From a neurobiological standpoint, the question of consciousness centers on whether one or more structures in the brain play a role in the function of consciousness. That could be a single structure or brain area, or a network connecting different brain areas. Movements, sensations, emotions, vegetative regulations, all kinds of cognition and complex actions are localised in certain brain regions (frontal lobe, temporal lobe, occipital lobe, parietal lobe, brainstem, cerebellum) and networks. These brain regions are basic common structures in all of mankind.

We conducted a systematic review investigating the efficacy and tolerability of adrenocorticotropic hormone (ACTH) and corticosteroids in children with epilepsies other than infantile epileptic spasm syndrome (IESS) that are resistant to anti-seizure medication (ASM). We included retrospective and prospective studies reporting on more than five patients and with clear case definitions and descriptions of treatment and outcome measures. We searched multiple databases and registries, and we assessed the risk of bias in the selected studies using a questionnaire based on published templates. Results were summarized with meta-analyses that pooled logit-transformed proportions or rates. Subgroup analyses and univariable and multivariable meta-regressions were performed to examine the influence of covariates. We included 38 studies (2 controlled and 5 uncontrolled prospective; 31 retrospective) involving 1152 patients. Meta-analysis of aggregate data for the primary outcomes of seizure response and reduction of electroencephalography (EEG) spikes at the end of treatment yielded pooled proportions (PPs) of 0.60 (95% confidence interval [CI] 0.52-0.67) and 0.56 (95% CI 0.43-0.68). The relapse rate was high (PP 0.33, 95% CI 0.27-0.40). Group analyses and meta-regression showed a small benefit of ACTH and no difference between all other corticosteroids, a slightly better effect in electric status epilepticus in slow sleep (ESES) and a weaker effect in patients with cognitive impairment and "symptomatic" etiology. Obesity and Cushing's syndrome were the most common adverse effects, occurring more frequently in trials addressing continuous ACTH (PP 0.73, 95% CI 0.48-0.89) or corticosteroids (PP 0.72, 95% CI 0.54-0.85) than intermittent intravenous or oral corticosteroid administration (PP 0.05, 95% CI 0.02-0.10). The validity of these results is limited by the high risk of bias in most included studies and large heterogeneity among study results. This report was registered under International Prospective Register of Systematic Reviews (PROSPERO) number CRD42022313846. We received no financial support.

Zusammenfassung In diesem Bericht fassen wir die Ergebnisse eines systematischen Reviews (SR) zusammen, in dem Daten zur Wirksamkeit und Verträglichkeit von ACTH (adrenocorticotropes Hormon) und Kortikosteroiden (KST) bei Kindern mit anderen Epilepsien als dem infantilen epileptischen Spasmussyndrom (IESS) ausgewertet wurden, die auf Anfallssuppressiva (ASM) nicht angesprochen hatten. Der SR umfasste retrospektive und prospektive Studien, die über mehr als 5 Patienten berichteten und klare Falldefinitionen sowie Beschreibungen der Behandlung und der Ergebnisse enthielten. Achtunddreißig (2 kontrollierte und 5 unkontrollierte prospektive, 31 retrospektive) Studien mit 1152 Patienten wurden eingeschlossen. Die Metaanalyse der aggregierten Daten zur Anfallsreduktion > 50 % und zur Verringerung der EEG(Elektroenzephalogramm)-Spikes am Ende der Initialbehandlung ergab gepoolte Raten (PR) von 0,60 (95 %-KI [Konfidenzintervall] 0,52–0,67) und 0,56 (95 %-KI 0,43–0,68). Die Rückfallquote war hoch (PR 0,33, 95 %-KI 0,27–0,40). Subgruppenanalysen und eine Metaregression zeigten keinen signifikanten Unterschied zwischen den eingesetzten Substanzen, eine etwas bessere Wirkung bei entwicklungsbedingter und/oder epileptischer Enzephalopathie mit Spike-and-Wave-Aktivierung im Schlaf (DEE-SWAS) und eine schwächere Wirkung bei Patienten mit kognitiver Beeinträchtigung und „symptomatischer“ Ätiologie. Die Höhe der kumulativen Dosis der initialen Behandlungsphase hatte keinen Einfluss auf die Behandlungsergebnisse. Adipositas und Cushing-Syndrom waren die häufigsten unerwünschten Wirkungen, die oft in Studien mit kontinuierlicher ACTH- (PR 0,73, 95 %-KI 0,48–0,89) oder KST-Gabe (PR 0,72, 95 %-KI 0,54–0,85), aber selten bei intermittierender intravenöser oder oraler KST-Gabe (PR 0,05, 95 %-KI 0,02–0,10) auftraten. Die Aussagekraft dieser Ergebnisse wird durch ein hohes Verzerrungsrisiko der meisten eingeschlossenen Studien und eine große Heterogenität zwischen den Studiendaten eingeschränkt. Der volle SR wurde unter https://doi.org/10.1111/epi.17918 publiziert.

Identifying genetic risk factors for highly heterogeneous disorders such as epilepsy remains challenging. Here we present, to our knowledge, the largest whole-exome sequencing study of epilepsy to date, with more than 54,000 human exomes, comprising 20,979 deeply phenotyped patients from multiple genetic ancestry groups with diverse epilepsy subtypes and 33,444 controls, to investigate rare variants that confer disease risk. These analyses implicate seven individual genes, three gene sets and four copy number variants at exome-wide significance. Genes encoding ion channels show strong association with multiple epilepsy subtypes, including epileptic encephalopathies and generalized and focal epilepsies, whereas most other gene discoveries are subtype specific, highlighting distinct genetic contributions to different epilepsies. Combining results from rare single-nucleotide/short insertion and deletion variants, copy number variants and common variants, we offer an expanded view of the genetic architecture of epilepsy, with growing evidence of convergence among different genetic risk loci on the same genes. Top candidate genes are enriched for roles in synaptic transmission and neuronal excitability, particularly postnatally and in the neocortex. We also identify shared rare variant risk between epilepsy and other neurodevelopmental disorders. Our data can be accessed via an interactive browser, hopefully facilitating diagnostic efforts and accelerating the development of follow-up studies.

Childhood absence epilepsy (CAE), involves 3 Hz generalized spikes and waves discharges (GSWDs) on the electroencephalogram (EEG), associated with ictal discharges (seizures) with clinical symptoms and impairment of consciousness and subclinical discharges without any objective clinical symptoms or impairment of consciousness. This study aims to comparatively characterize neuronal networks underlying absence seizures and subclinical discharges, using source localization and functional connectivity (FC), to better understand the pathophysiological mechanism of these discharges. Routine EEG data from 12 CAE patients, consisting of 45 ictal and 42 subclinical discharges were selected. Source localization was performed using the exact low-resolution electromagnetic tomography (eLORETA) algorithm, followed by FC based on the imaginary part of coherency. FC based on the thalamus as the seed of interest showed significant differences between ictal and subclinical GSWDs (p < 0.05). For delta (1-3 Hz) and alpha bands (8-12 Hz), the thalamus displayed stronger connectivity towards other brain regions for ictal GSWDs as compared to subclinical GSWDs. For delta band, the thalamus was strongly connected to the posterior cingulate cortex (PCC), precuneus, angular gyrus, supramarginal gyrus, parietal superior, and occipital mid-region for ictal GSWDs. The strong connections of the thalamus with other brain regions that are important for consciousness, and with components of the default mode network (DMN) suggest the severe impairment of consciousness in ictal GSWDs. However, for subclinical discharges, weaker connectivity between the thalamus and these brain regions may suggest the prevention of impairment of consciousness. This may benefit future therapeutic targets and improve the management of CAE patients.

Nachruf auf den ehemaligen Professor für Urologie und Kinderurologie und Klinikdirektor am Universitätsklinikum Schleswig-Holstein (UKSH), Klaus-Peter Jünemann, der Ende August 2023 starb.

The Phospholipid Phosphatase Related 4 gene (PLPPR4,  *607813) encodes the Plasticity-Related-Gene-1 (PRG-1) protein. This cerebral synaptic transmembrane-protein modulates cortical excitatory transmission on glutamatergic neurons. In mice, homozygous Prg-1 deficiency causes juvenile epilepsy. Its epileptogenic potential in humans was unknown. Thus, we screened 18 patients with infantile epileptic spasms syndrome (IESS) and 98 patients with benign familial neonatal/infantile seizures (BFNS/BFIS) for the presence of PLPPR4 variants. A girl with IESS had inherited a PLPPR4-mutation (c.896C > G, NM_014839; p.T299S) from her father and an SCN1A-mutation from her mother (c.1622A > G, NM_006920; p.N541S). The PLPPR4-mutation was located in the third extracellular lysophosphatidic acid-interacting domain and in-utero electroporation (IUE) of the Prg-1p.T300S construct into neurons of Prg-1 knockout embryos demonstrated its inability to rescue the electrophysiological knockout phenotype. Electrophysiology on the recombinant SCN1Ap.N541S channel revealed partial loss-of-function. Another PLPPR4 variant (c.1034C > G, NM_014839; p.R345T) that was shown to result in a loss-of-function aggravated a BFNS/BFIS phenotype and also failed to suppress glutamatergic neurotransmission after IUE. The aggravating effect of Plppr4-haploinsufficiency on epileptogenesis was further verified using the kainate-model of epilepsy: double heterozygous Plppr4-/+|Scn1awt|p.R1648H mice exhibited higher seizure susceptibility than either wild-type, Plppr4-/+, or Scn1awt|p.R1648H littermates. Our study shows that a heterozygous PLPPR4 loss-of-function mutation may have a modifying effect on BFNS/BFIS and on SCN1A-related epilepsy in mice and humans.

Folker Hanefeld was born and grew up in Meiβen in Saxony/East Germany. After finishing school and because he was not allowed to study in East- Germany (GDR) he went to Cologne University, West Germany, where he studied Medicine from 1956 to 1961. In Cologne he also wrote his doctoral thesis at the Max-Planck-Institut für Hirnforschung (Max-Planck-institute for brain research) on a topic in experimental brain tumor pathology.

AIM:This prospective observational study evaluated the long-term EEG changes in children treated with everolimus (EVO) for refractory TSC-associated epilepsy. Changes in EEG-abnormalities were related to developmental outcomes.METHODS:Thirteen children treated with EVO were examined for EEG-recorded seizures and interictal epileptic discharges (IED) during a 72-hour-video-EEG-monitoring, which was performed at baseline and repeated at follow-up intervals of at least 9 months. Antiseizure medication was left unchanged for at least 27 months. Changes in cognitive developmental parameters were related to reduction of seizures and IED at the last monitoring.RESULTS:We found a significant reduction of recorded seizures and IED during sleep at the first as well as the last follow-up recording. The reduction of IED was especially prominent during sleep. For patients who continued for more than one monitoring under EVO (n = 8), number of seizures further decreased. In patients with developmental examination (n = 9), we observed that only (nearly) full cessation of IED was related to acquisition of new skills.DISCUSSION:In children with TSC, EVO was effective in reducing recorded seizures and IED; long-term EVO treatment led to a more pronounced reduction and an improvement of nocturnal IED even when the patient was initially not seizure-free. Cessation of IED in children with developmental improvement may point to the importance of healthy sleep for cognition.

Systemic drug application is the main approach in epilepsy treatment. However, the central nervous system (CNS) is a challenging target for drug delivery as the blood-brain barrier (BBB) restricts the transfer of drugs into the brain. Accordingly, there is a general interest in developing new therapeutic strategies to improve CNS drug accessibility. Intrathecal administration of antiseizure drugs (ASDs) e.g. via pumps or advanced materials could be a possible approach to bypass the BBB and increase the availability of neuroactive compounds in the CNS. The aim of this study was the evaluation of intracerebroventricular (i.c.v.) compared to systemic drug application in generalized epilepsy. The i.c.v. administration of the established ASD ethosuximide (ETX) in Genetic Absence Epilepsy Rats from Strasbourg (GAERS) caused a robust and dose-dependent reduction of spike-wave discharges (SWDs) without causing obvious behavioral abnormalities. Additionally, we could show that i.c.v. treatment with ETX is significantly more effective in seizure suppression than systemic treatment with the same dose. The localized application resulted in reduced systemic drug exposure compared to standard systemic ETX therapy. The tracing of dye distribution throughout the CNS supported the view that i.c.v. applied drugs cross into brain tissue surrounding the ventricles but largely remain restricted to the site of injection. Our data suggest that intrathecal application represents a possible route for the treatment in generalized epilepsy through direct drug penetration from CSF into brain tissue.

Mobile apps for the smartphone enable monitoring and treatment of medical conditions, such as epilepsy and to prevent complications in particular due to noncompliance and missing adherence. Data from smartphone applications can be used to support medical decision-making. An overview of the current status of medical apps in the healthcare system with respect to their application possibilities in the treatment of people with epilepsy is given.

Both mild and severe epilepsies are influenced by variants in the same genes, yet an explanation for the resulting phenotypic variation is unknown. As part of the ongoing Epi25 Collaboration, we performed a whole-exome sequencing analysis of 13,487 epilepsy-affected individuals and 15,678 control individuals. While prior Epi25 studies focused on gene-based collapsing analyses, we asked how the pattern of variation within genes differs by epilepsy type. Specifically, we compared the genetic architectures of severe developmental and epileptic encephalopathies (DEEs) and two generally less severe epilepsies, genetic generalized epilepsy and non-acquired focal epilepsy (NAFE). Our gene-based rare variant collapsing analysis used geographic ancestry-based clustering that included broader ancestries than previously possible and revealed novel associations. Using the missense intolerance ratio (MTR), we found that variants in DEE-affected individuals are in significantly more intolerant genic sub-regions than those in NAFE-affected individuals. Only previously reported pathogenic variants absent in available genomic datasets showed a significant burden in epilepsy-affected individuals compared with control individuals, and the ultra-rare pathogenic variants associated with DEE were located in more intolerant genic sub-regions than variants associated with non-DEE epilepsies. MTR filtering improved the yield of ultra-rare pathogenic variants in affected individuals compared with control individuals. Finally, analysis of variants in genes without a disease association revealed a significant burden of loss-of-function variants in the genes most intolerant to such variation, indicating additional epilepsy-risk genes yet to be discovered. Taken together, our study suggests that genic and sub-genic intolerance are critical characteristics for interpreting the effects of variation in genes that influence epilepsy.

Purpose: To investigate the efficacy and tolerability of long-term treatment with Everolimus (EVO) in patients with tuberous sclerosis complex (TSC) and therapy-resistant epilepsy in a compassionate use trial. Methods: After a 3-month baseline, patients were treated with EVO. Treatment was divided into treatment phases each lasting at least 9 months. Patients started with one of three target serum levels. In case of insufficient seizure control, subsequent treatment phases with other target serum levels followed. The accompanying antiseizure medication (ASM) remained stable during the baseline phase and for at least the initial three treatment phases. We evaluated changes in seizure frequency and seizure-free days compared to baseline for each patient (CoxStuart-test). Results: Fifteen patients were followed up for up to 10 years (minimum 0.6 years, median 5.8 years). Twelve patients (80%) experienced a significant reduction in seizure frequency or an increase in seizure-free days: Six (40%) patients became seizure-free and four patients (26.7%) remained seizure free for > 7 years, of which three required no additional ASM. All participants reported at least one adverse effect, the vast majority (92.5%) of which were mild or moderate. Conclusion: Long-term treatment with EVO was highly efficacious, safe and well tolerated. While EVO can be a therapeutic option for therapy-resistant epilepsy in TSC, it can take a long time for seizure relief to manifest.

Free AccessKindheit und Entwicklung – 30 JahreUlrike Petermann, Martin H. Schmidt, and Ulrich StephaniUlrike PetermannZentrum für Klinische Psychologie und Rehabilitation der Universität BremenSearch for more papers by this author, Martin H. SchmidtZentralinstitut für seelische Gesundheit, Medizinische Fakultät Mannheim der Universität HeidelbergSearch for more papers by this author, and Ulrich StephaniKlinik für Neuropädiatrie, Universitätsklinikum Schleswig-HolsteinSearch for more papers by this authorPublished Online:January 11, 2021https://doi.org/10.1026/0942-5403/a000327PDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInRedditE-Mail SectionsMoreSeit dem 25jährigen Bestehen der Kindheit und Entwicklung sind schon wieder fünf Jahre vergangen. Unsere interdisziplinäre Zeitschrift befindet sich also nun schon im 30. Jahrgang. Und es hat sich vieles seit 2016 verändert. So ist einer der drei Gründungsherausgeber 2019 verstorben, nämlich Prof. Dr. Franz Petermann (Bereich Klinische Kinderpsychologie, Universität Bremen). Er gestaltete die Kindheit und Entwicklung mit seinen Kollegen und seiner Kollegin in den vergangenen drei Jahrzehnten immer wieder neu, indem er aktuelle Themen und Forschungsergebnisse aufgriff. So prägte er zusammen mit Prof. Gerhard Neuhäuser (Bereich Neuropädiatrie, Universität Gießen) und Prof. Martin H. Schmidt (Bereich Kinder- und Jugendpsychiatrie, Zentralinstitut für seelische Gesundheit, Universität Heidelberg) unser Journal entscheidend mit. Für ihn gehörten zur Klinischen Kinderpsychologie immer auch die Entwicklungspsychopathologie, die körperlich chronischen Krankheiten von Kindern und ihre damit verbundenen Risiken, psychisch zu erkranken, Wirksamkeitsstudien zu präventiven und psychotherapeutischen Methoden bzw. manualisierten und standardisierten Interventionen und schließlich ausgewählte diagnostische Verfahren und Vorgehensweisen in Kombination mit spezifischen Fragestellungen aus den Bereichen psychische und Entwicklungsstörungen.In den ersten 25 Jahren erweiterten Prof. Ulrike Petermann (Bereich Klinische Kinderpsychologie und Kinderverhaltenstherapie, Universität Bremen) sowie Prof. Ulrich Stephani (Bereich Neuropädiatrie, Universitätsklinikum Schleswig-Holstein) das Herausgeberteam der Kindheit und Entwicklung (Petermann, Petermann, Schmidt & Stephani, 2016). Und nun stehen wieder Änderungen bevor: Neue, junge Herausgeberinnen und Herausgeber sollen in naher Zukunft die Staffel übernehmen und die Kindheit und Entwicklung genauso interdisziplinär fortführen wie bisher, mit dem Anspruch, Brücken zwischen Theorie, Forschung und evidenzbasierter Praxis zu bauen.Schwerpunktthemen dreier JahrzehnteIn den drei Jahrzehnten, den Jahrgang 2021 eingerechnet, wurden 119 Themenschwerpunkte gestaltet. Die meisten Zuwächse sind in den Themenschwerpunkten „Kinderverhaltenstherapie und neue Therapieansätze“, „Psychische und psychiatrische Störungen“ sowie „Risikokinder, Risikofamilien und familienorientierte Interventionen“ zu verzeichnen. In Zukunft sollen auch die Thematiken „Körperlich-chronische Krankheiten“ und „Verhaltensmedizin“, die assoziativ verknüpft sind, stärker berücksichtigt werden (s. Tab. 1). Tabelle 1 Übersicht über die Themenschwerpunkte von 1992 bis 2021 (n = 119) Themenschwerpunkt Häufigkeit von 1992bis 2016… bis 2021Anmerkung: Die Zahlen in Klammer sind die Zuwächse seit 2017; die Zahl vor der Klammer ist bereits die neue Summe.Psychische/psychiatrische Störungen3539 (+4)Risikokinder/Risikofamilien/familienorientierte Interventionen 1519 (+4)Kinderverhaltenstherapie,neue Therapieansätze 914 (+5)Entwicklungsstörungen 911 (+2)Kinder- und Jugendhilfe 810 (+2)Klinische Kinderneuropsychologie/Entwicklungsdiagnostik 79 (+2)Körperlich-chronische Krankheiten 77Säuglingsforschung, frühe Kindheit,Erziehungskompetenz 67 (+1)Verhaltensmedizin 33Tabelle 1 Übersicht über die Themenschwerpunkte von 1992 bis 2021 (n = 119) View as image HTML Ein besonderer Themenschwerpunkt befasste sich mit der „Mannheimer Risikokinderstudie“ (Esser & Schmidt, 2017) unter dem Aspekt von Ergebnissen 25 Jahre nach Studienstart. Beeindruckend ist die geringe Drop-Out-Quote, was sicherlich auch mit der sehr guten Stichprobenpflege zusammenhing. Die ersten Studienergebnisse wurden schon Ende der 1990er und Anfang der 2000er Jahre in der Kindheit und Entwicklung publiziert. Andere Themenschwerpunkte greifen Probleme der Zeit auf, wie „Jugendliche Flüchtlinge“ (Piegenschke, Sihorsch & Christiansen, 2019) oder „Cybermobbing und Cyberbullying“ (Scheithauer, Petras & Petermann, 2020). Und regelmäßig werden typisch klinisch-kinderpsychologische Themen bearbeitet, wie „Angststörungen“ (Sachser & Goldbeck, 2017), „aggressives und oppositionelles Verhalten“ (Vasileva, Petermann, Nitkowski & Petermann, 2018), „ADHS“ (Petermann & Petermann, 2019) sowie „Essstörungen“ (Verbeek & Petermann, 2019). Immer häufiger werden bei gut erforschten Themen wie Angst und Aggression transgenerationale Übergänge sowie Zusammenhänge dieser Störungen thematisiert (Vasileva et al., 2018) oder die Assoziation mit anderen Störungen und deren transdiagnostischen Effekte aufgrund der Behandlung betrachtet (Sachser & Goldbeck, 2017).Bewährtes und NeuesBewährt hat es sich, die englische Zusammenfassung auf 3000 Zeichen zu erhöhen, wie im Editorial zum 25jährigen Bestehen unserer Zeitschrift angekündigt (Petermann, Petermann, Schmidt & Stephani, 2016). Dadurch ist die Kindheit und Entwicklung international sichtbarer geworden, was an der gestiegenen Nachfrage von einzelnen Beiträgen unseres Journals im Kontext diverser Internet-Plattformen ablesbar ist.Neu ist ab diesem Jahrgang, dass nach einem festen Schema die deutsche Zusammenfassung und der englische Abstract gegliedert sein muss (s. Tab. 2). Tabelle 2 Gliederung von Zusammenfassung und Abstract Deutsche Zusammenfassung Englischer Abstract Theoretischer Hintergrund Theoretical Background Fragestellung Objective Methode Method Ergebnisse Results Diskussion und Schlussfolgerung Discussion and Conclusion Tabelle 2 Gliederung von Zusammenfassung und Abstract View as image HTML Dies verbessert die Auffindbarkeit der Zeitschrift Kindheit und Entwicklung mit ihren verschiedenen Beiträgen in den Literaturdatenbanken. Auch dies bedeutet eine bessere Sichtbarkeit der Kindheit und Entwicklung, und dadurch wird die Zeitschrift häufiger rezipiert – national wie international.Neue Themenschwerpunktlegungen werden sicherlich durch das neue Herausgeberteam verstärkt in unsere Zeitschrift eingebracht werden. So gestalten die beiden neuen Herausgeberinnen je einen Themenschwerpunkt im Jubiläumsjahrgang der Kindheit und Entwicklung:Heft 2/2020: Moralentwicklung im Jugendalter, gestaltet von Prof. Ute Koglin, Universität Oldenburg, undHeft 3/2020: Traumafokussierte Verhaltenstherapie bei Kindern mit Misshandlungen, gestaltet von Prof. Hanna Christiansen, Universität Marburg.Es werden aber auch bekannte Themen, die in der Kindheit und Entwicklung immer wieder behandelt wurden, mit neuen Ergebnissen und Perspektiven aufgegriffen werden, beispielsweise Emotionale Entwicklung und Emotionsregulation, Angststörungen, multisystemische Familienhilfe oder psychosoziale Folgen chronischer Erkrankungen.Wünsche an die ZukunftEs ist sehr zu wünschen, dass die Rubrik Aktuelle Kontroverse neu belebt wird. Themen gäbe es genug, wie beispielsweise „Übereinstimmung und Unterschiede von DSM-5 und ICD-10 beziehungsweise ICD-11“ oder „Kategoriale versus dimensionale Diagnostik in der Psychotherapie“ oder „Wirkfaktoren der Kinder- und Jugendlichenpsychotherapie“. Ein Themenschwerpunkt „Wirkfaktoren“ war mehrmals angedacht, jedoch mangels Manuskripten nicht realisierbar.Eine mögliche Vorgehensweise für die Aktuelle Kontroverse könnte sein, dass zwei Kolleginnen beziehungsweise Kollegen ein Betrags-Tandem bilden, jeweils eine Pro- und eine Kontraposition zu einem Thema einnehmend.So bleibt der Kindheit und Entwicklung für die Zukunft weiter eine zahlreiche Leserschaft zu wünschen, mit mutig angepackten Themen und guter Akzeptanz bei praktisch tätigen Kinder- und Jugendlichenpsychotherapeutinnen und -therapeuten ebenso wie bei interdisziplinär forschenden klinischen Kinderpsychologinnen und -psychologen, Pädiaterinnen und Pädiatern sowie Kinder- und Jugendpsychiaterinnen und -psychiatern.LiteraturEsser, G. & Schmidt, M. H. (2017). Die Mannheimer Risikokinderstudie. Idee, Ziele und Design. Kindheit und Entwicklung, 26, 198 – 202. First citation in articleLink, Google ScholarPetermann, F., Petermann, U., Schmidt, M. H. & Stephani, U. (2016). Kindheit und Entwicklung – 25 Jahre. Kindheit und Entwicklung, 25, 1 – 3. First citation in articleLink, Google ScholarPetermann, U. & Petermann, F. (2019). ADHS: Neue Ansätze in Diagnostik und Therapie. Kindheit und Entwicklung, 28, 81 – 84. First citation in articleLink, Google ScholarPiegenschke, K., Sihorsch, M. & Christiansen, H. (2019). Begleitete minderjährige Geflüchtete. Eine systematische Übersicht über psychologische Interventionen mit Familieneinbezug. Kindheit und Entwicklung, 28, 147 – 159. First citation in articleLink, Google ScholarSachser, C. & Goldbeck, L. (2017). Angst, Depression und Trauma – transdiagnostische Effekte der traumafokussierten kognitiven Verhaltenstherapie (TF-KVT). Kindheit und Entwicklung, 26, 93 – 99. First citation in articleLink, Google ScholarScheithauer, H., Petras, I.-K. & Petermann, F. (2020). Cybermobbing/Cyberbullying. Kindheit und Entwicklung, 29, 63 – 66. First citation in articleLink, Google ScholarVasileva, M., Petermann, F., Nitkowski, D. & Petermann, U. (2018). Den transgenerationalen Kreislauf der Gewalt durchbrechen. Wie kann man aggressiven Jugendlichen mit Gewalterfahrungen helfen? Kindheit und Entwicklung, 27, 91 – 101. First citation in articleLink, Google ScholarVerbeek, D. & Petermann, F. (2019). Essstörungen. Kindheit und Entwicklung, 28, 191 – 196. First citation in articleLink, Google ScholarProf. Dr. Ulrike Petermann, Zentrum für Klinische Psychologie und Rehabilitation, Universität Bremen, Grazer Straße 6, 28359 Bremen, upeterm@uni-bremen.deFiguresReferencesRelatedDetails Schwerpunkt: Frühkindliche Entwicklung und Früherkennung von EntwicklungsstörungenVolume 30Issue 1Januar 2021ISSN: 0942-5403eISSN: 2190-6246 InformationKindheit und Entwicklung (2021), 30, pp. 1-3 https://doi.org/10.1026/0942-5403/a000327.© 2021Hogrefe VerlagPDF download

Objective: Childhood absence epilepsy (CAE) is a disease with distinct seizure semiology and electroencephalographic (EEG) features. Differentiating ictal and subclinical generalized spikes and waves discharges (GSWDs) in the EEG is challenging, since they appear to be identical upon visual inspection. Here, spectral and functional connectivity (FC) analyses were applied to routine EEG data of CAE patients, to differentiate ictal and subclinical GSWDs. Methods: Twelve CAE patients with both ictal and subclinical GSWDs were retrospectively selected for this study. The selected EEG epochs were subjected to frequency analysis in the range of 1-30 Hz. Further, FC analysis based on the imaginary part of coherency was used to determine sensor level networks. Results: Delta, alpha and beta band frequencies during ictal GSWDs showed significantly higher power compared to subclinical GSWDs. FC showed significant network differences for all frequency bands, demonstrating weaker connectivity between channels during ictal GSWDs. Conclusion: Using spectral and FC analyses significant differences between ictal and subclinical GSWDs in CAE patients were detected, suggesting that these features could be used for machine learning classification purposes to improve EEG monitoring. Significance: Identifying differences between ictal and subclinical GSWDs using routine EEG, may improve understanding of this syndrome and the management of patients with CAE. (C) 2021 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

Background and objective: The human brain displays rich and complex patterns of interaction within and among brain networks that involve both cortical and subcortical brain regions. Due to the limited spatial resolution of surface electroencephalography (EEG), EEG source imaging is used to reconstruct brain sources and investigate their spatial and temporal dynamics. The majority of EEG source imaging methods fail to detect activity from subcortical brain structures. The reconstruction of subcortical sources is a challenging task because the signal from these sources is weakened and mixed with artifacts and other signals from cortical sources. In this proof-of-principle study we present a novel EEG source imaging method, the regional spatiotemporal Kalman filter (RSTKF), that can detect deep brain activity.Methods: The regional spatiotemporal Kalman filter (RSTKF) is a generalization of the spatiotemporal Kalman filter (STKF), which allows for the characterization of different regional dynamics in the brain. It is based on state-space modeling with spatially heterogeneous dynamical noise variances, since models with spatial and temporal homogeneity fail to describe the dynamical complexity of brain activity. First, RSTKF is tested using simulated EEG data from sources in the frontal lobe, putamen, and thalamus. After that, it is applied to non-averaged interictal epileptic spikes from a presurgical epilepsy patient with focal epileptic activity in the amygdalo-hippocampal complex. The results of RSTKF are compared to those of low-resolution brain electromagnetic tomography (LORETA) and of standard STKF.Results: Only RSTKF is successful in consistently and accurately localizing the sources in deep brain regions. Additionally, RSTKF shows improved spatial resolution compared to LORETA and STKF.Conclusions: RSTKF is a generalization of STKF that allows for accurate, focal, and consistent localization of sources, especially in the deeper brain areas. In contrast to standard source imaging methods, RSTKF may find application in the localization of the epileptogenic zone in deeper brain structures, such as mesial frontal and temporal lobe epilepsies, especially in EEG recordings for which no reliable averaged spike shape can be obtained due to lack of the necessary number of spikes required to reach a certain signal-to-noise ratio level after averaging.

This prospective observational study focuses on developmental outcomes in the treatment of tuberous sderosis complex (TSC) with everolimus (EVO). Fourteen children/adolescents aged 1.7-13.07 and one adult aged 31 years, all with TSC and refractory epilepsy participated. All were treated with EVO for 3-70 months (md: 37). Development/adaptive functioning were evaluated at baseline with follow-up in 11 patients; all patients were assessed during the course of treatment. Our exploratory analyses included factors contributing to developmental impairment and change from baseline to last evaluation. The majority of patients showed severe developmental impairment (86%). Patients with a higher age at inclusion, duration of epilepsy, and number of previous antiepileptic drugs (AEDs) showed lower developmental levels. Earlier onset of epilepsy and a higher number of current AEDs were associated with worse adaptive functioning. At their last examination, four patients were seizure-free (27%), and four experienced a reduction of seizures >50% (27%). With treatment, (slight) increase was seen in absolute values of developmental age (DA) regarding both development and adaptive functioning. Yet, when accounting for age. decrease was seen in both assessments. While developmental disorders were prominent, we observed an overall progression at a slower pace. Despite a positive effect on seizure occurrence, treatment with EVO did not reverse developmental problems in the observation period of this study. (C) 2020 Elsevier Inc. All rights reserved.

Geriatric medicine is a rapidly evolving field that addresses diagnostic, therapeutic and care aspects of older adults. Some disabilities and disorders affecting cognition (e.g. dementia), motor function (e.g. stroke, Parkinson’s disease, neuropathies), mood (e.g. depression), behavior (e.g. delirium) and chronic pain disorders are particularly frequent in old subjects. As knowledge about these age-associated conditions and disabilities is steadily increasing, the integral implementation of neurogeriatric knowledge in geriatric medicine and specific neurogeriatric research is essential to develop the field. This article discusses how neurological know-how could be integrated in academic geriatric medicine to improve care of neurogeriatric patients, to foster neurogeriatric research and training concepts and to provide innovative care concepts for geriatric patients with predominant neurological conditions and disabilities.