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Purpose: Interpersonal factors are of major importance for cancer patients’ physical and mental health. Brain tumor patients rank amongst those cancer patients with the highest psychosocial burden....

It is still unclear why some individuals completely recover after an acute trauma and others develop a long-lasting post-traumatic stress disorder (PTSD). This study investigates whether the contingent negative variation (CNV) – a slow negative event-related potential – may be associated with the occurrence of PTSD after acute trauma. CNV (auditory 2-stimulus reaction time paradigm) was recorded within one month as well as 6 months after an acute trauma (dangerous or grave physical injuries, witnessing of attempted suicide or murder, robbery, extortion, accidents, heavy illness, death or loss of an important person, hostage-taking) in 39 otherwise healthy adults and compared with CNV recordings in 38 healthy control subjects without potentially traumatizing experience in their history. According to their subsequent clinical course, these subjects were divided into two groups: participants who recovered completely 1 month after the trauma (PTSD- group, n = 31), and those who began to experience PTSD (PTSD+ group, n = 8). Patients from both trauma groups were characterized by a significantly longer reaction time immediately after the trauma. The PTSD+ group demonstrated lower amplitudes of the late CNV component immediately and six months after the trauma compared with the PTSD- and the control group. Whether the lower CNV amplitudes in patients who develop PTSD after the acute trauma, which is already present in the first days after the trauma, may be related to a higher risk for development of PTSD in these subjects, this has to be clarified in further prospective studies.

Objectives Awake craniotomy is a well-established procedure in surgery of intracranial tumors in eloquent areas. However, sufficiently standardized instruments for the assessment of sensory-motor function before, during and after the operation are currently lacking, despite their importance for evaluation of operative outcome. Patients and methods To address this issue, we designed a standardized assessment tool (the “sensory-motor profile awake scale”; SMP-a). The final scale consists of three motor sections (face, arm and leg) assessing both gross and fine motor skills and one sensory section. It differentiates between six grades of impairment and its tasks are applicable for intraoperative continuous monitoring of sensory-motor functions and supporting processes. We analyzed the data of 17 patients with intracranial tumors eligible for awake craniotomy who were preoperatively assessed with the SMP-a. In addition, we present an exemplary case. Results Our data support the assumption that the SMP-a is feasible in patients eligible for awake craniotomy, even in patients with symptoms of mild aphasia or more severe sensory-motor deficits caused by tumor recurrence. The exemplary case demonstrates the feasibility of repeated measures with the SMP-a in a tumor patient, including the adaption of tasks to the individual requirements of an intraoperative setting. Conclusion This exploratory study suggests that the SMP-a might be a feasible rating scale in patients with intracranial tumors. The flexibility of the scale enables individual adaption, but preserves the standardized scoring system to allow comparison between assessment dates, patients and, hopefully in the future, institutions. However, future studies are mandatory to provide data on the instrument’s diagnostic properties with respect to feasibility, objectivity, validity and reliability.

Objective: Multifocal epileptic activity is an unfavourable feature of a number of epileptic syndromes (Lennox-Gastaut syndrome, West syndrome, severe focal epilepsies) which suggests an overall vulnerability of the brain to pathological synchronization. However, the mechanisms of multifocal activity are insufficiently understood. This explorative study investigates whether pathological connectivity within brain areas of the default mode network as well as thalamus, brainstem and retrosplenial cortex may predispose individuals to multifocal epileptic activity. Methods: 33 children suffering from multifocal and monofocal (control group) epilepsies were investigated using EEG-fMRI recordings during sleep. The blood oxygenated level dependent (BOLD) signal of 15 regions of interest was extracted and temporally correlated (resting-state functional connectivity). Results: Patients with monofocal epilepsies were characterized by strong correlations between the corresponding interhemispheric homotopic regions. This pattern of correlations with pronounced short-distance and weak long-distance functional connectivity resembles the connectivity pattern described for healthy children. Patients with multifocal epileptic activity, however, demonstrated significantly stronger correlations between a large number of regions of the default mode network as well as thalamus and brainstem, with a significant increase in long-distance connectivity compared to children with monofocal epileptic activity. In the group of patients with multifocal epilepsies there were no differences in functional connectivity between patients with or without Lennox-Gastaut syndrome. Conclusion: This explorative study shows that multifocal activity is associated with generally increased long-distance functional connectivity in the brain. It can be suggested that this pronounced connectivity may represent either a risk to pathological over-synchronization or a consequence of the multifocal epileptic activity. Fil: Siniatchkin, Michael. Christian-Albrechts-Universität zu Kiel; Alemania Fil: Moehring, Jan. Christian-Albrechts-Universität zu Kiel; Alemania Fil: Kroeher, Bianca. Christian-Albrechts-Universität zu Kiel; Alemania Fil: Galka, Andreas. Christian-Albrechts-Universität zu Kiel; Alemania Fil: Ondarza, Gisela von. Christian-Albrechts-Universität zu Kiel; Alemania Fil: Moeller, Friederike. Christian-Albrechts-Universität zu Kiel; Alemania Fil: Wolff, Stephan. Christian-Albrechts-Universität zu Kiel; Alemania Fil: Tagliazucchi, Enzo Rodolfo. Christian-Albrechts-Universität zu Kiel; Alemania. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Física de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Física de Buenos Aires; Argentina Fil: Steinmann, Elisabeth. Christian-Albrechts-Universität zu Kiel; Alemania Fil: Boor, Rainer. Christian-Albrechts-Universität zu Kiel; Alemania Fil: Stephani, Ulrich. Christian-Albrechts-Universität zu Kiel; Alemania

This study presents the first validation of the Brief Cognitive Status Exam (BCSE) against two other screening tools for cognitive impairment in patients with intracranial tumors. 58 patients and 22 matched healthy controls completed the BCSE, the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Patients were additionally tested with a comprehensive neuropsychological battery. Based on this assessment, they were classified as cognitively impaired or unimpaired on five cognitive domains. Analyses revealed a comparable feasibility of the BCSE relative to the MoCA and the MMSE, but a smaller range of assessed functions (e.g., no correlation with the domain visual-spatial functions). The ability to separate patients and healthy controls was extremely poor for BCSE and MMSE (sensitivity of 38.6 % and less), but moderate for MoCA (sensitivity 68.97 %). Detection of cognitive impairment in patients was worst with BCSE (sensitivity 37 %; MoCA 92.9 %, MMSE 44.4 %) as compared to neuropsychological testing. Moreover, prediction of cognitive outcome was also worst for the BCSE (AUC = .713, NPV = 50 %). An optimal cut-off of 50.5 increased the results slightly. In summary, the BCSE showed good feasibility but no sufficient results in separating healthy individuals from patients or detecting cognitive impairment in patients. Consequently, as a screening measure, we would recommend the MoCA instead of the BCSE. However, since even the MoCA failed to detect cognitive impairment, our study supports the view that reliable results could only be obtained with a comprehensive neuropsychological battery.

Aim of the study was the cross-cultural adaptation and validation of the German version of the Scale for Outcomes in Parkinson’s disease-Sleep Scale (SCOPA-Sleep) for assessment of night-time sleep problems (NS) and daytime sleepiness (DS). Eighty-three patients with Parkinson’s disease completed the SCOPA-Sleep and a multitude of measures for assessment of validity (e.g., PSQI, ESS). Twenty patients completed the SCOPA-Sleep twice within 2 months for assessment of retest reliability. Sixty-four healthy controls were also included for validity estimation. Internal consistency (Cronbach’s alpha) was good with coefficients of .801 and .854 for SCOPA-NS and SCOPA-DS, respectively. Test-retest reliability and inter-rater agreement were excellent. Factor analysis revealed two factors, one for each of the subscales NS and DS. Convergent validity was high with correlations of .797 between SCOPA-NS and PSQI, and .679 between SCOPA-DS and ESS. The German version of the SCOPA-Sleep showed good diagnostic accuracy. Optimal cutoff scores were calculated, resulting in an AUC of .908 for NS and of .959 for DS. The German version of the SCOPA-Sleep is a reliable and valid instrument for assessing NS and DS in patients with Parkinson’s disease. As diagnostic accuracy is excellent, this scale can be recommended for routine assessment of both NS and DS in PD combined with other standard measures.

Objectives One of the important prerequisites for successful social interaction is the willingness of each individual to cooperate socially. Using the ultimatum game, several studies have demonstrated that the process of decision-making to cooperate or to defeat in interaction with a partner is associated with activation of the dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC), anterior insula (AI), and inferior frontal cortex (IFC). This study investigates developmental changes in this neuronal network. Methods 15 healthy children (8–12 years), 15 adolescents (13–18 years) and 15 young adults (19–28 years) were investigated using the ultimatum game. Neuronal networks representing decision-making based on strategic thinking were characterized using functional MRI. Results In all age groups, the process of decision-making in reaction to unfair offers was associated with hemodynamic changes in similar regions. Compared with children, however, healthy adults and adolescents revealed greater activation in the IFC and the fusiform gyrus, as well as the nucleus accumbens. In contrast, healthy children displayed more activation in the AI, the dorsal part of the ACC, and the DLPFC. There were no differences in brain activations between adults and adolescents. Conclusion The neuronal mechanisms underlying strategic social decision making are already developed by the age of eight. Decision-making based on strategic thinking is associated with age-dependent involvement of different brain regions. Neuronal networks underlying theory of mind and reward anticipation are more activated in adults and adolescents with regard to the increasing perspective taking with age. In relation to emotional reactivity and respective compensatory coping in younger ages, children have higher activations in a neuronal network associated with emotional processing and executive control.

Entsprechend dem Konzept der Fötalen Programmierung wirkt sich pränataler Stress nachhaltig auf die Gesundheit des Nachkömmlings aus. Die Hypothalamus-Hypophysen-Nebennierenrinden-Achse wird als eine mediierende Struktur angenommen, über welche sich mütterlicher Stress in der intrauterinen Umwelt auf den Fötus auswirkt. In der vorliegenden Studie wurde an 46 Mutter-Kind-Paaren die berichtete mütterliche Stressbelastung und Kortisolausschüttung während der Schwangerschaft erfasst. Im Alter von fünf Monaten wurden das frühkindliche Temperament sowie die motorische und kognitive Entwicklung der Säuglinge untersucht. Säuglinge von Müttern mit höherer pränataler Stressbelastung zeigten erwartungsgemäß ein schwierigeres Temperament, jedoch erwartungskonträr eine bessere motorische Entwicklung. Ein schwieriges Temperament des Säuglings stellt einen Risikofaktor für eine frühe Störung der Mutter-Kind-Interaktion dar. Frühe Präventionsmaßnahmen könnten helfen, dieses Risiko zu minimieren und Schutzfaktoren zu etablieren.

Die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) zählt zu den häufigsten psychischen Störungen im Kindesalter. Ziel ist es, den Status Quo der Ätiologie hinsichtlich genetischer, neurobiologischer und neuropsychologischer Faktoren zu beschreiben. Es werden die derzeit anerkannten Therapiemethoden in der Behandlung der ADHS sowie ihre Wirksamkeit vorgestellt. Moderne Bildgebungsmethoden (z. B. MRT; fMRT) bieten die Möglichkeit, nichtinvasiv spezifische Aussagen über anatomische und funktionelle Änderungen zutreffen. Untersuchungen mit Hilfe dieser bildgebenden Verfahren stehen deswegen im Fokus der hier zitierten Ätiologie- und Therapieforschung. Abschließend folgt ein kurzer Ausblick auf mögliche Zukunftsfragen.

Several studies have demonstrated that behavioural therapy oriented interventions exert a positive influence on the clinical course of the attention-deficit hyperactivity disorder (ADHD). However, the long-term effects of the behavioral treatment in ADHD, especially those on neuronal mechanisms underlying this disorder, have been studied insufficiently. Functional MRI (Go-NoGo paradigm) was carried out in 9 children with ADHD before and 1.5 years after a response cost and token-based training. In the follow-up, patients were still characterized by a significant increase in activation in the anterior cingulate and in the precentral gyrus compared with recordings done before the training. It seems likely that the behavioural training elicits stable neuronal changes in children with ADHD which correspond with an improvement of neuropsychological functioning and clinical symptoms.

Atypical benign partial epilepsy (ABPE) is a subgroup among the idiopathic focal epilepsies of childhood. Aim of this study was to investigate neuronal networks underlying ABPE and compare the results with previous electroencephalography (EEG)-functional magnetic resonance imaging (fMRI) studies of related epilepsy syndromes. Ten patients with ABPE underwent simultaneous EEG-fMRI recording. In all 10 patients several types of interictal epileptiform discharges (IEDs) were recorded. Individual IED-associated blood oxygen level-dependent (BOLD) signal changes were analyzed in a single subject analysis for each IED type (33 studies). A group analysis was also performed to determine common BOLD signal changes across the patients. IED-associated BOLD signal changes were found in 31 studies. Focal BOLD signal changes concordant with the spike field (21 studies) and distant cortical and subcortical BOLD signal changes (31 studies) were detected. The group analysis revealed a thalamic activation. This study demonstrated that ABPE is characterized by patterns similar to studies in rolandic epilepsy (focal BOLD signal changes in the spike field) as well as patterns observed in continuous spikes and waves during slow sleep (CSWS) (distant BOLD signal changes in cortical and subcortical structures), thereby underscoring that idiopathic focal epilepsies of childhood form a spectrum of overlapping syndromes.

Background Atypical benign partial epilepsy/pseudo-Lennox syndrome (ABPE/PLS) and continues spike and wave during sleep (CSWS) belong to a spectrum of idiopathic focal epilepsy syndromes ranging from benign Rolandic epilepsy to more severe seizure disorders, which are commonly characterized by the association of various epileptic seizure types, aggravation of spike-wave discharges during slow sleep, and cognitive and/or behavioral disturbances. The Aim of our study was to evaluate the risk factors that influence cognitive outcome in patients with ABPE/PLS and CSWS in a retrospective analysis. Methods Thirty patients fulfilled the diagnostic criteria for ABPE/PLS and 12 for CSWS and were chosen for the descriptive analysis. Cognitive achievement was evaluated according to psychological tests and school performances. Results Severe global and specific cognitive disturbances occurred almost regularly in cases of ABPE. Already at the time of epilepsy presentation the level of cognitive performance was lower than that of the normal population. At the time of disease presentation only 56% of the children had IQ within the standard range (≥85). We observed that the level of cognitive developmental delay did not change significantly during the disease process. We were not able to observe any statistically significant connection between the development of EEG abnormalities and cognitive development. The conclusion can be drawn that many patients exhibit cognitive impairment at disease presentation which is not affected significantly during the treatment process. Judging from the observed data, we assume that EEG abnormalities, duration of active epilepsy, and antiepileptic medication have less influence on the cognitive development than was previously assumed.

Response cost and token approach (RCT) within the scope of a summer camp training is an effective treatment program for attention deficit hyperactivity disorder (ADHD). It is likely that intensive RCT training influences networks responsible for ADHD symptoms. Functional magnetic resonance imaging (fMRI) was carried out in 12 children with ADHD before and after the RCT program and in 12 healthy control children twice. For fMRI, a Go/No-go paradigm was used to investigate the influence of RCT training on attention and impulsivity. The No-go condition revealed only weak activation in the dorsal part of the anterior cingulate cortex (ACC), parietal and dorsolateral prefrontal cortex (DLPFC) before the training in children with ADHD compared to healthy children. However, this activation in these brain regions was significantly more pronounced after the training. This increase in hemodynamic response cannot be attributed merely to repetition of the measurement since the effect was not observed in healthy children. The increase in hemodynamic response in the ACC and right DLPFC was significantly associated with a reduction in response time variability and clinical symptoms in ADHD patients. After the RCT training, the children with ADHD demonstrated more pronounced activation of cortical structures which are typically related to response monitoring and self-control. It seems likely that children with ADHD learned more cognitive control in a continuous performance task as was revealed by both neuropsychological outcome and fMRI.