The incidence of vertigo and dizziness in childhood is estimated about one in 100 compare to adults. Among 77 patients in nation center of National Center for Child Health and Development, vestibular migraine (=21) was the most common followed by benign paroxysmal vertigo (N=16), unilateral vestibulopathy (N=12), psychogenic vertigo (N=8) and so on. The important information for the diagnosis of benign paroxysmal vertigo is the presence of headache, the family history of migraine, and the presence of car sickness. There is the shift from benign paroxysmal vertigo to vestibular migraine. The presence of anxiety for the sudden attack sometimes has the patient to prevent to go to school. It is important to obtain correct diagnosis and offer relevant treatment in the early stage of the disease.

  The prevalence of children with attention deficit hyperactivity disorder (ADHD) appears to be increasing in Japan. Establishment of standardized diagnostic methods and approaches to the treatment of ADHD is therefore imperative. In general, ADHD is behaviorally diagnosed with behavioral questionnaires as a rating scale because objective biomarkers for ADHD remain elusive. For ADHD children, objective biomarkers must be simple, definitive, and definable using non-invasive evaluations. In recent years, neurophysiological findings with non-invasive evaluations of brain function have been reported for ADHD. Herein I review non-invasive evaluations of brain function for ADHD, with a particular focus on frequency analysis of electroencephalograms (EEGs), event-related potentials (ERPs), and near-infrared spectroscopy (NIRS). In resting EEGs, the rate of power spectra as measured by delta/beta was increased in ADHD children. Attempts have been made to apply the delta/beta ratio to the diagnosis of ADHD, and this approach has positive and negative aspects. ERPs such as P300, NoGo potentials, and mismatch-negativity (MMN) have reportedly shown utility in diagnosis and evaluation of treatment for ADHD children. NIRS is easy to perform at the forehead and is suitable for analysis of frontal functions in children. As a result, numerous studies have reported frontal dysfunctions in ADHD children. These data suggest that hemodynamic and electrophysiological findings might be useful as biomarkers in ADHD children. In the future, these methods are likely to be applicable as adjunctive methods for diagnosis and evaluation of therapy.

  Objective: We examined the characteristics of school refusal in children and the prognostic factors that may influence their outcomes. Methods: We retrospectively investigated 80 cases of school refusal in children who visited our hospital from 2007 to 2009, mainly focusing on the underlying diseases such as developmental and psychiatric disorders, educational support, and their outcomes. Results: Children with school refusal often had the underlying diseases including neurodevelopmental disorders such as pervasive developmental disorder and attention-deficit/hyperactivity disorder (57% of the patients) and psychiatric disorders (24% of the patients). In addition to the school refusal, unexplained physical complaints such as sleep disturbances or headache were observed in 91% of the patients. The reasons for school refusal were mixed, and the most frequent reason was difficulty in human relations. Regarding the prognosis one year later, 48% and 26% of the patients attended school completely or partially, respectively. Sixty percent of schoolchildren and 41% of junior high school and high school children led to complete school attendance. Forty two percent of normal development patients and 17% of patients who have developmental disorders kept school refusal. All patients who received special needs education attended school completely. Conclusions: Children with school refusal often have underlying diseases. Therefore, appropriate educational support depending on their developmental characteristics and mental status may help such children to overcome school refusal and to enjoy their school life.

  Objective: Children with severe motor and intellectual disabilities (SMID) often suffer from autonomic nervous system disturbances. The purpose of our study was to clarify the autonomic nerve activities during sleep in SMID. Methods: Fifteen children with SMID (mean age; 11.0±3.4 years old) from the school for the children with disabilities and 13 typically developed children (mean age; 9.9±3.4 years old) participated in this study. We recorded their gross motor activities by actigraph for monitoring sleep behaviors. Heart rate variability (HRV) was assessed by using a heart rate monitor during three consecutive 3 nights. Time of falling asleep and time of waking up were obtained through activity recordings. Autonomic nerve activities; low frequency (LF), high frequency (HF), LF/HF, during sleep were assessed by using power spectral analysis of HRV. We divided their sleep time into four periods by each two hours from sleep to awake, and calculated the average values of LF, HF and LF/HF in each period for comparing the change of autonomic nerve activity among the two groups. Results: There was no significant difference in sleep behaviors between the two groups. During the sleep time, HF was significantly lower and LF/HF was significantly higher in SMID than those in typically developed children. The LF/HF in SMID was significantly higher than those in typically developed children in all time period. Conclusions: The autonomic nerve status in SMID was suggestive of the predominance of sympathetic activity through the all sleep time by the decrease in parasympathetic activity. These findings may show that characteristics of autonomic nerve activity during sleep in SMID are associated with respiratory problems and immaturity of the ability to control autonomic nervous system in the central nervous system that caused by brain lesion.

  We report a case of a 10-year-old boy with gliomatosis cerebri (GC) who was initially treated for suspected acute disseminated encephalomyelitis (ADEM). He presented to a nearby hospital's neurology department with a≧1-week history of headache and nausea. A neurologic examination revealed no abnormality, and the results of cerebrospinal fluid (CSF) analysis were normal. MRI showed a diffuse white matter abnormality, and ADEM was suspected. He received three courses of methylprednisolone pulse therapy (1 g/day for 3 days). His symptoms improved and then relapsed withn 1 month. A repeat MRI showed residual white matter abnormality and enlargement of the ventricle indicating hydrocephalus. One month after the start of the steroid therapy, he was referred to our hospital's neurosurgery department and we performed a venticuloperitoneal shunt surgery. His symptoms transiently disappeared. One month later, his symptoms reappeared. He was referred to our department. He showed somnolence, horizontal nystagmus with left gazing, and truncal ataxia. The results of a CSF analysis was normal. MRI showed belt-shaped hyperintense lesions lining ventricle walls from the lateral ventricles to the 4th ventricle in a T2-weighted image and FLAIR image, with poor gadolinium-enhancement. We performed an endscopic biopsy through the lateral ventricle. Pathology revealed a gradeⅢ astrocytoma. Taken together, the imaging findings and pathologic analysis led to the diagnosis of GC. The differential diagnosis for diffuse white matter lesions should include GC.

  We report a 2-year-old girl with sepsis-associated encephalopathy (SAE) caused by Streptococcus pyogenes. At onset, she presented with fever and status epilepticus, and clinical and neuroradiological findings indicated fulminant neurological damage. Initial MRI findings showed several small ischemic lesions, but the images on the 9^th hospital day demonstrated the signs of remarkable brain edema and late reduced diffusion. Elevated cerebrospinal fluid interleukin (IL) -6 level and normal IL-10 level were similar to the findings of AESD (acute encephalopathy with biphasic seizures and late reduced diffusion). Our findings suggest that SAE can present in various forms of encephalopathy because a number of pathophysiological mechanisms are involved in SAE.

  We performed MR spectroscopy of the splenium of the corpus callosum in two patients with clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). MRS in the acute stage showed a high choline/creatine ratio in comparison with that in the chronic stage with complete clinical and radiological recovery, which suggested myelin dysfunction of the myelin, including intramyelinic edema.

  A 10-year-old boy was admitted to the hospital complaining of a fever of 7 days' duration and myalgia. He had undergone renal transplantation at the age of seven due to chronic renal failure and had been receiving immunosuppressive agents. On admission, he complained of severe pain in his lower extremities and difficulty walking. Based on elevated serum creatine kinase, acute viral myositis was diagnosed. Seven days after admission, however, urinary incontinence as well as sensory disturbances in the hip and genitalia became evident. Based on the presence of Epstein-Barr virus (EBV) DNA in the cerebrospinal fluid and abnormal signals on MRI of the spinal cord at levels lower than Th8, EBV-associated myelitis was diagnosed. Immunosuppressive agents were reduced, and administration of immunoglobulin, ganciclovir and steroids was started. His condition gradually recovered with minimal sequelae. The antibody titer against EBV confirmed the past infection, suggesting that his myelitis might have been caused by EBV reactivation. This case indicates that reactivating EBV should be considered as a potential cause of myelitis in immunosuppressed patients.