[Nocturnal polysomnographic study in children with attention deficit hyperactivity disorder]. / Estudio polisomnografico nocturno en niños con trastorno por deficit de atencion con hiperactividad.

INTRODUCTION: The main symptoms of attention deficit hyperactivity disorder (ADHD) are attention deficit, hyperactivity and impulsivity. Its prevalence lies between 3 and 5% in schoolchildren. Children with ADHD can present a high prevalence rate of comorbidity. A timely diagnosis and treatment can modify the educational and psychosocial development of most of these children. A number of subjective reports (especially from parents) describe sleep disorders. The objective verification of these disorders and the exact nature of the sleep problems are still to be determined and the purpose of this study is to deal with these issues. PATIENTS AND METHODS: We studied a sample of 48 children (9 females and 39 males) with a mean age of 8 (SD: 2.59) who met DSM IV criteria. They were submitted to a general exploration as well as a neurological exploration, including their patient record, and then they were evaluated using the DSM IV, which was carried out by parents and teachers (in order to evaluate two different environments), and a nocturnal polysomnographic study. In the sample there were 26 children with predominant attention deficit type ADHD (ADHD/AD); 4 children with predominant hyperactivity impulsivity type ADHD (ADHD/H); and 18 children with combined type ADHD (ADHD/C). RESULTS: The most frequently diagnosed subtype is the attention deficit subtype. The sleep architecture of children with ADHD presents the most consistent differences as compared to normal children in an increase in the percentage of phase 3 of sleep and, consequently, an increase in the percentage of slow sleep. Epileptiform type paroxysms were observed in 16.7% of the children who presented symptoms of ADHD. The number of epileptiform paroxysms is more usual in the attention deficit subtype. CONCLUSIONS: The increase in phase 3 may be related to the alterations in noradrenaline and dopamine transmission present in children who suffer from ADHD. Some children with ADHD can have a region of the brain with intense epileptic activity, which does not trigger epileptic seizures but gives rise to behavioural disorders, learning disorders and language problems.

Estudio polisomnográfico nocturno en niños con trastorno por déficit de atención con hiperactividad / Nocturnal polysommographic study in children with attention déficit hyperactivity disorder

Introducción. Los síntomas principales del trastorno por déficit de atención con hiperactividad (TDAH) son: déficit de atención, hiperactividad e impulsividad. Su prevalencia se sitúa entre un 3 y un 5% en niños en edad escolar. Los niños con TDAH pueden presentar una elevada prevalencia de comorbilidad. El diagnóstico y tratamiento a tiempo puede modificar el desarrollo educacional y psicosocial de la mayoría de estos niños. Existen informes subjetivos (sobre todo, por parte de los padres) sobre alteraciones del sueño. La verificación objetiva de estos trastornos y la naturaleza exacta de los problemas del sueño está todavía por determinar, y es el objetivo del presente estudio. Pacientes y métodos. 48 niños (9 niñas y 39 niños) con una media de edad de 8 años (DE: 2,59) que cumplen los criterios de DSM-IV. Se les realizó una exploración general y una exploración neurológica, una historia clínica, se les hizo el DSM-IV por parte de los padres y del profesor (evaluando así dos ambientes) y un estudio polisomnográfico nocturno. En la muestra hay 26 niños con TDAH tipo predominio déficit de atención (TDAH/DA); 4 niños con TDAH tipo predominio hiperactivo-impulsivo (TDAH/H); y 18 niños con TDAH tipo combinado (TDAH/C). Resultados. El subtipo más frecuentemente diagnosticado es el subtipo con déficit de atención. La arquitectura del sueño de los niños con TDAH presenta las diferencias más consistentes –cuando lo comparamos con niños normales– en un aumento del porcentaje de la fase 3 de sueño y como consecuencia un aumento del porcentaje de sueño lento. Se han observado paroxismos de tipo epileptiforme en un 16,7% de los niños que presentan síntomas del TDAH. El número de paroxismos epileptiformes es más frecuente en el subtipo con déficit de atención. Conclusión. El aumento de la fase 3 puede estar relacionado la alteración de la transmisión noradrenérgica y dopaminérgica que tienen los niños que padecen TDAH. Algunos niños con TDAH pueden tener una zona cerebral con intensa actividad epiléptica, que no provoca crisis epilépticas, pero da lugar a trastornos del comportamiento, alteraciones del aprendizaje y retrasos en el lenguaje (AU)

Introduction. The main symptoms of attention deficit hyperactivity disorder (ADHD) are attention deficit, hyperactivity and impulsivity. Its prevalence lies between 3 and 5% in schoolchildren. Children with ADHD can present a high prevalence rate of comorbidity. A timely diagnosis and treatment can modify the educational and psychosocial development of most of these children. A number of subjective reports (especially from parents) describe sleep disorders. The objective verification of these disorders and the exact nature of the sleep problems are still to be determined and the purpose of this study is to deal with these issues. Patients and methods. We studied a sample of 48 children (9 females and 39 males) with a mean age of 8 (SD: 2.59) who met DSM-IV criteria. They were submitted to a general exploration as well as a neurological exploration, including their patient record, and then they were evaluated using the DSM-IV, which was carried out by parents and teachers (in order to evaluate two different environments), and a nocturnal polysomnographic study. In the sample there were 26 children with predominant attention deficit-type ADHD (ADHD/AD); 4 children with predominant hyperactivity-impulsivity-type ADHD (ADHD/H); and 18 children with combined-type ADHD (ADHD/C). Results. The most frequently diagnosed subtype is the attention deficit subtype. The sleep architecture of children with ADHD presents the most consistent differences –as compared to normal children– in an increase in the percentage of phase 3 of sleep and, consequently, an increase in the percentage of slow sleep. Epileptiform-type paroxysms were observed in 16.7% of the children who presented symptoms of ADHD. The number of epileptiform paroxysms is more usual in the attention deficit subtype. Conclusions. The increase in phase 3 may be related to the alterations in noradrenaline and dopamine transmission present in children who suffer from ADHD. Some children with ADHD can have a region of the brain with intense epileptic activity, which does not trigger epileptic seizures but gives rise to behavioural disorders, learning disorders and language problems (AU)

[Cognitive evoked potentials in autistic children]. / Potenciales evocados cognitivos en niños autistas.

AIMS: The aim of this study was to examine the latency, amplitude and distribution of N400 potential in order to evaluate the semantic processing capacity in autistic children and in children suffering from Asperger s syndrome (AS), and to compare them with a control group. PATIENTS AND METHODS: 24 autistic children, six boys with AS and 25 controls, aged between 6 and 14 years old. The cases were examined using the DSM IV diagnostic criteria. Auditory stimulation was performed with pairs of congruent and incongruent words: two lists of 20 pairs of semantically related words (congruent) and 20 pairs of words with no semantic relationship whatsoever (incongruent). RESULTS: The most striking parameter is the increase in latency in N400 for the group of autistic children, which did not occur in the group of children with AS. Maximum N400 negativity for the children with autism was found in the left frontocentral region. No significant differences were observed for the amplitude of N400 between the three groups that were studied. CONCLUSION: Neurophysiologically, the autistic children and those affected by AS perhaps use different neuronal networks in semantic processing. The N400 wave can be a valid test for monitoring verbal processing in these children.

Potenciales evocados cognitivos en niños autistas / Cognitive evoked potentials in autistic children

Objetivo. Estudiar la latencia, amplitud y distribución del potencial N400 para valorar la capacidad de procesamiento semántico en niños autistas y en niños con síndrome de Asperger (SA) y compararlos con un grupo control. Pacientes y métodos. 24 niños autistas, seis niños con SA y 25 controles, con edades comprendidas entre 6 y 14 años. Se utilizaron los criterios diagnósticos del DSM-IV para los casos. Se realizó una estimulación auditiva con pares de palabras congruentes e incongruentes: dos listas de 20 pares de palabras relacionadas semánticamente (congruentes) y 20 pares de palabras sin relación semántica alguna (incongruentes). Resultados. El parámetro más llamativo es el incremento de la latencia en la N400 para el grupo de autistas, que no fue así en el grupo de niños con SA. La máxima negatividad de la N400 para los niños con autismo se localiza en la región frontocentral izquierda. No se observaron diferencias significativas para la amplitud de la N400 entre los tres grupos estudiados. Conclusión. Neurofisiológicamente, los niños autistas y los afectos de SA posiblemente utilizan redes neuronales diferentes para el procesamiento semántico. La onda N400 puede ser un test válido para el seguimiento del procesamiento verbal de estos niños (AU)

Aims. The aim of this study was to examine the latency, amplitude and distribution of N400 potential in order to evaluate the semantic processing capacity in autistic children and in children suffering from Asperger’s syndrome (AS), and to compare them with a control group. Patients and methods. 24 autistic children, six boys with AS and 25 controls, aged between 6 and 14 years old. The cases were examined using the DSM IV diagnostic criteria. Auditory stimulation was performed with pairs of congruent and incongruent words: two lists of 20 pairs of semantically related words (congruent) and 20 pairs of words with no semantic relationship whatsoever (incongruent). Results. The most striking parameter is the increase in latency in N400 for the group of autistic children, which did not occur in the group of children with AS. Maximum N400 negativity for the children with autism was found in the left frontocentral region. No significant differences were observed for the amplitude of N400 between the three groups that were studied. Conclusion. Neurophysiologically, the autistic children and those affected by AS perhaps use different neuronal networks in semantic processing. The N400 wave can be a valid test for monitoring verbal processing in these children (AU)

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