EEG and seizures in autistic children and adolescents: further findings with therapeutic implications.

The goal of this study was to investigate the incidence of epilepsy and also the EEG findings among children with autism (A), a devastating disorder, and to compare these data to an EEG control group. EEGs were quantified as to the degree of epileptiform activity and also slow wave abnormalities. Abnormal EEGs were found in 75% of the 59 A children and 82% of their 151 EEGs; 46% had clinical seizures. Nearly all children with seizures had epileptiform activity, but almost 20% of those with spike discharges did not have clinical attacks. Slow wave abnormalities were more frequent and of a greater degree of severity in the A group, compared to controls. One new finding was that a greater variability of EEG abnormalities was found in the A group. Therapeutic implications, based on these latter findings, are discussed.     

Frequency of EEG abnormalities in age-matched siblings of autistic children with abnormal sleep EEG patterns

Epileptiform activity in sleep has been described even in the absence of clinical seizures in 43-68% of patients with autistic spectrum disorders (ASDs). Genetic factors may play a significant role in the frequency of epilepsy, yet the frequency in normal age-matched controls is unknown. We studied overnight ambulatory electroencephalograms (EEGs) in 12 nonepileptic, nonautistic children with a sibling with both ASDs and an abnormal EEG. EEG studies were read and described independently by two pediatric epileptologists; 10 were normal studies and 2 were abnormal. The occurrence of abnormal EEGs in our sample (16.6%) was lower than the reported occurrence in children with ASDs. Further, the two abnormal EEGs were of types typically found in childhood and were different from those found in the ASD-affected siblings. The lack of similarity between sibling EEGs suggests that genetic factors alone do not explain the higher frequency of EEG abnormalities reported in ASDs.     

Delirious behavior in children with influenza: its clinical features and EEG findings

The clinical characteristics and electroencephalogram (EEG) findings in delirious behavior in children with influenza were studied in order to differentiate it from influenza-associated encephalitis/encephalopathy. Fifteen consecutive children with delirious behavior associated with influenza were investigated. Their clinical courses were investigated using medical records. EEG was obtained during the delirious behavior, when possible. The body temperature during the delirious behavior was 39.0 degrees C or higher in 13 children. A subtle reduction of consciousness was observed in 10 children. Seizures were observed in five children. EEG revealed some mildly abnormal findings in 13 children, including mild slowing of the background activity, insertion of semirhythmic high voltage slow waves, and appearance of relatively high voltage semirhythmic theta waves. The EEG findings normalized after the delirious behavior had disappeared. EEG revealed transient and mild abnormalities in children with delirious behavior but without encephalitis/encephalopathy, and thus might be useful for diagnostic evaluation in such condition.     

Radiological findings in autistic and developmentally delayed children

PURPOSE: The aim of this study was to evaluate the prevalence of brain abnormalities in a group of young children with developmental disorders, specifically including children that came to the attention of a child psychiatrist before the age of 3 years. METHODS: Forty-five children participated in an MR study (mean age 43 months, SD=12, four females). The study design was approved by the local Medical Ethical Review Board. All parents gave written informed consent. Scans were independently assessed by two board-certified radiologists for malformations of gray and white matter. RESULTS: Cohen's kappa for the consensus between the two raters was 0.79. In 22 children (49%) abnormalities were reported. Four patients (8.5%) had an arachnoid cyst. One female was diagnosed with a Chiari I malformation. Three children show enlarged Virchow-Robin spaces, an increased occurrence when compared to the normal population. CONCLUSIONS: A high rate of intracranial abnormalities was found in this study. Radiological findings do not contribute to the diagnosis of developmental disorders. However, young children with developmental disorders may not be able to express discomfort associated with brain abnormalities, such as a Chiari I malformation. Given the high prevalence of abnormalities in this sample neuroimaging may be a useful tool in clinically assessing children with developmental disorders.     

Hemispheric lateralization of language in autistic and aphasic children

The profound language deficit in early infantile autism has led to speculation about the similarities between autistic and language-impaired children. Since aphasia in adults and many children is typically the result of left cerebral hemisphere damage, some researchers have suggested that autistic children also suffer from left hemisphere damage. So far, only indirect or unreliable evidence has been offered in support of this hypothesis. In the present experiment, autistic, language-impaired, and non-language-impaired children were compared on a dichotic listening task designed to overcome some of the deficiencies of earlier research. Language-impaired children were found to exhibit a left ear bias for language material (indicating right hemisphere lateralization for language), whereas the autistic and non-language-impaired children showed the opposite, right ear bias. As the autistic children showed a pattern similar to that of normal children, the present experiment found no evidence for either left hemisphere damage or aphasiclike performance among autistic children. The implications of these findings for understanding the autistic language deficit are explored.     

Categorization skills and receptive language development in autistic children

The category knowledge and receptive language skills of 16 autistic, mentally retarded, and normal children were assessed. The autistic children's knowledge of function, form, and color categories was comparable to that of the mental-age-matched mentally retarded and normal comparison groups. Category knowledge and receptive language were more closely associated for mentally retarded and normal children than for autistic children. The findings indicate that category knowledge is not sufficient for the development of receptive language in autistic children.     

Epileptic seizures in multiple sclerosis: clinical and EEG correlations

Abstract. Epileptic seizures occur more frequently in multiple sclerosis (MS) patients than in the general population. We evaluated clinical, electroencephalographic (EEG) and magnetic resonance imaging (MRI) findings, as well as EEG-MRI correlations and the response to antiepileptic drugs (AEDs) in 270 consecutive patients with definite MS referred to our Department from 1995 to 2002. Thirteen (4.8%) subjects experienced epileptic seizures. In four cases, seizures manifested within 1–2 years (early-onset), and in six cases within 8–23 years (late-onset) of MS diagnosis. Seizures were usually partial with secondary generalization. Thus, acute symptomatic seizures occurred in three cases. Epilepsy usually appeared late in the course of disease, although a single episode or a cluster of seizures can represent the onset symptom or a relapse of MS. Prognosis of epilepsy during the course of MS is usually good but the choice of AEDs remains a matter of debate.     

EEG and neuroimaging correlations in children with lissencephaly

PurposeTo study the usefulness of EEG in the diagnosis of lissencephaly, a rare cortical developmental disorder associated with abnormal cellular proliferation. Currently, the clinical emphasis is placed on the radiological and genetic aspects for the diagnosis of lissencephaly.MethodsThis is a retrospective review of consecutive EEG recordings and imaging data from 14 children, with the diagnosis of lissencephaly, who were admitted from January 1998 to January 2010. All EEG recordings were performed with the 10–20 system of electrode placement, in both awake and sleep states. All EEG recordings were reviewed using anterior-posterior bipolar and transverse montages and then they were interpreted blindly, with respect to the imaging and genetic investigations for each patient.ResultsAll children showed one of the three characteristic EEG patterns reported in the literature of lissencephaly. The EEG pattern I, showed an anterior posterior gradient that corresponded to the severity of the imaging study abnormality. All patients were on two or more AEDs and reported to continue having active epilepsy.ConclusionIn a child with clinical characteristics of lissencephaly, one of these three reported EEG patterns can prove useful in making the diagnosis very probable, preceding imaging and genetic testing.     

Speech following sign language training in autistic children with minimal verbal language

This study was carried out to test the main and interaction effects of training condition and pretreatment-elicited verbal imitation ability when predicting spoken language use during language training of 60 minimally verbal autistic children. Subjects were randomly assigned to Speech Alone, Sign Alone, Simultaneous Presentation of Sign and Speech, and Alternating Presentation of Sign and Speech training conditions. Speech Alone, Simultaneous Presentation, and Alternating Presentation condition facilitated more child-initiated speech during treatment than did the Sign Alone condition. Regardless of training condition, pretreatment verbal imitation ability positively predicted the size of child-initiated spoken vocabulary observed during training. Exploratory analyses indicated that, in addition to verbal imitation, pretreatment age and IQ may also predict spoken language developed during training.Portions of this paper were presented at the Regional Society for Child Development Conference, Athens, Georgia, 1984, and at the Gatlinburg Conference on Mental Retardation, Gatlinburg, Tennessee, 1984. This research was supported by grant NO1-NS-9-2305 National Institute of Neurological and Communicative Disorders and Stroke to the University of North Carolina at Chapel Hill. Points of view or opinions stated do not necessarily represent official NINCDS position or policy.     

Seizure disorder mimicking an acute confusional state as clinical presentation of neurocysticercosis: neuroimaging, EEG findings and clinical correlations

Epilepsy is the main clinical manifestation of neurocysticercosis (NC). We studied an adult subject who presented a seizure disorder mimicking an acute confusional state as clinical expression of NC. Diagnosis was made with neuroimaging and western blot determination of specific antibodies on serum. Computed tomography and magnetic resonance imaging displayed multiple calcifications and a few transitional cysts in the cerebral parenchyma. Electroencephalography showed a pattern of periodic lateralized epileptiform discharges (PLEDs) which could be related topographically to a cystic lesion located in the left parietal lobe. In our view there was a clear pathogenic correlation between the seizure disorder and the parasitic cyst located in the left parietal lobe. Neither antiepileptic drugs nor steroids were prescribed. Follow-up to one year ruled out other clinical manifestations of the disease. This case is an example of acute symptomatic seizure related to a transitional cystic lesion of NC. Received: 31 February 2001 / Accepted in revised form: 13 July 2001     

EEG diagnoses of neonatal seizures: clinical correlations and outcome

Electroencephalographic seizures were evaluated in 112 neonates. The first portion of the study involved 80 neonates with clinically identified abnormal movements, 8 of whom (10%) had electroencephalographic evidence of seizures coincident with this activity. Patients with abnormal movements (90%) had no concurrent electrical seizures. In the second part of the study, 40 infants who had electrical seizures were investigated. Eight of these infants had been identified during the first part of the study. Two-thirds of the patients (25) were premature. Sixteen patients (40%) died; 90% had brain lesions documented by computed tomography and/or postmortem study. Cerebral infarction and intraventricular hemorrhage were the most common lesions. One-third of the survivors (8 of 24 patients) were normal at a mean age of 3 years, while two-thirds had significant neurologic and developmental abnormalities. Neonatal seizures often are subtle, not associated with observable clinical expression, and associated with adverse development. Electroencephalographic confirmation is important in the evaluation of neonatal seizures.     

Teaching autistic children to use sign language: Some research issues

Three questions are raised with respect to the use of sign language as an alternative system of communication for nonverbal autistic children. First, does teaching a child to sign facilitate speech development? The data suggest that following simultaneous communication training, mute children are not likely to learn to talk; however, a combination of simultaneous communication training and separate vocal training may have a synergetic effect on speech development. In contrast, children who initially have good verbal imitation skills apparently show gains in speech following simultaneous communication training alone. Second, what is the upper limit of sign acquisition? Data suggest that abstract concepts, syntax, and generative skills can be taught. Procedures used in the operant conditioning of speech may prove useful in training complex signing skills. Third, does sign acquisition result in a general improvement in adaptive functioning? It appears that following sign training, some children do show increases in spontaneous communication, decreases in self-stimulatory behavior, and improvement in social skills. However, these outcomes are often difficult to interpret. Some data are described that help clarify the relationship between sign training and general behavioral improvement.     

Nonverbal communication and play correlates of language development in autistic children

The aim of this study was to determine the social and cognitive correlates of language acquisition in autistic children. Functional and symbolic play skills were shown to be associated with language abilities in a sample of young autistic children (mean CA 54.5 months), thereby replicating previous findings. Certain types of nonverbal communication skills were also shown to be significant correlates of language development in this group of autistic children. These involved the ability to use gestures to coordinate visual attention between social partners with respect to objects or events. The play and nonverbal communication variables were not significantly correlated, suggesting that these variables reflect independent psychological factors associated with language development in young autistic children.