Repeat testing enhances long-term verbal memory in children with epilepsy.

To (i) determine whether accelerated long-term forgetting (ALF) can be found using standardized verbal memory test materials in children with genetic generalized epilepsy (GGE) and temporal lobe epilepsy (TLE), and (ii) to establish whether ALF is impacted by executive skills and repeat testing over long delays. One hundred and twenty-three children aged 8 to 16, (28 with GGE, 23 with TLE, and 72 typically developing; TD) completed a battery of standardized tests assessing executive functioning and memory for two stories. Stories were recalled immediately and after a 30-min delay. To examine whether repeat testing impacts long-term forgetting, one story was tested via free recall at 1-day and 2-weeks, and the other at 2-weeks only. Recognition was then tested for both stories at 2-weeks. Children with epilepsy recalled fewer story details, both immediately and after 30-min relative to TD children. Compared to TD children, the GGE group, but not the TLE group, showed ALF, having significantly poorer recall of the story tested only at the longest delay. Poor executive skills were significantly correlated with ALF for children with epilepsy. Standard story memory materials can detect ALF in children with epilepsy when administered over long delays. Our findings suggest that (i) ALF is related to poor executive skills in children with epilepsy, and (ii) repeated testing may ameliorate ALF in some children.

Accelerated long-term forgetting in children with temporal lobe epilepsy: A timescale investigation of material specificity and executive skills.

Recently, children with temporal lobe epilepsy (TLE) were found to be at risk of accelerated long-term forgetting (ALF). In this study, we examined the temporal trajectory of ALF, while exploring the relationship between ALF, executive skills, and epilepsy variables. Fifty-one children, (23 with TLE and 28 typically developing) completed a battery of neuropsychological tests of verbal and visual memory, executive skills, and two experimental memory tasks (verbal and visual) involving recall after short (30-min) and extended (1-day and 2-week) delays. Side of seizure focus and hippocampal integrity were considered. On the visual task (Scene Memory), children with TLE performed comparably to typically developing children following a 30-min and 1-day delay, although worse than typically developing children at 2 weeks: ALF was observed in children with right TLE focus. The two groups did not differ on the experimental verbal memory task. Children with TLE also had worse performance than typically developing children on standardized verbal memory test and on tests of executive skills (i.e., verbal generativity, inhibition, working memory, complex attention). Only complex attention was associated with visual ALF. ALF was present for visuo-spatial materials in children with TLE at two weeks, and children with right TLE were most susceptible. A relationship was identified between complex attention and long-term forgetting. The findings extend our understanding of difficulties in long-term memory formation experienced by children with TLE.

Verbal memory in children with temporal lobe epilepsy: Exploring task-specificity.

RATIONALE: This study explored the applicability of the adult model of task-specificity of memory to children with temporal lobe epilepsy (TLE). METHOD: Retrospective clinical audit; 38 children and adolescents (6-16 years) with lesional TLE (n = 22 mesial; n = 16 lateral) treated at tertiary pediatric hospitals completed two types of verbal memory paradigms: arbitrary associative (Verbal Paired Associates - Hard Pairs) and semantically related (Verbal Paired Associates - Easy Pairs; Stories). RESULTS: Children with mesial TLE performed more poorly than their lateral TLE counterparts on both types of memory paradigms: arbitrary associative and semantically related (Stories only). Groups with left and right TLE performed comparably on all verbal memory measures. CONCLUSIONS: Our findings suggest that the adult model of task-specificity may not be completely applicable to children with TLE. Consideration of the developmental context is critical in research and clinical work with pediatric populations.

A neuropsychological model for the pre-surgical evaluation of children with focal-onset epilepsy: An integrated approach.

This review explores the complexities of pre-surgical neuropsychological assessment for children with focal-onset epilepsy. A model is proposed outlining a range of factors that potentially influence the neuropsychological formulation. These factors include a developmental, epilepsy, psychological and cognitive dimension, together with family and social context and intrinsic factors. This model is child-centered and recognizes that these factors will be weighted differently for each individual. In some instances the neuropsychological profile might suggest localized and lateralized function, but there are significant limitations to this approach in the context of the contemporary view of epilepsy as a network disorder. This review recognizes that a range of issues impact on neuropsychological function in children with focal-onset epilepsy, including the connectivity between neural systems and the dynamic nature of development. The aim of this review is to provide a neuropsychological framework to enhance and support clinical decision-making in the pre-surgical evaluation of children with focal-onset epilepsy.

Theory of mind and social competence in children and adolescents with temporal lobe epilepsy.

OBJECTIVE: The primary aim of this study was to examine theory of mind (ToM) and its relationship to social competence in children and adolescents with temporal lobe epilepsy (TLE). The secondary aim was to explore the relationship between ToM, social competence, epilepsy variables, and executive functioning (EF). METHOD: Twenty-two children and adolescents (8-16 years old) with TLE and 22 typically developing controls completed two advanced behavioural tests of ToM (faux-pas, strange stories), measures of EF and verbal IQ. Parents completed questionnaires assessing ToM and social competence of their child. Epilepsy variables were obtained from treating neurologists and interviews with parents. RESULTS: Children and adolescents with TLE had significant impairments in cognitive and affective ToM, reduced social competence, and lower verbal IQ than controls. Although verbal IQ was reduced in the TLE group, it was not related to ToM or social functioning. ToM impairment (a single score encompassing cognitive and affective ToM) was significantly correlated with social competence problems in our TLE group. Longer duration of epilepsy was related to reduced ToM and social competence, while earlier onset of seizures was related to social competence problems only. Finally, EF was neither impaired nor related to ToM or social problems in children and adolescents with TLE. CONCLUSION: This study revealed marked ToM impairments and associated social difficulties in children and adolescents with TLE. The results support studies demonstrating similar impairments in children with other epilepsy subtypes and highlight the importance of detecting and treating ToM and social difficulties in this group. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Facial emotion perception and social competence in children (8 to 16 years old) with genetic generalized epilepsy and temporal lobe epilepsy.

Facial emotion perception (FEP) impairments are common in adults with epilepsy and associated with impaired psychosocial functioning. Research into the presence of FEP deficits in children with epilepsy and the functional implications of these deficits is limited. The primary aims of this study were to assess FEP abilities in children (8 to 16 years old) with genetic generalized epilepsy (GGE) and temporal lobe epilepsy (TLE) and examine whether FEP is related to everyday social functioning. Forty-four children (8 to 16 years) with epilepsy (22 GGE, 22 TLE) and 22 typically developing controls completed the Pictures of Facial Affect (POFA) battery to assess FEP and a brief test of intellectual functioning (intelligence quotient [IQ]). Parents completed questionnaires assessing social competence of their child. Neurologists completed the Global Assessment of Severity of Epilepsy (GASE) scale as a measure of overall epilepsy severity. Demographic and clinical information was obtained from medical records and clinical interviews with parents. Findings revealed significant, overall FEP impairments and reduced social competence in children with GGE and TLE compared to controls. The magnitude of FEP impairment (i.e., across all emotions) was comparable in the two epilepsy groups, yet different emotions were impaired in each group: children with GGE were impaired in recognizing anger and disgust, whereas children with TLE were impaired in sadness and disgust, compared to controls. Contrary to expectations, total FEP accuracy was not significantly correlated with social competence in either epilepsy group. In conclusion, children with GGE and TLE have significant impairments recognizing emotional expressions on faces. Further research is needed to examine whether underlying FEP impairments relate to social and emotional functioning in children with epilepsy.

Virtual peer-delivered memory intervention: a single-case experimental design in an adolescent with chronic memory impairment.

BACKGROUND: Children and adolescents with chronic memory impairment may develop coping strategies that enable functioning, yet these often remain undetectable using traditional psychometric measures. Personalized intervention studies that promote the use of such strategies designed specifically for use by this young cohort are scarce. OBJECTIVE: To investigate the effect of a novel virtual reality peer-delivered memory intervention on the everyday functioning and well-being of SE, a 17-year-old female with a history of chronic verbal memory issues, impaired autobiographical event recall and elevated mood symptoms. RESEARCH DESIGN: A single-case ABA experimental design study was used to assess change. METHODS: Following initial baseline assessment using objective neuropsychological and subjective functional questionnaires and intervention training, case SE used the intervention daily for 3 weeks before repeating key outcome measures. RESULTS: Using non-overlap of all pairs and qualitative feedback analysis, the results revealed a significant increase in event recall and self-reported positive changes to levels of everyday functioning. CONCLUSION: Supporting autobiographical event recall and prospective memory via a virtual peer-delivered intervention may lead to reduction in cognitive load, and benefit overall well-being and everyday functioning.

Environmental Contributions to Social and Mental Health Outcomes Following Pediatric Stroke.

Mental health and social outcomes following acquired brain injury (ABI) in children are often considered to be due to brain insult, but other factors, such as environment, may also play a role. We assessed mental health and social function in children with chronic illness, with and without stroke (a form of ABI), and typically developing (TD) controls to examine environmental influences on these outcomes. We recruited 36 children diagnosed with stroke, 15 with chronic asthma, and 43 TD controls. Children and parents completed questionnaires rating child mental health and social function and distal and proximal environment. TD children had significantly less internalizing and social problems than stroke and asthma groups, and engaged in more social activities than children with stroke. Poorer parent mental health predicted more internalizing and social problems and lower social participation. Family dysfunction was associated with internalizing problems. Lower parent education contributed to children's social function. Children with chronic illness are at elevated risk of poorer mental health and social function. Addition of brain insult leads to poorer social participation. Quality of home environment contributes to children's outcomes, suggesting that supporting parent and family function provides an opportunity to optimize child mental health and social outcomes.

Developmental stage affects cognition in children with recently-diagnosed symptomatic focal epilepsy.

This study explored the impact of developmental stage on cognitive function in children with recently-diagnosed epilepsy. In keeping with a neurodevelopmental framework, skills in a critical developmental period were expected to be more vulnerable than those stable at the time of seizure onset. We studied children with early-onset (EO) symptomatic focal epilepsy (onset: 3-5 years; n=18) and compared their performance with that of the group with late-onset (LO) epilepsy (onset: 6-8 years performance of; n=8) on a range of cognitive tasks. Performance of both groups was compared with normative standards. 'Critical' and 'stable' classifications were based on developmental research. Nonparametric analyses revealed that skills in a critical developmental period for the group with EO epilepsy fell below normative standards (Phonological Processing: p=.007, Design Copying: p=.01, Visuomotor Precision:, p=.02) and fell below the performance of the group with LO epilepsy (Design Copying: p=.03, Visuomotor Precision: p=.03). There were no differences between the group with EO epilepsy and the group with LO epilepsy on measures of receptive vocabulary and memory, which were proposed to be in a stable developmental period across both groups. Auditory span, as measured by Word Order, was reduced for both the group with EO epilepsy (p=.02) and the group with LO epilepsy (p=.02) relative to normative standards, but the groups did not differ from each other. These results are consistent with a prolonged period of critical development for this skill. These findings support the notion that skills in a critical phase of development are particularly vulnerable following the onset of symptomatic focal epilepsy in childhood.

Social competence following pediatric stroke: contributions of brain insult and family environment.

Limited information is available regarding predictors of psychosocial difficulties in children following stroke. This study aimed to (i) compare social competence of children with arterial ischemic stroke (AIS) to those with chronic illness and healthy controls and (ii) investigate the contribution of stroke pathology, neurological outcome and environment. Thirty-six children with AIS > 12 months prior to recruitment were compared with children with chronic illness (asthma) (n = 15) and healthy controls (n = 43). Children underwent intellectual assessment, and children and parents completed questionnaires to assess social competence. Children with AIS underwent MRI scan and neurological evaluation. Child AIS was associated with poorer social adjustment and participation, and children with AIS were rated as having more social problems than controls. Lesion volume was not associated with social outcome, but subcortical stroke was linked to reduced social participation and younger stroke onset predicted better social interaction and higher self-esteem. Family function was the sole predictor of social adjustment. Findings highlight the risk of social impairment following pediatric stroke, with both stroke and environmental factors influencing children's social competence in the chronic stages of recovery. They indicate the potential for intervention targeting support at the family level.

Juvenile Parkinsonism.

We present the case of a 14-year-old boy presented with a recent history of progressive neurologic decline and extrapyramidal features. The history and findings with illustrative figures are detailed, and a diagnostic approach to the presentation is considered. The therapeutic options and broader management issues are briefly reviewed.

Changes in memory function in children and young adults with temporal lobe epilepsy: a follow-up study.

This longitudinal study explored change in memory function from childhood to young adulthood in temporal lobe epilepsy (TLE). The 24 participants (11 left TLE; 13 right TLE) had a mean age of 16.10 years (SD=4.13 years), and 14 had undergone surgery since initial assessment. Contrary to baseline, verbal memory deficits were lateralized (left

Estrategias de tratamiento del paciente con hipertensión arterial esencial: Perfil neurohormonal y geometría ventricular izquierda

La geometría ventricular izquierda, determinada por ecocardiografía bidimensional, proporciona de manera indirecta información sobre el perfil hemodinámico y neurohormonal del paciente hipertenso. En dos estudios pilotos, llevados a cabo en el Instituto de Investigaciones Cardiovasculares de la Universidad de Los Andes hemos utilizado al patrón geométrico como guía para orientar el tratamiento farmacológico del paciente hipertenso. La correspondencia de la estrategia farmacológica con el mecanismo neurohormonal, responsable de la hipertensión arterial, permite un control de la presión arterial con menor número de medicamentos y reduce la incidencia de efectos colaterales y complicaciones. Más aún, el proceso de remodelación cardiaca puede ser influenciado favorable o desfavorablemente, si la estrategia terapéutica empleada se corresponde o no con el mecanismo neurohormonal subyacente. El proceso de remodelación cardiaca, en la transición hacia los dos fenotipos de insuficiencia cardiaca congestiva, se caracteriza por modificaciones opuestas de la geometría y función ventricular. Los pacientes que evolucionan hacia la insuficiencia cardiaca sistólica experimentan una progresiva dilatación de las cavidades cardiacas izquierdas y disminución de la función sistólica. Por el contrario, en los pacientes que evolucionan hacia la insuficiencia cardiaca diastólica, el tamaño de las cavidades cardiacas se reduce y la relajación ventricular se altera.

The neurohormonal and hemodynamic profiles, of uncomplicated hypertensive patients, can be inferred from the left ventricular geometric pattern. We have used the left ventricular geometric pattern to guide the pharmacological treatment of hypertensive patients. Blood pressure control can be achieved with less medications and complications and adverse effects are reduced with a therapeutic strategy aimed at the underlying neurohormonal and hemodynamic profiles. On the contrary, cardiac remodelling is unfavorably influenced by a therapeutic strategy unmatched to the underlying responsable mechanisms. During transition to the two phenotypes of congestive heart failure, cardiac remodelling evolves in opposite directions. Thus, patients with systolic heart failure undergo progressive ventricular dilatation with thinning of its walls, where as, diastolic heart failure patients are characterized by shrinking of their left ventricular cavities with increasing relative wall thickness.

Language lateralization correlates with verbal memory performance in children with focal epilepsy.

PURPOSE: Assessment of language dominance with functional magnetic resonance imaging (fMRI) and neuropsychological evaluation is often used prior to epilepsy surgery. This study explores whether language lateralization and cognitive performance are systematically related in young patients with focal epilepsy. METHODS: Language fMRI and neuropsychological data (language, visuospatial functions, and memory) of 40 patients (7-18 years of age) with unilateral, refractory focal epilepsy in temporal and/or frontal areas of the left (n = 23) or right hemisphere (n = 17) were analyzed. fMRI data of 18 healthy controls (7-18 years) served as a normative sample. A laterality index was computed to determine the lateralization of activation in three regions of interest (frontal, parietal, and temporal). RESULTS: Atypical language lateralization was demonstrated in 12 (30%) of 40 patients. A correlation between language lateralization and verbal memory performance occurred in patients with left-sided epilepsy over all three regions of interest, with bilateral or right-sided language lateralization being correlated with better verbal memory performance (Word Pairs Recall: frontal r = -0.4, p = 0.016; parietal r = -0.4, p = 0.043; temporal r = -0.4, p = 0.041). Verbal memory performance made the largest contribution to language lateralization, whereas handedness and side of seizures did not contribute to the variance in language lateralization. DISCUSSION: This finding reflects the association between neocortical language and hippocampal memory regions in patients with left-sided epilepsy. Atypical language lateralization is advantageous for verbal memory performance, presumably a result of transfer of verbal memory function. In children with focal epilepsy, verbal memory performance provides a better idea of language lateralization than handedness and side of epilepsy and lesion.

Enfermedad glomeruloquística en dos perros con insuficiencia renal / Glomerulocystic kidney disease in two dogs with renal failure

Two cases of glomerulocystic kidney disease (GCKD) are described in dogs with renal failure. The laboratory test of the two dogs showed renal hyperazotemia with secondary non-regenerative anemia, associated to chronic renal failure. Macroscopic kidney lesions in both dogs were similar: showing multiple small cysts with an average of 1 mm in diameter, mainly in the renal cortex. Histopathological examination of the kidneys in both dogs revealed dilatation in the filtration space and Bowman's capsule forming cysts with glomerular atrophy and mild to severe periglomerular and interstitial fibrosis. These findings suggest that cystic glomerular changes may be developed as a consequence of fibrosis, which could act by compressing the glomerulo-tubular junctions. There are few reported cases of GCKD in dogs prior to these two. It may be explained that this is only a sporadic entity, adding that it may well be mistaken with other similar renal cystic pathologies, linked or not to a renal failure; therefore, it should be included in the differential diagnoses. For the first time, this report gives a clinical-pathological description of two cases in dogs with GCKD in Mexico.

Se describen dos casos de enfermedad glomeruloquística renal (EGQR) en perros con insuficiencia renal. En los análisis de laboratorio de ambos animales se encontró hiperazotemia renal con anemia no regenerativa secundaria, asociada con insuficiencia renal crónica. Las lesiones macroscópicas en los riñones de dichos perros fueron similares: se observaron múltiples pequeños quistes de 1 mm de diámetro en promedio, localizados principalmente en la corteza renal. En el examen histopatológico de los riñones de ambos perros se observaron dilataciones del espacio de filtración y de la cápsula de Bowman formando quistes, con atrofia de los ovillos glomerulares, así como fibrosis periglomerular e intersticial de moderada a severa. Estos hallazgos sugieren que los cambios glomerulares quísticos se pueden desarrollar como consecuencia de la fibrosis, la cual pudiera ejercer efecto compresor de las uniones glomérulo-tubulares. En el ámbito mundial, en perros caseros existen muy pocos informes previos de EGQR, debido quizá a que realmente es una entidad esporádica, además de que pudiera confundirse con otras patologías renales quísticas parecidas, asociadas o no con insuficiencia renal, por ello debe incluirse dentro de los diagnósticos diferenciales. Este informe aporta la descripción clínico-patológica de dos casos de EGQR en perros, por primera vez en México.

The Observer Memory Questionnaire-Parent Form: introducing a new measure of everyday memory for children.

Relatively little research has focused on everyday memory function in childhood, possibly reflecting the limited number of measures available. This study introduces the Observer Memory Questionnaire-Parent Form (OMQ-PF), which assesses parental beliefs about their child's everyday memory. The OMQ-PF and a selection of neuropsychological measures were administered to a cohort of healthy children in Study 1 (n = 376; 5-16 years old) and a temporal lobe epilepsy (TLE) group in Study 2 (n = 44; 6-16 years old). Study 1 found the OMQ-PF had sound internal consistency and was significantly correlated to a learning task. Study 2 found the TLE group was impaired on the OMQ-PF relative to the healthy cohort. Everyday memory ratings were related to a wider range of neuropsychological measures in this group. Findings are encouraging in terms of the properties of the OMQ-PF and suggest further development of the scale is warranted.

The localization and lateralization of memory deficits in children with temporal lobe epilepsy.

PURPOSE: It is often reported that children with temporal lobe epilepsy (TLE) experience nonlateralized memory impairments. However, many of these studies have been exploratory and not based on memory theory. Further, differences between mesial and lateral subgroups have not been adequately examined. This study aimed to discern more specific patterns of memory impairment in children with TLE. METHODS: Forty-three children (5-16 years) with lesional TLE participated. Subjects were categorized in terms of lesion laterality (left, n = 21; right, n = 22) and intratemporal location (mesial, n = 31; lateral, n = 12). Verbal and nonverbal memory tasks were administered that reflected associative, allocentric and recognition paradigms. RESULTS: Facial recognition was poorer in right TLE (p = 0.03). There were no differences between left and right groups on any other memory task, even when comparisons were restricted to cases with mesial involvement. Irrespective of laterality, clear differences were observed between mesial and lateral lesion subgroups (arbitrary associative learning, p = 0.01; complex figure recall, p = 0.03). The lateral lesion subgroup displayed intact memory function relative to normative standards. CONCLUSIONS: Memory is more frequently impaired in children with mesial as opposed to lateral TLE. Tasks with an associative component discriminated between these subgroups, supporting an associative model of hippocampal function. With the exception of facial recognition, memory deficits were not lateralized. Therefore, the nature of memory impairment experienced by children with TLE cannot be extrapolated from adult models.

Air pollution-associated changes in lung function among asthmatic children in Detroit.

In a longitudinal cohort study of primary-school-age children with asthma in Detroit, Michigan, we examined relationships between lung function and ambient levels of particulate matter < or = 10 microm and < or = 2.5 microm in diameter (PM10 and PM2.5) and ozone at varying lag intervals using generalized estimating equations. Models considered effect modification by maintenance corticosteroid (CS) use and by the presence of an upper respiratory infection (URI) as recorded in a daily diary among 86 children who participated in six 2-week seasonal assessments from winter 2001 through spring 2002. Participants were predominantly African American from families with low income, and > 75% were categorized as having persistent asthma. In both single-pollutant and two-pollutant models, many regressions demonstrated associations between higher exposure to ambient pollutants and poorer lung function (increased diurnal variability and decreased lowest daily values for forced expiratory volume in 1 sec) among children using CSs but not among those not using CSs, and among children reporting URI symptoms but not among those who did not report URIs. Our findings suggest that levels of air pollutants in Detroit, which are above the current National Ambient Air Quality Standards, adversely affect lung function of susceptible asthmatic children.