Neuroplasticity during the transition period: How the adolescent brain can recover from aphasia. A pilot study.

BACKGROUND: Increasing clinical and scientific attention is given to the transition of neurological stages from child to adult. Data on brain plasticity during adolescence is interesting for providing adequate evidence-based medical attention to neurological conditions in this population. Acquired aphasia is well described in adults and children, but not in adolescence. OBJECTIVE: We describe a 5-year follow-up of language in three adolescent subjects with post-brain injury aphasia. METHODS: We analysed and scored formal aspects of language three times, language hemispheric dominance twice with dichotic listening test and functional magnetic resonance imaging (fMRI) brain activation patterns that supported expressive and comprehensive language during the recovery period. RESULTS: We found similarities to both paediatric and adult aphasia in these three adolescents. While the level of recovery resembled that of children with aphasia, a more efficient language rehabilitation occurred in those who remained with left hemispheric dominance in the chronic stage, as it is reported in adults. CONCLUSIONS: Our analysis and long-term follow-up provide data for a better understanding on how the injured brain matures during adolescence. More studies with larger samples will help to understand the function of the remaining networks and the recovery from injury in this particular age group.

Amnesia del desarrollo y daño cerebral temprano: neuropsicología y neuroimagen / Developmental amnesia and early brain damage: neuropsychology and neuroimaging

Objetivo. Contribuir a la descripción de la amnesia del desarrollo como síndrome específico en niños que sufrieron agresión temprana, pero no masiva, de ambos hipocampos. Sujetos y métodos. Muestra de 24 escolares de ambos sexos, de 6-16 años de edad. Se distribuye en tres grupos: pacientes afectos de encefalopatía hipóxico-isquémica perinatal, con parálisis cerebral espástica, inteligencia normal y fallos de memoria (n = 8); pacientes con similares características, pero sin quejas de memoria (n = 7); y escolares sanos sin antecedentes de riesgo (n = 9) como grupo control. Se aplican escalas y tests para comprobar la normalidad intelectual y atencional, y para medir el perfil de rendimiento en tareas de memoria. En todos los sujetos, mediante resonancia magnética, se estima la presencia y grado de atrofia hipocámpica con la escala de Scheltens, y se calcula el índice espectroscópico NAA/(Cho + Cr). Resultados. El perfil neuropsicológico de los ocho pacientes del primer grupo es claramente sugestivo de amnesia el desarrollo, que contrasta con la normalidad en los otros grupos. En siete escolares con amnesia se constata bilateralmente algún grado de atrofia bihipocámpica o disminución significativa del índice NAA/(Cho + Cr). Conclusiones. La amnesia del desarrollo se caracteriza por afectación de la memoria episódica con preservación del aprendizaje semántico y procedimental. Se explica por daño parcial bihipocámpico temprano. El correcto diagnóstico permite una intervención psicoeducativa específica. En el futuro cabría ensayar terapias farmacológicas asociadas a la intervención psicoeducativa (AU)

Aim. To contribute to neuropsychological profiling of developmental amnesia subsequent to bilateral damage to both hippocampi in early age. Subjects and methods. The total sample of 24 schoolchildren from both sexes is distributed in three groups: perinatal hypoxic-ischaemic encephalopathy and everyday complaints of memory in school age (n = 8); perinatal hypoxic-ischaemic encephalopathy without memory complaints (n = 7); and a group of typically developing (n = 9). All participants in every groups did have normal general intelligence and attention. Both clinical groups had, as another clinical consequence, spastic cerebral palsy (diplegia). Neuropsychological exam consisted on tests of general intelligence, attentional abilities, declarative memory and semantic knowledge. All participants had a brain magnetic resonance image and spectroscopy of hippocampi. Scheltens criteria were used for visual estimation of hippocampal atrophy. Parametric and non-parametric statistical contrasts were made. Results. Despite preservation of semantic and procedural learning, declarative-episodic memory is impaired in the first group versus the other two groups. A significant proportion of bilateral hippocampal atrophy is only present in the first group versus the other two non-amnesic groups using Scheltens estimation on MRI. Two cases without evident atrophy did have diminished NAA/(Cho + Cr) index in both hippocampi. Conclusions. Taken together, these results contribute to delineate developmental amnesia as an specific impairment due to early partial bihippocampal damage, in agreement with previous studies. After diagnosis of developmental amnesia, a specific sychoeducational intervention must be made; also this impairment could be candidate for pharmacological trials in the future (AU)

Stylohyoid Complex (Eagle) Syndrome Starting in a 9-Year-Old Boy.

Background There are only four previous pediatric reports of the glossopharyngeal neuralgic form of the stylohyoid complex syndrome. Stylohyoid complex has merely been described as cases of glossopharyngeal neuralgia in children. Case Report A 12-year-old boy came to our hospital because of recurrent episodes of severe cranial pain (9/10) lasting for 5 to 15 minutes. Pain affected the right tonsillar fossa, ear, and mastoid region. Since the start at the age of 9 years, the frequency of painful episodes has progressively increased: when admitted to our clinics 3 years later, the child was having up to five episodes daily in spite of analgesic, antiepileptic, and antidepressant drugs; he had abandoned school and leisure. Between episodes, neurological examination detected only discomfort to pressure on the right tonsillar fossa. Three-dimensional computed tomography images of the skull base showed an elongated right styloid process and bilateral calcification of the stylohyoid ligament. After surgical excision of the right styloid process and of part of the stylohyoid ligament, the glossopharyngeal painful episodes ceased. The patient remains asymptomatic seven years later. Conclusion In spite of its rarity in childhood, this debilitating but treatable syndrome should be kept in mind for the differential diagnosis of recurrent cranial pain in the pediatric population.

Acquisition of Motor and Cognitive Skills through Repetition in Typically Developing Children.

BACKGROUND: Procedural memory allows acquisition, consolidation and use of motor skills and cognitive routines. Automation of procedures is achieved through repeated practice. In children, improvement in procedural skills is a consequence of natural neurobiological development and experience. METHODS: The aim of the present research was to make a preliminary evaluation and description of repetition-based improvement of procedures in typically developing children (TDC). Ninety TDC children aged 6-12 years were asked to perform two procedural learning tasks. In an assembly learning task, which requires predominantly motor skills, we measured the number of assembled pieces in 60 seconds. In a mirror drawing learning task, which requires more cognitive functions, we measured time spent and efficiency. Participants were tested four times for each task: three trials were consecutive and the fourth trial was performed after a 10-minute nonverbal interference task. The influence of repeated practice on performance was evaluated by means of the analysis of variance with repeated measures and the paired-sample test. Correlation coefficients and simple linear regression test were used to examine the relationship between age and performance. RESULTS: TDC achieved higher scores in both tasks through repetition. Older children fitted more pieces than younger ones in assembling learning and they were faster and more efficient at the mirror drawing learning task. CONCLUSIONS: These findings indicate that three consecutive trials at a procedural task increased speed and efficiency, and that age affected basal performance in motor-cognitive procedures.

La adaptación al castellano de la Children’s Communication Checklist permite detectar las dificultades en el uso pragmático del lenguaje y diferenciar subtipos clínicos / The Spanish adapted version of the Children’s Communication Checklist identifies disorders of pragmatic use of language and differentiates between clinical subtypes

Introducción. La Children’s Communication Checklist (CCC) de Bishop es una prueba útil para la valoración de la pragmática verbal en los escolares. El objetivo del trabajo es comprobar la fiabilidad y la validez de esta escala en castellano. Sujetos y métodos. Se analiza la CCC contestada por los padres de 360 niños/as de 4-12 años, con inteligencia normal, 160 controles y 200 de cuatro grupos clínicos: trastorno por déficit de atención/hiperactividad (n = 68), trastorno de aprendizaje no verbal procedimental (n = 77), trastorno de la comunicación social (n = 25) y trastornos del espectro autista de nivel 1 (n = 30). Se realizan análisis: factorial para agrupar los ítems del cuestionario, de fiabilidad de las nuevas escalas y discriminante para comprobar si clasifica bien a los afectos de dificultades en el uso del lenguaje. Resultados. Se obtienen siete factores (Kaiser-Meyer-Olkin: 0,852) con moderada similitud a las de la CCC original: relaciones sociales, intereses y otros cinco que constituyen pragmática (habilidades conversacionales, coherencia-comprensión, compenetración, comunicación no verbal y pertinencia). La correlación es significativa entre todos ellos, en el grupo control, y entre los cinco que configuran pragmática, en los grupos clínicos (r de Pearson). La fiabilidad de las escalas es buena (alfa de Cronbach: 0,914). El cuestionario clasifica bien al 98,9% de los casos agrupados con y sin trastorno pragmático; y al 78% de los participantes en sus correspondientes grupos clínicos. Además, permite diferenciar las patologías según la presencia e intensidad de los síntomas. Conclusiones. Esta versión española de la CCC es altamente válida y fiable. Los estadísticos aportados pueden utilizarse como valores de referencia (AU)

Introduction. The Children’s Communication Checklist (CCC) by Bishop is a useful scale for evaluation of pragmatic verbal abilities in school children. The aim of the study is to ascertain the validity and reliability of the CCC in Spanish. Subjects and methods. Answers to the CCC items by parents of 360 children with normal intelligence were analyzed. There were five groups: 160 control children; 68 children with attention deficit hyperactivity disorder, 77 with procedural non-verbal disorder, 25 children with social communication disorder and 30 with autism spectrum disorder. Investigations included: factorial analysis in order to cluster checklist items, reliability analyses of the proposed scales and discriminant analysis to check whether the scale correctly classifies children with pragmatic verbal abilities. Results. Seven factors were obtained (Kaiser-Meyer-Olkin: 0.852) with moderate similarity with those of the original scale: social relationships, interests, and five more that can be grouped into pragmatic verbal ability (conversational abilities, coherence-comprehension, empathy nonverbal communication and appropriateness). All factors are significantly correlated with each other in the control group, and the five that compose pragmatic verbal ability correlate with each other in the clinical groups (Pearson r). The scales have good reliability (Cronbach’s alpha: 0.914). The questionnaire correctly classifies 98.9% of grouped cases with and without pragmatic disorder and 78% of subjects in their appropriate clinical group. Besides, the questionnaire allows to differentiate the pathologies according to the presence and intensity of the symptoms. Conclusions. This Spanish version of the CCC is highly valid and reliable. The proposed statistics can be used as normativereference values (AU)

A leaky splicing mutation in NFU1 is associated with a particular biochemical phenotype. Consequences for the diagnosis.

Mutations in NFU1 were recently identified in patients with fatal encephalopathy. NFU1 is an iron-sulfur cluster protein necessary for the activity of the mitochondrial respiratory chain complexes I-II and the synthesis of lipoic acid. We report two NFU1 compound heterozygous individuals with normal complex I and lipoic acid-dependent enzymatic activities and low, but detectable, levels of lipoylated proteins. We demonstrated a leaky splicing regulation due to a splice site mutation (c.545+5G>A) that produces small amounts of wild type NFU1 mRNA that might result in enough protein to partially lipoylate and restore the activity of lipoic acid-dependent enzymes and the assembly and activity of complex I. These results allowed us to gain insights into the molecular basis underlying this disease and should be considered for the diagnosis of NFU1 patients.

Procedural Learning in Children With Developmental Coordination, Reading, and Attention Disorders.

The aim is to assess repetition-based learning of procedures in children with developmental coordination disorder (DCD), reading disorder (RD) and attention-deficit hyperactivity disorder (ADHD). Participants included 187 children, studied in 4 groups: (a) DCD comorbid with RD and ADHD (DCD+RD+ADHD) (n = 30); (b) RD comorbid with ADHD (RD+ADHD) (n = 48); (c) ADHD (n = 19); and typically developing children (control group) (n = 90). Two procedural learning tasks were used: Assembly learning and Mirror drawing. Children were tested on 4 occasions for each task: 3 trials were consecutive and the fourth trial was performed after an interference task. Task performance by DCD+RD+ADHD children improved with training (P < .05); however, the improvement was significantly lower than that achieved by the other groups (RD+ADHD, ADHD and controls) (P < .05). In conclusion, children with DCD+RD+ADHD improve in their use of cognitive-motor procedures over a short training period. Aims of intervention in DCD+RD+ADHD should be based on individual learning abilities.

[Depressive phenomenology at the outset of neuropaediatric diseases]. / Fenomenología depresiva al inicio de enfermedades neuropediátricas.

INTRODUCTION: Depressive phenomenology, in its diverse nosological forms, affects 8-10% of children and adolescents of general population. Most frequently mood disorders have a primary origin, following poligenic multifactorial model. Moreover there is a non negligible proportion of cases in which depressive symptoms accompany neurological illnesses or they even constitute a part of predominant manifestations at the clinical start of neurologic disease, or mark a point of inflexion in its course. The aim of the present article is to review relevant literature dealing with this topic. DEVELOPMENT: A significative higher frequency of depressive phenomenology, not explainable by hazard, can be an early manifestation in children and adolescents with: epileptic syndromes, sleep disorders, chronic recurrent cephalalgias, several neurometabolic diseases, and intracranial tumors. Points of coincidence have been shown in dysequilibrium of brain neurotransmitters (serotonine, noradrenaline, hyperglutamatergic states) which could not be hypothesized as maintaining both neurological and mood conditions. CONCLUSIONS: The suspiction of a neurological disease should be adopted in cases of mood disorder not easily explainable by familial antecedents or clear biographical stressors. The search for a brain disorder by means of a meticulous anamnesis and neurological clinical and ancillary exams makes possible to discover the brain disorder at a very early stage and ameliorate the chances of accurately manage both the neurological and mood disorders. The simultaneous treatment of both dimension of the illness helps to improve the patients' quality of life.

TITLE: Fenomenologia depresiva al inicio de enfermedades neuropediatricas.Introduccion. La depresion, en sus diversas formas, afecta al 8-10% de niños y adolescentes y en la mayor parte de casos su origen es primario, siguiendo el modelo genetico multifactorial. Pero hay una proporcion de pacientes, no bien cuantificada todavia, en la que la depresion acompaña precozmente una enfermedad neurologica o marca un punto de inflexion en el curso de esta. El objetivo es revisar la bibliografia al respecto. Desarrollo. Se observa fenomenologia depresiva, con una frecuencia significativamente mayor que por azar, en niños y adolescentes afectos de epilepsia, trastornos del sueño, cefaleas primarias cronicas recurrentes, enfermedades neurometabolicas y tumores intracraneales. En varias de estas patologias neuropediatricas se hipotetizan puntos de coincidencia fisiopatologica con la depresion a traves de un deficit de disponibilidad cerebral de serotonina y noradrenalina. No se considera aqui la depresion disadaptativa a una neurodiscapacidad cronica. Conclusiones. En niños y adolescentes, los trastornos del animo sintomaticos de enfermedad neurologica deben sospecharse en ausencia de antecedentes familiares o de experiencias vitales que los expliquen. La busqueda sistematica de anomalias neurologicas y los examenes complementarios permitirian en estos casos abordar precozmente el tratamiento de la enfermedad cerebral causante del cuadro depresivo. A su vez, como ocurre en casos de epilepsia, cefaleas o trastorno del sueño, la terapia farmacologica y psicologica del cuadro depresivo contribuye a mejorar la calidad de vida de los afectados.

AULA virtual reality test as an attention measure: convergent validity with Conners' Continuous Performance Test.

The majority of neuropsychological tests used to evaluate attention processes in children lack ecological validity. The AULA Nesplora (AULA) is a continuous performance test, developed in a virtual setting, very similar to a school classroom. The aim of the present study is to analyze the convergent validity between the AULA and the Continuous Performance Test (CPT) of Conners. The AULA and CPT were administered correlatively to 57 children, aged 6-16 years (26.3% female) with average cognitive ability (IQ mean = 100.56, SD = 10.38) who had a diagnosis of attention deficit/hyperactivity disorder (ADHD) according to DSM-IV-TR criteria. Spearman correlations analyses were conducted among the different variables. Significant correlations were observed between both tests in all the analyzed variables (omissions, commissions, reaction time, and variability of reaction time), including for those measures of the AULA based on different sensorial modalities, presentation of distractors, and task paradigms. Hence, convergent validity between both tests was confirmed. Moreover, the AULA showed differences by gender and correlation to Perceptual Reasoning and Working Memory indexes of the WISC-IV, supporting the relevance of IQ measures in the understanding of cognitive performance in ADHD. In addition, the AULA (but not Conners' CPT) was able to differentiate between ADHD children with and without pharmacological treatment for a wide range of measures related to inattention, impulsivity, processing speed, motor activity, and quality of attention focus. Additional measures and advantages of the AULA versus Conners' CPT are discussed.

[Dysfunction of central coherence in schoolchildren with procedural learning disorder. Reply]. / Disfunción de la coherencia central en niños con trastorno de aprendizaje procedimental. Réplica.

TITLE: Disfuncion de la coherencia central en ninos con trastorno de aprendizaje procedimental. Replica.

[Dysfunction of central coherence in schoolchildren with procedural learning disorder]. / Disfunción de la coherencia central en niños con trastorno de aprendizaje procedimental.

INTRODUCTION: Children with coordination disorder -non verbal learning disorder, procedural learning disorder (PLD)- have difficulties in understanding complex simultaneous visual information. AIM: Validation of two different visual tasks to measure central coherence function of children with PLD. SUBJECTS AND METHODS: A chimeric image and a complex visual story are showed to 200 schoolchildren: 20 of them have PLD, 60 have PLD plus attention deficit/hyperactivity disorder (PLD + ADHD), 60 have non comorbid ADHD, and 60 subjects are typical control children. A chi square test and a discriminant analysis are used to study the performances of the different groups in verbal description of both images. RESULTS: Performance is lower in children with PLD and PLD + ADHD than in those with non-comorbid ADHD or controls. Moreover 93% and 92% of children with poor performance in, respectively, chimeric and complex images, have PLD or PLD + ADHD. Eighty seven per cent of subjects with PLD + ADHD fail in some of the tasks and, by contrast only 15% of children with ADHD do. CONCLUSIONS: Children with PLD have disability in quick understanding of simultaneous complex information and central coherence. The two tasks used in this research are useful to detect these difficulties, with high sensibility and specificity.

Disfunción de la coherencia central en niños con trastorno de aprendizaje procedimental / Dysfunction of central coherence in schoolchildren with procedural learning disorder

Introducción. Los niños con trastorno de aprendizaje procedimental (TAP) tienen dificultades para percatarse rápidamente de la coherencia o incoherencia de un material complejo y describirlo verbalmente. Objetivo. Estudiar la capacidad de escolares con TAP para percatarse de las incoherencias presentes en dos imágenes complejas. Sujetos y métodos. Se muestran el test de imagen quimérica y la escena visual incoherente a 200 escolares: 20 afectos de TAP, 60 con trastorno por déficit de atención/hiperactividad (TDAH), 60 con TDAH + TAP y 60 escolares típicos como grupo control. Se comparan las respuestas de todos los grupos mediante chi al cuadrado. Se calcula la sensibilidad, eficiencia y especificidad de cada prueba por separado y se realiza análisis discriminante según el rendimiento conjunto en ambas. Resultados. El rendimiento en los dos grupos con TAP es inferior al de los grupos control y TDAH, tanto en el test de imagen quimérica como en la escena visual incoherente. El 93 y el 92% de los niños que, respectivamente, rinden bajo en el test de imagen quimérica y en la escena visual incoherente están afectos de TAP (con o sin TDAH comórbido). El 87% de los sujetos con TDAH + TAP falla en una de las pruebas o en ambas, mientras que sólo lo hace el 15% de los niños con TDAH. Conclusiones. Las dificultades específicas para la comprensión rápida, simultánea y coherente de imágenes o escenas complejas, que forman parte del perfil neuropsicológico del TAP, son detectables mediante el test de imagen quimérica y la escena visual incoherente. Estos instrumentos se han revelado altamente sensibles, eficaces y específicos (AU)

Introduction. Children with coordination disorder -non verbal learning disorder, procedural learning disorder (PLD)- have difficulties in understanding complex simultaneous visual information. Aim. Validation of two different visual tasks to measure central coherence function of children with PLD. Subjects and methods. A chimeric image and a complex visual story are showed to 200 schoolchildren: 20 of them have PLD, 60 have PLD plus attention deficit/hyperactivity disorder (PLD + ADHD), 60 have non comorbid ADHD, and 60 subjects are typical control children. A chi square test and a discriminant analysis are used to study the performances of the different groups in verbal description of both images.Results. Performance is lower in children with PLD and PLD + ADHD than in those with non-comorbid ADHD or controls. Moreover 93% and 92% of children with poor performance in, respectively, chimeric and complex images, have PLD or PLD + ADHD. Eighty seven per cent of subjects with PLD + ADHD fail in some of the tasks and, by contrast only 15% of children with ADHD do. Conclusions. Children with PLD have disability in quick understanding of simultaneous complex information and central coherence. The two tasks used in this research are useful to detect these difficulties, with high sensibility and specificity (AU)

Test de escucha dicótica para niños hispanohablantes: validación de unas nuevas series de pares de palabras y de sílabas en castellano / Dichotic listening in Spanish-speaking children: validation of a set of dichotic lists of Spanish words and syllables

Introducción. El test de escucha dicótica verbal (TED) estima la dominancia hemisférica cerebral para el lenguaje. Objetivo. Validar ocho nuevas series dicóticas para niños castellanohablantes. Sujetos y métodos. Hay un grupo de referencia estratificado, con 40 niños diestros de 3,5 a 7,5 años, de ambos sexos, normohablantes del castellano, y un grupo clínico de 12 niños con parálisis cerebral hemiparética derecha, inteligenciamedia e índice superior a -2z en una prueba de repetición de frases. Cada serie dicótica opone 20 pares de palabras, números o sílabas, o trenes de dos o tres números o sílabas, con proporción equilibrada de consonantes sonoras y sordas,duración y acento. Con el número de respuestas, bajo atención libre, desde los oídos derecho e izquierdo, se calcula elíndice de lateralización (IL) hemisférica. Se contrastan las series más adecuadas con arreglo a la edad. Resultados. Con un rango de 0 a 200, los IL ≥ 112 indican dominancia hemisférica izquierda, mientras que los IL ≤ 88 señalan dominancia del hemisferio derecho. En cada niño del grupo de referencia, se constata dominancia hemisférica izquierda para el lenguaje, sin influencia de la edad ni del sexo. En cambio, 10 de 12 (83%) sujetos del grupo clínicopresentan dominancia hemisférica derecha. Esta doble disociación muestra la validez de nuestras series en una primeraestimación de la dominancia cerebral para el lenguaje.Conclusiones. Las series de pares dicóticos en castellano aquí presentadas son válidas para estimar la dominancia hemisféricapara el lenguaje en niños, utilizando el TED bajo atención libre (AU)

Introduction. Dichotic listening test can estimate hemispheric dominance for language. Aim. To study the usefulness of a new set of dichotic pairs of Spanish stimuli in middle childhood. Subjects and methods. The stratified control group comprised 40 healthy, right-handed children, aged 3.5- 7.5 years, of both sexes, with average ability at speaking Spanish. The clinical sample comprised 12 children with right spastic hemiparetic cerebral palsy, average general intelligence and sentence repetition index over -2z. Each listening series is composedof 20 age-appropriate dichotic pairs: one syllable, word, or number; or trains of two or three syllables or numbers. Voiceonset time, duration and stress of stimuli were balanced. Hemispheric dominance index (HDI) for language was calculated using a formula with the scores of stimuli from right or left ears. Statistical analysis evaluated the age-related accuracyand discriminant power of each HDI.Results. In the non-forced attention paradigm, the range of HDI is 0-200. Values of HDI ≥ 112 indicate left hemisphere dominance for language, whereas values of HDI ≤ 88 indicate right hemisphere dominance. All 40 typical subjects showed left HDI for language, without influence of age and sex. In contrast, ten out of twelve (83%) right hemiparetic childrenhad right HDI. Conclusions. The results show that this new set of dichotic pairs is useful in the initial assessment of cerebral dominancefor language and valid for use in Spanish speaking children aged 3.5 years or more (AU)

[Dichotic listening in Spanish-speaking children: validation of a set of dichotic lists of Spanish words and syllables]. / Test de escucha dicótica para niños hispanohablantes: validación de unas nuevas series de pares de palabras y de sílabas en castellano.

INTRODUCTION: Dichotic listening test can estimate hemispheric dominance for language. AIM: To study the usefulness of a new set of dichotic pairs of Spanish stimuli in middle childhood. SUBJECTS AND METHODS: The stratified control group comprised 40 healthy, right-handed children, aged 3.5- 7.5 years, of both sexes, with average ability at speaking Spanish. The clinical sample comprised 12 children with right spastic hemi-paretic cerebral palsy, average general intelligence and sentence repetition index over -2z. Each listening series is composed of 20 age-appropriate dichotic pairs: one syllable, word, or number; or trains of two or three syllables or numbers. Voice onset time, duration and stress of stimuli were balanced. Hemispheric dominance index (HDI) for language was calculated using a formula with the scores of stimuli from right or left ears. Statistical analysis evaluated the age-related accuracy and discriminant power of each HDI. RESULTS: In the non-forced attention paradigm, the range of HDI is 0-200. Values of HDI ≥ 112 indicate left hemisphere dominance for language, whereas values of HDI ≤ 88 indicate right hemisphere dominance. All 40 typical subjects showed left HDI for language, without influence of age and sex. In contrast, ten out of twelve (83%) right hemiparetic children had right HDI. CONCLUSIONS: The results show that this new set of dichotic pairs is useful in the initial assessment of cerebral dominance for language and valid for use in Spanish speaking children aged 3.5 years or more.

[Brain plasticity for language in children and adolescents]. / Plasticidad cerebral para el lenguaje en el nino y el adolescente.

INTRODUCTION: Plasticity makes possible adaptative modelling of the nervous system to experiences i.e. learning and development. AIM: To review current literature on clinical long term evolution and functional magnetic resonance imaging (fMRI) features of brain remodelling after focal stroke in left perisylvian regions involved in basic language processing during infancy and childhood. DEVELOPMENT: Each of the main neurocognitive subsystems develops with different timing, so altered plasticity and vulnerability are diverse, according with age at insult and its topography. Genetic programming makes human brain capable for installing basic formal linguistic abilities on an associative perisylvian subsystem, highly specialised. A focal lesion of this region leads to remodelling phenomena by disinhibition of contralateral frontal and perisylvian structures and by a more or less efficacious activation of neighboring homolateral cortex, as it has been shown by fMRI studies and DTI tractography. As a result, very early local stroke to language areas is generally well compensated in terms of linguistic behaviour. Meanwhile acquired aphasias into middle and late childhood, even if they have a better prognosis than in adults, they fail to resume without lexical access defaults and/or difficulties in written language. CONCLUSION: Brain plasticity can promote restoration and further development of language following a stroke in left peri-sylvian areas, specially when lesion occurs at perinatal to middle childhood.

Plasticidad cerebral para el lenguaje en el niño y el adolescente / Brain plasticity for language in children and adolescents

Introducción. La plasticidad posibilita el modelado estructural y funcional del sistema nervioso a lo largo de la vida por la experiencia, y fundamenta así los procesos de aprendizaje. Objetivo. Revisar la literatura clínica y de resonancia magnética funcional (RMf) referente al remodelado de los sistemas cerebrales específicamente implicados en el lenguaje tras una lesión focal ocurrida desde el período perinatal hasta la adolescencia temprana. Desarrollo. Cada uno de los grandes subsistemas neurocognitivos se desarrolla a diferentes ritmos; así, la plasticidad y la vulnerabilidad son diversas según la edad y el subsistema en los que ocurre una lesión cerebral focal. Al modificarse el programa genético local por lesiones, adquiridas durante el desarrollo, de áreas perisilvianas izquierdas, se ponen en marcha fenómenos de remodelado que desinhiben regiones homólogas contralaterales y activan, con mayor o menor fortuna, regiones vecinas homolaterales preservadas, según muestran los estudios con escucha dicótica, RMf y tractografía. Cuando la lesión focal ocurre en una edad prelingüística, o en la niñez temprana, el remodelado tisular permite un desarrollo lingüístico generalmente normal, a largo plazo. En las afasias por lesión adquirida a partir de los 5 años, la recuperación y el ulterior desarrollo del lenguaje son variables, con especial vulnerabilidad del acceso al léxico y de la lectoescritura. Conclusión. El funcionalismo neurolingüístico posee subsistemas de reserva que permiten diferentes formas de plasticidad tras lesiones focales de las áreas específicas en el niño (AU)

Introduction. Plasticity makes possible adaptative modelling of the nervous system to experiences i.e. learning and development. Aim. To review current literature on clinical long term evolution and functional magnetic resonance imaging (fMRI) features of brain remodelling after focal stroke in left perisylvian regions involved in basic language processing during infancy and childhood. Development. Each of the main neurocognitive subsystems develops with different timing, so altered plasticity and vulnerability are diverse, according with age at insult and its topography. Genetic programming makes human brain capable for installing basic formal linguistic abilities on an associative perisylvian subsystem, highly specialised. A focal lesion of this region leads to remodelling phenomena by disinhibition of contralateral frontal and perisylvian structures and by a more or less efficacious activation of neighboring homolateral cortex, as it has been shown by fMRI studies andDTI tractography. As a result, very early local stroke to language areas is generally well compensated in terms of linguistic behaviour. Meanwhile acquired aphasias into middle and late childhood, even if they have a better prognosis than in adults, they fail to resume without lexical access defaults and/or difficulties in written language. Conclusion. Brain plasticity can promote restoration and further development of language following a stroke in left perisylvian areas, specially when lesion occurs at perinatal to middle childhood (AU)

[Difficulties in the swift recognition of contradictions in procedural learning disorder: possible central coherence dysfunction]. / Dificultades en la percatacion rapida de incongruencias en el trastorno de aprendizaje procedimental: posible disfuncion de la coherencia central.

INTRODUCTION: Procedural learning disorder, or non-verbal learning disorder, affects the automation of perceptual motor and cognitive skills and routines. AIM: To further our knowledge of the neurocognitive dysfunction in this disorder and, more specifically, to analyse the difficulties experienced when going from recognition of the constituting elements of something to an understanding of the whole. DEVELOPMENT: Contrasting simultaneous visual information and the swift recognition of contradictions are especially difficult abilities for children with procedural learning disorder. CONCLUSIONS: These difficulties may reflect a central coherence dysfunction and can partly account for the deficient ability to adapt their social behaviour displayed by these children.

A preliminary study of the frequency of anti-basal ganglia antibodies and streptococcal infection in attention deficit/hyperactivity disorder.

Attention deficit/hyperactivity disorder (ADHD) is often present in patients with post-streptococcal neuropsychiatric disorders such as Sydenham's chorea and PANDAS, in which anti-basal ganglia antibodies (ABGA) have been frequently found. Our study investigates the hypothesis that pharyngeal group A beta-hemolytic streptococcus (GABHS) infections and serum ABGA are more frequent in children with ADHD non-comorbid (nc-ADHD) with obsessive-compulsive disorder or tics than in controls. We compared 22 children with nc-ADHD (DSM-IV-TR) and 22 healthy controls matched by age, gender and season of sample collection, for the frequency of recent GABHS infection and the presence of ABGA. Eleven out of 22 children (51%) with nc-ADHD showed evidence of GABHS infection compared to three out of 22 (14%) controls (P = 0.007). We found positive ABGA in one ADHD subject (4%) and in one control (4%). This preliminary study indicates that frequency of ABGA in children with nc-ADHD does not differ from that in matched controls, despite the fact that our ADHD patients had had more recent GABHS infections than the controls. This suggests that ABGA do not have a role in the pathogenesis of nc-ADHD.

[Alternating hemiplegia of childhood in Spanish population. Study of a series of 17 patients]. / Hemiplejía alternante de la infancia en la población española. Estudio de una serie de 17 pacientes.

BACKGROUND AND OBJECTIVE: Alternating hemiplegia of childhood (AHC) is a rare disease of unknown etiology characterized by early onset of recurrent episodes of hemiplegia, tonic or dystonic attacks and abnormal ocular movements with a fatal outcome to severe encephalopathy. Our aim was to describe the clinical manifestations, precipitating factors, complementary studies results, long-term outcome and response to treatment in a series of AHC patients. PATIENTS AND METHOD: Descriptive, retrospective and multicenter study in 17 Spanish patients aged between 1-24 years who fulfilled diagnostic criteria of AHC. RESULTS: Twelve cases fulfilled criteria of typical AHC and 5 were atypical. Mean age at diagnosis was 26 months and 47% cases had a family history of migraine. Mean age at onset of hemiplegic attacks was 9.3 months. Symptoms disappeared during sleep and precipitating factors were present in 94% cases. Most patients developed mental retardation with ataxia and dysarthria. Work-up tests (metabolic, neurophysiologic and radiologic) were normal or nonspecific. In 3 patients mutations in CACNA1A, ATP1A2 were ruled out. Positive responses to flunarizine was observed in 81%. CONCLUSIONS: The characteristic clinical symptoms are still the clue to make the diagnosis of this disease, with a lack of genetic, biochemical or radiological specific studies. Early diagnosis avoids invasive tests, repeating procedures, using ineffective and potentially toxic treatments, and allows to start treatment with flunarizine without delay. More genetic studies are needed in broader series of patients.