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Summary 12 cases of non-ketotic hyperglycinemia in neonates diagnosed at a time of neurological distress were studied. A characteristic tracing was observed permitting correct diagnosis in 6 cases. It consisted of a burst suppression characterized by high voltage complexes separated by low amplitude sequences. This appearance remained until the 15 th day, with no electroclinical changes. In cases followed the trace closely resembled hypsarrhythmia.

Summary This article is devoted to a consideration of the clinical prognostic significance of “trace discontinu”. The authors first distinguish “trace discontinu” from the “trace paroxystique” and “trace alternant” patterns in the newborn. The distinction is very important. The bad prognosis of the “trace paroxystique” is well known, but prognosis of the “trace discontinu” seems to be different. If the “trace discontinu” is permanent, there was a 50% favourable outcome in our 22 newborn babies brought to the reanimation department. If some continuous activity can be observed: beginning of sleep organisation, then the prognosis seems to be better: 61% of our cases. As blood levels of anticonvulsants are rarely measured it seems difficult, given our present knowledge, to appreciate anticonvulsive drug effects on EEG recordings. Thus 3 aims should be pointed out: o - Measurements of anticonvulsant blood level each time a “trace discontinu” is observed in a treated newborn. - Early EEG recordings of sufficient duration to obtain eventually some continuous tracing. - Correct differentiation between “trace paroxystique” and “trace discontinu” for the clinician: “trace discontinu” in a full-term newborn should never allow the paediatrician to stop treatment.

Summary A study of the E.E.G. abnormalities observed in 15 children with herpes encephalitis demonstrated typical periodic complexes in 12 of the recordings, which is in conformity with the data in the published literature concerning findings in adults. Early E.E.G. recordings are the only means of obtaining a diagnosis rapidly, as the clinical picture is not specific and may be misleading and the virological test results are positive only at a late stage. These findings are compared to those obtained in 13 cases of acute non-herpetic encephalitis, which showed periodic abnormalities. The main problem which arises from the periodic changes seen during non-herpetic encephalitis is that of deciding whether early specific antiviral therapy should be instituted, as this appears to be effective against herpes simplex but not against other viruses where it is not indicated.

Summary The purpose of this study was to evaluate the prognostic value of neonatal E.E.G. tracings in children born at term. The clinical course of 45 children was followed and related to E.E.G. abnormalities reported during the first 5 days of life. Essentially the findings confirmed those previously reported by others. However some differences were noted : paroxysmal tracings were not associated with a poor clinical state, and moderately abnormal tracings (the prognostic significance of which has never been defined) led on sometimes to a severe encephalopathy. We whish to stress certain aspects of our findings : -- recordings in the first 24 hours of life may be misleading. -- recordings, to be of value, must be taken before any treatment which could induce paroxystic E.E.G. patterns. -- E.E.Gs should be repeated during the post-natal period when the findings are non-specific. -- the prognostic significance of tracings reported as « generalised or localised overactivityshould be evaluated.

The periodic EEG pattern during the first week associated with lethargy and myoclonic jerks is the major clinical sign in non-ketotic hyperglycinaemia. The blood and urine glycine level may be at the upper limit of the normal range in some cases. Diagnosis must be done with this characteristic clinical picture associated with a high CSF glycine level.

Resume 27 cas d'abces cerebraux neo-nataux enregistres precocement ont ete etudies. Deux groupes ont ete distingues: nouveau-nes ayant convulse (20 cas), nouveau-nes n'ayant pas convulse (7 cas). Les auteurs etudient les differents aspects de l'EEG initial, sa valeur diagnostique et pronostique. Ils notent l'absence de correlation de signes focaux a l'EEG avec les localisations trouvees a l'examen tomodensitometrique. Par ailleurs, ils soulignent la gravite de l'evolution electroclinique dans plus de la moitie des cas.

The EEG study was carried out on 8 cases of methylmalonic acidaemia, in the neonatal period (3 cases), developing later with a ketotic coma, hyperglycinemia, hyperammonaemia, leucopenia and thrombocytopenia (3 cases) and detected before birth (2 cases). The tracings of the neonates in the first group had a periodic appearance. The 2 children detected pre-natally had essentially normal EEGs bar a slightly faster rhythm. The tracings of the children in ketotic coma were similar to those seen in metabolic coma of other cause. The value of this study was, besides characterizing the EEC pattern which resembled that seen in other metabolic illnesses in the neonatal period, to study the changes in the EEG trace and their improvement during dialysis treatment. In one case recordings were made throughout the duration of dialysis.

Summary Fifteen children between the age of 3 and 7 years who had had unilateral seizure followed by a transitory hemiplegia (without fever) were observed. This seizure was the only one in 13 of the children; a second fit appeared in 2 others. The average duration of the observation period was 10 years. 6 months. The evolution of the EEG shows that after a post-ictal delta focus contralateral to the hemiplegia, spike foci of variable localisations were formed in 12 cases. These cases, chosen because of their benign evolution, seem to be related closely to rolandic paroxysmal epilepsy (EPR).

Summary Of 61 newborns with disorders in amino acid metabolism, 20 had seizures; 15 of them have been recorded. Clinically, seizures are mostly partial clonic jerks. There seems to be some homogeneity of EEG features in relation to causal amino acidopathy. In every case where seizures, either electroclinical or only infraclinical, occurred the evolution was very poor, even in those diseases that would have had a good prognosis. Therefore the EEG in the newborns is especially interesting, both as an aid to diagnosis by interictal recording and as a prognostic tool by registration of seizures.

Summary The authors have studied the EEG characteristics of 188 children aged 1–4, without serious pathology, during waking and falling asleep spontaneously in the afternoon. The children were divided into 3 groups: aged 12–23 months, 24–35 months and 36–47 months. On falling asleep the EEG appearances varied, but hypersynchrony was most marked in the youngest children and in the older group theta activity was commonest. Only 3 of the 188 children had runs of paroxysmal activity on falling asleep. The waking study again showed appearances governed by the patients' age with respect to 7 c/sec activity on provoked waking, but the appearances were more diverse on spontaneous waking and anterior theta activity only occurred in the oldest children. In general, a relation appeared to exist between the EEG appearance on falling asleep and on waking, in the respect that children falling asleep without hypersynchrony never wake up with it.

Summary An EEG has been recorded during surgery for a cervico-mediastinal desmoid fibroma in a 3-year-old child. Soon after anesthetic induction a bronchospasm occurred, followed by major respiratory difficulties. During more than 3 h, hypercapnia reaching 15–24 kpa was noted without hypoxia. Meanwhile the EEG recording was inactive. The respiratory difficulties subsided only with the surgical liberation of the trachea. As the hypercapnia decreased, the EEG began to show “burst suppressive” activity. Progressively the tracing was more and more continuous with slow waves until complete recovery. The following day the EEG was quite normal. The mechanisms of these EEG features are discussed with regards to anesthetic drugs and to brain hypercapnic edema.

Summary Since 1973 the authors have studied the EEG appearances in hyperphenylalaninaemia : 82 children were studied, comprising : 68 children with phenylketonuria, 33 of whom had been treated within the first 3 months of life, whilst 35 had only started therapy after 9 months ; 14 patients with hyperphenylalaninaemia. The morphological appearances seen commonly were compared with those described in the literature : the abnormalities and maturational changes were observed, including background rhythm changes, characteristic appearance of high amplitude, sharp spindles and percentages of generalised fast rhythms. Incidence of re-evaluation tests was also studied. Serial changes represented the most important aspect of this study, correlations being possible between the tracings and the child's development. The effects of correct dietary management, nonadherence to treatment, and the changes occurring on stopping treatment were also assessed. An assessment of the value of the EEG in following these cases could thus be made.

Summary The authors have attempted a systematic E.E.G. study in 32 neonates suffering from disorders of amino-acid metabolism, during the first days of life. These consisted of cases with ketosis (13 cases of leucinosis, 5 methylmalonic acidaemia, isovaleric acidaemia and 3 with hyperlactacidaemia) and cases without ketosis (6 cases of hyperglycinaemia and 3 with congenital hyperammonaemia). A study of the E.E.G. showed some characteristic features, the most typical of which were : -- a periodic tracing with large sharps complexes intermingled with less active periods occurring in every case of hyperglycinaemia without ketosis, in 2 cases of leucinosis and 2 cases of methylmalonic acidaemia. This record indicates a poor prognosis. -- a less stereotyped periodic tracing with variable evolution. -- distinctive figures characterised by rapid Rolandic rhythms always found in cases of leucinosis compared with sharp spindles (between the 10th and 30th day). It is concluded that the E.E.G. patterns are not in close correlation with the anatomical lesions.

Summary This study was carried with the intention of explaining the causes of modifications in intracranial pressure (ICP) during paradoxical sleep (PS) in normal and hydrocephalic infants, and establishing relationships between these modifications and cerebral blood volume (CBV). All tests (conventional sleep polygraphy, ICP measured by a transducer on the fontanel, CBV measured by isotopic labelling of red blood cells in vivo) were carried out whitout use of surgical procedures. During paradoxical sleep there was a sustained wave of increased intracranial pressure lasting from 10 to 20 minutes, as well as phase-type variations lasting no longer than 1 minute. Increased ICP was also observed in the normal subject. Recordings show that there is well-defined correlation between the sustained wave of high intracranial pressure and an increase in CBV.

Summary The authors study fast EEG rhythms in amino acidopathies of the newborn and in progressive encephalopathy of the central nervous system in children, when an inborn error of metabolism has either been found or is suspected. In the first group: amino acidopathies (including phenylketonuria), fast rhythms on the EEG of the neonates are of low amplitude, spindle-like bursts of 7–13 Hz and usually located in rolandic areas. This activity progressively disappears. Later, fast rhythms of β-frequency and low voltage are spread on the whole scalp with a normal EEG organisation. They are seen in the favourable or rather favourable development of children receiving a diet. In the second group: progressive encephalopathy of the central nervous system, fast rhythms of 14–24 Hz appearing at a rather late stage of the disease, while the normal background activity completely disappears. In neuro-axonal dystrophy, where they are considered as ‘specific,’ they are of very high voltage, i.e., 50–200 μV. The authors insist on the importance of EEG fast rhythms both in amino acidopathies of the newborn, as a contributive factor to diagnosis and prognosis, and in progressive encephalopathies of the central nervous system, as a valuable tool in the diagnosis of numerous affections.

Summary The authors studied 11 children (mean age 5 1/2 years) before and during anaesthesia, and then several times from 1 to 6 hours after the injection of althesin. The anaesthetic agent was either pure althesin or althesin combined with dextromoramide. The electroclinical correlations described for adults are also found in children : slow waves, discontinuous and then isoelectric recording during the operation stage, then rapid recovery after ending drug administration. The special interest of this study was the analysis of E.E.G. recordings during the hours following clinical recovery : only once was the recording like that of full consciousness. Repeated recordings were all of drowsiness and even sleep, despite the clinical state of the subject. A short associated study concerns the E.E.G. of neonates during their first 24 hours, born to mothers anaesthetised with alfathesin.

Summary The authors analyse the technical problems encountered in using E.E.G. in children's reanimation. They show some examples which illustrate the importance of E.E.G. in diagnosis and therapy of such cases. Emphasis is laid upon the need for close collaboration between the EEGers and the reanimation staff.

An EEG has been recorded during surgery for a cervico-mediastinal desmoid fibroma in a 3-year-old child. Soon after anesthetic induction a bronchospasm occurred, followed by major respiratory difficulties. During more than 3 h, hypercapnia reaching 15-24 kpa was noted without hypoxia. Meanwhile the EEG recording was inactive. The respiratory difficulties subsided only with the surgical liberation of the trachea. As the hypercapnia decreased, the EEG began to show "burst suppressive" activity. Progressively the tracing was more and more continuous with slow waves until complete recovery. The following day the EEG was quite normal. The mechanisms of these EEG features are discussed with regards to anesthetic drugs and to brain hypercapnic edema.

The authors studied 27 brain abscesses in neonates. The neonates were divided in two groups: neonates with seizures and neonates without seizures. The authors tested the diagnostic and predictive value of the initial EEG aspect. They noted the absence of correlation between EEG focal abnormalities and localizations shown by the CT scan. They observed a severe electroclinical evolution in more than fifty percent of the cases presented.

This article is devoted to a consideration of the clinical prognostic significance of "tracé discontinu". The authors first distinguish "tracé discontinu" from the "tracé paroxystique" and tracé alternant" patterns in the newborn. The distinction is very important. The bad prognosis of the "tracé paroxystique" is well known, but prognosis of the "tracé discontinu" seems to be different. If the "tracé discontinu" is permanent, there was a 50% favourable outcome in our 22 newborn babies brought to the reanimation department. If some continuous activity can be observed: beginning of sleep organisation, then the prognosis seems to be better: 61% of our cases. As blood levels of anticonvulsants are rarely measured it seems difficult, given our present knowledge, to appreciate anticonvulsive drug effects on EEG recordings. Thus 3 aims should be pointed out: --Measurements of anticonvulsant blood level each time a "tracé discontinu" is observed in a treated newborn. --Early EEG recordings of sufficient duration to obtain eventually some continuous tracing. --Correct differentiation between "tracé paroxystique" and "tracé discontinu" for the clinician: "tracé discontinu" in a full-term newborn should never allow the paediatrician to stop treatment.

The EEG study was carried out on 8 cases of methylmalonic acidaemia, in the neonatal period (3 cases), developing later with a ketotic coma, hyperglycinemia, hyperammonaemia, leucopenia and thrombocytopenia (3 cases) and detected before birth (2 cases). The tracings of the neonates in the first group had a periodic appearance. The 2 children detected pre-natally had essentially normal EEGs bar a slightly faster rhythm. The tracings of the children in ketotic coma were similar to those seen in metabolic coma of other cause. The value of this study was, besides characterizing the EEC pattern which resembled that seen in other metabolic illnesses in the neonatal period, to study the changes in the EEG trace and their improvement during dialysis treatment. In one case recordings were made throughout the duration of dialysis.

This study was carried with the intention of explaining the causes of modifications in intracranial pressure (ICP) during paradoxical sleep (PS) in normal and hydrocephalic infants, and establishing relationships between these modifications and cerebral blood volume (CBV). All tests (conventional sleep polygraphy, ICP measured by a transducer on the fontanel, CBV measured by isotopic labelling of red blood cells in vivo) were carried out without use of surgical procedures. During paradoxical sleep there was a sustained wave of increased intracranial pressure lasting from 10 to 20 minutes, as well as phase-type variations lasting no longer than 1 minute. Increased ICP was also observed in the normal subjects. Recordings show that there is well-defined correlation between the sustained wave of high intracranial pressure and an increase in CBV.

Fifteen children between the age of 3 and 7 years who had had unilateral seizure followed by a transitory hemiplegia (without fever) were observed. This seizure was the only one in 13 of the children; a second fit appeared in 2 others. The average duration of the observation period was 10 years, 6 months. The evolution of the EEG shows that after a post-ictal delta focus contralateral to the hemiplegia, spike foci of variable localisations were formed in 12 cases. These cases, chosen because of their benign evolution, seem to be related closely to rolandic paroxysmal epilepsy (EPR).

The authors studied 11 children (mean age 5 1/2 years) before and during anaesthesia, and then several times from 1 to 6 hours after the injection of althesin. The anaesthetic agent was either pure althesin or althesin combined with dextromoramide. The electroclinical correlations described for adults are also found in children: slow waves, discontinuous and then isoelectric recording during the operation stage, then rapid recovery after ending drug administration. The special interest of this study was the analysis of E.E.G. recordings during the hours following clinical recovery: only once was the recording like that of full consciousness. Repeated recordings were all of drowsiness and even sleep, despite the clinical state of the subject. A short associated study concerns the E.E.G. of neonates during their first 24 hours, born to mothers anaesthetised with alfathesin.

By measuring cerebral blood volume (CBV) and intracranial pressure (ICP) variations at the same running time during sleep, it has been demonstrated that the ICP wave which appears during the REM sleep in hydrocephalic infants is produced by intracerebral vaso-dilatation. Nine infants with stabilized hydrocephalus were investigated by non-invasive means: REM phases were distinguished with the usual polysomnographic electrodes. Intracranial pressure was measured with a fontanel palpation transducer and CBV variations were obtained by recording 99mTc activity at the head level after in vivo labelling of red cells with 99mTc--pertechnetate. The time-activity curves, obtained from regions of interest and selected on the sequential radioisotope images, show that an increased ICP wave, occurring during the REM period, is related to a simultaneous increase in the blood volume, limited to the cerebral sector and not to the area of the external carotid artery.

Since 1973 the authors have studied the EEG appearances in hyperphenylalaninaemia : 82 children were studied, comprising : 68 children with phenylketonuria, 33 of whom had been treated within the first 3 months of life, whilst 35 had only started therapy after 9 months; 14 patients with hyperphenylalaninaemia. The morphological appearances seen commonly were compared with those described in the literature: the abnormalities and maturational changes were observed, including background rhythm changes, characteristic appearance of high amplitude, sharp spindles and percentages of generalised fast rhythms. Incidence of re-evaluation tests was also studied. Serial changes represented the most important aspect of this study, correlations being possible between the tracings and the child's development. The effects of correct dietary management, nonadherence to treatment, and the changes occurring on stopping treatment were also assessed. An assessment of the value of the EEG in following these cases could thus be made.

12 cases of non-ketotic hyperglycinemia in neonates diagnosed at a time of neurological distress were studied. A characteristic tracing was observed permitting correct diagnosis in 6 cases. It consisted of a burst suppression characterized by high voltage complexes separated by low amplitude sequences. This appearance remained until the 15th day, with no electroclinical changes. In cases followed the trace closely resembled hypsarrhythmia.

The purpose of this study was to evaluate the prognostic value of neonatal E.E.G. tracings in children born at term. The clinical course of 45 children was followed and related to E.E.G. abnormalities reported during the first 5 days of life. Essentially the findings confirmed those previously reported by others. However some differences were noted: paroxysmal tracings were not associated with a poor clinical state, and moderately abnormal tracings (the prognostic significance of which has never been defined) led on sometimes to a severe encephalopathy. We wish to stress certain aspects of our findings: -recordings in the first 24 hours of life may be misleading. -recordings, to be of value, must be taken before any treatment which could induce paroxystic E.E.G. patterns. -E.E.Gs should be repeated during the post-natal period when the findings are non-specific. -the prognostic significance of tracings reported as "generalised or localised overactivity" should be evaluated.

Of 61 newborns with disorders in amino acid metabolism, 20 had seizures; 15 of them have been recorded. Clinically, seizures are mostly partial clonic jerks. There seems to be some homogeneity of EEG features in relation to causal amino acidopathy. In every case where seizures, either electroclinical or only infraclinical, occurred the evolution was very poor, even in those diseases that would have had a good prognosis. Therefore the EEG in the newborns is especially interesting, both as an aid to diagnosis by interictal recording and as a prognostic tool by registration of seizures.

The authors study fast EEG rhythms in amino acidopathies of the newborn and in progressive encephalopathy of the central nervous system in children, when an inborn error of metabolism has either been found or is suspected. In the first group: amino acidopathies (including phenylketonuria), fast rhythms on the EEG of the neonates are of low amplitude, spindle-like bursts of 7-13 Hz and usually located in rolandic areas. This activity progressively disappears. Later, fast rhythms of beta-frequency and low voltage are spread on the whole scalp with a normal EEG organisation. They are seen in the favourable or rather favourable development of children receiving a diet. In the second group: progressive encephalopathy of the central nervous system, fast rhythms of 14-24 Hz appearing at a rather late stage of the disease, while the normal background activity completely disappears. In neuro-axonal dystrophy, where they are considered as 'specific,' they are of very high voltage, i.e., 50-200 microV. The authors insist on the importance of EEG fast rhythms both in amino acidopathies of the newborn, as a contributive factor to diagnosis and prognosis, and in progressive encephalopathies of the central nervous system, as a valuable tool in the diagnosis of numerous affections.

The authors have attempted a systematic E.E.G. study in 32 neonates suffering from disorders of amino-acid metabolism, during the first days of life. These consisted of cases with ketosis (13 cases of leucinosis, 5 methylmalonic acidaemia, isovaleric acidaemia and 3 with hyperlactacidaemia) and cases without ketosis (6 cases of hyperglycinaemia and 3 with congenital hyperammonaemia). A study of the E.E.G. showed some characteristic features, the most typical of which were: -a periodic tracing with large sharps complexes intermingled with less active periods occurring in every case of hyperglycinaemia without ketosis, in 2 cases of leucinosis and 2 cases of methylmalonic acidaemia. This record indicates a poor prognosis. -a less stereotyped periodic tracing with variable evolution. -distinctive figures characterised by rapid Rolandic rhythms always found in cases of leucinosis compared with sharp spindles (between the 10th and 30th day). It is concluded that the E.E.G. patterns are not in close correlation with the anatomical lesions.

The authors have studied the EEG characteristics of 188 children aged 1-4, without serious pathology, during waking and falling asleep spontaneously in the afternoon. The children were divided into 3 groups: aged 12-23 months, 24-35 months and 36-47 months. On falling asleep the EEG appearances varied, but hypersynchrony was most marked in the youngest children and in the older group theta activity was commonest. Only 3 of the 188 children had runs of paroxysmal activity on falling asleep. The waking study again showed appearances governed by the patients' age with respect to 7 c/sec activity on provoked waking, but the appearances were more diverse on spontaneous waking and anterior theta activity only occurred in the oldest children. In general, a relation appeared to exist between the EEG appearance on falling asleep and on waking, in the respect that children falling asleep without hypersynchrony never wake up with it.

The authors analyse the technical problems encountered in using E.E.G. in children's reanimation. They show some examples which illustrate the importance of E.E.G. in diagnosis and therapy of such cases. Emphasis is laid upon the need for close collaboration between the EEGers and the reanimation staff.