The study was conducted on 80 children with speech disorders in preschool children who attended the outpatient clinic of neurology and phoniatric departments, during the period February 2018 to March 2019. Consent from the parents of the patient was taken to participate in this study, which was approved by the local ethics committee Institutional Research Board (IRB) of our departments of neurology. Code RP. 19.10.45 date 30 October 2019. These children were suffering from expressive language abnormalities and combined expressive-receptive language disorders. Control group were 80 healthy children with age and sex match. The age was about 3–6 years. Previous history of perinatal hypoxic-ischemic damage, meningitis or encephalitis, motor weakness, hearing disorders, intelligence quotient (IQ) below seventy, cerebral palsy (CP), social deprivation, autism, and psychiatric disorders were considered as an exclusion criterion.
Participants underwent an evaluation with detailed history, developmental status analysis, and a comprehensive examination. Computed tomography (CT) brain was done for all patients and MRI brain was carried out for all patients with epileptiform activity or with suspected lesion in CT brain.
Electroencephalogram was done for all patients to document the presence or absence of any epileptiform activity. An electroencephalogram (EEG) was carried out using the 10–20 international system for about 20 min under standard conditions and by using provocative techniques like hyperventilation and photic stimulation. Recordings were performed using EB Neuro Basis BE Hardware (Firenze, Italy) and Galileo Software (Firenze, Italy) for EEG data acquisition and review.
Because children have a tendency to move during EEG acquisition, electrode application should be carried out with high care. All 21 electrodes of the International 10–20 system should be used. Especially active children may need more recurrent check of electrode recording quality. The voltage of EEG activity in children is higher than that of adults, and a decrease of sensitivity to 10–15 mV/mm could be used. Hyperventilation was done at the start of EEG recording and photic stimulation at the end. In older children, EEG acquisition may involve periods with open and closed eyes. Sleep recordings are preferred, with continuous EEG recording rather than pausing in between states (waking vs. drowsy vs. sleep) and should be indicated clearly at the start of the EEG acquisition with each montage [16].
EEGs finding were defined according to the following [17, 18]:
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“Normal: is within the range of frequency and amplitude distribution”.
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“Epileptiform: describes transient background activity with characteristic spikes, sharp waves, spike slow-wave or sharp slow-wave complexes of focal or generalized distribution” and the background abnormality not matched with the state and age of the child.
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“Abnormal without epilepsy: deviations from normal in terms of background frequency patterns, usually in the form of excessive slow activity”.
“Epilepsy is defined as a group of neurological disorders characterized by repetitive attacks of epileptic seizures [19]. An epileptic seizure is a transient incidence of signs and/or symptoms due to abnormal synchronous neuronal activity in the brain [20].
The International League Against Epilepsy (ILAE) official reported in 2017 that epilepsy is considered if two or more seizures occurring > 24 h apart, one unprovoked seizure and a probability of recurrent seizure risk more than 60% [19]. If there is any epileptiform discharge on EEG, or a potential epileptogenic structure on brain imaging, the probabilities of repetitive epileptic attack more than 60% [21]”.
Phoniatric assessment was carried out for all participants. Evaluation of cognitive age (mental age): using the Stanford-Binet Intelligence Scale Fifth Edition (SB5) classification of the IQ [22]:
IQ range
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Classification
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145–160
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(Highly advanced)
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130–144
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(Very advanced)
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120–129
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(Superior)
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110–119
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(High average)
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90–109
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(Average)
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80–89
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(Low average)
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70–79
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(Borderline impaired)
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55–69
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(Mildly impaired)
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40–54
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(Moderately impaired)
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Evaluation of social age: using the Vineland Social Maturity Scale [23]. The Vineland Social Maturity Scale (VSMS) estimates the social abilities. It gives a measure of social age (SA) and social quotient (SQ). VSMS scans social abilities among kids in the areas of self-help general, self-help eating, self-help dressing, self-direction, occupation, communication, locomotion, and socialization.
The VSMS is formed of 89 test sub-items grouped according to year levels and consists of group of questions for children of each completed year ranged from 0 up to 15 years. Compute social quotient (SQ) by dividing social age by chronological age and multiplying by 100.
Language evaluation by Comprehensive Arabic Language Test (CALT) [24] which is a test battery composed of five subtests.
Test of phonology that consists of 71 words. Each Arabic phoneme is evaluated in a variable position and the articulation of the corresponding picture is assessed. Test of semantics includes 214 items. Recognize and name: different semantic groups as vegetables, clothes, and fruits. Also, variable concepts as direction, quantity, time, and matching. Test of the morphology consist of 56 questions. Variable morphological structures as personal pronouns, verb tense, negation, and derivation. Test of the syntax include the receptive syntactic ability is (repeating 10 sentences, following 8 directives, and answering 7 questions. The expressive syntactic ability is describing 10 actions, sequencing 4 events, and finally test of pragmatics consists of 42 questions indicating different speech act as requesting, regulating, informing, and expressing. The core of each subtest is the sum of the correct answers.
A score of 2 or more standard deviation (SD) below the test mean of CALT and the VSMS is considered impaired.
Statistical analysis
Information and findings of the present study were analyzed with computed SPSS version 21 (SPSS, version 21; SPSS Inc., Chicago, IL, USA). Continuous data were expressed in the form of mean ± SD while categorical data were expressed in the form of numbers and %. Continuous data were compared by utilizing Student’s t test, while categorical comparison was done utilizing chi-square test. For abnormally distributed data, a comparison between the two groups was made using the Mann–Whitney test. The frequency of EEG abnormality in the two groups was related to statistical significance. P value of 0.05 or less is considered of statistical significance. The correlation of abnormal EEG activity and SLI, IQ, cognitive age, and social age was performed by Spearman correlation analysis.