[A case of painful seizure accompanying ictal paresis and homonymous hemianopia due to post-stroke epilepsy].

A 69-year-old female with an old infarct of the left parietotemporal lobe was admitted for the evaluation of suspected painful seizures accompanying ictal paresis. The painful seizure and ictal paresis involved her right extremities without convulsions, although intermittent tremulous movements were noted on the right upper extremity. She also showed right hemianopia during the seizure. Ictal scalp EEG demonstrated lateralized rhythmic sharply contoured delta activity intermingled with a large amount of spikes, sharp waves, and fast activity mainly on the posterior half of the left hemisphere. Ictal MRI showed restricted diffusion in the postcentral gyrus and dilatation of distal branches of the left middle cerebral artery (MCA). 99mTc-ECD SPECT revealed hyperperfusion on the left parietal cortex. Treatment with antiepileptic drugs successfully prevented seizure recurrence, then she was discharged home. On the follow-up SPECT after 1 month, the abnormal hyperperfusion disappeared. MRI demonstrated resolution of the restricted diffusion and the MCA dilatation. Taken together with the EEG abnormality and the transient abnormalities in SPECT and MRI, we concluded that her seizures were epileptic and that her painful seizures likely arise from the left primary somatosensory cortex. The mechanism of ictal paresis would be attributed to some disturbed functional architecture in the left primary motor cortex leading to loss of normal motor function through epileptic interference by ictal discharges. The same mechanism in the visual cortex could be assumed for her ictal hemianopia. Painful seizure and ictal paresis each is rarely encountered, even more so the combination thereof. These ictal manifestations might be difficult to differentiate from transient ischemic attack or postictal paresis, and thus EEG is essential to diagnose this treatable condition.

Negative Correlation between Serum Cytokine Levels and Cognitive Abilities in Children with Autism Spectrum Disorder.

Evidence suggests that cytokines may be one of the major factors influencing cognitive development in those with autism spectrum disorder (ASD). To shed light on the neural and cognitive mechanisms of ASD, we investigated the association between peripheral cytokine levels and cognitive profiles in children with ASD. The serum levels of 10 cytokines (granulocyte macrophage colony-stimulating factor, interferon (IFN)-γ, interleukin (IL)-1ß, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, and tumor necrosis factor-α) were examined in 14 children with ASD using the Human Ultrasensitive Cytokine Magnetic 10-Plex Panel for the Luminex platform. The Wechsler Intelligence Scale for Children (WISC) was administered to each subject, and the relationships between WISC scores and serum levels of the cytokines were examined. The full-scale intelligence quotient (IQ) was significantly negatively correlated with the levels of IL-6 (Spearman's rank, p < 0.0001, false discovery rate q < 0.01). The levels of IL-6 and IFN-γ showed significant negative correlations with the verbal comprehension index (p < 0.001, q < 0.01) and working memory index (p < 0.01, q < 0.05), respectively. No other cytokines were significantly correlated with full-scale IQ or with any of the subscale scores of the WISC. The present results suggest negative correlations of IL-6 and IFN-γ levels with cognitive development of children with ASD. Our preliminary findings add to the evidence that cytokines may play a role in the neural development in ASD.

Normalization of sonographical multifocal nerve enlargements in a MADSAM patient following a good clinical response to intravenous immunoglobulin.

Focal nerve enlargements at sites of conduction blocks can be visualized sonographically in patients with multifocal acquired demyelinating sensory and motor neuropathy (MADSAM). However, little is known about association between nerve morphological changes and treatment responses. Here we present a 73-year-old female MADSAM patient whose sonographical multifocal nerve enlargements normalized following a good treatment response. She was admitted to our department with progressive asymmetrical muscle weakness and sensory disturbances for 6 months. Ultrasonography revealed multifocal nerve enlargements at sites of electrophysiological demyelination. Intravenous immunoglobulin improved her symptoms and electrophysiological abnormalities. Six months later, ultrasonography revealed normalization of multifocal nerve enlargements. Contrary to our observations, one previous report described a MADSAM patient with persistent nerve enlargements at the sites of resolved conduction blocks. In this earlier patient, however, the time from onset to remission was approximately 30 months. Morphological changes of nerve enlargements in MADSAM may vary with treatment response.

Neuroanatomical correlates of attention-deficit-hyperactivity disorder accounting for comorbid oppositional defiant disorder and conduct disorder.

AIM: An increasing number of neuroimaging studies have been conducted to uncover the pathophysiology of attention-deficit-hyperactivity disorder (ADHD). The findings are inconsistent, however, at least partially due to methodological differences. In the present study voxel-based morphometry (VBM) was used to evaluate brain morphology in ADHD subjects after taking into account the confounding effect of oppositional defiant disorder (ODD) and conduct disorder (CD) comorbidity. METHODS: Eighteen children with ADHD and 17 age- and gender-matched typically developing subjects underwent high-spatial resolution magnetic resonance imaging. The regional gray matter volume differences between the children with ADHD and controls were examined with and without accounting for comorbid ODD and CD in a voxel-by-voxel manner throughout the entire brain. RESULTS: The VBM indicated significantly smaller regional gray matter volume in regions including the bilateral temporal polar and occipital cortices and the left amygdala in subjects with ADHD compared with controls. Significantly smaller regional gray matter volumes were demonstrated in more extensive regions including the bilateral temporal polar cortices, bilateral amygdala, right occipital cortex, right superior temporal sulcus, and left middle frontal gyrus after controlling for the confounding effect of comorbid ODD and CD. CONCLUSION: Morphological abnormalities in ADHD were seen not only in the regions associated with executive functioning but also in the regions associated with social cognition. When the effect of comorbid CD and ODD was taken into account, there were more extensive regions with significantly smaller volume in ADHD compared to controls.

Impact of behavioral/developmental disorders comorbid with conduct disorder.

AIMS: The aim of the present study was to verify the comorbidity of conduct disorder (CD) and behavioral/developmental disorders in children and adolescents, and to examine the traits of CD comorbid with them. METHODS: Subjects were 64 children (60 boys, four girls) who were resident at three institutions for delinquent children or who were conduct-disordered outpatients of a university hospital aged under 18 years. A diagnostic interview was carried out by experienced child psychiatrists and the intelligence score and the Adverse Childhood Experiences score were measured by a licensed psychologist. RESULTS: A total of 57 children were diagnosed as having CD, of whom 26 (45.6%) were diagnosed with comorbid attention-deficit-hyperactivity disorder (ADHD), 12 were diagnosed with comorbid pervasive developmental disorder (PDD, 21,1%), and 19 (33.3%) had no comorbidity of either disorder. Six children (18.8% of CD comorbid with ADHD) met the criteria for both ADHD and PDD. The group with comorbid PDD was significantly younger at onset (F = 6.51, P = 0.003) and included unsocialized type more frequently (chi(2) = 6.66, P = 0.036) compared with the other two groups. CONCLUSIONS: Clinicians should be aware that not only ADHD but also PDD may be comorbid with CD. Establishment of the correct diagnosis is important because recognizing the presence of PDD will enable us to provide appropriate treatment and guidance, which may improve prognosis.

Establishing the cut-off point for the Oppositional Defiant Behavior Inventory.

The purpose of the present paper was to make a detailed examination of the cut-off point for the Oppositional Defiant Behavior Inventory (ODBI). The subjects were 56 untreated boys (age 6-15 years), who were diagnosed to have oppositional defiant disorder and who presented between December 2001 and March 2008. Controls were 690 boys with no history of contacting hospitals and no developmental or behavioral disorders at two elementary schools and two junior high schools in a city and its suburbs. It was shown that the level of opposition in boys could be evaluated regardless of the age groups by the ODBI, because there was no significant difference in the ODBI score for the one-way analysis of variance. Based on the sensitivity (88.2%), specificity (90.0%), positive predictive value (75.0%) and negative predictive value (95.7%), a score of 20 points was thus established as a suitable cut-off point to distinguish the children who are eligible for ODD diagnosis from those who are not.

The reliability and validity of the Oppositional Defiant Behavior Inventory.

OBJECTIVE: The aim of this study was to develop an evaluation scale for use as a supplementary tool for the diagnosis of oppositional defiant disorder (ODD). METHOD: The subjects were 98 Japanese children (91 males and 7 females), aged 6-15 years, diagnosed with attention deficit/hyperactivity disorder (ADHD) or ODD. Internal consistency, test-retest reliability, concurrent validity and divergent validity of the oppositional defiant behavior inventory (ODBI), an evaluation scale of oppositional defiant tendency, were examined. RESULTS: Cronbach's alpha coefficient of the ODBI was 0.925. The correlation coefficient between the test and the retest was 0.820 (p < 0.0001). Both the ODBI scores (test and retest) were correlated with the number of items that matched the ODD diagnostic criteria of DSM-IV (r = 0.660, 0.659, p < 0.001), and with the ODD-scale of Disruptive Behavior Disorders Rating Scale (r = 0.725, 0.654, p < 0.001). Compared with the ADHD group or controls, the ADHD and ODD group showed a significantly higher ODBI score at p < 0.0001. CONCLUSION: The concurrent use of this scale with clinical examination is expected to increase the accuracy of the diagnosis of ODD.

Behavioral and developmental disorders among conduct disorder.

The purpose of the present study was to clarify the percentage of children with conduct disorder (CD) who also have behavioral and developmental disorders. A survey of comorbidity observed in children with CD, was carried out on 33 subjects from a disciplinary facility for children. Female teachers as the mother were interviewed as regards the subjects' condition using the semistructured interview, and male teachers as the father were interviewed for their psychosocial problems. The subjects underwent the Wechsler Intelligence Scale for Children (WISC)-III and their conditions were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV). Of the 33 children, 27 were diagnosed as having CD. Of the 27 CD children, 18 (67%) were diagnosed as having attention deficit hyperactivity disorder (ADHD), and 19 (70%) had oppositional defiant feature (ODF). Eight children (30%) were diagnosed as having mental retardation and in seven children (26%), the verbal IQ was significantly lower than the performance IQ. Two (7%) were diagnosed as having pervasive developmental disorders (PDD). Of 27 children diagnosed with CD, 23 (85%) had some behavioral and developmental disorders. The classification of these behavioral and developmental disorders into the following three types appeared to be clinically useful: type 1, ADHD and ODF; type 2, low intelligence, especially low verbal intelligence; and type 3, PDD. To understand and treat children with CD, the accurate diagnosis of these underlying behavioral and developmental disorders is indispensable.

Psychosocial problems in attention-deficit hyperactivity disorder with oppositional defiant disorder.

The purpose of this study is to clarify psychosocial characteristics of the comorbidity of attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) in comparison with ADHD or ODD alone. Thirty-one patients with ADHD comorbid with ODD were compared with 23 ADHD alone and 10 with ODD alone, in terms of various examination items including objective assessment scales. The comorbid group demonstrated higher Children Depression Inventory score and State-Trait Anxiety Inventory for Children (state-anxiety) score than the ADHD or the ODD group, possessing more problems in the relationship with teachers than the ADHD group, with friends more than the ADHD or the ODD group, and with their mothers more than the ADHD group and less than the ODD group. School refusal occurred more frequently in the comorbid group than the ADHD group and less than the ODD group. The comorbid group had more psychosocial problems than the ADHD group and the ODD group. These problems could be classified into three types: (i) those derived from ODD, problems in the relationship with teachers; (ii) those derived from ODD but reduced by the coexistence of ADHD, problems in the relationship with their mothers; and (iii) those resulting from the comorbidity of ADHD and ODD, problems in the relationship with friends and anxious and depressive tendency. The difficulties in the relationship with teachers and friends observed in the comorbid group may lead to school refusal.