Severity Of Neuropsychological Impairment Research Articles

Outcomes following surgical interventions for hypothalamic hamartomas: protocol for a systematic review and individual patient data meta-analysis

IntroductionHypothalamic hamartomas (HHs) are deep-seated congenital lesions that typically lead to pharmacoresistant epilepsy and a catastrophic encephalopathic syndrome characterised by severe neuropsychological impairment and decline in quality of life. A...

Why should we ask binge drinkers if they smoke cannabis? Additive effect of alcohol and cannabis use on college students’ neuropsychological performance

IntroductionBinge drinking (BD) and cannabis use are prevalent in European adolescents and students. BD has been shown to have a negative impact on neuropsychological functioning, but little is known about the additive effect when it is combined with cannabis consumption. We therefore investigated the neuropsychological profiles of students who engage in combined BD and cannabis use, in order to explore the potentially harmful additive effects of cannabis use and BD on cognition. Material and methodsA sample of college students (N = 298) completed questionnaires on alcohol and cannabis use, and were screened for neuropsychological impairments using the Brief Evaluation of Alcohol-Related Neuropsychological Impairments (BEARNI). First, after dividing students into three groups according to their alcohol and cannabis use (i.e., light drinkers, binge drinkers, and binge drinkers consuming cannabis), we ran a linear mixed model based on the BEARNI z scores to test the performances of the three groups. Information yielded by the mixed model was supplemented by individual analyses. Second, to explore the heterogeneity of binge drinkers’ profiles, we ran a cluster analysis to characterize the alcohol users at higher risk of more severe neuropsychological impairment. ResultsOverall, poorer neuropsychological performances were observed among binge drinkers compared with light drinkers, whether they used cannabis or not. However, flexibility, episodic memory and working memory were particularly affected among binge drinkers who used cannabis. ConclusionsResults emphasize the importance of asking binge drinkers if they smoke cannabis, in order to adapt care and prevention strategies to their consumption and neuropsychological profile.

Neuropsychological Functioning in Patients with Cushing's Disease and Cushing's Syndrome.

To present a systematic review of the presence and severity of neuropsychological impairment in the six main neuropsychological domains (attention, executive function, language, visuospatial processing, intelligence, and memory) in patients with Cushing's disease (CD) and/or Cushing's Syndrome (CS) at various stages of the illness. The work aims to identify neuropsychological leverage points for focused diagnosis and rehabilitation in CS/CD patients. A pubmed literature search was performed and augmented by searching the reference lists of review articles identified by this search strategy. After excluding irrelevant hits, we systematically extracted data from 27 studies for each main neuropsychological domain, differentiating between active disease, short- and long-term remission. The literature gives evidence for neuropsychological impairment in all domains in Cushing patients with active disease. The most consistent impairments concerned memory and visuo-spatial processing, whereas the data are discordant for all other domains. Significant improvement of neuropsychological function - although not returning to normal in all domains - is shown in short-term and long-term remission of the disease. However, the published literature is thin, suffering from repetitive subsample analyses publishing, methodological concerns as lack of control for confounders such as depression. Memory is the most extensively investigated domain in CS/CD patients and impairment is most prominent in active disease. Patients should be counseled that neuropsychological function will improve with normalization of hypercortisolism and over time. More studies with more stringent methodological criteria, larger patient samples and controlling for confounders are required to enhance our understanding of neuropsychological function in patients with CS/CD.

24.1 NEUROCOGNITIVE DEVELOPMENT FROM INFANCY TO EARLY ADULTHOOD IN THE PSYCHOSIS SPECTRUM

BackgroundThe majority of patients with psychotic disorders experience severe neuropsychological impairment. The onset and course of this impairment, however, is debated. Moreover, the course of neuropsychological functioning in other psychiatric conditions remains largely unexamined. This study used longitudinal data from infancy to early adulthood to chart the course of general and specific neuropsychological functions in individuals with psychotic disorders, psychotic experiences and depression.MethodsData were from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective cohort study comprising all live births between 1991 and 1992 in Avon, UK. All participants who underwent cognitive testing at 18 months, 4, 8, 15 and 20 years, and psychiatric assessment at age 18 were included. Individuals with non-affective psychotic disorder, affective psychotic disorder, subclinical psychotic experiences and depression were compared to controls on full-scale, verbal and non-verbal IQ, and measures of processing speed, working memory, language, visuospatial ability and attention.ResultsIndividuals with non-affective psychosis showed continually increasing deficits between infancy (18 months) and adulthood (20 years) in full-scale IQ (effect size of change (ESΔ) =−1.09, p=.02), and non-verbal IQ (ESΔ=−0.94, p=.008). The depression group showed a small, increasing deficit in non-verbal IQ (ESΔ=−0.29, p=.04) between infancy and adulthood. Between ages 8 and 20, the non-affective psychosis group exhibited developmental lags (i.e. slower growth) on measures of processing speed, working memory and attention (ESΔ=−0.68, p=.001; ESΔ=−0.59, p=.004; ESΔ=−0.44, p=.001), and large, static deficits on measures of language and visuospatial ability (ES=−0.87, p=.005; ES=−0.90, p=.001). There was only weak evidence for neuropsychological deficits in individuals with affective psychosis, depression, and subclinical psychotic experiences.DiscussionThese findings suggest that the origins of non-affective psychotic disorder involve dynamic neurodevelopmental processes, which effect both verbal and non-verbal abilities throughout the first two decades of life. These neurodevelopmental processes do not manifest in other psychiatric disorders, such as affective psychotic disorder and depression.

The relationship between theory of mind and insight in obsessive-compulsive disorder

Background: It is known that obsessive-compulsive disorder (OCD) patients with poor insight display more severe neuropsychological impairments than other patients with OCD. There are limited studies of OCD and theory of mind (ToM).Aim: To investigate ToM skills in patients with OCD and the relationship between insight and ToM skills by comparing OCD patients with good and poor insight.Methods: Eighty patients with OCD and 80 healthy controls completed the structured clinical interview for DSM-IV axis I disorders, the Yale Brown Obsessive-Compulsive Scale, the Beck Anxiety and Beck Depression Inventories, and the Brown Assessment of Beliefs Scale. To assess ToM skills, first- and second-order false-belief tests, a hinting test, a faux pas test, a reading the mind in the eyes test, and a double-bluff test were administered.Results: Patients with OCD had poorer ToM abilities than healthy controls. All ToM scores were significantly lower in the poor insight group than in the good insight group (p < .001). A significant negative correlation was found between the BABS-total scores and all the ToM test mean scores (p < .05).Conclusions: The finding of significantly lower ToM skills in OCD with poor insight than in OCD with good insight may contribute to the idea of OCD with poor insight being a subtype with different clinical and neuropsychological characteristics.

Novel Unbalanced Translocations Affecting the Long Arms of Chromosomes 10 and 22 Cause Complex Syndromes with Very Severe Neurodevelopmental Delay, Speech Impairment, Autistic Behavior, and Epilepsy

Isolated abnormalities in terminal regions of chromosomes 10q and 22q were formerly described in patients affected by neuropsychological impairment, abnormal facies, and heterogeneous structural abnormalities of the body. Chromosomes 10q and 22q harbor important genes that play a major role in CNS development, like DOCK1 and SHANK3, and in overall body growth, like FGFR2 and HTRA1. By using clinical, neuroradiological, neurophysiological, and genetic assessment, we studied 3 siblings affected by 2 different forms of very severe neuropsychological impairment with structural physical abnormalities, epilepsy, and body overgrowth. The genetic analysis revealed 2 different unbalanced translocations t(10;22)(q26.13;q13.32) of genetic material between the long arms of chromosomes 10 and 22, deriving from a maternal balanced translocation. Consequences of the unbalanced translocation were the simultaneous partial monosomy of 10q26.13 to 10qter and partial trisomy of 22q13.32 to 22qter in 2 patients and the simultaneous trisomy distal q10 and monosomy distal q22 in 1 patient, respectively. To the best of our knowledge, we here describe for the first time a causal association between an unbalanced translocation t(10;22) affecting the long arms of both chromosomes 10 and 22 and a very severe neurodevelopmental delay in 3 siblings.

Clinical and Biological Risk Factors for Neuropsychological Impairment in Alcohol Use Disorder

The effects of alcoholism on cognitive and motor functioning are heterogeneous. While the role of some factors (patterns of alcohol consumption, eating habits or associated liver disease) has been hypothesized, the origins of this heterogeneity remain difficult to establish. The goals of the present study were thus to identify the clinical and biological risk factors for alcohol-related neuropsychological impairments and to determine the threshold beyond which these risk factors can be considered significant. Thirty alcoholic patients and 15 healthy controls had a blood test and underwent a neuropsychological examination. Alcohol severity measures, and liver, thiamine and malnutrition variables, were included in logistic regression models to determine the risk factors for cognitive and motor impairments (executive functions, visuospatial abilities, verbal episodic memory, ataxia), as well as those related to the severity of patients’ overall neuropsychological profile (moderate or severe impairments). Liver fibrosis was found to be a risk factor for executive impairments and also for ataxia, when it was associated with long-term alcohol misuse and symptoms of withdrawal. Altered thiamine metabolism was solely predictive of verbal episodic memory impairments. This combination of biological abnormalities was associated with a profile of moderate neuropsychological impairments. Malnutrition was associated with a profile of more severe impairments. Malnutrition, altered liver function and thiamine metabolism explain, at least partially, the heterogeneity of alcohol-related neuropsychological impairments. Our findings could allow clinicians to identify patients at particular risk of severe neuropsychological impairments before the onset of irreversible and debilitating neurological complications.

Impairment of sleep-related memory consolidation in schizophrenia: relevance of sleep spindles?

ObjectivesDeficits in declarative memory performance are among the most severe neuropsychological impairments in schizophrenia and contribute to poor clinical outcomes. The importance of sleep for brain plasticity and memory consolidation is widely accepted, and sleep spindles seem to play an important role in these processes. The aim of this study was to test the associations of sleep spindles and picture memory consolidation in patients with schizophrenia and healthy controls. MethodsWe studied 16 patients with schizophrenia on stable antipsychotic medication (mean age ± standard deviation, 29.4 ± 6.4 years) and 16 healthy controls matched for age and educational level. Sleep was recorded and scored according to American Academy of Sleep Medicine (AASM) standard criteria. We performed a picture recognition paradigm and compared recognition performance for neutral and emotional pictures in sleep and wake conditions. ResultsRecognition accuracy was better in healthy controls than in patients with schizophrenia in the sleep and wake conditions. However, the memory-promoting effect of sleep was significantly lower in schizophrenia patients than in controls. Sleep spindle activity was reduced in patients, and sleep spindle density was correlated with sleep-associated facilitation of recognition accuracy for neutral pictures. ConclusionReduced sleep spindles seem to play an important role as a possible mechanism or biomarker for impaired sleep-related memory consolidation in patients with schizophrenia, and are a new target for treatment to improve memory functions and clinical outcomes in these patients.

ABSTRACT 374

Background and aims: Febrile Infection-Related Epilepsy Syndrome (FIRES), is a rare condition in which previously healthy children develop refractory status epilepticus after a febrile illness, leading to refractory epilepsy and severe neuropsychological impairment. Overlapping signs and symptoms with other causes of encephalopathy and seizures make diagnosis and treatment challenging. Aims: We present a case of a 6 year old boy with a typical disease course and review current pathophysiologic research and treatment options. Methods: After a febrile illness, the boy was found comatose with a tongue bite. He was intubated and ventilated, and started on anticonvulsives, antibiotics and antiviral medication. He initially improved and was extubated, but developed more generalised tonic clonic seizures, encephalopathy and in the course of a few days a convulsive state. Seizures were reduced temporarily but never completely inhibited, also not by barbiturate coma nor by a ketogenic diet. Dysregulation of the autonomic nerve system including temperature and blood pressure instability were noted. Results: A full infectious, metabolic (including muscle biopsy) and immunological work up, did not reveal any etiology. EEGs, a PET-CT and serial MRI investigations were performed, compatible with a diagnosis of FIRES. Eventuelly, the boy went home subcomatose with a tracheostoma and ventilated, in the care of his parents and nursing service. Conclusions: This case illustrates the diagnostic and therapeutic difficulties in Febrile Infection-Related Epilepsy Syndrome. Current research shows some insight in the pathophysiology and preferable treatment, although outcome remains limited in many cases.

Bilateral brachial plexus injury following acute carbon monoxide poisoning

BackgroundCarbon monoxide (CO) intoxication is a leading cause of severe neuropsychological impairments. Peripheral nerve injury has rarely been reported. It consists usually in a demyelinating polyneuropathy or mononeuropathy affecting mainly the lower limbs. Isolated involvement of both upper extremities has been described in only 4 patients related to root damage. We report the first case of bilateral brachial plexus injury following CO poisoning and review all previous CO-induced neuropathy described in literature.Case presentationAfter being unconscious for three hours, a 42 years old man experienced bilateral brachial weakness associated with edema of the face and the upper limbs. Neurological examination showed a brachial diplegia, distal vibratory, thermic and algic hypoesthesia, deep tendon areflexia in upper limbs. There was no sensory or motor deficit in lower extremities. No cognitive disturbances were detected. Creatine kinase was elevated. Electroneuromyogram patterns were compatible with the diagnosis of bilateral C5 D1 brachial axonal plexus injury predominant on the left side. Clinical course after hyperbaric oxygen therapy was marked by a complete recovery of neurological disorders.ConclusionPeripheral neuropathy is an unusual complication of CO intoxication. Bilateral brachial plexus impairment is exceptional. Various mechanisms have been implicated including nerve compression secondary to rhabdomyolysis, nerve ischemia due to hypoxia and direct nerve toxicity of carbon monoxide. Prognosis is commonly excellent without any sequelae.

Long-term neurological and neuropsychological outcome in patients with severe traumatic brain injury

BackgroundSevere traumatic brain injury (TBI) remains a major cause of death and disability worldwide. The aim of the study was to evaluate predictors for neurological and neuropsychological long-term outcome in patients with severe TBI treated according to an intracranial pressure (ICP-) targeted therapy. MethodsFrom 08/2005 to 12/2008, 46 patients with severe TBI and more than 12h of intensive care treatment were included in this study. Neurological outcome was assessed with the Glasgow Outcome Scale (GOS). Neuropsychological performance assessing 9 different domains was evaluated at long-term follow-up (median 20.5 months; range 10–46). Logistic regression was used to identify favourable outcomes according to the GOS and Fisher's exact tests were used to identify predictors of severe neuropsychological impairments at follow-up. ResultsTwenty-nine patients were available for neuropsychological assessment at long-term follow-up. Only 2 out of 29 patients presented normal or average neuropsychological findings throughout all 9 neuropsychological domains at long-term follow-up. The percentage of a favourable outcome (GOS 4-5) increased from 13.8% at hospital discharge to 75.8% at rehabilitation discharge to 79.3% at long-term follow-up, respectively. Age ≤40 was found to be a strong predictor of favourable outcome at follow-up (OR 5.95, 95% CI 1.41 25.00, p=0.015). The GOS at hospital discharge was not a predictor for severe impairments in any of the 9 different neuropsychological domains (all p-values were p>0.268). In contrast, the GOS at rehabilitation discharge was found to be a predictor of severe impairments at follow-up in all but one domain assessed (all p-values less than p<0.038). ConclusionsThe GOS at rehabilitation discharge should be regarded as a better predictor for neuropsychological impairments at long-term follow-up than the GOS at hospital discharge. Even in patients with favourable GOS after finishing a course of rehabilitation, three quarters of these patients may have at least one severe neuropsychological deficit. Therefore, it remains of paramount importance to provide long-term neuropsychological support to further improve outcome after TBI.

Apathy and Cognitive Test Performance in Patients Undergoing Cardiac Testing

Background. Psychiatric comorbidity is common in patients with cardiovascular disease, with the literature indicating that this population may be at risk for apathy. The current study examined the prevalence of apathy in patients with cardiovascular disease and its relation to aspects of cognitive function. Methods. 123 participants from an outpatient cardiology clinic completed a brief neuropsychological battery, a cardiac stress test, and demographic information, medical history, and depression symptomatology self-report measures. Participants also completed the Apathy Evaluation Scale to quantify apathy. Results. These subjects reported limited levels of apathy and depression. Increased depressive symptomatology, history of heart attack, and metabolic equivalents were significantly correlated with apathy (P < 0.05). Partial correlations adjusting for these factors revealed significant correlations between behavioral apathy and a measure of executive function and the other apathy subscale with a measure of attention. Conclusion. Findings revealed that apathy was not prevalent in this sample though associated with medical variables. Apathy was largely unrelated to cognitive function. This pattern may be a result of the mild levels of cardiovascular disease and cognitive dysfunction in the current sample. Future studies in samples with severe cardiovascular disease or neuropsychological impairment may provide insight into these associations.

Absence of Quantitative Improvement in Neuropsychological Profiles in Patients Who Exhibit Moderate Brain Impairment: Comparisons of Cross-Sectional and Longitudinal Data (1 through 4 Years Post-Injury)

A total of 127 adult patients who had sustained an impact of significant mechanical energy to their skulls during motor vehicle incidents were given thorough neuropsychological, cognitive and personality assessments between 0.5 years and 4 years after the event. Cross-sectional analysis indicated no statistically significant objective changes in patients as a function of yearly intervals. However there was strong evidence of significant deterioration of neuropsychological proficiency and efficiency between 0.3 to 1.0 years after the injury. A subset (n = 20) of patients who displayed moderately severe neuropsychological impairment when assessed about 1 year after the injury showed no statistically significant changes when reassessed about 1.5 years later (2.5 years after the brain trauma). These results challenge the traditional concept of “recovery” following a traumatic brain injury and indicate that insidious processes that adversely affect neurocognitive capacity may emerge 0.5 years after the trauma. Post-hoc analysis indicated that the occurrence of unconsciousness or its duration at the time of the injury minimally affected the magnitude of subsequent indices of neuropsychological impairment but influenced the incidence of electroencephalographic theta activity during the years following the injury.

Brain structural changes and neuropsychological impairments in male polydipsic schizophrenia

BackgroundPolydipsia frequently occurs in schizophrenia patients. The excessive water loading in polydipsia occasionally induces a hyponatremic state and leads to water intoxication. Whether polydipsia in schizophrenic patients correlates with neuropsychological impairments or structural brain changes is not clear and remains controversial.MethodsEight polydipsic schizophrenia patients, eight nonpolydipsic schizophrenia patients, and eight healthy controls were recruited. All subjects underwent magnetic resonance imaging (MRI) and neuropsychological testing. Structural abnormalities were analyzed using a voxel-based morphometry (VBM) approach, and patients’ neuropsychological function was assessed using the Brief Assessment of Cognition in Schizophrenia, Japanese version (BACS-J).ResultsNo significant differences were found between the two patient groups with respect to the clinical characteristics. Compared with healthy controls, polydipsic patients showed widespread brain volume reduction and neuropsychological impairment. Furthermore, the left insula was significantly reduced in polydipsic patients compared with nonpolydipsic patients. These nonpolydipsic patients performed intermediate to the other two groups in the neuropsychological function test.ConclusionsIt is possible that polydipsia or the secondary hyponatremia might induce left insula volume reduction. Furthermore, this structural brain change may indirectly induce more severe neuropsychological impairments in polydipsic patients. Thus, we suggest that insula abnormalities might contribute to the pathophysiology of polydipsic patients.

MK EFFECT OF AGE AT ONSET AND DURATION OF EPILEPSY ON MEMORY ENCODING IN TEMPORAL LOBE EPILEPSY

RationaleEarlier age at onset and longer duration of epilepsy is associated with more severe neuropsychological impairment in temporal lobe epilepsy (TLE). The prefrontal cortex (PFC) and medial temporal lobe (MTL)...

Specifying the Neuropsychology of Affective Disorders: Clinical, Demographic and Neurobiological Factors

Neuropsychological research in patients with affective disorders shows heterogeneous results with regard to the severity and profile of cognitive impairments. In this paper we hypothesize that the investigation of clinical (subtypes, comorbidity, traumatization, personality, severity, diurnal swings, course, duration, age of onset, biased processing, rumination, motivation, experience of failure, sleep, suicidal tendencies, computer attitudes), demographic (age, education, gender) and neurobiological factors (structural and functional brain changes, glucocorticoids, medication, ECT) that are related to cognitive performance has specified the understanding of severity and profile of neuropsychological impairments. We reviewed the literature pertaining to clinical, demographic and neurobiological factors following Pubmed and PsychInfo databases using different combinations of general key-terms including "Affective Disorder," "Depression," "Mania," "Neuropsychological," "Neurobiological," "Moderator," and "Review" as well as more specific demographic, clinical and neurobiological search terms. Findings from the literature show that the consideration of these factors has improved knowledge about the severity of neuropsychological impairments in patients with affective disorders whereas the neuropsychological profile is still poorly understood. Despite limited understanding, however, the existent results provide promising suggestions for the development of treatment programs.

Adults with autism spectrum disorders and ADHD neuropsychological aspects

The purpose of the present study was to assess which types of neuropsychological deficits appear to be most commonly associated with autism spectrum disorders (ASD) and attention-deficit/hyperactivity disorder (ADHD) in adults. The effect of the combination of ASD with ADHD (ASD/ADHD) was also studied. One hundred and sixty-one adult individuals (≥18 years of age) were included in the study. None had full scale IQ less than 71. The neuropsychological investigations included measures of intellectual ability, learning and memory, attention/executive function and theory of mind. The three diagnostic groups showed reduced performance in most cognitive domains. However, within these domains differentiating distinct features could be seen. The dysfunctions of the ASD/ADHD group cannot be seen as a summary of the dysfunctions found in the ASD and ADHD groups. The ADHD seemed to have the most severe neuropsychological impairments of the three groups. No domain-specific deficit typical of any of the diagnostic groups was found.

Geriatric mental health: Recent trends in molecular neuroscience

Byline: T. Sathyanarayana Rao, B. Praveena, K. Jagannatha Rao For every eight seconds, a Baby Boomer turns 60 in the world. By 2015, nearly 15% of our population will be over 65 years of age. This is increasing and expected to increase geriatric population burden in health and financial sector in every country. We have limited geriatric healthcare and care giving facilities and this is the essential need due to changing social and financial spheres in our lives. Research on aging and aging processes leads the way to a greater understanding of all age-related diseases.[sup] [1],[2],[3],[4],[5],[6] It has the potential to improve public health to a far greater extent than science that examines only one disease at a time. Research on aging also provides the hope and the promise for everyone to live healthier, longer lives, less susceptible to disease and disability. Aging research is likely to be the least expensive path to preventing and curing many diseases of aging. Studying aging requires two complementary approaches: studying the components of disease that are related to aging and studying the underlying mechanisms of aging and how they regulate the processes in our bodies.[sup] [7],[8] In USA, for 28 years, the American Federation for Aging Research (AFAR) has been at the forefront of this revolutionary approach to the science of healthier aging. AFAR has played a major role in providing and advancing knowledge of aging and mechanisms of age-related diseases by providing grants to more than 2,600 talented scientists. There is an urgent need in India too to have advanced research in aging related to Indian situation. We don't have any cross sectional study either on healthy aging or age related neurological disorders and their burden in India. Government of India need to play a significant role in funding geriatric research. Americans are living longer than ever, according to the latest life expectancy statistics. But American men still aren't living as long as American women. The average life expectancy for men in the US is now roughly 75 years. For women, it's more than 80. Exactly why men are shorter-lived than women isn't entirely clear. Even in infancy, boys run a higher risk of dying than girls, and researchers aren't sure why. Research, however, does suggest that a leading reason for the longevity gap between men and women is that men don't take care of themselves as well as women do. Surveys have found, for example, that women are much more likely to have a regular healthcare provider, and to see him or her within the course of the year, than men are. Men are also more likely to engage in risky behavior - like smoking and drinking heavily then women. The greatest health asset for geriatric population is spending time and doing things with other people, of all ages, which can help keep them mentally, physically and emotionally fit. It can also give brain a boost and lift the mood. They need to volunteer, or join community or other groups and get involved in activities they enjoy. But in the current situation is not so satisfactory for our aged. In India, there is an urgent need to develop models to keep geriatric populations active through out life. We need to provide a comprehensive plan on post retirement healthy and active living.[sup] [9],[10],[11] Unhealthy aging is a risk factor for geriatric mental disorders. The failure in normal healthy aging leads to mental disorders in aged population. Bipolar disorder (BD) is a major geriatric mental health problem and affects about 1% of the population and causes severe neuropsychological impairments and is implicated in functional impairment. What is meant by normal aging and healthy aging and what are the triggering risk factors for geriatric mental health problems are the major puzzling issues. We need to understand biology of aging properly. Biological changes during aging include neuropeptide (involved in memory and emotion), calcium balance, hormones like oxytocin, neural networks, metal homeostasis, and genetic instability and related gene expression changes. …

Evidence of altered DNA integrity in the brain regions of suicidal victims of Bipolar Depression

Deoxyribonucleic acid (DNA) integrity plays a significant role in cell function. There are limited studies with regard to the role of DNA damage in bipolar affective disorder (BP). In the present study, we have assessed DNA integrity, conformation, and stability in the brain region of bipolar depression (BD) patients (n=10) compared to age-matched controls (n=8). Genomic DNA was isolated from 10 postmortem BD patients’ brain regions (frontal cortex, Pons, medulla, thalamus, cerebellum, hypothalamus, Parietal, temporal, occipital lobe, and hippocampus) and from the age-matched control subjects. DNA from the frontal cortex, pons, medulla, and thalamus showed significantly higher number of strand breaks in BD (P<0.01) compared to the age-matched controls. However, DNA from the hippocampus region was intact and did not show any strand breaks. The stability studies also indicated that the melting temperature and ethidium bromide binding pattern were altered in the DNA of BD patients’ brain regions, except in the hippocampus. The conformation studies showed B-A or secondary B-DNA conformation (instead of the normal B-DNA) in BD patients’ brain regions, with the exception of the hippocampus. The levels of redox metals such as Copper (Cu) and Iron (Fe) were significantly elevated in the brain regions of the sufferers of BD, while the Zinc (Zn) level was decreased. In the hippocampus, there was no change in the Fe or Cu levels, whereas, the Zn level was elevated. There was a clear correlation between Cu and Fe levels versus strand breaks in the brain regions of the BD. To date, as far as we are aware, this is a new comprehensive database on stability and conformations of DNA in different brain regions of patients affected with BD. The biological significance of these findings is discussed here.

Atypical rolandic epilepsy

Typical benign rolandic epilepsy (BRE) is a frequent and well-delineated epileptic syndrome in childhood. Mild cognitive and behavioral difficulties are increasingly recognized in the course of BRE and should not be considered as atypical features. Atypical features are recognized on electroclinical grounds. These features, particularly early age at onset and frequent spikes or spike-wave discharges, seem to be risk factors for neuropsychological deficits but also for an atypical evolution of BRE. Atypical evolutions of BRE are defined by the appearance of severe neuropsychological impairments and continuous spike-and-waves during slow sleep (CSWSS). The clinical expressions of these situations correspond to the syndromes known as atypical benign focal epilepsy of childhood (ABFEC), status of BRE, Landau-Kleffner syndrome (LKS), and CSWSS syndrome, which may be part of a continuum related to BRE.