Ataxias and cerebellar dysfunction: involvement of synaptic plasticity deficits?

Adaptive processes within cerebellar circuits, such as long-term depression and long-term potentiation at parallel fiber-Purkinje cell synapses, have long been seen as important to cerebellar motor learning, and yet little attention has been given to any possible significance of these processes for cerebellar dysfunction and disease. Several forms of ataxia are caused by mutations in genes encoding for ion channels located at key junctures in pathways that lead to the induction of synaptic plasticity, suggesting that there might be an association between deficits in plasticity and the ataxic phenotype. Herein we explore this possibility and examine the available evidence linking the two together, highlighting specifically the role of P/Q-type calcium channels and their downstream effector small-conductance calcium-sensitive (SK2) potassium channels in the regulation of synaptic gain and intrinsic excitability, and reviewing their connections to ataxia.     

DSM-IV or ICD-10-DCR diagnoses in child and adolescent psychiatry: does it matter?

OBJECTIVE: DSM-IV is the most widely used diagnostic classification system in research, whereas ICD-10 is more widely used clinically. Knowledge of differences is essential when research findings are implemented in daily clinical practice. We examined differences between the two diagnostic systems regarding three major child psychiatric diagnostic categories. METHODS: A total of 199 consecutively referred, child psychiatric patients were interviewed with a semistructured diagnostic interview (K-SADS-PL) including questions covering specific ICD-10-DCR criteria, and diagnosed according to both diagnostic systems. RESULTS: Differences were found regarding the diagnoses major depressive disorder/depressive episode and attention deficit hyperactivity disorder/disturbance of activity and attention. In both cases, more children met DSM-IV-TR criteria than ICD-10-DCR criteria. The diagnosis, oppositional defiant disorder, proved interchangeable between the two diagnostic systems. CONCLUSION: Differences between diagnostic systems must be taken into account when research findings using one diagnostic system are implemented with children diagnosed by another diagnostic system.     

Editorial: Evidence,policy and practice – gold standard,good enough or doing it differently?

Welcome to the first issue of Child and Adolescent Mental Health (CAMH) in 2021 and also to my first issue as editor-in-chief. Needless to say, 2020 has been one of the most difficult years in living memory for many children and young people around the globe, and, as we discussed in our recent issues, the potential impact of COVID-19 on children’s mental health is profound. The case for increased funding for child and adolescent mental health and investing in research has never been greater. Nevertheless, as we step into 2021, there are seeds of optimism as science drives forward treatment and vaccine developments.     

Visual deficits and cognitive assessment of multiple sclerosis: confounder,correlate, or both?

Journal of Neurology - The relationship between visual impairment and cognitive performance in multiple sclerosis (MS) remains poorly understood. To determine associations between visual acuity and...     

Pathways and outcomes of psychiatric care: does it depend on who you are, or what you've got?

OBJECTIVES: To investigate predictors of outcome and cost for patients treated by Mental Health Services in the south metropolitan area of Perth using logistic regression to control for potential confounding factors. METHOD: Data were collected over a 3-month period on 2691 subjects (47% male, 53% female) as part of the Mental Health Classification and Services Cost Project. RESULTS: The average age of subjects was 44.3 years. Nearly 80% of care occurred in community settings and virtually all inpatient care was for acute emergencies. The most common diagnosis was schizophrenia (33%) followed by mood disorders (30%). Within the study period, 88% of patients had only one episode of care (n = 2361) and a further 8% two (n = 223). Patients with schizophrenia were one-third as likely to be discharged from care (95% CI = 0.2-0.4) and 30% as likely to have longer episodes of care (95% CI = 1.1-1.6). Patients with personality, substance or adjustment disorders spent less time in treatment, and those with personality or substance disorders were more likely to be discharged from psychiatric care. A past history of inpatient care was associated with a worse outcome in terms of length of care, or not being successfully discharged. Severity of illness as determined by involuntary treatment or elevated Health of the Nation Outcome Scales and Life Skills Profile (LSP) scores was associated with increased costs. Greater disability on the LSP was also associated with increased length of care. Sociodemographic factors were as least as important as diagnosis in predicting the cost and outcome of treatment. CONCLUSIONS: Demographic factors may better predict increased health service use than diagnostic casemix. Since sociodemographic variables contribute as much to outcome as diagnosis, comparing results between units is likely to be misleading unless adjusted for these factors.     

Do peers matter? A review of peer and/or friends' influence on physical activity among American adolescents

This systematic review investigated the relationship between peer and/or friend variables and physical activity among adolescents by synthesising cross-sectional, longitudinal, and experimental research conducted in the US. Seven electronic databases were searched to identify related articles published within the last 10 years and the articles reviewed included adolescents between 10 and 18 years. Studies reporting a measure of physical activity for adolescents and at least one potential peer and/or friend variable were included. Research demonstrated that peers and friends have an important role to play in the physical activity behavior of adolescents. Six processes were identified through which peers and/or friends may have an influence on physical activity including: peer and/or friend support, presence of peers and friends, peer norms, friendship quality and acceptance, peer crowds, and peer victimization. The theoretical significance of these results is assessed and the development of peer-related physical activity programs for adolescents is discussed.     

Different effects of exogenous cues in a visual detection and discrimination task: delayed attention withdrawal and/or speeded motor inhibition?

Several studies examining spatial attention have found a discrepancy regarding the effects of exogenous cues on reaction times in visual detection and discrimination tasks. Namely, across a wide range of cue-target intervals, responses are slower for targets at cued than at uncued locations (inhibition of return) in detection tasks, whereas responses are faster for targets at cued than at uncued locations (facilitation) in discrimination tasks. Two hypotheses were proposed to account for this discrepancy. First, attention may dwell much longer on the exogenously cued location in discrimination tasks because stimuli have to be identified (i.e., the delayed attention withdrawal hypothesis). Secondly, due to increased motor preparation in detection tasks, cue-induced motor inhibition may rise much faster in these tasks than in discrimination tasks (i.e., the speeded motor inhibition hypothesis). We examined to what extent these hypotheses can account for effects of exogenous cues in a detection and discrimination task on the extrastriate P1 component, and the onset of motor activation, as indexed by the lateralized readiness potential. Some support was found for the delayed attention withdrawal hypothesis, as task-dependent cueing effects were found on the P1 component. Other aspects of our data, however, indicate that motor inhibition is also involved. Based on these findings, we propose that effects of exogenous cues in detection and discrimination tasks are determined by the interplay between two mechanisms, of which the time courses of activation may be modulated by the specific setting.     

Reduced skilfulness of arm motor behaviour among motor stroke patients with good clinical recovery: does it indicate reduced automaticity? Can it be improved by unilateral or bilateral training? A kinematic motion analysis study

Functional cortical reorganisation had been demonstrated to accompany recovery from motor stroke. In agreement with a previous study, quantitative kinematic analysis of aimed movements in 14 almost completely recovered hemiparetic stroke patients and 14 healthy control subjects indicated a reduced skilfulness of both the more ballistic initial movement phase and the more feedback-guided late homing-in phase of aimed movements. By means of two dual motor tasks it was further investigated whether the reduced skilfulness of patients was due to an increased attentional demand and thus a reduced automaticity of motor control. Interference effects by dual tasks, however, were similar for patients and control subjects. Thus, the notion of reduced automaticity could not be supported empirically, and reduced skilfulness seemed rather related to residual pyramidal motor deficits. By means of a repetitive daily training for 1 week based on the Arm Ability Training approach, patients were able to reduce their performance deficits in both movement phases significantly. Whether patients practised with the affected arm or simultaneously with both the affected and non-affected arm only marginally modified outcome, unilateral training being slightly more efficacious. These findings demonstrate that even clinically minor residual motor deficits can be improved by a structured training for the affected arm.     

The influences of environmental enrichment, cognitive enhancement, and physical exercise on brain development: Can we alter the developmental trajectory of ADHD?

Attention-deficit/Hyperactivity Disorder (ADHD) is characterized by a pervasive pattern of developmentally inappropriate inattentive, impulsive and hyperactive behaviors that typically begin during the preschool years and often persist into adulthood. The most effective and widely used treatments for ADHD are medication and behavior modification. These empirically-supported interventions are generally successful in reducing ADHD symptoms, but treatment effects are rarely maintained beyond the active intervention. Because ADHD is now generally thought of as a chronic disorder that is often present well into adolescence and early adulthood, the need for continued treatment throughout the lifetime is both costly and problematic for a number of logistical reasons. Therefore, it would be highly beneficial if treatments would have lasting effects that remain after the intervention is terminated. This review examines the burgeoning literature on the underlying neural determinants of ADHD along with research demonstrating powerful influences of environmental factors on brain development and functioning. Based upon these largely distinct scientific literatures, we propose an approach that employs directed play and physical exercise to promote brain growth which, in turn, could lead to the development of potentially more enduring treatments for the disorder.     

Different,difficult or distinct? Mothers' and fathers' perceptions of temperament in children with and without intellectual disabilities

Background Can ratings of temperament be a way of identifying young children with intellectual disabilities (ID) who are at risk for being experienced as difficult? We aimed to explore parents' reports of temperament in their young children with or without ID, as well as positive and negative impact of the child on parents. Method Mothers and fathers of 55 children recently diagnosed with ID and 183 age‐matched typically developing (TD) children completed the EASI Temperamental Survey and two scales of the Family Impact Questionnaire measuring positive and negative impact of the child on parents. Results Parents rated children with mixed ID/DD (developmental delay) as shyer and more impulsive, and less active and sociable when compared with TD children. Children with mixed ID/DD were also reported to have more negative and less positive impact on the family compared with the TD group. In subgroup analyses, children with Down syndrome and cerebral palsy/motor impairment were described as having less negative impact on parents and were described as low in negative emotionality. Children with autism spectrum disorder (ASD), ID/DD nos and other less common diagnoses had a similar pattern of temperament with high emotionality, shyness and impulsivity, and low activity and sociability. Parents of children with ASD and ID/DD reported the highest level of negative impact. Conclusions Temperamental characteristics such as high negative emotionality and impulsivity, which can be identified earlier than behavioural problems, could be indicators of negative impact on parents of young children with ID. Despite great variability in temperament among children with mixed ID/DD, results indicated common temperamental characteristics among children with ASD, ID/DD and other diagnosis.     

Localization and processing of CLN3, the protein associated to Batten disease: where is it and what does it do?

Although the CLN3 gene for Batten disease, the most common inherited neurovisceral storage disease of childhood, was identified in 1995, the function of the corresponding protein still remains elusive. A key to understanding the pathology of this devastating disease will be to elucidate the function of CLN3 at the molecular level. CLN3 has proven difficult to study, as it is predicted to be a membrane protein, and is of apparently low abundance in cells. Different groups have reported differing subcellular localization of CLN3. The purpose of this review is to critically examine the various cell biological approaches undertaken to localize CLN3 and to piece together a potential function for CLN3 in neuronal cells. The most likely conclusion of this is that CLN3 is a lysosomal/endosomal protein that is trafficked through the endoplasmic reticulum (ER) and Golgi. Furthermore, studies are required to confirm whether CLN3 has a potential role in the recycling of synaptic vesicles through the endosome/lysosome.     

Source of cannabinoids: what is available,what is used,and where does it come from?

Cannabis sativa L. is an ancient medicinal plant wherefrom over 120 cannabinoids are extracted. In the past two decades, there has been increasing interest in the therapeutic potential of cannabis‐based treatments for neurological disorders such as epilepsy, and there is now evidence for the medical use of cannabis and its effectiveness for a wide range of diseases. Cannabinoid treatments for pain and spasticity in patients with multiple sclerosis (Nabiximols) have been approved in several countries. Cannabidiol (CBD), in contrast to tetra‐hydro‐cannabidiol (THC), is not a controlled substance in the European Union, and over the years there has been increasing use of CBD‐enriched extracts and pure CBD for seizure disorders, particularly in children. No analytical controls are mandatory for CBD‐based products and a pronounced variability in CBD concentrations in commercialized CBD oil preparations has been identified. Randomized controlled trials of plant‐derived CBD for treatment of Lennox‐Gastaut syndrome (LGS) and Dravet syndrome (DS) have provided evidence of anti‐seizure effects, and in June 2018, CBD was approved by the Food and Drug Administration as an add‐on antiepileptic drug for patients two years of age and older with LGS or DS. Medical cannabis, with various ratios of CBD and THC and in different galenic preparations, is licensed in many European countries for several indications, and in July 2019, the European Medicines Agency also granted marketing authorisation for CBD in association with clobazam, for the treatment of seizures associated with LGS or DS. The purpose of this article is to review the availability of cannabis‐based products and cannabinoid‐based medicines, together with current regulations regarding indications in Europe (as of July 2019). The lack of approval by the central agencies, as well as social and political influences, have led to significant variation in usage between countries.     

The measurement of CSF flow through the aqueduct in normal and hydrocephalic children: from where does it come, to where does it go?

Purpose  

Despite 100 years of study, the theories of cerebrospinal fluid (CSF) formation and absorption remain controversial. Measuring CSF flow through the aqueduct using magnetic resonance imaging (MRI) provides a unique insight into the physiology of CSF hydrodynamics. The published data in adults tend to refute rather than support the prevailing theories of CSF flow. There are limited data regarding this metric in children. This paper seeks to measure the aqueduct flow in normal and hydrocephalic children to help formulate a more complete theory of CSF flow.     

(How) does it make a difference? Perspectives of adults with lesbian, gay, and bisexual parents

Few studies have addressed the experiences or perceptions of adult children of lesbian, gay, and bisexual (LGB) parents. In this study, 46 adult children of LGB parents were interviewed, and their perceptions of how growing up with LGB parents influenced them as adults were examined. Qualitative analysis revealed that adults felt that they were more tolerant and open minded and had more flexible ideas about gender and sexuality as a function of growing up with LGB parents. Participants often felt protective of their parents and the gay community, and some went to great efforts to defend them to peers, family members, and society. Some participants struggled with issues of trust in adulthood, which they related to the experience of their parents' unexpected coming out, as well as to experiences of teasing and bullying. The importance of understanding these findings in the context of societal heterosexism is discussed.     

CT angiography in acute stroke: does it provide additional information on occurrence of infarction and functional outcome after 3 months?

OBJECTIVE: To investigate whether acute phase intracranial CT angiography (CTA) independently predicts infarction and functional outcome in ischemic stroke. METHODS: Hundred and fifty-one consecutive patients with acute (<12 h) ischemic stroke who received intracranial CTA were investigated. Stroke severity on admission was determined using the National Institute of Health Stroke Scale (NIHSS). Reconstructed CTAs were investigated for relevant pathology. Follow-up imaging was performed 24-48 h after admission. Functional outcome was assessed after 3 months using the modified Rankin scale. Single factor and multiple logistic regression analyses were performed to predict infarction and dependency (modified Rankin scale > or = 3) on follow-up. RESULTS: Median NIHSS on admission was 10 (IQR 3-14). Out of the 151 patients, 61 (40%) had pathological CTA findings. Infarction was demonstrated in 60/61 patients (98%) with and in 67/90 patients (74%) without vessel pathology. Presence of infarction on follow-up imaging and dependency at 3 months were correlated with pathological CTA findings on admission in single factor analysis (each p < 0.001). After adjustment for age (> or =/<65 years), NIHSS (> or =/<10), sex, therapy, and time to presentation (> or =/<3 h), only NIHSS > or = 10 on admission was predictive of dependency at follow-up (p < 0.001). CONCLUSIONS: Pathological CTA findings in the acute phase of ischemic stroke do not independently predict a poor outcome at 3 months after acute stroke.