Diagnoses of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are increasingly being made in adulthood. However, assessments can fail to address the diverse range of problems that patients have experienced. The current study applied an early symptomatic syndromes eliciting neurodevelopmental clinical examinations (ESSENCE) framework to explore retrospectively reported childhood developmental and behavioral problems. It examined if adult ASD and ADHD patients would show problems outside those reflected in the respective diagnostic criteria, and also if these patient groups would show more extensive childhood problems than other psychiatric patients. Parents of adults with ADHD (n = 130), ASD (n = 57), coexisting ADHD and ASD (n = 38), and other psychiatric disorders (n = 56) reported on a range of childhood problems. Descriptions of the ADHD, ASD, and ADHD+ASD groups reflected greater impairment than descriptions for patients with other psychiatric disorders in most problem areas. Although differences were observed between ADHD and ASD patients in the core diagnostic areas, these syndromes also shared a number of childhood difficulties. The ESSENCE approach can assist in understanding the symptom history of adult ADHD and ASD patients and can be helpful to distinguish their childhood experiences from other psychiatric patients' experiences.
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Cites: J Am Acad Child Adolesc Psychiatry. 2012 Jan;51(1):28-40.e322176937
Comparison of conventional and non-invasive techniques for the early identification of diabetic neuropathy in children and adolescents with type 1 diabetes.
Neuropathy is an important complication and contributes to the morbidity of diabetes mellitus. The availability of simple and non-invasive tests for screening of early diabetic neuropathy (DN) in children with diabetes may prevent further progression of this complication. The purpose of this study was to compare conventional nerve conduction studies (NCS) with non-invasive techniques, including vibration perception thresholds (VPT) and tactile perception thresholds (TPT) for the detection of DN in children and adolescents with type 1 diabetes.
Children from the Alberta Children's Hospital Diabetes Clinic with at least 5 yr duration of type 1 diabetes underwent detailed evaluations, including neurologic exam, NCS, VPT, and TPT testing. Information on duration of diabetes, height, and mean glycosylated hemoglobin (A1C) were also collected. Descriptive statistics, including Student's t-test and chi-squared test, were used for analysis.
Seventy-three children (mean age of 13.7+/-2.6 yr) completed the study. The mean duration of diabetes was 8.1+/-2.6 yr, and the mean A1C was 9.0+/-1.0%. Forty-two (57%) children had DN based on NCS. Using NCS as a gold standard, the sensitivity and specificity of VPT were 62 and 65%, while the sensitivity and specificity of TPT were 19 and 64%, respectively.
Subclinical DN is common among children and adolescents with type 1 diabetes, and there is a need for better metabolic control in this population. VPT and TPT may not be adequate screening tools for the detection of DN in children.
Currently available methods for diagnosis of chronic mercury intoxication (CMI) are applied at the any stage of the disease. Changes in these indices sometimes have no the specificity for any CMI stage, and a conclusion on them has the descriptive character. In addition, the above mentioned methods possess not sufficiently high accuracy in the diagnosis of intoxication at early stages of the development of the disease. The purpose of the research is the development of the method permitting to make the differential diagnosis between the initial symptoms of mercury poisoning and its first degree. 118 men who work/worked in the contact with mercury vapor were examined. There were evaluated electroencephalogram, long-latency auditory and cognitive evoked potentials, cerebral hemodynamics, noradrenaline (NA)content in the blood plasma. Statistical processing was performed with the use of «Statistica 6.0» software. The levels of NA in the development of CMI were shown to increase, by the time of the shaping of this disease the noted change was decompensated in the nature. The study of reactivity of cerebral vessels revealed the presence of abnormal responses during hypercapnic load in 14 - 24% of examined cases. In the analysis of auditory evoked potentials there was established the change in indices of latency and amplitude of the V- wave, which pronounced in the prolong response time, significant elongation in the P1 peak latency and the gain in the latency of N1 peak. There was established the presence of the wave-like change in the index of the latency of P300. In workers without an occupational disease, there was noted the marked elongation of the latent period of cognitive potential, while in patients with the newly made diagnosis the latency of P300 corresponded to standard values, and in the long term there was observed a sharp deterioration in this index. With the aid of the discriminant analysis with the calculation of canonical value there were revealed the most informative neurobiochemical indices, reoencephalogric ones and evoked potentials. The developed method of diagnosis allows to distinguish between the initial symptoms of mercury intoxication and the first stage of the disease.
To measure the effect of age on Multiple Sleep Latency Test (MSLT)characteristics, sleep latency, and number of sleep-onset REM periods (SOREMP) in two large populations of narcoleptic patients with similar genetic backgrounds.
Clinical and polygraphic information on the severity of the condition was obtained on 236 well-defined narcolepsy-cataplexy-human leukocyte antigen DR2-positive patients from Montpellier (France) and on 147 similar patients from Montreal (Canada).
The results show a progressive decrease in the number of SOREMP with age and a progressive increase in the mean sleep latency on the MSLT as a function of age. This finding is also related to the severity of cataplexy as assessed from the clinical history with a progressive decrease in the frequency of cataplexy attacks with age. These results may reflect the progressive increase in sleep latency seen in normal aging and suggest that clinical improvement might be due to changes in the neural mechanisms responsible for SOREMP, which may weaken with age.
The progressive decrease in the number of SOREMP and increase in the mean sleep latency on the MSLT as a function of age suggest that the current criteria used for diagnosis may be too stringent in older patients. The major influence of age on MSLT results should therefore be taken into account when diagnosing a narcoleptic patient.
Neurosurgery is one of the most dynamic and fast-developing medical sciences aimed at studying a wide range of diseases and lesions of the nervous system with constant improvement of methods of their diagnosis and surgical treatment. With the routine clinical use of computed tomography, positron emission tomography, magnetic resonance imaging the possibilities of revealing structural, metabolic and functional changes in the brain in different types of pathology have significantly enlarged. Today, methods of neurovisualization are widely used for preoperative modeling and intraoperative navigation. Also, these methods permit to study the fundamental aspects of brain functioning in health and pathology at the organ, tissue, cellular and molecular levels. In the last decades, the spectrum of neurosurgical methods including microsurgical, endoscopic, stereotactic, radiosurgical, reconstructive and other technologies was extended and diver-
The first data illustrating work efficiency of health centres in this country are presented. They suggest the necessity to change both the strategy of activities and the patient population. Studies on variability of cardiac rhythms and characteristics of vegetative status in adolescents showed that the equipment used is poorly adapted to the purpose.
Section for Neurosurgery, Department of Surgical Sciences, University of Bergen, and Haukeland University Hospital, Bergen, Norway. chhe@helse-bergen.no
We have gradually adopted a liberal attitude towards surgical decompression of arachnoid cysts. This study describes the results from our institution.
Long term clinical and neuroimaging results of 156 adult patients (aged > or = 16 years) operated on for arachnoid cysts in our department during the period January 1987 to September 2004 were assessed based on their medical and neuroimaging records, and on a questionnaire.
The clinical and/or neuroimaging results indicated that the cyst was successfully decompressed in all patients. 82% of patients were asymptomatic or had insignificant complaints at follow-up. 12% reported no symptom relief whereas 6% experienced worsening of symptoms. The cyst disappeared after surgery, or was reduced to
Stroke severity is an important determinant of outcome, however, quantitative data on the initial neurological status might be lacking in retrospective studies. We wanted to assess the reliability and validity of the retrospective use of the Canadian Neurological Scale (CNS).
In 181 patients with validated stroke, two raters scored the CNS based on medical record review. We assessed interrater reliability and construct validity of the CNS. Predictive validity was assessed by the ability of the CNS to predict 30-day and 1-year mortality.
Interrater reliability was high (kappa or weighted kappa 0.76-0.96). Correlations between similar items of prospective Scandinavian Stroke Scale scores and retrospective CNS scores ranged from 0.54 to 0.85. CNS total score was a strong predictor of death within 30 days and 1 year in multivariate models.
The retrospective algorithm for the CNS had a high to substantial interrater reliability and predictive validity. Accordingly, in retrospective stroke studies using medical record information, the CNS can be a feasible instrument to adjust for differences in stroke severity.
