When Is EEG Indicated in Attention-Deficit/Hyperactivity Disorder?

The authors investigated the parameters for predicting epileptiform abnormalities in a group of children diagnosed with attention-deficit/hyperactivity disorder (ADHD). The sample consisted of 148 subjects aged between 6 and 13 (8.76 ± 1.26; 25.7% female) years. Subtypes of ADHD and comorbid psychiatric disorders were defined according to DSM-IV criteria. The Wechsler Intelligence Scale for Children-Revised was applied to all patients. Most of the subjects (89.2%) had wakefulness and sleep electroencephalography examinations lasting about one hour. The authors found out that the coexistence of speech sound disorder (odds ratio [OR] 3.90, 95% confidence interval [CI]: 1.61-9.48) and higher Digit Span test performance (OR 1.24, 95% CI: 1.06-1.44) predicted the presence of accompanying epileptiform abnormalities. The prevalence of epileptiform abnormalities was 26.4%, and they were frequently localized in the frontal (41%) and centrotemporal (28.2%) regions. Higher percentage of speech sound disorder co-occurrence (64%) in subjects with rolandic spikes suggests that epileptiform abnormalities associated with ADHD can be determined genetically at least in some cases. Pathophysiology of epileptiform abnormalities in ADHD might have complex genetic and maturational background.

Anti-N-methyl-d-aspartate (Anti-NMDA) receptor encephalitis: rapid and sustained clinical improvement with steroid therapy starting in the late phase.

Anti-N-methyl-d-aspartate (anti-NMDA) receptor encephalitis is an autoimmune/paraneoplastic encephalitis, with neurologic and psychiatric symptoms. Early and aggressive therapy has been shown to improve prognosis although problems with executive functions and memory have continued for several years. A 15-year-old girl had a history of initial symptoms including behavioral difficulties, poor attention, and frequent seizures progressing to a catatonia-like state, 2.5 months after onset of initial symptoms. Anti-NMDA receptor antibodies were detected in serum and cerebrospinal fluid. Subsequent to treatment with methylprednisolone starting 3 months after onset, motor skills, responsiveness, self-care, and speech improved rapidly. Her neuropsychologica profile assessed after 2 months showed global difficulties predominantly in attention, executive functions, memory, and visual perception, which moderately recovered in the 7th and 24th months, respectively. Contrary to current literature supporting the positive impact of early immunomodulatory therapy, a dramatic resolution of major neurologic and psychiatric symptoms was detected with steroid treatment given in the late phase.

A prevalence study of restless legs syndrome in Turkish children and adolescents.

OBJECTIVE: To determine the prevalence of restless legs syndrome (RLS) in Turkish school children and adolescents during the past 12 months. METHODS: A cross-sectional population study conducted in three primary and four high schools was randomly selected in the Umraniye district of Istanbul. In the first step, a 7-item questionnaire including pediatric diagnostic criteria of RLS proposed by the International Restless Legs Study Group was given to 4346 students aged from 10 to 19 years in the classroom. Candidates for "definite RLS" or "probable RLS" were selected by a face-to-face interview done by an expert. In the second step, a 58-item questionnaire was administered to the families of the selected subjects. The questionnaire aimed to survey family history, parent's awareness, and their behaviors for seeking treatment, as well as the differential diagnosis and comorbid disorders of RLS. RESULTS: Definite RLS was diagnosed in 119 (2.74%) of the subjects and was more prevalent in females (3.42%) compared to males (2.04%) (p=0.007). A family history of RLS was positive in 15.8% of the first-degree relatives of those 119 subjects. Less than half of the parents (45%) were aware of their children's symptoms and only 10.9% of these parents consulted medical centers. The most prevalent symptoms of sleep disturbances were restless sleep (28.6%) and daytime sleepiness (21%). Growing pains were reported in 54.5% of the 119 subjects with definite RLS. Symptoms of Attention-Deficit/Hyperactivity Disorder were found in 15.3% of the 119 subjects. CONCLUSIONS: RLS is prevalent in Turkish children and adolescents although family awareness of RLS is relatively low.