The variety of visual perceptual impairments in pre-school children with perinatal brain damage.

To study the selectivity of visual perceptual impairment in children with early brain injury, eight visual perceptual tasks (L94), were administered to congenitally disabled children both with and without risk for cerebral visual impairment (CVI). The battery comprised six object-recognition and two visuoconstructive tasks. Seven tasks were newly designed. For these normative data are presented (age 2.75-6.50 years). Because the recognition tasks required object naming, each item included a canonical control drawing and visual perceptual ability was evaluated relative to the non-verbal intelligence level, instead of chronological age. In 22 multiple disabled children with no indications of CVI, the frequency of impairment did not exceed that in the reference sample for any L94 task. In contrast, in 57 5-year-old children who were at risk for CVI due to pre-maturity or birth asphyxia, a significant increase in the frequency of impairment was seen on six L94 tasks (range 12-38%). However, only five children had more than two impairments, indicating that the deficits were selective, not pervasive. We conclude that early brain lesions interfere with the functioning of particular visual subsystems, yet leave other subsystems intact and functioning within the normal range.

Relation between visual perceptual impairment and neonatal ultrasound diagnosis of haemorrhagic-ischaemic brain lesions in 5-year-old children.

Visual-perceptual abilities were assessed in 5-year-old children with the following neonatal neurological conditions: born preterm with normal ultrasound scan (NL, n=17); born preterm with ultrasound diagnosis of intraventricular haemorrhage (IVH, n=17); born preterm with ultrasound diagnosis of periventricular leukomalacia (PVL, n=12); born term with hypoxic-ischaemic encephalopathy (HIE, n=11). Visual-perceptual ability was evaluated with the L94: eight visual-perceptual tasks designed to evaluate different aspects of visual perception at the preschool level in children with multiple disabilities. Impairment was established in comparison to the performance age obtained on non-verbal intelligence subtests, instead of chronological age. Frequency of L94 impairment was highest in children with PVL, while children with IVH did not differ from the NL control group. Impairment rates were increased also in children with transient periventricular echodensities, and in children with HIE. Impairments were only moderately related to the delay of visual acuity maturation in infancy.

Visual, cognitive, and neurodevelopmental outcome at 51/2 years in children with perinatal haemorrhagic-ischaemic brain lesions.

To determine predictive values of early visual and neurocognitive assessment in children with perinatally acquired haemorrhagic or ischaemic brain lesions selected on the basis of ultrasound, 63 children (37 boys, 26 girls), who had been followed and examined until the age of 18 months, were reexamined at 5 1/2 years. Good correlations between visual and neurodevelopmental assessments at 18 months and at 5 1/2 years were found. When ultrasound abnormalities were combined with early visual and neurocognitive assessment data, good predictive values, especially for the group of children who had grade 2 to 4 leukomalacia, were found for visual acuity and neurodevelopment.

Seizure semiology of occipital lobe epilepsy in children.

PURPOSE: Occipital lobe epilepsy in children occurs as an idiopathic form, i.e., Benign Epilepsy with Occipital Paroxysms (BEOP), and a symptomatic form. This study attempted to determine whether seizure semiology could distinguish between the two forms. METHODS: Fifty children (34 boys, 16 girls) with clinical seizures and interictal EEGs presenting occipital spikes were included consecutively in the study. Seizure onset was between the ages of 2 months and 15 years. Epilepsy was considered symptomatic when psychomotor retardation and/or abnormalities at neurological and/or neuroradiological examination were found: 17 children were classified as idiopathic, and the remaining 33 children were classified as symptomatic. Seizure semiology was assessed by means of a structured interview of the children and their parents, using a detailed questionnaire. Seizure semiology was determined to comprise motor (versive or other movements of the eyes, versive movements of the head, (hemiconvulsions), visual, other signs (e.g. vomiting and headache), and impairment of consciousness. RESULTS: There were no statistically significant differences in seizure semiology between the two groups. CONCLUSIONS: Seizure semiology cannot distinguish between different forms of occipital lobe epilepsy: Further clinical examination, clinical neurophysiological investigations, and neuroimaging studies are needed for a correct classification.