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P12.4 Studying medically unexplained neurological symptoms in children within international classification of functioning and disability framework
S80 Results: The median full-scale intelligence quotients (FIQ) of the patients with HLHS (97.0, p < 0.0001) and of the patients with UVH (112.0, p = 0.024) were significantly lower than that of the control children (120.5). A major neurodevelopmental impairment was present in 6/23 (26%) and in 3/13 (23%) of the patients with HLHS and UVH, respectively. A minor neurological dysfunction was found in 10/23 (43%) of the patients with HLHS, in 6/13 (46%) of the patients with UVH, and in 4/40 (10%) of the controls. Both patients with HLHS (median score 11, p = 0.0016) and patients with UVH (10.5, p = 0.0029) scored significantly worse compared to controls (3) in the Movement ABC test. Abnormal MRI findings, most often small ischemic changes or infarcts, were found in 14/17 (82%) of the patients with HLHS and in 5/9 (56%) of the patients with UVH. Conclusions: Univentricular heart defects represent a major risk for neurodevelopment, and routine follow-up by a pediatric neurologic team is indicated for these patients. P12.4 Studying medically unexplained neurological symptoms in children within international classification of functioning and disability framework K. Vijayakumar1 *, P. Prabhakar1 . 1 Great Ormond Street Hospital, London, United Kingdom Aim: To study the prevalence and provide disability data on medically unexplained neurological symptoms (MUNS) within the framework of WHO’s International Classification of Functioning disability and health (ICF). Method: Of the 652 admissions to tertiary neurology service over 2007 2009, 82 episodes of admissions (12.6%) in 55 children documented to have MUNS were identified. 52 were studied applying the ICF model. Results: Body structure and Function: The predominant neurological manifestations were: loss of neurological function 27, paroxysmal events 14, pain syndrome 4, others 7. Activities and Participation: 29/52 (56%) had 24/42 (57%) had limitation on mobility and school participation respectively. Environmental and Personal factors: There was preponderance of girls (35/55), median age 13years (range 14 months to 17 yrs 2 months). The use of resources include: therapy input (65%), psychology (66%) and social service input (48%) during the admission. Medication overuse was high and multiple repeated neurological investigations were performed (57 neuro-imaging in 32 children and 32 EEG’s in 22 children) during the assessment process. The cumulative length of in-patient bed stay was significantly longer when compared to non-MUNS patients (chi squared test − p < 0.005). Following discharge, ongoing support was recommended through Child and Adolescent Mental Health Service (27), Cognitive Behaviour Therapy (4), and psychology input (2). Interpretation: Prevalence of MUNS was 12.5% of total admission within tertiary neurology centre. The educational and psychosocial morbidity in MUNS is high. Early recognition of this condition is important in order to provide appropriate support services for ongoing rehabilitation. P12.5 The effect of enviromental enrichment on the physical and psychomotor developments of rats subjected to maternal deprivation 1 ¨ *, F. Turna1 , H. I˙nce1 , H.A. Tasdemir1 , S. Ata1 , H. Ozyurek 1 1 O.F. Aydin . Ondokuz Mayis University Pediatric Neurology Unit, Turkey
Aim: To investigate the protective activity of enviromental enrichment for the possible detrimental effects of early life maternal deprivation on somatic development, reflex, motor coordination, and behavioral characteristics.
Poster sessions Material-Methods: There were three groups in our study including control, rats subjected to maternal deprivation, and rats exposed to enviromental enrichment after maternal deprivation. All pups except control group were deprivated from their mothers from postnatal day 2−14 for 3h daily. Enviromental enrichment group was located into enriched cages after day 14 until behavioral tests. Somatic and reflex developments (righting reflex, negative geotaxis reflex) were tested during the first 2 weeks. Open-field, elevated plus maze, forced swim and passive avoidance tests were performed on postnatal weeks 5−8. Statistical analysis was performed using two-way analysis of variance (ANOVA) followed by Tukey-Kramer post hoc analysis. Results were considered significant when p < 0.05. Results: Compared to control animals, maternally deprivated rats showed an increase in reversal latency in negative geotaxis and righting reflexes. In terms of somatic development, there was no significant difference between the two groups. Maternally deprivated rats spent more time in the closed arms than in the open arms of elevated plus maze. In the open field test, they showed less motor activity and spent more time in the center compared to enriched and control animals. The deprivated animals showed increased immobilization period in the forced swimming test and they entered the dark room after a shorter period during passive avoidance test. Although the maternally deprivated rats showed the increased depressive and anxiety behaviors, the enriched animals performed more motor activity in the open field, less immobilization period in the forced swimming test. In the passive avoidance test, there was no significant difference between control and enrichment group. Conclusion: The study is the first extensive study showing that the detrimental effects of early life maternal deprivation can be compensated via environmental enrichment. P12.6 Does cognitive impairment in Dravet syndrome come from a cerebellar disorder? D. Battaglia1 *, D. Chieffo1 , D. Lettori1 , C. Brogna1 , D. Leone1 , B. Gentile1 , G. Leo1 , E.M. Mercuri1 , C. Dravet1 , F. Guzzetta1 . 1 Child Neurology Catholic University, Rome, Italy Dravet syndrome is an epileptic syndrome consisting of early onset prolonged febrile seizures, followed by polymorphic seizures (unilateral or generalized, myoclonic, atypical absences, epileptic status) and associated with a cognitive decline. Speculation on aetiology and mechanisms underlying cognitive impairment in Dravet syndrome is still controversial. The question thus may arise about possible causes other than epilepsy accounting for the cognitive impairment. Cerebellum involvement in Dravet syndrome is suggested by neurological findings such as hypotonia and ataxia. Furthermore, such cerebellar involvement has been supported by recent experimental studies that showed a decreased excitability of inhibitory cerebellar Purkinje neurons in the mouse genetic model with loss of function in Nav 1.1, leading to possible cortical deleterious effects such as epileptic and developmental disorders. So, it is particularly interesting to verify whether cerebellum may play a contributing role in determining the cognitive impairment in Dravet syndrome. The authors report a study on 12 patients with Dravet syndrome who were assessed using a detailed clinical and neuropsychological evaluation. Neuropsychological assessment in particular consisted of an extensive evaluation of specific cognitive abilities including attention, language, visual and verbal memory, visuo-motor and visuoperceptual abilities, executive functions. The pattern of cognitive impairment with a particular deficit in attention, visual and executive functions associated with specific language disorders especially affecting the phonologic loop in a context
Aim: To investigate the protective activity of enviromental enrichment for the possible detrimental effects of early life maternal deprivation on somatic development, reflex, motor coordination, and behavioral characteristics.
Poster sessions Material-Methods: There were three groups in our study including control, rats subjected to maternal deprivation, and rats exposed to enviromental enrichment after maternal deprivation. All pups except control group were deprivated from their mothers from postnatal day 2−14 for 3h daily. Enviromental enrichment group was located into enriched cages after day 14 until behavioral tests. Somatic and reflex developments (righting reflex, negative geotaxis reflex) were tested during the first 2 weeks. Open-field, elevated plus maze, forced swim and passive avoidance tests were performed on postnatal weeks 5−8. Statistical analysis was performed using two-way analysis of variance (ANOVA) followed by Tukey-Kramer post hoc analysis. Results were considered significant when p < 0.05. Results: Compared to control animals, maternally deprivated rats showed an increase in reversal latency in negative geotaxis and righting reflexes. In terms of somatic development, there was no significant difference between the two groups. Maternally deprivated rats spent more time in the closed arms than in the open arms of elevated plus maze. In the open field test, they showed less motor activity and spent more time in the center compared to enriched and control animals. The deprivated animals showed increased immobilization period in the forced swimming test and they entered the dark room after a shorter period during passive avoidance test. Although the maternally deprivated rats showed the increased depressive and anxiety behaviors, the enriched animals performed more motor activity in the open field, less immobilization period in the forced swimming test. In the passive avoidance test, there was no significant difference between control and enrichment group. Conclusion: The study is the first extensive study showing that the detrimental effects of early life maternal deprivation can be compensated via environmental enrichment. P12.6 Does cognitive impairment in Dravet syndrome come from a cerebellar disorder? D. Battaglia1 *, D. Chieffo1 , D. Lettori1 , C. Brogna1 , D. Leone1 , B. Gentile1 , G. Leo1 , E.M. Mercuri1 , C. Dravet1 , F. Guzzetta1 . 1 Child Neurology Catholic University, Rome, Italy Dravet syndrome is an epileptic syndrome consisting of early onset prolonged febrile seizures, followed by polymorphic seizures (unilateral or generalized, myoclonic, atypical absences, epileptic status) and associated with a cognitive decline. Speculation on aetiology and mechanisms underlying cognitive impairment in Dravet syndrome is still controversial. The question thus may arise about possible causes other than epilepsy accounting for the cognitive impairment. Cerebellum involvement in Dravet syndrome is suggested by neurological findings such as hypotonia and ataxia. Furthermore, such cerebellar involvement has been supported by recent experimental studies that showed a decreased excitability of inhibitory cerebellar Purkinje neurons in the mouse genetic model with loss of function in Nav 1.1, leading to possible cortical deleterious effects such as epileptic and developmental disorders. So, it is particularly interesting to verify whether cerebellum may play a contributing role in determining the cognitive impairment in Dravet syndrome. The authors report a study on 12 patients with Dravet syndrome who were assessed using a detailed clinical and neuropsychological evaluation. Neuropsychological assessment in particular consisted of an extensive evaluation of specific cognitive abilities including attention, language, visual and verbal memory, visuo-motor and visuoperceptual abilities, executive functions. The pattern of cognitive impairment with a particular deficit in attention, visual and executive functions associated with specific language disorders especially affecting the phonologic loop in a context