Caffeine effects on resting-state electrodermal levels in AD/HD suggest an anomalous arousal mechanism

The effect of a single oral dose of caffeine was examined in a randomised double-blind placebo-controlled repeated-measures cross-over study. Eighteen children with AD/HD, aged between 8 and 13 years, were individually age- and gender-matched with a control group. All children participated in two sessions, one week apart. Skin conductance level (SCL) from a 3 min eyes-closed epoch, commencing 30 min after ingestion of caffeine or placebo, was examined. Across conditions, mean SCL was lower in the AD/HD group than controls, confirming hypoarousal in AD/HD. Caffeine produced an increase in SCL, and this increase did not differ between the groups. However, arousal increases were dose-dependent in controls, but not in AD/HD. Rather, caffeine-induced arousal increases in the AD/HD group were positively related to their hyperactivity/impulsivity levels. This suggests an anomalous arousal mechanism in AD/HD functionally related to impairment in one symptom dimension.     

Complications of low-dose heparin prophylaxis following pelvic lymphadenectomy

All patients who underwent pelvic lymphadenectomy for prostatic carcinoma over a five-year period were reviewed to evaluate the effect of minidose heparin prophylaxis on lymphocele formation and postoperative complications. The overall incidence of complications was found to be consistent with that reported in the current literature. However, when the rate of lymphocele occurrence was correlated with perioperative minidose heparin therapy, the incidence rose from 2.5 per cent in those receiving no heparin to 38 per cent in patients receiving both pre- and postoperative prophylactic heparinization. Other major postoperative complications were also significantly increased when minidose heparin was pre- or postoperatively administered. A strong recommendation is made for caution in the routine use of prophylactic low-dose heparin during pelvic surgery.     

Hemostatic control with flexible compression tape used during partial nephrectomy and organ salvage.

PURPOSE: A secure method of achieving hemostasis during partial nephrectomy to accomplish guillotine polar amputation is described. MATERIALS AND METHODS: A common hardware item, the so-called cable tie, proved to be useful during removal of a block of neoplastic renal tissue from the lower central pole of a unilateral kidney. RESULTS: Complete hemostasis and resection of the renal parenchyma were obtained with ease and minimal expense. CONCLUSIONS: The use of a flexible plastic compression tape has proved valuable to adhere to organ contours closely, maximally control bleeding and marking a line of incision during amputation of a portion of the renal substance. This device may prove useful for analogous surgical purposes with other vascular organs.     

Age and sex effects in the EEG: development of the normal child.

OBJECTIVES: This study investigated age-related changes and sex differences in the EEGs of normal children. METHODS: Forty boys and 40 girls, between the ages of 8 and 12 years, participated in this study. The EEG was recorded during an eyes-closed resting condition and Fourier transformed to provide estimates for total power, absolute and relative power in the delta, theta, alpha and beta bands, and for theta/alpha and theta/beta ratios. RESULTS: Absolute delta activity decreased with age. Relative delta and theta decreased and alpha and beta increased with increasing age. The theta/alpha and theta/beta ratios decreased with increasing age. All of these indicated a developmental reduction in slow wave activity. Maturational differences were found in the rates of change between the midline and the two hemispheres. In the absolute delta and the theta/beta ratio, the midline and the two hemispheres became more equipotential with age. In the beta band, power increased at a greater rate than in the two hemispheres. Sex differences were found, with males having less theta and more alpha than females. CONCLUSIONS: These results indicated that maturation occurs earlier at the midline than in the two hemispheres. Females were also found to have a developmental lag in the EEG compared with males.     

The effect of methylphenidate on response inhibition and the event-related potential of children with attention deficit/hyperactivity disorder.

Children with Attention Deficit/Hyperactivity Disorder (AD/HD) appear to be deficient in inhibitory processes, as reflected in behavioural and electrophysiological measures. This study examined the effect of methylphenidate (MPH) on response inhibition in children with AD/HD. Event-related potentials (ERPs) and skin conductance level (SCL) were recorded from 18 boys with AD/HD and 18 controls while they performed a cued Go/Nogo task with 70% Go probability. All participants performed the task twice, with an hour interval between test sessions. At the beginning of this interval children with AD/HD took their normal morning dose of MPH. The AD/HD group showed lower SCL than controls pre-medication, a difference not found subsequent to the administration of MPH. While the AD/HD group made more overall errors (omission+commission) pre-medication, and continued to make more omission errors than controls post-medication, the groups became comparable on the number of commission errors, suggesting MPH ameliorates deficits in response inhibition. Children with AD/HD displayed enhanced N1 and P2 amplitudes, and reduced N2 amplitudes relative to controls. These differences were not significant post-medication, at least partly attributable to the action of MPH. This study is unusual in the concurrent examination of electrodermal and electrophysiological measures of medication effects in children with AD/HD, with the retesting of both the AD/HD and control groups allowing a more valid estimate of the effects of medication, rather than assuming that retesting does not have a substantial impact.     

Adjusting EEG coherence for inter-electrode distance effects: an exploration in normal children.

Electroencephalographic (EEG) coherence between two points is strongly related to the distance between them, being inflated by volume conduction effects at short distances and reduced by signal phase differences at larger distances. This precludes simple comparison of coherence estimates involving different inter-electrode distances. We investigated adjusting coherence measures to remove such distance effects. After subtracting the estimated effects of random coherence due to volume conduction, exponential regression of the reduced coherence values against measured inter-electrode distance was used to estimate the remaining effects of inter-electrode distance. Residuals from this procedure were taken as coherences corrected for the systematic distance effects. These were adjusted to the mean reduced coherence level to avoid complexities in conceptualising negative residual coherences. It was found that systematic inter-electrode distance effects accounted for more than 50% of the variance remaining after removal of random coherence estimates. After these were also removed, substantial effects of EEG frequency band, different regions of the brain, and interhemispheric versus intrahemispheric values, as well as laterality effects within the latter, were obtained. Regional and frequency differences in adjusted coherence appear to reflect patterns expected from normal cortical development, but detailed understanding of more complex interactive effects is limited by the lack of relevant developmental data. Adjusting coherence values to remove systematic variability due to inter-electrode distances better represents cortico-cortical coupling and allows more efficient statistical analysis. This may contribute towards a better integration of coherence data in the EEG exploration of both normal and atypical brain functioning.     

Excess beta activity in the EEG of children with attention-deficit/hyperactivity disorder: A disorder of arousal?

Past research has reported that a small proportion of children with attention-deficit/hyperactivity disorder (AD/HD) have excess beta activity in their EEG, rather than the excess theta typical of the syndrome. This atypical group has been tentatively labeled as hyperaroused. The aim of this study was to determine whether these children have a hyperaroused central nervous system. Participants included 104 boys aged 8 to 13 years old, with a diagnosis of either the Combined or Inattentive type of AD/HD (67 combined type), and 67 age-matched male controls. Ten and a half minutes of EEG and skin conductance (SCL) were simultaneously recorded during an eyes-closed resting condition. The EEG was Fourier transformed and estimates of total power, and relative power in the delta, theta, alpha, and beta bands, and the theta/beta ratio, were calculated. AD/HD patients were divided into an excess beta group and a typical excess theta group. Relative to controls, the typical excess theta group had significantly increased frontal total power, theta and theta/beta ratio, with reduced alpha and beta across the scalp. The excess beta group had significantly reduced posterior total power, increased centro-posterior delta, globally reduced alpha, globally increased beta activity, and globally reduced theta/beta ratio. Both AD/HD groups had significantly reduced SCL compared to the control group, but the two groups did not differ from each other on SCL. These results indicate that AD/HD children with excess beta activity are not hyperaroused, and confirm that the theta/beta ratio is not associated with arousal. This is the first study of arousal measures in AD/HD children with excess beta activity, and has implications for existing models of AD/HD.     

A survey of 22 individuals with Prader-Willi syndrome in New South Wales

Twenty-two individuals with Prader-Willi Syndrome in New South Wales were surveyed. The results show that males were diagnosed at a significantly earlier age than females and suggest a recent trend towards earlier diagnosis. The advantages of early diagnosis are discussed. In those in whom cytogenetic studies had been performed, 47% were found to have a deletion involving chromosome 15q11-13. Profound neonatal hypotonia had been present in all cases. Obesity became apparent between 1.5 and 10 years (mean = 3.8 years). Facial dysmorphism was reported in 83% and acromicria in 100%. Sixty-two per cent of subjects were regarded as less pigmented than first degree relatives. Cognitive assessments were performed on nine subjects. Two (22%) were functioning in the normal range of intelligence. Behaviour problems, both food-related and non-food-related, were present in the majority and placed considerable stress on the family caring for the individual with Prader-Willi Syndrome.     

Age and sex effects in the EEG: differences in two subtypes of attention-deficit/hyperactivity disorder.

OBJECTIVES: This study investigated age-related changes and sex differences in the EEGs of two groups of children with attention-deficit/hyperactivity disorder (ADHD) combined type and ADHD predominantly inattentive type, in comparison with a control group of normal children. METHODS: Forty boys and forty girls were included in each group. The EEG was recorded during an eyes-closed resting condition and Fourier transformed to provide estimates for total power, absolute and relative power in the delta, theta, alpha and beta bands, and for theta/alpha and theta/beta ratios. RESULTS: Total power, relative alpha, and the theta/alpha and theta/beta ratios were differentiated between all 3 groups. Sex differences between the ADHD subjects and the control group were greater in males than females and matured faster in males. With increasing age, the EEG of the ADHD inattentive group was found to change at a similar rate to the changes found in the normal group, with the differences in power levels remaining constant. In the ADHD combined group, the power was found to change at a greater rate than in the ADHD inattentive group, with power levels of the two ADHD groups becoming similar with age. CONCLUSIONS: These results are supportive of a two-component model of ADHD, with the hyperactive/impulsive component maturing with age and the inattentive component remaining more stable.     

EEG development in Attention Deficit Hyperactivity Disorder: From child to adult

ObjectiveAttention Deficit Hyperactivity Disorder (ADHD) is one of the most common psychiatric disorders found in children. While an extensive literature has documented the EEG in this clinical population, few studies have investigated EEG throughout the lifespan in ADHD. This study aimed to investigate EEG maturational changes, in subjects with ADHD combined type, that spanned from childhood into adulthood.MethodTwenty five male adults with ADHD were assessed between the ages of 8–12 years and again as adults. At both ages, an EEG was recorded during an eyes-closed resting period, and power estimates were calculated for relative delta, theta, alpha and beta.ResultsAt the childhood assessment, the ADHD subjects had elevated posterior delta. Relative theta was elevated, with diminished alpha activity across all sites. Significant maturational changes were observed, with reductions in the delta and theta bands, and increases in the alpha and beta bands across all electrodes. In adulthood, relative to controls, diminished frontal delta and elevated global theta activity were apparent.ConclusionsSubstantial developmental changes occurred in the EEG of these subjects. These results identify important issues when using EEG as part of the diagnosis for ADHD.SignificanceThis study is the first to explore EEG changes from childhood to adulthood over an 11 year period in the same subjects with ADHD.