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Cognition, behaviour and academic skills after cognitive rehabilitation in Ugandan children surviving severe malaria: a randomised trial
Paul Bangirana, Peter Allebeck, Michael J Boivin, Chandy C John, Connie Page, Anna Ehnvall, Seggane Musisi
BMC Neurology , 2011, DOI: 10.1186/1471-2377-11-96
Abstract: This parallel group randomised study was carried out in Kampala City, Uganda between February 2008 and October 2010. Sixty-one Ugandan children aged 5 to 12 years with severe malaria were assessed for cognition (using the Kaufman Assessment Battery for Children, second edition and the Test of Variables of Attention), academic skills (Wide Range Achievement Test, third edition) and psychopathologic behaviour (Child Behaviour Checklist) three months after an episode of severe malaria. Twenty-eight were randomised to sixteen sessions of computerised cognitive rehabilitation training lasting eight weeks and 33 to a non-treatment group. Post-intervention assessments were done a month after conclusion of the intervention. Analysis of covariance was used to detect any differences between the two groups after post-intervention assessment, adjusting for age, sex, weight for age z score, quality of the home environment, time between admission and post-intervention testing and pre-intervention score. The primary outcome was improvement in attention scores for the intervention group. This trial is registered with Current Controlled Trials, number ISRCTN53183087.Significant intervention effects were observed in the intervention group for learning mean score (SE), [93.89 (4.00) vs 106.38 (4.32), P = 0.04] but for working memory the intervention group performed poorly [27.42 (0.66) vs 25.34 (0.73), P = 0.04]. No effect was observed in the other cognitive outcomes or in any of the academic or behavioural measures.In this pilot study, our computerised cognitive training program three months after severe malaria had an immediate effect on cognitive outcomes but did not affect academic skills or behaviour. Larger trials with follow-up after a few years are needed to investigate whether the observed benefits are sustained.ISRCTN: ISRCTN53183087Cognitive deficits are common in children who have suffered from severe malaria having neurological involvement [1]. Severe malaria with neurolo
Malaria with neurological involvement in Ugandan children: effect on cognitive ability, academic achievement and behaviour
Paul Bangirana, Seggane Musisi, Michael J Boivin, Anna Ehnvall, Chandy C John, Tracy L Bergemann, Peter Allebeck
Malaria Journal , 2011, DOI: 10.1186/1475-2875-10-334
Abstract: This prospective case-control study was carried out in Kampala City, Uganda between February 2008 and October 2010. Sixty-two children with a history of malaria with neurological involvement were followed up and given assessments for cognitive ability (working memory, reasoning, learning, visual spatial skills and attention), behaviour (internalizing and externalizing problems) and academic achievement (arithmetic, spelling and reading) three months after the illness. Sixty-one community controls recruited from the homes or neighbouring families of the cases were also given the same assessments. Tests scores of the two groups were compared using analysis of covariance with age, sex, level of education, nutritional status and quality of the home environment as covariates. This study was approved by the relevant ethical bodies and informed consent sought from the caregivers.Children in the malaria group had more behavioural problems than the community controls for internalizing problems (estimated mean difference = -3.71, 95% confidence interval (CI), = -6.34 to -1.08, p = 0.007). There was marginal evidence of lower attention scores (0.40, CI = -0.05 to 0.86, p = 0.09). However, excluding one child from the analyses who was unable to perform the tests affected the attention scores to borderline significance (0.32, CI, = 0.01 to 0.62, p = 0.05). No significant differences were observed in other cognitive abilities or in academic achievement scores.Malaria with neurological involvement affects behaviour, with a minimal effect on attention but no detectable effect on academic achievement at three months post discharge. This study provides evidence that development of cognitive deficits after malaria with neurological involvement could be gradual with less effect observed in the short term compared to the long term.Malaria, caused by Plasmodium falciparum, is one of the most commonly occurring infections in children in sub-Saharan Africa with approximately 515 million cl
Socioeconomic Predictors of Cognition in Ugandan Children: Implications for Community Interventions  [PDF]
Paul Bangirana,Chandy C. John,Richard Idro,Robert O. Opoka,Justus Byarugaba,Anne M. Jurek,Michael J. Boivin
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0007898
Abstract: Several interventions to improve cognition in at risk children have been suggested. Identification of key variables predicting cognition is necessary to guide these interventions. This study was conducted to identify these variables in Ugandan children and guide such interventions.
Severe neurological sequelae and behaviour problems after cerebral malaria in Ugandan children
Richard Idro, Angelina Kakooza-Mwesige, Stephen Balyejjussa, Grace Mirembe, Christine Mugasha, Joshua Tugumisirize, Justus Byarugaba
BMC Research Notes , 2010, DOI: 10.1186/1756-0500-3-104
Abstract: Records of children attending a specialist child neurology clinic in Uganda with severe neurological sequelae following cerebral malaria between January 2007 and December 2008 were examined to describe deficits in gross motor function, speech, vision and hearing, behaviour problems or epilepsy. Deficits were classified according to the time of development and whether their distribution suggested a focal or generalized injury. Any resolution during the observation period was also documented.Thirty children with probable exposure to cerebral malaria attended the clinic. Referral information was inadequate to exclude other diagnoses in 7 children and these were excluded. In the remaining 23 patients, the commonest severe deficits were spastic motor weakness (14), loss of speech (14), hearing deficit (9), behaviour problems (11), epilepsy (12), blindness (12) and severe cognitive impairment (9). Behaviour problems included hyperactivity, impulsiveness and inattentiveness as in attention deficit hyperactivity disorder (ADHD) and conduct disorders with aggressive, self injurious or destructive behaviour. Two patterns were observed; a) immediate onset deficits present on discharge and b) late onset deficits. Some deficits e.g. blindness, resolved within 6 months while others e.g. speech, showed little improvement over the 6-months follow-up.In addition to previously described neurological and cognitive sequelae, severe behaviour problems may follow cerebral malaria in children. The observed differences in patterns of sequelae may be due to different pathogenic mechanisms, brain regions affected or extent of injury. Cerebral malaria may be used as a new model to study the pathogenesis of ADHD.Cerebral malaria is the most severe neurological complication of falciparum malaria. Children with cerebral malaria are admitted with fever, seizures, coma and brainstem signs and despite adequate treatment using current guidelines, about 20% die[1]. Earlier studies suggested that ther
Neurological Involvement in Behcet’s Disease  [PDF]
Gül?en Akman-Demir
Turkderm , 2009,
Abstract: One of the most dreaded organ involvement in Behcet’s disease is neurological involvement. The majority of the cases present with parenchymal CNS involvement characterized as a brainstem meningoencephalitis; a rarer presentation is dural sinus thrombosis. Both situations very rarely occur in the same patient. Since parenchymal neurological involvement in Behcet’s disease is associated with severe sequelae or mortality, it is a poor prognostic organ involvement. In contrast, dural sinus thrombosis in Behcet’s disease has a much better prognosis as compared to the parenchymal involvement, as well as dural sinus thromboses due to other etiologies. There are no randomized controlled treatment trials carried out in neuro-Behcet disease. Mostly accepted approach is to give high dose intravenous steroids at the atack, with a very slow tapering of steroid dose, and adding a long term immunosuppresant. One of the most critical points in neuro-Behcet treatment is not to stop steroids prematurely, and abruptly. It is notable that with the present treatment options, prognosis of neurological involvement in Behcet’s disease is not as grave as it was in the previous years.
Juvenile systemic lupus erythematosus: neurological involvement
Schmutzler, Katia M.R.S.;Vilanova, Luiz Celso P.;Lima, José Geraldo C.;Hilário, Maria Odete;Naspitz, Charles K.;
Arquivos de Neuro-Psiquiatria , 1997, DOI: 10.1590/S0004-282X1997000400016
Abstract: with the purpose of analyzing the neurological involvement due to systemic lupus erythematosus (sle), we evaluated 17 female patients who were seen regularly at the hospital and had been diagnosed as having sle according to classification criteria proposed by the american college of rheumatology revised in 1982, before the age of 16. neurological involvement was detected in 12 patients (71%): headache (35%), extrapyramidal syndrome (35%), epileptic syndrome (24%) pyramidal syndrome (24%), peripheral neuropathy (12%) and optic neuritis (6%). the findings of ct scan (58%) and cerebrospinal fluid (50%) were most closely correlated to clinical neurological involvement.
Neurological involvement in visceral leishmaniasis: case report
Diniz, Lílian Martins Oliveira;Duani, Helena;Freitas, Camila Rodrigues;Figueiredo, Rosangela Maria;Xavier, Christov?o Castro;
Revista da Sociedade Brasileira de Medicina Tropical , 2010, DOI: 10.1590/S0037-86822010000600031
Abstract: visceral leishmaniasis is a severe and potentially fatal vector-borne disease. the most typical symptoms are fever, hepatosplenomegaly, weight loss, bleeding and bacterial infections. neurological changes are rarely reported. this paper describes a child who presented with neurological signs as the first symptoms of leishmaniasis; tone was diminished and tremors in the extremities were observed. a diagnosis of visceral leishmaniasis was confirmed by parasite detection in the bone marrow. symptoms were reversed by specific treatment. the nature of a possible mechanism of neurological involvement in visceral leishmaniasis remains unexplained.
Subclinical neurological involvement in Behcet′s disease  [cached]
Tunc Tugba,Ortapamuk Hulya,Naldoken Seniha,Ergun Ufuk
Neurology India , 2006,
Abstract: Context: Behηet′s disease (BD) is a multisystem inflammatory disorder with unknown etiology characterized by recurrent oral and genital aphthous ulcers and uveitis. Behηet′s disease can affect the central nervous system. Aims: We aimed to investigate subclinical neurological involvement in patients who were suffering from BD and who had no neurological symptoms. Settings and Design: A total of 49 patients were included in the study. For the investigation of subclinical neurological involvement, the patients received imaging and/or neurophysiologic evaluations. Materials and Methods: The evaluation techniques were as follows: single photon emission computed tomography, 33 patients; cranial magnetic resonance imaging (MRI), 25 patients; brainstem auditory evoked potential examination, 36 patients; and electroencephalography (EEG), 30 patients. Statistical Analysis Used: The Mann-Whitney U test and Wilcoxon Rank-Sum W test were used. Results: Patients in the MRI and EEG groups showed significantly more abnormalities than did age- and gender-matched controls. Conclusions: Early diagnosis of neurological involvement in BD is important in reducing or preventing complications. Cranial MRI and EEG were found to be useful for detecting subclinical neurological abnormalities in patients with Behηet′s disease.
Seizure activity and neurological sequelae in Ugandan children who have survived an episode of cerebral malaria
RO Opoka, P Bangirana, MJ Boivin, CC John, J Byarugaba
African Health Sciences , 2009,
Abstract: Background: Seizures are a common presenting feature in children with cerebral malaria (CM) and neurologic deficits have been described in survivors of CM. However few prospective studies have described the frequency of seizure activity and neurologic deficits in survivors of CM over time. Methods: Eighty-two children aged 3 to 12 years who survived an episode of CM were followed up and monitored for seizure activity and neurologic deficits at discharge, 3, 6 and 24 months. Seventy six children with uncomplicated malaria (UM) and 105 healthy community controls (CC) age 3 to 12 years were recruited as comparison groups and the frequency of seizures in the 6 to 24 month follow-up period was compared in the 3 groups. Results: Cumulative incidence of seizures increased over time in children with CM, with a total of 2 of 76 children (2.6%) reporting seizures at 3 months, 3 of 74 children (4.1%) at 6 months and 11 of 68 children (16.2%) at 24 months (Chi square for trend = 9.36, P=0.002). In contrast, neurologic deficits almost completely resolved over time, occurring in 19 of 76 children with CM (25%) at discharge, 2 of 74 children (2.7%) at 6 months, and 1 of 68 (1.5%) children at 24 months. Conclusions: During the 24 months following a CM episode, neurologic deficits resolve but the cumulative incidence of seizures increases in children with CM. Neurologic impairment after an episode of CM may not be limited to the neurologic deficits seen at discharge.
A Quantum Neurological Model of Perception-Cognition and Awareness in Ambiguous Figures and the Case of the Dalmatian Dog  [PDF]
Elio Conte, Ignazio Licata, Raúl Alelú-Paz
Journal of Behavioral and Brain Science (JBBS) , 2015, DOI: 10.4236/jbbs.2015.512051
Abstract: The present paper has mainly the aim to formulate a quantum neurological model of brain dynamics during perception and cognition of ambiguous figures here including the case of the Dalmatian dog. First of all, we summarize our previous experimental and theoretical studies, evidencing as the basic conceptual foundations of quantum mechanics enter in a decisive manner in explaining the basic functions of brain dynamics at perceptive and cognitive level and at the level of our consciousness. This is done in detail in Sections 2 and 3 where we discuss also the role of the so called quantum interference effect and we include here the results of an our recent experiment confirming the role of quantum theory and of its quantum interference effect also at perceptive-cognitive and awareness levels. In Section 4, following our previous study, we consider the so called Mach-Zehnder interferometer. It is a physical device that is employed in quantum mechanical experiments in order to analyze such quantum interference effect. Soon after the discussion of this device, we proceed with the elaboration of a detailed quantum neurological model in the sense that we consider the brain regions identified in V1; V2/V3/V4 and A20 and we obtain that they may behave just as the beam splitters involved in the Mach-Zehnder quantum mechanical interferometer. In this manner, we formulate a model of V1; V2/V3/V4, A20 brain dynamics as a Mach-Zehnder interferometer and such model delineates a proposed neurological mechanism explaining perception-cognition and awareness in humans under the input of ambiguous figures and in the particular case of the Dalmatian dog.
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