Relationship between sleep duration and childhood obesity: Systematic review including the potential underlying mechanisms.

AIM: The prevalence of obesity is continually increasing worldwide. Determining risk factors for obesity may facilitate effective preventive programs. The present review focuses on sleep duration as a potential risk factor for childhood obesity. The aim is to summarize the evidence on the association of sleep duration and obesity and to discuss the underlying potential physiological and/or pathophysiological mechanisms. DATA SYNTHESIS: The Ovid MEDLINE, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for papers using text words with appropriate truncation and relevant indexing terms. All studies objectively measuring sleep duration and investigating the association between sleep duration and obesity or factors (lifestyle and hormonal) possibly associated with obesity were included, without making restrictions based on study design or language. Data from eligible studies were extracted in tabular form and summarized narratively. After removing duplicates, 3540 articles were obtained. Finally, 33 studies (including 3 randomized controlled trials and 30 observational studies) were included in the review. CONCLUSION: Sleep duration seems to influence weight gain in children, however, the underlying explanatory mechanisms are still uncertain. In our review only the link between short sleep duration and the development of insulin resistance, sedentarism and unhealthy dietary patterns could be verified, while the role of other mediators, such as physical activity, screen time, change in ghrelin and leptin levels, remained uncertain. There are numerous evidence gaps. To answer the remaining questions, there is a need for studies meeting high methodological standards and including a large number of children.

Valproate treatment normalizes EEG functional connectivity in successfully treated idiopathic generalized epilepsy patients.

AIM: To investigate the effect of chronic VPA treatment of EEG functional connectivity in successfully treated idiopathic generalized epilepsy (IGE) patients. PATIENTS AND METHODS: 19-channel waking, resting-state EEG records of 26 IGE patients were analyzed before treatment (IGE) and after the 90th day of treatment (VPA), in seizure-free condition. Three minutes of artifact-free EEG background activity (without epileptiform potentials) was analyzed for each patient in both conditions. A group of 26 age-matched healthy normative control persons (NC) was analyzed in the same way. All the EEG samples were processed to LORETA (Low Resolution Electromagnetic Tomography) to localize multiple distributed sources of EEG activity. Current source density time series were generated for 33 regions of interest (ROI) in each hemisphere for four frequency bands. Pearson correlation coefficients (R) were computed between all ROIs in each hemisphere, for four bands across the investigated samples. R values corresponded to intrahemispheric, cortico-cortical functional EEG connectivity (EEGfC). Group and condition differences were analyzed by statistical parametric network method. MAIN RESULTS: p<0.05, corrected for multiple comparisons: (1) The untreated IGE group showed increased EEGfC in the delta and theta bands, and decreased EEGfC in the alpha band (as compared to the NC group); (2) VPA treatment normalized EEGfC in the delta, theta and alpha bands; and (3) degree of normalization depended on frequency band and cortical region. CONCLUSIONS: VPA treatment normalizes EEGfC in IGE patients.

Neurophysiology of juvenile myoclonic epilepsy: EEG-based network and graph analysis of the interictal and immediate preictal states.

INTRODUCTION: The neuronal mechanisms of enduring seizure propensity and seizure precipitation in juvenile myoclonic epilepsy (JME) are not known. We investigated these issues, within the framework of the "network concept" of epilepsy. METHODS: Design1: 19, unmedicated JME patients were compared with nineteen, age-, and sex-matched normal control persons (NC). A total of 120s, artifact-free, paroxysm-free, eyes-closed, resting state EEG background activity was analyzed for each person. Design2: interictal and immediate preictal periods of the JME patients were compared in order to explore interictal-preictal network differences. For both comparison designs, statistically significant differences of EEG functional connectivity (EEGfC), nodal and global graph parameters were evaluated. MAIN RESULTS: Design1: maximum abnormalities were: increased delta, theta, alpha1 EEGfC and decreased alpha2 and beta EEGfC in the JME group as compared to the NC group, mainly among cortical areas that are involved in sensory-motor integration. Nodal degree and efficiency of three, medial, basal frontal nodes were greater in JME than in NC, in the alpha1 band. Design2: preictal delta EEGfC showed further increase in the above-mentioned areas, as compared to the interictal state. DISCUSSION: Increased EEGfC indicates a hypercoupled state among the specified cortical areas. This interictal abnormality further increases in the preictal state. Nodal graph statistics indicates abnormal neuronal dynamics in the cortical area that is the ictal onset zone in JME. SIGNIFICANCE: Interictal and preictal neuronal dysfunction has been described in terms of network dynamics and topography in JME patients. Forthcoming investigations of seizure precipitation and therapeutic drug effects are encouraged on this basis.

EEG-LORETA endophenotypes of the common idiopathic generalized epilepsy syndromes.

OBJECTIVE: We tested the hypothesis that the cortical areas with abnormal local EEG synchronization are dissimilar in the three common idiopathic generalized epilepsy (IGE) phenotypes: IGE patients with absence seizures (ABS), juvenile myoclonic epilepsy (JME) and epilepsy with generalized tonic-clonic seizures exclusively (EGTCS). PATIENTS AND METHODS: Groups of unmedicated ABS, JME and EGTCS patients were investigated. Waking EEG background activity (without any epileptiform potentials) was analyzed by a source localization method, LORETA (Low Resolution Electromagnetic Tomography). Each patient group was compared to a separate, age-matched group of healthy control persons. Voxel-based, normalized broad-band (delta, theta, alpha, and beta) and very narrow band (VNB, 1Hz bandwidth, from 1 to 25Hz) LORETA activity (=current source density, A/m(2)) were computed for each person. Group comparison included subtraction (average patient data minus average control data) and group statistics (multiple t-tests, where Bonferroni-corrected p<0.05 values were accepted as statistically significant). RESULTS: Statistically not significant main findings were: overall increased delta and theta broad band activity in the ABS and JME groups; decrease of alpha and beta activity in the EGTCS group. Statistically significant main findings were as follows. JME group: bilaterally increased theta activity in posterior (temporal, parietal, and occipital) cortical areas; bilaterally increased activity in the medial and basal prefrontal area in the 8Hz VNB; bilaterally decreased activity in the precuneus, posterior cingulate and superior parietal lobule in the 11Hz and 21-22Hz VNBs. ABS group: bilaterally increased theta activity emerged in the basal prefrontal and medial temporal limbic areas. Decreased activity was found at 19-21Hz in the right postcentral gyrus and parts of the right superior and medial temporal gyri. EGTCS group: decreased activity was found in the frontal cortex and the postcentral gyrus at 10-11Hz, increased activity in the right parahippocampal gyrus at 16-18Hz. DISCUSSION: Increased theta activity in the posterior parts of the cortex is the endophenotype for JME. Increased theta activity in the fronto-temporal limbic areas is the endophenotype for ABS. Statistically not significant findings might indicate diffuse biochemical abnormality of the cortex in JME and ABS. SIGNIFICANCE: EEG-LORETA endophenotypes may correspond to the selective propensity to generate absence and myoclonic seizures in the ABS and JME syndromes.

EEG background activity is abnormal in the temporal and inferior parietal cortex in benign rolandic epilepsy of childhood: a LORETA study.

INTRODUCTION: Benign rolandic epilepsy of childhood (BERS) is an epilepsy syndrome with presumably genetic-developmental etiology. The pathological basis of this syndrome is completely unknown. We postulated that a developmental abnormality presumably results in abnormal EEG background activity findings. PATIENTS AND METHODS: 20 children with typical BERS and an age- and sex-matched group of healthy control children underwent EEG recording and analysis. 60×2 s epochs of waking EEG background activity (without epileptiform potentials and artifacts) were analyzed in the 1-25 Hz frequency range, in very narrow bands (VNB, 1 Hz bandwidth). LORETA (Low Resolution Electromagnetic Tomography) localized multiple distributed sources of EEG background activity in the Talairach space. LORETA activity (current source density) was computed for 2394 voxels and 25 VNBs. Normalized LORETA data were processed to voxel-wise comparison between the BERS and control groups. Bonferroni-corrected p<0.05 Student's t-values were accepted as statistically significant. RESULTS: Increased LORETA activity was found in the BERS group (as compared to the controls) in the left and right temporal lobes (fusiform gyri, posterior parts of the superior, middle and inferior temporal gyri) and in the angular gyri in the parietal lobes, in the 4-6 Hz VNBs, mainly at 5 Hz. DISCUSSION: (1) Areas of abnormal LORETA activity exactly correspond to the temporal and parietal cortical areas that are major components of the Mirsky attention model and also the perisylvian speech network. Thus the LORETA findings may correspond to impaired attention and speech in BERS patients. (2) The LORETA findings may contribute to delineating the epileptic network in BERS. SIGNIFICANCE: The novel findings may contribute to investigating neuropsychological disturbances and organization of the epileptic network in BERS.

EEG functional connectivity of the intrahemispheric cortico-cortical network of idiopathic generalized epilepsy.

AIMS: Intrahemispheric, cortico-cortical EEG functional connectivity (fC) was investigated in untreated patients with idiopathic generalized epilepsy (IGE) in this explorative study. PATIENTS AND METHODS: Group comparison was carried out between 19, drug-naive IGE patients and 19, matched healthy persons. 90×2s of 19 channels waking, interictal background EEG signal (without epileptiform potentials) were processed to the LORETA (low resolution electromagnetic tomography) software to compute current source density for 2394 voxels representing parcels of the cerebral cortex for 25 very narrow bands of 1Hz bandwidth (VNBs) from 1 to 25Hz. EEG fC was investigated among the already localized sources. Pearson correlation coefficients (R) were computed among the 33 regions of interest (ROI) within the left and within the right hemisphere, separately. Group differences were computed by means of t-statistics. Corrected p<0.05 differences were accepted as statistically significant. MAIN RESULTS: (1) The anatomical patterns of the fC differences showed great frequency-dependency. (2) Hemispheric asymmetry was prominent within most VNBs. (3) Decreased fC in the IGE group was found across all VNBs in the 1-6Hz frequency range as compared to mixed patterns comprising both increased and decreased fC at >6Hz frequencies. (4) In the 5-25Hz range, decreased fC dominated in the anterior, increased fC in the posterior parts of the cortex. (5) The results delineated an anterior and a posterior network. DISCUSSION: (1) Decreased fC in the 1-6Hz band might indicate some relationship to yet hidden structure network abnormalities. (2) The anatomical patterns of fC indicate frequency-dependent, pathological coupling and decoupling processes in the interictal state. (3) The two networks might help to understand seizure liability and seizure precipitation in IGE. SIGNIFICANCE: This is the first study to explore EEG fC in the interictal condition of IGE patients. The importance of EEG frequencies in evaluating fC in IGE was demonstrated and starting points for further research were given.

Quantitative EEG abnormalities in persons with "pure" epileptic predisposition without epilepsy: a low resolution electromagnetic tomography (LORETA) study.

OBJECTIVE: Epileptic predisposition means genetically determined, increased seizure susceptibility. Neurophysiological evaluation of this condition is still lacking. In order to investigate "pure epileptic predisposition" (without epilepsy) in this pilot study the authors prospectively recruited ten persons who displayed generalized tonic-clonic seizures precipitated by 24 or more hours of sleep deprivation but were healthy in any other respects. METHODS: 21-channel EEGs were recorded in the morning, in the waking state, after a night of sufficient sleep in the interictal period. For each person, a total of 120s artifact-free EEG was processed to low resolution electromagnetic tomography (LORETA) analysis. LORETA activity (Ampers/meters squared) was computed for 2394 voxels, 19 active electrodes and 1Hz very narrow bands from 1 to 25Hz. The data were compressed into four frequency bands (delta: 0.5-4.0Hz, theta: 4.5-8.0Hz, alpha: 8.5-12.0Hz, beta: 12.5-25.0Hz) and projected onto the MRI figures of a digitized standard brain atlas. The band-related LORETA results were compared to those of ten, age- and sex-matched healthy persons using independent t-tests. p<0.01 differences were accepted as statistically significant. RESULTS: Statistically significant decrease of alpha activity was found in widespread, medial and lateral parts of the cortex above the level of the basal ganglia. Maximum alpha decrease and statistically significant beta decrease were found in the left precuneus. Statistically not significant differences were delta increase in the medial-basal frontal area and theta increase in the same area and in the basal temporal area. DISCUSSION: The significance of alpha decrease in the patient group remains enigmatic. beta decrease presumably reflects non-specific dysfunction of the cortex. Prefrontal delta and theta increase might have biological meaning despite the lack of statistical significance: these findings are topographically similar to those reported in idiopathic generalized epilepsy in previous investigations. SIGNIFICANCE: Quantitative EEG characteristics of the genetically determined epilepsy predisposition were given in terms of frequency bands and anatomical distribution.

Theta EEG source localization using LORETA in partial epilepsy patients with and without medication.

OBJECTIVE: To investigate and localize the sources of spontaneous, scalp-recorded theta activity in patients with partial epilepsy (PE). METHODS: Nine patients with beginning, untreated PE (Group 1), 31 patients with already treated PE (Group 2), and 14 healthy persons were investigated by means of spectral analysis and LORETA, low resolution electromagnetic tomography (1 Hz very narrow band analysis, age-adjusted, Z-scored values). The frequency of main interest was 4-8 Hz. RESULTS: Group analysis: Group 1 displayed bilateral theta maxima in the temporal theta area (TTA), parietal theta area (PTA), and frontal theta area (FTA). In Group 2, theta activity increased all over the scalp as compared to the normative mean (Z=0) and also to Group 1. Maximum activity was found in the TTA, PTA, and FTA. However, in the PTA and FTA the centers of the abnormality shifted towards the medial cortex. Individual analysis: all the patients showed preferential activation (maximum Z-values) within one of the three theta areas. CONCLUSIONS: EEG activity in the theta band is increased in anatomically meaningful patterns in PE patients, which differs from the anatomical distribution of theta in healthy persons. SIGNIFICANCE: The findings contribute to our understanding of the sources of theta rhythms and the pathophysiology of PE.

Ultrasound-guided, intraglandular injection of botulinum toxin A in children suffering from excessive salivation.

BACKGROUND: The aim of this study was to describe the authors' minimally invasive procedure developed to significantly decrease excessive salivation in children suffering from chronic neurological diseases, using botulinum toxin A. OBJECTIVE: Ultrasound-guided, intraglandular injection of botulinum toxin blocks the parasympathetic innervation of salivary glands, resulting in a temporary decrease in saliva production and improved quality of life, lasting about three to four months. MATERIALS AND METHODS: Prior to introducing the method into clinical practice, animal experiments were conducted in order to verify the lack of histological changes three months following botulinum toxin administration. Twenty-one children were included in the clinical study, with ages ranging from two and a half to 14 years. RESULTS: The animal studies did not reveal any histological changes three months after botulinum toxin administration. Although botulinum toxin A proved to be ineffective in a single case, the majority of the other 20 patients responded well, with a highly significant reduction of their symptoms. The parents of 18 responder children requested repeated treatment with botulinum toxin A. However, two families refused to be further involved in the study, despite good results. The protein content of saliva, regulated by sympathetic innervation, was not affected by the treatment. CONCLUSION: This minimally invasive method, applied repeatedly three to four times a year, may be a viable alternative to surgical procedures such as submandibular duct relocation, duct ligature or nervus tympanicus neurectomy.

Lamotrigine decreases EEG synchronization in a use-dependent manner in patients with idiopathic generalized epilepsy.

OBJECTIVE: To investigate the quantitative EEG effects of lamotrigine (LTG) monotherapy. HYPOTHESIS: LTG was predicted to decrease thalamo-cortical neuronal synchronization in idiopathic generalized epilepsy (IGE). METHODS: Waking EEG background activity of 19 IGE patients was investigated before treatment and in the course of LTG monotherapy. Raw absolute power (RAP), raw percent power (RRP), and raw mean frequency (RMF) were computed for 19 electrodes and four frequency bands (delta=1.5-3.5Hz, theta=3.5-7.5Hz, alpha=7.5-12.5Hz, and beta=12.5-25.0Hz). Inter- and intrahemispheric coherence was computed for eight electrode pairs and the four frequency bands. In addition, scalp-averages were calculated for each variable. Group differences were computed by means of nonparametric statistics including correction for multiple comparisons. RESULTS: Main results were decreased delta and theta RAP (p<0.05 for scalp-averages). LTG compressed the delta, theta, and alpha RAP datasets, reducing the upper limit of the scatter in particular. Spearman r-values indicated marked correlation between the starting values (RAPuntreated) and the LTG-related decrease (RAPtreated-RAPuntreated) in three bands: delta (r=-0.72; p=0.0005), theta (r=-0.59; p=0.007), and alpha (r=-0.61; p=0.006). Thus, the greater the baseline neuronal synchronization, the marked the dampening effect of LTG on it. The remaining findings were decreased theta RRP, theta RMF, and increased alpha RMF (p<0.05 for scalp-averages). The electrode-related changes were small but topographically consistent across the 19 electrode sites. LTG did not affect coherence. CONCLUSIONS: 1. LTG partially normalized the spectral composition of EEG background activity. LTG decreased pathological thalamo-cortical synchronization in use-dependent manner. 2. LTG did not cause quantitative EEG alterations suggesting worsening of the physiological brain functions. Instead, its profile suggested a mild psychostimulant effect. SIGNIFICANCE: The results contribute to the understanding of the effect of LTG at the network level.

[Refsum disease]. / Refsum-kór.

For the first time in literature the authors interpret the pathography of Refsum's disease, in the case of their patient, as pseudo-hypervitaminosis A. The biochemical basis of the clinical picture is a defect in the activity of phytanic-acid-alpha-hydrolase belonging to the peroxisomal system. As a consequence, phytanic acid accumulates in the serum and in the parenchymal tissues. Retinol, an alcohol with high molecular weight, is a natural ligand of nuclear RXR (retinoid-X-receptor), which plays an important role in the regulation of peroxisoma synthesis. In Refsum's disease the phytanic acid accumulated because of the enzyme defect competes with the biotransformation derivates (all-trans-retinoic acid, 9-cis-retinoic acid) of the all-trans-retinol (vitamin A) for the nuclear RX receptor binding sites, and as a very potent receptoractivator it causes the intestinal symptoms of hypervitaminosis A. The authors review the procedure of fatty-acid chromatography necessary for the establishment of the diagnosis and discuss--in addition to dietary restrictions--recent therapeutic possibilities, like plasmapheresis, cascade filtration, lipapheresis and oral batylalcohol treatment.

[PEHO syndrome (progressive encephalopathy, edema, hypsarrhythmia. optic atrophy)]. / PEHO syndroma (progresszív encephalopathia, oedema, hypsarrhythmia, opticus atrophia).

The authors report the case of a now 2-year-old boy with PEHO syndrome. The syndrome is rare and it has not been published yet in Hungary. The syndrome was named after the first letters of its main characteristic signs: progressive encephalopathy, edema, hypsarrhythmia and optic atrophy. The aetiology of the syndrome is still unknown. Autosomal recessive inheritance is likely. The prognosis is poor. Intractable infantile spasms and the arrest of the psychomotoric and mental development can be expected.

Pedigree analysis of Hungarian Rett syndrome girls.

Twenty-two Hungarian families with Rett syndrome girls were genealogically examined. None of our 23 probands was born to first-cousin couples, but we established increased number of consanguineous marriages among the ancestors of the patients. Observing the places where the Rett families originate from, we found a predominance in the north-east part of Hungary. Our results support the findings of the Swedish analysis.

[Hallervorden-Spatz disease]. / Hallervorden-Spatz-betegség.

Based on the history of a 5-year-old boy, the clinical picture and the natural history of Hallervorden-Spatz disease are reviewed. In the past, the diagnosis of Hallervorden-Spatz disease has usually been made only post mortem. In the T2 weighted MRI images "eye of the tiger" sign is seen. This is due to iron-accumulation in the pallidum and it makes the earlier, in vivo diagnosis of the disease possible.

[A case of herpes simplex encephalitis requiring surgical management]. / Herpes simplex encephalitis mütéti kezelést igénylö esete.

The authors report about surgical treatment of herpes simplex encephalitis, although conservative management of this disease is the method of choice in the first place. They draw a lesson from this case that certain cases of large space occupying lesions of infectious origin leading to brain stem compression may require surgical management, even if they customary treatment is conservative.

Ewing's sarcoma in the occipital bone. Case report.

The head is a very rare primary site for Ewing's sarcoma which occurs most often in the long bones of the extremities and in the pelvis. This report describes an unusual case of Ewing's sarcoma arising from the occipital bone in a seven year old girl. The tumour compressed the venous sinuses, thus lowering the intracranial pressure resulted in temporary recovery which made the diagnosis difficult.

[Glucosylated proteins and perinatal growth]. / Glucosilált proteinek és perinatalis növekedés.

The concentration of HbA1c and glycosylated serum proteins were measured colorimetrically in 30 and 29 newborn infants of various gestational age, at the postnatal age of 0-24 hrs and 19-23 days, respectively. No relationship was found either between the maturity and the prenatal and early postnatal growth of the studied infants or the concentration of glycosylated haemoglobin and serum proteins.

[Concentration of C-reactive protein in neonatal pathology]. / C-reaktív protein koncentráció pathologiás újszülöttekben.

C-reactive protein concentration was measured in 56 preterm and 61 full term newborn infants with various pathology, at the postnatal age of 0-24 hrs and 1, 2, 3, 4 weeks. One third of all study babies had an increased (greater than 10 mg/l) CRP level measured within 24 hrs of birth. On the first day, CRP concentration in neonates with a pronounced perinatal asphyxia was as high as in those who suffered from perinatal infection. Further postnatal changes in CRP level need individual evaluation in every case, considering the diagnosis, clinical course and treatment. In connection with the results the clinical usefulness of CRP determinations in neonatal medicine is shortly discussed.