Depression in children is often an elusive disorder and its diagnostic tools are a matter of controversy. Several scales have been developed in an attempt to specifically detect some of the major aspects of depression, i.e. anhedonia, sadness, hopelessness. On the other hand, in adults depression frequently induces changes in sleep patterns, particularly a shortening in REM sleep latency. The alteration of sleep patterns in depressed children has been a matter of controversy. It is possible that a diagnostic deficiency might be the source of the contradictory reports. In the present study, The Child Depression Inventory, a rating scale specifically developed for child depression was applied to 396 school children (8-12 years of age). Nearly 15% of the children (N = 45) obtained scores higher than the established limit in this test for normal healthy subjects. A sample of children found within the highest (N = 25) and within the lowest (N = 25) scores in the scale were selected. After a clinical evaluation, only those who meet the inclusion criteria (N = 21 for depressed and N = 7 for healthy controls) were electroencephalographically recorded. Children with depressive symptoms showed a significant shortening in REM sleep latency (mean = 108 min) when compared to non-depressed (mean = 150 min). In addition, significant increases were observed in sleep latency, REM sleep duration and the number of awakenings. Furthermore, results showed an unexpected high frequency of EEG abnormalities in children with depressive symptoms (75%) characterized by sharp waves and polyspikes in the frontal region. The present results support the notion that depression, in children, is accompanied by changes in sleep patterns, mainly concerning REM sleep.

AimThis work explores the effects of clinical variables on self‐reported quality of life (QoL) in pharmacoresistant temporal lobe epilepsy (TLE), correlating this information with results from the Quality of Life in Epilepsy questionnaire (QOLIE‐31) and selective memory tests of the Barcelona Battery and the Rey‐Osterrieth figure.MethodsWe retrospectively analysed the records of 60 TLE patients and correlated patient variables (e.g. gender, aetiology; mesial TLE with hippocampal sclerosis [HS] versus lesional TLE, side of ictal onset, age, age at onset, duration of epilepsy, seizure frequency, and use of AEDs) with selective memory test scores and self‐reported QoL.ResultsRight ictal onset was associated with lower emotional well‐being scores. MTLE‐HS patients had lower QOLIE‐31 scores for seizure worry, social function, overall QoL, energy/fatigue, cognitive function, and obtained a lower overall score, compared to those with lesional TLE. Older age at epilepsy onset was associated with worse emotional well‐being, energy/fatigue, medication effects, and seizure worry outcomes. Higher seizure frequency and older age at time of evaluation were associated with lower cognitive function scores. Generalised seizures were associated with lower scores based on the variables: seizure worry, overall quality of life, emotional well‐being, and cognitive function. Regarding memory tests, only visuospatial memory correlated positively with cognitive function score. Patients with MTLE‐HS underwent evaluation for pharmacoresistant epilepsy, on average, 10 years later than those with lesional TLE.ConclusionsMTLE‐HS, right‐sided epileptogenic zone, late onset, and higher seizure frequency were associated with worse QoL. Objective testing revealed specific memory deficits that were not reflected in self‐reported QoL scores.

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OBJECTIVE Supplementary motor area (SMA) epilepsy is a well-known clinical condition; however, long-term surgical outcome reports are scarce and correspond to small series or isolated case reports. The aim of this study is to present the surgical results of SMA epilepsy patients treated at 2 reference centers in Mexico City. METHODS For this retrospective descriptive study (1999-2014), 52 patients underwent lesionectomy and/or corticectomy of the SMA that was guided by electrocorticography (ECoG). The clinical, neurophysiological, neuroimaging, and pathological findings are described. The Engel scale was used to classify surgical outcome. Descriptive statistics, Student t-test, and Friedman, Kruskal-Wallis, and chi-square tests were used. RESULTS Of these 52 patients, the mean age at epilepsy onset was 26.3 years, and the mean preoperative seizure frequency was 14 seizures per month. Etiologies included low-grade tumors in 28 (53.8%) patients, cortical dysplasia in 17 (32.7%) patients, and cavernomas in 7 (13.5%) patients. At a mean follow-up of 5.7 years (range 1-10 years), 32 patients (61%) were classified as Engel Class I, 16 patients (31%) were classified as Engel Class II, and 4 (8%) patients were classified as Engel Class III. Overall seizure reduction was significant (p = 0.001). The absence of early postsurgical seizures and lesional etiology were associated with the outcome of Engel Class I (p = 0.05). Twenty-six (50%) patients had complications in the immediate postoperative period, all of which resolved completely with no residual neurological deficits. CONCLUSIONS Surgery for SMA epilepsy guided by ECoG using a multidisciplinary and multimodality approach is a safe, feasible procedure that shows good seizure control, moderate morbidity, and no mortality.

Importance: The functional anatomy of the brain, especially of the subcortical structures, is one of the least understood areas in neurophysiology. A great deal of the understanding of the functional neuroanatomy is derived from the study of patients whose brain has been damaged under different circumstances. Carbon monoxide (CO) poisoning affects particularly the basal ganglia and subcortical white matter, providing insight into the functional neuroanatomy of this complex region of the central nervous system. Since the regulating mechanisms of the sleepwake cycle depend on multiple brain regions, damage of any of these regions may result in states of vigilance disturbances. Methods:Sleep was recorded and scored using 30-s epochs according to standard methods, including central and occipital EEG (C3-A1, C4-A2, O1-A1 and O2-A2), submental EMG and periorbital EOG. Oronasal airflow and thoracic and abdominal respiratory effort were also monitored throughout the night. Results:In addition to disruption of continuity and alterations in the sleep architecture, total sleep time was significantly reduced in the patient under study; consequently, sleep efficiency was severely affected. Reduction in total time spent in REM sleep was related to the mean duration but not to the number of REM sleep episodes displayed across the recording of sleep. Cardiac and respiratory activities exhibited a tendency across the sleepwake cycle different to that observed in healthy subjects. Conclusions:This report suggests that cortical and subcortical brain damage caused by CO poisoning induces sleep disturbances and functional modification of the autonomic nervous system. Therapies to improve the sleep quality of patients exposed to CO poisoning should be implemented.