Benign neonatal sleep myoclonus in a child

Benign neonatal sleep myoclonus (BNSM), is a disorder generally mistaken for seizures during the newborn period. Benign neonatal sleep myoclonus is featured by myoclonic "lightninglike" jerks of the extremities that exclusively occur during sleep; it is not associated with epilepsy that occur only during sleep and cease abruptly when the child is agitated. This case reported was a 50 days-old baby boy with a history suggestive of abnormal movements for limbs noted over the preceding 7 days. Diagnosis of BNSM in infant based on history taking, clinical manifestation, and with no electroencephalographic changes. BNSM is usually not associated with any other neurologic impairment and spontaneously subsides within the first year of life. Its importance lies in the differential diagnosis with the epileptic, especially myoclonic, seizures of infancy. BNSM can be misinterpreting for neonatal seizures or even neonatal status epilepticus, the recognition of benign sleep myoclonus of infancy is imperative to elude unnecessary diagnostic studies and treatments.

Trastornos paroxísticos no epilépticos en el lactante / Non-paroxysmal disorder in infant

Los trastornos paroxísticos no epilépticos (TPNE) se definen como episodios que se repiten periódicamente y que remedan una crisis epiléptica. Su aparición es generalmente brusca y de breve duración, originados por una disfunción cerebral de origen diverso y que no obedecen a una descarga neuronal excesiva (a diferencia de una crisis epiléptica). Su incidencia es diez veces más elevada que la epilepsia y pueden aparecer a cualquier edad, pero son más frecuentes en los primeros años de vida. La inmadurez del sistema nervioso en la infancia hace que en este período las manifestaciones sean muy diversas y diferentes a otras edades. El primer paso para un diagnóstico correcto es un buen interrogatorio y establecer si el episodio puede corresponder a una crisis epiléptica o a un TPNE. El diagnóstico diferencial es muy amplio, especialmente en las primeras edades. Aparte del examen neurológico completo, en caso de duda se debe ampliar el estudio con exámenes complementarios que en la mayoría de las ocasiones serán normales/ negativos. En algunos casos se ha demostrado una base genética. Las opciones terapéuticas son escasas y la mayoría de los TPNE, especialmente en el lactante, desaparecen con la edad sin dejar secuelas.

Non-epileptic paroxysmal disorders (PNED) are defined as events that mimic epileptic seizures. Its onset is usually sudden and short-lived, caused by brain dysfunction of various origins, but not due to excessive neuronal firing. Its incidence is higher than the epilepsy (10:1). They can occur at any age but are most common in children, especially in the first year of life. The immature nervous system in childhood causes in this period, paroxysmal manifestations that are very diverse and different from other ages. Normal and common paroxysmal disorders in children can mimic epileptic seizures. The first step is to establish a correct diagnosis, if the clinical paroxysmal episode is a seizure or PNED. Differential diagnosis is very broad, especially in the first ages. It's necessary a complete neurological examination in case of doubt and the study should be extended with complementary exams, investigations that in most cases will be normal/negative. In some of them, a genetic basis has been shown. Treatment options are limited and most PNED untreated have a favorable outcome.

Benign Neonatal Sleep Myoclonus: Frequently Misdiagnosed as Neonatal Seizures.

18 neonates aged 5-60 days with Benign neonatal sleep myoclonus were identified. Fifteen neonates had been misdiagnosed as neonatal seizures before referral. All treatments were withdrawn once the diagnosis of benign neonatal sleep myoclonus was made. Benign neonatal sleep myoclonus should be considered early in the differential diagnosis of neonatal seizures.

Conversion Disorder: Socio-demographic and Psychosocial correlates of patients presenting with Nonepileptic events.

Objective: To study the socio-demographic and psychosocial correlates in patients with conversion disorder presenting with nonepileptic events and discuss its interventional implication. Material and Methods: This cross-sectional descriptive study was carried out in a tertiary care centre of eastern India from September 2008 to February 2009. 151 consecutive patients with conversion disorder satisfying the inclusion and exclusion criteria were selected. They were interviewed using semi-structured socio-demographic profile proforma, Holmes and Rahe stress scale for the exploration of psycho-social stressors. The data were entered on MS excel, analyzed by SPSS-version 16.0. Results: The psychosocial stressors were clearly identified in all patients. Almost ninety five (94.70%, n=143) out of the total 151 subjects had a history of stressors, while in the rest 4.95% no stressors could be established. The commonest stressors were Troubles with in-laws (26.49%), Death of close family member (11.92%) and Increase in argument with significant others (10.59 %). Conclusion: Significantly higher number of the patients presented with the stressor of troubles with in-laws, when assessed on the Holmes and Rahe Social Readjustment Rating Scale. Detection of exact nature of correlates has immense potential for therapeutic as well as preventive field.

A neuro-fuzzy system to support in the diagnostic of epileptic events and non-epileptic events using different fuzzy arithmetical operations / Um sistema neuro-difuso para auxiliar no diagnóstico de eventos epilépticos e eventos não epilépticos utilizando diferentes operações aritméticas difusas

OBJECTIVE: To investigate different fuzzy arithmetical operations to support in the diagnostic of epileptic events and non epileptic events. METHOD: A neuro-fuzzy system was developed using the NEFCLASS (NEuro Fuzzy CLASSIfication) architecture and an artificial neural network with backpropagation learning algorithm (ANNB). RESULTS: The study was composed by 244 patients with a bigger frequency of the feminine sex. The number of right decisions at the test phase, obtained by the NEFCLASS and ANNB was 83.60 percent and 90.16 percent, respectively. The best sensibility result was attained by NEFCLASS (84.90 percent); the best specificity result were attained by ANNB with 95.65 percent. CONCLUSION: The proposed neuro-fuzzy system combined the artificial neural network capabilities in the pattern classifications together with the fuzzy logic qualitative approach, leading to a bigger rate of system success.

OBJETIVO: Investigar diferentes operações aritméticas difusas para auxíliar no diagnóstico de eventos epilépticos e eventos não-epilépticos. MÉTODO: Um sistema neuro-difuso foi desenvolvido utilizando a arquitetura NEFCLASS (NEuro Fuzzy CLASSIfication) e uma rede neural artificial com o algoritmo de aprendizagem backpropagation (RNAB). RESULTADOS: A amostra estudada foi de 244 pacientes com maior freqüência no sexo feminino. O número de decisões corretas na fase de teste, obtidas através do NEFCLASS e RNAB foi de 83,60 por cento e 90,16 por cento, respectivamente. O melhor resultado de sensibilidade foi obtido com o NEFCLASS (84,90 por cento); o melhor resultado de especificidade foi obtido com a RNAB (95,65 por cento). CONCLUSÃO: O sistema neuro-difuso proposto combinou a capacidade das redes neurais artificiais na classificação de padrões juntamente com a abordagem qualitativa da logica difusa, levando a maior taxa de acertos do sistema.