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abnormal EEG/Infant

our 3 mos. foster baby who was exposed in utero to cocaine at the least, has had two EEGs. the second at a different hospital returned a report " continuous polymorphic delta activity excessively slow for age", and "generalized background slowing" . Has anyone an idea of what these terms indicate? I cannot find a good match on the net. oh yes, it also said, "no epileptiform features observed". The test was only 20 minutes long. We suspect focal? seizures: eyes deviated and fixed, about 4 secs. She is otherwise observed to be developing normally. We haven't seen a neurologist and our appointment is too far away to wait. ant insights? Thanks!

Comments

chrisalis, I've been

chrisalis,
I've been trying to find info on the net also that would be close to her reading to help you. The closest I have been able to find is neonatal and newborn. Through reading these, they pretty well say the same thing, that EEG's will be necessary as the baby grows. It seems a true reading is difficult to make on babies regarding EEG's. Here is one of the places I found and am still searching...

http://www.emedicine.com/neuro/topic545.htm

Hope this helps! I'm still looking!

-Spiz

Re: chrisalis, I've been

Thank you, Spiz, I did study this page this morning and took notes such as " severe but reversible diffuse abnormalities are exemplified by low-voltage pattern throughout eeg record" and, "Delta waves: 4 Hz or less=low-voltage" I also saw links to dementia, which was interesting, wondering what that would instead be for an infant. Saw notes to mental retardation, dysmaturity, and maple syrup urine disorder. Also Rett Syndrome, which I have witnessed first hand. I would think they'd order an MRI to determine if lesions are present. I saw something about subcortical lesions, and it is certainly possible that she experienced hypoxia or eschemia while exposed to crack use. Thank you for the research, I certainly know how tedious it is, esp for poor baby on my lap while I do it...

Re: Re: chrisalis, I've been

PS: this is her second EEG already, the first report was normal, but neurologist wanted EEG done at different hospital.

Re: Re: Re: Re: chrisalis, I've been

I found another on Emed.

http://www.emedicine.com/neuro/topic108.htm

I'm going to research and see what I can find on MRI's on infants. There may be a reason for not doing one on one so young, I don't know. But, I'll see what I can find. Take care!

-Spiz

Re: Re: Re: Re: Re: chrisalis, I've been

you've done too much already--are you a reference librarian? Will look at these tomorrow. Must go to bed early for those early am feedings. THANK YOU!!!

Re: Re: Re: Re: Re: Re: chrisalis, I've been

chrisalis,
No, an incurable insomniac that loves research, learning, and wants to help. I can't imagine what it must be like for the parents to watch their child go through this and need answers. I know all our hearts go out to all of you parents.

Here are two links having to do with infant MRI's that I think may help. They are an interesting read too.

http://www.medscape.com/viewarticle/499273

Hope these help!

-Spiz

I'll have to copy and paste the second one...it doesn't want to work.

The Necessity and Difficulty of
Conducting Magnetic Resonance
Imaging Studies on Infant Brain
Development
ABBREVIATION. MRI, magnetic resonance imaging.
D
ecision-making in the care of gravely ill, pre-
maturely born infants must balance the long-
term effects of numerous medical complica-
tions with those of their treatments. Antenatal and
postnatal administration of glucocorticoids clearly
enhance fetal lung maturation and survival,
1–3
and
yet growing clinical and preclinical data suggest that
these therapies may be associated with disturbances
in long-term brain development and cognition.
4–6
The article by Murphy and colleagues
7
in the Febru-
ary 2001 issue of Pediatrics contributed importantly
to this growing evidence by showing that postnatal
glucocorticoid administration is associated with a
reduced volume of cortical gray matter in preterm
infants. This article is the latest in a series of studies
from this investigational team that has helped to
characterize normal and pathologic infant brain de-
velopment.
8–13
The work from this group has been
bold, pioneering, and (given the innumerable tech-
nical difficulties associated with scanning infants)
nothing short of heroic.
Because of the potential implications of this par-
ticular study for clinical decision-making, it is impor-
tant to note its limitations and the inherent difficul-
ties of interpreting findings from similar magnetic
resonance imaging (MRI) studies of infant develop-
ment. First, the number of infants in this study who
received postnatal steroids was small and the results
must be considered preliminary. Second, antenatal
steroid administration was undocumented and may
have also influenced brain development in these pre-
term infants.
4
Third, the cumulative exposure to
dexamethasone was relatively large, and the find-
ings, if confirmed, may not apply to lower cumula-
tive exposures. Fourth, the effects of the medical
conditions for which the steroids were administered
are exceedingly difficult to dissociate from the effects
on brain development of the steroids themselves.
14
These considerations pertain to clinical aspects of
studies of preterm birth. Other considerations per-
tain more specifically to the inherent limitations of
imaging methodologies used in this and other stud-
ies of infants. First, studies of regional volumes must
account for scaling effects within the brain. Bigger
infants will have bigger brains, and infants with
bigger brains will have bigger subregions within
their brains. When comparing brain volumes be-
tween preterm and term infants, therefore, the anal-
yses must account for these scaling effects. Precisely
how best to do this is a subject of some controversy,
but most studies control the analyses statistically
either for total body size (using a measure such as
height) or for head size (using a measure such as
head circumference or intracranial volume).
15–17
In
the study from Murphy and colleagues, scaling ef-
fects on regional brain volumes were not considered.
It is likely that the preterm infants who received
dexamethasone had smaller body sizes and reduced
intracranial volumes resulting from their greater pre-
maturity and more severe respiratory illnesses.
A subtler but more intractable problem in infant
scanning is the inherent difficulty in determining the
histologic correlates of the various tissue classes that
are assigned using MRI (eg, “cortical gray,” “unmy-
elinated white,” “myelinated white,” and “cerebro-
spinal fluid”). The basic unit of information available
on an MRI scan is the degree of grayness in any
portion of the image. Our ability to discriminate and
measure different brain tissues is provided mainly
by the image contrast—how “white” the white mat-
ter appears, for instance, compared with the “gray”
of the adjacent cortical gray matter.
18
Tissue contrast
in infant MRI scans differs dramatically from scans
in later childhood primarily because of a much
higher water content and a much lower myelin dep-
osition in infant brains.
19–21
Unfortunately, the high
water content in infant brains alters MRI-based tissue
characteristics (relaxation times) and thereby reduces
the contrast in images from pulse sequences typically
used in older children,
20
such as those used in the
Murphy et al study. When using main magnetic field
strengths of 1.5 Tesla or more, repetition times and
echo times need to be considerably longer in infants
to achieve adequate tissue contrast.
20
In addition, water content and myelin deposition
change considerably in the weeks preceding and in
the year after term birth. MRI tissue contrast, there-
fore, also varies significantly during that time
20,21
and so may regional volumes, especially if the
change in water content is not constant across tissue
types. As noted by other investigators, pulse se-
quences may need to be tailored specifically to the
age of the infants to maximize contrast and improve
our ability to discriminate tissue classes.
20,21
Even
then, assigning histologic correlates to tissues of
varying grayness in MRI scans is difficult. The MRI
contrast between tissues called “cortical gray” and
“unmyelinated white matter,” for instance, must by
definition be based on tissue characteristics other
than myelin content, and these characteristics cur-
rently are unknown. The histologic basis of MRI-
based tissue assignment in infants, therefore, re-
quires further clarification.
Regional brain water content, myelin deposition,
and the resulting tissue contrast could differ in pre-
term compared with term children (or compared
with preterm children treated with dexamethasone)
and thereby systematically alter the volumes of the
various tissue compartments measured on MRI
scans. These difficulties are not unique to the study
from Murphy and colleagues and do not diminish
Received for publication Jan 12, 2001; accepted Jan 12, 2001.
Reprint requests to (B.S.P.) Yale Child Study Center, 230 South Frontage Rd,
New Haven, CT 06520. E-mail: bradley.peterson@yale.edu
PEDIATRICS (ISSN 0031 4005). Copyright © by the American Academy of
Pediatrics.
COMMENTARIES
593
Page 2
the importance of their findings. They do, however,
underscore how difficult it is to interpret group dif-
ferences and putative developmental changes in re-
gional brain volumes in infants using MRI.
Bradley S. Peterson, MD*‡
Laura R. Ment, MD§
*Child Study Center
Departments of ‡Diagnostic Imaging, §Neurology,
and Pediatrics
Yale University School of Medicine
New Haven, CT 06520

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