Schweizer Archiv für Neurologie und Psychiatrie ... - Sanp.ch

Posters SSNP
60
Isolated focal cerebellar lesions during development:
Neurological and neuropsychological outcome
K. Wingeier 1 , S. Bigi 1 , M. El-Koussy 2 , Th. Heinks-Maldonado 1 ,
E. Boltshauser 3 , M. Steinlin 1
1
University Children’s Hospital, Inselspital, Bern, Switzerland,
2
University Hospital, Inselspital, Bern, Switzerland, 3 University
Children’s Hospital, Zurich, Switzerland
Introduction: The extent of influence of the cerebellum on
developing cognitive functions is unknown. However, there
are signs that it might play a crucial role. Consequently, the
topic of cognitive disturbances after cerebellar lesions during
development has become of increasing interest. The aim of the
present study was to assess long-term sequelae after cerebellar
lesions during childhood.
Methods: Eight participants with isolated focal hemorrhagic
cerebellar stroke before the age of sixteen were recruited. All
patients underwent a neurologic exam including the Zurich
Neuromotor Assessment (ZNA), the International Cooperative
Ataxia Rating Scale (ICARS) as well as an extensive
neuropsychological battery assessing a broad range of cognitive
functions. Quality of life and possible behaviour/emotional
problems were assessed with different questionnaires.
Results: The results revealed adaptive fine motor problems
(ZNA) and restricted oculomotor movements (ICARS).
Conversely, no overall neuropsychological pattern could
be identified except marginally reduced reaction times and
susceptibility to interference. Furthermore, borderline results in
semantic and phonological word fluency tasks were apparent.
However, verbal performance and reading abilities were nonpathologic.
The majority of the participants reported good
quality of life without major physical restrictions or emotional
disturbances.
Conclusions: In this patient group the presence of a cerebellar
cognitive affective syndrome as frequently described in the
literature cannot be confirmed. Nevertheless, individual
neuropsychological impairments are present. Moreover, fine
motor problems were common. Probably heterogeneity of age at
stroke and exact lesion site (as well as its afferent and efferent
connections to the cerebrum) may have led to interpersonal
differences in neuropsychological outcome.
61
Language lateralisation correlates with verbal memory
performance in children with focal epilepsy
R. Everts 1 , S.A. Harvey 2 , L.M. Lillywhite 3 , J. Wrennall 4 ,
D. Abbott 3 , L. Gonzalez 1 , G. Jackson 3 , V. Anderson 1
1
Critical Care and Neuroscience, Murdoch Children’s Research
Institute, Melbourne, Australia, 2 Department of Neurology, The
Royal Children’s Hospital, Melbourne, Australia, 3 Brain Research
Institute, Florey Neuroscience Institutes, Melbourne, Australia,
4
Department of Psychology, The Royal Children’s Hospital,
Melbourne, Australia
Introduction: Assessment of language dominance
with functional magnetic resonance imaging (fMRI) and
neuropsychological assessment is often used prior to
neurosurgical interventions and is important in minimizing the
risk of functional loss after surgery. The present study explores
whether language lateralisation and cognitive performance are
systematically related in young patients with focal epilepsy.
Methods: Language fMRI and neuropsychological data
(language, visuo-spatial perception, memory) of 40 patients
(7–18 years) with unilateral, refractory focal epilepsy in temporal
and/or frontal areas of the left (n = 23) or right hemisphere (n =
17) were analysed. fMRI data of 18 healthy controls (7–18 years)
served as a normative sample. A laterality index was computed
to determine the lateralization of activation in three regions of
interest (frontal, parietal, temporal).
Results: Atypical language lateralisation was demonstrated
in 12/40 (30%) patients. A correlation between language
lateralisation and verbal memory performance occurred in
patients with left-sided epilepsy: bilateral or right-sided language
lateralisation correlated with better verbal memory performance
(Word Pairs Recall: frontal r = –0.4, p = .016 parietal r = –0.4,
p = .043, temporal r = –0.4, p = .041). Verbal memory
performance made the largest contribution to language
lateralisation, whereas handedness and side of seizures did
not contribute to the variance in language lateralisation.
Conclusion: This finding reflects the strong association between
neocortical language and hippocampal memory regions in
patients with left-sided epilepsy. Atypical language lateralisation
is advantageous for verbal memory performance, presumably
a result of a transfer of verbal memory function. In children with
focal epilepsy, verbal memory performance provides a better
idea of language lateralisation than handedness and side of
epilepsy and lesion. Knowledge about the relationship between
language lateralisation and verbal memory performance allows
for a refined clinical interpretation of pre-surgical language fMRI
and neuropsychological data.
62
Longitudinal neurodevelopmental evolution in patients
with severe to profound static encephalopathy
G.P. Ramelli 1 , U. Antonini 1 , V. D’Apuzzo 1 , R. Brunner 1
1
Ospedale San Giovanni, Bellinzona, Switzerland, 2 Istituto
Provvida Madre, Balerna, Switzerland, 3 Istituto Provvida Madre,
Balerna, Switzerland, 4 Universitätskinderklinik beider Basel,
Basel, Switzerland
Introduction: Little information is currently available on the
longitudinal neurodevelopmental evolution in patients with static
encephalopathy and severe to profound cognitive dysfunction.
Methods: Between 1984 and 2005, patients with severe to
profound static encephalopathy on care at the Istituto Provvida
Madre underwent neuredevelopmental evaluation by means
of the Munich functional Developmental Diagnostics test on an
annual basis. Repeated multivariate analysis was used to assess
the presence of longitudinal trends.
Results: 35 patients (18 female and 17 male subjects)
underwent testing for at least 3 consecutive years. The
underlying conditions were chromosomal disorders in 14,
hypoxic-ischemic encephalopathy in 3, autism spectrum disorder
in 3, brain malformations in 3, mitochondrial cytopathies in 2,
epileptic encephalopathy in 1, congenital Cytomegalovirus
infection in 1 and unknown in the remaining 8 cases. The
median age of the patients at the time of initial testing was 6
years (range, 1.6–16), and the median follow-up from the time
of the first testing was 4 years (range, 3–11). The median age
at the most recent evaluation was 13 years (range, 5–18).
Developmental evaluation of the 35 patients disclosed a linear
maturation throughout the testing period of 1.0 to 2.0 months per
year, whatever the underlying condition. Some minor differences
were noted between the different task categories: gross motor
skill (1.0-2.0 months per year), fine motor skill
(2.0 months per year), perception (2.0 months per year), active
language (1.0 months per year), passive language (2.0 months
per year), social contact (1.0 months per year), autonomy
(2.0 months per years).
Conclusions: These longitudinal observations in patients with
severe to profound static encephalopathy demonstrate a linear
maturation of 1.0 to 2.0 months per years, which is independent
of the underlying etiology.
63
Mirror therapy in hemiparetic children: a pilot study
M. Jequier Gygax, P. Schneider, C.J. Newman
Unité de Neurologie et Neuroréhabilitation Pédiatrique,
DMCP, CHUV, Lausanne, Switzerland
Objective: In mirror therapy, the mirror reflection of the
non-paretic arm provides patients with the visual illusion
of a functional paretic limb and modulates the abnormal
proprioceptive input. Mirror therapy has been used in
rehabilitation of hemiparesis after stroke. No study using mirror
therapy has been conducted in cerebral palsy. In this pilot
study we tested the effectiveness and practicability of the mirror
therapy in a small group of hemiparetic children.
Methods: In a cross-over study, we measured strength and
utilization of the paretic upper limb in ten children after 2x 2
weeks of bi-manual training with and without a mirror. We used
handheld dynamometers to monitor the effects on grasping and
pinch maximal strength, and a functional scale, the SHUEE
(Shriner’s Hospital Upper Extremity Evaluation) to analyze the
spontaneous function and dynamic position. Using SPSS 16.0
we performed paired T-tests to compare outcomes of grasp,
pinch strength and upper extremity utilization.
Results: We found that maximal grasp strength increased on
average by 11% when testing was done behind the mirror (with
mirror 5.60 ± 0.59 ppsi; without mirror 5.03 ± 0.56 ppsi;
p = 0.037). Grasp strength was improved by the training (week
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