Brain Dysfunction in Children

Bender-Gestalt Test. The Bender-Gestalt is a nonverbal performance test in which the individual copies a design shown on a card. It is often used to identify a problem of visual perception and/or motor performance or minimal brain dysfunction in children. 

Wender, P., Eisenberg, L. (1975). Minimal brain dysfunction in children. In S. Arieti (Ed.), American handbook of psychiatry (Vol. 2). New York Basic Books. 

It is a mild CNS stimulant having a therapeutic potency intermediate to caffeine and amphetamine. It is used in the treatment and management of minimal brain dysfunction in children. 

Wender, P. H. (1971). Minimal Brain Dysfunction in Children. Wiley, New York. 

Conners, C.K. Psychological effects of stimulant drugs in children with minimal brain dysfunction. Pediatrics 49 702-708, 1972. 

With disruption of this barrier, molecules such as albumin freely enter the brain and ions and water follow. Because the brain lacks a well-developed lymphatic system, clearance of plasma constituents is slow, edema occurs, and intracranial pressure rises. At lower levels of exposure, subtle dysfunction of the blood-brain barrier may contribute to neurobehavioral deficits in children (Bressler and Goldstein 1991 Goldstein 1993). The particular vulnerability of the fetus and infant to the neurotoxicity of lead may be due in part to immaturity of the blood-brain barrier and to the lack of the high-affinity leadbinding protein in astroglia, which is discussed later in this section. Results of measurements of transendothelial electrical resistance across the blood-brain barrier from mice of various ages showed that lead potentiates cytokines-induced increase in ion permeability of the blood-brain barrier (Dyatlov et al. 

The notion that colors, flavors, and other common food additives could adversely affect children s behavior was widely publicized in the 1970s. According to Feingold (1974), 40-70% of children who exhibited impulsive behavior, learning disabilities, short attention spans, and other symptoms characteristic of attention deficit hyperactivity disorder or ADHD (formerly called hyperkinesis, hyperactivity, or minimal brain dysfunction) showed dramatic improvement when placed on diets without food dyes and other common additives. 

The therapeutic indications for the psychomotor stimulants are quite limited. They are beneficial in the treatment of the hyperkinetic syndrome (attention deficit-hyperactivity disorder with minimal brain dysfunction). This is generally a childhood disease characterized by hyperactivity, inability to concentrate, and impulsive behavior. Amphetamines and the more extensively used methylphenidate paradoxically are quite effective in calming a large proportion of children with this disorder. Pemoline Cylert) is also used in the treatment of attention deficit disorder with hyperkinetic behavior. The mechanism by which these compounds are effective in this disorder is not known. 

Indicative of serotonergic dysfunction, abused children with depression were shown to exhibit increased prolactin, but normal cortisol responses to the injection of E-5-hydroxytryptophan, a precursor of 5-HT, as compared to nonabused depressed children and controls (Kaufman et ah, 1998). Likewise, increased prolactin responses to fenfluramine were observed in boys with adverse rearing environment (Pine et ah, 1997). Since prolactin, but not cortisol release, is mediated via 5-HTia receptors, these findings suggest sensitization of these receptors due to early-life stress. Another study recently reported that children with traumatic brain injury (TBl) who had experienced abuse have dramatic increases in CSE concentrations of glutamate, compared to nonabused TBI children (Ruppel et ah, 2001). 

Williams, D.T., Mehl, R., Yudofsky, S., Adams, D., and Roseman, B. (1982) The effect of propranolol on uncontrolled rage outbursts in children and adolescents with organic brain dysfunction. J Am Acad Child Psychiatry 21 129—35. 

Connors, C.K. (1975) Controlled trial of methylphenidate in preschool children with minimal brain dysfunction. Int J Ment Health 4 61-74. 

Neuropsychological deficits exist in children with Asperger s syndrome, nonverbal learning dysfunction and other learning disabilities, mental retardation (MR), frontal lobe and temporal lobe dysfunction, and traumatic brain injury (Filley et al., 2001). 

Conners CK, Taylor E. Pemoline methylphenidate, and placebo in children with minimal brain dysfunction. Arch Gen Psychiatry 1980 37 922-930. 

In the 1960s, Ritalin was prescribed for children identified as having personality-driven symptoms—the condition first called MBD (minimal brain dysfunction) and hyperkinetic reaction. Having excessive motor activity was a prerequisite to fit into this category. As a result, many children were not considered eligible for Ritalin. 

Nonallergic hyperreactivity corresponds to the traditional notion of food intolerance. It is a syndrome in which dysfunctions are similar to those observed in the course of allergic diseases, induced by various mechanisms, excluding immunology-related factors. Nonallergic hyperreactivity occurs more frequently than allergy. Morbidity rate in children is approximately 20%-50%, while in adults it is estimated to be approximately 20%. Attention is drawn to the fact that the enzymatic system in children is less mature, so the capacity to bind chemical compounds by plasma proteins is poorer, and so is the blood-brain barrier permeability by low molecular weight compounds. 

There is large variation in individual responses to methylphenidate among hyperactive children with minimal brain dysfunction. It is therefore advisable to start with small divided doses, since some sjmptoms (extrapjr-amidal and seizure-like) could be dose-related. 

Approximately 7% of all live-born humans bear birth defects. This value may be as high as 10% if children are evaluated to age 10 years to include subtle structural or functional deficits such as minimal brain dysfunction or attention deficit disorders. More than 560 000 lives out of 3 million births per year in the United States are lost through infant death, spontaneous abortion, stillbirths, and miscarriage due presumably to defective fetal development. The relative contributions to human teratogenesis have been estimated as follows known germinal mutations, 20% chromosomal and gene aberrations, 3-5% environmental causes such as radiation, <1% infections, 2% or 3% maternal metabolic imbalance, 1% or 2% drugs and environmental chemicals, 4% or 5% contributions from maternal dietary deficiencies or excesses and... 

Promethazine causes sedation by reducing stimuli to the brain stem reticular system. Like other antihistamines, promethazine has significant anticholinergic effects it should be used with caution in patients with narrow-angle glaucoma, peptic ulcer, or pyloroduodenal obstruction or urinary bladder obstruction from prostatic hypertrophy or narrowing of the bladder neck. It also should be used with caution in patients with CVD or hypertension because of the risk of palpitations with acute or chronic respiratory dysfunction (especially children) because promazine may depress the cough reflex. 

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