group, F10–F19) and mental retardation (8th group, F70–F79) were most common. Their total contributions to the structure of the overall and primary incidence were 69.7 and 74.9%, respectively. Unfortunately, these mental disorders among 18–19 year old men in the Republic of Belarus in 2003–2015 tended to increase.Conclusion. The existing system of military medical examination of draftees, professional selection, along with distribution of personnel according to military registration specialties based on personal characteristics, professional preparedness and functional reserves of the organism, as well as medical support in the Armed Forces of the Republic of Belarus help to optimize the military professional adaptation of military conscripts and psycho-prevention of mental disorders.
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Nazme, Nure Ishrat, Md Mahbubul Hoque, and Manzoor Hussain. "Congenital Rubella Syndrome: An Overview of Clinical Presentations in Bangladeshi Children." Delta Medical College Journal 2, no. 2 (2014): 42–47. http://dx.doi.org/10.3329/dmcj.v2i2.20522.
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Background: Congenital Rubella Syndrome (CRS) has long been characterized by the triad of deafness, cataract and cardiovascular malformations with or without mental retardation. Objective: This study was conducted to observe the clinical manifestations of CRS in children of Bangladesh. Materials and method: This cross sectional study was carried out in Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh and National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh. Total 40 cases of CRS were enrolled from indoor and outpatient departments of these two hospitals, who were diagnosed according to standard case definition. Serological test for rubella antibody, chest X-ray, colour Doppler echocardiography, visual examination and hearing assessment were done in relative specialised centres. Results: The mean(±SD) age of the study subjects was 6.6(±5.7) months (range: 0-24 months). Among the subjects, 68% were male and 32% were female. Serum for rubella specific antibody revealed positive IgG in 60% cases and IgM in 28% cases. Neurological problem was the most frequently observed (90%) systemic complication followed by visual problem (83%), congenital hearing loss (80%) and congenital heart disease (78%). Cataract was the commonest (55%) among visual problems and microcephaly (62%) among neurological manifestations. Patent ductus arteriosus (PDA) was the most common (37.5%) isolated structural cardiac defect. Maximum (62.5%) children came from poor socioeconomic status. Maternal onset of infection was commonly detected in 1st trimester of pregnancy. Conclusion: Diagnosis of CRS and recognition of its versatile pattern of clinical presentation are crucial for better prognosis of the affected children. DOI: http://dx.doi.org/10.3329/dmcj.v2i2.20522 Delta Med Col J. Jul 2014; 2(2): 42-47
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Batta, Priya, Davinder Dhillon, and Alan R. Hirsch. "174 Pseudogout Induced by Vortioxetine." CNS Spectrums 23, no. 1 (2018): 100. http://dx.doi.org/10.1017/s1092852918000561.
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AbstractStudy ObjectiveVortioxetine induced monoarticular pain has not heretofore been described. Such a case is presented.MethodCase study: A 49 year old right handed female with a past history of multiple hospitalizations for chronic severe migraine, presented with complaints of depression and stress. She has had depression for 20 years, which has been constant and worsened in the past 5 years. As her migraines became more frequent, her depression also worsened. She has never been suicidal, but does endorse sadness, crying spells, fatigue, demotivation, lack of interest, poor concentration, irritability, anger, guilt, hopelessness, helplessness, anorexia, PM insomnia with frequent awakenings, absent libido and racing thoughts.ResultsAbnormalities in her mental status examination: Orientated times 2. Disheveled. Defensive. Motor retardation. Mood: depressed, anxious and irritable with blunted affect. Remote memory: President: Obama,?. Beck Depression Inventory II: 23 (moderate depression). Beck Anxiety Inventory: 25 (moderate anxiety).The patient was begun on 5 mg of vortioxetine every night. Within two days, she developed pain and swelling of the distal interphalangeal joint of the left great toe. The pain was so severe that she demonstrated an antalgic gait. After five days the medication was discontinued and two days later, there was full resolution of the swelling and pain, and ambulation returned to normal.ConclusionsThe mechanism whereby vortioxetine induced this monoarticular pain is unclear. Underlying depression alone can precipitate arthritic exacerbation (Trivedi, 2004). This was unlikely given the long duration of her depression as well as the timing of the precipitant (vortioxetine use) and resolution shortly after the medication was discontinued. Alternatively, in the depressed state, there may be a greater perception of somatic pain, which allowed her to appreciate any arthritic pain which may have pre-existed the use of vortioxetine (Howard, 1991). As such, this may have represented a correspondence bias (Gilbert, 1995). Furthermore, mild new pain is perceived as more intense in those who are depressed (Howard, 1991). Thus, any minimal arthritic injury may be viewed as more intense. Vortioxetine may have paradoxically exacerbated anxiety and anxiety can precipitate pain (Narasimhan & Campbell). Alternatively, vortioxetine could have caused a generalized allergic reaction, which may have initially manifest in the great toe. If the patient continued the medication, she may have developed a generalized systemic reaction including involvement of multiple joints. Another possibility is that it caused an allergic histamine mediated hive like reaction, generalized, as well as on the toe. Continued use of the joint may have caused this to be intensified, with associated swelling, while the general reaction subsided. Inquiry about monoarticular involvement in those taking vortioxetine is warranted.Funding AcknowledgementsSmell & Taste Treatment and Research Foundation
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Grover, Sandeep, Aseem Mehra, Subho Chakrabarti, and Ajit Avasthi. "Association of Cognitive and Noncognitive Symptoms of Delirium: A Study from Consultation-liaison Psychiatry Set-up." Journal of Neurosciences in Rural Practice 07, S 01 (2016): S007—S012. http://dx.doi.org/10.4103/0976-3147.196440.
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ABSTRACT Aims: This study aims to evaluate the cognitive functions of patients with delirium using Hindi Mental Status Examination (HMSE), to study the correlation of cognitive functions assessed by HMSE with noncognitive symptoms as assessed using Delirium Rating Scale-Revised 1998 (DRS-R-98) and to study the association of cognitive functions assessed using HMSE and DRS-R98. Methods: A total of 76 consecutive patients fulfilling the diagnosis of delirium were evaluated on DRS-R-98, HMSE, and Short Informant Questionnaire on Cognitive Decline in the Elderly (retrospective IQCODE). Results: The mean DRS-R-98 score 33.9 (standard deviation [SD] - 7.2) and the mean DRS-R-98 severity score was 25.9 (SD - 7.2). The mean score on HMSE was 19.3 (7.98). There were significant correlations of all the domains of HMSE with DRS-R-98 total score, DRS-R-98 severity score, DRS-R-98 cognitive subscale score, DRS-R-98 noncognitive domain subscale score, and DRS severity score without attention score. When the association of each item of DRS-R-98 and HMSE was evaluated, except for the items of delusions, lability of affect and motor retardation, there were significant negative association between all the items of DRS-R-98 and HMSE, indicating that higher severity of cognitive symptoms as assessed on HMSE is associated with higher severity of all the cognitive symptoms and most of the noncognitive symptoms as assessed by DRS-R-98. Conclusion: The present study suggests that attention deficits in patients with delirium influence the severity of cognitive and noncognitive symptoms of delirium. Further, the present study suggests an increase in the severity of cognitive symptoms in other domains is also associated with an increase in the severity of noncognitive symptoms of delirium.
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Iguchi, Akihiro, Minako Sugiyama, Yukayo Terashita, Junjiro Ohshima, Yuko Cho, and Tadashi Ariga. "Neurological Complications in Stem Cell Transplantation of Childhood." Blood 120, no. 21 (2012): 4465. http://dx.doi.org/10.1182/blood.v120.21.4465.4465.
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Abstract Abstract 4465 Introduction: Stem cell transplantation (SCT) is an effective treatment for hematological diseases and inborn errors of metabolism. Neurological complications in SCT are serious matters, which affect the patients' survival and quality of life. We analyzed the incidence of neurological complications in patients receiving SCT at the Hokkaido University Hospital to evaluate risk factors relating to the onset of these manifestations. Patients and methods: Between February 1988 and May 2012, a total of 236 patients (149 males and 87 females) received SCT; 188 patients received allogenic SCT, 48 patients received autologlous SCT. All of these patients were included in this study. Mean age was 8.1 years (range, 0–31). Indications for transplantation were hematological malignancies such as acute leukemia and lymphoma in 142 patients, bone marrow failure such as aplastic anemia in 30, malignant solid tumor such as neuroblastoma and rhabdomyosarcoma in 36, congenital immunodeficiency in 20, congenital metabolic disorder and brain tumor in 4 each. 213 patients received myeloabelative conditioning (MAC) including total body irradiation (97 patients), 23 patients receiving reduce intensity conditioning (RIC). 116 patients received prophylaxis against graft versus host disease (GVHD) with cyclosporine (CsA) or tacrolimus (Tac) in combination with methotrexate (MTX), 54 patients received CsA or Tac in combination with methylprednisolone, 10 patients received MTX alone, 7 patients received prednisolone or CsA alone. We carefully examined according to the protocol of neurological examination, in Hokkaido university school of medicine department of pediatrics, including (1) mental status including conscious status, orientation emotional reaction, and memory, (2) speech, (3) praxis, (4) gnosia, (5) cranial nerve sign, (6) motor and sensory system, (7) coordination, (8) gait and position, and (9) reflexes. All signs were considered the patients' age. Results: Among the 236 patients, 57 patients (24.2%) developed neurological symptoms. The neurological events observed in every patient were depicted on the time-course of SCT. The occurrence of the neurological complications seemed to be categorized into 4 on the basis of time of onsets and symptoms: (1) 10 episodes during the conditioning regimen such as convulsion, (2) 17 episodes during hematological recovery such as intracranial hemorrhage, viral encephalitis, syndrome of inappropriate secretion of antidiuretic hormone (SIADH), and posterior reversible encephalopathy syndrome (PRES), (3) 24 episodes around 2–3 months after SCT such as PRES, intracranial hemorrhage, viral encephalitis, and SIADH, (4) 28 episodes beyond 3 months after SCT such as mental retardation, leukoencephalopathy and epilepsy. Neurological complications were seen significantly in the patients receiving allogenic SCT (p=0.013), cord blood transplantation (CBT) (p=0.032), and patients with acute GVHD of over grade II (p=0.048). Moreover, overall survival and event free survival showed significant difference between patients with neurological events and those without the events (59.6±3.8% vs 38.8±7.4% (p=0.015) and 54.7±3.8% vs 39.0±6.6% (p=0.026), respectively). No significant differences were observed between patients with neurological events and those without the events in age, sex, diseases (malignancy or non-malignancy), irradiation during the conditioning regimen, and conditioning regimen (MAC or RIC). Conclusion: It was thought that allo-immunoreaction such as GVHD, administration of immunosuppressive drugs, vascular disorder related SCT, and virus reactivation participated in development of neurological complications. Particularly, CBT was significant high risk for neurological complications. High frequent virus reactivation such as human herpes virus 6 might induce significantly high incidence of neurological complications in patients receiving CBT. Disclosures: No relevant conflicts of interest to declare.
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Miserocchi, Anna, Beatrice Cascardo, Chiara Piroddi, et al. "Surgery for temporal lobe epilepsy in children: relevance of presurgical evaluation and analysis of outcome." Journal of Neurosurgery: Pediatrics 11, no. 3 (2013): 256–67. http://dx.doi.org/10.3171/2012.12.peds12334.
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Object The authors' goal in this paper was to retrospectively evaluate the relevance of the presurgical workup and the postoperative outcome in children (< 15 years) who undergo surgery for temporal lobe epilepsy (TLE). Methods The authors performed a retrospective analysis of 68 patients (43 boys and 25 girls) who underwent resection for TLE between 2001 and 2010 at a single center and had a minimum postoperative follow-up of 12 months. Presurgical investigations included full clinical evaluation, interictal electroencephalography (EEG), and MRI in all cases; cognitive evaluation in patients older than 5 years; scalp video-EEG in 46 patients; and invasive EEG in 3 patients. Clinical evaluation included a careful assessment of ictal semiology (based on anamnestic reports or video-EEG review), with particular attention to early signs and/or symptoms suggestive of temporal lobe origin of the seizure. Microsurgical resections were performed within the anatomical limits of the temporal lobe, and surgical specimens were processed for histological examination. Postoperative assessment of seizure outcome (Engel classification system) and cognitive performance was conducted at regular intervals. The effect on postoperative seizure outcome (good = Engel Class I; poor = Engel Classes II–IV) of several presurgical and surgical variables was investigated by bivariate statistical analysis. Results All patients had at least 1 early sign or symptom suggesting a temporal lobe origin of their seizures. Lateralized interictal or ictal EEG abnormalities were seen in all patients, and they were localized to the temporal lobe in 45 patients. In all cases MRI demonstrated a structural abnormality. Surgery consisted of a tailored anterior temporal lobectomy in 64 patients and a neocortical lesionectomy in 4 patients. Postoperatively, 58 patients (85%) were in Engel Class I. Variables significantly associated with a poor outcome were preoperative sensory motor deficit (p = 0.019), mental retardation (p = 0.003), MRI abnormalities extending outside the temporal lobe (p = 0.0018), history of generalized seizures (p = 0.01) or status epilepticus (p = 0.008), unremarkable histology (p = 0.001), seizures immediately postoperatively (p = 0.00001), and ipsilateral epileptiform activity on postoperative EEG (p = 0.005). At postoperative neuropsychological assessment, the percentage of patients with a pathological score at the final visit invariably decreased compared with that at the preoperative evaluation in all considered cognitive domains. Conclusions Among the study population, a surgical selection based on a noninvasive evaluation was possible in most patients. The invaluable information resulting from the rigorous noninvasive electroclinical and neuroimaging evaluation can lead to excellent surgical results without the use of invasive, time-consuming, and expensive diagnostic tools. The potential reduction of invasiveness-related risks, complexity, and costs of presurgical investigations should hopefully allow for an increase in the number of children with TLE who will receive surgery, particularly in centers with limited technological resources.
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Troitskaya, L., and N. Malahova. "Cognitive Function Estimation in Children with Tuberous Sclerosis." KnE Life Sciences, November 1, 2018. http://dx.doi.org/10.18502/kls.v4i8.3345.
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Tuberous sclerosis (TSC) is a genetic disease characterized by cerebral structural abnormalities (such as cortical tubers, subependymal nodes and abnormal cerebral white matter) which are detected by means of neuroimaging methods (e.g., MRI). Typically, these events cause neurological complications (i.e., epilepsy).Objective: cognitive function estimation in TSC children considering severity and nature of clinical course of the disease. 15 children with tuberous sclerosis (i.e., experimental group) and 46 children with normal development (i.e., control group) aged 6-16 years old underwent neuropsychological examination. As a result, polymorphic disorders of higher mental functions were revealed in TSC children. Neuropsychological deficit (p<0.05) was detected. Namely, voluntary attention and memorization impairments were found in TSC children with normaldevelopment. Operational thinking disorders, immaturity of dynamic and kinesthetic movement basis, somatosensory gnosis, optical spatial or quasi-three-dimensional imaging, as well as insufficient oral/aural and semantical memorization were mentioned in TSC children with mental retardation. Regardless of mental development, TSC children demonstrate neurodynamic activity disorder (p<0.05) presented by slow task performance, increased exhaustibility and attention fluctuation. According to comparison between research findings and clinical course data, severity of cognitive disorders substantially depends on epilepsy onset age because early onset results in more severe developmental disorder (p<0.05). Since tuberous sclerosis is a dynamic disease with new potential symptoms arising over a lifetime, neuropsychological testing will provide timely mental status qualification and development of corrective actions to activate the cognitive activity of a child.
 Keywords: tuberous sclerosis, children, higher mental function (HMF) developmental disorders.