norms and maturation of f-wave responses in children ages newborn to 14 years

1
105 PBL/100 U IL-2) proliferative response (3HTdR uptake). The results of FACS analysis did not indicate any major shift in the subpopulation phenotypes of lymphocytes in SSPE patients as compared to the normal population. However, NK and LAK cell-dependent cytotoxicity was found to be substantially im- paired (31.7% + 9.3 S.E. cytotoxicity for NK cells; 47% + 1.4% S.E. cytotoxicity for LAK cells at 100:1, effector:target cell ratio as compared to normal; 68.8% + 8.7% cytotoxicity for NK cells (P < .05) and 81.66% + 10.3% cytotoxicity for LAK cell (P < .02). In pretreated SSPE patients, a variable degree of sup- pression (6-17% for PHA, 4-31% for PWM, 4-21% for IL-2) was also observed as compared to normal controls. Although all patients treated with combined therapy showed improvement in immunologic competency, this was associated with clinical im- provement or remission in only 6 patients. Although there were only 18 patients, the degree in increase of immunologic compe- tency particularly in NK/LAK functions appears to be one factor in treatment success or failure. 20. COMPARING STUDY FOR NORMS OF PATTERN VEP RECORDED IN WAKE AND SLEEPING UNDER CHLORAL HYDRATE SEDATION IN INFANCY Fangcheng Cai and Xuewen Wang, Chongqing, China To ascertain the possibility and reliability of pattern-reversal visual evoked potential (1,VEP) recorded in sleep as a clinically convenient test for infancy, the latency, amplitudes, and pre- sented rate of PVEP waves in 20 infants (ages 3-12 mos) and 22 children (ages 13 mos to 6 yrs) under chloral hydrate sedation were analyzed and compared to the recording during wakeful- ness before sedation. According to the American EEG Society Recommended Standard for Visual Evoked Potentials, the meth- ods producing PVEPs were essentially the same during the recording of either awake or sleeping patients with the exception of a dilated pupil by 0.5% tropicamide and a blepharostat to keep the eye opened under sedation. 1,1 (P100) waves were present in all cases asleep and awake. The latencies of all waves (N1, P1, N2, 1'2) in sleep for all age groups were prolonged proportionally; furthermore, the latency of wave P1 was in very close relation linearly to the latency of wave P1 during wakeful- ness (r = 0.79 - 0.87). No significant differences were found on the amplitudes of all waves between the states. There was a similar maturational pace with age of latency and amplitude of PVEP waves either during wakefulness or sleep. With the recordings during wakefulness the difference of the latencies of wave 1,1 between two eyes in sleeping for normal children should be less than 6.4 ms (2 S.D.) or 8.8 ms (3 S.D.) and the ratio of amplitudes of wave PI between both eyes should be less than 0.6 (2 S.D.) or 0,5 (3 S.D.). On the basis of this study, the prolonged latency of wave PI was presumably due to the "cen- tral postponement" of the message transmission along the cen- tral visual pathway during sleep. However, the 1,VEP recorded in sleep would be a valuable test for infants and uncooperative patients to determine the function of the visual pathway. 21. NORMS AND MATURATION OF F-WAVE RE- SPONSES IN CHILDREN AGES NEWBORN TO 14 YEARS Fangcheng Cai and Jeaming Zhang, Chongqing, China To ascertain the norms and maturation of F-wave responses in early life, the velocities, conduction time, latencies, amplitudes, duration, and F-ratio of F-waves at median, ulnar, and tibial nerves in 150 normal children ages newborn to 14 years of age were analyzed and compared with the data of 20 young adults. F-waves could be elicited at any age in which the best one was chosen among 10 responses after stimulation repeatedly. The velocities at birth only reached about 40% of that found in adults and were developed as a function in close relationship with age or the length of extremities after birth. The adult levels were reached during 6-14 and 3-6 years of age for upper and lower extremities, respectively, which were slower than MCV for same motor nerve. It was presumably related to the prema- ture development of the proximity of motor nerve and anterior horn cells which made longer duration of central conduction in spinal cord in infants. The velocities in the upper extremities were faster than the lower ones and also faster at proximal than distal recording. However, the latencies of F-waves in all motor nerve as above varied inversely with age and the length of ex- tremities significantly. It can be concluded that as with adults, the F-wave responses are also a valuable clinical test in children to determine the function of motor nerves, anterior horn cells, and roots of the motor nerve. Table 21-1. Conduction velocities of F-waves (m/s) Median Nerve Ulnar Nerve Age Distal Proximity Distal Proximity Newborn 26.1 + 5.0 27.0 + 4.5 27.1 + 4.5 26.1 + 3.9 to 3 mos 33.3+-3.9 32.8_+4.1 33.3_+3.5 33.3_+4.9 to 6 mos 36.8 _+ 4.2 38.0 +-6.0 38.2 _+ 3.9 37.9 +-4.3 to 1 yr 40.7 + 10.0 44.7 _+ 6.0 42.4 + 4.4 38.8 + 4.7 to 3 yrs 51.9+-6.5 52.9+-9.9 51.9+-7.1 48.4_+7.4 to 6 yrs 55.7 + 3.8 56.5 _+ 5.4 55.3 _+ 5.2 50.3 _+ 5.9 to 14 yrs 59.6 _+ 4.5 62.5 +-6.8 61.9 _+ 4.3 59.0 _+ 5.8 Adult 63.8 _+ 4.2 63.5 +-4.1 61.0 + 4.8 61.2 _+ 6.3 Tibial Nerve Age Distal Proximity Newborn 23.8 + 2.9 23.7 + 3.3 to 3 mos 29.3 + 2.3 30.0 + 2.6 to 6 rots 35.0 _+ 2.7 36.9 + 3.9 to 1 yr 40.5+3.7 41.4+_4.1 to 3 yrs 43.6 + 2.7 44.0 _+ 3.3 to 6 yrs 48.4 + 4.0 50.3 + 6.0 to 14 yrs 50.6+_4.5 51.3_+4.3 Adult 50.9 + 2.4 50.9 +- 3.6 22. EARLY RIGHT HEMISPHERIC DAMAGE AND LEARNING DISABILITY Rajkumar R. Pandey and Levon O. Badalyan, Moscow, Russia Lou et al. reported hypofunction of the right striatum in atten- tion deficit and hyperkinetic disorder [1]. MRI studies have shown significantly smaller fight anterior width measurements than controls in both dyslexic and ADD/H children. In our study of hemiplegic cerebral palsy children of 9-15 years of age, ante/perinatal origin (18 control, 9 right hemiparetics, 6 left hemiparetics) only the group of children with left hemiparesis had increased absolute amplitude of theta and delta activity (1 S.D.) in the frontocentral and frontocentrotemporal regions, re- spectively. Assessment of auditory-speech and visual memory PEDIATRIC NEUROLOGY Vol. 8 No. 5 349

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105 PBL/100 U IL-2) proliferative response (3HTdR uptake).

The results of FACS analysis did not indicate any major shift in the subpopulation phenotypes of lymphocytes in SSPE patients

as compared to the normal population. However, NK and LAK

cell-dependent cytotoxicity was found to be substantially im-

paired (31.7% + 9.3 S.E. cytotoxicity for NK cells; 47% + 1.4%

S.E. cytotoxicity for LAK cells at 100:1, effector:target cell ratio as compared to normal; 68.8% + 8.7% cytotoxicity for NK cells (P < .05) and 81.66% + 10.3% cytotoxicity for LAK cell (P < .02). In pretreated SSPE patients, a variable degree of sup- pression (6-17% for PHA, 4-31% for PWM, 4-21% for IL-2) was also observed as compared to normal controls. Although all patients treated with combined therapy showed improvement in immunologic competency, this was associated with clinical im- provement or remission in only 6 patients. Although there were only 18 patients, the degree in increase of immunologic compe- tency particularly in NK/LAK functions appears to be one factor in treatment success or failure.

20. COMPARING STUDY FOR NORMS OF PATTERN VEP RECORDED IN WAKE AND SLEEPING UNDER C H L O R A L H Y D R A T E S E D A T I O N IN INFANCY

Fangcheng Cai and Xuewen Wang, Chongqing, China

To ascertain the possibility and reliability of pattern-reversal visual evoked potential (1,VEP) recorded in sleep as a clinically convenient test for infancy, the latency, amplitudes, and pre- sented rate of PVEP waves in 20 infants (ages 3-12 mos) and 22

children (ages 13 mos to 6 yrs) under chloral hydrate sedation were analyzed and compared to the recording during wakeful- ness before sedation. According to the American EEG Society Recommended Standard for Visual Evoked Potentials, the meth- ods producing PVEPs were essentially the same during the recording of either awake or sleeping patients with the exception

of a dilated pupil by 0.5% tropicamide and a blepharostat to keep the eye opened under sedation. 1,1 (P100) waves were present in all cases asleep and awake. The latencies of all waves (N1, P1, N2, 1'2) in sleep for all age groups were prolonged

proportionally; furthermore, the latency of wave P1 was in very close relation linearly to the latency of wave P1 during wakeful- ness (r = 0.79 - 0.87). No significant differences were found on the amplitudes of all waves between the states. There was a similar maturational pace with age of latency and amplitude of PVEP waves either during wakefulness or sleep. With the

recordings during wakefulness the difference of the latencies of wave 1,1 between two eyes in sleeping for normal children should be less than 6.4 ms (2 S.D.) or 8.8 ms (3 S.D.) and the

ratio of amplitudes of wave PI between both eyes should be less than 0.6 (2 S.D.) or 0,5 (3 S.D.). On the basis of this study, the prolonged latency of wave PI was presumably due to the "cen- tral postponement" of the message transmission along the cen- tral visual pathway during sleep. However, the 1,VEP recorded in sleep would be a valuable test for infants and uncooperative patients to determine the function of the visual pathway.

21. N O R M S AND M A T U R A T I O N O F F - W A V E RE- SPONSES IN C H I L D R E N AGES NEWBORN TO 14 YEARS Fangcheng Cai and Jeaming Zhang, Chongqing, China

To ascertain the norms and maturation of F-wave responses in early life, the velocities, conduction time, latencies, amplitudes, duration, and F-ratio of F-waves at median, ulnar, and tibial

nerves in 150 normal children ages newborn to 14 years of age

were analyzed and compared with the data of 20 young adults.

F-waves could be elicited at any age in which the best one was

chosen among 10 responses after stimulation repeatedly. The velocities at birth only reached about 40% of that found in adults and were developed as a function in close relationship with age or the length of extremities after birth. The adult levels were reached during 6-14 and 3-6 years of age for upper and lower extremities, respectively, which were slower than MCV

for same motor nerve. It was presumably related to the prema- ture development of the proximity of motor nerve and anterior horn cells which made longer duration of central conduction in spinal cord in infants. The velocities in the upper extremities were faster than the lower ones and also faster at proximal than distal recording. However, the latencies of F-waves in all motor

nerve as above varied inversely with age and the length of ex- tremities significantly. It can be concluded that as with adults,

the F-wave responses are also a valuable clinical test in children to determine the function of motor nerves, anterior horn cells, and roots of the motor nerve.

Table 21-1. Conduction velocities of F-waves (m/s)

Median Nerve Ulnar Nerve Age Distal Proximity Distal Proximity

Newborn 26.1 + 5.0 27.0 + 4.5 27.1 + 4.5 26.1 + 3.9 to 3 mos 33.3+-3.9 32.8_+4.1 33.3_+3.5 33.3_+4.9 to 6 mos 36.8 _+ 4.2 38.0 +- 6.0 38.2 _+ 3.9 37.9 +- 4.3 to 1 yr 40.7 + 10.0 44.7 _+ 6.0 42.4 + 4.4 38.8 + 4.7 to 3 yrs 51.9+-6.5 52.9+-9.9 51.9+-7.1 48.4_+7.4 to 6 yrs 55.7 + 3.8 56.5 _+ 5.4 55.3 _+ 5.2 50.3 _+ 5.9 to 14 yrs 59.6 _+ 4.5 62.5 +- 6.8 61.9 _+ 4.3 59.0 _+ 5.8 Adult 63.8 _+ 4.2 63.5 +- 4.1 61.0 + 4.8 61.2 _+ 6.3

Tibial Nerve Age Distal Proximity

Newborn 23.8 + 2.9 23.7 + 3.3 to 3 mos 29.3 + 2.3 30.0 + 2.6 to 6 rots 35.0 _+ 2.7 36.9 + 3.9 to 1 yr 40.5+3.7 41.4+_4.1 to 3 yrs 43.6 + 2.7 44.0 _+ 3.3 to 6 yrs 48.4 + 4.0 50.3 + 6.0 to 14 yrs 50.6+_4.5 51.3_+4.3 Adult 50.9 + 2.4 50.9 +- 3.6

22. E A R L Y R I G H T H E M I S P H E R I C D A M A G E AND L E A R N I N G DISABILITY

Rajkumar R. Pandey and Levon O. Badalyan, Moscow, Russia

Lou et al. reported hypofunction of the right striatum in atten- tion deficit and hyperkinetic disorder [1]. MRI studies have

shown significantly smaller fight anterior width measurements than controls in both dyslexic and ADD/H children. In our study of hemiplegic cerebral palsy children of 9-15 years of age, ante/perinatal origin (18 control, 9 right hemiparetics, 6 left hemiparetics) only the group of children with left hemiparesis had increased absolute amplitude of theta and delta activity (1 S.D.) in the frontocentral and frontocentrotemporal regions, re- spectively. Assessment of auditory-speech and visual memory

PEDIATRIC NEUROLOGY Vol. 8 No. 5 349