Children with a history of atypical febrile seizures show abnormal steady state visual evoked potential brain responses

Atypical febrile seizures (FSs) are considered a risk factor for the onset of epilepsy in later life as well as for potential cognitive impairment. However, distinctive characteristics defining the group of children at risk for negative outcomes are not well established. In the following study, children from 6 to 59 months with a history of atypical FSs were investigated using steady state visual evoked potentials (ssVEP), a brain response known to increase with age. Abnormally, low theta and alpha ssVEP brain responses were found in children with a history of atypical FSs.

Cognitive disorders in pediatric epilepsy

Childhood epilepsy may cause cognitive disorders and the intellectual quotient is indeed not normally distributed in epileptic children, a fair proportion of whom show an IQ in the deficient range. Some epileptic syndromes happen during vulnerability periods of brain maturation and interfere with the development of specific cognitive functions. This is the case for the Landau-Kleffner syndrome, which generally appears during speech development and affects language. Similarly, West syndrome - or infantile spasms - is an epileptogenic encephalopathy appearing during the first years of life and induces a major delay in social and oculo-motor development. Specific impairments can also be identified in partial childhood epilepsies in relation with seizure focus localization. For instance, left temporal and frontal epilepsies are frequently associated with verbal impairments. Moreover, episodic memory disorders have been described in children suffering from temporal lobe epilepsy whereas executive deficits (planning, self-control, problem solving) have been reported in frontal lobe epilepsy. In most cases, including its mildest forms, childhood epilepsy induces attention deficits, which may affect academic achievement. These observations militate in favor of individual neuropsychological assessments as well as early interventions in order to provide the child with an optimal individualized treatment program.

Functional reorganization of the auditory pathways following late callosotomy

Injuries at various levels of the auditory system have been shown to lead to functional reorganization of the auditory pathways. In particular, it has recently been shown that such reorganization can occur in callosal agenesis. The pattern of cortical activity following callosotomy is however still unknown, but behavioral results suggest that it could be significantly different from that observed in callosal agenesis. We aimed to confirm this hypothesis by investigating fMRI responses to complex sounds presented binaurally and monaurally in a callosotomized patient. In the binaural condition, the callosotomized subject showed patterns of auditory cortical activation that were similar to those of neurologically intact individuals. However, in both monaural conditions, the callosotomized individual showed a significant increase of the asymmetries favoring the contralateral pathways. Such patterns of cortical responses are only partially consistent with the results obtained from callosal agenesis subjects using the exact same procedure. Indeed, the latter show differences compared with normals in both binaural and monaural conditions. These findings provide neurological evidence that callosotomy could lead to distinctive functional reorganization of the human auditory pathways.

Women process multisensory emotion expressions more efficiently than men

Despite claims in the popular press, experiments investigating whether female are more efficient than male observers at processing expression of emotions produced inconsistent findings. In the present study, participants were asked to categorize fear and disgust expressions displayed auditorily, visually, or audio-visually. Results revealed an advantage of women in all the conditions of stimulus presentation. We also observed more nonlinear probabilistic summation in the bimodal conditions in female than male observers, indicating greater neural integration of different sensory-emotional informations. These findings indicate robust differences between genders in the multisensory perception of emotion expression.

Auditory processing in a patient with a unilateral lesion of the inferior colliculus

The role of the inferior colliculus (IC) in human auditory processing is still poorly understood. We report here the results obtained with a 12-year-old boy (FX) who suffered a very circumscribed lesion of the right IC without additional neurological damage. The child underwent an extensive battery of psychophysical hearing tests. Results revealed normal peripheral auditory functioning, bilaterally. Furthermore, masking-level differences and frequency-pattern recognition were normal for each ear. When the right ear was stimulated, behavioural tests assessing central auditory processing yielded normal results. However, when the left ear was stimulated, speech recognition in the presence of a competing ipsilateral signal and duration-pattern recognition were impaired. Similarly, performance on two dichotic speech recognition tests was poor when the target stimulus was presented in the left and the competing signal in the right ear. Finally, sound-source localization in space was deficient for speakers located on the side contralateral to the lesion. The pattern of results suggests that auditory functions such as recognition of low-redundancy speech presented monaurally, recognition of tone duration patterns, binaural separation and integration, as well as sound-source localization in space, depend on the integrity of the bilateral auditory pathways at the IC level.

Cross-modal reorganization and speech perception in cochlear implant users

Recent work suggests that once the auditory cortex of deaf persons has been reorganized by cross-modal plasticity, it can no longer respond to signals from a cochlear implant (CI) installed subsequently. To further examine this issue, we compared the evoked potentials involved in the processing of visual stimuli between CI users and hearing controls. The stimuli were concentric circles replaced by a different overlapping shape, inducing a shape transformation, known to activate the ventral visual pathway in human adults. All CI users had their device implanted for >1 year, but obtained different levels of auditory performance following training to establish language comprehension. Seven of the 13 patients showed good capacities for speech recognition with the CI (good performers) while the six others demonstrated poor speech recognition abilities (poor performers). The evoked potentials of all patients showed larger amplitudes, with different distributions of scalp activations between the two groups. The poor performers exhibited broader, anteriorly distributed, high P2 amplitudes over the cortex whereas the good performers showed significantly higher P2 amplitudes over visual occipital areas. These results suggest the existence of a profound cross-modal reorganization in the poor performers and an intramodal reorganization in the good performers. We interpret these data on the basis of enhanced audiovisual coupling as the key to a long-term functional improvement in speech discrimination in CI users.

The effect of visors on head and facial injury in National Hockey League players

There has been an increase in the number of concussions sustained by players in the National Hockey League (NHL). While wearing a helmet is now required by the NHL, the face visor remains optional. It is unknown to what degree face visors influence concussion, other head injury and eye-injury rates at the professional level. Data from the 2001-2002 NHL season were examined. It was found that wearing a face visor did not significantly influence the prevalence of concussion. Visor protection did, however, minimise eye-injuries and other, non-concussion head injuries. These data suggest that, while a visor may prevent some head and eye-injuries, other measures may be necessary to reduce the number of concussions.

Electrophysiological Markers of Visuocortical Development

The development of noninvasive techniques for the assessment of functional brain maturation is critical. The present study analyzed 63 babies' and children's (27 days to 5.5 years) cerebral responses to a pattern-reversal visual stimulation using high-density (128 electrodes) electrophysiological recordings. Developmental data were further compared with those of young adults (n = 16). Tremendous changes in pattern visual evoked potentials (pVEPs) morphology were observed between 7 and 24 months characterized by the emergence of negative components labeled "N70" and "N145" and the reduction of the P100 amplitude. The adult pattern of response appears from 24 months onward. Spectral density values show an increase of higher frequencies with age. Coherence values show a reduction between 3 and 23 months of age as well as a further increase toward adulthood between areas implicated in visual processing. These results are discussed in light of developmental features such as synaptogenesis, myelination, and neuronal networks refinement.

Interaction between the flash evoked SSVEPs and the spontaneous EEG activity in children and adults

OBJECTIVE

To evaluate the interaction between the steady-state visual evoked potentials (SSVEPs) recorded during the intermittent photic stimulation (IPS) and the spontaneous EEG activities both in children and adults.

METHODS

EEG was recorded during the rest and under 5, 7.5, 10 and 12.5 Hz IPS in 41 children between 3 and 16 years and 10 adults. We distinguished between the spontaneous resting EEG spectra, SSVEPs (1st harmonic) and undriven (ongoing) EEG spectra recorded during the IPS.

RESULTS

We show that IPS influences spontaneous EEG activity by specifically suppressing or desynchronizing individual posterior dominant resting EEG frequencies (DF) in both children and adults. Further, this highly significant and consistent suppressing effect positively correlates with the SSVEPs amplitude.

CONCLUSIONS

Our data suggest that the desynchronization of the spontaneous EEG activity under IPS and the SSVEPs are related to each other.

SIGNIFICANCE

These relationships could be interesting to study in pathological conditions where the neural synchronization and the responses to IPS have been shown to be affected, such as epilepsy and schizophrenia.

Impact of childhood epilepsy on reading and phonological processing abilities

Although children with epilepsy tend to exhibit more reading difficulties than their classmates, no systematic studies have investigated the relationship between these difficulties and epilepsy. As functional neuroimaging studies have implicated both temporal and frontal lobes in the phonological aspect of reading [K.R. Pugh, B.A. Shaywitz, S.E. Shaywitz, et al. Brain 1996;119:1221-38], seizure activity originating in either region could interfere with phonological processing, whereas generalized seizures would not disturb this function as much. To explore this hypothesis, we compared the metaphonological skills of school-aged children with either temporal lobe epilepsy (TLE), frontal lobe epilepsy (FLE), or generalized absence seizures (ABS) with those of healthy controls. While the reading ability of all epileptic children was close to 2 years behind expectations, children with TLE did not differ from the controls on phonological tasks. In contrast, children with FLE exhibited significant deficits, whereas children with ABS showed difficulties restricted to phonemic segmentation. The results suggest that FLE and, to a lesser extent, generalized seizures may interfere with phonological processing, whereas TLE may affect other aspects of reading.

Blind subjects process auditory spectral cues more efficiently than sighted individuals

The goal of the present study was to investigate how monaural sound localization on the horizontal plane in blind humans is affected by manipulating spectral cues. As reported in a previous study (Lessard et al. 1998), blind subjects are able to calibrate their auditory space despite their congenital lack of vision. Moreover, the performance level of half of the blind subjects was superior to that of sighted subjects under monaural listening conditions. Here, we first tested ten blind subjects and five controls in free-field (1) binaural and (2) monaural sound localization tasks. Results showed that, contrary to controls and half the blind subjects, five of the blind listeners were able to localize the sounds with one ear blocked. The blind subjects who showed good monaural localization performances were then re-tested in three additional monaural tasks, but we manipulated their ability to use spectral cues to carry out their discrimination. These subjects thus localized these same sounds: (3) with acoustical paste on the pinna, (4) with high-pass sounds and unobstructed pinna and (5) with low-pass sounds and unobstructed pinna. A significant increase in localization errors was observed when their ability to use spectral cues was altered. We conclude that one of the reasons why some blind subjects show supra-normal performances might be that they more effectively utilize auditory spectral cues.

[Neuropsychological profile of intractable partial epilepsies]

The neuropsychological assessment is an essential part of the clinical work-up of patients suffering from pharmaco-resistant epilepsy. The aim of the present article is to give an overview of the assessment with regard to the functions tested, the techniques employed and the factors influencing the interpretation of the results. In the first part of the article, the role of the neuropsychological evaluation is discussed in relation to other methods of clinical investigation, such as EEG, brain imaging techniques and sodium amytal exploration, all of which intend to identify the localization (region and laterality) of the epileptogenic focus. This is particularly important for patients slated for epilepsy surgery. In addition, the neuropsychological exam aims to determine the extent of the deficits in various cognitive and sensori-motor domains by taking into account the structural and/or functional reorganization that may have taken place and the compensatory mechanisms that are available to the patient. In this context, the effect of various factors influencing the mental and emotional functioning of the patient, such as the age at onset and duration of the epilepsy, the presence of a structural lesion, the type and number of anticonvulsant drugs, the personality and the adaptability of the patient must be considered. In children, the effect of recurrent seizures may be more devastating since these risk to interfere with normal brain development. On the other hand, the greater plasticity of the immature brain provides a larger window in which compensation can take place. Evidence suggests that attentional processes are affected in all types of epilepsy. Furthermore, the antiepileptic medication may have a deleterious effect on the cognitive and emotional status of the patient, particularly in patients with pharmaco-resistant epilepsy who are usually taking a combination of anticonvulsant drugs. The second part of the article presents localization-specific neuropsychological impairments and the tests most suited to reveal these deficits. Thus, in temporal lobe epilepsy, memory functions are more affected than in other types of partial epilepsy, whereas intellectual functions are usually preserved. However, recent studies cast some doubt on the prevailing view that left-hemisphere foci are associated with verbal memory deficits only and that right-hemisphere foci solely affect visuo-spatial memory. The dichotomy appears to be more subtle, especially in patients with a long-standing seizure history. Frontal foci produce deficits in motor coordination, attention, working memory and executive functions. These deficits appear to be more pronounced in children than in adults. Few studies have explored the neuropsychological consequences of parieto-occipital foci given that this type of epilepsy is relatively rare. The neuropsychological profile of the patient should guide healthcare providers to implement the necessary remedial measures to facilitate the patient's social integration and to improve his quality of life.

Impact of temporal lobe epilepsy on phonological processing and reading: a case study of identical twins

In order to evaluate the possible consequences of temporal lobe epilepsy on reading acquisition, we first compared the reading skills and phonological awareness abilities in a set of 13-year-old identical twins, one of whom is affected by temporal lobe epilepsy (LB). We then compared their performances to those of an age- and IQ-matched control group. Both siblings have an intellectual quotient above average as well as normal memory and linguistic abilities. Results showed that the reading age of LB (assessed by the Lefabvrais French reading test) was more than two years behind expectations whereas that of her sister was above average. Further, in contrast to her sister and healthy control subjects, LB exhibited specific deficits in elaborate metaphonological awareness abilities (non-word repetition, rhyme production, phonemic segmentation and syllabic inversion). These could be linked to temporal lobe dysfunction, thus confirming the important role of the temporal lobes in reading acquisition.

Callosal contribution to procedural learning in children

A previous study in acallosal patients (De Guise, et al., 1999) has demonstrated the crucial role of the corpus callosum (CC) in a procedural learning task that requires the participation of both hemispheres. Because children often display limitations in interhemispheric communication linked to callosal immaturity, we expected that they would have difficulties learning a procedural skill that involved interhemispheric integration during its acquisition, but not when the skill was learned intrahemispherically. To test this hypothesis, 40 children, divided into 4 age groups (6 to 8 years, 9 to 11 years, 12 to 14 years, and 15 to 16 years), performed a modified version of the serial reaction time task developed by Nissen and Bullemer (1987). This task involves uni- or bimanual key-pressing responses to a fixed sequence of 10 visual stimuli that are repeated 80 times. All the children were able to learn the visuomotor skill in the unimanual condition and to transfer it interhemispherically. However, only the older children (12 years and over) learned the task in the bimanual (interhemispheric) condition. The results indicate that the maturation of the CC affects interhemispheric acquisition of a procedural skill in two different ways: While the immature CC appears to be sufficient to transfer a skill acquired by one hemisphere, a mature CC seems to be required to learn the skill bihemispherically. The latter skill was achieved around the age of 12, coinciding with the end of the maturation cycle of the CC. Although the young children were unable to learn the bimanual task implicitly, some of them showed explicit knowledge of the procedure, confirming once again the dissociation between explicit and implicit memory suggested by Squire (1992).

Recommendations for grading of concussion in athletes

Mild sports-related concussions, in which there is no loss of consciousness, account for >75% of all sports-related brain injury. Universal agreement on concussion definition and severity grading does not exist. Grading systems represent expertise of clinicians and researchers yet scientific evidence is lacking. Most used loss of consciousness and post-traumatic amnesia as markers for grading concussion. Although in severe head injury these parameters may have been proven important for prognosis, no study has done the same for sport-related concussion. Post-concussion symptoms are often the main features to help in the diagnosis of concussion in sport. Neuropsychological testing is meant to help physicians and health professionals to have objective indices of some of the neurocognitive symptoms. It is the challenge of physicians, therapists and coaches involved in the care of athletes to know the symptoms of concussion, recognise them when they occur and apply basic neuropsychological testing to help detect this injury. It is, therefore, recommended to be familiar with one grading system and use it consistently, even though it may not be scientifically validated. Then good clinical judgement and the ability to recognise post-concussion signs and symptoms will assure that an athlete never returns to play while symptomatic.

Prosopagnosia: a case study involving problems in processing configural information

An ongoing issue in face recognition research is whether holistic face processing relies on the segregation of local discrete facial parts. Evidence in favor of the holistic-plus-parts view stems from a recent study reported by Arguin and Saumier (1999), who show that the priming effects of individual facial parts (i.e., eyes, nose, mouth, orcontour) depends on the presence of configural information and that the magnitude of priming augments as the number of facial parts serving as primes increase. The present study demonstrates that these global processing effects are absent in a prosopagnosic patient (A.R.), who shows no priming from single face parts and a linear increase in the magnitude of priming as a function of the number of parts presented. These findings indicate that A.R. is incapable of integrating individual facial parts into a global facial configuration ant that this is likely at the root of her prosopagnosia.

Absence of interhemispheric transfer of unilateral visuomotor learning in young children and individuals with agenesis of the corpus callosum

This study was undertaken to investigate the role of the corpus callosum in interhemispheric transfer of unilateral visuomotor learning. In the first experiment, the cross-manual performance of 4 callosal agenesis participants was compared to that of 4 age- and IQ-matched controls. In the second experiment, normal children of different ages (6-7 and 11-12 years) and adults were submitted to the same task to assess the impact of callosal maturation on interhemispheric transfer. Participants had to make aiming movements from a starting position toward either a central or a lateral target on the same side as the hand used, while maintaining central fixation. Prior to training, a pretest was performed with the hand contralateral to the hand used during learning. Participants were then submitted to a posttest with the untrained hand. All participants learned the unilateral aiming task in the learning phase, as evidenced by a reduction in spatial errors with an increasing number of practice trials. However, acallosal participants and children aged 6 to 7 years failed to transfer the acquired skill from the trained to the untrained hemisphere. These findings suggest that interhemispheric transfer of visuomotor skills cannot be assumed by other structures in the case of agenesis or morphological immaturity of the corpus callosum. The results further indicate that unilateral visuomotor learning leads to the formation of a single, unihemispheric engram in the absence, whether functional or anatomical, of the corpus callosum.

DEVELOPMENT OF NONINVASIVE AND QUANTITATIVE METHODOLOGIES FOR THE ASSESSMENT OF CHRONIC ULCERS AND SCARS IN HUMANS

Chronic ulcers are a significant and common cause of morbidity and mortality worldwide. They disrupt the epidermis and dermis, resulting in a loss of barrier function. Keloids and hypertrophic scars (benign cutaneous tumors) represent an abnormal healing response. These fibroproliferative disorders are characterized by an overabundance of collagen and accumulation of extracellular matrix due to an imbalance between synthesis and degradation, culminating in excessive scarring. The objectives of this study were to evaluate and compare noninvasive biophysical methods for the measurement of outstanding quantitative parameters of scars and chronic ulcers, and to establish correlations between the parameters measured and the results of conventional subjective clinical evaluations. The development of new technologies, based on ultrasonography and laser Doppler, makes possible new dermatological evaluation methods. Fifteen patients (6 females and 9 males) with 15 chronic ulcers (4 diabetic ulcers, 10 venous ulcers and 1 pressure ulcer) and 30 patients (19 females and 11 males) with 30 scars (25 hypertrophic and 5 keloids) were included in this study. Clinical evaluation was performed by a dermatologist, an aesthetic surgeon and an endocrinologist. Biophysical measurements were used to assess local blood flow by laser Doppler flowmetry (Moor DRT4), thickness and echogenicity by high frequency ultrasonography (20 MHz, Dermascan C) and ulcer linear dimensions by image analysis. Our results show that blood flow within the ulcers and scars was higher than within normal skin. Also, skin thickness of chronic ulcers was decreased when compared to normal skin; the thickness of hypertrophic scars, but not of keloids, was increased in comparison to normal skin, and presented the possibility of measuring wound and scar surfaces with precision. In summary, this pilot study established the feasibility of measuring various biophysical parameters and adapted their potential utility to research on wounds.

Hyperbaric oxygen for children with cerebral palsy: a randomised multicentre trial. HBO-CP Research Group

BACKGROUND

The use of hyperbaric oxygen for children with cerebral palsy has spread worldwide, despite little scientific evidence of efficacy. We did a randomised trial to assess the efficacy and side-effects of this form of therapy in children with cerebral palsy.

METHODS

111 children with cerebral palsy aged 3-12 years were randomly assigned hyperbaric oxygen (n=57) or slightly pressurised room air (n=54). All children received 40 treatments over 2 months. Hyperbaric oxygen treatment was 1 h in 100% oxygen at 1.75 atmospheres absolute (ATA); children on slightly pressurised air received air at 1.3 ATA (the lowest pressure at which pressure can be felt, thereby ensuring the maintenance of masking). The main outcome measure was gross motor function. Secondary outcomes included performance in activities of daily living, attention, working memory, and speech.

FINDINGS

For all outcomes, both groups improved over the course of the study, but without any difference between the two treatments. The score on the global gross motor function measure increased by 3.0% in the children on slightly pressurised air and 2.9% in those on hyperbaric oxygen. The mean difference between treatments was -0.40 (95% CI -1.69 to 0.90, p=0.544). Other changes were seen in speech, attention, memory, and functional skills. Ear problems occurred in 27 children treated by hyperbaric oxygen and in 15 treated with hyperbaric air (p=0.004).

INTERPRETATION

In this study, hyperbaric oxygen did not improve the condition of children with cerebral palsy compared with slightly pressurised air. The improvement seen in both groups for all dimensions tested deserves further consideration.

Concussions in athletes produce brain dysfunction as revealed by event-related potentials

We have used event-related potentials (ERP) to assess cerebral activity following mild traumatic brain injuries in 20 college athletes practising contact sports. Concussion victims showed a striking decrease in P300 amplitude, an effect presumed to reflect alterations in attentional-cognitive processes. Moreover, the degree of impairment was strongly related to the severity of post-concussion symptoms. Our data suggest that concussions cause objectively measurable changes in the electrophysiological markers of brain activity and hence in the functions of the structures from which they originate. ERPs may thus constitute a reliable method to accurately monitor the clinical course and recovery of head injuries in athletes.

Sound localization in hemispherectomized subjects: the contribution of crossed and uncrossed cortical afferents

The aim of the present study was to evaluate how hemispherectomized subjects localize sounds in free field using residual auditory structures under monaural testing conditions. The main objective of using a monaural condition with these subjects, who lack the terminal fields of auditory projections on one side, was to evaluate how the crossed and uncrossed pathways compare, with the aim of resolving this biologically critical function. In this model, crossed and uncrossed inputs refer to auditory stimulation presented to the unobstructed ear on the contralateral and the ipsilateral side of the intact hemisphere, respectively. Three hemispherectomized subjects (Hs) and ten control subjects (Cs) were tested for their accuracy to localize broad band noise bursts (BBNBs) of fixed intensity presented on the horizontal plane. BBNBs were delivered randomly through 16 loudspeakers mounted at 10 degrees intervals on a calibrated perimeter frame located inside an anechoic chamber. Subjects had to report the apparent stimulus location by pointing to its perceived position on the perimeter. Hs were less accurate than Cs in the baseline binaural condition, confirming the finding that with a single hemisphere and/or residual (subcortical) structures they cannot analyze binaural cues to sound localization as efficiently as with two fully functional hemispheres. In the monaural condition, Hs localized poorly when they had to depend on the uncrossed input, but performed as well or even better than the Cs with the crossed input. These findings suggest that monaural spectral cues, which constitute the only residual cue to localization under the monaural testing condition, are treated more efficiently, that is, they lead to better localization performance when relayed to the cortex via crossed pathways than through uncrossed pathways.

Sensorimotor organization in patients who have undergone hemispherectomy: a study with (15)O-water PET and somatosensory evoked potentials

To identify cortical structures that subserve residual motor and sensory function in patients with congenital hemiparesis due to a porencephalic cyst, we examined, using [(15)O]H2O, PET and somatosensory evoked potentials (SEPs) in three patients with left-sided hemiparesis who had undergone hemispherectomy. Motor stimulation of the affected hand produced ipsilateral activation in the premotor area in all patients, the SMA in two patients, and SII in two patients. Vibrotactile stimulation resulted in activation of the ipsilateral SII in all subjects. Median nerve stimulation of the affected hand produced ipsilateral long-latency SEPs in fronto-centro-parietal areas, whereas stimulation of the non-affected hand produced normal early cortical potentials in the contralateral hemisphere. Our results suggest that residual function in the paretic hand is warranted through non-primary motor and sensory areas, and higher order associative areas in the intact hemisphere.

An fMRI study of the lateralization of motor cortex activation in acallosal patients

Transcranial magnetic stimulation (TMS) studies have suggested that callosal afferents may mediate inhibition of the ipsilateral motor cortex (IMC) during unilateral hand movements. To test this concept, we used fMRI to determine whether acallosal patients have increased IMC activation with either complex or simple unilateral finger movements. Neither the localization of motor cortical regions activated, the volumes of activation, or the relative hemispheric lateralization of activations were different between the patients and normal controls. The potential callosal inhibitory pathway identified by TMS therefore does not appear to contribute to the interhemispheric suppression of physiologically relevant activations in the motor cortex as measured by fMRI.

Divided visuo-spatial attention systems with total and anterior callosotomy

The role of the corpus callosum in the inter-hemispheric integration of the visuo-spatial attention system, was investigated in patients with a total callosotomy or with an anterior callosal section. Subjects produced simple reaction times (RTs) to visual targets shown to the left or right visual hemifield. Preceding the target by an interval of 500 ms, arrow cues predicting the target location were shown left and right of the point of ocular fixation. For a majority of total and anterior callosotomy patients, results with valid focused cues (both arrows pointing to the target location) and with divided-attention cues (arrows pointing away from fixation) did not differ and both conditions produced shorter RTs than with neutral cues (equal signs). In contrast, neurologically intact subjects showed equal RTs with divided-attention and neutral cues, whereas valid focused cues produced reduced RTs relative to neutral cues. These results indicate that most split-brains, in contrast to normal observers, are capable of directing their attention to left and right visual field locations simultaneously, and therefore that each cerebral hemisphere controls its own visuo-spatial attention mechanism.

Neuropsychology of childhood epilepsy: pre- and postsurgical assessment

Childhood epilepsy is one of the most prevalent forms of chronic and disabling childhood disorders. Because it disrupts brain maturation, it has long been thought to produce non-specific consequences such as mental deficiency and behavioral problems. However, advances in medical knowledge have shown that childhood epilepsy should not be considered as a single disorder, and it is now becoming apparent that various clinical entities have different cognitive expressions that yet need to be specified. The purpose of this paper is to provide an up-to-date analysis of this multi-faceted pathology. The first section is devoted to the characterization of the neuropsychological profile that accompanies focal epilepsies, as defined by the site of the epileptic process. We report the first group study of children with frontal lobe epilepsy. The results indicate that frontal lobe epilepsy produces symptoms (deficits of planning, attention and motor dexterity) that are akin to those found in frontal-lesioned adults. Similarly, like in adults, temporal lobe epilepsy produces memory impairment in children as well as behavioral and academic disturbances. Occipito-parietal lobe epilepsy is rare in children and its effects still need to be specified. The second section deals with the neuropsychological techniques used in presurgical evaluation. Finally, the various neurosurgical procedures that are increasingly being used as part of the arsenal of epilepsy treatment are described along with the neuropsychological findings that are associated with these interventions. It can be concluded that the beneficial effects of epilepsy surgery (callosotomy, hemispherectomy, temporal and extra-temporal resections) by far outweigh the few cognitive deficits that are occasionally reported following these interventions.

Brain functional reorganization in early blind humans revealed by auditory event-related potentials

Visually challenged individuals often compensate for their handicap by developing supra-normal abilities in their remaining sensory systems. Here, we examined the scalp distribution of components N1 and P3 of auditory evoked potentials during a sound localization task in four totally blind subjects who had previously shown better performance than sighted subjects. Both N1 and P3 waves peaked at their usual positions while blind and sighted individuals performed the task. However, in blind subjects these two components were also found to be robust over occipital regions while in sighted individuals this pattern was not seen. We conclude that deafferented posterior visual areas in blind individuals are recruited to carry out auditory functions, enabling these individuals to compensate for their lack of vision.

Localization of moving sounds by hemispherectomized subjects

The objective of the present study was to evaluate the localization abilities of the residual auditory structures in hemispherectomized subjects (Hs) during monaural and binaural listening. The monaural stimulus presentations were aimed at evaluating the relative contribution of crossed and uncrossed afferents to the perception of a moving auditory target. Three Hs and ten control subjects (Cs) were asked to localize a simulated moving sound source of fixed intensity presented on the horizontal plane. The moving stimulus was delivered randomly through 16 loudspeakers which were mounted at 10 degree intervals on a calibrated perimeter frame located inside an anechoic chamber. The apparent movement traveled in either direction over three different distances in the peri-central and lateral fields. Listeners had to report the movement trajectory by pointing with the index finger where they thought the beginning and the ending of the stimulus occurred on the perimeter. Hs were less accurate than Cs in the binaural condition, suggesting that the residual hemisphere and/or subcortical structures are not by themselves as efficient to accurately analyze motion as when the two hemispheres are present. In the monaural testing conditions, most of the subjects showed a prominent lateral displacement of the perceived localization towards the functional ear. However, all subjects, particularly the Cs, were able to perceive different lengths of trajectories although they did not discriminate the direction of the motion. For the Hs, the pattern of performance differed for each subject. One right Hs was more accurate for localizing the sources delivered on the side of the functional ear when relying on crossed-input. A left Hs was able to detect the appropriate side of the moving sound source even when it was presented on the side to the obstructed ear. The other left Hs who had developed normally until the age of 5, was more affected by the hemidecortication in both the binaural and the monaural listening conditions. These findings suggest that it is possible to detect moving sounds in the absence of binaural cues and without the integration carried out by both cerebral hemispheres. However it appears that interaural disparities and bihemispheric integration are required for finer analysis.