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Suppiej A, Ceccato C, Maritan V, Cermakova I, Colavito D, Leon A. Exome sequencing and electro-clinical features in pediatric patients with very early-onset retinal dystrophies: A cohort study. Eur J Paediatr Neurol 2021; 31:1-9. [PMID: 33529788 DOI: 10.1016/j.ejpn.2021.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/01/2021] [Accepted: 01/10/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVE Inherited retinal dystrophies (IRDs) are a major cause of childhood blindness. Timely diagnosis requires a high level of clinical suspicion from both neurologists and ophthalmologists and is increasingly important given recent advancements in gene therapy. We focused our study on genotype-phenotype associations in very early-onset forms of retinal dystrophy, the least well characterized and most challenging diagnostic subgroup. METHODS From January 12, 2015 to March 31, 2017, we prospectively performed whole exome sequencing targeted on the phenotype of non-syndromic IRDs and phenotype characterization in a cohort of 68 children affected by very early-onset inherited retinal dystrophies, defined by the onset before five years of age. Phenotype parameters included age at onset, clinical presentation, ophthalmic evaluation, electrophysiological patterns and clinical course. RESULTS A genetically confirmed diagnosis was achieved in 50 out of 60 (83%) families. The median age at onset was 4 months (<6 m in 70%, < 2 y in 82% of the cases). Clinical presentation was associated with visual loss and nystagmus in the majority of patients. Three (CNGB3, CNGA3 and CACNA1F) out of 22 genes considered pathogenic in the cohort, accounted for 51% of all IRD's, all within the class of stationary IRDs. CONCLUSIONS This study reports on the largest cohort of very early-onset retinal dystrophies, including a description of electroretinography patterns. The electro-clinical phenotype coupled with genetic diagnosis provided additional clues for child neurologists dealing with low vision and nystagmus in infancy. A high level of clinical suspicion improves the diagnosis with important implications for the future of the affected child.
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Affiliation(s)
- A Suppiej
- Department of Medical Sciences, Paediatric Section, University of Ferrara, Italy; Paediatric University Hospital of Padova- Neuro-ophthalmology Program, Italy; Robert Hollman Foundation, Padova, Italy.
| | - C Ceccato
- Robert Hollman Foundation, Padova, Italy
| | - V Maritan
- Paediatric University Hospital of Padova- Neuro-ophthalmology Program, Italy; Ophthalmology Unit, Azienda ULSS 6 Euganea, Padova, Italy
| | | | - D Colavito
- Research & Innovation (R&I Genetics), Padova, Italy
| | - A Leon
- Research & Innovation (R&I Genetics), Padova, Italy
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Suppiej A, Vedovelli L, Boschiero D, Bolzon M, Cainelli E. Abnormal heart rate variability at school age in survivors of neonatal hypoxic-ischemic encephalopathy managed with therapeutic hypothermia. Eur J Paediatr Neurol 2020; 29:66-70. [PMID: 32863129 DOI: 10.1016/j.ejpn.2020.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/13/2020] [Accepted: 08/18/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Major deficits in the autonomic nervous system function, detected by measuring heart rate variability (HRV), are reported in neonatal hypoxic-ischemic encephalopathy (HIE)). However, it is unknown if they will recover in the long-term. Because of the possible implications for the neurological outcome, this study aimed to evaluate the HRV at school age, in a cohort of children who survived HIE managed with therapeutic hypothermia. METHODS A cross-sectional study of HRV in 40 children: 20 HIE survivors and 20 healthy peers. All underwent 5-min plethysmography using the PPG Stress Flow device (BioTekna Italy). Absolute and normalized HRV spectral power in the very low frequency (VLF), low frequency (LF), and high frequency (HF) bands and total power were compared between patients and healthy children. The outcome evaluation included neurological, cognitive (WISC-IV), and psychosocial (Parent Stress Index-Short Form-PSI-SF and psychosocial interview) measures. RESULTS All mean HRV values were significantly higher in survivors of HIE, compared to healthy peers, with the larger effect size for the HF band (Total Power 8.57 ± 0.59 vs 7.82 ± 0.77 ms2, p .003 ES 0.21; HF 7.82 + 0.77 vs 8.57 + 0.59 ms2, p .001 EF 0.24). None of the children had major health, neurological and psychosocial (PSI-SF/interview) problems. The IQ (WISC-IV) was normal in 17/20 patients, borderline in 2, and <70 in 1. CONCLUSIONS HRV measures highlight autonomic dysfunction at school age in survivors of neonatal HIE, in the absence of major neurodevelopmental and psychosocial problems. The significance of this finding for children's future life needs further neuropsychiatric investigations and longer follow-up.
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Affiliation(s)
- A Suppiej
- Department of Medical Sciences, Paediatric Section, University of Ferrara, Italy; Pediatric University Hospital, Padova, Italy.
| | - L Vedovelli
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Italy
| | - D Boschiero
- BIOTEKNA Biomedical Technologies, Venice, Italy
| | - M Bolzon
- Neuro-Intensive Care and Anaesthesiology, University Hospital, Borgo Trento Hospital, Verona, Italy
| | - E Cainelli
- Pediatric University Hospital, Padova, Italy; Department of Developmental and Social Psychology, University of Padova, Italy
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Bah MG, Rodriguez D, Cazeneuve C, Mochel F, Devos D, Suppiej A, Roubertie A, Meunier I, Gitiaux C, Curie A, Klapczynski F, Allani‐Essid N, Carneiro M, Van Minkelen R, Kievit A, Fluss J, Leheup B, Ratbi L, Héron D, Gras D, Do Cao J, Pichard S, Strubi‐Villaume I, Audo I, Lesca G, Charles P, Dubois F, Comet‐Didierjean P, Capri Y, Barondiot C, Barathon M, Ewenczyk C, Durr A, Mignot C. Deciphering the natural history of SCA7 in children. Eur J Neurol 2020; 27:2267-2276. [DOI: 10.1111/ene.14405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 06/10/2020] [Indexed: 11/30/2022]
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Suppiej A, Toffoli E, Festa I, Cervesi C, Cappellari A, Manara R, Magarotto M, Cainelli E. Perinatal carotid artery ischemic stroke: Report of two cases. J Neonatal Perinatal Med 2019; 12:479-485. [PMID: 31450516 DOI: 10.3233/npm-1816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The mechanisms of perinatal stroke are poorly understood but preclinical studies point to the crucial role of perinatal inflammation. Carotid artery occlusion represents a very rare and severe cause of perinatal stroke. We describe two cases diagnosed with extensive ischemic stroke due to carotid artery occlusion. In both cases, we demonstrated placental vasculopathy. High levels of C-reactive protein in mother and/or neonates suggested inflammatory mechanism as a potential trigger. Both cases underwent hypothermic treatment without complications because of initial diagnosis of perinatal asphyxia. The prognosis at the time of the last follow up was severe including cerebral palsy, epilepsy and cognitive impairment. Our cases contribute to the actual debate on pathogenic mechanisms and treatment options for this rare condition.
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Affiliation(s)
- A Suppiej
- Department of Medical Sciences, Pediatric Section, University of Ferrara, Ferrara, Italy.,Child Neurology and Clinical Neurophysiology, Pediatric University Hospital, Padua, Italy
| | - E Toffoli
- Child Neurology and Clinical Neurophysiology, Pediatric University Hospital, Padua, Italy
| | - I Festa
- Child Neurology and Clinical Neurophysiology, Pediatric University Hospital, Padua, Italy
| | - C Cervesi
- Child Neurology and Clinical Neurophysiology, Pediatric University Hospital, Padua, Italy
| | - A Cappellari
- Child Neurology and Clinical Neurophysiology, Pediatric University Hospital, Padua, Italy
| | - R Manara
- Department of Neurosciences, Neuroradiology Unit, University of Salerno, Salerno, Italy
| | - M Magarotto
- Neonatal Intensive Care Unit, Pediatric University Hospital, Padua, Italy
| | - E Cainelli
- Child Neurology and Clinical Neurophysiology, Pediatric University Hospital, Padua, Italy
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Burattin E, Ceccato C, Ermani M, Schoch V, Suppiej A. Steady-state flash VEPs in children with optic nerve atrophy: preliminary data. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2018.09.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Cainelli E, Vedovelli L, Bolzon M, Santangelo L, Suppiej A. Heart rate variability in the healthy school-age children. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2018.09.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Cainelli E, Trevisanuto D, Cavallin F, Suppiej A. Evoked potentials predict psychomotor development in neonates with normal MRI after hypothermia for hypoxic-ischemic encephalopathy. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2018.09.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Suppiej A, Schoch V, Ceccato C. Skin-electroretinography patterns in early onset retinal dystrophies. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2018.09.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Spagnolo V, Agatiello M, Trevisanuto D, Talenti G, Cainelli E, Suppiej A. Clinical and electroencephalographic risk factors for severe outcome in asphyxiated neonates undergoing therapeutic hypothermia. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2018.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cione G, Cainelli E, Cappellari A, Di Capua M, Janes A, Pro S, Vittorini R, Manara R, Suppiej A. 36. Bilateral loss of cortical SEPs predict severe MRI lesions in neonatal hypoxic ischemic encephalopathy treated with hypothermia. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Agatiello M, Cainelli E, Fava E, Toffoli E, Tessari L, Scarabel F, Cappellari A, Sole M, Di Capua M, Suppiej A. 87. Median nerve SEPs predict motor outcome in neonatal ipossic-ischemic encephalopathy treated with hypothermia. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.09.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Santangelo L, Cainelli E, Nosadini M, Sartori S, Sole M, Suppiej A. 3. Evaluation of long term cognitive risks associated with the presence of seizure during acute disseminated encephalomyelitis. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Verrotti A, Laino D, Rinaldi VE, Suppiej A, Giordano L, Toldo I, Margari L, Parisi P, Rizzo R, Matricardi S, Cusmai R, Grosso S, Gaggero R, Zamponi N, Pavone P, Capovilla G, Rauchenzauner M, Cerminara C, Di Gennaro G, Esposito M, Striano P, Savasta S, Coppola G, Siliquini S, Operto F, Belcastro V, Ragona F, Marseglia GL, Spalice A. Clinical dissection of childhood occipital epilepsy of Gastaut and prognostic implication. Eur J Neurol 2015; 23:241-6. [PMID: 26498733 DOI: 10.1111/ene.12840] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/03/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to describe the clinical and electrical features and the long-term evolution of childhood occipital epilepsy of Gastaut (COE-G) in a cohort of patients and to compare long-term prognosis between patients with and without other epileptic syndromes. METHODS This was a retrospective analysis of the long-term outcome of epilepsy in 129 patients with COE-G who were referred to 23 Italian epilepsy centres and one in Austria between 1991 and 2004. Patients were evaluated clinically and with electroencephalograms for 10.1-23.0 years. The following clinical characteristics were evaluated: gender, patient age at seizure onset, history of febrile seizures and migraine, family history of epilepsy, duration and seizure manifestations, circadian distribution and frequency of seizures, history of medications including the number of drugs, therapeutic response and final outcome. RESULTS Visual hallucinations were the first symptom in 62% and the only manifestation in 38.8% of patients. Patients were subdivided into two groups: group A with isolated COE-G; group B with other epileptic syndromes associated with COE-G. The most significant (P < 0.05) difference concerned antiepileptic therapy: in group A, 45 children responded to monotherapy; in group B only 15 children responded to monotherapy. At the end of follow-up, the percentage of seizure-free patients was significantly higher in group A than in group B. CONCLUSIONS Childhood occipital epilepsy of Gastaut has an overall favourable prognosis and a good response to antiepileptic therapy with resolution of seizures and of electroencephalogram abnormalities. The association of typical COE-G symptoms with other types of seizure could be related to a poor epilepsy outcome.
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Affiliation(s)
- A Verrotti
- Department of Paediatrics, University of Perugia, Perugia, Italy
| | - D Laino
- Department of Paediatrics, University of Perugia, Perugia, Italy
| | - V E Rinaldi
- Department of Paediatrics, University of Perugia, Perugia, Italy
| | - A Suppiej
- Paediatric Neurology Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - L Giordano
- Paediatric Neuropsychiatric Division, Spedali Civili, Brescia, Italy
| | - I Toldo
- Paediatric Neurology Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - L Margari
- Unit of Child Neuropsychiatry, Department of Basic Medical Sciences, Neuroscience and Sense Organs, 'Aldo Moro' University of Bari, Bari, Italy
| | - P Parisi
- NESMOS Department, Chair of Paediatrics, Paediatric Headache Centre, Paediatric Sleep Centre and Child Neurology, Faculty of Medicine and Psychology, Sant'Andrea Hospital, 'Sapienza University', Roma, Italy
| | - R Rizzo
- Section of Child Neuropsychiatry, Department of Paediatrics, University of Catania, Catania, Italy
| | - S Matricardi
- Departement of Paediatrics, University of Chieti, Chieti, Italy.,Department of Paediatric Neuroscience, Foundation IRCCS Neurological Institute 'C. Besta', Milano, Italy
| | - R Cusmai
- Neurology Unit, 'Bambino Gesù' Children's Hospital, IRCCS, Roma, Italy
| | - S Grosso
- Paediatric Neurology-Immunology and Endocrinology Unit, University of Siena, Siena, Italy
| | - R Gaggero
- Paediatric Unit, San Paolo Hospital, Savona, Italy
| | - N Zamponi
- Child Neuropsychiatry Unit, Polytechnic University of the Marche, Ancona, Italy
| | - P Pavone
- Unit of Paediatrics and Paediatric Emergency 'Costanza Gravina', University-Hospital 'Vittorio Emanuele, Policlinic', University of Catania, Catania, Italy
| | - G Capovilla
- Department of Child Neuropsychiatry, Epilepsy Centre, C. Poma Hospital, Mantova, Italy
| | - M Rauchenzauner
- Department of Paediatrics, Medical University Innsbruck, Innsbruck, Austria
| | - C Cerminara
- Paediatric Neurology, Department of Neurosciences, Tor Vergata University of Rome, Roma, Italy
| | | | - M Esposito
- Department of Mental Health, Physical and Preventive Medicine, Clinic of Child and Adolescent Neuropsychiatry, Centre for Childhood Headache, Second University of Naples, Napoli, Italy
| | - P Striano
- Paediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 'G. Gaslini' Institute, Genova, Italy
| | - S Savasta
- Department of Paediatrics, Pavia University Foundation, IRCCS Policlinico San Matteo, Pavia, Italy
| | - G Coppola
- Child and Adolescent Neuropsychiatry, Medical School, University of Salerno, Salerno, Italy
| | - S Siliquini
- Child Neuropsychiatry Unit, Polytechnic University of the Marche, Ancona, Italy
| | - F Operto
- Unit of Child Neuropsychiatry, Department of Basic Medical Sciences, Neuroscience and Sense Organs, 'Aldo Moro' University of Bari, Bari, Italy
| | - V Belcastro
- Neurology Unit, Department of Neuroscience, 'Sant'Anna' Hospital, Como, Italy
| | - F Ragona
- Department of Paediatric Neuroscience, Foundation IRCCS Neurological Institute 'C. Besta', Milano, Italy
| | - G L Marseglia
- Department of Paediatrics, Pavia University Foundation, IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Spalice
- Child Neurology, Chair of Paediatrics, II Faculty of Medicine, University of Rome, Roma, Italy
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Agatiello M, Toffoli E, Scarabel F, Tessari L, Traverso A, Bizzaro E, Capua MD, Pro S, Cappellari A, Suppiej A. 17. Somatosensory evoked potentials recorded during hypothermia in neonatal hypoxic–ischemic encephalopathy. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2014.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Cainelli E, Cappellari A, Bisiacchi P, Sole M, Di Bono M, Suppiej A. 19. Early brain connectivity differences in premature infants. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2014.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sole M, Cainelli E, Cappellari A, Bisiacchi P, Suppiej A. 27. Prognostic role of spectral analysis of the EEG in premature infants. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2014.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Cainelli E, de Palma L, Nosadini M, Sartori S, Boniver C, Suppiej A. 20. Spectral analysis of the eeg in paediatric anti-NMDAR encephalitis. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2014.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Cappellari A, Cainelli E, Trevisanuto D, Mardari R, Manara R, Suppiej A. 7. Bilateral absence of cortical SEP and neuroimaging: Study of a cohort of 40 neonates suffering from hypoxic-ischemic encephalopathy treated with therapeutic hypothermia. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Toffoli E, Carlo DD, Cappellari A, Cainelli E, Trevisanuto D, Suppiej A. 113. Neurophysiology in neonatal stroke undergoing therapeutic hypotermia: An illustrative case. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Scaioli V, Suppiej A, Lori S, Capua MD, Cappellari A, Curzi S, Alessandri B, Gualandi D. 109. Multicenter evaluation of somatosensory evoked potentials (SEPs) normative data in infancy. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tessari L, Bizzaro E, Toffoli E, Cappellari A, Cainelli E, Suppiej A. 111. The utility of video EEG in very early prematurity: A case of twin babies. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cainelli E, Cappellari A, Bisiacchi P, Trevisanuto D, Suppiej A. 60. Spectral analysis of the neurophysiological activity in the human developing brain. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nosadini M, Sartori S, Toldo I, Cappellari A, de Palma L, Cainelli E, Zuliani L, Giometto B, Boniver C, Suppiej A. 114. Movement disorder and EEG patterns in anti-NMDAr antibodies encephalitis. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zuliani L, Zoccarato M, Sartori S, Pelizza M, Rosellini I, Argentiero V, Marson P, Suppiej A, Giometto B. Anti-NMDAR encephalitis: Clinical and immunological characterization of a case series. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.2312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Suppiej A, Cainelli E, De Benedittis M, Rizzardi E, Bisiacchi PS, Ermani M, Orzan E, Zanardo V. Failure of hearing screening in high-risk neonates does not increase parental anxiety. J Matern Fetal Neonatal Med 2013; 26:932-5. [PMID: 23327442 DOI: 10.3109/14767058.2013.766687] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether a failure of neonatal hearing screening affected the anxiety level of parents of high-risk infants. METHODS Two hundred and eighty-eight parents of infants included in the neonatal hearing screening protocol of our Institution were tested with the Spielberger State-Trait Anxiety Inventory and with an open-question questionnaire investigating parents' attitude to hearing problems in their child, done at the time of audiological follow-up. 105 were parents of high-risk infants who had been discharged from neonatal intensive care unit (NICU) and 183 of low-risk infants discharged from well-baby nursery. RESULTS No differences in anxiety levels were seen between parents of high-risk infants passing and failing neonatal hearing screening using homogeneous case-control pairs. Additionally, no differences in the level of anxiety were found between parents of high- and low-risk infants failing neonatal auditory screening. CONCLUSIONS Failure of neonatal auditory screening does not affect the anxiety levels of parents of high-risk infants at post discharge from NICU. This finding is a key factor to be considered when evaluating the costs and benefits of tests for universal neonatal hearing screening.
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Affiliation(s)
- A Suppiej
- Child Neurology and Clinical Neurophysiology, Paediatric University Hospital, Padua, Italy.
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Suppiej A, Cappellari A, De Caro D, Traverso A, Trevisanuto D, Ermani M. P12.11 Effect of hypothermia on somatosensory evoked potentials and electroencephalogram in infants with birth asphyxia. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60414-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Suppiej A, Festa I, Bartolini L, Cappellari A, Trevisanuto D, Ermani M. S9.4 Power spectral analysis of two-channel EEG in very preterm infants undergoing heat loss prevention. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60072-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Suppiej A, Cappellari A, Franzoi M, Traverso A, Ermani M, Zanardo V. Bilateral loss of cortical somatosensory evoked potential at birth predicts cerebral palsy in term and near-term newborns. Early Hum Dev 2010; 86:93-8. [PMID: 20172665 DOI: 10.1016/j.earlhumdev.2010.01.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 01/21/2010] [Accepted: 01/29/2010] [Indexed: 11/28/2022]
Abstract
Bilateral loss of cortical somatosensory evoked potential (SEP) is considered the single best indicator of adverse outcome in acute encephalopathy of adult patients and older children. This study determines whether the presence or absence of the neonatal cortical SEP can predict cerebral palsy at two years in survivors of neonatal encephalopathy scored according to Sarnat criteria. We also compare SEPs with visual evoked potentials (VEPs), the EEG and neonatal neurological status. Fifty-nine neonates admitted to the neonatal intensive care unit had SEP, VEP and EEG recordings analysed according to the presence (n=37, 63%) or absence (n=22, 37%) of neonatal encephalopathy (score >or=1). Cortical SEP was always present in the perinatal period in those surviving without major neurological disability, while it was bilaterally absent in all but one patient with a subsequent diagnosis of cerebral palsy. Multivariate analysis using the logistic regression model showed that bilateral loss of cortical SEP and Sarnat Score correctly classified the neurological outcome in all patients. Bilateral absence of cortical SEP indicates early identification of neonates at risk of cerebral palsy indicating that EPs have a clinical role in the workup of neonatal encephalopathy.
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Affiliation(s)
- A Suppiej
- Child Neurology and Clinical Neurophysiology Unit, Department of Paediatrics, University of Padova, Italy. >
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Travaglini L, Brancati F, Attie-Bitach T, Audollent S, Bertini E, Kaplan J, Perrault I, Iannicelli M, Mancuso B, Rigoli L, Rozet JM, Swistun D, Tolentino J, Dallapiccola B, Gleeson JG, Valente EM, Zankl A, Leventer R, Grattan-Smith P, Janecke A, D'Hooghe M, Sznajer Y, Van Coster R, Demerleir L, Dias K, Moco C, Moreira A, Kim CA, Maegawa G, Petkovic D, Abdel-Salam GMH, Abdel-Aleem A, Zaki MS, Marti I, Quijano-Roy S, Sigaudy S, de Lonlay P, Romano S, Touraine R, Koenig M, Lagier-Tourenne C, Messer J, Collignon P, Wolf N, Philippi H, Kitsiou Tzeli S, Halldorsson S, Johannsdottir J, Ludvigsson P, Phadke SR, Udani V, Stuart B, Magee A, Lev D, Michelson M, Ben-Zeev B, Fischetto R, Benedicenti F, Stanzial F, Borgatti R, Accorsi P, Battaglia S, Fazzi E, Giordano L, Pinelli L, Boccone L, Bigoni S, Ferlini A, Donati MA, Caridi G, Divizia MT, Faravelli F, Ghiggeri G, Pessagno A, Briguglio M, Briuglia S, Salpietro CD, Tortorella G, Adami A, Castorina P, Lalatta F, Marra G, Riva D, Scelsa B, Spaccini L, Uziel G, Del Giudice E, Laverda AM, Ludwig K, Permunian A, Suppiej A, Signorini S, Uggetti C, Battini R, Di Giacomo M, Cilio MR, Di Sabato ML, Leuzzi V, Parisi P, Pollazzon M, Silengo M, De Vescovi R, Greco D, Romano C, Cazzagon M, Simonati A, Al-Tawari AA, Bastaki L, Mégarbané A, Sabolic Avramovska V, de Jong MM, Stromme P, Koul R, Rajab A, Azam M, Barbot C, Martorell Sampol L, Rodriguez B, Pascual-Castroviejo I, Teber S, Anlar B, Comu S, Karaca E, Kayserili H, Yüksel A, Akcakus M, Al Gazali L, Sztriha L, Nicholl D, Woods CG, Bennett C, Hurst J, Sheridan E, Barnicoat A, Hennekam R, Lees M, Blair E, Bernes S, Sanchez H, Clark AE, DeMarco E, Donahue C, Sherr E, Hahn J, Sanger TD, Gallager TE, Dobyns WB, Daugherty C, Krishnamoorthy KS, Sarco D, Walsh CA, McKanna T, Milisa J, Chung WK, De Vivo DC, Raynes H, Schubert R, Seward A, Brooks DG, Goldstein A, Caldwell J, Finsecke E, Maria BL, Holden K, Cruse RP, Swoboda KJ, Viskochil D. Expanding CEP290 mutational spectrum in ciliopathies. Am J Med Genet A 2009; 149A:2173-80. [PMID: 19764032 DOI: 10.1002/ajmg.a.33025] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Ciliopathies are an expanding group of rare conditions characterized by multiorgan involvement, that are caused by mutations in genes encoding for proteins of the primary cilium or its apparatus. Among these genes, CEP290 bears an intriguing allelic spectrum, being commonly mutated in Joubert syndrome and related disorders (JSRD), Meckel syndrome (MKS), Senior-Loken syndrome and isolated Leber congenital amaurosis (LCA). Although these conditions are recessively inherited, in a subset of patients only one CEP290 mutation could be detected. To assess whether genomic rearrangements involving the CEP290 gene could represent a possible mutational mechanism in these cases, exon dosage analysis on genomic DNA was performed in two groups of CEP290 heterozygous patients, including five JSRD/MKS cases and four LCA, respectively. In one JSRD patient, we identified a large heterozygous deletion encompassing CEP290 C-terminus that resulted in marked reduction of mRNA expression. No copy number alterations were identified in the remaining probands. The present work expands the CEP290 genotypic spectrum to include multiexon deletions. Although this mechanism does not appear to be frequent, screening for genomic rearrangements should be considered in patients in whom a single CEP290 mutated allele was identified.
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Affiliation(s)
- Lorena Travaglini
- CSS-Mendel Institute, Casa Sollievo della Sofferenza Hospital, Rome, Italy
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Abstract
BACKGROUND A tethered cord (TC) has been reported in as much as 50% of the patients affected by anorectal malformation (ARM). No guidelines for timing and modality of diagnosis and treatment have been established. We present the preliminary results of a multidisciplinary protocol carried out at our center. METHODS Seventy-four ARM patients underwent spinal magnetic resonance imaging (MRI). All TC patients underwent videourodynamic (UD), somatosensory-evoked potentials (SEPs), and neurological examination at baseline and, if normal, at 5 and 10 years of age. Conversely, when UD or SEP abnormalities were detected the follow-up was individually tailored at shorter time. RESULTS 25/74 patients had a neuroradiological TC (33.7%). Based on the results of UD, SEP, and neurological status, four patients were untethered, eight are possible candidates, nine are stable, and four were excluded because of incomplete data. DISCUSSION Tethered cord is frequent in ARM patients. Because neurological deficits secondary to TC can contribute to neurological disability, we recommend routine MRI examination and a multidisciplinary program of follow-up in cases of TC. Preliminary results suggest the combined use of SEPs and UD could represent a useful adjunct to clinical examination in patients in whom a "wait and see" approach is preferred to the prophylactic surgery.
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Affiliation(s)
- A Suppiej
- Child Neurology and Clinical Neurophysiology Unit, University of Padua, Padua, Italy
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Suppiej A, Cappellari A, Cogo P. Prognostic role of somatosensory and auditory evoked potentials in paediatric hypoxic-ischemic encephalopathy managed with hypothermia: An illustrative case. Neurophysiol Clin 2009; 39:101-5. [DOI: 10.1016/j.neucli.2009.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 11/21/2008] [Accepted: 02/22/2009] [Indexed: 10/21/2022] Open
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Zannin ME, Martini G, Buscain I, Cermakova I, Suppiej A, Manara R, Zulian F. Sudden visual loss in a child with juvenile idiopathic arthritis-related uveitis. Br J Ophthalmol 2009; 93:282-3, 417. [DOI: 10.1136/bjo.2008.137794] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Atzori M, Battistella PA, Perini P, Calabrese M, Fontanin M, Laverda AM, Suppiej A, Drigo P, Grossi P, Rinaldi L, Gallo P. Clinical and diagnostic aspects of multiple sclerosis and acute monophasic encephalomyelitis in pediatric patients: a single centre prospective study. Mult Scler 2008; 15:363-70. [PMID: 18987105 DOI: 10.1177/1352458508098562] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of the study was to compare and contrast the initial presenting demographic, clinical, neuroimaging, and laboratory features in a cohort of children affected from multiple sclerosis (MS) or acute disseminated encephalomyelitis (ADEM). METHODS A 12-year prospective study was conducted in 68 pediatric patients (age<or=17 years) who presented with a first episode of central nervous system inflammation suggestive of a demyelinating multifocal pathology. All patients had undergone magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) examination. The mean follow-up period, as at ending on December 31, 2007, was 6.8+/-2.7 years (range 3.2-12.6 years). RESULTS At clinical onset, children who developed MS during the follow-up (48 patients; 34 females, 14 males; mean age at onset: 14.4+/-2.5) significantly differed from children affected by ADEM (20 patients; 8 females, 12 males; mean age at onset: 8.1+/-3.8) for the following parameters: prevalence of females affected (female/male ratio: 2.8 versus 0.6, P=0.03); mean age at onset (P<0.001); monosymptomatic onset (73% vs 30%, P=0.002); encephalopathy-like onset (0% vs 50%, P<0.001); presence of oligoclonal IgG bands (IgGOB) in CSF (83% vs 10%, P<0.001); and periventricular (79% vs 20%, P<0.001), brain stem (12.5% vs 60%, P=0.000), and basal ganglia (10% vs 50%, P<0.001) lesions at MRI. CONCLUSIONS Our findings depict a pattern of demographic, clinical, neuroimaging, and laboratory findings that can help to distinguish, at clinical onset, children suffering from ADEM from those who will develop MS. Childhood-onset MS seems not to differ from adult-onset MS from both clinical and paraclinical features.
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Affiliation(s)
- M Atzori
- Multiple Sclerosis Centre of The Veneto Region, First Neurology Clinic, Department of Pediatrics, University of Padova, and Department of Neuroscience, University Hospital of Padova, Padova, Italy.
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34
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Suppiej A, Rizzardi E, Zanardo V, Franzoi M, Ermani M, Orzan E. Reliability of hearing screening in high-risk neonates: Comparative study of otoacoustic emission, automated and conventional auditory brainstem response. Clin Neurophysiol 2007; 118:869-76. [PMID: 17317296 DOI: 10.1016/j.clinph.2006.12.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Revised: 12/08/2006] [Accepted: 12/26/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the diagnostic reliability of automated transient evoked otoacoustic emissions (a-TEOAE), automated auditory brainstem response (a-ABR) and conventional brainstem auditory evoked potential (BAEP/ABR) for identification of hearing loss in high-risk neonates. METHODS Two hundred and six neonatal intensive care unit (NICU) admitted neonates were tested pre-discharge. Follow-up included a-TEOAE in all children, repetition of a-ABR or BAEP if failed in NICU. Sensitivity and specificity were compared and correlated with auditory risk factors. RESULTS BAEP had the highest sensitivity (100%) and specificity (90.8%), a-ABR the lowest (88.9% and 70.6%). A statistically significant difference in risk factors for temporary hearing loss was observed between normal and false positive a-TEOAE and BAEP, but not a-ABR outcome. Differences in specificity between a-ABR and a-TEOAE explain the pattern of "absent a-ABR/present a-TEOAE" in 13.8% of ears. CONCLUSIONS The BAEP appears the more reliable test for hearing screening of high-risk neonates because of highest sensitivity and specificity and should be used to confirm the diagnosis of "auditory neuropathy" in high-risk neonates. The reliability of a-ABR devices in critically ill neonates needs further investigation. SIGNIFICANCE This is, to our knowledge, the first attempt to compare the diagnostic reliability of a-TEOAE, a-ABR and BAEP in high-risk neonates.
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Affiliation(s)
- A Suppiej
- Department of Clinical Neurophysiology, Pediatric Hospital, University of Padova, 35100 Padua, Italy.
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35
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Suppiej A. [Role of evoked potentials in neonatal hypoxic-ischemic encephalopathy: review of the literature]. Ann Ist Super Sanita 2002; 37:515-25. [PMID: 12046221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Results of the studies on evoked potentials (EP) in neonates with hypoxic-ischaemic encephalopathy and their technical feasibility support extensive application in neonatal intensive care units. The combined application of visual evoked potentials (VEP) and somestesic evoked potentials (SEP) is the method of choice for neurodevelopmental prognostication in full-term neonate; especially useful in cases with moderate encephalopathy; in preterm neonates EP are complementary to head ultrasound scans, particularly early on when the findings are in the process of evolution. Brainstem auditory evoked potentials (BAEP) are the technique of choice for early identification of sensorineural hearing loss necessitating intervention. Long term prognosis on vision and audition is based on VEP and BAEP. Studies devoted to definition of the role of EP in selection of babies and monitoring neuroprotective intervention are warranted.
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Affiliation(s)
- A Suppiej
- Servizio di Neurofisiologia Clinica, Dipartimento di Pediatria, Università degli Studi, Padova
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36
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Zaramella P, Freato F, Amigoni A, Salvadori S, Marangoni P, Suppiej A, Suppjei A, Schiavo B, Chiandetti L. Brain auditory activation measured by near-infrared spectroscopy (NIRS) in neonates. Pediatr Res 2001; 49:213-9. [PMID: 11158516 DOI: 10.1203/00006450-200102000-00014] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study presents a new measure of the hemodynamic changes to an auditory stimulus in newborns. Nineteen newborns born at 28-41 wk and aged 1 to 49 d were studied in waking and/or sleeping state, for a median time of 4 min 40 s before, 2 min 40 s during, and 3 min 5 s after an acustic stimulus (tonal sweep of frequency increasing from 2 to 4 kHz, intensity 90 dB SPL) originating 5 cm from the external auditory meatus. The emitter and detector optodes were placed over the left or right temporal region, corresponding to T3 or T4 EEG electrodes. The concentration changes in cerebral chromophores Delta[HbO2], Delta[Hb] and Deltaoxidized-reduced cytochrome aa(3) were recorded every 5 s. Changes in cerebral blood volume were calculated from the changes in total Hb x 0.89/large vessel Hb concentration. Increased oxyhemoglobin, Delta[HbO2], total Hb, Delta[Hb (sum)], and cerebral blood volume, DeltaCBV, were found in 13/19 neonates, with the exception of a neonate who only had increased in Delta[Hb], Delta[Hb (sum)] and DeltaCBV. During the stimulation phase there was a significant increase in DeltaCBV (t test, p = 0.00006) in the responsive newborns from a mean value of 0.006 (+/-0.02) mL/100 g in the pretest phase to 0.09 (+/-0.06) mL/100 g during the auditory stimulus. After the test DeltaCBV decreased to 0.04 (+/-0.07) mL/100 g (t test, p = 0.01), so did Delta[Hb (sum)] (p = 0.02). Hemodynamic responses of the subjects who showed increases in Delta[Hb (sum)] and Delta[HbO(2)] were analyzed to study the Delta[Hb]. The responder subjects could be classified into two groups according to Delta[Hb] changes: 8/13 (61.5%) showed an increase of Delta[Hb] (pattern A), while 5/13 (38.4%) showed a decrease (pattern B) (t test, p = 0.03). These two patterns did not show differences related to Delta[HbO(2)] and Delta[Hb (sum)]. The DeltaCBV changes in nonresponders presented a decrease during the test phase (t test, p = 0.04). CBV did not return to pretest values, suggesting a fronto-temporal brain pathway for storing unusual sounds. The increase in CBV followed the local increase in oxyhemoglobin and total Hb concentrations due to a greater use of oxygen in the homolateral temporal cortex of the newborns.
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Affiliation(s)
- P Zaramella
- Department of Paediatrics, University of Padua, Via Giustiniani, 3, IT-35128 Padova, Italy
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37
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Burlina AB, Bonafé L, Ferrari V, Suppiej A, Zacchello F, Burlina AP. Measurement of neurotransmitter metabolites in the cerebrospinal fluid of phenylketonuric patients under dietary treatment. J Inherit Metab Dis 2000; 23:313-6. [PMID: 10896282 DOI: 10.1023/a:1005694122277] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- A B Burlina
- Department of Paediatrics, University of Padova, Italy.
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Bisiacchi PS, Suppiej A, Laverda A. Neuropsychological evaluation of neurologically asymptomatic HIV-infected children. Brain Cogn 2000; 43:49-52. [PMID: 10857661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Forty-two children born to HIV positive mothers (29 infected at different stages of the disease, according to the Disease Control Classification Centers, and 13 noninfected) underwent evaluation using a battery of neuropsychological tests. Executive function impairments were present in all infected children, whereas memory and visuo-prassic deficits were evident only in those with full-blown AIDS. Language abilities and overall intelligence were spared. Performance of seroreverters was in the normal range. These findings suggest that even in neurologically asymptomatic children, neuropsychological evaluation can identify early impairment of specific cognitive functions. The findings are discussed in the light of the prognostic power of neuropsychological assessment for early signs of HIV neurological involvement.
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Abstract
A 16-year-old boy with the classic or postinfantile type of Hallervorden-Spatz syndrome is described. Bilateral optic atrophy with visual loss but without retinal changes was the only presenting symptom. Mild cognitive impairment, behavioural disturbances and insidious extrapyramidal involvement appeared later. MRI showed marked symmetrical hypointensity of the globi pallidi and substantia nigra. This new observation suggests that the occurrence of optic atrophy in a patient with Hallervorden-Spatz syndrome should be regarded as noncoincidental and stresses the importance of an accurate neurological work-up in all adolescents with any unusual form of progressive optic atrophy.
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Abstract
In the present era of resource management, there is increasing emphasis on the need to make the best possible use of available resources. We therefore measured the productive factors directly involved in performance of 59 evoked potential examinations (brainstem auditory evoked potentials, BAEPs; flash visual evoked potentials, F-VEPs; and electroretinograms, ERGs) in different pediatric age groups. In order to ascertain the gap between the costs of instrumental examinations performed in our service on children and the fees reimbursed by the Italian national health service (NHS) a breakdown was made of the costs of tests and their scheduling in relation to the different age variables involved. It was found that the fees reimbursed do not cover the real costs, because they underestimate the actual consumption of resources. The findings recorded indicate that for pediatric tests the economic audit should be graded according to the ages of the children examined and should include an analysis of different test phases. The economic audit should also be considered a preliminary step in clinical audit. It is concluded that it is financially punitive to reimburse a pediatric service with a fee based on the examination of adults, because in pediatrics the variable "age" influences the duration and complexity of tests and also their interpretation.
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Affiliation(s)
- M L Chiozza
- Department of Pediatrics, University of Padua, Padova, Italy
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41
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Laverda AM, Battaglia MA, Drigo P, Battistella PA, Casara GL, Suppiej A, Casellato R. Congenital muscular dystrophy, brain and eye abnormalities: one or more clinical entities? Childs Nerv Syst 1993; 9:84-7. [PMID: 8319237 DOI: 10.1007/bf00305313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Four children with congenital muscular dystrophy (CMD), eye and brain abnormalities are described. Their clinical and neuroradiological features are compatible with a diagnosis of Walker-Warburg syndrome (WWS), according to the criteria proposed by Dobyns et al. (i.e., presence of type II lissencephaly, typical cerebellar and retinal malformations, CMD), who also conclude that WWS is indistinguishable from the muscle-eye-brain disease (MEBD) described by Santavuori. On the basis of our own experience and two recently published series, we emphasize certain features that are different in patients with WWS and patients with MEBD, which make their inclusion in the same syndrome dubious.
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Affiliation(s)
- A M Laverda
- Dipartimento di Pediatria, Università di Padova, Padua, Italy
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Abstract
Neurophysiological studies have shown defects in peripheral conduction in up to 75% of adults with end-stage renal disease (ESRD), though abnormalities of central conduction seem more variable. There are no comparable pediatric data. We therefore measured median nerve somatosensory evoked potentials (SEPs) in 10 children with ESRD, maintained by hemodialysis, who had no neurological signs or symptoms, and compared the results with those for age-matched controls. The latencies of N9, P14, N20 and P22, and interpeak latencies, N9-N20, N9-P14 and P14-N20, were not significantly different between the two groups (Student's t test). However, the children with ESRD were significantly retarded in growth and when arm length was taken into account, a significant difference in peripheral conduction was revealed. There was no correlation with other indexes of disease severity (parathormone, aluminium, Hb, Na, K, Cl, BUN and creatinine). SEPs appear to reflect subclinical changes in peripheral conduction in sensory pathways in children with ESRD which are not correlated with other measures of disease severity.
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Affiliation(s)
- A Suppiej
- Department of Pediatrics, University of Padova, Italy
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43
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Boniver C, Suppiej A, Vecchi M, Laverda AM, Drigo P, Battistella PA, Colamaria V, Casara GL. [Encephalopathies with neonatal onset and suppression-burst type EEG pattern]. Minerva Pediatr 1991; 43:209-14. [PMID: 1908050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- C Boniver
- Clinica Pediatrica I, Università di Padova
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Battistella PA, Laverda AM, Drigo P, Boniver C, Suppiej A, Casara GL. [Endocranial calcifications. Diagnostic procedure]. Minerva Pediatr 1991; 43:219-21. [PMID: 1870520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Suppiej A, Drigo P, Salandin M, Boniver C, Laverda AM, Battistella PA, Casara GL. [Early auditory evoked potentials in neuropediatrics]. Minerva Pediatr 1991; 43:179-81. [PMID: 1870515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- A Suppiej
- Clinica Pediatrica I, Università di Padova
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Abstract
99mTC HM-PAO SPECT brain imaging was performed during the headache-free period in 19 young migraineurs, affected by common migraine (CM, 10 cases), classic migraine (CLM, 6 cases) and hemiplegic migraine (HM, 3 cases). SPECT findings were negative in all 10 patients with CM, in 3 cases of CLM and in 2 cases of HM. Positive findings in the remaining 4 patients (3 cases of CLM and 1 of HM) showed a decreased tracer distribution in the temporo-occipital regions (2 cases) and parietal regions (2 cases): the two with decreased temporo-occipital perfusion reported prodromal symptoms exclusively contralateral to the areas of hypoperfusion. An impaired regional cerebral vascular autoregulation may exist even during headache-free intervals in patients suffering from classic and hemiplegic migraine.
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Montini G, Zacchello G, Baraldi E, Zanconato S, Suppiej A, Fabris F, Andreetta B, Pavanello L, Zacchello F. Benefits and risks of anemia correction with recombinant human erythropoietin in children maintained by hemodialysis. J Pediatr 1990; 117:556-60. [PMID: 2213378 DOI: 10.1016/s0022-3476(05)80688-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Ten children with renal failure (age range 2 years 6 months to 18 years 9 months; median 11 years 10 months), maintained by long-term hemodialysis, had successful correction of their anemia after intravenous administration of recombinant human erythropoietin in a dosage escalating every 2 weeks (75 to 150 to 300 to 450 IU/kg/wk). Mean hemoglobin concentration increased from 6.4 +/- 0.9 to 11.5 +/- 1.0 gm/dl. Blood cell counts used to evaluate the correction of anemia were done after dialysis; this was especially important for children less compliant with water restriction. The higher hemoglobin concentration resulted in improvement of the quality of life, a greater tolerance for physical effort (exercise tolerance doubled and the ventilatory anaerobic threshold increased significantly), correction of some subclinical central nervous system abnormalities detected by evoked potentials testing, and reduction of bleeding time. Few side effects were noted; severe hypertension developed in one patient when postdialysis hematocrit was only 28%, and there were two episodes of hypertransaminasemia with no other evidence of liver dysfunction. We conclude that in children with renal failure the use of recombinant human erythropoietin to correct anemia is safe and strongly advisable, because of the resolution of many of the symptoms correlated with anemia.
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Affiliation(s)
- G Montini
- Department of Pediatrics, University of Padua, Italy
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48
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Casara G, Battistella P, Drigo P, Boniver C, Suppiej A, Laverda A. [Finding of focal heterotopy with magnetic resonance. Description of a case associated with late onset epilepsy]. Pediatr Med Chir 1989; 11:89-91. [PMID: 2717492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
A case of late onset focal epilepsy in a mentally and neurologically normal girl in which the MRI showed a focal heterotopia is presented. The efficacy of this new procedure in detecting migratory disorders is discussed and the scanty literature reviewed. This case suggests that in the future more cases of epilepsy previously classified as "cryptogenetic" will be demonstrated as secondary to developmental abnormalities.
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Affiliation(s)
- G Casara
- Dipartimento di Pediatria - Università degli Studi di Padova, Italia
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49
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Battistella PA, Suppiej A, Casara G, Cavinato MS, Olivotto D, Pitassi I, Zacchello F. Brainstem auditory evoked potentials (BAEPs) in childhood migraine. Headache 1988; 28:204-6. [PMID: 3384645 DOI: 10.1111/j.1526-4610.1988.hed2803204.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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