Background and objectives: Spatial orientation and spatial learning depend on the medial temporal lobe. A new test of spatial memory in humans is described, and applied to patients with Alzheimer's disease (AD), with presumable damage of that region, and to patients with unilateral mesial temporal sclerosis (MTS) submitted or not to treatment by selective surgical amygdala-hippocampectomy (SAH). Methods: Subjects were asked to go to each of four objects hanging from the wall of a room: a cylinder, a square, a ball and a triangle (trial 1). In trial 2 they repeated this blindfolded; all figures except the cylinder were removed; once the subjects reached the cylinder they had to say what figures should be at the left, right and back. In trial 3, all figures were withdrawn and the subjects, again blindfolded, were instructed first to go to the front, right, left and back, and then to go to the former positions occupied by the cylinder, the ball, the square and the triangle. Results: Experiment 1 studied 10 patients with mild AD and 10 controls matched by age, gender and schooling. Performance was 46% lower in AD patients relative to controls (p < 0.001). Experiment 2 studied 23 patients with MTS, 20 patients submitted to SAH, and 23 healthy volunteers with similar levels of age, gender and schooling. No differences in performance among these three groups were observed. Conclusions: The test distinguished performance deficits of AD patients relative to controls, but not among MTS and STH patients and controls.

OBJETIVO: Descrever as características, aspectos morfológicos e incidência das ondas agudas temporais (OAT) em recém - nascido pré-termo e a termo pareados por idade concepcional (IC). MÉTODO: OAT foram identificadas e analisadas nos EEGs de dois grupos de recém - nascidos normais. O GI (n=40) foi constituído de recém - nascidos com idade gestacional (IG) de 34 a 40 semanas, submetidos a EEG com 24-48 horas de vida. O GII consistia de 10 recém - nascidos pré - termo com IG entre 30 - 32 semanas, seguidos com EEG semanal até atingirem IC de 42 semanas. As OAT foram divididas de acordo com sua morfologia em serrilhada, isolada e repetitivas. O número total, índice e densidade de OAT foram calculados em cada EEG neonatal e relacionados ao estágio do sono e IC. A lateralidade (esquerda/direita) também foi analisada. Os grupos foram comparados nas seguintes semanas de IC: 34, 36,38 e 40 semanas. RESULTADOS: O índice e a densidade de OAT diminuíram com o aumento da IC (p<0.001). A morfologia serrilhada foi registrada em ambos os grupos somente até a IC de 34 semanas. As OAT com morfologia isolada e repetitiva foram visualizadas mais freqüentemente entre 36-40 semanas. No GI foram observadas diferenças significativas em relação à morfologia e densidade de OAT em sono REM, em associação ao aumento da IC. A densidade das OAT isoladas foi significativamente superior no GI na 34ª semana de IC. Não foram observadas diferenças no GII, assim como também não foi observada diferença significativa entre os recém - nascidos dos grupos I e II quando pareados por IC. CONCLUSÃO: OAT são elementos normais do EEG neonatal já que são registradas em recém - nascidos normais. Sua incidência varia de acordo com a morfologia e tende a desaparecer com o aumento da idade concepcional. A morfologia serrilhada é mais freqüente em prematuros. Nossos resultados sugerem que o índice, a densidade e a morfologia das OAT variam de acordo com a idade concepcional.

OBJECTIVE: To describe developmental characteristics, morphological aspects and incidence of temporal sharp transients (TST) in normal preterm and term newborns at matched conceptional ages (CA). METHOD: Neonatal EEGs from two groups of normal newborns were evaluated in order to identify and characterize TST. Group I (n=40) consisted of newborns from 34 to 40 weeks of gestational age (GA) that were submitted to a single EEG between 24 and 48 hours of life. Group II consisted of 10 preterm newborns with GA between 30-32 weeks, followed with a weekly EEG until they reached term. Morphology of TST was divided in 3 groups (temporal sawtooth, isolated transients or repetitive transients). TST index, density and total number were calculated in each polysomnography and related to sleep stages and CA. Laterality (right/left) was also evaluated. The groups were compared at 34, 36, 38 and 40 weeks of CA. RESULTS: TST index and density decreased with the increase of CA in both groups (p<0.0001). The temporal sawtooth feature was registered in both groups only at 34 weeks. Although rare, repetitive and isolated TST were the most prevalent morphology between 36 - 40 weeks CA. Significant intragroup difference was observed in the comparison of TST density in REM and transitional sleep in GI. Moreover, isolated TST morphology was significant higher in GI at 34 weeks when compared to the others CA. No intragroup differences were observed on GII. No significant differences between the groups were observed considering TST number, index, density, morphology or laterality, at the matched CA. CONCLUSION: TST are normal features of neonatal EEG, as they are registered in normal newborns. Its incidence varies accordingly to morphology and they tend to disappear following the increase of CA. Temporal sawtooth appears more often in preterm newborns. Our results suggest that TST index, density and morphology variability may be a function of CA.

A posição prona para dormir, tem sido relacionada como fator de risco para síndrome da morte súbita do lactente (SMSL). Com o objetivo de identificar qual a posição preferencial para dormir adotada nos hospitais, que orientações são fornecidas aos pais de recém-nascidos sobre a posição preferencial para dormir durante o primeiro ano de vida e prevenção de SMSL, realizamos estudo multicentrico por meio de questionário, sendo selecionados hospitais com programa de Residência Médica em Pediatria. Analisamos as informações referentes a 55 instituições, cuja média de nascimentos/ano variou entre 240 e 11.000 (mediana 2.750). O decúbito lateral é a posição preferencial para dormir (44,4%) e a mais orientada para uso domiciliar (67%). Concluímos que, a recomendação da posição supina ao dormir e orientações para prevenção da SMSL, não têm sido realizadas na rotina dos hospitais pesquisados. Entretanto, na alta hospitalar, o incentivo ao aleitamento materno e a importância das imunizações, são enfatizados em 100% das instituições e recomendações sobre evitar fumo, em 85%.

The prone sleeping position has been causally linked to sudden infant death syndrome (SIDS). This survey aimed to determine whether maternity hospitals in Brazil were promoting the prone sleeping position for newborns. Information was also collected on SIDS prevention messages. The study adopted a multicenter collaborative approach in hospitals with training in pediatrics, using questionnaires. Correctly completed questionnaires were received from 55 hospitals. The number of deliveries/year varied at the hospitals from 240 to 11,000 (median 2,750). The majority of hospitals encouraged the lateral (side) sleeping position in the normal care nurseries (44.4%) and at discharge (67%). In conclusion, the majority of hospitals surveyed are not promoting the supine sleeping position or any other intervention for SIDS prevention, although verbal information is provided to parents about breastfeeding (100%), immunization (100%), and smoking (85%).

A panencefalite esclerosante subaguda é doença neurodegenerativa inflamatória relacionada à persistência do vírus do sarampo no organismo. Sua incidência vem diminuindo significativamente com a erradicação do sarampo, mas eventualmente alguns casos ainda têm sido diagnosticados. Com o objetivo de descrever aspectos epidemiológicos da panencefalite no Brasil contactamos Neurologistas Infantis de todo país. Foram registrados 48 pacientes, 27% da região sudeste, 34 (70%) do sexo masculino, 35 (73%) brancos, 9 (19%) apresentaram sarampo e receberam imunização, 7 (14%) somente imunizados, um paciente apresentou provável forma neonatal. Intervalo médio entre primeiro sintoma e diagnóstico de 12 meses, 22 pacientes (45%) iniciaram o quadro com mioclonus ou convulsões tônico-clônicas, 7 (14%) com distúrbios comportamentais; 36 (75%) apresentaram EEG com complexos pseudoperiódicos. Seguimento de 28 pacientes (57%) demonstrou 12 óbitos, 2 remissões completas, demais com sequelas neurológicas. Nossos resultados evidenciam regiões endêmicas no país, alta incidência de casos pós-imunização e demora na confirmação do diagnóstico.

Subacute sclerosing panencephalitis (SSPE) is an inflammatory neurodegenerative disease related to the persistence of measles virus. Although its frequency is declining because of measles eradication, we still have some cases being diagnosed. With the aim to describe epidemiological aspects of SSPE in Brazil, we sent a protocol to Child Neurologists around the country, 48 patients were registered, 27 (56 %) were from the southeast region, 34 (71%) were male and 35 (73%) white, 27 (56%) had measles, 9 (19%) had measles and were also immunized, 7 (14%) received only immunization, 1 patient had a probable neonatal form. Mean time between first symptoms and diagnosis was 12 months (22 started with myoclonus or tonic-clonic seizures, 7 (14%) with behavioral disturbances); 36 patients (75%) had EEG with pseudoperiodic complexes. Follow up performed in 28 (58 %) patients showed: 12 died, 2 had complete remission and the others had variable neurological disability Our data shows endemic regions in the country, a high incidence of post-immunization SSPE and a delay between first symptom and diagnosis.

Fazemos uma análise das alterações neuropatológicas encontradas em 300 casos consecutivos de cirurgia da epilepsia realizadas durante período de 6 anos. O material foi predominantemente de lobo temporal (70,33%), sendo a esclerose hipocampal o diagnóstico mais frequente (44%), seguido das neoplasias (15%) e dos distúrbios da migração neuronal (10%). Os tumores mais frequentes foram o ganglioglioma (42,22%) e tumor neuroepitelial disembrioplástico (20%). Segue revisão dos diagnósticos mais comuns em epilepsia baseados nessa série e relatados na literatura.

We report histopathological findings in 300 consecutive surgical specimens from epilepsy surgery during 6 years. Our material was mainly from temporal lobe epilepsy (70.33%). In 44% the diagnosis was hippocampal sclerosis. There were tumors in 15% of cases and neuronal migration disorders in 10%. The most common tumors were gangliogliomas (42.22%) and dysembryoplastic neuroepithelial tumors (20%). We review the more frequent diagnosis in epilepsy surgery based on this series and comparing with literature.