MRI-based radiologic scoring system for extent of brain injury in children with hemiplegia.

BACKGROUND AND PURPOSE: Brain MR imaging is recommended in children with cerebral palsy. Descriptions of MR imaging findings lack uniformity, due to the absence of a validated quantitative approach. We developed a quantitative scoring method for brain injury based on anatomic MR imaging and examined the reliability and validity in correlation to motor function in children with hemiplegia. MATERIALS AND METHODS: Twenty-seven children with hemiplegia underwent MR imaging (T1, T2-weighted sequences, DTI) and motor assessment (Manual Ability Classification System, Gross Motor Functional Classification System, Assisting Hand Assessment, Jebsen Taylor Test of Hand Function, and Children's Hand Experience Questionnaire). A scoring system devised in our center was applied to all scans. Radiologic score covered 4 domains: number of affected lobes, volume and type of white matter injury, extent of gray matter damage, and major white matter tract injury. Inter- and intrarater reliability was evaluated and the relationship between radiologic score and motor assessments determined. RESULTS: Mean total radiologic score was 11.3 ± 4.5 (range 4-18). Good inter- (ρ = 0.909, P < .001) and intrarater (ρ = 0.926, P = < .001) reliability was demonstrated. Radiologic score correlated significantly with manual ability classification systems (ρ = 0.708, P < .001), and with motor assessments (assisting hand assessment [ρ = -0.753, P < .001]; Jebsen Taylor test of hand function [ρ = 0. 766, P < .001]; children's hand experience questionnaire [ρ = -0. 716, P < .001]), as well as with DTI parameters. CONCLUSIONS: We present a novel MR imaging-based scoring system that demonstrated high inter- and intrarater reliability and significant associations with manual ability classification systems and motor evaluations. This score provides a standardized radiologic assessment of brain injury extent in hemiplegic patients with predominantly unilateral injury, allowing comparison between groups, and providing an additional tool for counseling families.

Transuranic and fission product contamination in lake sediments from an alpine wetland, Boréon (France).

Transuranics and fission products have been measured in lake sediment samples, collected in an alpine wetland, to determine their vertical distribution and calculate inventories. The radionuclides considered are 90Sr, 137Cs, 238Pu, 239/240Pu and 241Am. From the results, a better knowledge of radionuclide accumulation mode and behaviour was obtained. In addition, the origins of the individual pollutants could be deduced from activity ratios. Analyses were made on different sediment cores. The sampling sites were chosen to enable future determination of the mass balances of the radiopollutants. As the selected study area is in a recreational area used by urban populations, a rough estimate was made of the mean external dose from 137Cs for comparison with the French regulation.

Predictors of weight loss in children with attention deficit hyperactivity disorder treated with stimulant medication.

OBJECTIVE: A retrospective study was undertaken to examine predictors of weight loss in children with attention deficit hyperactivity disorder (ADHD) treated with stimulant medication. DESIGN: Children diagnosed with ADHD and treated with methylphenidate hydrochloride (MPH) or dextroamphetamine sulfate (DEX) for at least 5 months were identified by retrospective chart review. Analyses were performed on 32 children (29 boys) treated with MPH and 28 children (25 boys) treated with DEX. Variables examined included pretreatment weight, pretreatment body mass index (BMI), duration of treatment, total daily dose, and weight-adjusted dose. RESULTS: The MPH-treated group was initially seen at a mean age (+/- standard deviation) of 7.5 years (+/- 2.1). Mean duration of follow-up was 11.2 months (+/- 3.8). Mean total daily dose was 25.5 mg (+/- 8.2) and mean weight-adjusted dose was 1.0 mg/kg/day (+/- .5). Mean change in weight as expressed in z scores was -0.4 SD (+/- .7). The DEX-treated group was initially seen at a mean age of 9.3 years (+/- 2.7). Mean duration of follow-up was 10.8 months (+/- 4.1). Mean total daily dose was 14.9 mg (+/- 8.2) and mean weight-adjusted dose was .5 mg/kg/day (+/- .3). Mean change in weight was -0.6 SD (+/- .6). Although the MPH group was younger than the DEX group, there were no between-group differences in weight or height either before treatment or at follow-up when adjusted for age and gender. Using linear regression analysis, significant correlations were found between pretreatment weight and change in weight for both the MPH-treated group (r = .63) and the DEX-treated group (r = .47). Stepwise multiple-regression analysis indicated that pretreatment age, weight-adjusted dose, and duration of follow-up did not significantly contribute to the variance in change of weight for either the MPH- or DEX-treated groups. To adjust for height, changes in BMI were also analyzed. For both medication groups, no differences were found between the heavier (BMI > or = 50%) and thinner (BMI < 50%) children in duration of follow-up, total daily dose, or weight-adjusted dose. When the medication groups were combined, a greater proportion of heavier children experienced a decrease relative to their predicted BMI compared with thinner children (80% vs 52%). Comparisons of mean BMI slopes revealed that the heavier group experienced an absolute decrease in their BMI (-.139) in contrast to the thinner group (+.014) (t = 2.70). CONCLUSIONS: Pretreatment weight, adjusted for age, gender, and height, is a significant predictor of weight loss in children with ADHD treated with either MPH or DEX. In contrast, pretreatment age, duration of treatment, and weight-adjusted dose were not found to be significant predictors.