Stereotyped Movements Research Articles

In silico analysis of SNPs and miRNAs of KCTD13, CSDE1, SLC6A1 genes associated with autism spectrum disorder

BackgroundSingle nucleotide polymorphism (SNP) is called changes in a single base sequence in DNA between individuals. Micro-RNAs (miRNAs) are short, non-coding RNA molecules that control gene expression after transcription. Today, SNPs and miRNAs are associated with many diseases, and one of them is autism spectrum disorder (ASD). ASD is a neurodevelopmental condition identified by symptoms that reduce the quality of life such as stereotypical movements, lack of social interaction and communication skills, cognitive and language disorders. The objective of this study is to utilize in silico tools to predict the possible damaging impacts of SNPs (missense) in ASD-related KCTD13, CSDE1, and SLC6A1 genes that cause amino acid substitution on protein function, stability, structure, and miRNA target binding sites.MethodsThe SNPs and protein amino acid sequences were obtained from the NCBI dbSNP and UniProt databases. This data served as input for predictions, which were carried out using different computational tools like SIFT, PolyPhen-2, SNPs&GO, PROVEAN, MutationAssessor, PhD-SNP, PANTHER, SNAP-2, Meta-SNP, I-Mutant 2.0, MUpro, and Project HOPE. For miRNA analysis, the miRSNP and PolymiRTS tools were utilized. GeneMANIA and STRING were also employed to explore gene–gene and protein–protein interactions.ResultsA total of 16 variants in these three genes were estimated to be potentially harmful via in silico analysis. As a result of the miRSNP and PolymiRTS analyses, it was found that 407 miRNAs could affect the regulation of target genes through the identified SNP variations. Furthermore, the predictive impact of those SNPs on protein stabilization was examined and three-dimensional protein models were created.ConclusionThis study revealed the potential effects of genetic variations on three genes associated with ASD. The findings suggest that computational analysis of miRNA and SNPs on these ASD-related genes could provide valuable insights into the genetic mechanisms underlying ASD. In addition, it is suggested to investigate through experimental research whether the findings can be utilized as potential biomarkers for diagnosing and treating autism.

Upper arm movements in the last days of life: A new possible sign of impending death.

One of the most crucial stages of palliative care is the last days and hours of life, which require special attention and knowledgeable identification of clinical signs described as signs of impending death (SID). Our case series of 11 patients receiving home palliative care describes bilateral hypoactive, stereotyped upper arm movements (scratching of the head, forehead, and nose) that were previously unknown or described, often accompanied by SID.

Clinical and genetic characterization of a progressive RBL2-associated neurodevelopmental disorder.

Retinoblastoma (RB) proteins are highly conserved transcriptional regulators that play important roles during development by regulating cell-cycle gene expression. RBL2 dysfunction has been linked to a severe neurodevelopmental disorder. However, to date, clinical features have only been described in six individuals carrying five biallelic predicted loss of function (pLOF) variants. To define the phenotypic effects of RBL2 mutations in detail, we identified and clinically characterized a cohort of 35 patients from 20 families carrying pLOF variants in RBL2, including fifteen new variants that substantially broaden the molecular spectrum. The clinical presentation of affected individuals is characterized by a range of neurological and developmental abnormalities. Global developmental delay and intellectual disability were uniformly observed, ranging from moderate to profound and involving lack of acquisition of key motor and speech milestones in most patients. Disrupted sleep was also evident in some patients. Frequent features included postnatal microcephaly, infantile hypotonia, aggressive behaviour, stereotypic movements, seizures, and non-specific dysmorphic features. Neuroimaging features included cerebral atrophy, white matter volume loss, corpus callosum hypoplasia and cerebellar atrophy. In parallel, we used the fruit fly, Drosophila melanogaster, to investigate how disruption of the conserved RBL2 orthologue Rbf impacts nervous system function and development. We found that Drosophila Rbf LOF mutants recapitulate several features of patients harbouring RBL2 variants, including developmental delay, alterations in head and brain morphology, locomotor defects, and perturbed sleep. Surprisingly, in addition to its known role in controlling tissue growth during development, we found that continued Rbf expression is also required in fully differentiated post-mitotic neurons for normal locomotion in Drosophila, and that adult-stage neuronal re-expression of Rbf is sufficient to rescue Rbf mutant locomotor defects. Taken together, our study provides a clinical and experimental basis to understand genotype-phenotype correlations in an RBL2-linked neurodevelopmental disorder, and suggests that restoring RBL2 expression through gene therapy approaches may ameliorate some symptoms caused by RBL2 pLOF.

Hybrid 3D Convolutional–Transformer Model for Detecting Stereotypical Motor Movements in Autistic Children During Pre-Meltdown Crisis

Computer vision using deep learning algorithms has served numerous human activity identification applications, particularly those linked to safety and security. However, even though autistic children are frequently exposed to danger as a result of their activities, many computer vision experts have shown little interest in their safety. Several autistic children show severe challenging behaviors such as the Meltdown Crisis which is characterized by hostile behaviors and loss of control. This study aims to introduce a monitoring system capable of predicting the Meltdown Crisis condition early and alerting the children’s parents or caregivers before entering more difficult settings. For this endeavor, the suggested system was constructed using a combination of a pre-trained Vision Transformer (ViT) model (Swin-3D-b) and a Residual Network (ResNet) architecture to extract robust features from video sequences to extract and learn the spatial and temporal features of the Stereotyped Motor Movements (SMMs) made by autistic children at the beginning of the Meltdown Crisis state, which is referred to as the Pre-Meltdown Crisis state. The evaluation was conducted using the MeltdownCrisis dataset, which contains realistic scenarios of autistic children’s behaviors in the Pre-Meltdown Crisis state, with data from the Normal state serving as the negative class. Our proposed model achieved great classification accuracy, at 92%.

AUTISM AS A DISORDER OF AFFECTIVE REGULATION OF CONSCIOUSNESS AND BEHAVIOR

This article talks about autism, which is one of the most pressing problems of our time, disorders of affective regulation of consciousness and behavior and the correctional work carried out with them. Information is given about the problems in their behavior and that they have been studied by scientists. The article covers communication and socialization of children with autism syndrome, skills of their diagnosis from an early age, upbringing and preparation for school education. Motor stereotypes described by Kainer. They are distinguished by “field behavior”, aimless movement in space, they can climb to any height without fear, avoid adults without looking back, since they do not have a developed sense of danger. Children of the first group do not have speech, although it is known that a child can very rarely pronounce a word or even a phrase, but such sudden “pop-up” words are no longer repeated.

Comparative Efficacy of Antipsychotic Medication for Stereotypic Behavior in Autism Spectrum Disorder: A Systematic Review and Meta-analysis

Background: Stereotypic movements in autism form core symptoms under the rubric of repetitive and restricted patterns of behavior. Aim: The systematic review was aimed to find which antipsychotic has better efficacy in treating stereotypic behavior in autism spectrum disorder. Methods: We searched for journal publications in the English from PubMed and Cochrane databases (CENTRAL), January 1992–June 2024, for randomized controlled trials that compared antipsychotics with a placebo of at least 6 weeks’ trial, with the outcome measure being a change in stereotypy score. Quality assessment of the included studies in the meta-analysis was done using Cochrane risk of bias tool version 2. We followed PRISMA guidelines for systematic review. The mean difference in change of stereotypy symptoms score was calculated between antipsychotic and placebo participants along with 95% confidence interval (CI) using the random-effects model. Results: 146 studies were screened, and 25 studies were deemed eligible to retrieve full-length articles for review. A total of nine studies were included in the systematic review that had used aripiprazole, risperidone, or lurasidone as an antipsychotic. Six studies (n = 726) that had all data on mean difference in stereotypy scores on the Aberrant Behavior Checklist (ABC)-Stereotypy subscale and four studies (n = 554) that reported stereotypy scores using Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS)-Compulsions subscale were included in the meta-analysis. Antipsychotics showed a significant reduction in ABC-Stereotypy scores (−1.84 [−2.84, −0.85; 95% CI], Z = 3.83, P < 0.001) with moderate heterogeneity between the studies (I 2 = 53%). Whereas, antipsychotics did not show significant improvement in compulsions as measured on CY-BOCS (−0.87 [−1.89, 0.16; 95% CI], Z = 1.65, P = 0.10). Conclusion: Stereotypy in autism is difficult to measure, and no uniform measure exists. Trials are limited to short duration and limited to few antipsychotics. Among antipsychotics, risperidone has robust efficacy in reducing stereotypic behaviors.

Late-onset drug-resistant epilepsy in pyridoxamine 5′-phosphate oxidase deficiency: a case report

BackgroundPyridoxamine 5′-phosphate oxidase deficiency is a rare inborn error of vitamin B6 metabolism that presents with drug-resistant epileptic seizures. However, the condition is responsive to supplementation with the active vitamin B6 metabolite pyridoxal 5′-phosphate and, in some cases, pyridoxine. Case presentationIn this case report, a 10-year-old Iranian male of Fars ethnicity came to a regional hospital in Tehran, Iran with a chief complaint of tic-like movement. He had a history of unintentional, repetitive, and stereotypic movements of both arms since the age of 4 years. The physical examination depicted facial dimorphism. During admission, the patient experienced habitual hypermotor seizures and generalized tonic–clonic seizures. Ictal electroencephalography demonstrated a generalized background attenuation and bursts of generalized, predominantly left-sided, biphasic spike-wave complexes. Whole-genome sequencing revealed a pyridoxamine 5′-phosphate oxidase deficiency as the underlying cause of the drug-resistant seizures, resulting in a low serum level of pyridoxal 5′-phosphate. The patient underwent pyridoxine supplementation therapy, which ultimately resolved his seizures. At 6 months, he was seizure free.ConclusionPhysicians ought to be aware of manifestations of vitamin B6 deficiency such as mimicking tic and consider it in the differential for drug-resistant epilepsy.

Spectral EEG and heart rate changes associated with leg movements during the suggested immobilization test in patients with restless legs syndrome.

Restless legs syndrome is usually associated with periodic limb movements during sleep, which are defined as repetitive, stereotyped movements in sleep. Changes in spectral analysis of electroencephalography and heart rate were shown to be associated with periodic limb movements during sleep and non-periodic leg movements in sleep. Considering the circadian distribution of symptoms of restless legs syndrome, we investigated spectral electroencephalography and heart rate accompanying periodic limb movements, isolated leg movements and short-interval leg movements during suggested immobilization test. The mean age of 53 patients was 51.9 ± 13 years, 54.7% were females. Prominent increases in electroencephalography activation were associated with periodic limb movements, isolated leg movements and short-interval leg movements during the suggested immobilization test, which were significant in all spectral bands (p < 0.001). An increase in all electroencephalography bands started ~10 s before periodic limb movements, isolated leg movements and short-interval leg movements; increases in delta and theta band activities ended ~10 s after the movements, while increases in alpha and beta band activities lasted for about ~20 s. Maximum increases in delta, theta, alpha and beta bands were all observed after periodic limb movements and short-interval leg movements, but before isolated leg movements in theta and alpha bands, and after isolated leg movements in delta and beta bands. A notably longer increase in alpha and beta bands was evident for periodic limb movements and short-interval leg movements. An increase in heart rate was prominent at 4-12 s after movement onset in short-interval leg movements, being significantly higher than those associated with periodic limb movements and isolated leg movements. Our study shows that, in patients with restless legs syndrome, periodic limb movements, isolated leg movements and short-interval leg movements during suggested immobilization test are associated with prominent cortical and cardiac activation, which warrants confirmation in larger restless legs syndrome cohorts and requires long-term follow-up studies to delineate its possible clinical consequences.

Catatonia in autism spectrum disorders: Prevalence, functional impact, and diagnostic insights

The current study aimed to evaluate subtle catatonia behaviors and functionality in adolescents with autism spectrum disorders (ASD). The sample consisted of 48 patients (11 female, 37 male) aged 12–18 (13.77 ± 2.01). DSM-5 catatonia criteria and Bush-Francis Catatonia Rating Scale (BCRS) was utilized to assess catatonia, while the impairment in functionality was appraised using the Global Assessment Scale. Parents fulfilled the Revised Child Anxiety and Depression Scale-Parent version (RCADS-PV) and Repetitive Behavior Scale-Revised (RBS-R). The presence of catatonia was detected in 18 out of 48 (37.5 %) participants according to BCRS, and in 16 cases (35.4 %) according to DSM-5 criteria. A significant association between two diagnostic tools was observed (p < 0.001). In the group with mild impairment in functionality, 2 cases had catatonia (12.5 %), while in the group with more impaired functionality, 16 cases (50 %) had catatonia (p = 0.011) according to BCRS. Major depressive disorder subscale scores of RCADS-PV and stereotypic movements (RBS-R) were correlated with the presence of catatonia (p < 0.05). The findings suggest a higher prevalence of catatonia in ASD, and a potential correlation between the presence of catatonia and functionality. More research is warranted to highlight the presence and course of catatonia beginning from the early years of ASD.

Automated long-term monitoring of stereotypical movement in polar bears under human care using machine learning

The welfare of animals under human care is often assessed by observing behaviours indicative of stress or discomfort, such as stereotypical behaviour (SB), which often shows as repetitive, invariant pacing. Traditional behaviour monitoring methods, however, are labour-intensive and subject to observer bias. Our study presents an innovative automated approach utilising computer vision and machine learning to non-invasively detect and analyse SB in managed populations, exemplified by a longitudinal study of two polar bears. We designed an animal tracking framework to localise and identify individual animals in the enclosure. After determining their position on the enclosure map via homographic transformation, we refined the resulting trajectories using a particle filter. Finally, we classified the trajectory patterns as SB or normal behaviour using a lightweight random forest approach with an accuracy of 94.9 %. The system not only allows for continuous, objective monitoring of animal behaviours but also provides insights into seasonal variations in SB, illustrating its potential for improving animal welfare in zoological settings. Ultimately, we analysed 607 days for the occurrence of SB, allowing us to discuss seasonal patterns of SB in both the male and female polar bear monitored. This work advances the field of animal welfare research by introducing a scalable, efficient method for the long-term, automated detection and monitoring of stereotypical behaviour, paving the way for its application across various settings and species that can be continuously monitored with cameras. We made the code publicly available at https://github.com/team-vera/stereotypy-detector.

Concentration- and time-dependent behavioural effects of ethanol on Lumbriculus variegatus.

Ethanol is one of the most widely used drugs in the world. Ethanol induces profound physiological and behavioural responses in invertebrate model organisms, such as Caenorhabditis elegans and Drosophila melanogaster. Lumbriculus variegatus (Annelida, Oligochaete) is an aquatic worm which shows behavioural responses to common drugs and thus is potentially useful in pharmacological research. The effects of ethanol are unknown in this organism. In this study, we examine the effects of acute exposure to ethanol (0-500 mM) on the stereotypical movements and locomotor activity of L. variegatus and examine the concentration- (0-500 mM) and time-dependent (0-210 min) effects of ethanol in L. variegatus. We show that ≥250 mM ethanol reversibly reduced the ability of tactile stimulation to elicit stereotypical movements, namely body reversal and helical swimming and locomotor activity (p < 0.05, N = 8). We also found that 2 min of exposure to ≥250 mM ethanol rapidly induces steady-state hypokinesis (p < 0.05, N = 11) and confirm ethanol absorption into L. variegatus tissues. Additionally, we also observed acute ethanol tolerance after 150 min of exposure to 500 mM ethanol (p < 0.05, N = 24). This study is the first to report the behavioural effects of ethanol in L. variegatus. Our results show that this is a model organism for use in ethanol studies, providing further evidence for its utility in pharmacological research.

ChangPu YuJin Tang improves Tourette disorder symptoms by modulating amino acid neurotransmitters in IDPN model rats.

Changpu Yujin Tang(CPYJT), a Chinese herbal compound, is an effective therapeutic strategy for pediatric patients with Tourette disorder (TD). Therefore, this work aims to investigate the therapeutic mechanisms of CPYJT. Behavioral and cellular ultrastructural evaluation of the therapeutic effects of CPYJT in TD model rats. Colorimetric methods, reverse transcription‑quantitative PCR, and Western Blot were used to measure the altered levels of GLU, GABA, and the levels of VGLUT1, GLUD1, GABRA3, and GAD65 in the cortex, striatum, and thalamus of the TD model rats after 7, 14, 21, and 28 days of CPYJT administration. CPYJT significantly reduced stereotypic behavior and motor behavior scores in TD model rats. CPYJT ameliorates myelin structural damage in TD model rat neuronal cells. CPYJT decreased GLU content, elevated GABA content, decreased GLUD1 and VGLUT1 levels, and elevated GAD65 and GABRA3 levels in TD model rats' cortex, striatum, and thalamus. CPYJT has different regulatory time points in the cortex, striatum, and thalamus for critical factors of amino acid-based neurotransmission. CPYJT protects behavioral and structural damage of neuronal cells in multiple brain regions in TD model rats.

Quo vadis DSM-6? An expert survey on the classification, diagnosis, and differential diagnosis of body-focused repetitive behaviors

BackgroundMany conditions we now call body-focused repetitive behaviors (BFRBs) have been subject to research for several decades, most notably trichotillomania and skin picking. However, the American Psychiatric Association did not combine these conditions into a single category, body-focused repetitive behavior disorders (BFRBDs), until the fifth edition of the DSM (2013). Several aspects of the disorder remain uncertain and controversial. For example, ongoing debate surrounds which specific conditions fall under this diagnostic category and how to best differentiate BFRBs from conditions such as nonsuicidal self-injury (NSSI). The current article presents results from a survey of experts' opinions on diagnostic criteria, with the goal of refining the diagnostic criteria. MethodWe contacted experts on BFRB via various sources and invited them to complete an online survey on the phenomenology, classification, and differential diagnosis of BFRB. We also inquired about possible alternative syndrome labels (e.g., body-focused habit). ResultsData from the final sample of 50 experts demonstrates that most experts agree with the present classification of BFRB/BFRBD as an obsessive-compulsive and related disorder and recommend retaining the labels BFRB or BFRBD. The experts considered the following conditions BFRB, with an agreement of over 60%: trichotillomania, skin picking, dermatophagia, nail biting, and lip-cheek biting. Mixed results emerged for awake bruxism and thumb sucking in adults. Only a minority regarded night bruxism and knuckle cracking as BFRB. To differentiate BFRB from NSSI, the experts noted that the motive behind the urge (self-harm/injury versus release of tension) should be considered. Analyses of a sub-sample of experts with at least six years of clinical and/or research experience yielded results compatible with those of the entire sample. DiscussionThe survey supports the usefulness of the BFRBD diagnostic entity. However, some criteria require further refinement. Future editions of the DSM should more explicitly delineate which conditions qualify as BFRB. Furthermore, it is important to give more attention to the primary motivation behind BFRB to distinguish it from NSSI and potentially from stereotypic movement behavior.

Automated Analysis of Stereotypical Movements in Videos of Children With Autism Spectrum Disorder

Stereotypical motor movements (SMMs) are a form of restricted and repetitive behavior, which is a core symptom of autism spectrum disorder (ASD). Current quantification of SMM severity is extremely limited, with studies relying on coarse and subjective caregiver reports or laborious manual annotation of short video recordings. To assess the utility of a new open-source AI algorithm that can analyze extensive video recordings of children and automatically identify segments with heterogeneous SMMs, thereby enabling their direct and objective quantification. This retrospective cohort study included 241 children (aged 1.4 to 8.0 years) with ASD. Video recordings of 319 behavioral assessments carried out at the Azrieli National Centre for Autism and Neurodevelopment Research in Israel between 2017 and 2021 were extracted. Behavioral assessments included cognitive, language, and autism diagnostic observation schedule, 2nd edition (ADOS-2) assessments. Data were analyzed from October 2020 to May 2024. Each assessment was recorded with 2 to 4 cameras, yielding 580 hours of video footage. Within these extensive video recordings, manual annotators identified 7352 video segments containing heterogeneous SMMs performed by different children (21.14 hours of video). A pose estimation algorithm was used to extract skeletal representations of all individuals in each video frame and was trained an object detection algorithm to identify the child in each video. The skeletal representation of the child was then used to train an SMM recognition algorithm using a 3 dimensional convolutional neural network. Data from 220 children were used for training and data from the remaining 21 children were used for testing. Among 319 behavioral assessment recordings from 241 children (172 [78%] male; mean [SD] age, 3.97 [1.30] years), the algorithm accurately detected 92.53% (95% CI, 81.09%-95.10%) of manually annotated SMMs in our test data with 66.82% (95% CI, 55.28%-72.05%) precision. Overall number and duration of algorithm-identified SMMs per child were highly correlated with manually annotated number and duration of SMMs (r = 0.8; 95% CI, 0.67-0.93; P < .001; and r = 0.88; 95% CI, 0.74-0.96; P < .001, respectively). This study suggests the ability of an algorithm to identify a highly diverse range of SMMs and quantify them with high accuracy, enabling objective and direct estimation of SMM severity in individual children with ASD.

The effectiveness of a training program based on the assessment of basic language and learning skills- revised tool ‘ABLLS-R’ in reducing stereotyped behaviors among children with autism spectrum disorder

This study investigates the efficiency of a developed training program based on ABLLS-R in reducing stereotypical behaviors among children with autism spectrum disorder (ASD). The experimental approach is employed specifically the single experimental group. The study population consists of 7 children with simple ASD. A measuring stereotypical behaviors was developed which includes two dimensions (motor stereotypical and routine stereotypical behaviors), in addition, a training program based on the ABLLS-R is developed. The findings reveal statistically significant differences between the pre and post treatment of stereotypical behaviors among Jordanian children with ASD in favor of the post-treatment in terms of motor stereotypical behaviors and Routine stereotypical behaviors. The findings indicate that there is an impact and a direct effect on lessen stereotypical motor and routine behaviors among Children with ASD improvement rate (66.6%).

Motives for Performing Body-Focused Repetitive Behaviors (BFRBs): Similarities to and Differences from Non-Suicidal Self-Injurious and Stereotypic Movement Behaviors

BackgroundIn the DSM-5, body-focused repetitive behaviors (BFRBs) are now classified in the obsessive-compulsive and related disorders section. Differential diagnosis is complicated by the overlap of BFRBs with other disorders, especially non-suicidal self-injurious behavior (NSSI) and stereotypic movement behavior (SMB). The present study examined participants’ motives for performing BFRBs to provide a better understanding of how BFRBs may differ from NSSI and SMB and to determine whether BFRB is best characterized as an obsessive-compulsive spectrum disorder.MethodsA total of 268 individuals with various BFRBs were assessed with respect to their motives for performing BFRBs, comorbid diagnoses, emotions accompanying their BFRBs, and whether they felt an urge to perform the behavior on others as well as themselves.ResultsThe main motives for performing BFRBs were release of stress (84.7%), boredom (51.5%), and gratification/pleasure (34.7%). Approximately one third of the sample were unable to provide a clear motive. The majority were ambivalent about their behavior. Participants rarely engaged in cutting; 16.4% performed a BFRB on someone else’s body or wanted to do so. OCD was self-reported by only 7.5% of the participants.DiscussionAmbivalence towards symptoms is high in individuals with BFRBs; the main motive for performing the behavior was emotion regulation, particularly of stress. Limitations of the study are the self-reported assessment and the high attrition during the assessment. Further research is needed to clarify whether BFRBs, NSSI, and SMB should be kept separate or should be combined into one category, perhaps with specifiers. The current classification of BFRBs as an OCD-related disorder should be reconsidered.

Level of knowledge of Stereotypic Movement Disorders among paediatric population. An update on proper differential diagnosis and management including physical exercise approach - comprehensive literature review

Level of knowledge of Stereotypic Movement Disorders among paediatric population. An update on proper differential diagnosis and management including physical exercise approach - comprehensive literature review

Neural substrates for regulating self-grooming behavior in rodents.

Grooming, as an evolutionarily conserved repetitive behavior, is common in various animals, including humans, and serves essential functions including, but not limited to, hygiene maintenance, thermoregulation, de-arousal, stress reduction, and social behaviors. In rodents, grooming involves a patterned and sequenced structure, known as the syntactic chain with four phases that comprise repeated stereotyped movements happening in a cephalocaudal progression style, beginning from the nose to the face, to the head, and finally ending with body licking. The context-dependent occurrence of grooming behavior indicates its adaptive significance. This review briefly summarizes the neural substrates responsible for rodent grooming behavior and explores its relevance in rodent models of neuropsychiatric disorders and neurodegenerative diseases with aberrant grooming phenotypes. We further emphasize the utility of rodent grooming as a reliable measure of repetitive behavior in neuropsychiatric models, holding promise for translational psychiatry. Herein, we mainly focus on rodent self-grooming. Allogrooming (grooming being applied on one animal by its conspecifics via licking or carefully nibbling) and heterogrooming (a form of grooming behavior directing towards another animal, which occurs in other contexts, such as maternal, sexual, aggressive, or social behaviors) are not covered due to space constraints.

Comparison of Continuous Intracortical and Scalp Electroencephalography in Comatose Patients with Acute Brain Injury.

Depth electroencephalography (dEEG) is a recent invasive monitoring technique used in patients with acute brain injury. This study aimed to describe in detail the clinical manifestations of nonconvulsive seizures (NCSzs) with and without a surface EEG correlate, analyze their long-standing effects, and provide data that contribute to understanding the significance of certain scalp EEG patterns observed in critically ill patients. We prospectively enrolled a cohort of 33 adults with severe acute brain injury admitted to the neurological intensive care unit. All of them underwent multimodal invasive monitoring, including dEEG. All patients were scanned on a 3T magnetic resonance imaging scanner at 6months after hospital discharge, and mesial temporal atrophy (MTA) was calculated using a visual scale. In 21 (65.6%) of 32 study participants, highly epileptiform intracortical patterns were observed. A total of 11 (34.3%) patients had electrographic or electroclinical seizures in the dEEG, of whom 8 had both spontaneous and stimulus-induced (SI) seizures, and 3 patients had only spontaneous intracortical seizures. An unequivocal ictal scalp correlate was observed in only 3 (27.2%) of the 11 study participants. SI-NCSzs occurred during nursing care, medical procedures, and family visits. Subtle clinical manifestations, such as restlessness, purposeless stereotyped movements of the upper limbs, ventilation disturbances, jerks, head movements, hyperextension posturing, chewing, and oroalimentary automatisms, occurred during intracortical electroclinical seizures. MTA was detected in 18 (81.8%) of the 22 patients. There were no statistically significant differences between patients with MTA with and without seizures or status epilepticus. Most NCSzs in critically ill comatose patients remain undetectable on scalp EEG. SI-NCSzs frequently occur during nursing care, medical procedures, and family visits. Semiology of NCSzs included ictal minor signs and subtle symptoms, such as breathing pattern changes manifested as patient-ventilator dyssynchrony.

A Case of Autism Spectrum Disorder Treated with Theridion currasavicum Prescribed on the Basis of Group Approach

Abstract Background Autism spectrum disorder (ASD) is a pervasive developmental disorder of unknown aetiology. There is a growing prevalence of ASD globally. Currently, there are no specific treatment that can address the core impairments of ASD. Case Summary A 5-year male child was brought to outpatient department with complaints of irritability, restlessness, howling, repeating words spoken to him, repeating phrases, hand flapping, self-hurting and hurting others, climbing stairs repeatedly, repeated drawing of squares everywhere, poor social interaction, poor peer-play and inappropriate playing with toys. The case was diagnosed as ASD and was assessed with the autism treatment evaluation checklist (ATEC) at baseline and follow-up visits. The case was treated with Theridion currasavicum in centesimal scale. ATEC score at baseline of 118 turned to 69 at the 12th month and 42 after 24 months of treatment. The remedy was repeated during monthly visits in ascending potencies. The child improved in the domains of social interaction, communication, repetitive stereotype movements, restricted interests and general health. The likelihood of causal relationship between intervention and outcome has been discussed as per modified Naranjo criteria for homoeopathy. This case report highlights the usefulness of the group approach and aetiological prescription as one way of arriving at the similimum in children with autism.