Neuropediatric Unit

Beersheba, Israel

Neuropediatric Unit

Beersheba, Israel

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Ben-Pazi H.,Neuropediatric Unit | Stoner J.A.,The University of Oklahoma Health Sciences Center | Cunningham M.W.,The University of Oklahoma Health Sciences Center
PLoS ONE | Year: 2013

Background:Sydenham chorea (SC), a neuropsychiatric sequela of group-A streptococcal infection, is associated with basal ganglia autoantibodies. Although autoantibodies have been proposed in neuropsychiatric disorders, little evidence has been shown to link autoimmunity and clinical symptoms. We hypothesized that dopamine receptor-autoantibody interactions may be the basis of neuropsychiatric symptoms in SC.Methods:Sera from 22 children with SC (age 10.7±4.5 years) and 22 age-matched controls were studied. Clinical neuropsychiatric symptoms were measured in SC at sample collection using the UFMG-Sydenham's-Chorea-Rating-Scale (USCRS). Anti-dopamine D1 receptor (D1R) and anti-dopamine D2 receptor (D2R) autoantibodies were measured by the enzyme linked immunosorbent assay (ELISA) and were correlated with clinical symptoms.Results:Anti-D1R and anti-D2R autoantibodies were significantly higher in SC compared to controls (n = 44; p = 0.010 and p = 0.017, respectively). We found that the ratio (anti-D2R/D1R) of the two anti-dopaminergic receptor antibodies correlated with neuropsychiatric symptoms as determined by USCRS measurements (n = 18; r = 0.53, p = 0.024). In addition, anti-D2R titers correlated with antistreptolysin-O titers (n = 43; r = 0.49, p = 0.0008).Interpretation:Our report linked, for the first time, autoimmunity with neuropsychiatric symptoms. The significant correlation was found using ratios of autoantibodies against dopamine receptors (anti-D2R/D1R) rather than the absolute elevated individual anti-D1R or anti-D2R titers. We suggest that autoantibodies may lead to a receptor imbalance and induce greater sensitivity to dopamine signaling potentially leading to neuropsychiatric symptoms in SC. Our novel findings suggesting altered balance in the dopaminergic system may provide a new approach in understanding autoimmune neuropsychiatric disorders with possible implications for diagnosis and treatment. © 2013 Ben-Pazi et al.


Levy-Zaks A.,Neuropediatric Unit | Pollak Y.,Neuropediatric Unit | Ben-Pazi H.,Neuropediatric Unit
Neurological Research | Year: 2014

Objective: We examined whether the type of brain injury impacts the psychopathological profile and quality of life in children with cerebral palsy (CP). Methods: We assessed 18 children with CP [9 premature, 9 asphyxia at term] and 16 siblings using parent forms of the child behavior checklist (CBCL), disruptive behavior disorder rating scale (DBDRS), and pediatric quality of life inventory (PEDSQL). Results: Children with CP demonstrated more emotional and behavioral symptoms (depression, anxiety, and social, thought, and attention problems) and lower quality of life than their siblings. The pathopsychological profile of children with CP due to prematurity and asphyxia was similar. Conclusion: Etiology does not impact the psychopathology in children with CP. © W. S. Maney & Son Ltd 2014.


Kroyzer N.,Hebrew University of Jerusalem | Kroyzer N.,Neuropediatric Unit | Gross-Tsur V.,Neuropediatric Unit | Pollak Y.,Hebrew University of Jerusalem | Pollak Y.,Neuropediatric Unit
Journal of Nervous and Mental Disease | Year: 2014

Risk taking is commonly attributed to individuals with attention deficit hyperactivity disorder (ADHD). This study investigated whether adolescents with ADHD would choose to take greater risks on a probabilistic task in which contingencies are explicitly presented. Adolescents with and without ADHD, aged 13 to 18 years, performed a modified version of the Cambridge Gambling Task. The subjects with ADHD risked smaller sums and chose the unfavorable outcomes more frequently than did the controls but had the same speed of decision and risk adjustment. The results indicate that their poor decisions were not due to impulsivity or insensitivity to the concept of probability and that increased risk taking is not always associated with ADHD. Moreover, in situations that do not demand learning of contingencies, ADHD may be associated with decreased, rather than increased, risk taking. Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.


Segel R.,Medical Genetics Institute | Ben-Pazi H.,Neuropediatric Unit | Zeligson S.,Medical Genetics Institute | Fatal-Valevski A.,Dana Childrens Hospital | And 9 more authors.
Neurology | Year: 2015

Objective: To determine the prevalence and characteristics of copy number variations (CNVs) in children with cerebral palsy (CP) of unknown etiology, comprising approximately 20% of the CP population. Methods: Fifty-two participants (age 10.5 ± 7.8 years; Gross Motor Function Classification System scale 2.8 ± 1.3) with nonprogressive pyramidal and/or extrapyramidal signs since infancy and no identified etiology were enrolled. Individuals with evidence of acquired causes were excluded. Participants underwent neurologic and clinical genetic examinations before the genomic testing. Chromosomal microarray analysis to detect CNVs was performed using the Affymetrix platform. CNVs identified were classified as pathogenic, likely pathogenic, likely benign, or benign. Only pathogenic and likely pathogenic CNVs were defined as clinically significant. Results: Thirty-nine CNVs were found in 25 of 52 participants (48%). Sixteen participants (31%) had clinically significant CNVs: 10 pathogenic and 6 likely pathogenic, of which 7 were not previously associated with motor disability. Nine participants had likely benign CNVs. Clinically significant CNVs were more frequently de novo (12/16; p < 0.001) including in 5 of 8 individuals who had a first- or second-degree relative with a major neurologic disorder. Dysmorphic features and nonmotor comorbidities were more prevalent in individuals with clinically significant CNVs (p < 0.05 for both). Conclusion: CNVs, most frequently de novo, are common in individuals with cryptogenic CP. We recommend CNV testing in individuals with CP of unknown etiology. © 2015 American Academy of Neurology.


Pollak Y.,Hebrew University of Jerusalem | Pollak Y.,Neuropediatric Unit | Shoham R.,Hebrew University of Jerusalem | Shoham R.,Talpiot College
Journal of Abnormal Child Psychology | Year: 2015

Inept probabilistic decision making is commonly associated with ADHD. In experimental designs aimed to model probabilistic decision making in ADHD, feedback following each choice was, in the majority of studies, part of the paradigm. This study examined whether feedback processing plays a role in the maladaptive choice behavior of subjects with ADHD by comparing feedback and no-feedback conditions. Sixty adolescents (49 males), ages 13–18, with and without ADHD, performed a descriptive probabilistic choice task in which outcomes and probabilities were explicitly provided. Subjects performed the task either with or without feedback. Under the no-feedback condition, adolescents with ADHD and controls performed similarly, whereas under the feedback condition, subjects with ADHD chose the unfavorable outcomes more frequently and risked smaller sums than controls. These finding demonstrate the crucial role of feedback in the decision making of adolescents with ADHD. © 2015, Springer Science+Business Media New York.


Ben-Pazi H.,Neuropediatric Unit | Jaworowski S.,Neuropediatric Unit | Jaworowski S.,Shaare Zedek Medical Center | Shalev R.S.,Neuropediatric Unit
Developmental Medicine and Child Neurology | Year: 2011

Aim The cognitive and psychiatric aspects of adult movement disorders are well established, but specific behavioural profiles for paediatric movement disorders have not been delineated. Knowledge of non-motor phenotypes may guide treatment and determine which symptoms are suggestive of a specific movement disorder and which indicate medication effects. Method The goal of this review is to outline the known cognitive and psychiatric symptoms associated with paediatric movement disorders. We used a systematic approach, via PubMed, and reviewed over 400 abstracts of studies of selected disorders, of which 88 papers reporting paediatric non-motor symptoms are summarized. Results Obsessive-compulsive disorder was manifest in children with paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and Sydenham chorea. Children with opsoclonus-myoclonus syndrome had, for the most part, cognitive and behavioural problems, and attention-deficit-hyperactivity disorder was reported as a major comorbidity in Tourette syndrome, stereotypies, and restless legs syndrome. Symptoms of depression and anxiety were more frequent in individuals with idiopathic dystonia. Affective disorders were suggestive of Wilson disease. Cognitive decline was common in children with juvenile Huntington disease. A limitation of this review was the lack of systematic assessment in paediatric movement disorders for evaluation and uniform definitions. Interpretation Although the literature in non-motor phenomena is still emerging, recognition of salient cognitive and psychiatric phenomena may facilitate management of paediatric movement disorders. © The Authors. Developmental Medicine & Child Neurology © 2011 Mac Keith Press.


Vakil E.,Bar - Ilan University | Blachstein H.,Bar - Ilan University | Wertman-Elad R.,Neuropediatric Unit | Greenstein Y.,Kinneret and Zefat Academic Colleges
Child Neuropsychology | Year: 2012

The primary purpose of the present study is to examine the effects of attention deficits, learning disability, and the combined effects of both on the learning and memory processes, as measured by the Rey Auditory Verbal Learning Test (AVLT). Thirty children (age range 12-17) diagnosed with attention deficit/hyperactivity disorder (ADHD), 18 children (age range 11-17) diagnosed with learning disabilities (LD), and 64 children (age range 12-17) diagnosed with ADHD as well as with LD, and 28, 18, and 62 matched controls, respectively, participated in this study. It was found that the children diagnosed with ADHD did not differ in any of the verbal learning and memory measures derived from the Rey AVLT. The group with LD was impaired in the overall number of words recalled across the learning phase. Performance of the children diagnosed with ADHD +LD showed a similar impairment as the group with LD (i.e., overall amount of words learned) and, in addition, their retrieval efficiency was also impaired. In conclusion, this study indicates that verbal memory is preserved in children with ADHD if they have no LD and their intelligence is in the normal range or above. LD by itself leads to difficulties in acquisition, but the combination of ADHD+LD leads to additional impairment in retrieval processes. © 2012 Psychology Press.


Gilboa T.,Neuropediatric Unit
Epilepsia | Year: 2012

Multiple triggers have been shown to provoke seizures in reflex epilepsy. Among these are external stimuli (flickering light, hot water), actions (chewing, reading), and even mental tasks. We present a 9-year-old girl whose seizures were provoked mainly by emotional stress. In most cases of emotional stress-related seizures, especially when a specific confrontational incidence preceded the seizure, the suspicion for a nonepileptic event is high. In our patient we were able to show that the seizures were epileptic. Further investigation to clarify the pathophysiology of stress-related seizures is needed. © 2011 International League Against Epilepsy.


Pollak Y.,Neuropediatric Unit | Shomaly H.B.,Haifa University | Weiss P.L.,Haifa University | Rizzo A.A.,University of Southern California | Gross-Tsur V.,Institute of Child Development
CNS Spectrums | Year: 2010

Background: Continuous performance tasks (CPTs) embedded in a virtual reality (VR) classroom environment have been shown to be a sensitive and user-friendly assessment tool to detect cognitive deficits related to attention-deficit/hyperactivity disorder (ADHD). The aim of the current study was to compare the performance of children with ADHD on a VR-CPT while on and off treatment with methylphenidate (MPH) and to compare the VR-CPT to a currently used CPT, Test of Variables of Attention (TOVA). Methods: Twenty-seven children with ADHD underwent the VR-CPT, the same CPT without VR (no VR-CPT), and the TOVA, 1 hour after the ingestion of either placebo or 0.3 mg/kg MPH, in a double-blind, placebo-controlled, crossover design. Immediately following CPT, subjects described their subjective experiences on the Short Feedback Questionnaire. Results: MPH reduced omission errors to a greater extent on the VR-CPT compared to the no VR-CPT and the TOVA, and decreased other CPT measures on all types of CPT to a similar degree. Children rated the VR-CPT as more enjoyable compared to the other types of CPT. Conclusions: It is concluded that the VR-CPT is a sensitive and user-friendly assessment tool in measuring the response to MPH in children with ADHD. © MBL Communications Inc.


Shalev R.,Neuropediatric Unit
Developmental Medicine and Child Neurology | Year: 2013

This commentary is on the original article by Santos et al. on pages 654-660 of this issue. Developmental Medicine & Child Neurology. © 2013 Mac Keith Press.

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