Quantitative Electroencephalography Indicators in Children with Acute Purulent Meningitis.

The aim of the present work was to assess the state of brain bioelectrical activity in children during the acute period of bacterial purulent meningitis, with quantitative mathematical analysis of the changes found. The studies included 31 children on days 1 and 6 from onset of illness: 16 children (8.9 ± 2.4 years) admitted to the Pediatric Scientific Clinical Center for Infectious Diseases with laboratory confirmation of diagnoses of purulent meningitis (due to Neisseria meningitidis) (n = 11) or Streptomyces pneumoniae (n = 2) or unidentified pathogen (n = 3)), along with 15 healthy children. Electroencephalogram (EEG) traces were recorded from all these children in the state of calm waking using a Neuron-Spectrum 4/VP 16-channel electroencephalograph. Clinical assessment of the EEG included analysis of background rhythms, zonal differences, and detection of pathological types of activity. Quantitative analysis consisted of the mean power (µV2) and amplitude (µV) of the α, θ, and δ rhythms, along with mean power ratios - α/θ and α/δ. Visual analysis of the EEG in 100% of children in the acute period of purulent meningitis showed diffuse slowing with detection of δ and θ waves. Focal changes in the form of sharp waves were seen in 18.8% of cases (three patients). No cases displayed periodic activity. Meningitis patients showed significant reductions in the α/δ (p = 0.001) and α/θ (p = 0.048) spectral ratios. ROC analysis showed that the α/θ value was <0.18 and the α/δ value was <0.02 (sensitivity 100% and specificity 80%, AUROC 0.9), which may be evidence of the likely development of cerebral edema. Thus, pediatric patients with acute purulent meningitis showed significant impairments to the normal α/θ and α/δ rhythm power ratios on the EEG, which is presumptively explained by suppression of the functional activity of the thalamus and thalamocortical pathways, as well as the reticular formation of the brain.

[Herpesviruses and biomarkers in disseminated encephalomyelitis and multiple sclerosis in children (part II)]. / Gerpesvirusy i biomarkery pri disseminirovannom entsefalomielite i rasseyannom skleroze u detei (chast' II).

Recently, the problem of demyelinating diseases in children is still very acute. This occurs, on the one hand, by high access and specificity of diagnostic methods and, on the other hand - by high morbidity of children different neuroinfectious diseases which can lead to demyelinating diseases. This literature review presents the currently available information on the autoantibodies and neurospecific protein role in the development of multiple sclerosis and acute disseminative encephalitis in children. The authors also describe their experience of complex etiopatogenic therapy and cytoflavin use that helps to reduce frequency and expression of demyelinating process and endothelium dysfunction in case of active herpesvirus infection.

[Herpesviruses and biomarkers in disseminated encephalomyelitis and multiple sclerosis in children]. / Gerpesvirusy i biomarkery pri disseminirovannom entsefalomielite i rasseyannom skleroze u detei.

The relevance of the study of demyelinating diseases is due to their increasing frequency in children, clarification of the role of infectious agents in their genesis, as well as the possibility of transformation of disseminated encephalomyelitis into multiple sclerosis. The literature review presents the currently available information on the causes of the development of demyelinating diseases, biomarkers of disseminated encephalomyelitis and multiple sclerosis, the causes of an unfavorable course and possible laboratory parameters indicating the transition from one disease to another, which can be used as prognostic factors. The authors also noted the experience of the authors on the importance of adequate etiopathogenetic therapy in changing the nature of the course of the disease, in particular, when confirming the relationship between the frequency of exacerbations of ADEM and MS with the activation of herpesvirus infections, courses of specific antiviral therapy are effective, as well as pathogenetic therapy aimed at correcting endothelial dysfunction using the drug cytoflavin.

[Clinical-etiological and MRI parallels of encephalitis in children]. / Kliniko-etiologicheskie i MRT paralleli entsefalitov u detei.

OBJECTIVE: Improving the diagnosis of encephalitis (EF) in children by establishing clinical, etiological and MRI parallels. MATERIAL AND METHODS: 364 children aged from 1 month to 17 years with EF were examined. MRI of the brain and spinal cord, blood and CSF examination for herpes viruses type 1-6 (HHV), enteroviruses (EV), tick-borne encephalitis viruses (TBEV), Borrelia burgdorferi (BB), varicella zoster (VVZ), herpes simplex (HSV1) and Epstein-Barr (EBV) were performed. RESULTS: The etiological structure was dominated by HHV types 1-6, tick-borne infections (19%), EV (14.6%), and other agents (6%). Clinical and topical variants of EF: leukoencephalitis (leukoePH) - 68.4%, polyoencephalitis (polioePH) - 22.8% and panencephalitis (panePH) - 8.8%. LEUKOEPH was more often caused by VVZ, EBV and BB, foci in the white matter of the large hemispheres, sensitive, cerebellar and pyramidal symptoms, acute course followed by complete recovery (65.8%), the risk of exacerbations and progression with the development of multiple sclerosis in 6% were observed in 80.7%. POLIO in 71.1% were caused by TBEV or EV, lesions were located in the thalamus, basal ganglia, cortex, manifested by deep depression of consciousness, epilepsy, central paralysis and speech disorders, in 83.1% there was a chronic course with the development of brain atrophy. PanEF was caused by cytomegalovirus in more than 1/2 of cases, with subtotal-total white matter damage, in 1/3 of cases - with the involvement of other structures, there was a chronic course with polymorphism of neurological symptoms, rare complete recovery (15.6%). The cerebellar form of EF in 88.7% was associated with VZV, subcortical and stem - with TBEV and EV, cortical and limbic - with HSV-1 and 2 and HHV-6. The outcomes of EF depend both on the timeliness of etiological and neuroimaging diagnostics, and on the adequacy of early therapy already with EF, including the use of acyclovir in combination with recombinant interferons alpha-2-ß with antioxidants, and the immediate appointment of Cytoflavin infusions upon admission to the hospital. CONCLUSIONS: Clinical and topical variants and forms of EF in children are associated with etiology, have different rates of complications, the nature of the course and outcomes, the knowledge of which makes it possible to optimize the diagnostic process.