We report the results of three years of the population-based, prospective Swiss NeuroPaediatric Stroke Registry (SNPSR) of children (up to 16 years) with childhood arterial ischaemic stroke (AIS1), neonatal stroke (AIS2), or symptomatic sinus venous thrombosis (SVT). Data on risk factors (RF), presentation, diagnostic work-up, localisation, and short-term neurological outcome were collected. 80 children (54 males) have been included, 40 AIS1, 23 AIS2, and 17 SVT. The data presented will be concentrated on AIS. The presentation for AIS1 was hemiparesis in 77% and cerebellar symptoms and seizures in 20%, respectively. AIS2 presented in 83% with seizures and in 38% with abnormality of muscle tone. Two or more RF were detected in 54%, one RF in 35%. The most prominent RF for AIS1 were infections (40%), followed by cardiopathies and coagulopathies (25% each). AIS2 were frequently related to birth problems. Neurological outcomes in AIS1 and AIS2 were moderate/severe in 45 % and 32 %, respectively. The outcome correlated significantly with the size of infarction (p = 0.013) and age at stroke (p = 0.027). The overall mortality was 6%. Paediatric stroke is a multiple risk problem, which leads to important long-term sequelae.

Moderate cognitive and motor deficits, behavioral problems, and impairment in some aspects of quality of life frequently remain after stroke in childhood. Visuospatial functions are more often reduced than verbal functions, independent of the hemispheric side of lesion. This indicates a functional superiority of verbal skills compared to visuospatial skills in the process of recovery after brain injury. Compared to the cognitive outcome following stroke in adults, cognitive sequelae after childhood stroke do indicate neither the lateralization nor the location of the lesion focus. Age at stroke seems to be the only determining factor influencing cognitive outcome.

Cognitive functions in the child's brain develop in the context of complex adaptive processes, determined by genetic and environmental factors. Little is known about the cerebral representation of cognitive functions during development. In particular, knowledge about the development of right hemispheric (RH) functions is scarce. Considering the dynamics of brain development, localization and lateralization of cognitive functions must be expected to change with age. Twenty healthy subjects (8.6-20.5 years) were examined with fMRI and neuropsychological tests. All participants completed two fMRI tasks known to activate left hemispheric (LH) regions (language tasks) and two tasks known to involve predominantly RH areas (visual search tasks). A laterality index (LI) was computed to determine the asymmetry of activation. Group analysis revealed unilateral activation of the LH language circuitry during language tasks while visual search tasks induced a more widespread RH activation pattern in frontal, superior temporal, and occipital areas. Laterality of language increased between the ages of 8-20 in frontal (r 5 0.392, P 5 0.049) and temporal (r 5 0.387, P 5 0.051) areas. The asymmetry of visual search functions increased in frontal (r 5 20.525, P 5 0.009) and parietal (r 5 20.439, P 5 0.027) regions. A positive correlation was found between Verbal-IQ and the LI during a language task (r 5 0.585, P 5 0.028), while visuospatial skills correlated with LIs of visual search (r 5 20.621, P 5 0.018). To summarize, cognitive development is accompanied by changes in the functional representation of neuronal circuitries, with a strengthening of lateralization not only for LH but also for RH functions. Our data show that age and performance, independently, account for the increases of laterality with age.

"Evidenz" liefert ein Urteil nur dann und nur insofern, als es sich auf tatsächlich vorhandene Fakten bezieht. Urteile und Schlussfolgerungen, die auf Annahmen beruhen, bieten keine Evi-denz, auch wenn sie klug berechnet sind. Das gilt auch für die Evidenz basierte Medizin, EBM, wie man sehr gut am Beispiel der Lancet-Studie über Homöopathie von SHANG et al. aus dem Berner Institut für Sozial-und Präventivmedizin von Prof. Egger sehen kann [1]. Prof. Egger gilt als prominenter Vertreter von EBM. Seine Arbeitsgruppe kommt auf Grund einer Meta-Regression bekanntlich zum Schluss, dass Homöopathie nicht wirkungsvoller sei als Placebo. Bezieht sich dieses Urteil tatsächlich auf nachgewiesene Fakten? Nein. Die wesentlichen Schlussfolgerung sind Hypostasen, die auf theoretischen Annahmen und darauf aufbauenden probabilistischen Berechnungen beruhen. 1. Es wird angenommen, dass die Effekte der untersuchten Homöopathie-Studien homogen seien, denn nur unter dieser Voraussetzung ist das Herzstück der Studie, die gewählte Funnel Plot Methode sinnvoll. In Wirklichkeit umfassen die Studien jedoch unterschiedlichste Stu-dienmodelle und homöopathische Vorgehensweisen, so dass homogene Effektarten nicht zu erwarten sind. Bei inhomogenen Effektarten kann der Funnel Plot ähnlich schief werden wie in der vorliegenden Arbeit, auch ohne dass ein Publication Bias vorliegt [2]. Das ist bereits im Schlussbericht PEK im Hinblick auf Eggers Arbeit kritisert worden [3]. 2. Es wird von der Egger-Gruppe aus rein theoretischen Gründen angenommen, dass der schiefe Funnel Plot auf einem Publication Bias beruhe, ohne faktischen Nachweis. Dem Publication Bias sind jedoch schon LINDE et al. in ihrer Meta-Analyse von 1997 genauer nachge-gangen, indem sie systematisch nach nicht-publizierten Studien suchten und ihre Berech-nungen auch für einen hypothetischen Publication Bias adjustierten. Dadurch verminderte sich der gepoolte Effekt der Studien, er blieb aber immer noch signifikant positiv zu Gunsten der Homöopathie. Es wären je nach Berechnung 923 oder 4511 (!) "fehlende" Studien mit einem Null-Effekt nötig gewesen, um den Gesamteffekt unter die Signifikanzgrenze zu sen-ken [ 2]. Es gibt aber weltweit nicht genügend Arbeitsgruppen, um so viele Studien zustande zu bringen und sie erst noch zu verstecken. Im übrigen zeigen auch die meisten von LINDE et al. gefundenen nicht-publizierten Studien einen positiven Effekt. 3. Es wird rein theoretisch vorausgesetzt, dass die grossen Studien qualitativ besser seien als die kleineren. Die faktische Evidenz dafür wurde nicht geprüft. Bei der Klassischen Homöo-pathie ist eher das Gegenteil der Fall, nämlich dass ihre individualisierende Vorgehensweise in einer grossen Studie nicht gewährleistet ist oder dass nicht genügend kompetente Thera-peuten zu Verfügung stehen. Falsch negative Ergebnisse sind dann die Folge. Für konventio-nelle Therapien gilt wegen ihrer weitgehenden Standardisierung und der viel weiter gehen-den Unabhängigkeit der Medikamentengabe von der spezifischen Kompetenz der Ärzte nicht dasselbe....

The AcroQoL questionnaire represents a reliable, construct valid and disease-specific tool for assessing health-related quality of life in patients with acromegaly. Patients with biochemically uncontrolled acromegaly showed significantly lower HRQoL than patients with acromegaly in remission or discordant remission status.

Working memory is crucial for meeting the challenges of daily life and performing academic tasks, such as reading or arithmetic. Very preterm born children are at risk of low working memory capacity. The aim of this study was to examine the visuospatial working memory network of school-aged preterm children and to determine the effect of age and performance on the neural working memory network. Working memory was assessed in 41 very preterm born children and 36 term born controls (aged 7-12 years) using functional magnetic resonance imaging (fMRI) and neuropsychological assessment. While preterm children and controls showed equal working memory performance, preterm children showed less involvement of the right middle frontal gyrus, but higher fMRI activation in superior frontal regions than controls. The younger and low-performing preterm children presented an atypical working memory network whereas the older high-performing preterm children recruited a working memory network similar to the controls. Results suggest that younger and low-performing preterm children show signs of less neural efficiency in frontal brain areas. With increasing age and performance, compensational mechanisms seem to occur, so that in preterm children, the typical visuospatial working memory network is established by the age of 12 years.

This cross-sectional study examined the performance of children born very preterm and/or at very low birth weight (VPT/VLBW) and same-aged term-born controls in three core executive functions: inhibition, working memory, and shifting. Children were divided into two age groups according to the median (young, 8.00-9.86 years; old, 9.87-12.99 years). The aims of the study were to investigate whether (a) VPT/VLBW children of both age groups performed poorer than controls (deficit hypothesis) or caught up with increasing age (delay hypothesis) and (b) whether VPT/ VLBW children displayed a similar pattern of performance increase in executive functions with advancing age compared with the controls. Fifty-six VPT/VLBW children born in the cohort of 1998-2003 and 41 healthy-term-born controls were recruited. All children completed tests of inhibition (ColorWord Interference Task, Delis-Kaplan Executive Function System (D-KEFS)), working memory (Digit Span Backwards, HAWIK-IV), and shifting (Trail Making Test, Number-Letter Sequencing, D-KEFS). Results revealed that young VPT/VLBW children performed significantly poorer than the young controls in inhibition, working memory, and shifting, whereas old VPT/VLBW children performed similar to the old controls across all three executive functions. Furthermore, the frequencies of impairment in inhibition, working memory and shifting were higher in the young VPT/ VLBW group compared with the young control group, whereas frequencies of impairment were equal in the old groups. In both VPT/VLBW children and controls, the highest increase in executive performance across the ages of 8 to 12 years was observed in shifting, followed by working memory, and inhibition. Conclusions: This study provides evidence that (a) poor performance in inhibition, working memory, and shifting of young VPT/VLBW children might reflect a delay rather than a deficit and (b) that VPT/VLBW children are likely to display a similar pattern of performance increase in these three executive functions compared with that of controls.

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