Brain Dysfunction In Children Research Articles

Dorsolateral prefrontal cortex dysfunction caused by a go/no-go task in children with attention-deficit hyperactivity disorder: A functional near-infrared spectroscopy study.

Children with attention-deficit hyperactivity disorder (ADHD) exhibit executive function deficits, which can be attributed to a dysfunction in the prefrontal region of the brain. Our study aims to evaluate the alteration of brain activity in children with ADHD during the administration of a go/no-go task using functional near-infrared spectroscopy (fNIRS) in comparison to a control group containing typically developing (TD) children. 32 children with ADHD and 31 of their TD peers were recruited and asked to perform a go/no-go task while undergoing measurements, with the aim of detecting changes in average oxygenated hemoglobin signaling (Δavg oxy-Hb) via fNIRS in the prefrontal lobe. fNIRS data showed significant differences between the left and right dorsolateral prefrontal cortices, with a lower Δavg oxy-Hb change in the ADHD group compared to the TD group. Our results indicate that brain dysfunction in children with ADHD is related to functional impairments in the dorsolateral prefrontal cortex. The go/no-go task paired with fNIRS represents a useful measurement tool to assess prefrontal brain dysfunction in children struggling with ADHD.

Prognostic factors for long-term outcome in children with fetal alcohol spectrum disorders

IntroductionKnown protective factors for long-term outcome in children with fetal alcohol spectrum disorders (FASD) are early diagnosis and a stable, non-violent supportive environment. Which factors contribute to the stability of care is not yet known. Thus, the aim of our study was to evaluate whether the age at diagnosis and the complexity of brain dysfunction play a role for placement changes in children with FASD. Materials and methodsAn online survey was conducted among caregivers and professionals caring for children with FASD and seeking help at the German FASD Competence Centre Bavaria (N = 232). The survey collected information about diagnosis, brain dysfunctions, behavioural factors influencing everyday life and changes of placement. The association of timing of diagnosis, brain dysfunctions and neurobehavioral impairment with changes of placement (<2 vs. 2 or more changes) was evaluated via logistic regression models. ResultsAbout 50% of the children received their diagnosis of FASD after the age of 5 years. The complexity of brain dysfunctions in children with FASD affecting everyday life was high. 15% of the children experienced four or more changes of placement. Children with more neuropsychological impairments experienced more changes of placement (OR: 2.53, 95% CI: 1.36–4.71). ConclusionsEven though our results need to be interpreted with caution due to methodological limitations such as the use of a convenience sample and limited statistical power, they imply that severely affected children with FASD experience a less stable environment. These children may therefore be at high risk for a negative prognosis. To warrant a better prognosis for the affected children, professionals urgently need to pay attention to early recognition and the complexity of neuropsychological impairments in children with FASD as well as to the support that caregivers urgently need.

Prognostic Factors for Pediatric Acute Encephalopathy Associated with Severe Brain Edema

Background and Objective: Acute encephalopathy is a life-threatening brain dysfunction in children, often associated with a preceding infection and diffuse noninflammatory brain edema. At present, the role of decompressive craniectomy (DC) over the swollen area of the brain is unclear. The risk factors for predicting clinical deterioration also need clarification. Methods: A retrospective study of pediatric patients admitted between 2015 and 2019 with acute cerebral encephalopathy was carried out. Patients were classified according to: (1) the preceding pathogens, (2) the syndromic classification, and (3) the extent of brain edema. The syndromic classification is a relatively new classification of acute encephalopathy proposed in 2016 and divides patients into 3 groups: those with systemic inflammatory reactions or “cytokine storms” (group 1), those with status epilepticus but no cytokine storm (group 2), and others (group 3). Glasgow Outcome Scale (GOS) scores of 1–3 were defined as unfavorable, while a GOS score of 4 or 5 was defined as a favorable outcome in this study. DC was performed for select patients with life-threatening signs of brainstem compression. Results: Nineteen patients (mean age: 23.3 months) were included in the study, 8 (42.1%) of whom had an unfavorable outcome. There was no significant correlation between the types of pathogens and outcome. Unfavorable outcomes were observed in significantly more patients in group 1 (87.5%) than group 2 (14.3%) and group 3 (0%). There was a significant association between diffuse brain edema and unfavorable outcomes (72.7%). Neurosurgical DC was performed in 2 patients to alleviate life-threatening brainstem compression: one with a cytokine storm and diffuse bilateral brain edema, and the other with prolonged status epilepticus causing diffuse right-sided brain edema. The GOS score was 3 and 4, respectively. Conclusion: The risk factors for clinical deterioration in pediatric acute encephalopathy were evaluated based on a variety of classifications, including the new syndromic classification. Laboratory features of cytokine storms and radiological evidence of diffuse brain edema were associated with unfavorable outcomes. The role of surgical decompression is still controversial and should be assessed on a case-by-case basis.

小児外傷性高次脳機能障害の実態(A survey on post–traumatic Higher Brain Dysfunction in children at an emergency center)

要旨小児の外傷性高次脳機能障害（post–traumatic Higher Brain Dysfunction: ptHBD）を急性期に予測し得るか，またその現状と課題について，救命救急センターの視点から検討した報告はない。そこで，2012年4月1日からの3年間に当センターが診療した15歳以下の頭部外傷のうち，外傷性脳損傷（以下，TBI）で入院加療を要し，その後自宅退院した43例を対象に，受傷時の状態，治療内容，入院中の知能検査結果およびリハビリ施設紹介の有無に関する後方視的調査と，受傷後1年以降のptHBDアンケート調査を行った。調査の同意と回答を得た26例のうち，46.2%（12/26例）にptHBDを認めた。ptHBDの有無と，入院時の頭部AIS，ISS，GCSとの間に有意差を認めなかった。ptHBDは入院中の知能検査低下群で80.0%に認めたのに対し，正常域群でも42.9%に認めた。自宅退院した小児のptHBDを入院時の外傷重症度や受傷後急性期の知能検査で予測するには限界があり，退院後のフォローアップの必要性が示唆された。今後は，受傷前の気質や家庭環境といった，ptHBDに関わる小児特有の要因を含めたさらなる長期予後調査が必要と考える。

Emergence delirium in children is not related to intraoperative burst suppression \u2013 prospective, observational electrography study

BackgroundEmergence-delirium is the most frequent brain dysfunction in children recovering from general anaesthesia, though the pathophysiological background remains unclear. The presented study analysed an association between emergence delirium and intraoperative Burst Suppression activity in the electroencephalogram, a period of very deep hypnosis during general anaesthesia.MethodsIn this prospective, observational cohort study at the Charité - university hospital in Berlin / Germany children aged 0.5 to 8 years, undergoing planned surgery, were included between September 2015 and February 2017. Intraoperative bi-frontal electroencephalograms were recorded. Occurrence and duration of Burst Suppression periods were visually analysed. Emergence delirium was assessed using the Pediatric Assessment of Emergence Delirium Score.ResultsFrom 97 children being analysed within this study, 40 children developed emergence delirium, and 57 children did not. Overall 52% of the children displayed intraoperative Burst Suppression periods; however, occurrence and duration of Burst Suppression (Emergence delirium group 55% / 261 + 462 s vs. Non-emergence delirium group 49% / 318 + 531 s) did not differ significantly between both groups.ConclusionsOur data reveal no correlation between the occurrence and duration of intraoperative Burst Suppression activity and the incidence of emergence delirium. Burst Suppression occurrence is frequent; however, it does not seem to have an unfavourable impact on cerebral function at emergence from general anaesthesia in children.Trail registrationNCT02481999, June 25, 2015.

Approaches for Reducing the Risk of Early-Life Iron Deficiency-Induced Brain Dysfunction in Children.

Iron deficiency is the most common micronutrient deficiency in the world. Women of reproductive age and young children are particularly vulnerable. Iron deficiency in late prenatal and early postnatal periods can lead to long-term neurobehavioral deficits, despite iron treatment. This may occur because screening and treatment of iron deficiency in children is currently focused on detection of anemia and not neurodevelopment. Anemia is the end-stage state of iron deficiency. The brain becomes iron deficient before the onset of anemia due to prioritization of the available iron to the red blood cells (RBCs) over other organs. Brain iron deficiency, independent of anemia, is responsible for the adverse neurological effects. Early diagnosis and treatment of impending brain dysfunction in the pre-anemic stage is necessary to prevent neurological deficits. The currently available hematological indices are not sensitive biomarkers of brain iron deficiency and dysfunction. Studies in non-human primate models suggest that serum proteomic and metabolomic analyses may be superior for this purpose. Maternal iron supplementation, delayed clamping or milking of the umbilical cord, and early iron supplementation improve the iron status of at-risk infants. Whether these strategies prevent iron deficiency-induced brain dysfunction has yet to be determined. The potential for oxidant stress, altered gastrointestinal microbiome and other adverse effects associated with iron supplementation cautions against indiscriminate iron supplementation of children in malaria-endemic regions and iron-sufficient populations.

Rehabilitation for higher brain dysfunction in children with severe head injury : case report

Rehabilitation for higher brain dysfunction in children with severe head injury : case report

Iron assessment to protect the developing brain

Iron deficiency (ID) before the age of 3 y can lead to long-term neurological deficits despite prompt diagnosis of ID anemia (IDA) by screening of hemoglobin concentrations followed by iron treatment. Furthermore, pre- or nonanemic ID alters neurobehavioral function and is 3 times more common than IDA in toddlers. Given the global prevalence of ID and the enormous societal cost of developmental disabilities across the life span, better methods are needed to detect the risk of inadequate concentrations of iron for brain development (i.e., brain tissue ID) before dysfunction occurs and to monitor its amelioration after diagnosis and treatment. The current screening and treatment strategy for IDA fails to achieve this goal for 3 reasons. First, anemia is the final state in iron depletion. Thus, the developing brain is already iron deficient when IDA is diagnosed owing to the prioritization of available iron to red blood cells over all other tissues during negative iron balance in development. Second, brain ID, independently of IDA, is responsible for long-term neurological deficits. Thus, starting iron treatment after the onset of IDA is less effective than prevention. Multiple studies in humans and animal models show that post hoc treatment strategies do not reliably prevent ID-induced neurological deficits. Third, most currently used indexes of ID are population statistical cutoffs for either hematologic or iron status but are not bioindicators of brain ID and brain dysfunction in children. Furthermore, their relation to brain iron status is not known. To protect the developing brain, there is a need to generate serum measures that index brain dysfunction in the preanemic stage of ID, assess the ability of standard iron indicators to detect ID-induced brain dysfunction, and evaluate the efficacy of early iron treatment in preventing ID-induced brain dysfunction.

P235 Localizing non-epileptic abnormal brain function in children using high density EEG (HDEEG): Electric source imaging (ESI) of focal slowing

Objectives Interictal focal slowing is an important EEG index of brain activity dysfunction, possibly representing an additional tool for presurgical evaluation in pediatric epilepsy. Here, we investigate the accuracy of electric source imaging (ESI) applied to pathological focal EEG slowing (FS) as new neurophysiological index localizing the epileptic focus in children with drug-resistant epilepsy. Method We selected16 children (12 ± 4yrs), who performed hdEEG, presurgical evaluation and underwent surgical resection with at least 1 year of post-operative seizure freedom. For each patient, we exported 15 FS-epochs of 2 s. The S-transform was applied to select the frequency band (delta/theta: 1–4 Hz/4–8 Hz) with maximal power. ESI was performed using a distributed linear inverse solution and an individual head model. The solution point with maximal average power in the band of interest was selected as the source of focal slowing (ESI-FS). Finally, we computed the Euclidian distance between the ESI-FS and the nearest solution point included in the resection with a 5 mm margin. Results In 11/16 (69%), ESI of focal slowing (ESI-FS) was inside the margins of resection. The remaining 5/16 cases had distances 15 mm. Discussion and Conclusions These findings suggest that a “non-epileptiform” activity, such as focal slowing, could help to localize the epileptogenic zone. ESI-FS may aid presurgical lateralization in patients without focal interictal spikes improving the identification of possible good candidate for surgical treatment. Significance The study provides a new quantitative marker of brain dysfunction in children, with a potential application to other neurological disorders, using a non-invasive tool as hdEEG.

PP06.1 – 2574: Aetiologies of CVI in Mainstream Secondary Education

Objective To study the aetiology of the brain dysfunction in children with CVI (cerebral visual impairment) in mainstream secondary education. Methods A retrospective study in children with CVI in mainstream secondary education is performed. 19 Children are included, 7 male/12 female. Mean age is 15 years, from 13 years to 18 years. The visual acuity of the best eye is 10/10 in 10 children, the lowest acuity measured is 1.6/10 and mean visual acuity is 8/10. 26% had another ophtalmological diagnosis (5/19), e.g. cataract or retinopathy of prematurity. IQ was good: total mean 90, from 72 to 127. 79% suffered from comorbidity, e.g. DCD and ASD. 20 Children with CVI, who attend special education are not included in this study. Results 63% have perinatal problems (12/19). Only 4 are born premature. The lowest gestational age is 29/40, with a birth weight of 1100 g. In 4 term children problems during delivery are reported. Only very few is known about neonatal hypoglycaemia and CVI. In only 1 child neonatal hypoglycaemia is reported. In all the other children information on neonatal glycaemia is lacking. The periventricular leukomalacia on MRI images of children with neonatal hypoglycaemia is very similar to what is seen in children with CVI. 37% have no history of any perinatal problem (7/19). The aetiologies in these children are tumour, meningitis, head injury, hypoxia at later age, turner syndrome or an arteriovascular malformation. Conclusion The children with CVI in mainstream education have less disabling aetiology than those reported in literature. They have the same % of comorbidity, but less severe comorbidity. They have better visual acuity. They compensate due to good IQ. In the future we will study the children with CVI who follow special education in order to compare whether they have different aetiologies than those in mainstream education. To study the aetiology of the brain dysfunction in children with CVI (cerebral visual impairment) in mainstream secondary education. A retrospective study in children with CVI in mainstream secondary education is performed. 19 Children are included, 7 male/12 female. Mean age is 15 years, from 13 years to 18 years. The visual acuity of the best eye is 10/10 in 10 children, the lowest acuity measured is 1.6/10 and mean visual acuity is 8/10. 26% had another ophtalmological diagnosis (5/19), e.g. cataract or retinopathy of prematurity. IQ was good: total mean 90, from 72 to 127. 79% suffered from comorbidity, e.g. DCD and ASD. 20 Children with CVI, who attend special education are not included in this study. 63% have perinatal problems (12/19). Only 4 are born premature. The lowest gestational age is 29/40, with a birth weight of 1100 g. In 4 term children problems during delivery are reported. Only very few is known about neonatal hypoglycaemia and CVI. In only 1 child neonatal hypoglycaemia is reported. In all the other children information on neonatal glycaemia is lacking. The periventricular leukomalacia on MRI images of children with neonatal hypoglycaemia is very similar to what is seen in children with CVI. 37% have no history of any perinatal problem (7/19). The aetiologies in these children are tumour, meningitis, head injury, hypoxia at later age, turner syndrome or an arteriovascular malformation. The children with CVI in mainstream education have less disabling aetiology than those reported in literature. They have the same % of comorbidity, but less severe comorbidity. They have better visual acuity. They compensate due to good IQ. In the future we will study the children with CVI who follow special education in order to compare whether they have different aetiologies than those in mainstream education.

Long-term anti-epileptic drug therapy and metabolic bone disase in children

Epilepsy is a common chronic brain dysfunction in children. Studies have showed that antiepi- leptic drugs （AED） affect the hydroxylation of vitamin D in liver and kidney and inhibit the calcification of bone, mainly by up-regulating cytochrome oxidase P450 and promoting the resolution of vitamin D, and then increasing serum parathyroid hormone compensatory. Long-term use can cause children metabolic bone disease occurrence, clinical manifestations include bone pain, short stature, rickets, teeth agenesis, fracture, etc. AED firstly affect the hormones related to bone metabolism in vivo,so that the present researches focus on biochemical tests and meas- urement of sclerotin and bone density. In the children＇s long-term use of antiepileptic drug treatment at the same time,the application of Vitamin D,calcium and exercise can prevent the occurrence of metabolic bone disease. Key words: Antiepileptic drug; Metabolic bone disease in children

Usefulness of near‐infrared spectroscopy to detect brain dysfunction in children with autism spectrum disorder when inferring the mental state of others

The purpose of this study was to examine the usefulness of near-infrared spectroscopy (NIRS) for identifying abnormalities in prefrontal brain activity in children with autism spectrum disorders (ASD) as they inferred the mental states of others. The subjects were 16 children with ASD aged between 8 and 14 years and 16 age-matched healthy control children. Oxygenated hemoglobin concentration was measured in the subject's prefrontal brain region on NIRS during tasks expressing a person's mental state (MS task) and expressing an object's characteristics (OC task). There was a significant main effect of group (ASD vs control), with the control group having more activity than the ASD group. But there was no significant main effect of task (MS task vs OC task) or hemisphere (right vs left). Significant interactions of task and group were found, with the control group showing more activity than the ASD group during the MS task relative to the OC task. NIRS showed that there was lower activity in the prefrontal brain area when children with ASD performed MS tasks. Therefore, clinicians might be able to use NIRS and these tasks for conveniently detecting brain dysfunction in children with ASD related to inferring mental states, in the clinical setting.

Effect of hypoxia in early perinatal ontogenesis on behavior and structural characteristics of the rat brain

The study has shown the acute hypoxia in newborn rat pups to lead to disturbances of processes of formation of brain structures, behavior reactions, and learning in the subsequent ontogenesis. The single normobaric hypoxia at the 2nd day of life causes retardation of such integrative parameter or genera development and growth as body mass at the period of feeding. In such animals, essential disturbances of the sensorimotor development were revealed in forms of delay of reflex reactions of turning on a plane, negative geotaxis, and avoidance of edge. Also detected was action of hypoxia on hanging on a rope by using front legs (a symptom of muscle weakness). Morphological study has shown stereotypic reaction to the early postnatal action of hypoxia in all studies of all studied functional zones of neocortex - motor, sensomotor, auditory, visual. The death of nerve cells is predominant in the II-III associative layers, the sizes and number of pyramidal neurons are sharply decreased. Different hippocampus fields maturing in mammals show a characteristic response to hypoxia. In individual hippocampus fields there was detected different degree of death of neurons, predominant in the CA3 and CA4 fields. A possibility of modeling of perinatal encephalopathy with minimal brain dysfunctions in children is discussed.

Beery-Buktenica Developmental Test of Visual-Motor Integration performance in children with traumatic brain injury and attention-deficit/hyperactivity disorder.

Evaluation of visuoconstructional abilities is a common part of clinical neuropsychological assessment, and the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI; K. E. Beery & N. A. Beery, 2004) is often used for this purpose. However, few studies have examined its psychometric properties when used to assess children and adolescents with traumatic brain injury (TBI) or attention-deficit/hyperactivity disorder (ADHD), even though these are among the most common acquired and neurodevelopmental forms of brain dysfunction in children. This study examined the validity of VMI scores in 123 children with TBI and 65 with ADHD. The TBI and ADHD groups performed significantly worse than the standardization sample, obtaining VMI mean scores of 87.2 (SD = 13.7) and 93.5 (SD = 11.27). Previous research has noted decrements in visuoconstructional abilities in TBI but relative sparing in ADHD. To examine the criterion validity of VMI scores, the authors therefore compared these 2 groups. As anticipated, the TBI group performed significantly worse than the ADHD group, but receiver operator characteristic analysis indicated that VMI scores were poor at discriminating between groups. Nonetheless, convergent validity evidence supported interpretation of VMI scores as measuring perceptual organization in both groups. In particular, principal components analysis indicated that VMI total scores loaded with perceptual organization tests from the Wechsler Intelligence Scale for Children, 3rd ed. (WISC-III; D. Wechsler, 1997), and its highest correlation was with the WISC-III Perceptual Organization Index. Also, the VMI correlated significantly with the Grooved Pegboard test for the group with TBI. These findings suggest that VMI scores are sensitive to visuoconstructional and motor deficits in children with developmental and acquired brain dysfunction.

EEG coherence in children with attention-deficit/hyperactivity disorder and comorbid reading disabilities

This study investigated EEG coherence differences between two groups of children with attention-deficit/hyperactivity disorder Combined type (AD/HD), with or without comorbid Reading Disabilities (RD), and normal control subjects. Each group consisted of 20 children between the ages of 8 and 12 years, and groups were matched on age and gender. EEG was recorded during an eyes-closed resting condition from 21 monopolar derivations. Wave-shape coherence was calculated for 8 intrahemispheric electrode pairs (4 in each hemisphere), and 8 interhemispheric electrode pairs, within each of the delta, theta, alpha and beta bands. In the intrahemispheric comparisons, the AD/HD groups compared to controls showed across-hemisphere reductions in coherences in the delta band at longer inter-electrode distances. Interhemispheric coherences in the frontal areas were elevated in theta and reduced in alpha; in the temporal area, coherences were reduced in alpha. Compared with children with AD/HD without comorbid RD, intrahemispheric coherences at shorter inter-electrode distances in children with comorbid RD were reduced in the left hemisphere for slow wave activity, particularly delta. Across hemispheres, the comorbid group also showed a reduced level of intrahemispheric coherence at longer inter-electrode distances in alpha. There were no interhemispheric differences associated with RD. The present results indicate that children with AD/HD and comorbid RD show deficits additional to those found in AD/HD patients without comorbid RD. These involve reduced lateralisation and impaired coupling of frontal and occipital brain regions in children with comorbid RD. Results confirm and clarify the additivity of brain dysfunctions in children with comorbid AD/HD and RD, previously reported by EEG power studies. Findings suggest that optimal treatment of these children should recognise the need to specifically address the RD, in addition to employing a medication regime focussed on the AD/HD symptoms.

The significance of sensory–motor functions as indicators of brain dysfunction in children

Sensory–perceptual and motor functions are closely dependent on the integrity of the brain and nervous system. Standardized tests have been developed to assess these functions, but such tests are not routinely used to evaluate children who are suspected of having a neuropsychological basis for their difficulties. Higher-level functions (such as verbal and academic abilities, executive functioning, etc.) are obviously important in producing successful performances, but the brain and nervous system correlates of these abilities are less well defined than the correlates for sensory–motor abilities. Our contention is that tests from these two general areas (higher-level and lower-level aspects of brain functioning) can be used effectively in a complementary manner to evaluate individual children. The first step in this process is to evaluate formal sensory–motor tests and to assess their validity as a brief preliminary examination used to differentiate between brain-damaged and control children. The results of this study demonstrated striking differences between the groups and indicated that sensory–motor testing might serve very effectively, when used in conjunction with higher-level tests, to identify those children whose higher-level impairment is due to brain impairment rather than a lack of environmental opportunities or advantages.

The significance of sensory-motor functions as indicators of brain dysfunction in children

Sensory-perceptual and motor functions are closely dependent on the integrity of the brain and nervous system. Standardized tests have been developed to assess these functions, but such tests are not routinely used to evaluate children who are suspected of having a neuropsychological basis for their difficulties. Higher-level functions (such as verbal and academic abilities, executive functioning, etc.) are obviously important in producing successful performances, but the brain and nervous system correlates of these abilities are less well defined than the correlates for sensory-motor abilities. Our contention is that tests from these two general areas (higher-level and lower-level aspects of brain functioning) can be used effectively in a complementary manner to evaluate individual children. The first step in this process is to evaluate formal sensory-motor tests and to assess their validity as a brief preliminary examination used to differentiate between brain-damaged and control children. The results of this study demonstrated striking differences between the groups and indicated that sensory-motor testing might serve very effectively, when used in conjunction with higher-level tests, to identify those children whose higher-level impairment is due to brain impairment rather than a lack of environmental opportunities or advantages.

The first neurophysiological evidence for cognitive brain dysfunctions in children with CATCH.

CATCH syndrome, caused by a microdelection in chromosome 22, is characterized by cleft palate and cardiac anomalies. The majority of these children also have learning difficulties or speech and language deficits. These problems are often due to the dysmorphology of the articulatory system. In the present study, the duration of auditory sensory memory, which is of central importance to speech perception and understanding, was investigated. As a research method we used mismatch negativity (MMN), an attention independent event-related potential, which provides an objective electrical index of auditory sensory memory. The present data suggest that the duration of this memory span is considerably shorter in 6-10-year-old children with CATCH than in healthy controls. Thus, the language-related problems encountered in children suffering from CATCH syndrome are likely to be caused also by CNS dysfunctions.

Book Reviews

Book reviewed in this article:Proteins in the Nervous System. Structure and Function, Bernard Haber, Jose Regino Perez‐Polo, and Joe Dan Coulter (eds.)Techniques and Basic Experiments for the Study of Brain and Behavior, 2nd revised and enlarged ed. Jan Bureš, Olga Burešová, and Joseph P. Huston.Temporal Lobe Epilepsy, Mania, and Schizophrenia and the Limbic System. Advances in Biological Psychiatry, vol. 8, W. P. Koella and M. R. Trimble (eds.).Neural Substrates of Limbic Epilepsy, Makran Girgis.Hysterical Conversion‐Reactions: A Clinical Guide to Diagnosis and Treatment, Michael I. Weintraub.Having Epilepsy. The Experience and Control of Illness. Joseph W. Schneider and Peter Conrad.Behavioral Approaches to Neurology, Joel F. Lubar and William M. Deering.Introduction to EEG and Evoked Potentials.Charles M. Epstein and Mary R. Andriola.Current Developments in Psychopharmacology, vol. 6, Walter B. Essman and L. Valzelli, (eds.)Essentials of Emergency Medicine. Douglas A. Rund,Brain Dysfunction in Children. Etiology, Diagnosis, and Management. Perry Black (ed.).Briefly Noted: The Child with Disabling Illness. Principles of Rehabilitation. 2nd ed. John A. Downey and Niels L. Low (eds.).Briefly Noted: Electroencephalography in Drug Research. Werner M. Herrmann (ed.).Briefly Noted: Endorphins and Opiate Antagonists in Psychiatric Research. Clinical Implications. Nandkumar S. Shah and Alexander G. Donald (eds.).Briefly Noted: Guided Brain Operations. Methodological and Clinical Developments in Stereotactic Surgery. Contributions to the Physiology of Subcortical Structures. Ernest A. Spiegel.Briefly Noted: Headache: Physiopathological and Clinical Concepts. Advances in Neurology. Volume 33. Mac‐donald Critchley, Arnold P. Friedman, Sergio Gorini, and Federigo Sicuteri (eds.).Briefly Noted: The Impact of Randomized Clinical Trials on Health Policy and Medical Practice: Background Paper. U.S. Congress, Office of Technology Assessment.Briefly Noted: Language and Cognitive Styles. Patterns of Neu‐rolinguistic and Psycholinguistic Development. Robert N. St. Clair and Walburga von Raffler‐Engel.Briefly Noted: Molecular Genetic Neuroscience. Francis O. Schmitt, Stephanie J. Bird, and Floyd E. Bloom (eds.).Briefly Noted: The Neurology of Aphasia. Howard S. Kirshner and Frank R. Freemon (eds.).Briefly Noted: Neuronal Plasticity and Memory Formation. International Brain Research Organization Monograph Series, vol. 9. Cosimo Ajmone‐Marsan and H. H. MatthiesBriefly Noted: Orphan Drugs. Fred E. Karch (ed.).Briefly Noted: Sexual Dysfunction in Neurological Disorders. Diagnosis, Management, and Rehabilitation. Francois Boiler and Ellen Frank.

Book Review: The Diagnosis and Treatment of Minimal Brain Dysfunction in Children — A Clinical Approach.

Book Review: The Diagnosis and Treatment of Minimal Brain Dysfunction in Children — A Clinical Approach.