Psychic disturbances in infiltrative gliomata of the brain stem

Pathological laughter and behavioural change in childhood pontine glioma

Children with pontine glioma usually present classically with ataxia, motor deficits and cranial nerve palsies. The pons has generally not been regarded as a structure that mediates complex affective behaviour. However, we report nine children who either at the time of presentation or progression demonstrated marked behavioural changes manifesting as either "pathological laughter" or separation anxiety in the form of school refusal. A mechanism of how pontine lesions can cause such complex affective and cognitive behaviour has been suggested to consist of the disruption of a network of cerebro-ponto-cerebellar pathways and the evidence for this mechanism is discussed.

Neuropsychiatry and child psychiatry: the case of the brainstem evoked potential as an illustration

In child psychiatry one may frequently and reasonably suspect the existence of a neurophysiological abnormality of some kind even though this abnormality is not detectable with readily available technology: in children presenting developmental or acquired aphasia, in some specific learning disabilities, in severe developmental disorders or perhaps in a subgroup of those labeled Attention Deficit Disorder. 1. The importance for us as child psychiatrists to keep in mind the possible role of neurophysiological factors is put into perspective. 2. What Evoked Potentials are is briefly described as well as the basic principles of the technique used in recording them. 3. A review of the literature reveals how the Brainstem Auditory Evoked Responses (BAER) have helped in understanding unknown facets of known diseases (Diabetes, Hyperthyroidism, Bell Palsy, etc. . . . ) from this, it is argued that this is reasonable to expect the same usefulness for diagnosis in child psychiatry. 4. An opinion is offered as to how and when a child psychiatrist should make use of this investigation.