Recent advances in the pathophysiology of meningitis in children

Over the past decade, much has changed on the landscape of meningitis. The purpose of this study was to investigate the involvement of nitric oxide [NO] and tumor necrosis factor alpha [TNF-alpha] in the pathogenesis of childhood meningitis. We measured the concentration of NO[-][2] [a stable metabolite of NO] and TNF-alpha in serial samples of cerebrospinal fluid [CSF] from 21 children with septic and 18 with aseptic meningitis and 20 control patients without meningitis. Significantly higher CSF NO[2] concentrations were detected in those with bacterial meningitis than those with aseptic meningitis [27.6 +/- 26.8 versus 12.2 +/- 12.3 micro mol/L; P<0.001] or among non-meningitis subjects [13.2 +/- 24.2 micro mol/L; P<0.0001]. Clinical and laboratory improvement following administration of antibiotics and dexamethasone was associated with a fall in CSF [NO[-][2] to normal levels in these patients. The mean [ +/- SD] of concentration in septic meningitis was 148.74 +/- 338.77 pg/ml. There was significantly more TNF-alpha than aseptic meningitis [6.85 +/- 17.93 pg/ml; [P<0.,001] or non-meningitis [7.67 +/- 16.07 pg/ml; P<0.001]. We did not find a correlation between CSF nitrate/nitrite levels and TNF-alpha [r = 0.046]. Our findings indicate that NO and TNF- alpha [r = 0.046]. Our findings indicate that NO and TNF- alpha [r = 0.046]. Our findings indicate that NO and TNF- alpha production are enhanced in the CSF compartment of children with septic meningitis and support the hypothesis that both markers are involved in the pathophysiology of septic meningitis

Value of motor and somatosensory evoked potentials in assessment of motor function in cerebral palsy

Cerebral palsy is a static non progressive motor disability that occurs at birth or early childhood. It results from injury to the neuromotor components of the central nervous system. Evoked potentials [EPs] are neurophysiological investigations used to demonstrate the existence of central nervous system lesions and were used as a screening method for neuropediatric diseases. Motor and somatosensory evoked potential [SEP] are the most sensitive methods of evoked potentials. They can provide a non-invasive objective method of evaluating the central and peripheral nervous system. The present study included 20 Egyptian children, 11 males and 9 females ranging in age from 3 to 6 years with a mean age of 3.9 years, presenting with spastic diplegia. All patients had mild to moderate motor disability and I.Q. above 50. Control group included 20 children, age and sex-matched with patients group. We studied motor and somatosensory evoked potentials in those patients and their correlation with motor functions. Transcranial magnetic stimulation [TMS] to the right upper limb [abductor pollicis brevis muscle] and somatosensory evoked potentials testing from the right median nerve and the left posterior tibial nerve were used to assess function of the corresponding systems. Motor evoked potentials from the right upper limb showed significant delay in cortical latencies and significant prolongation of central motor conduction time in CP patients compared to control group. However, the amplitude of cortical response showed no significant changes. Somato-sensory evoked potentials of right median nerve showed significantly prolonged cortical N19 / P22 absolute latency, N13 - N20, Erb's - N20, N13 - N20 inter peak latencies respectively. However, Erb's, N13, Erb's - N13 absolute latencies and inter peak latency showed non significant changes but N20 amplitude was significantly decreased. Somatosensory evoked potentials of the left posterior tibial nerve showed significant prolonged cortical and lumbar absolute latencies and inter peak latency as well as a significant decrease of amplitude of cortical wave. A statistically highly significant positive correlation was observed between the hand function and N20 amplitude [P < 0.01] of SEPs of the right median nerve while all other variables showed no statistically significant correlation with each other. Also, a statistically significant positive correlation was observed between the foot function and cortical amplitude [P < 0.05] of SEPs of the left posterior tibial nerve while all other variables showed no statistically significant correlation with each other. A tendency towards positive correlation was observed between hand functions and cortical latency [P < 0.09] of motor evoked potentials to the right abductor pollicis brevis muscle. We concluded that somatosensory evoked potentials are sensitive, non-invasive techniques for detection of the severity of motor impairment. We recommend MEPs and SSEPs as a relatively fast and effective means of assessing the functional integrity of the central nervous system in cerebral palsy patients

Value of motor and somatosensory evoked potentials in assessment of motor function in cerebral palsy

Cerebral palsy is a static non progressive motor disability that occurs at birth or early childhood. It results of injury to the neuromotor components of the central nervous system. Evoked potentials [EPs] are neurophysiological investigations used to demonstrate the existence of central nervous system lesions and were used as a screening method for neuropediatric diseases. Motor and somatosensory evoked potential [SEP] are the most sensitive methods of evoked potentials. They can provide a noninvasive objective method of evaluating the central and peripheral nervous system. The present study included 20 Egyptian children, 11 males and 9 females ranging in age from 3 to 6 years with a mean age of 3.9 years, presenting with spastic diplegia. All patients had mild to moderate motor disability and I.Q. above 50. Control group included 20 children, age and sex-matched with patients group. We studied motor and somatosensory evoked potentials in those patients and their correlation with motor functions. Transcranial magnetic stimulation [TMS] to the right upper limb [abductor pollicis brevis muscle] and somatosensory evoked potentials testing from the right median nerve and the left posterior tibial nerve were used to assess function of the corresponding systems. Motor evoked potentials from the right upper limb showed significant delay in cortical latencies and significant prolongation of central motor conduction time in CP patients compared to control group. However, the amplitude of cortical response showed no significant changes. Somato-sensory evoked potentials of right median nerve showed significantly prolonged cortical N[19]/ P[22] absolute latency, N[13] - N[20], Erb's - N[20], N[13] - N[20] inter peak latencies respectively, however, Erb's, N[13], Erb's - N[13] absolute latencies and inter peak latency showed non significant changes but N[20] amplitude was significantly decreased. Somatosensory evoked potentials of the left posterior tibial nerve showed significant prolonged cortical and lumber absolute latencies and inter peak latency. Also, significant decrease of amplitude of cortical wave. A statistically highly significant positive correlation was observed between the hand function and N[20] amplitude [P < 0.01] of SEPs of the right median nerve while all other variables showed no statistically significant correlation with each other. Also, a statistically significant positive correlation was observed between the foot function and cortical amplitude [P < 0.05] of SEPs of the left posterior tibial nerve while all other variables showed no statistically significant correlation with each other. A tendency towards positive correlation was observed between hand functions and cortical latency [P < 0.09] of motor evoked potentials to the right abductor pollicis brevis muscle. We concluded that somatosensory evoked potentials are sensitive, non-invasive techniques for detection of the severity of motor impairment. We recommend MEPs and SSEPs as a relatively fast and effective means of assessing the functional integrity of the central nervous system in cerebral palsy patients