Sleep problems and daytime behavior in childhood idiopathic epilepsy.

PURPOSE: To evaluate the presence of sleep problems and their association with behavioral and adjustment problems in children with idiopathic epilepsy. METHODS: A parental questionnaire was used to assess sleep problems in 89 children with idiopathic epilepsy for comparisons with 49 siblings and 321 healthy control children, equally distributed for age and sex. Sleep problems were clustered into five factors: parasomnias, parent/child interaction during the night, sleep fragmentation, daytime drowsiness, and bedtime difficulties. Daytime behavior and psychological adjustment were assessed by means of the Child Behavior Checklist. Maternal distress and disturbance was evaluated by the Malaise Inventory. The better to identify factors associated with sleep problems in the children with epilepsy, multiple regression analysis was performed. RESULTS: Children with epilepsy showed significantly more sleep problems than did both siblings and healthy controls. Within the epileptic group, children with current seizures complained more of sleep problems than did the seizure-free children. Moreover, children with epilepsy showed more behavioral problems and maladjustment. Age, paroxysmal activity density, duration of illness, seizure frequency, and behavioral problems were significantly associated with sleep problems in the epileptic group. CONCLUSIONS: The results of this study in a highly selected sample pointed out the presence of sleep problems, and adjustment and behavioral problems in children with idiopathic epilepsy. The presence of epilepsy, although benign, in childhood is associated with adaptive problems of the child. From this point of view, the alteration of some sleep habits may be a sign of emotional maladjustment. Although parents failed to perceive them as a problem, our findings indicate that attention to sleep and behavioral problems is important in clinical management of children with idiopathic epilepsy.

Prevalence of sleep disorders in childhood and adolescence with headache: a case-control study.

Although a relationship between headache and sleep disturbances has been reported in adults, only few data have been available in children. Accordingly, we performed a survey to determine the prevalence of sleep disturbances in children with migraine and tension-type headache. A questionnaire of history and clinical data and of sleep disturbances was given to parents of 283 headache subjects (164 with migraine and 119 with tension-type headache). Results were compared to a normative group comparable for age and sex of 893 normal healthy subjects. Migraine subjects showed a higher prevalence of sleep disturbances during infancy as well as 3-month colic. In both headache groups, more parents had sleep disturbances and there was a higher occurrence of co-sleeping and napping. A high frequency of sleep disturbances involving sleep quality, night awakenings, nocturnal symptoms and daytime sleepiness was reported in headache children. No statistical differences were found in the prevalence of sleep disturbances between migraine and tension-type headache. However, the migraine group tended to have "disturbed sleep" more often with increased prevalence of nocturnal symptoms such as sleep breathing disorders and parasomnias. Our results give further support to an association between sleep and migraine that may have a common intrinsic origin.

Desmopressin and imipramine in the management of nocturnal enuresis: a multicentre study.

The efficacy and safety of desmopressin (Minirin/DDAVP) treatment compared with imipramine were investigated in a multicentre, open, cross-over design in 57 patients, aged 6-15 years, affected by nocturnal enuresis to establish the best therapeutic approach to this condition. After a two-weeks observation and control period, patients were randomised to one of two groups: intranasal administration of desmopressin, 30 micrograms/day for three weeks, followed by imipramine, 0.9 mg/kg for a further three weeks, or imipramine 0.9 mg/kg for three weeks, followed by desmopressin, 30 micrograms/day for a further three weeks. Following treatment, all patients were observed for a further two weeks. Administration of either treatment protocol resulted in a statistically significant decline in the number of enuretic episodes per week compared to the control. The greater antidiuretic effect observed in the group receiving imipramine followed by desmopressin suggests the two compounds have different profiles. Also, when the treatment period was compared with the follow-up, the antidiuretic effect had a longer duration in the group initially given imipramine. No further improvement was seen when desmopressin was administered first, with a mild worsening of the effect sometimes occurring, suggesting a different carry-over effect between the two treatments. This suggests that desmopressin offers a better approach to the management of nocturnal enuresis.

The Sleep Disturbance Scale for Children (SDSC). Construction and validation of an instrument to evaluate sleep disturbances in childhood and adolescence.

To attempt a categorization of sleep disorders in children, we developed a 27 item Likert-type rating scale (Sleep Disturbance Scale for Children: SDSC) and assessed the psychometric properties was developed. The scale was distributed to the mothers of 1304 children (1157 controls, mean age 9.8 y; 147 sleep disorder subjects, mean age 9.2y, composed of four clinical groups: Insomnia 39 subjects, Hypersomnia 12 subjects, Respiratory disturbances during sleep 25 subjects and Parasomnias 71 subjects). The internal consistency was high in controls (0.79) and remained at a satisfactory level in sleep disorder subjects (0.71); the test/retest reliability was adequate for the total (r = 0.71) and single item scores. The factor analysis (variance explained 44.21%) yielded six factors which represented the most common areas of sleep disorders in childhood and adolescence. Enuresis was the only item with a factor loading lower than 0.40 and with a low inter-item correlation and was therefore eliminated, resulting in a final scale of 26 items. The re-evaluation of the sample, using the factor scores, supported the validity and the discriminating capacity of the scales between controls and the four clinical groups. The correlation between factor scores corroborated the hypothesis that childhood sleep disturbances are not independent entities nor do they cluster into different groupings related to each other. The SDSC appears to be a useful tool in evaluating the sleep disturbances of school-age children in clinical and non-clinical populations.

Sleep characteristics in healthy children from birth to 6 years of age in the urban area of Rome.

The current survey is an attempt to evaluate age-specific sleep characteristics and to identify the presence of sleep problems in Italian normally developing preschool-aged children. A cross-sectional survey by parental interview on sleep behavior was carried out on 2,889 children (from birth to 6 years). Groups were formed based on age level. Results showed a developmental trend of some sleep characteristics, regarding mainly the length of sleep and rating of night wakings. Comparison with other studies showed that the children in this study had a later sleep onset time and slept less than children of the same age living in some other countries. These dissimilarities may be due to sociocultural and climate differences. Sleep problems (sleep latency longer than 30 minutes or disruptive night wakings) were found in 35% of children less than 2 years old, in 23% of 2-3-year-olds and in 14% of 4-6-year-olds. Children with sleep problems slept significantly less (on average 30-40 minutes across all age levels, required parental presence at time of sleep onset and shared their parents' bed more frequently than those without sleeping problems.

Short temperament questionnaire for children aged 8-12 years in the city of Rome.

The assessment of temperament is usually measured by means of parental questionnaires. Since temperament questionnaires in children aged 8-12 years do not exist in Italy we planned a study to develop an Italian questionnaire. Initially we tried to adapt Hegvik et al.'s questionnaire and delivered 389 questionnaires to the mothers of children aged 8-12 years, but most of them were given back uncompleted, essentially because they often described behavior not usually observed in Italian children. Then we prepared a new, short (30 items) questionnaire which we distributed to 431 mothers of children aged 8-12 years. This new questionnaire was completed by 98.76% of mothers and a high three week rating-re-rating reliability for the different temperamental characteristics under assessment was proved. We believe that this new questionnaire is reliable for temperament assessment in Italian children aged 8 to 12 years, living in a big city environment in Central Italy.

[Early diagnosis of intellectual deficiency]. / Diagnosi precoce di deficit intellettivo.

The Author reports the results of some studies of the developing cognitive competences in infants. Utilizing the Hz-giris-Hunt's and the Brunet-Lezine's Scales in 18 infants during the two first months of life did not observe significant correlation between neurologic examination and development of cognitive competence. In an other study of 52 infants of less than two months old, with or without perinatal brain damage, the attentive motricity resulted to be predictive index of future cognitive abilities until twelfth month of age.

The effect of niaprazine on some common sleep disorders in children. A double-blind clinical trial by means of continuous home-videorecorded sleep.

A placebo-controlled double-blind clinical trial on the effect of niaprazine on children with some common sleep disorders was carried out. Niaprazine at a daily dosage of 1 mg/kg body weight or placebo at random was administered to a selected group of 36 children (aged from 6 months to 6 years) suffering from frequent nighttime waking or inability to fall asleep. The effect of niaprazine (or placebo) on sleep disorders was studied by means of continuous home-videorecorded sleep before and after the trial. A reliable positive effect of niaprazine on the sleep disorders considered was found. No adverse side effects were observed. We conclude that niaprazine seems to represent an effective and safe drug for the therapy of frequent nighttime waking and inability to fall asleep.

Laterality of arm movement in full-term newborn.

We have investigated 20 healthy full-term newborns between the 4th and the 6th day of life in standard conditions for laterality of arm movements, before and after introduction of a target. The durations of recording were: (a) 5 min continuously before target introduction; (b) five 1-min units during target presentation. The movements studied were extension, flexion, movement with semiflexed arm with hand half-open or open toward the midline of the body, and total movements. Each of these items were counted separately and the counts were compared within and between sides. Spontaneous movements showed no side preference whereas in the presence of the target, movements toward the midline (target directed movements) showed a significant right-hand preference.

Personality inventory for children and childhood migraine. A case-controlled study.

The personality inventory for children (PIC), which is similar in structure to the MMPI and hence free from subjective interpretation, is applicable to children from 6 to 16 years of age. We used it in 40 children with common migraine aged 8 to 14 years and in 40 controls comparable in age, sex, and socioeconomic status. Although the migraine subjects did not emerge as globally different from the controls, they presented significantly higher scores on the Somatic concern, Depression, and Anxiety scales, irrespective of sex. These results underline the value of PIC in the diagnostic assessment of childhood migraine.

Flunarizine and migraine in childhood. An evaluation of endocrine function.

Flunarizine was tested for prophylactic efficacy and for side effects in 10- to 13-year-old patients with severe migraine (greater than 2 attacks per month). The 13 preadolescents received a single 5-mg dose at night for 2 months. The attack frequency decreased significantly, and the effect was maintained over time. The endocrine status, investigated before and after treatment, showed no significant interference with pituitary, beta-pancreatic, or gonadal function.

Headache and epilepsy in childhood: analysis of a series of 620 children.

The relationships between various types of headache and epilepsy were investigated in a sample of 620 children aged 2 to 16 years with special reference to the frequency and types of epilepsy, their distribution over the types of headache, the frequency of familiarity of convulsions and epilepsy by headache type and the frequency of epileptiform EEGs in headache-free intervals. Data were correlated with those of a control group of 100 suffering from Recurrent Respiratory Infection Syndrome (RRIS). Children with and without epilepsy were compared in respect of the course of headache in order to elicit any differences. Epilepsy was definitely more common in headache patients than in the control group, and so was a family history of epilepsy and convulsions. The frequency of epilepsy was uniform across the various types of headache, migrainous or not. The frequency of epileptiform EEGs was high (20%) compared to the control group, but was not an index of severity for headache, except in cases with multifocal EEG abnormalities. Neither the presence of epilepsy nor the frequency of epileptiform changes significantly effect the migraine attack rate.

Random dominance and childhood migraine: a new marker? A controlled study of laterality in children with migraine.

We assessed various aspects of laterality by direct observation in children with migraine and peer controls, with special reference to the frequency of random dominance. This frequency varied with the test battery used, being lower on the Edinburgh and Oldfield inventories which measure hand-use preference, and higher on the Handedness index and Spontaneous gestural index, which explore "genetic laterality". Random dominance would seem to be a new marker of migraine in childhood, for use alongside the hyperreactivity marker found in a previous study.

The utilization of the Rorschach test in a case-controlled study.

The Rorschach test was administered to 58 children of normal intelligence aged 7-14 years with a history of common migraine of at least 12 months and to a group of controls matched for age, sex, and IQ. The Rorschach test was scored blindly. The migraine group was characterized by marked intellectual inhibition with poor school performance and low response rates; inhibition of psychomotor activity and aggressiveness, shown by content analysis and by the presence of kinesthetic shock; inhibition of affect (ratio M/sum C); ineffective use of mechanisms of defence against anxiety (F-); prevalence of phobic features and massive use of repression, indicated by the high rejection rate and shock at red colour. The differences from the controls were significant at the 0.01 level with regard to all items in the preadolescent age group and with regard to all items except kinesthetic shock in the migraine group as a whole. There was thus a definite difference between the migraine group and the controls, a difference that might depend on impairment of ego function and on recurrent experience of pain.

Upper limb movements in the emergence of object cognition.

Previous studies showed that 40% of fullterm newborns with "anterior plane hypotonia" (APH) neuromotor anomaly present retarded development of object cognition. To understand the possible motor dynamics of this retardation, we studied the principal upper limb movements in a group of normal newborns and in one of APH newborns, with and without stimulus. The total quantity of movement proved to be similar in the two groups but there were differences in the frequencies of the various types of movement, to the detriment in the APH subjects of the movements considered most relevant to object relations. These data underline the importance of the qualitative integrity of newborn movement to the emergence of object cognition.

Functional bent of central nervous system: neonatal hyperreactivity and developmental disorders. A 10-year follow-up study.

The relevance of newborn individuality to subsequent course of childhood has long been controversial. This study was designed to find out whether neonatal hyperreactivity influences signs and symptoms that appear in childhood. A reactivity test administered to 1184 healthy term newborns identified two populations: hyperreactives and normoreactives. Ninety-four hyperreactives and 80 normoreactives were followed up periodically to the age of 10 years. Hyperreactives had a significantly higher frequency of developmental disorders. Their parents' histories showed a higher frequency of the same disorders than that of normoreactives' parents. The importance of heredity in the genesis of hyperreactivity implies that hyperreactivity depends on the nervous system.

Childhood headache risk: warning signs and symptoms present during the first six months of life.

In the history of children suffering from non-organic headache, the presence of periodic syndromes can often be found. In previous observations we ascertained that periodic syndromes are a common finding in children showing physical and behavioural characteristics of "hyperreactivity" in the first months of their lives. We have tried to verify, through a prospective study, whether children with "hyperreactivity" in the first months of life are particularly prone to develop periodic syndromes and/or non-organic headache. We have developed an appropriate test for the assessment of hyperreactivity in the first 6 months of life. We have isolated 183 hyperreactive subjects; 102 of them have been followed-up to an average age of 10.8 years, together with a control group of 80 subjects followed-up to an average age of 10.2 years. Of the 102 hyperreactive infants, 54 (52.9%) suffered from common migraine, versus 12 (15%) of the control group; 66 (64.5%) hyperreactive infants suffered from periodic syndrome, versus 10 (12.5%) of the control group. There was frequently a co-existence of migraine and periodic syndrome. It is thus possible to identify infants who are particularly prone to develop periodic syndromes and headache.

Psychological peculiarities in children with recurrent primary headache.

Thirty-five children with idiopathic headache (average age 10.2 years) were subjected to various examinations and a series of tests (WISC, Bender, Rorschach, Duss, "tree" and "family" tests) on the nature and characteristics of headache with a view to establishing possible psychological peculiarities. The sample was correlated with a random control group of 20 subjects (average age 10.4 years) undergoing all of the above tests except the Rorschach test. This showed a significant decrease in the "digit span" WISC subtest and in the Bender test with respect to normal population, and a drop in "digit span" and in picture completion subtests and in headache length in months. Feelings of being excluded from the family group, insecurity and repressed hostility towards the important figures, were significantly stronger in the headache patients group.