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ABSTRACT: To clarify the prognostic value of conventional EEG for the identification of preterm infants at risk for subsequent adverse neurodevelopment in the current perinatal care and medicine setting.
We studied 780 EEG records of 333 preterm infants born <34 weeks' gestation between 2002 and 2008. Serial EEG recordings were conducted during 3 time periods; at least once each within days 6 (first period), during days 7 to 19 (second period), and days 20 to 36 (third period). The presence and the grade of EEG background abnormalities were assessed according to an established classification system. Neurodevelopmental outcomes were assessed at a corrected age of 12 to 18 months.
Of the 333 infants, 33 (10%) had developmental delay and 34 (10%) had cerebral palsy. The presence of EEG abnormalities was significantly predictive of developmental delay and cerebral palsy at all 3 time periods: the first period (n = 265; odds ratio [OR], 4.5; 95% confidence interval [CI], 2.2-9.4), the second period (n = 278; OR, 7.6; 95% CI, 3.6-16), and the third period (n = 237; OR, 5.9; 95% CI, 2.8-13). The grade of EEG abnormalities correlated with the incidence of developmental delay or cerebral palsy in all periods (P < .001). After controlling for other clinical variables, including severe brain injury, EEG abnormality in the second period was an independent predictor of developmental delay (OR, 3.2; 95% CI, 1.1-9.7) and cerebral palsy (OR, 6.8; 95% CI 2.0-23).
EEG abnormalities within the first month of life significantly predict adverse neurodevelopment at a corrected age of 12 to 18 months in the current preterm survivor.
PEDIATRICS 09/2012; 130(4):e891-7. · 4.47 Impact Factor
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ABSTRACT: We report the case of a 17-month-old infant who developed an isolated cystic lesion of the callosal genu as a unique lesion of traumatic axonal injury (TAI). Although one of the most common sites of TAI is the corpus callosum, there have been no reports describing the lesion seen in our patient. Brain computed tomography findings were normal on the day of the traffic accident. After 3 months, brain magnetic resonance imaging showed an isolated cystic lesion of the callosal genu that had the appearance of a cystic cavity. This lesion decreased in size 16 months later. The neuroimaging findings of this patient suggest that an isolated cystic lesion of the callosal genu could appear as a unique form of TAI in infants after traumatic brain injury (TBI), but it is nevertheless important to attend to such lesions in children with TBI.
Neuropediatrics 05/2012; 43(3):162-3. · 0.94 Impact Factor
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ABSTRACT: Introduction:To assess differences in amplitude among electrode locations on amplitude-integrated electroencephalograms (aEEGs) in preterm infants and change therein between preterm age and term-equivalent age (TEA), we investigated aEEGs in preterm infants at both 30-32 weeks post-conceptional age (PCA) and TEA.Methods:The median values of upper- and lower-margin amplitudes were quantitatively calculated every 5 min (Med-UMA5 and Med-LMA5, respectively), and peak, median, and bottom values were extracted at each location for the trans-frontal, trans-central, trans-occipital, fronto-central, and centro-occipital electrodes.Results:In 38 clinically stable preterm infants studied, most measurement items showed significant differences among the electrode locations at both preterm age and TEA. At 30-32 weeks PCA, the bottom of Med-LMA5 was significantly higher for the trans-frontal electrodes than for the trans-central ones. In contrast, all measurements for Med-LMA5 were significantly lower for the trans-frontal electrodes than for the trans-central ones.Discussion:Amplitudes on aEEGs were significantly different among the electrode locations in preterm infants and that locational differences in amplitude changed between preterm age and TEA. It is necessary to understand the differences in amplitudes among the electrode locations on aEEGs in infants to appropriately evaluate them.
Pediatric Research 04/2012; · 2.70 Impact Factor
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Developmental Medicine & Child Neurology 02/2012; 54(9):862. · 2.92 Impact Factor
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ABSTRACT: We report on a 4-year-old boy with transient reduced diffusion in the cortex, thalamus, and hippocampus on diffusion-weighted imaging (DWI) performed after prolonged febrile seizures (PFS). He had experienced intermittent right hemiconvulsions lasting about 90 min during the febrile illness, but his neurological symptom resolved completely after several hours. DWI performed immediately after the PFS showed abnormally high signal intensities in the left extended cortex and pulvinar of the ipsilateral thalamus. Two days later, these DWI lesions resolved completely, but abnormally high signal intensities were observed in the left hippocampus. Three months later, the DWI was normal, and no atrophy or gliosis was seen. This patient had unique lesions on DWI after PFS, but it is nevertheless important to attend to such lesions on the DWI of patients with PFS.
Brain & development 01/2012; 34(9):773-5. · 1.74 Impact Factor
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ABSTRACT: We report a preterm infant, who showed abnormal amplitude-integrated electroencephalogram (aEEG) findings 1h after birth and later developed cystic periventricular leukomalacia (PVL). The patient was a girl with a gestational age of 29weeks. She was delivered by emergency cesarean section because of placental abruption and intrauterine co-twin demise. Artificial ventilation and administration of surfactant were needed to treat respiratory distress syndrome. Her cardiovascular condition was stable with artificial ventilation. Cranial ultrasonography showed extended cystic PVL after 11days of age. aEEG 1h after birth showed a consistently inactive pattern that resolved completely 28h after birth. The neurophysiological findings of this patient suggest that aEEG findings during the very early period after birth provide significant information for predicting PVL.
Brain & development 12/2011; · 1.74 Impact Factor
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ABSTRACT: To investigate the accuracy of conventional electroencephalograms (cEEGs) and amplitude-integrated EEGs (aEEGs) in the evaluation of brain maturation in normal pre-term infants. In addition, extrauterine acceleration of brain maturation was investigated.
A total of 129 EEGs recorded between 27 and 37 weeks of postconceptional age (PCA) from 37 clinically stable pre-term infants were analysed. One expert investigator blindly estimated PCA using cEEG and total cerebral function monitoring (CFM) score on aEEG. The estimated PCA (ePCA) on aEEG was calculated from a regression equation.
The linear regression analysis showed a significant correlation between chronological PCA (cPCA) and ePCA on cEEG and between cPCA and total CFM score on aEEG. The estimation gap was smaller on cEEG, which was between -2 and +2 weeks in 96.9%. No significant correlation was observed between postnatal age and the estimation gap on cEEG or aEEG.
Estimated brain maturation was well correlated with cPCA on cEEG and aEEG. However, the evaluation of brain maturation was much more accurate on cEEG than aEEG. Extrauterine acceleration of brain maturation was not observed on either cEEG or aEEG.
cEEG and aEEG will be valuable tools for evaluation of brain maturation in pre-term infants.
Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 04/2011; 122(10):1967-72. · 3.12 Impact Factor
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ABSTRACT: This study aimed to assess amplitude-integrated electroencephalography (aEEG) findings in preterm infants with cystic periventricular leukomalacia (cPVL) in the early neonatal period.
We analyzed five infants with cPVL, whose gestational age was between 27 and 30 weeks, and 15 matched control infants. Two-channel (C3-O1 and C4-O2) aEEG was obtained by digital conversion from a conventional electroencephalogram, which was recorded at days 0-5, 6-13, and 21-34 in each infant. We evaluated the averaged two-channel values of several measurements using visual and quantitative analyses.
Infants with cPVL had a significant higher maximal upper-margin amplitude value, with a median of 47.5 μV (range of 42.5-60) compared with the control infants (median, 33.8; range, 23.8-50) in the second visual-analysis record. Infants with cPVL also had a significantly higher mean upper-margin amplitude value, with a median of 18.8 μV (range, 17.7-23.2) compared with the control infants (median, 16.3; range, 10.3-19.0) in the second quantitative-analysis record.
We demonstrated that the upper-margin amplitude of aEEG in infants with cPVL was significantly higher than that in the control infants at 6-13 days after birth.
Early human development 01/2011; 87(3):217-21. · 2.12 Impact Factor
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ABSTRACT: To clarify the features of acute encephalopathy associated with 2009 pandemic flu. We identified 51 patients with acute encephalopathy with seasonal flu from the data base accumulated by Tokai Pediatric Neurology Society. We also collected 10 patients with acute encephalopathy with 2009 pandemic flu. The clinical course, laboratory data, neuroimaging findings, treatment, and the outcome of these patients were recruited using a structured research form. These data were compared between the two groups. The age was larger in the 2009 pandemic flu group (median, 109.5months) than in the seasonal flu group (median, 44months). There was no significant difference in other demographic data, neurologic symptoms, laboratory and neuroimaging findings, and treatment. Various degrees of neurologic sequelae including death were observed in 32% of the patients in the seasonal flu group, and in 50% in the 2009 pandemic flu groups. The analyses of patients with ages of 6years or older revealed that moderate or more severe sequelae were more frequent in patients with 2009 pandemic flu. Acute encephalopathy with 2009 pandemic flu occurred mainly among children with 6years of age or older, and the outcome was worse in this age group compared with acute encephalopathy with seasonal flu.
Brain & development 01/2011; 34(1):13-9. · 1.74 Impact Factor
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ABSTRACT: Periventricular leukomalacia (PVL) is one of the most important causes of adverse outcome of preterm infants. We hypothesized that inflammatory or some other specific pathways will have been activated at birth in preterm infants who later develop PVL. The aim of this study is to examine the difference in mRNA expression in umbilical cord blood according to the presence or absence of PVL.
A total of 61 umbilical cord blood samples were collected from preterm infants with gestational age less than 33 weeks together with the patients' medical information during perinatal period. RNA expression patterns in the collected cord bloods were analyzed by microarray. On the basis of cranial ultrasonography and brain MRI examination, 3 infants (4.9%) were diagnosed as cystic PVL and selected as the subjects. Five patients who showed similar perinatal factors to those of infants with PVL but did not show PVL were selected as the normal control.
Five of the 15 up-regulated genes are coding ribosomal proteins, and another encodes a translation elongation factor. Three of the 7 down-regulated genes encode proteins that may be related to immune response and/or inflammation.
Up-regulation of the ribosomal proteins may indicate an activation of lymphocytes during the fetal period.
Early human development 10/2010; 86(10):665-7. · 2.12 Impact Factor
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Toru Kato,
Akihisa Okumura,
Fumio Hayakawa,
Takeshi Tsuji,
Seiji Hayashi,
Tetsuo Kubota,
Tatsuya Fukasawa,
Motomasa Suzuki,
Koichi Maruyama,
Makoto Oshiro,
Tetsuo Hattori,
Hiroyuki Kidokoro,
Jun Natsume,
Masahiro Hayakawa,
Kazuyoshi Watanabe
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ABSTRACT: This study was performed to clarify the relationship between prolonged depression of electroencephalography (EEG) in term and near-term infants with hypoxic ischemic encephalopathy (HIE) and the later development of West syndrome (WS).
We investigated 17 term and near-term infants with HIE. Inclusion criteria were as follows: ≥35 weeks of gestation, clinical signs of HIE, magnetic resonance imaging (MRI) lesions corresponding to HIE, assessment of outcome at >18 months of age, depression of EEG, and serial EEG examinations. The 17 infants were divided into the following two groups: Group A (n = 4) with prolonged EEG depression over 21 days of age, and group B (n = 13) with disappearance of EEG depression by 21 days of age.
WS developed in all four infants in group A, but in only one of 13 infants in group B. WS occurred significantly more frequently in group A than in group B. For the prediction of subsequent development of WS, prolonged EEG depression over 21 days of age showed sensitivity of 0.80 and specificity of 1.0. In both groups, abnormal irregular faster waves with or without EEG depression were seen in 11 infants between 2 and 28 days of age. They had no significant relationship with WS, but were significantly related to an adverse developmental outcome.
Prolonged depression of EEG over 21 days of age in term or near-term infants with HIE is a valuable predictor of the later development of WS.
Epilepsia 09/2010; 51(12):2392-6. · 3.96 Impact Factor
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ABSTRACT: We describe two infants with subcortical leukomalacia and decreased water diffusivity in widespread white matter on magnetic resonance imaging. In both infants, diffusion-weighted imaging at age 1 day revealed a widespread increase in signal intensities, predominantly in subcortical areas. The corticospinal tract in the brainstem was not involved. Subsequently, diffusion-weighted imaging produced apparently normal results, and conventional magnetic resonance imaging indicated diffuse but subcortical-dominant white matter lesions in the subacute phase. Follow-up magnetic resonance imaging revealed a volume loss and gliosis of the white matter. In one infant, psychomotor development was mildly delayed, and epilepsy occurred. The other infant experienced normal development and no epilepsy. Neither infant developed spastic cerebral palsy. These infants represent a characteristic group with perinatal brain injury.
Pediatric Neurology 05/2010; 42(5):375-9. · 1.52 Impact Factor
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Pediatrics International 10/2009; 51(5):742-4. · 0.63 Impact Factor
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ABSTRACT: This study sought to clarify chronologic changes in neonatal electroencephalographic (EEG) findings in periventricular leukomalacia (PVL).
We obtained serial EEG findings for all premature infants who were admitted to our hospital at gestational age of < or =33 weeks between 1997 and 2006. EEG recordings were obtained on days 1 to 4, 5 to 14, 15 to 28, 29 to 56, and 57 to 84. Abnormal EEG findings were classified as acute-stage abnormalities (ASAs) or chronic-stage abnormalities (CSAs) and were subclassified as mild, moderate, or severe. PVL was classified as noncystic, localized cystic, or extensive cystic. The final diagnosis of PVL was made through neurologic assessment and MRI findings at 24 months.
Fifty-five infants were diagnosed as having PVL, including 23 with noncystic PVL, 9 with localized cystic PVL, and 23 with extensive cystic PVL. ASAs were observed most frequently on days 1 to 4 and were observed rarely thereafter in all groups. CSAs were observed most frequently on days 5 to 14, were most severe on days 5 to 14, and then resolved within 1 to 2 months in all groups. CSAs in patients with extensive cystic PVL were more severe and persisted longer, compared with other groups. ASA and CSA severity was correlated with PVL severity.
EEG findings in PVL differed according to the severity of PVL and the time of recording. To detect PVL, > or =2 EEG recordings are recommended, 1 within 48 hours after birth, to detect ASAs, and 1 in the second week of life, to detect CSAs.
PEDIATRICS 09/2009; 124(3):e468-75. · 4.47 Impact Factor
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ABSTRACT: We retrospectively reviewed electroencephalography and magnetic resonance imaging findings for 21 children exhibiting delirious behavior during febrile illness. Among these, five patients had transient callosal lesions with or without white matter lesions on diffusion-weighted images. We compared the clinical characteristics, duration, and components of delirious behavior, the duration and severity of reduced consciousness, and EEG findings among patients with or without callosal lesions. No significant differences were detected in these items according to the presence or absence of callosal lesions. Adding insight into the pathogenesis of this condition, our study revealed that callosal lesions are not uncommon in patients exhibiting delirious behavior during febrile illness.
Brain & development 02/2009; 31(2):158-62. · 1.74 Impact Factor
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ABSTRACT: The aim of this study is to clarify the characteristics of ictal EEG findings of neonatal seizures in preterm infants. Seizures associated with ictal EEG changes were recognized in nine infants with gestational age of less than 37 weeks. Propagation, migration, shifting, changes in morphology of ictal EEG discharges were evaluated. Seizure manifestation was divided into the following categories; motor seizure, apneic seizure, automatic seizure and seizure without clinical symptoms. The types of the seizures were motor seizures in five infants, apneic in two, automatic in one and those without clinical symptoms in five. All seizures were of focal onset. The foci of seizures were temporal in six infants, occipital in two, central in one, and frontal in one. The morphology of ictal discharges was low voltage spikes or sharp waves in six infants, spikes in two, theta waves in one and high-voltage spiky theta in one. The propagation of ictal discharges was focal in five infants and regional in five. The migration of ictal discharges was observed in two infants and a shift in two. There was no clear relation between seizure manifestation and ictal EEG foci, duration of seizures and morphology or propagation of ictal discharges.
Brain and Development 05/2008; 30(4):261-8. · 2.12 Impact Factor
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ABSTRACT: This article reports the results of a study on the relationship between cord blood levels of erythropoietin and periventricular leukomalacia. Cord blood was obtained from 19 infants with gestational age between 27 and 32 weeks. Cystic periventricular leukomalacia was seen in 4 of them. Erythropoietin levels were not different between those with and those without periventricular leukomalacia.
Journal of Child Neurology 03/2008; 23(2):231-4. · 1.75 Impact Factor
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Yoshiaki Sato,
Masahiro Hayakawa,
Osuke Iwata,
Akihisa Okumura, Toru Kato,
Fumio Hayakawa,
Tetsuo Kubota,
Koichi Maruyama,
Masayuki Hasegawa,
Machiko Sato,
Makoto Oshiro,
Osamu Kito,
Seiji Kojima
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ABSTRACT: Parasagittal cerebral injury is a type of cerebral injury in term infants, which is characterized by the predominant injury of the arterial border zones of the anterior, middle and posterior cerebral arteries, however its early clinical manifestation is mostly unclear.
To understand early clinical features of parasagittal cerebral injury.
The clinical details of 18 newborn infants who were diagnosed as having parasagittal cerebral injury on magnetic resonance imaging (MRI). Eleven infants had localized injury within parasagittal regions ("Limited" group), 7 infants had diffuse extensive injury involving the deep gray matter and/or periventricular white matter ("Extensive" group). These infants were compared with 9 infants with perinatal asphyxia without MRI abnormalities ("Normal" group).
There was no significant difference in the rate of cardiotocographic abnormalities, low Apgar scores, low blood pH and base excess, and the requirement for mechanical ventilation among three groups. Compared with the Normal group, fewer infants in the Limited group developed neonatal encephalopathy within an hour after birth. Neonatal seizures were more frequent in the Limited and the Extensive groups. Hepatic and/or renal dysfunction was more often observed in the Limited group. Cerebral palsy and/or mental retardation were common in the Extensive group. Electro-cortical depression was more in the Extensive group. Progressive suppression of electro-cortical activity was common within infants in the Limited group (33%) and the Extensive group (60%).
Infants with parasagittal cerebral injury developed serious neurological abnormalities despite less serious physiological and neurological manifestation shortly after birth, suggesting the importance of careful longitudinal observation of asphyxiated infants.
European Journal of Paediatric Neurology 01/2008; 12(5):359-65. · 2.12 Impact Factor
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ABSTRACT: This study evaluated the usability of our MRI interpretation scheme among pediatricians with different skill levels in evaluating MRI of patients with cerebral palsy. We divided MRI findings into three groups: no abnormalities, pre/perinatally acquired lesions, and other abnormalities. Pre/perinatally acquired lesions were divided into six subgroups. Other abnormalities included brain malformations, ventriculomegaly, atrophic changes, and other unclassifiable abnormalities. We compared the interpretations of eight participants, i.e., three nonexpert pediatricians, two junior pediatric neurologists, and three senior pediatric neurologists, in evaluating magnetic resonance images of 73 children with cerebral palsy. The degree of agreement was substantial or near perfect for all participants. When limited to pre/perinatally acquired lesions, the degree of agreement was near perfect for all but one participant. The rate of correct diagnosis did not differ greatly according to participants' experience with pre/perinatally acquired lesions. For patients with basal ganglia thalamic lesions, multicystic encephalomalacia, and posthemorrhagic porencephaly, the rate of correct diagnosis increased according to participants' experience. Pre/perinatally acquired lesions can be appropriately interpreted by nonexpert pediatricians utilizing our interpretation scheme.
Pediatric Neurology 12/2007; 37(5):331-7. · 1.52 Impact Factor
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Akihisa Okumura,
Kazuyoshi Watanabe,
Tamiko Negoro,
Kosaburo Aso,
Jun Natsume,
Akiko Matsumoto,
Kiyokuni Miura,
Jun Furune,
Kazushi Nomura,
Fumio Hayakawa, Toru Kato
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ABSTRACT: The prognosis and evolutional changes of 77 patients with West syndrome (WS) were studied after patients were classified into four groups on the basis of their magnetic resonance imaging (MRI) findings: anomaly, perinatal injury, normal, and the other groups. The average age at onset of spasms was earliest in the patients with anomalies and latest in patients with normal MRI findings. Patients with normal MRI findings had the shortest duration of spasms, and patients with anomalies had the longest duration of spasms. Antecedent seizures were observed in 6 patients (3 patients with anomalies, 1 patient with normal MRI findings, and 2 patients with other abnormalities). Thirty-five patients had subsequent seizures. Patients with anomalies often had partial seizures and patients with perinatal injuries often had generalized seizures. Seizures were infrequent in patients with normal MRI findings. Developmental outcome was best in the patients with normal MRI findings and worst in patients with perinatal injuries. Various types of epileptic syndromes occurred subsequent to WS in patients with anomalies, although nonspecific symptomatic generalized epilepsy was common in patients with perinatal injuries. These results suggest that seizure prognosis, evolutional changes in seizures, and developmental outcome are different among the types of brain lesions.
Epilepsia 11/2007; 39(S5):46 - 49. · 3.96 Impact Factor
