[Endogenous and exogenous evoked potentials in the most common neurologic syndromes during development]. / Endogenne i egzogenne potencjaly wywolane w najczestszych zespolach neurologicznych wieku rozwojowego.

This paper presents the application of endo- and egzogenic evoked potentials (EP) in the most frequent neurological syndromes in children and adolescents on the basis of the author's own experiences. The advantages of the method are: objectiveness, noninvasive and the possibility of numerous repetitions. The principles of EPs application and interpretation are established by the recommendations of the International Federation of Clinical Neurophysiology. The analysis of the results contains morphology of recording, latencies and amplitudes of potentials. EPs constitute the important research method in child neurology. They are useful in diagnostics of demyelinating, degenerative and metabolic diseases, tumours of the nervous system, phacomatoses, infections and cerebrovascular disorders, CNS traumas and in cases of psychomotor retardation. The importance of this method consists in 1. diagnosis of symptomatic and asymptomatic pathological processes, 2. localization of the lesion, 3. confirmation of clinical diagnosis, 4. aid in differentiation, 5. monitoring of the treatment, 6. observation of the disease dynamics, 7. evaluation of the prognosis. Endogenic potentials enable neurophysiological evaluation of cognitive processes. Especially P 300 is analyzed in the range of its latency, amplitude and topography. P 300 is evaluated in relation to syndromes and diseases of developmental age, mostly in epilepsy, headaches, tumours, CVS traumas and minimal brain dysfunction.

Descriptive epidemiology of cerebral palsy.

The paper reviews the recent epidemiological literature on the prevalence of cerebral palsy (CP), including age, sex, and prevalence rates. Special attention is given to the clinical characteristics, including the forms of CP and the incidence of epilepsy, intellectual impairment, and defects of vision, speech, and hearing. Trends in the prevalence of CP are also considered, with particular reference to improvement in perinatal intensive care.

[Physical therapy in peripheral facial paresis]. / Leczenie fizykalne obwodowego porazenia nerwu twarzowego.

Peripheral facial paresis is a serious clinical and social problem. The effect of physical therapy in 44 patients aged 13-80 was studied. Idiopathic peripheral facial paresis was the cause of mimic muscles dysfunction in 75% of our patients. Medical treatment was conducted according to the established program, consisting in applying combined physical, thermal, electrotherapeutic procedures, exercises and massage. All the patients were examined before physical therapy and after I and II series of procedures, based on Pietruski's evolution table of paresis scored in point and percent scale. Patients between age 13-44 demonstrated 47-50% mimic facial muscles efficiency before the treatment, after I series of procedure it amounted to 80-90% and after the II series to 90-100%, so all the symptoms of paresis disappeared. Similar values were scored by patients aged 45-64 years. Minimal percentage of improvement of mimic facial muscles (57%) was noticed in patients aged 65-80 years The increase of the score was evaluated in the studied group after two stages of treatment. It seems to be best in the younger patients. In the examined group the best improvement evaluated as regression of the symptoms was found in patients with idiopathic peripheral facial paresis. The process of improvement was very slow and not full among patients who additionally suffered from co-existing diseases. Patients with diabetes improved by 57%, with arterial hypertension by 53%, the patients with obesity only by 43% after two cycles of treatment.

Visual and auditory evoked potentials during long-term vigabatrin treatment in children and adolescents with epilepsy.

OBJECTIVES: The aim of the study was to estimate the effects of Vigabatrin (VGB) as add-on therapy on visual (VEP) and brain-stem (BAEP) evoked potentials. METHOD: The investigation covered 100 epileptic patients from 8 to 18 years of age. The treatment included therapy with carbamazepine (CBZ) or valproate acid (VPA) using slow release formulations of these AEDs. Combination therapy was administered using add-on VGB in the recommended dose 57.4+/-26.5 mg/kg body mass/day. VEP and BAEP evoked potentials were recorded by means of Multiliner (Toennies, Germany). The obtained values were compared with age matched control group. RESULTS: Compared to control groups, significant differences in epileptic groups emerged in latencies of the peak III, V along with the interpeak intervals I-III of BAEP. Also VEP studies showed the reduction of N75/P100 and P100/N145 amplitudes. CONCLUSIONS: Adding VGB did not significantly increase the percentage of pathological abnormalities observed from EPs. Our electrophysiological studies demonstrate abnormalities in EPs parameters due to subclinical toxicity induced by AEDs. Major alterations produced bitherapy of VPA-SR + VGB and minor SR formulations of CBZ or VPA.

[Diagnostic value of sleep deprivation as the EEG activation method in diagnosis of epilepsy in developmental age]. / Wartosc diagnostyczna deprywacji snu jako metody aktywacji EEG w rozpoznawaniu padaczki w wieku rozwojowym.

The paper presented the significance of EEG activation in diagnosing epilepsy in children and adolescents. EEG records of 108 patients between 3-19 years of age with the occurrence of various types of paroxysmal disorders who were admitted to Chair and Department of Developmental Neurology University of Medical Sciences in Poznan were analysed. Standard EEG was administered to all children twice: the first examination at rest with hyperventilation (HV) and photostimulation (FS) and the second one after total or partial sleep deprivation (DS). At awaking state normal records were stated in 57% of cases, in 15% paroxysmal changes in HV or FS appeared, in the rest of cases (28%) generalised paroxysmal disorders, localised changes, lateralised or diffused were noted. Among EEG activation methods DS occurred to be the most effective after it, 52 patients (48%) were diagnosed for generalised paroxysmal changes, 20% for localised, 3% lateralised and for 6% for diffused changes. Normal EEG were recorded in 22% of examined children and adolescents. The epilepsy were diagnosed in 59 (55%) of patients mostly with generalised seizures (28) partial secondarily generalised (16) and partially complex (11). In 49 (45%) children were diagnosed with other paroxysmal disorders.

[The use of EEG polarization in the localization of epilepsy focus]. / Przydatnosc analizy dipolowej w lokalizacji ogniska padaczkowego.

Multiple spatio dipole structure of brain cortex has been developed to transform the traditional scalp EEG into an image of source activities. Computer use of complex calculation algorythms identify those brain regions which are active and contribute to the epileptiform discharges. The Chair and Department of Developmental Neurology at University of Medical Sciences in Poznan received a new imaging technique Focus (Megis, Germany) for testing, which allows to obtain maps of topographic EEG distribution at the instant chosen in time. Our research was based on 32-channel EEG files recorded on Ceegraph SE (Bio-Logic, USA). The purpose of the study was the comparison of traditional EEG evaluation and automatic analysis made by computer programm "FOCUS". EEG records in patients with simple partial and complex seizure were marked by a physician, electroencephalographer. Digital EEG records were also analysed by a source imaging Focus software. The best localisation of epileptic focus has been obtained in baso-mesial temporal lobe. The new technique of dipole automatic analysis is a non-invasive method providing information about seizure localisation.

[P300 event-related potential in epileptic children and adolescents]. / Endogenny potencjal wywolany P300 u dzieci i mlodziezy z padaczka.

P300 is a manifestation of activity in a limited capacity system "whose use in the service of different tasks is under relative control by instruction". It is accepted as an objective correlate of mental processing involved in the allocation of attentional resources when immediate memory is engaged. The aim of this study was to evaluate cognitive function in epileptic children and adolescents. We applied the "auditory oddball" paradigm to elicit event-related potentials (ERPs) according to the IFCN recommendation standards. ERPs were studied in fifteen patients with generalized epileptic seizures at matched age (8-18 years) (mean 13.8 +/- 2.4 y). 50 neurologically normal children were used as a control group. ERP were averaged with a Multiliner (Toennies, Germany) equipment. The method included two different tones for frequent and for rare stimuli generated at random. The tones were presented binaurally through headphones. ERPs were recorded at Fz, Cz and Pz according to the International 10-20 system. ERPs for target and non-target stimuli were averaged separately. The major positive peak between 250 and 500 ms for the rare tones was regarded as the cognitive evoked potential (P300). Latency values were obtained from the intersection of extrapolated lines from the ascending and descending slopes of each peak. The latencies of the N1, P2, N2 and P300 waves were determined for each subject, as well as peak to peak amplitudes of N1-P2, P2-N2, N2-P300. Auditory event related potential may be helpful procedures used in objective evaluation of cognitive function in patients with epilepsy.

[Bimodal evoked potentials during long-term therapy with conventional or slow release preparations of carbamazepine and valproic acid in children and adolescents with epilepsy]. / Bimodalne potencjaly wywolane podczas dlugotrwalego leczenia preparatami karbamazepiny i kwasu walproinowego o konwencjonalnym i przedluzonym dzialaniu u dzieci i mlodziezy z padaczka.

The measurement of evoked potentials (EPs) may be particularly useful in clinical neuropharmacology for investigation of drug effects of afferent nerve conduction within CNS. The study aims at estimating the long term effects of conventional or slow release formulation (CR) of carbamazepine (CBZ) and valproid acid (VPA) on visual (VPA) and brainstem auditory (BAEP) evoked potentials. Investigation covered 125 patients 8 to 18 years old to whom both formulations of CBZ or VPA were administered in monotherapy. Everyone received a drug dosage which gave an adequate therapeutic plasma concentration and satisfactory seizure control. Antiepileptic drugs (AEDs) plasma levels were measured by means of fluorescence polarization immunoassay method aided of TDx Analyzer (Abbott, Diagnostic). EPs were registered by means of Multiliner (Toennies, Germany). A pattern of reversal stimulation for VEP was used. The latencies of N75, P100, N145 as well as interpeak amplitudes of N75/P100, P100/N145 were evaluated. The following BAEP parameters were considered: morphology of the potential, absolute latencies of waves I, III, V and I-III, III-V, I-V. EP were always performed in the same conditions and with the same equipment for the epileptic and control groups. The obtained values were compared with age-matched control group. The following BAEP abnormalities were observed: prolonged absolute latencies of waves I, III, V as well as prolonged IPLs I-III. The BAEP V/I amplitude ratio and morphology of the waves were normal in all patients. The VEPs abnormalities manifested as prolongation of P100 or N145 latencies and reduction of amplitudes N75/P100, P100/N145. Results of these electrophysiological studies with CBZ and VPA demonstrate that EP are sensitive, noninvasive reflectors of AEDs effects within the CNS.

[The quality of life of school children and adolescents with headaches]. / Jakosc zycia dzieci i mlodziezy szkolnej z bólami glowy.

One of the most common children's ailments are headaches--based on literature--about 75% of the population under the age of 15 suffers from them. The aim of the study was to evaluate the influence of headache on the quality of life in children and adolescents. The study group was made up of 86 persons between the age of 12 and 18. The study was conducted with the help of an anonymous questionnaire in the form of inquiry that was identical for all the respondents. The questions, contained in it, played a multidimensional role since, on one hand they were related to the mental, physical and social problems and on the other hand they informed us about the headaches frequency, intensity and localisation. The questionnaire was worked out on the basis of the Questionnaire Quality de Vie Migraine--QVM and it was modified for the needs of the conducted studies. The respondents were the patients of Chair and Department of Developmental Neurology at the University of Medical Sciences in Poznan and their outpatient clinic. The studies also took place in the region of Koscian, the primary and secondary school in Poznan, in school infirmaries where children and adolescents where because of headaches. Changes in the bio-psycho-social existence in the examined groups were found. Negative emotional states and the feeling of diminished self-value in children and adolescents were estimated. High sickness absences at school, which didn't influence school records were also observed. A correlation was found between the experienced stress and the frequency of headache.

[Diagnostic studies of optic neuritis in children and adolescents]. / Badania diagnostyczne w zapaleniach nerwu wzrokowego u dzieci i mlodziezy.

PURPOSE: To evaluate the sensitivity of various diagnostic methods in the optic neuritis. MATERIAL AND METHODS: 15 patients, 10 boys and 5 girls, aged 6-18 years, with optic neuritis have been examined. Multiple sclerosis was diagnosed in 12 cases, the etiology of 3 was unknown. The full ophthalmological examination, including static perimetry and visual evoked potentials (VEP) as well as brain computed tomography (CT) and magnetic resonance imaging (MRI) were performed. RESULTS: MRI revealed plaques of demyelination in 11 patients; no pathological changes were observed in cases of idiopathic neuritis. In CT plaques of demyelination were found in 2 patients only. In most cases VEPs were abnormal, mainly there was prolonged latency of deflection, decreased amplitude and more rarely changes of the shape of the record. Static perimetry, with white and blue target, revealed multiple scattered absolute and relative scotoma in the 30 degrees central area. CONCLUSIONS: MRI and static perimetry were the most sensitive methods for detection of the changes in optic neuritis and these methods are also useful in cases with asymptomatic involvement of visual pathway, especially in multiple sclerosis.

The effect of chronic carbamazepine, valproic acid and phenytoin medication on the periodontal condition of epileptic children and adolescents.

Periodontal condition was studied in 84 epileptic 8-18 year-old patients who had been undergoing antiepileptic drug (AEP) treatment for a period of at least 3 years. They were diagnosed as suffering from partial seizures (simplex or complex) or general tonic-clonic fits and were treated with therapeutic oral doses of phenytoin (PHT) and carbamazepine (CBZ) or valproic acid (VPA) in mono- or polytherapy. All patients received a drug dosage to ensure adequate plasma concentration and satisfactory seizure control. The Gingival Index (GI), Sulcus Bleeding Index (SBI) and Plaque Index (Pl-I) were individually scored. The control group contained 30 age-matched healthy children and adolescents. The GI and SBI indices were higher in epileptics than in controls. Only the Pl-I was similar in both groups. Gingival enlargement was found in 30% of the epileptic patients. There was no definite plasma concentration-dependent increase in the incidence of gingival overgrowth.