Response to methylphenidate by adult and pediatric patients with attention-deficit/hyperactivity disorder: the Spanish multicenter DIHANA study.

BACKGROUND: The purpose of this multicenter Spanish study was to evaluate the response to immediate-release methylphenidate by children and adults diagnosed with attention-deficit/hyperactivity disorder (ADHD), as well as to obtain information on current therapy patterns and safety characteristics. METHODS: This multicenter, observational, retrospective, noninterventional study included 730 patients aged 4-65 years with a diagnosis of ADHD. Information was obtained based on a review of medical records for the years 2002-2006 in sequential order. RESULTS: The ADHD predominantly inattentive subtype affected 29.7% of patients, ADHD predominantly hyperactive-impulsive was found in 5.2%, and the combined subtype in 65.1%. Overall, a significant lower Clinical Global Impression (CGI) score and mean number of DSM-IV TR (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision) symptoms by subtype were found after one year of treatment with immediate-release methylphenidate; CGI decreased from 4.51 to 1.69, symptoms of inattention from 7.90 to 4.34, symptoms of hyperactivity from 6.73 to 3.39, and combined subtype symptoms from 14.62 to 7.7. Satisfaction with immediate-release methylphenidate after one year was evaluated as "very satisfied" or "satisfied" by 86.90% of the sample; 25.75% of all patients reported at least one adverse effect. At the end of the study, 41.47% of all the patients treated with immediate-release methylphenidate were still receiving it, with a mean time of 3.80 years on therapy. CONCLUSION: Good efficacy and safety results were found for immediate-release methylphenidate in patients with ADHD.

[Nocturnal polysomnogram in childhood autism without epilepsy]. / Polisomnograma nocturno en el autismo infantil sin epilepsia.

AIMS: To evaluate the presence of epileptiform discharges and the organisation of nocturnal sleep of autistic children without nocturnal polysomnographic epileptic seizures. SUBJECTS AND METHODS: Cross section analysis. SUBJECTS: 21 boys and girls with autistic spectrum using DSM IV criteria between the ages of 4 and 12, compared with a control group made up of normal children of the same ages. METHODS: nocturnal polysomnogram with a minimum efficiency of 75%. ANALYSIS: t test to compare the cycles and phases of sleep with significance p< 0.05. RESULTS: SUBJECTS presented a maximum of four sleep cycles compared with five or six in the control subjects. From the first third of the night onwards there was an increase in the slowest phases. 66% presented epileptiform paroxysmal discharges, all of which originated in the anterior half of the brain. CONCLUSION: Sleep is not destructured, but it is reduced in length, with epileptiform paroxysms of predominantly frontal origin. This could indicate that these two parameters are intrinsic to the autistic spectrum, as well as indicating a more focused origin of the generalised picture which is possibly closely related with the qualitative alteration of the social experiences of these children.

[Cognitive evoked potential in primary wide angle glaucoma]. / Potencial evocado cognitivo en el glaucoma primario de ngulo abierto.

INTRODUCTION: Primary wide angle glaucoma (PWAG) is the commonest form of this disorder. It is initially asymptomatic, until there has been considerable visual field loss. Personality changes have been described in patients with wide angle glaucoma, with a significant percentage of developing dementia or a tendency to react defensively. The P300 endogenous evoked potential is related to memory/attention to work. INTRODUCTION: To evaluate, in PWAG, the probable occurrence of a disorder of visual processing due to alteration in the attention/working memory and its neuronal network, using the P300 visual cognitive evoked potential in correlation with Lobo s cognitive mini exam (CME). PATIENTS AND METHODS: We selected 68 patients with PWAG and 68 controls, of both sexes, aged between 50 and 65 years. The CME was done after taking the clinical history, and then an electroretinogram, visual evoked potential using the alternating dameres (ERGd and VEPd) and P300 potential (passive odd ball). Statistical analysis was done using the t test, one way ANOVA and discriminating analysis. RESULTS: The amplitude on ERGd and latency on VEPd were significantly altered. Patients with glaucoma had lower scores on CME. Regarding the P300 wave, latency was the most significant parameter, whilst the amplitude and site were less well defined. PATIENTS AND METHODS: In PWAG a process of visual cognitive dysfunction occurs and affects memory/attention to work in a way which is not only due to the peripheral visual effect.

[Cerebral mapping and attention-deficit hyperactivity syndrome]. / Cartografía cerebral y síndrome de atención deficiente con hiperactividad.

INTRODUCTION: The clinical features of the attention-deficit hyperactivity disorder are characterized by attention deficit, an impulsive style of behavior and cognition and excessive motor activity. The incidence is estimated to be between 3 and 5% of the school population, and it is considered that there are one or two children with attention deficit in all children s classes during the early years of schooling. OBJECTIVE: Electroencephalogram measurements using spectral analysis gives fresh information about the cerebral electrogenesis of children with attention-deficit hyperactivity disorder. PATIENTS AND METHODS: In this study we diagnosed 21 children as having attention-deficit hyperactivity disorder and compared them with a control group of 13 healthy children of the same average age, at rest and whilst carrying out various tasks. RESULTS AND CONCLUSIONS: Greater values of delta relative amplitude were found in the attention-deficit hyperactivity disorder group in their basal EEG at the F7, F8, FP1, FP2, F3, F4 and C3 sites. During visual testing differences were observed in the alpha band, also in the frontal region (F7, FP1, FP2 and F4) with the children of the control group showing the higher values. The level of significance used was 0.05. The cortical distribution of the dominant frequencies was different also. In addition, we present a method for cerebral mapping by means of spline functions developed by Duchon, which allow cerebral bioelectrical activity to be mapped in three dimensions.

[Cerebral mapping in patients with dementia of Alzheimer's type]. / Cartografía cerebral en pacientes con demencia tipo Alzheimer.

INTRODUCTION: The electric cerebral activity maps complement the conventional electroencefalography quantifying electric cerebral activity. One of the applications is in Alzheimer's dementia. OBJECT: The object of this study is to analyse the differences in the electric cerebral activity, by means a quantified EEG, in DAT and SDAT when compared with a control group of the same age. MATERIAL AND METHODS: Thirty patients meeting the criteria of probabledementia (NINCDS-ADRDA) in the senile (n = 19) and presenile (n = 11) form were studied. They were compared with a control group of the same age, 20 individuals older than and 17 younger than 65. RESULTS: The patients suffering from senile dementia as well as those suffering from the presenile form showed a significative increase of the delta and theta bands. On the other hand, a significant reduction of the alfa frequency bands and mainly those of beta was observed in the patients with ADT but not in the ADST ones. The significant increase of the slow bands in ADT and ADST and the significant decrease of the fast bands in ADT have been found in wide areas. Topographically the biggest affect has been registered in the frontal regions for the beta bands in ADT. CONCLUSIONS: The differences found in the electrical activity, depending on the age, would support Alzheimer's disease heterogeneity.

[Study of electroretinogram components using pattern inversion in the early diagnosis of glaucoma]. / Etude des composants de l'électrorétinogramme par inversion de damier dans le diagnostic précoce du glaucome.

Current electrophysiological techniques that help guide the diagnosis of glaucoma include pattern-electroretinogram (PERG) and pattern-visual evoked potential (PEVP) recordings. However, PERG has been recognized over the last decade as a good indicator of retinal ganglion cell function. One hundred seventy one eyes corresponding to 89 subjects were studied using both PERG (gold foil electrodes) and PEVP recordings. Two groups respectively including 32 subjects with ocular hypertension (OHT) and 27 subjects with simple chronic glaucoma (SCG) were compared with a control group composed of 30 healthy age-matched subjects. In regard to PERG recordings, the amplitudes of the P50 and N95 components were measured, but statistically significant differences were shown only for the N95 amplitudes both SCG (P < 0.01) and OHT (P < 0.05) groups. The amplitude and latency of the PEVP P100 component were analyzed. P100 latency was significantly delayed (P < 0.05) in SCG patients only. These findings suggest that the amplitude of the N95 component is the most sensitive electrophysiological parameter for early glaucoma detection.

[Prognosis in recurrent peripheral idiopathic facial paralysis in childhood]. / Pronóstico de la parálisis facial periférica idiopática y recidivante en la infancia.

Fifty-nine cases of idiopathic peripheral facial palsy were diagnosed in our unit during the period from January 1, 1984 to December 31, 1989. During follow-up examinations we observed a relapse in eleven cases, corresponding to 18.6% of the patients. Nine patients suffered a relapse once, one case twice and another case four times. The children that presented more than one recurrence have later shown functional sequelae, both clinical and neurophysiological. We conclude that in our series of patients relapse of facial palsy is a factor that worsens the prognosis for recovery. Furthermore, the existence of facial palsy in the family history leads to a greater risk of a recurrence.