Periventricular nodular heterotopia (PVNH) is a malformation of cortical development (MCD) characterized by aggregates of gray matter adjacent to the lateral ventricular walls. Clinical presentation is heterogeneous with higher rates of seizures and reading impairments typically in the setting of average IQ (Felker et al. 2011). The majority of neuropsychological inquiry has focused on reading fluency, though a single case study showed a neurocognitive profile consistent with nonverbal learning deficits in a 7-year old boy with suspected autosomal dominant bilateral heterotopia (McCann et al., 2008). Given the periventricular focus and potential for unilateral presentations, non-linguistic neurocognitive sequelae may be expected in cases affecting the non-dominant hemisphere, yet this remains largely unexplored. Surgical ablation by laser interstitial thermal therapy (LITT) is increasingly used for epilepsy management in PVNH (Thompson et al., 2016, Whiting et al. 2020). However, there are no reported studies exploring cognitive outcomes following LITT of focal PVNH.

A 46-year-old, right handed, Black female with 16 years of education presented for management of medically refractory epilepsy. Epilepsy monitoring captured intermittent slow waves in the right temporal lobe, interictal polyspikes in the right temporal lobe, and three epileptic events all emanating from the right temporal lobe. MRI showed extensive migrational anomalies involving the right hemisphere posteriorly consistent with PVNH with no associated mesial temporal sclerosis. Pre-surgical neuropsychological evaluation showed a significant split in IQ, with verbal IQ = 99 and performance IQ = 76. Testing indicated circumscribed deficits in visuoperceptual judgement, visuoconstruction, visuospatial reasoning, non-verbal recall, and several executive weaknesses in the context of otherwise average neurocognitive functioning. Fine motor speed was impaired bilaterally. Her profile was suggestive of non-dominant fronto-parieto-temporal dysfunction, concordant with the remainder of her work-up. By history she reported longstanding academic weaknesses in math and organization with strong verbal and reading abilities.

The patient underwent partial LITT of right PVNH sparing areas involved in visual function. At 6-month follow-up she was seizure free (Engel outcome 1A). Post-surgical neuropsychological evaluation showed reliable improvements in perceptual reasoning, aspects of learning/memory, and verbal naming. Visuoconstruction remained impaired but qualitatively improved. She also reported subjective experience of improved mental clarity and was applying for jobs after regaining driving privileges.

This case demonstrates symptoms and history concerning for a nonverbal learning disorder in an adult woman with epilepsy secondary to right hemisphere PVNH and underscores the importance of exploring the range of neurocognitive profiles in MCD. Her notable neurocognitive and functional improvements following surgical ablation and seizure freedom suggest a possible release of function in the absence of inhibitory neurophysiological influences. This raises interesting questions about the endurance of her developmental profile. This case report contributes to our understanding of neuroanatomical correlates of neurocognitive and neurodevelopmental presentations. Future investigations should explore neuropsychological changes following LITT for PVNH.

The increasing incidence rates of concussive injuries, specifically among the youth age demographic, has led to the Center for Disease Control and Prevention to classify these injuries as a “silent epidemic.” While symptoms from concussion typically remit within four weeks, many experience symptoms that persist beyond what is typically expected. For children, the persistence of symptoms can have damaging side-effects that impact daily functioning and the progression through developmental and educational milestones. Recent research highlights factors that modify the nature of outcomes after a concussive injury. For youth-aged individuals, one such factor is the presence of premorbid conditions. A growing body of research suggests children with learning disorders (LDs) may be more susceptible to negative symptom outcomes across neuropsychological domains. Therefore, the purpose of this study is to further examine the influence of developmental learning disorders on concussion outcomes among youths.

Youths between 7 and 19 years of age that sought care at a concussion specialty clinic were screened for inclusion in the current study. The final sample of included 54 patients who reported having a neurodevelopmental LD between the ages of 8 and 17 and 54 patients without LDs matched on age, race/ethnicity, and gender to serve as paired case-controls. Measures of post-concussive physical symptoms (Modified Balance Error Scoring System; Quality of Life in Neurological Disorders: Neuro-QoL-SD, Neuro-QoL-F), emotional state (BAI, BDI), parent report measure of behavioral manifestations of cognitive functioning (Behavioral Rating Inventory of Executive Function), and select measures from the CogState automated test battery (i.e., One-Back, Two-Back, Groton Maze Learning, and Groton Maze Recall) were administered during the patient’s first examination at the clinic. Patients were instructed by the provider to follow-up at the clinic between two-three weeks for a repeat examination. The current study examined concussion outcome variables via two (group: LD, control) by two (time: initial examination, follow-up examination) repeated measures ANCOVAs where time between injury and the first examination was included as a covariate to control for the duration of elapsed days since injury.

Regarding cognitive symptoms, parent reported behaviors associated with executive functioning symptoms increased over time to reach clinically significant levels for the LD group, while symptoms decreased and remained within normal limits for the control group. Performance-based measures of cognition revealed no significant interactions or group/time differences. Additionally, the LD group showed more intense balance problems compared to the control group and symptom trends suggest LD participants may be more susceptible to prolonged, clinically significant, balance problems. With respect to sleep disturbances and fatigue, symptoms remained within normal limits across groups and time. Depression and anxiety symptoms remained within normal limits across groups and time as well.

Results highlight more intense balance problems and parent-reported executive dysfunction following concussion for youths with LDs compared to those without LDs. Additionally, though not significantly different

than the control group, results reveal several symptom domains in which the level of dysfunction meets clinical significance for the LD group participants only. As such, this study highlights the continued need for the scientific study of risk factors for vulnerable populations to aid in assessment and prevention efforts, especially for youths with LD.

Challenging behavior is a common reason for referral to psychiatric service. Psychotropic medications widely used to modify behaviors, even when no evidence of diagnosable mental illness. However, literature show little evidence that benefits outweigh the risks in their prescription. Monitoring using International guidelines may help improving the outcomes. We audit current practice against known standards.

- To assess adherence within the Qatar Mental Health Services to National guidelines on using medication to manage behavior problems in adults with a learning disability. - To identify strengths and weaknesses in current practice. - To Make recommendations to improve LD patient care

Patients with LD attending psychiatric clinic screened using selection and exclusion criteria and data collected and analyzed using format from the International standards.

102 patients screened, 85 selected and 17 cases excluded Age range 18 to 50 years. 27% mild, 29% moderate and 44% severe LD, Autism 40% Psychiatric Diagnosis 55% Challenging behavior 45% Antipsychotic prescribing: 79% Rationale documented in 74%, Capacity assessment in 81%, Review of side effects in 53% Safety of medication in 61%, Medication discontinuation in 66%, Reasons for discontinuation in 36%

Antipsychotics use (79%) is high with several combinations of IM and oral or more than 2 drugs. There is need for improvement across all standards. Rationalising the prescribing for LD patients to improve the outcomes for the safety of these patients. The audit indicate need for specialist service to monitor prescribing and apply standards of care in clinical service.

No significant relationships.

Developmental studies in infancy remain rare. Studies measuring depressive symptoms in gifted children are contradictory, considering more anxiety or depression than in non-gifted children. Furthermore, questionnaires or anxiety scales are used without taking into account all aspects of mood disorders and thus, rarely depression scales have been conducted.

To refine the developmental trajectory of depression in a national sample of French gifted children by identification of the specific risk and protective factors.

A self-reported depression scale MDI-C (Multiscore-Depression-Inventory-for-Children) were sent to families to be administered to their gifted children from preschool to high school, aged from 4 to 20 years-old (IQ >125) looking for help from gifted associations. A larger wave of data collection on different aspects of child and family history was collected (pregnancy, term and delivery mode, neonatal period, psychomotor development, health, schooling, interpersonal relationships with family and friends, personality, parental socio-economic status).

438 children (> 130) were eligible. Regarding anamnestic fields, Exploratory-Factor-Analysis highlighted six predictive factors of depression with eigenvalues from 1.09 to 3.17. Major factors explaining 62.96% of total variance are: Factor-1 “motor skills disorder” (14.53%). Factor-2 “positive family relationships” (14.04%). Factor-3 “positive social relationships with peers” (14.02%). Factor-4 “integration of social codes” (11.23%). Factor-6 “Learning disabilities and rehabilitation” (10.1%).

Our findings highlight specifics risk factors of depression in the field of learning disabilities or social cognition, while a good quality of social relationships since childhood seems to be a preventive factor.

No significant relationships.

Examine pre-existing learning disorders (LD) and attention deficit/hyperactivity disorders (ADHD) as risk factors for prolonged recovery and increased symptomology following pediatric mild traumatic brain injury (mTBI).

We conducted a retrospective cohort study of children/adolescents (5-17 years) with mTBI who presented to a Children’s Minnesota Concussion Clinic between April 2018 and March 2019. Differences across strata of pre-existing conditions (present vs. absent) in time to recovery measures were estimated via Kaplan–Meier and Cox proportional hazards analyses and differences in symptom trajectories were examined via linear mixed-effects regression models. Regression models were adjusted for age, sex and other confounders.

In our cohort of 680 mTBI patients, those with LD (n = 70) or ADHD (n = 107) experienced significantly longer median durations of symptoms (58 and 68 days, respectively) than those without (43 days). Accordingly, LD was significantly associated with delayed symptom recovery (adjusted hazard ratio (aHR) = 1.63, 95% CI: 1.16–2.29), return to school (1.47, 1.08–2.00), and return to physical activity (1.50, 1.10–2.04). Likewise, ADHD was associated with delayed recovery (1.69, 1.28–2.23), return to school (1.52, 1.17–1.97) and physical activity (1.55, 1.19–2.01). Further, patients with LD or ADHD reported, on average, significantly more concussion symptoms and higher vision symptom scores throughout recovery versus those without. There was no evidence that concussion or vision symptom recovery trajectories varied over time between those with/without LD or ADHD (joint P-interactions > 0.05).

Pre-existing LD and ADHD are risk factors for prolonged and more symptomatic mTBI recovery in youth. These results can inform clinical concussion management and recovery expectations.

Latent toxoplasmosis, the life-long presence of dormant stages of Toxoplasma in immunoprivileged organs and of anamnestic IgG antibodies in blood, affects about 30% of humans. Infected subjects have an increased incidence of various disorders, including schizophrenia. Several studies, as well as the character of toxoplasmosis-associated disturbance of neurotransmitters, suggest that toxoplasmosis could also play an etiological role in Obsessive-Compulsive Disorder (OCD).

The aim of the present cross-sectional study performed on a population of 7471 volunteers was to confirm the association between toxoplasmosis and OCD, and toxoplasmosis and psychological symptoms of OCD estimated by the standard Obsessive-Compulsive Inventory-Revised (OCI-R).

Incidence of OCD was 2.18% (n = 39) in men and 2.28% (n = 83) in women. Subjects with toxoplasmosis had about a 2.5 times higher odds of OCD and about a 2.7 times higher odds of learning disabilities. The incidence of 18 other neuropsychiatric disorders did not differ between Toxoplasma-infected and Toxoplasma-free subjects. The infected subjects, even the OCD-free subjects, scored higher on the OCI-R.

Limitations: Examined subjects provided the information about their toxoplasmosis and OCD statuses themselves, which could result in underrating the strength of observed associations.

The results confirmed earlier reports of the association between toxoplasmosis and OCD. They also support recent claims that latent toxoplasmosis is in fact a serious disease with many impacts on quality of life of patients.