AIM To investigate the utility of the Insight Inventory (a structured clinical inventory completed by caregivers) for assessment of children with cerebral visual impairment; and to investigate effectiveness of tailored habilitational strategies derived from the responses to the Insight Inventory. METHOD Fifty-one eligible children (26 males, 25 females; mean age 9y 5mo, SD 3y, range 5-16y) were recruited from Great Ormond Street Hospital, London. They underwent baseline assessment including neuro-ophthalmological and neuropsychological evaluations, and parent-and child-reported ratings on a questionnaire-based measure of quality of life. Parents also completed the Insight Inventory. On the basis of responses to the Inventory, families received individualized habilitational strategies. Follow-up assessments 6 months later included repeating the Insight Inventory and quality of life questionnaires. RESULTS Correlations were found between the Insight Inventory and the Wechsler Intelligence Scale for Children, Fourth Edition, the Beery-Buktenica Test of Visual-Motor Integration, and the Benton Facial Recognition Test, suggesting that the Insight Inventory is an effective tool to estimate visual-perceptual difficulties. At 6 months follow-up, caregiver reports indicated significant improvements in the quality of life of children below the age of 12 years. INTERPRETATION The Insight Inventory is a simple questionnaire which covers practical aspects of cognitive visual function in everyday life. It provides in-depth information about the aspects that children struggle with. It can also guide programmes of individualized habilitation strategies, which may enhance the quality of life of younger children.

The contribution of the pre-frontal cortex to movement-related potentials (MRPs) is unclear. We recorded MRPs from six subdural electrode strips placed over the frontal cortex in a 13-year-old girl being monitored prior to surgery for intractable epilepsy. MRPs were recorded prior to two types of movement: self-paced random joystick movements which involve 'what to do' and 'when to do' decision making on every trial and prior to joystick movements in a fixed forward direction triggered by a tone which does not involve any trial-by-trial decision making. Self-paced random joystick movements were associated with an increased subdural positivity starting from 1000 ms prior to onset of joystick movement at electrodes over the pre-motor cortex (BA 6) and dorsolateral and inferior pre-frontal cortex (BA 46/45/10), as evident from a magnetic resonance imaging scan. These results suggest that in addition to the pre-motor area, the pre-frontal cortex also contributes to the generation of MRPs in conditions involving decision making about the precise nature ('what to do') and timing ('when to do') of the movement. These preliminary results require replication in a larger series of patients.

We report a case of Coats' disease and lamellar macular hole in a 10-year-old boy who presented with blurring of vision in his left eye. This is the first reported case of Coats' disease presenting with a lamellar macular hole in a child. J Pediatr Ophthalmol Strabismus 2005;42:378–379.

Background: Surgery is a key approach for achieving seizure freedom in children with focal onset epilepsy. However, the resection can affect or be in the vicinity of the optic radiations. Multi-shell diffusion MRI and tractography can better characterize tissue structure and provide guidance to help minimize surgical related deficits. Whilst in adults tractography has been used to demonstrate that damage to the optic radiations leads to postoperative visual field deficits, this approach has yet to be properly explored in children.Objective: To demonstrate the capabilities of multi-shell diffusion MRI and tractography in characterizing microstructural changes in children with epilepsy pre-and post-surgery affecting the occipital, parietal or temporal lobes.Methods: Diffusion Tensor Imaging and the Spherical Mean Technique were used to investigate the microstructure of the optic radiations. Furthermore, tractography was used to evaluate whether pre-surgical reconstructions of the optic radiations overlap with the resection margin as measured using anatomical post-surgical T1weighted MRI.Results: Increased diffusivity in patients compared to controls at baseline was observed with evidence of decreased diffusivity, anisotropy, and neurite orientation distribution in contralateral hemisphere after surgery. Pre-surgical optic radiation tractography overlapped with post-surgical resection margins in 20/43 (46%) children, and where visual data was available before and after surgery, the presence of overlap indicated a visual field deficit. Frontiers in Neuroscience | www.frontiersin.org 1 April 2020 | Volume 14 | Article 269 Lacerda et al. Visual Pathways in Pediatric SurgeryConclusion: This is the first report in a pediatric series which highlights the relevance of tractography for future pre-surgical evaluation in children undergoing epilepsy surgery and the usefulness of multi-shell diffusion MRI to characterize brain microstructure in these patients.