Mirror Image Video Artifact: An Under-Reported Digital Video-EEG Artifact.

Synchronous video recording can be helpful in EEG recordings, especially in recognition of seizures and in rejection of artifacts. However, video recordings themselves are also subject to the risk of contamination by artifacts. We report a unique case in which a digital video artifact was identified, occurring during synchronous video-EEG recording, albeit independently of the EEG tracing itself. A synchronous digital video-EEG recording was performed on a 67-year-old male who presented in focal motor status epilepticus. During the initial review of the data, right-sided abnormalities on EEG apparently corresponded with (ipsilateral) right arm motor activity on video, suggesting a nonsensical anatomical localization. However, review of the patient's chart and discussion with the EEG technologist led to the recognition that the video data recorded a mirror image of the true findings of left arm motor activity. Review of the software settings led to the discovery that the video recording was inverted along the vertical axis, leading to mirror image video artifact. Recognition of this video artifact allowed for accurate interpretation of the study-that right hemispheric EEG abnormalities correlated appropriately with (contralateral) left arm twitching. Effective communication between the EEG reading physician, the treating team, and the EEG technologist is critical for recognition of such artifacts, for proper EEG interpretation, and for appropriate patient management. Mirror image video artifact affirms that bedside evaluation, astute technologists, and attentive EEG reading physicians remain important, even in the presence of video recording.

Injury to the preterm brain and cerebral palsy: clinical aspects, molecular mechanisms, unanswered questions, and future research directions.

Cerebral palsy will affect nearly 10% of the 60,000 very low-birth-weight infants born in the United States in the next year, and an even greater percentage will display some form of permanent neurological impairment resulting from injury to the preterm brain. The 2008 Neurobiology of Disease in Children Symposium, held in conjunction with the 37th annual meeting of the Child Neurology Society, aimed to define current knowledge and to develop specific aims for future clinical, translational, and fundamental science. A complex interplay of both destructive and developmental forces is responsible for injury to the preterm brain. Advances in imaging and histology have implicated a variety of cell types, though preoligodendrocyte injury remains the focus. Research into different mechanisms of injury is facilitating new neuroprotective and rehabilitative interventions. A cooperative effort is necessary to translate basic research findings into clinically effective therapies and better care for these children.

Neurofibromatosis type 1 revisited.

Neurofibromatosis type 1 (NF1) is an autosomal dominant condition with a worldwide incidence of approximately 1 per 2500 to 3000 individuals. Caused by a germ-line-inactivating mutation in the NF1 gene on chromosome 17, the disease is associated with increased morbidity and mortality. In the past several years, significant progress has been made in standardizing management of the major clinical features of neurofibromatosis type 1. Moreover, improved understanding of how the neurofibromatosis type 1 protein, neurofibromin, regulates cell growth recently provided insight into the pathogenesis of the disease and has led to the development of new therapies. In this review, we describe the clinical manifestations, recent molecular and genetic findings, and current and developing therapies for managing clinical problems associated with neurofibromatosis type 1.

Tumors of the central nervous system: clinical aspects, molecular mechanisms, unanswered questions, and future research directions.

Central nervous system tumors are the most common solid tumors in children. Many histological subtypes and biological variants exist. The 2007 Neurobiology of Disease in Children Symposium, held in conjunction with the 36th annual meeting of the Child Neurology Society, aimed to define current knowledge in the field and to develop specific aims for future clinical, translational, and fundamental science. Because of advances in structural and metabolic imaging, surgical technique, and combination therapies, the life expectancy of children with some of the most common tumors, such as cerebellar astrocytomas and medulloblastomas, has improved. Other common tumor types, including diffuse pontine gliomas and malignant embryonal tumors, still have a dismal prognosis. As novel therapies are identified for pediatric central nervous system tumors, long-term survival may be associated with considerable disability. A cooperative effort is crucial to early diagnosis and to translating basic research findings into safe, effective new treatments.

Targeting hyaluronan interactions in spinal cord astrocytomas and diffuse pontine gliomas.

Although significant advances have been made in treating malignant pediatric central nervous system tumors such as medulloblastoma, no effective therapy exists for diffuse pontine glioma or intramedullary spinal astrocytoma. Biology of these 2 tumors is poorly understood, in part because diffuse pontine gliomas are not treated surgically, and tumor specimens from intramedullary spinal astrocytomas are rare and minuscule. At the 2007 Neurobiology of Disease in Children Symposium, we presented evidence that malignant glioma behaviors, including antiapoptosis, invasiveness, and treatment resistance, are enhanced by hyaluronan, an extracellular glycosaminoglycan. We review the clinical course of pediatric intramedullary spinal astrocytoma and diffuse pontine glioma, and show expression of membrane proteins that interact with hyaluronan: CD44, extracellular matrix metalloproteinase inducer, and breast cancer resistance protein (BCRP/ABCG2). Furthermore, we describe novel animal models of these tumors for preclinical studies. These findings suggest that hyaluronan antagonism has potential therapeutic value in malignant central nervous system tumors.