Cerebellum atrophy and development of a peripheral dysgraphia: a paediatric case.

Two types of dysgraphia may be distinguished: the core ones, which reflect damage to the linguistic orthographic routes, and the peripheral ones, produced by alterations in the selection or execution of graphic motor patterns. We report the case of an 8-year-old male child, who consulted specialists due to difficulties in writing, with a background of acute cerebellar swelling at the age of 4. The writing pattern he has developed shows characteristic errors of a peripheral dysgraphia. The magnetic resonance imaging taken during the neuropsychological evaluation shows a mild atrophy in the cerebellum cortex. Our case is similar to previous studies of adult patients and equally supports the fact that the functional network responsible for the peripheral control of writing abilities may include the cerebellum, which not only maintains previously learnt writing processes but is also involved in the evolutionary acquisition of this ability.

Continuous giggling and autistic disorder associated with hypothalamic hamartoma.

We present the case of a child affected since early infancy from recurring episodes of giggling mixed with stereotypical behaviours, mingled with head drops, and eventually with falls, in the context of an autistic disorder. Scalp video-EEG recordings revealed an epileptic encephalopathy with generalized slow spike-and-wave complexes alternating with electrodecremental periods, which generally corresponded to the onset of the aforementioned clinical sequences. A resection of a hypothalamic hamartoma was achieved at the age of two. Since then, after 22 months of follow-up, the child is totally free from the giggling and the drops, and the autistic behaviour significantly improved during the second year of follow-up. This case illustrates the difficulties to recognize some subtle ictal manifestations during infancy and childhood, and encourages the early surgical treatment of hypothalamic hamartomas when associated with epileptic encephalopathy and when technically possible.