The aim of this study was to investigate the frequency of reading, writing, and calculation disabilities in children with typical rolandic epilepsy (RE) and healthy control children. We also aimed to define the possible electroclinical markers of specific cognitive dysfunctions in RE. School abilities were evaluated and compared in 20 children (eight males, 12 females; mean age 10y 3mo [SD 1y 7mo]; range 7y 9mo-12y 9mo) consecutively diagnosed with typical RE, and a group of 21 healthy controls (nine males, 12 females; mean age 10y 4mo [SD 1y 8mo]; range 7y 6mo-13y 3mo). All the children received standardized neuropsychological tests. For each patient an exhaustive seizure diary was kept and all the sleep electroencephalogram (EEG) recordings were reviewed. Specific difficulties with reading, writing, and calculation (diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition) were found in nine out of 20 children with RE and two out of 21 healthy controls (chi2=0.01). The specific learning disabilities in the RE group were correlated with a marked increase in epileptiform discharges during sleep (chi2=0.02) and an early onset of epilepsy (chi2=0.02). Our findings suggest that seizure onset before age 8 years and epileptiform discharges (more than 50% of the sleep EEG recording) in several tracings over more than a year are relevant markers for identifying patients at risk of developing academic difficulties.

OBJECTIVE:To investigate the clinical features of idiopathic headache with early onset, whose presence is probably underestimated by parents and physicians and the influence of environmental and psychological factors on headache in children. METHODS:We report on a prospective longitudinal evaluation of 35 consecutive children referred to the Neuropsychiatry Departments of the Universities of Varese and Pavia (mean age at the first observation: 4 years and 7 months, range: 12 months-6 years; mean age at onset: 4 years and 2 months, range: 10 months-6 years) presenting with headache symptomatology. Mean duration of clinical follow-up: 9.5 months. The diagnosis based on the IHS criteria was then compared to the intuitive clinical diagnosis made in accordance with alternative case definitions. We examined our patients for the presence of early developmental disorders and interictal somatic disorders. We also studied the role of psychosocial factors at the onset and in the course of headache. RESULTS: DIAGNOSIS:migraine without aura in two cases, episodic tension headache in four cases, migrainous disorders not fulfilling above criteria in eight cases, headache of the tension-type not fulfilling above criteria in 12 cases and headache not classifiable in nine cases. Clinical features of headache are described in the text. Early developmental disorders (0-2 years), such as eating difficulties and sleep disorders, were detected in 18/35 children. Among patients older than 2 years, we also detected interictal somatic disorders (20 cases) such as sleep disorders, eating difficulties, enuresis and idiopathic vomiting. In 14/35 subjects, we identified psychosocial components playing a significant role at the onset of, and during, the headache. CONCLUSIONS:A better clinical definition of the disorder would make it easier to identify very young affected children and consequently to plan more specific therapeutic interventions, taking into account environmental and psychological factors. A diagnosis of idiopathic headache becomes particularly significant: according to our cases, despite their being limited in number, migraine and tension headache can be considered also as indices of individual or family related problems requiring appropriate psychiatric or psychological intervention. This stresses the need for a multidisciplinary team of specialists that would include a psychologist/ psychiatrist or headache specialist with specific training in psychiatry.

The authors report the personality characteristics of 30 subjects, 16 males and 14 females, average age 13.7 years: 13 suffered from migraine without aura, 8 from migraine with aura and 9 from chronic tension-type headache. The study was based on a detailed clinical assessment (psychodynamically-oriented interviews with the child and its parents) and evaluation by tests. A blind test of the clinical personality characteristics was then carried out. The results of these investigations indicated that 13/30 of the subjects had a neurotic personality organization, 12/30 were borderline and 5/30 had a "white relation". Given the subjects' youth, these conditions are probably to be considered transient. From the data collected it seems that migrainous subjects are distributed along a continuum that ranges from one end characterized by more evolved and adaptive mental organization and defence mechanisms and the opposite end, where mental organization is less evolved and adaptive and at a greater risk of somatization.

Depression is relatively frequent in childhood. It has been well documented that expression or masking of depression in childhood is often represented by various forms or recurring headache including migraine. (1) (2) (3) Given the importance of depression both clinically and sub-clinically in children and in particular in vascular headache we decided to evaluate the entity and frequency of depressive disorders in a cohort of subjects with migraine or tension type headache. We used the scale proposed by E. Poznanski (CDRS-R) to differentiate between depressed and non-depressed children (6-12 years). (4) (5) (6) We evaluated 19 patients (7 females and 12 males) ranging in age from 7.58-12 years (average age 9,48 sd 1.11) 4 had episodic tension type headache, 3 had chronic tension type headache, 10 had migraine without aura and 2 had migraine with aura. All patients either visited the outpatient clinic or were in-patients in the Division of Child Neuropsychiatry of the University of Pavia. Each child received an accurate neurological and objective medical evaluation eventually associated with necessary radiological examination. One or more psychodynamic sessions with the child and his family were held, within a solid diagnostic-therapeutic framework. Using the CDRS-R scale the subjects were divided into 2 groups within a normal scoring limit of 30 points. The group with the highest score was mode up of 6 subjects, all males aged 8.25 to 12 years (average age 9.71 sd 1.27) of which 4 had migraine without aura, 1 with episodic tension type headache, 1 with chronic tension type headache. Scores were always between 30 and 40, therefore indicating borderline depression.