Pub Date : 2025-02-01DOI: 10.1016/j.braindev.2024.104319
Youngkyu Shim , Hunmin Kim , Jong Hee Chae , Ki Joong Kim , Byung Chan Lim
Objective
The present study aimed to investigate the initial clinical features of infantile-onset genetic epilepsy and compare initial seizure variables and responses to sodium channel blockers between SCN1A and non-SCN1A group.
Methods
We selected 122 patients, comprising 58 patients with SCN1A mutations and 64 patients with mutations in other than SCN1A, from our institutional database.
Results
Patients identified in the SCN1A group tended to present with fever, prolonged seizure duration, and hemiclonic seizure semiology. Clustering of seizures was found more frequently in patients from the non-SCN1A group. However, an overlap of seizure variables and seizure type in both groups was also noted. While sodium channel blockers aggravated seizures in more than half of the patients (21/29, 72.4 %) in the SCN1A group, the opposite tendency toward a favorable response to sodium channel blockers (19/30, 63.3 %) was found in those in the non-SCN1A group. Notably, no patient showed seizure aggravation after the use of sodium channel blockers in the non-SCN1A group.
Conclusion
This study highlights the need for comprehensive comparative research to guide the management of infantile onset genetic epilepsy patients.
{"title":"Analysis of initial seizure characteristics in patients with infantile onset genetic epilepsy","authors":"Youngkyu Shim , Hunmin Kim , Jong Hee Chae , Ki Joong Kim , Byung Chan Lim","doi":"10.1016/j.braindev.2024.104319","DOIUrl":"10.1016/j.braindev.2024.104319","url":null,"abstract":"<div><h3>Objective</h3><div>The present study aimed to investigate the initial clinical features of infantile-onset genetic epilepsy and compare initial seizure variables and responses to sodium channel blockers between <em>SCN1A</em> and non-<em>SCN1A</em> group.</div></div><div><h3>Methods</h3><div>We selected 122 patients, comprising 58 patients with <em>SCN1A</em> mutations and 64 patients with mutations in other than <em>SCN1A</em>, from our institutional database.</div></div><div><h3>Results</h3><div>Patients identified in the <em>SCN1A</em> group tended to present with fever, prolonged seizure duration, and hemiclonic seizure semiology. Clustering of seizures was found more frequently in patients from the non-<em>SCN1A</em> group. However, an overlap of seizure variables and seizure type in both groups was also noted. While sodium channel blockers aggravated seizures in more than half of the patients (21/29, 72.4 %) in the <em>SCN1A</em> group, the opposite tendency toward a favorable response to sodium channel blockers (19/30, 63.3 %) was found in those in the non-<em>SCN1A</em> group. Notably, no patient showed seizure aggravation after the use of sodium channel blockers in the non-<em>SCN1A</em> group.</div></div><div><h3>Conclusion</h3><div>This study highlights the need for comprehensive comparative research to guide the management of infantile onset genetic epilepsy patients.</div></div>","PeriodicalId":56137,"journal":{"name":"Brain & Development","volume":"47 1","pages":"Article 104319"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Epileptic encephalopathy (EE) is a serious clinical issue that manifests as part of developmental and epileptic encephalopathy (DEE), particularly in childhood epilepsy. In EE, neurocognitive functions and behavior are impaired by intense epileptiform electroencephalogram (EEG) activity. Hypotheses of pathophysiological mechanisms behind EE are reviewed to contribute to an effective solution for EE.
Review
Current hypotheses are as follows: 1) neuronal dysfunction based on genetic abnormalities that may affect neurocognitive functions and epilepsy separately; 2) impairment of synaptic homeostasis during sleep that may be responsible for DEE/EE with spike-and-wave activation in sleep; 3) abnormal subcortical regulation of the cerebral cortex; 4) abnormal cortical metabolism and hemodynamics with impairment of the neural network including default mode network; 5) neurotransmitter imbalance and disordered neural excitability; 6) the effects of neuroinflammation that may be caused by epileptic seizures and in turn aggravate epileptogenesis; 7) the interaction between physiological and pathological high-frequency EEG activity; etc. The causal relationship between epileptiform EEG activity and neurocognitive dysfunctions is small in DEE based on genetic abnormalities and it is largely unestablished in the other hypothetical mechanisms.
Conclusion
We have not yet found answers to the question of whether the single-central or multiple derangements are present and what seizures and intense epileptiform EEG abnormalities mean in EE. We need to continue our best efforts in both aspects to elucidate the pathophysiological mechanisms of DEE/EE and further develop epilepsy treatment and precision medicine.
{"title":"Hypotheses of pathophysiological mechanisms in epileptic encephalopathies: A review","authors":"Katsuhiro Kobayashi , Takashi Shibata , Hiroki Tsuchiya , Mari Akiyama , Tomoyuki Akiyama","doi":"10.1016/j.braindev.2024.104318","DOIUrl":"10.1016/j.braindev.2024.104318","url":null,"abstract":"<div><h3>Introduction</h3><div>Epileptic encephalopathy (EE) is a serious clinical issue that manifests as part of developmental and epileptic encephalopathy (DEE), particularly in childhood epilepsy. In EE, neurocognitive functions and behavior are impaired by intense epileptiform electroencephalogram (EEG) activity. Hypotheses of pathophysiological mechanisms behind EE are reviewed to contribute to an effective solution for EE.</div></div><div><h3>Review</h3><div>Current hypotheses are as follows: 1) neuronal dysfunction based on genetic abnormalities that may affect neurocognitive functions and epilepsy separately; 2) impairment of synaptic homeostasis during sleep that may be responsible for DEE/EE with spike-and-wave activation in sleep; 3) abnormal subcortical regulation of the cerebral cortex; 4) abnormal cortical metabolism and hemodynamics with impairment of the neural network including default mode network; 5) neurotransmitter imbalance and disordered neural excitability; 6) the effects of neuroinflammation that may be caused by epileptic seizures and in turn aggravate epileptogenesis; 7) the interaction between physiological and pathological high-frequency EEG activity; etc. The causal relationship between epileptiform EEG activity and neurocognitive dysfunctions is small in DEE based on genetic abnormalities and it is largely unestablished in the other hypothetical mechanisms.</div></div><div><h3>Conclusion</h3><div>We have not yet found answers to the question of whether the single-central or multiple derangements are present and what seizures and intense epileptiform EEG abnormalities mean in EE. We need to continue our best efforts in both aspects to elucidate the pathophysiological mechanisms of DEE/EE and further develop epilepsy treatment and precision medicine.</div></div>","PeriodicalId":56137,"journal":{"name":"Brain & Development","volume":"47 1","pages":"Article 104318"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Spinal muscular atrophy with respiratory distress type 1 (SMARD1) and Charcot-Marie-Tooth type 2S (CMT2S) typically present before age 10. Genetic factors account for up to 50 % of neuropathies, which often display varied symptoms. Mutations in the IGHMBP2 gene are associated with both CMT2S and SMARD1, resulting in a rare clinical condition marked by axonal neuropathy, spinal muscular atrophy, respiratory distress, and muscle weakness.
Method
Detailed family histories and medical data were collected. Segregation analysis was performed using Sanger sequencing and whole exome sequencing. Additionally, a review of molecularly confirmed patients was conducted. Protein tertiary structures expressed in the IGHMBP2 gene were tested for topological and conformational changes using modeling programs and in-silico tools.
Results
We identified a novel homozygous nonsense mutation (c.2568_2569del p.Gly857Alafs*27) in a family with a member showing neuropathy. This report details the clinical and genetic findings of the affected individuals, including a Turkish patient with neuropathy, and compares them with literature cases.
Conclusion
Understanding the clinical impact of the (c.2568_2569del p.Gly857Alafs*27) mutation will enhance our knowledge of IGHMBP2 gene defects role in neuropathy. This study aims to highlight this severe recessive disease caused by pathogenic IGHMBP2 gene mutations and to examine the mutation spectrum and phenotype differences.
{"title":"Novel biallelic nonsense mutation in IGHMBP2 gene linked to neuropathy (CMT2S): A comprehensive clinical, genetic and bioinformatic analysis of a Turkish patient with literature review","authors":"Cüneyd Yavas , Mustafa Dogan , Bilge Ozgor , Ekrem Akbulut , Recep Eroz","doi":"10.1016/j.braindev.2024.104313","DOIUrl":"10.1016/j.braindev.2024.104313","url":null,"abstract":"<div><h3>Background</h3><div>Spinal muscular atrophy with respiratory distress type 1 (SMARD1) and Charcot-Marie-Tooth type 2S (CMT2S) typically present before age 10. Genetic factors account for up to 50 % of neuropathies, which often display varied symptoms. Mutations in the <em>IGHMBP2</em> gene are associated with both CMT2S and SMARD1, resulting in a rare clinical condition marked by axonal neuropathy, spinal muscular atrophy, respiratory distress, and muscle weakness.</div></div><div><h3>Method</h3><div>Detailed family histories and medical data were collected. Segregation analysis was performed using Sanger sequencing and whole exome sequencing. Additionally, a review of molecularly confirmed patients was conducted. Protein tertiary structures expressed in the <em>IGHMBP2</em> gene were tested for topological and conformational changes using modeling programs and in-silico tools.</div></div><div><h3>Results</h3><div>We identified a novel homozygous nonsense mutation (c.2568_2569del p.Gly857Alafs*27) in a family with a member showing neuropathy. This report details the clinical and genetic findings of the affected individuals, including a Turkish patient with neuropathy, and compares them with literature cases.</div></div><div><h3>Conclusion</h3><div>Understanding the clinical impact of the (c.2568_2569del p.Gly857Alafs*27) mutation will enhance our knowledge of <em>IGHMBP2</em> gene defects role in neuropathy. This study aims to highlight this severe recessive disease caused by pathogenic <em>IGHMBP2</em> gene mutations and to examine the mutation spectrum and phenotype differences.</div></div>","PeriodicalId":56137,"journal":{"name":"Brain & Development","volume":"47 1","pages":"Article 104313"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To determine the effect of long-term tobramycin (TOB) inhalation therapy on recurrent pneumonia among ventilator-dependent children with profound neurological disabilities.
Methods
TOB inhalation was performed in eight series of trials in seven ventilator-dependent children who had intratracheal Pseudomonas aeruginosa and suffered from recurrent pneumonia. Their age at the initiation of therapy was 68 ± 50 months (mean ± standard deviation), whereas the duration of treatment was 30 ± 22 months. The participants were followed after the termination of therapy for a period of 38 ± 32 months.
Results
The annual rate of pneumonia was 5.6 episodes per year (n = 8) preceding the initiation of inhalation, which decreased to 3.7 (n = 8), 1.6 (n = 5), and 0.67 (n = 3) in the periods of 0–12, 12–24, and 24–36 months after initiation, respectively. The rates were 1.0 (n = 6), 0.6 (n = 5), and 1.4 (n = 5) in the periods of 0–12, 12–24, and 24–36 months after the termination of therapy.
Interpretation
Extended TOB inhalation therapy was effective in decreasing the morbidity of pneumonia in ventilator-dependent children with severe motor and intellectual disabilities.
{"title":"Prevention of chronic pneumonia in children with severe motor and intellectual disabilities by long-term tobramycin inhalation: Its benefits and limitations","authors":"Yoshiaki Saito , Yuto Arai , Takanori Omae , Keisuke Watanabe , Yusuke Saiki , Toshiaki Tanaka , Chika Hosoda , Akiko Tamasaki-Kondo , Yoshihiro Maegaki , Kensaku Okada","doi":"10.1016/j.braindev.2024.104317","DOIUrl":"10.1016/j.braindev.2024.104317","url":null,"abstract":"<div><h3>Aim</h3><div>To determine the effect of long-term tobramycin (TOB) inhalation therapy on recurrent pneumonia among ventilator-dependent children with profound neurological disabilities.</div></div><div><h3>Methods</h3><div>TOB inhalation was performed in eight series of trials in seven ventilator-dependent children who had intratracheal <em>Pseudomonas aeruginosa</em> and suffered from recurrent pneumonia. Their age at the initiation of therapy was 68 ± 50 months (mean ± standard deviation), whereas the duration of treatment was 30 ± 22 months. The participants were followed after the termination of therapy for a period of 38 ± 32 months.</div></div><div><h3>Results</h3><div>The annual rate of pneumonia was 5.6 episodes per year (<em>n</em> = 8) preceding the initiation of inhalation, which decreased to 3.7 (n = 8), 1.6 (<em>n</em> = 5), and 0.67 (<em>n</em> = 3) in the periods of 0–12, 12–24, and 24–36 months after initiation, respectively. The rates were 1.0 (<em>n</em> = 6), 0.6 (n = 5), and 1.4 (n = 5) in the periods of 0–12, 12–24, and 24–36 months after the termination of therapy.</div></div><div><h3>Interpretation</h3><div>Extended TOB inhalation therapy was effective in decreasing the morbidity of pneumonia in ventilator-dependent children with severe motor and intellectual disabilities.</div></div>","PeriodicalId":56137,"journal":{"name":"Brain & Development","volume":"47 1","pages":"Article 104317"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Safe pediatric magnetic resonance imaging (MRI) ideally relies on non-sedative techniques, as avoiding risky sedation is inherently safer. However, in practice, sedation often becomes unavoidable, particularly for younger children or those with anxiety, to ensure motion-free, high-quality imaging. This narrative review explores the current practices and proposes strategies to enhance safety in pediatric MRI examinations.
Methods
We identified and analyzed 247 studies addressing various aspects of pediatric MRI safety, including sedation protocols, patient monitoring, and team-based management approaches.
Results
Safe sedation requires careful drug selection tailored to individual needs, continuous monitoring, and robust emergency preparedness. While efforts are underway to minimize sedation, safer drug protocols and improved monitoring technologies remain essential. Assembling dedicated MRI teams trained in both technical and non-technical skills—such as situational awareness, communication, and teamwork—supports these strategies. Structured team briefings covering monitoring procedures, emergency scenarios, response protocols, and specific resuscitation roles are also critical. Developing a strong organizational culture that promotes patient safety and continuous learning from incident reports helps ensure ongoing improvements.
Conclusions
Achieving safe pediatric MRI examinations requires balancing the need for sedation with the goal of minimizing its use. Strengthening collaboration, refining sedation protocols, and implementing advanced safety monitoring systems are essential steps. Further advancements in imaging technologies are also necessary to reliably obtain high-quality scans without sedation, reducing risks and improving patient outcomes.
{"title":"Improving pediatric magnetic resonance imaging safety by enhanced non-technical skills and team collaboration","authors":"Masashi Uramatsu , Hidekuni Takahashi , Paul Barach , Yoshikazu Fujisawa , Megumi Takahashi , Shiro Mishima , Gaku Yamanaka","doi":"10.1016/j.braindev.2024.104311","DOIUrl":"10.1016/j.braindev.2024.104311","url":null,"abstract":"<div><h3>Background</h3><div>Safe pediatric magnetic resonance imaging (MRI) ideally relies on non-sedative techniques, as avoiding risky sedation is inherently safer. However, in practice, sedation often becomes unavoidable, particularly for younger children or those with anxiety, to ensure motion-free, high-quality imaging. This narrative review explores the current practices and proposes strategies to enhance safety in pediatric MRI examinations.</div></div><div><h3>Methods</h3><div>We identified and analyzed 247 studies addressing various aspects of pediatric MRI safety, including sedation protocols, patient monitoring, and team-based management approaches.</div></div><div><h3>Results</h3><div>Safe sedation requires careful drug selection tailored to individual needs, continuous monitoring, and robust emergency preparedness. While efforts are underway to minimize sedation, safer drug protocols and improved monitoring technologies remain essential. Assembling dedicated MRI teams trained in both technical and non-technical skills—such as situational awareness, communication, and teamwork—supports these strategies. Structured team briefings covering monitoring procedures, emergency scenarios, response protocols, and specific resuscitation roles are also critical. Developing a strong organizational culture that promotes patient safety and continuous learning from incident reports helps ensure ongoing improvements.</div></div><div><h3>Conclusions</h3><div>Achieving safe pediatric MRI examinations requires balancing the need for sedation with the goal of minimizing its use. Strengthening collaboration, refining sedation protocols, and implementing advanced safety monitoring systems are essential steps. Further advancements in imaging technologies are also necessary to reliably obtain high-quality scans without sedation, reducing risks and improving patient outcomes.</div></div>","PeriodicalId":56137,"journal":{"name":"Brain & Development","volume":"47 1","pages":"Article 104311"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.braindev.2024.104309
Basma AlFaris , Fahad B. AlBader , Rawan AlSheikh , Fahad A. Bashiri , Muddathir H. Hamad , Amal Kentab , Malak Alghamdi
Background
Carbonic anhydrase type II deficiency (CAII-D) syndrome is a rare autosomal recessive genetic disorder characterized by osteopetrosis, renal tubular acidosis, and brain calcifications. Understanding the clinical and radiological features of CAII-D is key to effective management.
Aim
This study aimed to comprehensively analyze and measure intracranial parenchymal calcium score in pediatric CAII-D in relation to the severity of neurological clinical presentation.
Methods
A retrospective chart review at King Saud University Medical City included pediatric CAII-D patients diagnosed between June 2015 and December 2022. Study variables included age, gender, genetic results, developmental status, developmental quotient (DQ), CT findings, optic canal diameter, intracranial calcium score, and neuropsychiatric symptoms.
Results
Ten CAII-D patients, median age 10.5 years, were included. Most patients displayed homozygous pathogenic CA2 gene variants. For neurodevelopmental symptoms, 60.0 % of patients presented with global developmental delay, 20.0 % had intellectual disability, and the remaining 20.0 % had normal development. The median DQ score was 63.50, with 80.0 % categorized as delayed. Neuropsychiatric disorders were present in 20.0 %. Optic nerve atrophy was observed in 22.2 %, while brain calcifications were present in 70.0 % of cases. Correlation analysis revealed no significant associations between intracranial parenchymal calcium score and age, DQ score, or optic canal diameter. Neurodevelopmental symptoms, neuropsychiatric symptoms, and DQ were not associated with intracranial parenchymal calcium score.
Conclusion
Intraparenchymal calcifications in CAII-D are common but unrelated to developmental delay and neuropsychiatric symptoms, suggesting complex pathophysiology. Follow-up brain imaging may not aid in prognosis or severity assessment, highlighting the need for further research.
{"title":"The correlation of intracranial parenchymal calcium score and the severity of neurological clinical presentation in carbonic anhydrase deficiency type 2","authors":"Basma AlFaris , Fahad B. AlBader , Rawan AlSheikh , Fahad A. Bashiri , Muddathir H. Hamad , Amal Kentab , Malak Alghamdi","doi":"10.1016/j.braindev.2024.104309","DOIUrl":"10.1016/j.braindev.2024.104309","url":null,"abstract":"<div><h3>Background</h3><div>Carbonic anhydrase type II deficiency (CAII-D) syndrome is a rare autosomal recessive genetic disorder characterized by osteopetrosis, renal tubular acidosis, and brain calcifications. Understanding the clinical and radiological features of CAII-D is key to effective management.</div></div><div><h3>Aim</h3><div>This study aimed to comprehensively analyze and measure intracranial parenchymal calcium score in pediatric CAII-D in relation to the severity of neurological clinical presentation.</div></div><div><h3>Methods</h3><div>A retrospective chart review at King Saud University Medical City included pediatric CAII-D patients diagnosed between June 2015 and December 2022. Study variables included age, gender, genetic results, developmental status, developmental quotient (DQ), CT findings, optic canal diameter, intracranial calcium score, and neuropsychiatric symptoms.</div></div><div><h3>Results</h3><div>Ten CAII-D patients, median age 10.5 years, were included. Most patients displayed homozygous pathogenic <em>CA2</em> gene variants. For neurodevelopmental symptoms, 60.0 % of patients presented with global developmental delay, 20.0 % had intellectual disability, and the remaining 20.0 % had normal development. The median DQ score was 63.50, with 80.0 % categorized as delayed. Neuropsychiatric disorders were present in 20.0 %. Optic nerve atrophy was observed in 22.2 %, while brain calcifications were present in 70.0 % of cases. Correlation analysis revealed no significant associations between intracranial parenchymal calcium score and age, DQ score, or optic canal diameter. Neurodevelopmental symptoms, neuropsychiatric symptoms, and DQ were not associated with intracranial parenchymal calcium score.</div></div><div><h3>Conclusion</h3><div>Intraparenchymal calcifications in CAII-D are common but unrelated to developmental delay and neuropsychiatric symptoms, suggesting complex pathophysiology. Follow-up brain imaging may not aid in prognosis or severity assessment, highlighting the need for further research.</div></div>","PeriodicalId":56137,"journal":{"name":"Brain & Development","volume":"47 1","pages":"Article 104309"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to elucidate the distribution of intracranial gamma-aminobutyric acid (GABA) receptors in patients with infantile epileptic spasms syndrome (IESS) of normal brain MRI findings using 123I-iomazenil single-photon emission computed tomography (IMZ-SPECT).
Methods
This retrospective study compared IMZ-SPECT images from 20 patients with IESS of unknown etiology with normal brain MRI (unknown IESS group) and 23 patients with developmentally normal epilepsy of the same age (developmentally normal group). A three-dimensional stereotactic region of interest (ROI) template was used to divide the brain into 24 segments (left and right callosomarginal, precentral, central, parietal, angular, temporal, posterior cerebral, pericallosal, lenticular nucleus, thalamus, hippocampus, and cerebellum), and the mean accumulation of 123I-iomazenil in each ROI was calculated. The IMZ ratio for each ROI was calculated by dividing the ROI count by the mean cerebellar count of the left and right sides for the same patient. IMZ ratios for 22 ROIs, excluding the cerebellum, between the unknown IESS group and the developmentally normal group were compared.
Results
No significant differences were observed between the background characteristics of the unknown and developmentally normal groups. Hypsarrhythmia were observed in 16 patients in the IESS group. The IMZ ratio showed no significant differences between the two groups across all 22 ROIs.
Conclusion
The IMZ ratio of the unknown IESS group was not significantly different from that of the developmentally normal group across the 22 ROIs, suggesting that GABA receptor distribution has little effect on epileptic spasms and hypsarrhythmia, and vice versa.
{"title":"Quantitative analysis of 123I-iomazenil single-photon emission computed tomography findings from patients with infantile epileptic spasm syndrome","authors":"Hirokazu Takeuchi , Kenjiro Kikuchi , Rikako Takeda , Yuko Hirata , Ryuki Matsuura , Reiko Koichihara , Shin-ichiro Hamano","doi":"10.1016/j.braindev.2024.104314","DOIUrl":"10.1016/j.braindev.2024.104314","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to elucidate the distribution of intracranial gamma-aminobutyric acid (GABA) receptors in patients with infantile epileptic spasms syndrome (IESS) of normal brain MRI findings using <sup>123</sup>I-iomazenil single-photon emission computed tomography (IMZ-SPECT).</div></div><div><h3>Methods</h3><div>This retrospective study compared IMZ-SPECT images from 20 patients with IESS of unknown etiology with normal brain MRI (unknown IESS group) and 23 patients with developmentally normal epilepsy of the same age (developmentally normal group). A three-dimensional stereotactic region of interest (ROI) template was used to divide the brain into 24 segments (left and right callosomarginal, precentral, central, parietal, angular, temporal, posterior cerebral, pericallosal, lenticular nucleus, thalamus, hippocampus, and cerebellum), and the mean accumulation of <sup>123</sup>I-iomazenil in each ROI was calculated. The IMZ ratio for each ROI was calculated by dividing the ROI count by the mean cerebellar count of the left and right sides for the same patient. IMZ ratios for 22 ROIs, excluding the cerebellum, between the unknown IESS group and the developmentally normal group were compared.</div></div><div><h3>Results</h3><div>No significant differences were observed between the background characteristics of the unknown and developmentally normal groups. Hypsarrhythmia were observed in 16 patients in the IESS group. The IMZ ratio showed no significant differences between the two groups across all 22 ROIs.</div></div><div><h3>Conclusion</h3><div>The IMZ ratio of the unknown IESS group was not significantly different from that of the developmentally normal group across the 22 ROIs, suggesting that GABA receptor distribution has little effect on epileptic spasms and hypsarrhythmia, and vice versa.</div></div>","PeriodicalId":56137,"journal":{"name":"Brain & Development","volume":"47 1","pages":"Article 104314"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.braindev.2024.104308
Kher Hui Ng , Choong Yi Fong , Mohd Fazrul Shafiq Kamarudzaman , Wei Hong Lo , Farah Khalid , Lee Ai Chong
Objectives
Children with cerebral palsy (CP) can experience a substantial amount of pain. Effective pain management hinges on precise and prompt assessment. We designed a mobile-based application NeuroPAIN app to monitor pain among children with CP. NeuroPAIN app allowed parents to record pain symptoms, pain duration, and rate the perceived pain their child was facing. We evaluated the usefulness of NeuroPAIN app in pain recognition and monitoring among Malaysian parents of children with bilateral CP.
Method
Prospective cohort study of all parents of children with bilateral non-ambulant CP who owned Android devices. NeuroPAIN app was installed in all participants. At 3-month follow-up, data of the NeuroPAIN app was analyzed and participants were given a feedback questionnaire to complete.
Results
Total of 60 parents participated in the study (child's median age 7 years, interquartile range 4–8.75 years). The vast majority (95 %) of parents reported pain in their children. Children with assisted tube feeding was associated with reported increased pain frequency. Majority (77 %) felt it was easy to navigate the NeuroPAIN app. Two-thirds regularly tracked their child's pain using the app over a 2-month period. Parents of children with prolonged periods of pain ≥25 s were associated with reduced app usage.
Conclusion
Majority of Malaysian children with bilateral CP often experience pain particularly among those with assisted tube feeding highlighting the importance for clinicians to be vigilant in monitoring pain among these children. Prolonged pain periods among children with CP may lead to parental fatigue in monitoring pain through the NeuoPAIN app.
{"title":"NeuroPAIN app: Usefulness of a mobile pain application evaluation system for children with cerebral palsy","authors":"Kher Hui Ng , Choong Yi Fong , Mohd Fazrul Shafiq Kamarudzaman , Wei Hong Lo , Farah Khalid , Lee Ai Chong","doi":"10.1016/j.braindev.2024.104308","DOIUrl":"10.1016/j.braindev.2024.104308","url":null,"abstract":"<div><h3>Objectives</h3><div>Children with cerebral palsy (CP) can experience a substantial amount of pain. Effective pain management hinges on precise and prompt assessment. We designed a mobile-based application NeuroPAIN app to monitor pain among children with CP. NeuroPAIN app allowed parents to record pain symptoms, pain duration, and rate the perceived pain their child was facing. We evaluated the usefulness of NeuroPAIN app in pain recognition and monitoring among Malaysian parents of children with bilateral CP.</div></div><div><h3>Method</h3><div>Prospective cohort study of all parents of children with bilateral non-ambulant CP who owned Android devices. NeuroPAIN app was installed in all participants. At 3-month follow-up, data of the NeuroPAIN app was analyzed and participants were given a feedback questionnaire to complete.</div></div><div><h3>Results</h3><div>Total of 60 parents participated in the study (child's median age 7 years, interquartile range 4–8.75 years). The vast majority (95 %) of parents reported pain in their children. Children with assisted tube feeding was associated with reported increased pain frequency. Majority (77 %) felt it was easy to navigate the NeuroPAIN app. Two-thirds regularly tracked their child's pain using the app over a 2-month period. Parents of children with prolonged periods of pain ≥25 s were associated with reduced app usage.</div></div><div><h3>Conclusion</h3><div>Majority of Malaysian children with bilateral CP often experience pain particularly among those with assisted tube feeding highlighting the importance for clinicians to be vigilant in monitoring pain among these children. Prolonged pain periods among children with CP may lead to parental fatigue in monitoring pain through the NeuoPAIN app.</div></div>","PeriodicalId":56137,"journal":{"name":"Brain & Development","volume":"47 1","pages":"Article 104308"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.braindev.2025.104322
Sergiusz Jóźwiak , Paolo Curatolo , Katarzyna Kotulska
Tuberous sclerosis complex (TSC) is classified among developmental epileptic encephalopathies, where epilepsy is often associated with comorbidities such as intellectual disability and autistic behavior. The recently introduced term TAND (TSC-associated neuropsychiatric disorders) encompasses the wide range of cognitive, behavioral, psychiatric, and psychosocial manifestations seen in TSC. The severity of these comorbidities is influenced by several factors, including the TSC1/TSC2 genotype, the age of epilepsy onset, the number, volume and type of cortical tubers, the interval between epilepsy onset and treatment initiation, and the presence of infantile spasms, hypsarrhythmia, or drug-resistant epilepsy. Clinical, genetic, EEG, and neuroimaging biomarkers enable the early identification of infants at high risk of developing intellectual disability or autism spectrum disorder. Early preventive intervention targeting seizures and tailored strategies during a sensitive developmental window may modify these contributing factors, leading to improved neurodevelopmental outcomes in infants with TSC.
{"title":"Intellectual disability and autistic behavior and their modifying factors in children with tuberous sclerosis complex","authors":"Sergiusz Jóźwiak , Paolo Curatolo , Katarzyna Kotulska","doi":"10.1016/j.braindev.2025.104322","DOIUrl":"10.1016/j.braindev.2025.104322","url":null,"abstract":"<div><div>Tuberous sclerosis complex (TSC) is classified among developmental epileptic encephalopathies, where epilepsy is often associated with comorbidities such as intellectual disability and autistic behavior. The recently introduced term TAND (TSC-associated neuropsychiatric disorders) encompasses the wide range of cognitive, behavioral, psychiatric, and psychosocial manifestations seen in TSC. The severity of these comorbidities is influenced by several factors, including the TSC1/TSC2 genotype, the age of epilepsy onset, the number, volume and type of cortical tubers, the interval between epilepsy onset and treatment initiation, and the presence of infantile spasms, hypsarrhythmia, or drug-resistant epilepsy. Clinical, genetic, EEG, and neuroimaging biomarkers enable the early identification of infants at high risk of developing intellectual disability or autism spectrum disorder. Early preventive intervention targeting seizures and tailored strategies during a sensitive developmental window may modify these contributing factors, leading to improved neurodevelopmental outcomes in infants with TSC.</div></div>","PeriodicalId":56137,"journal":{"name":"Brain & Development","volume":"47 2","pages":"Article 104322"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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