Biomedical subjects

Virginia Wong

Publications and source records attributed to Virginia Wong.

At least 19 recordsLinked to original sources

PubMed2006

Exon 3 polymorphisms of dopamine D4 receptor (DRD4) gene and attention deficit hyperactivity disorder in Chinese children.

Dopamine D4 receptor (DRD4) gene is implicated in the pathogenesis of attention deficit hyperactivity disorder (ADHD). The 7-repeat allele of the variable-number-of-tandem-repeat (VNTR) polymorphism in exon 3 has been reported to be associated with ADHD. However, studies in Chinese populations have yielded conflicting results. We therefore perform another study to investigate the association between ADHD and DRD4 gene polymorphism in Chinese children in Hong Kong. In this prospective family-based and case-control study during January-June 2004, we recruited consecutive Chinese children diagnosed with ADHD by DSM-IV and sex-matched controls admitted for acute upper respiratory infection, excluding those with perinatal brain insults, mental retardation, or neurological deficits. VNTR polymorphisms of the DRD4 gene were determined by standard PCR followed by agarose gel electrophoresis. Sixty-four ADHD cases (52 boys, 12 girls), their family members, and 64 normal controls were recruited. The 4-repeat allele (84.4%) and the 4/4-repeat genotype (70.3%) were the most prevalent. Both family-based and case-control analyses showed no association between ADHD and DRD4 gene polymorphisms (transmission dysequilibrium test (TDT): P = 0.91 and P = 0.33 for the 7-repeat and 4-repeat alleles, respectively; OR for the 7-repeat allele = 2.01 (95% CI 0.07-60.4, P = 0.66), OR for the 4-repeat allele = 1.51 (95% CI 0.80-2.85, P = 0.2)). However, the longer repeat alleles had a positive trend association with ADHD (P = 0.01) in the case-control analysis. We concluded that ADHD is not associated with a particular VNTR polymorphism of the DRD4 gene. Further studies are needed to clarify the role of repeat length of the VNTR region of the DRD4 gene in the pathogenesis of ADHD.

Asian People↗

PubMed2006

Absence of a paternally inherited FOXP2 gene in developmental verbal dyspraxia.

Mutations in FOXP2 cause developmental verbal dyspraxia (DVD), but only a few cases have been described. We characterize 13 patients with DVD--5 with hemizygous paternal deletions spanning the FOXP2 gene, 1 with a translocation interrupting FOXP2, and the remaining 7 with maternal uniparental disomy of chromosome 7 (UPD7), who were also given a diagnosis of Silver-Russell Syndrome (SRS). Of these individuals with DVD, all 12 for whom parental DNA was available showed absence of a paternal copy of FOXP2. Five other individuals with deletions of paternally inherited FOXP2 but with incomplete clinical information or phenotypes too complex to properly assess are also described. Four of the patients with DVD also meet criteria for autism spectrum disorder. Individuals with paternal UPD7 or with partial maternal UPD7 or deletion starting downstream of FOXP2 do not have DVD. Using quantitative real-time polymerase chain reaction, we show the maternally inherited FOXP2 to be comparatively underexpressed. Our results indicate that absence of paternal FOXP2 is the cause of DVD in patients with SRS with maternal UPD7. The data also point to a role for differential parent-of-origin expression of FOXP2 in human speech development.

Apraxias↗

PubMed2006

No association between VNTR polymorphisms of dopamine transporter gene and attention deficit hyperactivity disorder in Chinese children.

Dopamine transporter (DAT) gene is implicated in the pathogenesis of attention deficit hyperactivity disorder (ADHD). Previously a meta-analysis concluded no association between the variable-number-of-tandem-repeats (VNTR) polymorphisms of the DAT gene and ADHD. However, significant heterogeneity was present among studies and no conclusion can be drawn about the association in any single ethnicity given the small number of studies. There were also conflicting results in Chinese populations. We therefore perform the present study to investigate the association in Chinese children in Hong Kong. In this prospective family-based and case-control study during January to June 2004, we recruited consecutive Chinese children diagnosed with ADHD by DSM-IV criteria, their family members, and sex-matched controls admitted for acute upper respiratory infection, excluding those with perinatal brain insults, mental retardation, or neurological deficits. VNTR polymorphisms of the DAT gene were determined by standard PCR followed by agarose gel electrophoresis. Sixty-four ADHD cases (52 boys, 12 girls), their family members and 64 normal controls were recruited. The 10-repeat allele (92.6%) and the 10/10 repeat genotype (85.2%) were the most prevalent. Both family-based and case-control analyses showed no association between the DAT gene polymorphisms and ADHD (transmission dysequilibrium test: P = 0.99; odds ratio of 10-repeat allele = 0.89 (95%CI 0.35-2.28), P = 0.81; odds ratio of 10/10 repeat genotype = 0.69 (95%CI 0.26-1.84), P = 0.46). We concluded that VNTR polymorphism of the DAT gene is not associated with ADHD in Chinese children, and further studies are needed to clarify the polygenic and environmental influences for pathogenesis of ADHD.

Adolescent↗

PubMed2006

Meta-analysis of association between a catechol-O-methyltransferase gene polymorphism and attention deficit hyperactivity disorder.

There have been conflicting reports on the association between the Val158/108Met polymorphism of the catechol-O-methyltransferase (COMT) gene and attention deficit hyperactivity disorder (ADHD). Therefore we would like to perform a meta-analysis of previous studies to assess the overall magnitude and significance of the association. Family-based and case-control studies of the association between the COMT gene polymorphism and ADHD were searched systematically and comprehensively. Odds ratios (OR) of association were pooled by the fixed effects model if no significant heterogeneity was present among different studies. Subgroup analysis by gender and ADHD subtypes were also performed. Eleven family-based and two case-control studies were identified. After pooling the results, no significant association between the COMT Vall58/108Met polymorphism and ADHD was found (OR 0.99 (95% CI: 0.88-1.12), P = 0.87). There was also no significant association when the results were stratified by gender or ADHD subtype. There was no significant statistical heterogeneity (chi2 = 12.27, P = 0.2) although clinical heterogeneity was present in the studies, especially the ethnicity of subjects. Sensitivity analysis demonstrated absence of undue influence of any single study. Standard regression analysis showed no significant publication bias. We concluded that no significant association was present between the most common COMT gene polymorphism and ADHD. Further studies should employ larger sample size in more homogeneous subjects. Further investigations in moderator variables and gene-gene and gene-environment interactions are also warranted.

Amino Acid Substitution↗

PubMed2006

Febrile seizures in southern Chinese children: incidence and recurrence.

This study investigates the incidence, recurrence, and risk factors of febrile seizures in southern Chinese children. A retrospective study of a 5-year period (March 1998 through February 2003) was conducted for all children admitted with first febrile seizure to a university teaching hospital of Hong Kong, serving a population of 31,700 under 6 years. A total of 565 Chinese children (329 males, 236 females) were identified with mean age of 2.1 +/- 1.1 years. The annual incidence was 0.35%. Among them 16% (91/565) had complex febrile seizures. Family history of febrile and afebrile seizures was present in 17.5% and 2.7% respectively. The mean follow-up period was 2.33 +/- 1.69 years. Altogether 103 children (18%) had recurrence, and the cumulative rates by 1, 2, and 3 years were 12.7%, 18.7%, and 20.5% respectively. Three significant factors were identified for higher risk of recurrence: early age of onset, family history of febrile seizure, and complex febrile seizure. The incidence of first febrile seizure in Chinese children is low compared with the Western world and relatively similar to mainland China. Recurrence is also lower despite similarities in the predictive factors. Further epidemiologic and genetic studies will be necessary to confirm and explain this interethnic variation.

Asian People↗

PubMed2006

New training paradigms and program requirements.

Specialized training in vascular surgery evolved over the second half of the 20th century and continues to do so in 2006. Apprenticeship-style training in the 1960s and 1970s gave way to formal curriculum- and case-based programs created in the 1980s to improve the quality and consistency of vascular care. Recent developments have resulted in the Accreditation Council for Graduate Medical Education's approval of additional training pathways leading to certification by the American Board of Surgery. This article summarizes the history of vascular surgery training in the United States and describes the four types of currently approved programs--Standard, Early Specialization, Independent, and Integrated--for specialty training in vascular surgery. These are the only programs that can lead to American Board of Surgery certification in vascular surgery.

Certification↗

PubMed2006

Modified symbolic play test for Oriental children.

BACKGROUND: Symbolic play test (SPT) is a simple test for screening preverbal language in children. This test had been validated in English-speaking children. However, the toys may not be useful for other cultures such as Orientals like Chinese, Japanese, Koreans or Thais as they use chopsticks and bowls as eating utensils rather than spoon, fork or knife. The aim of this study was to find a set of miniature toys suitable for children of Oriental ethnic origin in order to get a reliable language test. METHODS: Altogether 140 children were recruited into this study. This included 62 control children and 78 with idiopathic developmental delay. The original SPT was applied together with an additional set of miniature toys appropriate for Oriental culture (i.e. modified version of SPT) by modifying play items in situations 3 and 4 to suit the Chinese culture. The authors replaced the knife, fork and plate with chopsticks and bowl in situation 3 and replaced the tractor and trailer with train carts in situation 4. For the ease of comparison, the authors segregated the age groups with the same age range as the original English-based SPT: less than 20 months (N= 11); 21-30 months (N= 45); 31-40 months (N= 43); 41-50 months (N= 21), and more than 50 months (N= 4). RESULTS: The mean scores of the cohort was higher (14.83) with the modified version of SPT than when the original SPT was used (13.64). A statistically significant increase in the mean score in situation 3 (3.67-3.24 = 0.43), situation 4 (3.76-3.36 = 0.40) and the overall score (14.83-13.64 = 1.19) was obtained when the modified SPT was used instead of the original SPT (all with P < 0.001). CONCLUSION: The authors recommend replacing play items like spoon, knife, fork and plate with Oriental culture-based items like chopsticks and bowl for the modified SPT (Oriental version). Users of the test should have a set of toy train carts available to supplement the tractor and trailer as these toys were not commonly seen in real life for Oriental children. The authors hope that the modified SPT can be used reliably to assess for preverbal ability of Oriental children, especially Chinese children.

Asian People↗

PubMed2006

Visual evoked potentials in neonatal hyperbilirubinemia.

The management of neonatal hyperbilirubinemia is very standardized. However, there is a lack of an objective method to evaluate the cerebral effects of bilirubin apart from brainstem auditory evoked potentials. There were few studies evaluating the effects of hyperbilirubinemia or phototherapy on the visual pathway in infants with hyperbilirubinemia. Serial visual evoked potentials of two groups of term neonates (N = 24)--group 1 with moderate hyperbilirubinemia (n = 16) and group 2 with severe hyperbilirubinemia (n = 8)--were evaluated prospectively. All infants had regular physical, neurologic, visual, and auditory evaluations until 3 years. Four (16%) had abnormal visual evoked potentials before 1 year, and the abnormalities returned to normal thereafter. There was no significant difference in visual evoked potentials between the two groups. All had normal neurodevelopmental status by 3 years, with the exception of one child from the severe group with ABO incompatibility with transient mild motor delay, hypotonia, and abnormal visual evoked potential. There were no abnormal effects of phototherapy on visual evoked potentials in infants with neonatal hyperbilirubinemia after 1 year of age. Although our sample size was small, the results suggest that the effects of hyperbilirubinemia on visual evoked potentials might be transient. (J Child Neurol 2006;21:58-62).

Child Development↗

PubMed2006

Recurrent headache in chinese children: any agreement between clinician diagnosis and symptom-based diagnoses using the International Classification of Headache Disorders (Second Edition)?

There has been a lack of published data on the pattern of recurrent headache in Chinese children. The validity of the International Classification of Headache Disorders criteria has not been evaluated in Chinese children. We performed a retrospective medical record review of 124 children aged <18 years with an International Classification of Diseases coding of headache followed up in a general outpatient clinic in a university-based hospital over a 3-year period (2000-2002). The aims of our study were to (1) study the pattern of recurrent headache in Chinese children and (2) study any agreement between clinical diagnoses made by our board-certified pediatricians and symptom-based diagnoses using the second edition of the International Classification of Headache Disorders (International Classification of Headache Disorders-II). The most common type was unclassified headache (70.2%), followed by infrequent episodic tension-type headache (24.2%) and migraine without aura (5.6%). A family history of headache or migraine was more commonly found in children with infrequent episodic tension-type headache or migraine without aura (P = .0109). The co-occurrence of abdominal pain with infrequent episodic tension-type headache was 30%; for unclassified headache, it was 19.5%. Dysmenorrhea occurred in 7.1% of girls with infrequent episodic tension-type headache and 8.6% of girls with unclassified headache. However, migraine without aura was not associated with abdominal pain or dysmenorrhea. Children with migraine without aura were more frequently referred to child neurologists (P = .0207) and admitted (P = .0000). Neurologic investigations, including electroencephalography, computed tomography, or magnetic resonance imaging of the brain, were performed in less than 30% of cases. Abnormal results were found in only seven cases; with two referred to a neurosurgeon and none requiring surgical intervention. Thus, by using the clinical diagnosis of our board-certified pediatricians as the standard, the sensitivity and specificity of International Classification of Headache Disorders-II-based definition of migraine without aura was 23.1% and 93.4%, respectively, and for infrequent episodic tension-type headache, it was 37.5% and 76%, respectively. The typical characteristics of migraine tend to emerge later and might have led to underdiagnosis of the younger age group, with a higher rate of referral and inpatient management. The new edition of the International Classification of Headache Disorders criteria is still restrictive in clinical practice and might not be able to reflect current pediatric practice. Further studies with a defined study period or recurrent headache might be more useful in analyzing the use of these new International Classification of Headache Disorders criteria in the diagnosis of recurrent headache in children.

Adolescent↗

PubMed2006

Tuberous sclerosis complex: correlation of magnetic resonance imaging (MRI) findings with comorbidities.

We studied the magnetic resonance imaging (MRI) findings in a cohort of Chinese children with tuberous sclerosis complex to determine the relationship between age, sex, mental retardation, autism, epilepsy, infantile spasm, and early age at onset of seizures and the numbers and locations of tubers detected. We searched our tuberous sclerosis registry, established in 1985 (N = 44), and performed an analysis of children who had MRIs of the brain performed (n = 22). A neuroradiologist blinded to the clinical findings scored the MRIs according to the total number and site of the tubers. The following factors were analyzed: age, sex, presence of autism (n = 7), presence (n = 19) and severity of mental retardation (mild [n = 12], moderate to severe [n = 7]), presence of epilepsy (n = 21) or infantile spasm (n = 8), and age at onset of seizures less than 1 year (n = 10). There was no significant relationship between the number and site of tubers and the following factors: sex, autism, mental retardation, degree of mental retardation, epilepsy, history of infantile spasm, or age at onset of seizures less than 1 year. Only the presence of cortical tubers in the parietal regions had a significant relationship with the history of infantile spasm (P = .012). Using multiple regression analysis of all of the risk factors, only age is related to the number of tubers in the MRI (P = .047), and a history of infantile spasm is related to the presence of tubers in the parietal (P = .009) and occipital (P = .031) lobes. The associated comorbidities in tuberous sclerosis complex might be explained by more complex underlying genetic or pathologic issues rather than purely by the site of the cortical tubers. We suggest that a developmental approach, by analyzing the age at the appearance of tubers in both symptomatic and asymptomatic cases with the development of other neuropsychiatric comorbidities, should be undertaken to assess the causal relationship.

Adolescent↗

PubMed2006

Short- and long-term outcome of severe neonatal nonhemolytic hyperbilirubinemia.

We studied the effects of hyperbilirubinemia on brainstem auditory pathways and neurodevelopmental status in 99 full-term neonates with severe nonhemolytic hyperbilirubinemia (total serum bilirubin level = 301 to 500 micromol/L) born between 1995 and 2000. These were divided into three groups: group 1, moderate hyperbilirubinemia (n = 30; mean maximum total serum bilirubin = 320.7 micromol/L or 18.9 mg%); group 2, severe hyperbilirubinemia (n = 63; mean maximum total serum bilirubin = 369.0 micromol/L or 21.7 mg%); and group 3, super hyperbilirubinemia (n = 6; mean maximum total serum bilirubin = 457.2 micromol/L or 26.9 mg%). All received phototherapy, and three neonates also had exchange transfusion. Initial brainstem auditory evoked potentials were recorded in all at the mean age of 3.1 months (range 1-9 months). At initial assessment, only nine neonates (9.1%) had abnormal brainstem auditory evoked potentials. All except two returned to normal at 2 years. These two children had a hearing threshold at 50 nHL. We then compared serial brainstem auditory evoked potentials until 2 years for these nine cases with initial abnormal brainstem auditory evoked potentials, and nine cases with initial normal brainstem auditory evoked potentials were recruited for comparison. All 99 children had regular physical, neurologic, visual, and auditory assessments every 3 to 6 months until the age of 3 years. There was no significant correlation between demographic factors (gender, gestational age, or birthweight), maximum total serum bilirubin, and total serum bilirubin at discharge with an abnormal brainstem auditory evoked potential. There was no significant difference in the rate of brainstem auditory evoked potential abnormalities between the three groups: moderate (10%), severe (7.9%), and super (16.7%). All had normal neurodevelopmental status at 3 years. Only two children had transient mild motor delay and hypotonia, and both had normal brainstem auditory evoked potentials. There was no relationship between the abnormalities of the brainstem auditory evoked potentials and neurodevelopmental status. None of the three children receiving exchange transfusion had abnormal brainstem auditory evoked potentials or neurodevelopmental outcome. With the neurophysiologic and clinical outcomes in our cohort with severe nonhemolytic hyperbilirubinemia, we propose that the toxic effect of hyperbilirubinemia on auditory brainstem pathways might be transient provided that prompt treatment is initiated.

Auditory Pathways↗

PubMed2006

Study of the relationship between tuberous sclerosis complex and autistic disorder.

There has been increasing awareness that there are behavioral phenotypes in tuberous sclerosis complex with neuropsychiatric symptom complex such as autistic disorder and attention-deficit hyperactivity disorder (ADHD). However, the neurobiologic basis of autistic disorder in tuberous sclerosis complex is still unknown. We studied two cohorts of children followed up since 1986 until 2003, one cohort with tuberous sclerosis complex and another cohort with autistic disorder, to determine the incidence of autistic disorder in tuberous sclerosis complex and the incidence of tuberous sclerosis complex in autistic disorder respectively. We established a Tuberous Sclerosis Complex Registry in 1985 at the University of Hong Kong. In 2004, 44 index cases (the male to female ratio was 0.75:1) were registered. Three had a positive family history of tuberous sclerosis complex. Thus, the total number of tuberous sclerosis complex cases was 47. We adopted the diagnostic criteria of tuberous sclerosis complex for case ascertainment. The period prevalence rate of tuberous sclerosis complex for children and adolescents aged < 20 years is 3.5 per 10,000 (on Hong Kong island, excluding the eastern region with 125,100 aged < 20 years in 2003). Of 44 cases with tuberous sclerosis complex, 7 had autistic disorder. Thus, the incidence of autistic disorder in tuberous sclerosis complex is 16%. During the 17-year period (1986-2003), we collected a database of 753 children (668 boys and 84 girls; male to female ratio 8:1) with autistic disorder and pervasive developmental disorders. For all children with autistic disorder or pervasive developmental disorders, we routinely examined for any features of tuberous sclerosis complex by looking for neurocutaneous markers such as depigmented spots, which appear in 50% of children with tuberous sclerosis complex by the age of 2 years. For those with infantile spasm or epilepsy, the clinical features of tuberous sclerosis complex were monitored regularly during follow-up. Of these, seven had tuberous sclerosis complex. Thus, the incidence of tuberous sclerosis complex in autistic disorder is 0.9%. All of these children are mentally retarded, with moderate to severe grades in an intellectual assessment conducted by a clinical psychologist. Future studies should be directed toward looking at the various behavioral phenotypes in tuberous sclerosis complex and defining these with standardized criteria to look for any real association with the underlying genetic mutation of TSC1 or TSC2 gene or even the site of tubers in the brain.

Adolescent↗

PubMed2005

Specific language impairment and child care by a domestic helper: a case-control study in Chinese children.

OBJECTIVE: To investigate the relationship between child care by domestic helper and specific language impairment (SLI). DESIGN: Retrospective case-control study. SETTING: A Child Assessment Center in Hong Kong that receives referrals from primary and secondary care settings. PARTICIPANTS: We reviewed medical records of all new referrals younger than 5 years during a 4-year period (1999-2003) and compared children with SLI (cases) with those referred with other behavioral problems and assessed to have normal language and overall development (controls) using the Griffiths Mental Developmental Scale. Specific language impairment was defined as a language quotient more than 1 SD below the mean and below the general developmental quotient in children with normal general developmental quotient but without neurological or other organic diseases. RESULTS: Four hundred ninety-six children were included (237 cases and 259 controls). The mean ages of cases and controls were 2.51 and 2.89 years, respectively. Boys predominated (cases = 73.4%, controls = 60.2%). The odds ratio (OR) of SLI for children cared for by a full-time domestic helper was 1.71 (95% confidence interval [CI], 1.06-2.77; P = .03), after adjusting for confounding sociodemographic variables. Male gender (OR = 1.91; 95% CI, 1.25-2.90), positive family history (OR = 2.70; 95% CI, 1.55-4.73), fewer siblings (P = .01), and lower paternal occupational status (P = .01) were also risk factors for an SLI. Childcare by a domestic helper was associated with a higher severity of an SLI in ordinal regression analysis (P = .048). CONCLUSIONS: Childcare by a domestic helper is associated with increasing risk and severity of an SLI. Further studies are required to confirm the association and to evaluate whether avoidance of childcare by a domestic helper could be recommended for children with an SLI or prone to develop an SLI.

Adult↗

PubMed2005

Program for Chinese children with developmental disabilities--the Hong Kong model.

Developmental disabilities (DD) are common childhood problems with significant impact on society. Early identification is important as there is potential for improvement through interventional/educational/(re)habilitative measures. There are currently no data revealing this situation in China. We review the current model of identification and management of Chinese children with DD in Hong Kong, a southern city in China. Our model was developed in the early 1960s and our system had been originally adopted from the Western culture due to political reasons, as Hong Kong was a British colony. This was modified over the years to suit our own unique, mixed Eastern and Western culture. With the expanding Western influence in mainland China recently, we hope this integrated model can be implemented in other parts of China.

Asian People↗

PubMed2005

Prognosis of Bell's palsy in children--analysis of 29 cases.

We report 29 children with 32 episodes of Bell's palsy admitted to a university affiliated hospital during an 8-year period (1995-2003). The peak age of onset was under 3 years. Three (10.3%) had recurrent attacks. Complete recovery occurred in all 32 episodes except 1 (3.1%) with partial recovery, having MRI evidence of parotitis shown in the contralateral side. The recovery rate within 3 weeks was 68.8%. There was statistically significant increase in the duration of complete recovery for those with positive virological confirmation or mycoplasma infection. There was no significant difference between the rate of recovery in those treated with a short course of steroid (N = 23 attacks) than those without steroid treatment (N = 9 attacks). As there were few studies in the natural course of children with Bell's palsy, evidence based trials should be done to assess the natural course rather than giving steroid empirically as those with more protracted recovery might be viral in origin.

Anti-Inflammatory Agents↗

PubMed2005

Multilingual home environment and specific language impairment: a case-control study in Chinese children.

Specific language impairment (SLI) is a common developmental disorder in young children. To investigate the association between multilingual home environment and SLI, we conducted a case-control study in Hong Kong Chinese children over a 4-year period in the Duchess of Kent Children's Hospital. Consecutive medical records of all new referrals below 5 years of age were reviewed and children diagnosed with SLI (case) were compared with those referred with other developmental and behavioural problems who had been assessed as having normal language and overall development (control) using the Griffiths Mental Developmental Scale. SLI was defined as those with a language quotient more than one standard deviation below the mean and below the general developmental quotient in children with normal general developmental quotient, but without neurological or other organic diseases. We used binary and ordinal logistic regression to assess any association between SLI and multilingual exposure at home, adjusting for age and gender of subjects, parental age, education level and occupational status, number of siblings, family history of language delay and main caregiver at home. Multivariable linear regression was used to examine the effect of covariates on the language comprehension and expression standard scores assessed by the Reynell Developmental Language Scale. A total of 326 cases and 304 controls were included. The mean ages of cases and controls were 2.56 and 2.89 years respectively. Boys predominated in both groups (cases, 75.2%; controls, 60.2%). The children were exposed to between one and four languages at home, the major ones being Cantonese Chinese followed by English. The adjusted odds ratio (OR) of SLI was 2.94; [95% confidence interval (CI) 1.82, 4.74] for multilingual compared with monolingual exposure. A significant linear dose-response relationship was found (OR of SLI = 2.58 [1.72, 3.88] for each additional language to which the child was exposed). Male gender (OR = 1.88 [1.24, 2.87]), positive family history (OR = 2.01 [1.17, 3.47]), lower education levels of parents (P = 0.028 for father, P = 0.038 for mother) and lower occupational status of father (P = 0.005) were also risk factors for SLI. Multilingual exposure also significantly reduced the language quotient (P = 0.012) and language comprehension standard score (P = 0.016) of children with SLI, but not of normal children. We concluded that multilingual home environment is associated with SLI with a dose-response relationship. Exposure to multiple languages might adversely affect subsequent language ability.

Analysis of Variance↗

PubMed2005

Topiramate-valproate-induced hyperammonemic encephalopathy syndrome: case report.

A 15-year-old boy with inverted duplication of chromosome 15 was admitted for acute onset of irritability, increasing sleepiness, and worsening of seizures. He had been on valproate and other anti-convulsants. However, he was found to have hyperammonemia within 2 weeks after the addition of low-dose topiramate to valproate. He recovered within 7 days after discontinuation of valproate. Topiramate was tailed off. The reintroduction of valproate monotherapy caused hyperammonemia again without clinical features of encephalopathy. He also developed anticonvulsant hypersensitivity syndrome following the use of phenytoin. We propose the term topiramate-valproate-induced hyperammonemic encephalopathy syndrome to include the following features: excessive sleepiness or somnolence, aggravation of seizures, hyperammonemia, and absence of triphasic waves on electroencephalography in any individual on simultaneous topiramate-valproate therapy. The ammonia level ranged from 1.5 to 2 times normal. The serum valproate level might be within the therapeutic range. The possible mechanism is topiramate-induced aggravation of all the known complications of valproate monotherapy. This condition is reversible with cessation of either valproate or topiramate.

Adolescent↗

PubMed2005

Correlation of Functional Independence Measure for Children (WeeFIM) with developmental language tests in children with developmental delay.

The Functional Independence Measure for Children (WeeFIM) is a simple tool for assessing the functional independence of three domains: mobility, self-care, and cognition. Children are usually apprehensive about performing standardized structured language or developmental tests, and only licensed professionals can administer standardized tests. We attempted to apply the Functional Independence Measure for Children for assessing children with developmental delay and to assess for any correlation of these scores with standardized language tests. We recruited 49 children with developmental delay, and the Functional Independence Measure for Children was administered. Two standardized language tests (Symbolic Play Test and Reynell Language Developmental Scale) were administered to assess language age. There was a significant correlation between Functional Independence Measure for Children scores with both verbal comprehension age and verbal expression age. There was no correlation of Functional Independence Measure for Children scores with gender, age, or having domestic helpers. Having trained staff administer the Functional Independence Measure for Children can reliably correlate the current language ability of a child with developmental delay; thus, the test can be used as a quick screening tool for targeted training.

Activities of Daily Living↗