Motor coordination and mental health in extremely low birth weight survivors during the first four decades of life

The co-morbidity of motor coordination and mental health problems is an increasing concern. While links between poor motor coordination and mental health have been examined extensively in individuals born at normal birth weight (NBW; >2500 g), relatively little research has examined these associations in special populations, particularly those born at extremely low birth weight (ELBW; <1000 g). In this study, we examined whether birth weight status (ELBW vs. NBW) moderated associations between motor coordination problems and levels of mental health problems from childhood into the fourth decade of life. The present study utilized the oldest known prospectively followed, population-based cohort of ELBW survivors (n = 151). This group was born between 1977 and 1982 in Ontario, Canada and was compared to a matched group of NBW controls (n = 145). Mental health problems were measured at age 8 using parent and teacher reports, and at age 22–26 and 29–36 using self-reports. Childhood motor coordination was retrospectively reported at age 29–36. In both ELBW and NBW groups, childhood coordination problems were associated with elevated levels of inattention and symptoms of anxiety and depression. However, we observed stronger associations between childhood motor coordination problems and mental health problems in NBW controls at 22–26 and 29–36 years of age than in ELBW survivors. Our findings highlight the importance of recognizing and screening for motor coordination problems not only in vulnerable, at-risk children, but in all children, as motor difficulties appear to be associated with mental health problems well into adult life.     

EEG functional connectivity in term age extremely low birth weight infants

ObjectiveThe hypothesis is tested that electrocortical functional connectivity (quantified by coherence) of extremely low birth weight (ELBW) infants, measured at term post-menstrual age, has regional differences from that of full term infants.Methods128 lead EEG data were collected during sleep from 8 ELBW infants with normal head ultrasound exams and 8 typically developing full term infants. Regional spectral power and coherence were calculated.ResultsNo significant regional differences in EEG power were found between infant groups. However, compared to term infants, ELBW infants had significantly reduced interhemispheric coherence (in frontal polar and parietal regions) and intrahemispheric coherence (between frontal polar and parieto-occipital regions) in the 1–12 Hz band but increased interhemispheric coherence between occipital regions in the 24–50 Hz band.ConclusionsELBW infants at term post-menstrual age manifest regional differences in EEG functional connectivity as compared to term infants.SignificanceDistinctive spatial patterns of electrocortical synchrony are found in ELBW infants. These regional patterns may presage regional alterations in the structure of the cortex.     

Psychiatric disorders in low birthweight young adults. Prevalence and association with assessments at 11 years

ObjectiveTo compare mental health of 136 young adults without neurosensory handicaps born with low birthweight (LBW, birthweight less than 2000 g) with 132 adults with normal birthweight (NBW).MethodA cohort of moderate LBW and NBW young adults were assessed with the Mini-International Neuropsychiatric Interview (MINI) at 19 years and the Children Assessment Schedule (CAS) at 11 years of age.ResultsAt 19 years of age, 44 out of 136 (32%) LBW young adults were diagnosed with a psychiatric disorder compared to 10% NBW (OR: 2.8; 95% CI: 1.1, 4.5, P = 0.02). Among the LBW young adults, affective-, anxiety-, ADHD- and antisocial personality disorders were most common, and nine subjects (20%) had more than one diagnosis. Of 97 LBW subjects examined both at 11 and 19 years of age, 54 (56%) were mentally healthy though out adolescence. This was half as many as for controls (OR: 0.6; 95% CI: 0.3 to 0.9).ConclusionModerate LBW was associated with an increased risk of psychiatric disorders in young adulthood. Only half of LBW young adults stayed healthy throughout adolescence.     

Motor functioning,exploration, visuospatial cognition and language development in preschool children with autism

In order to understand typical and atypical developmental trajectories it is important to assess how strengths or weaknesses in one domain may be affecting performance in other domains. This study examined longitudinal relations between early fine motor functioning, visuospatial cognition, exploration, and language development in preschool children with ASD and children with other developmental delays/disorders. The ASD group included 63 children at T1 (Mage = 27.10 months, SD = 8.71) and 46 children at T2 (Mage = 45.85 months, SD = 7.16). The DD group consisted of 269 children at T1 (Mage = 17.99 months, SD = 5.59), and 121 children at T2 (Mage = 43.51 months, SD = 3.81). A subgroup nested within the total sample was randomly selected and studied in-depth on exploratory behavior. This group consisted of 50 children, 21 children with ASD (Mage = 27.57, SD = 7.09) and 29 children with DD (Mage = 24.03 months, SD = 6.42). Fine motor functioning predicted language in both groups. Fine motor functioning was related to visuospatial cognition in both groups and related to object exploration, spatial exploration, and social orientation during exploration only in the ASD group. Visuospatial cognition and all exploration measures were related to both receptive and expressive language in both groups. The findings are in line with the embodied cognition theory, which suggests that cognition emerges from and is grounded in the bodily interactions of an agent with the environment. This study emphasizes the need for researchers and clinicians to consider cognition as emergent from multiple interacting systems.     

Double peaked P1 visual evoked potentials in healthy ageing

ObjectivesTo robustly examine the prevalence of the double peaked P1 visual evoked potential in healthy younger and older adult populations.MethodsThe evoked potentials and spectral power changes to simple visual stimuli of 26 healthy younger (M = 20.0 y) and 26 healthy older adults (M = 76.0 y) were examined.ResultsGroup and individual analyses showed a clear effect of age on P1 morphology and amplitude. Older adults showed significantly lower P1 amplitude and 44% of older adults showed a double peaked P1 compared to 12% of younger adults. Double peaked P1 responses were associated with an increase in spectral power in the gamma range.ConclusionsThe double peaked P1 may be more prevalent in older adults than previously demonstrated and may represent a de-synchronisation of the cortical sources of the visual P1 in healthy ageing. Increased power in post stimulus gamma in the double peak group may be indicative of compensatory neural processing.SignificanceClinically the prevalence of the double peaked P1 may have been underestimated, and its reflectance of demyelinating disease overestimated. Experimentally the results suggest that any investigation of visual processing in older adults must control for early changes in P1 morphology.     

Residual alterations of brain electrical activity in clinically asymptomatic concussed individuals: An EEG study

ObjectiveTo examine the neural substrates underlying performance on Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and HeadRehab Virtual Reality (VR) balance and spatial modules in a concussed and control group.MethodsThirteen controls and seven concussed participants were fitted with a Geodesic 128-channel EEG cap and completed three assessments: EEG baseline, ImPACT testing, and VR balance and spatial modules. Concussed participants completed were tested within 8 (5 ± 1) days after injury.ResultsEEG power was significantly (p < .05) decreased in the concussed group over all testing modalities. EEG coherence was significantly (p < .05) increased in the concussed group during EEG baseline and ImPACT. For VR testing, two conditions showed significant (p < .05) increases in EEG coherence between ROIs, while two different conditions showed significant (p < .05) decreases in coherence levels.ConclusionsConcussed participants passed all clinical concussion testing tools, but showed pathophysiological dysfunction when evaluating EEG variables.SignificanceConcussed participants are able to compensate and achieve normal functioning due to recruiting additional brain networks. This allows concussed participants to pass clinical tests while still displaying electrophysiological deficits and clinicians must consider this information when making return-to-play decisions.     

Spectral analysis of the sleep onset period in primary insomnia

ObjectiveTo compare the EEG power spectra characteristics of the sleep onset period (SOP) in patients with sleep onset insomnia (SOI), sleep maintenance insomnia (SMI) and good sleepers (GS).MethodsThe time course of EEG power density (1–40 Hz) during the SOP was examined in thirty subjects (SOI patients: N = 10, SMI patients: N = 10, GS: N = 10).ResultsThe EEG power of the beta2 frequency band (18–29.75 Hz) was significantly lower in SOI than in SMI in the period preceding sleep onset. The alpha power was significantly higher for the SMI group compared to GS before sleep onset. Despite the lack of statistical significance, several differences in EEG dynamics were observed in SOI compared to two other groups: delta power increased slower after sleep onset; beta2 and 3 (18–29.75 and 30–39.75 Hz) power decrease less abruptly before sleep onset; beta1 (15–17.75 Hz) power increase through the whole SOP.ConclusionsThe lower level of beta2 frequency band in SOI and the differences in dynamics in delta and beta bands may suggest that a mechanism other than hyperarousal participates in etiology of SOI.SignificanceSOI and SMI patients have different spectral characteristics in SOP, thus future studies should avoid the inclusion of mixed insomnia samples.     

First empirical evaluation of the link between attachment,social cognition and borderline features in adolescents

ObjectiveSeveral developmental models of borderline personality disorder (BPD) emphasize the role of disrupted interpersonal relationships or insecure attachment. As yet, attachment quality and the mechanisms by which insecure attachment relates to borderline features in adolescents have not been investigated. In this study, we used a multiple mediational approach to examine the cross-sectional interplay between attachment, social cognition (in particular hypermentalizing), emotion dysregulation, and borderline features in adolescence, controlling for internalizing and externalizing symptoms.MethodsThe sample included 259 consecutive admissions to an adolescent inpatient unit (M_age = 15.42, SD = 1.43; 63.1% female). The Child Attachment Interview (CAI) was used to obtain a dimensional index of overall coherence of the attachment narrative. An experimental task was used to assess hypermentalizing, alongside self-report measures of emotion dyregulation and BPD.ResultsOur findings suggested that, in a multiple mediation model, hypermentalizing and emotion dysregulation together mediated the relation between attachment coherence and borderline features, but that this effect was driven by hypermentalizing; that is, emotion dysregulation failed to mediate the link between attachment coherence and borderline features while hypermentalizing demonstrated mediational effects.ConclusionsThe study provides the first empirical evidence of well-established theoretical approaches to the development of BPD.     

Maturational changes of neonatal electroencephalogram: A comparison between intra uterine and extra uterine development

ObjectivesTo evaluate electroencephalogram (EEG) patterns in very low birth weight premature newborns when reaching term-to-term neonates, thereby comparing extra uterine to intra uterine development.MethodsEEG recordings were obtained between 2 and 14 days of life in 47 preterm (<37 weeks) very low birth weight (⩽1500 g) newborns and repeated when reaching term age (38–42 weeks) in a subsample (n = 22). EEG recordings were also obtained in term newborns. Clinical evaluation was performed at birth and at 6 and 12 months.ResultsRelative to the first EEG, preterm newborns showed a reduction in delta brushes and interburst intervals and increased interhemispheric synchrony, suggesting an improvement in EEG maturation. Further organization in sleep patterns, like a reduction in total sleep time and phase shifts, were also observed. However, when reaching term, preterm newborns still had less mature EEG patterns, phase shifts and transitional sleep than matched controls. Background abnormalities and dysmaturity in preterm newborns during the first EEG predicted adverse neurological outcome later on.ConclusionsEEG patterns in preterm very low birth weight newborns might be influenced by extra uterine development. Specific EEG abnormalities are related to increased risk of neurological disorders.SignificanceExtra uterine development of very low birth weight delays the acquisition of maturational EEG patterns.     

La dépression en refrain… Entre évaluations de dispositifs musicothérapiques et vécus émotionnels : une proposition intégrative

ObjectivesFew integrative and controlled researches have studied the impact of music-therapy (receptive, active, creative) in response to depressive symptomatology. The aims of this exploratory study are to assess quantitatively and qualitatively the mindfulness, the defensive functioning, the severity of depression, the alexithymic degree, the body distortion, the temporality, the creativity before, after and long after the participation in music-therapy workshops. The patient's experience is also noticed during these workshops, after and one month after all sessions.Patients and methodsEighty-four (male and female) have been integrated in the research. Hospitalized in a psychiatric hospital and clinic in Occitanie, 29 subjects participated in the active and creative workshop ((M_age = 52.70 ; ET = 18.60), 28 in the receptive and creative workshop (M_age = 52.00; ET = 12.70), and 27 in the usual care (M_age = 48.10; ET = 13.00). Each completed the Five Facets Mindfulness Questionnaire, the Defense Style Questionnaire, the Beck Depression Inventory, the Bermond-Vorst Alexithymia Questionnaire, and the Body Distortion Questionnaire. The two music-therapy groups also answered to the Clinical Scales of Mediatized Therapies.ResultsThe statistical analysis suggests significant differences between pre and post-test in connection with qualitative data. Improvements have been found at the different levels (mindfulness, defenses, severity of depression, emotions, affects, body distortion, temporality, creativity).ConclusionsA composite music-therapy device, addressed to caregivers, is developed at the end of this work. However, the positive impact of the workshops should be confirmed by research studying a larger sample.     

Lien entre usage des réseaux sociaux et image corporelle chez les adolescents : une revue systématique de la littérature

ObjectivesThis study aimed to update the scientific knowledge concerning the relationship between the use of social networking sites and body image among adolescents.MethodsA preregistered systematic review was conducted following PRISMA guidelines and allowed to include 30 peer-reviewed articles for qualitative analysis, consisting of 26 unique samples (n = 31,331; M_age = 14.89; SD_age = 1.07). The search was conducted on Pubmed, PsychInfo and Scopus focusing on studies that included any social network site use and body image measures while being based on general population adolescent samples. Social networking site use referred: 1) to any online activities such as browsing, posting, editing selfies, liking, commenting; 2) to any exposure to appearance-related content; or 3) to a measure of frequency use. The scope of social networking sites considered in the present review was extended to online video-sharing platforms and online dating applications due to their relationship with appearance. Body image as considered through MeSH terms referred to a wide range of possible outcomes including body and facial dissatisfaction, dysmorphophobia, body surveillance, self-objectification, body shame, weight concerns, self-monitoring. Any mental health outcome was extracted when available although its absence was not an exclusion criterion..ResultsAmong the 30 studies included in the review, 22 were cross-sectional, seven were longitudinal and one had an experimental design. Overall, among studies based on unique samples, 18 studies included both males and females (n = 28,081; M_age 14.84; SD_age = 1.06), seven were based exclusively on female samples (n = 2,507; M_age 14.87; SD_age = 1.19), while one study recruited only male adolescents (n = 743; M_age 15.90; SD_age = 0.54). Only six studies were based on representative samples. These studies reported a robust association between frequency of social networking site use and negative body image among both females and males. In addition, exposure to appearance-related content was also deleterious to body image. The association between the use of social media and negative body image may involve negative mental health outcomes, such as depressive symptoms, low body esteem and problematic use of social media. Measuring specific activities on social network sites or exposure to appearance-related content (e.g. selfies editing; selfies posting) may be more accurate than using a frequency of overall use (e.g. during the past month) when predicting body image. Studies addressing underlying processes supported that the relationship between use of social media and body image may not be direct but rather involve intermediary steps on both cognitive and social levels, namely internalization of the thin ideal, self-objectification, peer appearance-related feedback, ascendant social comparison with peers and celebrities. Also, it remains unclear whether mental health mediates this relationship.ConclusionsThe association between the use of social networking sites and negative body image is robustly supported in the literature. However, studies measuring frequency of overall use may instead be predicting negative body image with a nested measure of the use of social network sites, namely specific activities involving appearance-related content. Due to the observed discrepancies between self-reported frequency of social networking site use and actual use in methodological literature, future research may rather measure behaviors commonly encountered on a given platform. Furthermore, there is a need to distinguish specific site categories such as highly visual social media when focusing on body image outcomes. . Focusing on specific social media platforms may in turn lead to more targeted prevention regarding a safe utilization of social networking sites among adolescents. Despite the growing body of research concerning the association between social media and body image, the current review underlines that additional longitudinal and experimental studies are needed to investigate potential bidirectional effects, as well as studies based on representative samples to improve generalization to adolescent populations.     

Frontal EEG asymmetry in extremely low birth weight adult survivors: Links to antenatal corticosteroid exposure and psychopathology

Objective

Extremely low birth weight (ELBW; <1000?g) survivors are exposed to significant perinatal adversity. In many cases, mothers of these infants receive antenatal corticosteroids (ACS), which reduce offspring neonatal mortality but may have lasting neuropsychiatric effects. However, the long-term neurophysiological effects of being born at ELBW and exposed to ACS are unknown.

Executive function and attention in young adults with and without Developmental Coordination Disorder – A comparative study

The current research aimed at examining the executive function (EF) of young adults with Developmental Coordination Disorder (DCD) in comparison to young adults without DCD. The study used a randomized cohort (N = 429) of young adults with DCD (n = 135), borderline DCD (n = 149) and control (n = 145), from a previous study. This initial cohort was asked to participate in the current study three to four years later. Twenty-five individuals with DCD (mean age = 24 years, 1 month [SD = 0.88]; 18 males), 30 with borderline DCD (mean age = 24 years, 2 month [SD = 0.98]; 18 males) and 41 without DCD (mean age = 25 years, 2 months [SD = 1.91]; 20 males) participated in this study. Participants completed the BRIEF-A questionnaire, assessing EF abilities and the WURS questionnaire, assessing attention abilities. The DCD and borderline DCD groups had significantly lower EF profiles in comparison with the control group but no significant differences were found between the DCD and borderline DCD groups. While a high percentage of attention problems were found in both DCD groups, the executive functioning profiles remained consistent even when using the attention component as a covariate. The study results suggest that young adults with DCD have EF problems which remain consistent with or without attention difficulties.     

Self-rated health and interleukin-6: Longitudinal relationships in older adults

BackgroundBoth self-rated health (SRH) and inflammation are implicated in chronic diseases and premature mortality. Better SRH is associated with lower proinflammatory cytokines, but there is little evidence about whether this relationship is more stable or dynamic.ObjectiveTo study the between- and within-person associations between SRH and IL-6.MethodsOlder adults (N = 131; M_age = 75 years) rated their health and provided blood samples for analysis of IL-6 at separate occasions every 6 months over a period up to 5 years. Age, sex, BMI, neuroticism, and statin use were examined as covariates in multilevel models.ResultsIn bivariate models, better SRH, lower BMI, younger age, and female sex correlated with lower IL-6. In multilevel models, stable SRH (between-person differences; p < .001) but not dynamic SRH (within-person changes; p = .93) correlated with IL-6. The stable relationship persisted with demographic and health covariates in the model.ConclusionsBetter stable SRH but not dynamic SRH was robustly associated with lower IL-6 among older adults, lending support to previous cross-sectional findings on the relation between inflammatory markers and SRH. The findings suggest that trait-like mechanisms, rather than changes over a time scale of 6-month waves, govern this association. To further investigate the mechanisms behind the SRH–IL-6 association, studies with different measurement frequencies, higher within-person variability, and experimental approaches are warranted.     

Connectivity biomarkers can differentiate patients with different levels of consciousness

ObjectiveIn the present study, we searched for resting-EEG biomarkers that distinguish different levels of consciousness on a single subject level with an accuracy that is significantly above chance.MethodsWe assessed 44 biomarkers extracted from the resting EEG with respect to their discriminative value between groups of minimally conscious (MCS, N = 22) patients, vegetative state patients (VS, N = 27), and – for a proof of concept – healthy participants (N = 23). We applied classification with support vector machines.ResultsPartial coherence, directed transfer function, and generalized partial directed coherence yielded accuracies that were significantly above chance for the group distinction of MCS vs. VS (.88, .80, and .78, respectively), as well as healthy participants vs. MCS (.96, .87, and .93, respectively) and VS (.98, .84, and .96, respectively) patients.ConclusionsThe concept of connectivity is crucial for determining the level of consciousness, supporting the view that assessing brain networks in the resting state is the golden way to examine brain functions such as consciousness.SignificanceThe present results directly show that it is possible to distinguish patients with different levels of consciousness on the basis of resting-state EEG.     

EEG in the healthy term newborn within 12 hours of birth

ObjectiveTo characterise and quantify the EEG during sleep in healthy newborns in the early newborn period.MethodsContinuous multi-channel video-EEG data was recorded for up to 2 hours in normal newborns within 12 hours of birth. The total amount of active (AS) and quiet sleep (QS) was calculated in the first hour of recording. The EEG signal was quantitatively analysed for symmetry and synchrony. Spectral edge frequency (SEF), spectral entropy (H) and relative delta power (δ_R) were calculated for a ten-minute segment of AS and QS in each recording. Paired t-test and Wilcoxon rank sum test were used for data analysis.ResultsThirty normal newborn babies were studied, 10 within 6 hours of birth and 20 between 6 and 12 hours. All babies showed continuous symmetrical and synchronous EEG activity and well-developed sleep–wake cycling (SWC) with the median percentage of AS – 48.5% and QS – 36.6%. Quantitative EEG analysis of sleep epochs showed that SEF and H were significantly higher (p < 0.0001) and δ_R was significantly lower (p < 0.0001) in AS than in QS.ConclusionThe normal newborn EEG shows symmetrical and synchronous continuous activity and well-developed SWC as early as within the first 6 hours of birth. Quantitative analysis of the EEG in the early postnatal period reveals differences in SEF, H and δ_R for AS and QS periods.SignificanceThese findings may have implications for quantitative analysis of the newborn EEG, including the EEG of babies with hypoxic ischaemic encephalopathy.     

Positive occipital sharp transients of sleep (POSTS): A reappraisal

ObjectivePositive occipital sharp transients of sleep (POSTS) are considered a normal variant seen in non-REM sleep; their asymmetrical presentation and relationship with EEG abnormalities have received scarce attention to date. We analyzed these features in a large prospective EEG recordings’ sample.MethodsIn this case-control study, over 6 months we collected consecutive patients showing POSTS on their EEG. They were matched with consecutive control subjects (two for each). Demographical data, asymmetries for POSTS and alpha activity, and lateralized or diffuse occurrence of EEG abnormalities (slowing, epileptiform transients) were compared among these two groups.ResultsOut of 1254 EEG studies, 102 (8%) patients showed POSTS. They were younger (p = 0.031), and more likely to show EEG abnormalities (p = 0.008) – including epileptiform transients (p = 0.002) – than controls. However, this relationship was influenced by age and recording length. Thirty nine POSTS recordings (38%) had a consistent amplitude asymmetry, but this was not associated with specific EEG abnormalities or alpha asymmetry.ConclusionPOSTS are a normal EEG variant, occurring in less than 10% of unselected EEG recordings, mostly in younger adults, without gender predominance. Amplitude asymmetries are found in over one third of subjects.SignificancePOSTS asymmetry, as opposed to other sleep transients, should be considered as normal.     

Early screening and identification of psychological comorbidities in pediatric epilepsy is necessary

Youth with epilepsy often have co-occurring psychological symptoms that are due to underlying brain pathology, seizures, and/or antiepileptic drug side effects. The primary study aim was to compare the psychological comorbidities of youth with new-onset epilepsy versus chronic epilepsy. Primary caregivers of youth with either new-onset (n = 82; M_age = 9.9 ± 2.9) or chronic epilepsy (n = 76; M_age = 12.8 ± 3.3) completed the Behavioral Assessment Scale for Children—2nd Edition. Compared to those with new-onset epilepsy, the chronic group had significantly higher depressive and withdrawal symptoms, as well as lower activities of daily living. A higher proportion of youth with chronic epilepsy exhibited at-risk/clinically elevated depressive symptoms and difficulties with activities of daily living compared to the new-onset group. Proactive screening in youth with epilepsy to ensure timely identification of psychological symptoms and to guide early psychological intervention is warranted.     

Prediction of rhythmic and periodic EEG patterns and seizures on continuous EEG with early epileptiform discharges

BackgroundContinuous EEG (cEEG) is necessary to document nonconvulsive seizures (NCS), nonconvulsive status epilepticus (NCSE), as well as rhythmic and periodic EEG patterns of ‘ictal–interictal uncertainty’ (RPPIIU) including periodic discharges, rhythmic delta activity, and spike-and-wave complexes in neurological intensive care patients. However, cEEG is associated with significant recording and analysis efforts. Therefore, predictors from short-term routine EEG with a reasonably high yield are urgently needed in order to select patients for evaluation with cEEG.ObjectiveThe aim of this study was to assess the prognostic significance of early epileptiform discharges (i.e., within the first 30 min of EEG recording) on the following: (1) incidence of ictal EEG patterns and RPPIIU on subsequent cEEG, (2) occurrence of acute convulsive seizures during the ICU stay, and (3) functional outcome after 6 months of follow-up.MethodsWe conducted a separate analysis of the first 30 min and the remaining segments of prospective cEEG recordings according to the ACNS Standardized Critical Care EEG Terminology as well as NCS criteria and review of clinical data of 32 neurological critical care patients.ResultsIn 17 patients with epileptiform discharges within the first 30 min of EEG (group 1), electrographic seizures were observed in 23.5% (n = 4), rhythmic or periodic EEG patterns of ‘ictal–interictal uncertainty’ in 64.7% (n = 11), and neither electrographic seizures nor RPPIIU in 11.8% (n = 2). In 15 patients with no epileptiform discharges in the first 30 min of EEG (group 2), no electrographic seizures were recorded on subsequent cEEG, RPPIIU were seen in 26.7% (n = 4), and neither electrographic seizures nor RPPIIU in 73.3% (n = 11). The incidence of EEG patterns on cEEG was significantly different between the two groups (p = 0.008). Patients with early epileptiform discharges developed acute seizures more frequently than patients without early epileptiform discharges (p = 0.009). Finally, functional outcome six months after discharge was significantly worse in patients with early epileptiform discharges (p = 0.01).ConclusionsEpileptiform discharges within the first 30 min of EEG recording are predictive for the occurrence of ictal EEG patterns and for RPPIIU on subsequent cEEG, for acute convulsive seizures during the ICU stay, and for a worse functional outcome after 6 months of follow-up.This article is part of a Special Issue entitled Status Epilepticus.     

EEG features and epilepsy in MECP2-mutated patients with the Zappella variant of Rett syndrome

ObjectiveTo assess the presence/absence of peculiar EEG features and epilepsy in MECP2-mutated Rett patients with the Zappella–Rett variant (Z-RTT) also known as preserved speech variant.MethodsRetrospective analysis of 16 (age 19.4 ± 8.4 years; range 8–38 years) MECP2 mutated Z-RTT cases, including 11 high or intermediate performance (HIP), and five low-performance (LP) patients was performed. Peculiar EEG features were analyzed as a function of the HIP or LP Z-RTT categories: (1) centro-temporal spikes, (2) multifocal EEG activity, (3) EEG encephalopathy (i.e. multifocal EEG activity associated with the presence of background slowing and diffuse slow activity), (4) spindles and K-complex. Furthermore, we assessed the occurrence of epilepsy.Correlations between electroclinical features and category of Z-RTT genotype (missense or truncation mutation) were also tested.ResultsThe Z-RTT HIP group showed a very abnormal EEG (presence of centro-temporal spikes: p = 0.004808), although the cases studied were not epileptogenic and did not develop encephalopathy. The LP group showed multifocal EEG activity (p = 0.000229), EEG encephalopathy (p = 0.000229) and epilepsy (p = 0.299451). No significant differences between the prevalence of centro-temporal spikes, multifocal EEG activity, EEG encephalopathy, and epilepsy between the patients with the truncation or missense mutation were observed.ConclusionsEEG electrophysiological patterns and epileptogenic susceptibility differ in Z-RTT according to the level of performance (i.e. HIP or LP).SignificanceThese results indicate that HIP and LP Z-RTT should be considered as distinct entities, not only on a clinical basis, but also as it concerns EEG features and epileptogenic susceptibility.These results could offer support in the practical management of patients and family counseling.