[Did child-psychiatry patients really experience the dreaded clinical degradation during the COVID-19 pandemic lockdown?] / Les enfants suivis en psychiatrie infanto-juvénile ont ils connu la dégradation redoutée pendant la période de confinement liée à la pandémie COVID-19 ?

BACKGROUND: The general lockdown period during the COVID-19 pandemic which covered mid-March to mid-May 2020 in France raised important questions about the direct and indirect psychological effects on children and adolescents. Perceived intuitively as harmful and even traumatic in the media's discourse, we tried to better qualify its effects from two complementary approaches. We carried out a review of the literature on the subject to which we associated a regular assessment of the children's global clinical state in the entire active file of the child-psychiatry department of the Centre Hospitalier Universitaire de Brest throughout the lockdown period.The findings of the literature review on the psychological effects of lockdowns or quarantines during past or current epidemics, in particular in China, report many deleterious and variable effects such as symptoms of anxiety, depression, as well as Post Traumatic Stress Disorder, at a significant rate. However, the definition of the situations experienced and the contexts in which those studies took place appear to be not truly comparable to the French situation. Moreover, the effects of the fear of contamination are not differentiated from those linked to confinement itself. PATIENTS AND METHODS: Among children and adolescents under the care of the above department, 354 underwent an assessment of the impact of lockdown on their global clinical condition using the Clinical Global Impression Improvement (CGI-I) performed by their usual practitioner during the period from March 16 to May 11, 2020. RESULTS: Our results highlight that 50% of children remained in stable condition, 25 to 30% improved and 20 to 25% experienced a slight degradation. The evolution of the clinical status appeared stable over time during the eight weeks. The initial age or severity of mental disorder had no significant influence, although there was a slightly more frequent improvement in adolescents. CONCLUSION: These results are quite inconsistent with general discourse and common expectations. Several psychopathological hypotheses are discussed to support this absence of psychological degradation which might even be extended to children and adolescents in the general population.

Facial reflex myoclonus induced by language: a neuropsychological and neurophysiological study.

We studied a 53 year old right-handed patient who presented isolated myoclonus of right facial muscles induced exclusively by language. Twitching significantly hindered speaking and reading performance. MRI and CT-scan revealed no brain lesion. Conventional EEG showed a few spike-waves predominantly in the left hemisphere. Spike-waves increased during drowsiness. An EEG-EMG polygraphic study was performed during stimulation tests which included linguistic tasks and non-verbal/non-linguistic tests. Myoclonus was triggered by speaking and writing but not by non-linguistic tasks. The severity of myoclonus was dependent on the complexity of the language task. Back-averaging of right facial EMG bursts failed to show a reliable EEG-EMG correlation. However, the facial reflex myoclonus might have originated from the left rolandicopercular cortex, as it was triggered by complex language activities. Findings in this case are compared with those reported for other forms of reflex seizure and myoclonus.