201
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Acute and non-acute lower extremity pain in the pediatric population: part II. J Pediatr Health Care 2012; 26:216-30. [PMID: 22526001 DOI: 10.1016/j.pedhc.2012.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 01/27/2012] [Accepted: 01/30/2012] [Indexed: 11/21/2022]
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202
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Leviton A, Nichol SM, Allred EN, Loddenkemper T. What is quality improvement and why should child neurologists care? J Child Neurol 2012; 27:251-7. [PMID: 21997846 DOI: 10.1177/0883073811419258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In this article, the authors discuss the 6 domains of care identified by the Institute of Medicine report, Crossing the Chasm, with examples and questions that are especially relevant to physicians caring for children who have neurologic disorders and their families.
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Affiliation(s)
- Alan Leviton
- Departments of Neurology, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA.
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203
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Williams CH, Frush DP. Compendium of national guidelines for imaging of the pediatric patient. Pediatr Radiol 2012; 42:82-94. [PMID: 21826467 DOI: 10.1007/s00247-011-2211-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 06/21/2011] [Indexed: 12/24/2022]
Abstract
BACKGROUND Diagnostic imaging plays an integral role in diagnosing and managing many pediatric disorders, but there is growing concern in both the medical community and the general public about the long-term health effects of ionizing radiation in children, as well as utilization of imaging evaluation. These concerns, coupled with increasing pressure to reduce national health care spending, underscore the need for an assessment of readily available guidelines, especially evidence-based guidelines, for imaging in children. OBJECTIVE To generate a list of national medical organization-endorsed guidelines with provisions for imaging the pediatric patient. MATERIALS AND METHODS Several resources, including the National Guideline Clearinghouse (NGC) and the Web sites of major medical organizations, were searched for documents that contained specific recommendations for imaging in the pediatric population. RESULTS A total of 155 guidelines from 40 medical organizations met inclusion criteria and are represented in our compendium. CONCLUSIONS The compendium generated in this study can be used to direct clinical care, inform policy development and improve education of health care personnel. Additionally, the compendium can be used to identify areas of redundancy or deficiency, which may stimulate the reassessment of existing recommendations as well as the creation of new guidelines.
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204
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Sellier E, Uldall P, Calado E, Sigurdardottir S, Torrioli MG, Platt MJ, Cans C. Epilepsy and cerebral palsy: characteristics and trends in children born in 1976-1998. Eur J Paediatr Neurol 2012; 16:48-55. [PMID: 22079130 DOI: 10.1016/j.ejpn.2011.10.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 10/06/2011] [Accepted: 10/23/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Although epilepsy is common in children with cerebral palsy (CP), no data exists on prevalence rates of CP and epilepsy. AIMS To describe epilepsy in children with CP, and to examine the association between epilepsy and neonatal characteristics, associated impairments and CP subtypes. METHODS Data on 9654 children with CP born between 1976 and 1998 and registered in 17 European registers belonging to the SCPE network (Surveillance of Cerebral Palsy in Europe) were analyzed. RESULTS A total of 3424 (35%) children had a history of epilepsy. Among them, seventy-two percent were on medication at time of registration. Epilepsy was more frequent in children with a dyskinetic or bilateral spastic type and with other associated impairments. The prevalence of CP with epilepsy was 0.69 (99% CI, 0.66-0.72) per 1000 live births and followed a quadratic trend with an increase from 1976 to 1983 and a decrease afterwards. Neonatal characteristics independently associated with epilepsy were the presence of a brain malformation or a syndrome, a term or moderately preterm birth compared with a very premature birth, and signs of perinatal distress including neonatal seizures, neonatal ventilation and admission to a neonatal care unit. CONCLUSIONS The prevalence of CP with epilepsy followed a quadratic trend in 1976-1998 and mirrored that of the prevalence of CP during this period. The observed relationship between epilepsy and associated impairments was expected; however it requires longitudinal studies to be better understood.
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Affiliation(s)
- Elodie Sellier
- UJF-Grenoble 1/CNRS/TIMC-IMAG UMR 5525, Grenoble, F-38041, France.
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205
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Steven RA, Green KMJ, Broomfield SJ, Henderson LA, Ramsden RT, Bruce IA. Cochlear implantation in children with cerebral palsy. Int J Pediatr Otorhinolaryngol 2011; 75:1427-30. [PMID: 21893352 DOI: 10.1016/j.ijporl.2011.08.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 08/07/2011] [Accepted: 08/09/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Few studies have looked at the outcomes of children with complex needs following cochlear implantation. Increasing evidence supports the case for implantation in these children. To date there is very little evidence available evaluating the role of cochlear implantation in children with cerebral palsy. In this paper we look at the Manchester Cochlear Implant Programme's experience of implantation in 36 children with cerebral palsy. METHODS A retrospective review of prospectively collected data for all children with cerebral palsy was undertaken. Cognitive and physical disability was scored by members of the cochlear implant team. A modified version of Geers and Moogs 1987 Speech Reception Score was used to assess outcome. Data was analysed looking at the relationship between cognitive and physical impairment, age at implantation and the SRS outcomes. RESULTS This study demonstrated that children with cerebral palsy and a mild cognitive impairment do significantly better following implantation than those with a severe impairment (p=0.008). Children with mild physical impairment did not appear to do significantly better than those with moderate or severe impairments (mild versus severe p=0.13). Age at implantation was not a significant prognostic factor in this study group. CONCLUSIONS Children with complex needs are increasingly being referred for consideration of cochlear implantation. Further research is required to help guide candidacy, but each case must be considered individually. Higher functioning does appear to be the most important prognostic indicator regarding outcome but the effect of modest improvement in sound perception should not be underestimated.
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Affiliation(s)
- Richard A Steven
- Manchester Auditory Implant Centre, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
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206
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Abstract
All primary care providers will care for children with cerebral palsy in their practice. In addition to well-child and acute illness care, the role of the medical home in the management of these children includes diagnosis, planning for interventions, authorizing treatments, and follow-up. Optimizing health and well-being for children with cerebral palsy and their families entails family-centered care provided in the medical home; comanagement is the most common model. This report reviews the aspects of care specific to cerebral palsy that a medical home should provide beyond the routine health care needed by all children.
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207
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Reid SM, Modak MB, Berkowitz RG, Reddihough DS. A population-based study and systematic review of hearing loss in children with cerebral palsy. Dev Med Child Neurol 2011; 53:1038-45. [PMID: 21895642 DOI: 10.1111/j.1469-8749.2011.04069.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aims of this study were to estimate the frequency of hearing loss in children with cerebral palsy (CP), to examine factors associated with hearing loss, and to describe aspects of hearing in a population sample of children with CP and hearing loss. METHOD A systematic review of the international literature was undertaken, and data on the frequency of hearing loss or severe hearing loss were extracted from 14 data sets based on previously devised criteria. Six hundred and eight-five children with CP (406 males, 279 females) born in Victoria, Australia, between 1999 and 2004 were identified from the Victorian Cerebral Palsy Register. Children were included if they had an established post neonatal cause for their CP before the age of 2 years. Additional information was collected on 48 children with documented hearing loss based on a four-tone pure tone average in the better ear. RESULTS There was considerable variation in the definitions and proportions of hearing loss (range 4-13%) and severe hearing loss (range 2-12%) reported by CP registries in developed countries. In Victoria, 7% of individuals with CP had bilateral hearing loss of a moderate to profound degree, whereas the subgroup with a severe-profound degree of loss constituted 3% to 4% of the CP population. INTERPRETATION These population-based data are likely to more accurately reflect the true frequency of defined hearing loss in children with CP than previous reviews.
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Affiliation(s)
- Susan M Reid
- Departmental Disability Research, Murdoch Childrens Research Institute and Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.
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208
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Legault G, Shevell MI, Dagenais L. Predicting comorbidities with neuroimaging in children with cerebral palsy. Pediatr Neurol 2011; 45:229-32. [PMID: 21907883 DOI: 10.1016/j.pediatrneurol.2011.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 06/21/2011] [Indexed: 11/18/2022]
Abstract
A population-based registry was used to ascertain whether neuroimaging findings of children with cerebral palsy could predict the occurrence of certain comorbidities. Neuroimaging findings and comorbidities data were extracted from the Quebec Cerebral Palsy Registry for children born in a 4-year birth interval (1999-2002) covering half of the province's population. Neuroimaging studies were classified into 10 mutually exclusive categories (periventricular white matter injury/leukomalacia, cerebral malformation, cerebral vascular accident, deep gray matter injury, superficial gray matter injury, diffuse gray matter injury, intracranial hemorrhage, infection, nonspecific findings, and normal). Comorbidities studied included cortical blindness, severe auditory impairment, inability to communicate verbally, assisted feeding, and the presence of afebrile seizures in the prior 12 months. Neuroimaging results were available for a total of 213 children. Only deep gray matter injury (defined as signal abnormality or volume loss in subcortical gray matter, n = 9) was significantly (P < 0.05) linked with the occurrence of both the inability to communicate verbally (n = 5, 55.6% vs n = 46, 22.5%, P = 0.04) and with a higher mean number of comorbidities (1.67 vs 0.70, P < 0.01), and therefore with increased burden of comorbidities. These findings may improve our ability to prognosticate the outcome of children with cerebral palsy, enabling targeted early direct interventions.
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Affiliation(s)
- Geneviève Legault
- Division of Pediatric Neurology, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada
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209
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Rose S, Guzzetta A, Pannek K, Boyd R. MRI Structural Connectivity, Disruption of Primary Sensorimotor Pathways, and Hand Function in Cerebral Palsy. Brain Connect 2011; 1:309-16. [DOI: 10.1089/brain.2011.0034] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stephen Rose
- University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia
- Centre for Advanced Imaging, Queensland, Australia
- Centre for Medical Diagnostic Technologies in Queensland, Queensland, Australia
| | - Andrea Guzzetta
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, St Lucia, Brisbane, Australia
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy
| | - Kerstin Pannek
- University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia
- Centre for Advanced Imaging, Queensland, Australia
| | - Roslyn Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, St Lucia, Brisbane, Australia
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210
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Jenks KM, van Lieshout ECDM, de Moor JMH. Cognitive correlates of mathematical achievement in children with cerebral palsy and typically developing children. BRITISH JOURNAL OF EDUCATIONAL PSYCHOLOGY 2011; 82:120-35. [PMID: 22429061 DOI: 10.1111/j.2044-8279.2011.02034.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Remarkably few studies have investigated the nature and origin of learning difficulties in children with cerebral palsy (CP). AIMS To investigate math achievement in terms of word-problem solving ability in children with CP and controls. Because of the potential importance of reading for word-problem solving, we investigated reading as well. SAMPLE Children with CP attending either special (n= 41) or mainstream schools (n= 16) and a control group of typically developing children in mainstream schools (n= 16). METHOD Group differences in third grade math and reading, controlled for IQ, were tested with analyses of co-variance (ANCOVAs). Hierarchical regression was used to investigate cognitive correlates of third grade math and reading. Predictors included verbal and non-verbal IQ measured in first grade, components of working memory (WM) and executive function (EF) measured in second grade, and arithmetic fact fluency and reading measured in third grade. RESULTS Children with CP in special schools performed significantly worse than their peers on word-problem solving and reading. There was a trend towards worse performance in children with CP in mainstream schools compared to typically developing children. CONCLUSIONS Impairments of non-verbal IQ and WM updating predicted future difficulties in both word-problem solving and reading. Impairments of visuospatial sketchpad and inhibition predicted future word-problem, but not reading difficulty. Conversely, deficits of phonological loop predicted reading but not word-problem difficulty. Concurrent arithmetic fact fluency and reading ability were both important for word-problem solving ability. These results could potentially help to predict which children are likely to develop specific learning difficulties, facilitating early intervention.
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Affiliation(s)
- Kathleen M Jenks
- Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, The Netherlands.
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211
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Ramaswamy V, Jacob FD, Bolduc FV. Rearrangement of chromosome 14q with associated white matter disease. Pediatr Neurol 2011; 45:117-20. [PMID: 21763953 DOI: 10.1016/j.pediatrneurol.2011.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 03/07/2011] [Indexed: 11/30/2022]
Abstract
We report the case of a 29-month-old boy with spasticity and periventricular white matter changes on magnetic resonance imaging in whom a complex rearrangement consisting of a de novo duplication of 14q32.31q32.33 and deletion of 14q32.33 was identified by array-based comparative genomic hybridization. Our case replicates some of the previous features associated with chromosome 14q duplication and deletion while expanding its clinical spectrum with pyramidal tract dysfunction signs and neuroimaging features. Genomic lesions should be considered in cases of leukodystrophies, and genome-wide studies such as array-based comparative genomic hybridization could be considered in the assessment of undefined white matter disorders.
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Affiliation(s)
- Vijay Ramaswamy
- Division of Pediatric Neurology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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212
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Yoshida S, Hayakawa K, Oishi K, Mori S, Kanda T, Yamori Y, Yoshida N, Hirota H, Iwami M, Okano S, Matsushita H. Athetotic and Spastic Cerebral Palsy: Anatomic Characterization Based on Diffusion-Tensor Imaging. Radiology 2011; 260:511-20. [DOI: 10.1148/radiol.11101783] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
PURPOSE The objective was to investigate the clinical features of schizencephaly in children with spastic cerebral palsy. MATERIAL AND METHODS The present study included 180 children with cerebral palsy, spastic tetraplegia, diplegia, and hemiplegia. All magnetic resonance (MR) scans were obtained using a 1.5 T MR scanner with the use of a standard circularly polarized head coil. RESULTS Significant abnormalities relevant to cerebral palsy were evident on MRI in 95%. Periventicular leukomalacia was detected more frequently in children with spastic diplegia than in other patients. Cerebral atrophy was found more often in tetraplegic patients. Porencephalic cysts were detected more often in children with spastic hemiplegia. Congenital brain anomalies were evident in 20 (11.1%) children with spastic cerebral palsy. Twelve patients had schizencephaly with cerebral palsy. Children with spastic diplegia and tetraplegia had bilateral schizencephaly; patients with spastic hemiplegia only had unilateral schizencephaly. Most patients with schizencephaly had epilepsy. CONCLUSIONS Schizencephaly occurred more often in patients with spastic hemiplegia. Early detection of brain abnormalities in children with cerebral palsy may help in the prognosis and in the introduction of appropriate therapy.
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215
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Horridge KA, Johnston J, Phatak V, Guadagno A. Magnetic resonance imaging of the brain in children and young people with cerebral palsy: who reports matters? Dev Med Child Neurol 2011; 53:375-7. [PMID: 21232056 DOI: 10.1111/j.1469-8749.2010.03880.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Retrospective case note audits were undertaken of children with clinically diagnosed cerebral palsy known to paediatricians and physiotherapists in Sunderland (UK). Evidence of brain magnetic resonance imaging (MRI) was recorded, including expert opinions requested, in order to quantify the perceived mismatch between local, general radiological and regional, specialist neuroradiological reporting, towards ensuring the best possible yield to inform clinical practice and accurate information-sharing with families. One hundred and ninety-seven out of 214 (92%) had documented neuroimaging; 111 out of 197 (56.3%) were dual reported. Only 34 out of 111 reports were concordant overall. Sixty per cent of brain MRI reported as normal locally, were found not to be normal on specialist review. Clinicians requesting brain MRI in children with disordered development must be mindful of the expertise of those reporting. Those based in district settings must network closely with specialists in expert centres, if disabled children and young people are to receive equitable care of the highest standard.
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216
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Depositario-Cabacar DFT, Zelleke TG. Treatment of epilepsy in children with developmental disabilities. ACTA ACUST UNITED AC 2011; 16:239-47. [PMID: 20981762 DOI: 10.1002/ddrr.116] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Children with developmental disabilities are at increased risk for epilepsy with a prevalence rate higher than the general population. Some of the more common developmental disorders in childhood and the features of epilepsy in these conditions are discussed. Specifically, autism, cerebral palsy, mental retardation, and attention deficit and hyperactivity disorder are reviewed. Ideal treatment for developmentally-disabled children with epilepsy entails maximal seizure control without any significant adverse effects from the anti-epileptic drugs and good quality of life. Antiepileptic drugs' cognitive and behavioral adverse effects tend to occur more frequently in these children. Careful selection of the appropriate medication and close monitoring for drug adverse effects is important. The specific adverse effects of the older and newer antiepileptic drugs are also reviewed.
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217
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The Cerebral Palsy Demonstration Project: a multidimensional research approach to cerebral palsy. Semin Pediatr Neurol 2011; 18:31-9. [PMID: 21575839 DOI: 10.1016/j.spen.2011.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Cerebral palsy is the most common cause of physical impairment in pediatrics. As a heterogeneous disorder in all its disparate aspects it defies a simplistic research approach that seeks to further our understanding of its mechanisms, outcomes and treatments. Within NeuroDevNet, with its focus on abnormal brain development, cerebral palsy was selected as one of the three neurodevelopmental disabilities to be the focus of a dedicated demonstration project. The Cerebral Palsy Demonstration Project will feature a multi-dimensional approach utilizing epidemiologic, imaging, genetics, animal models and stem cell modalities that will at all times emphasize clinical relevance, translation into practice, and potential synergies between investigators now segregated by both academic disciplines and geographic distance. The objective is to create a national platform of varied complementary and inter-digitated efforts. The specific research plan to enable this will be outlined in detail.
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218
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Leonard JM, Cozens AL, Reid SM, Fahey MC, Ditchfield MR, Reddihough DS. Should children with cerebral palsy and normal imaging undergo testing for inherited metabolic disorders? Dev Med Child Neurol 2011; 53:226-32. [PMID: 21291466 DOI: 10.1111/j.1469-8749.2010.03810.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIM For the 9% to 16% of children with cerebral palsy (CP) who have normal brain imaging, further testing for metabolic and/or genetic conditions has been recommended. This study aimed to identify a cohort of children with CP with normal magnetic resonance imaging (MRI), clinically review and describe the cases, and assess the value of testing for inherited metabolic disorders in these children. METHOD Children with congenital CP born from 1999 to 2005 were selected from a population register. Normal MRI reports were identified and the scans reassessed. Children whose scans were performed before 18 months were excluded, as were children with spastic CP (Gross Motor Function Classification System [GMFCS] level I). The remainder were reviewed clinically and offered investigations. RESULTS Of 730 children identified, 515 had available imaging and 54 were confirmed as normal. Cases with non-spastic CP and those with milder clinical severity were more likely to have normal imaging. Twenty-three children (17 males, six females; mean age 6 y 11 mo, SD 1 y 10 mo, range 3 y 0 mo to 10 y 0 mo) were reviewed clinically and offered investigations. Twelve children had spasticity (11 with diplegia, one quadriplegia), three had dyskinesia, five ataxia, and three hypotonia. Two children functioned in GMFCS level I, 11 in level II, seven in level III and three in level IV. Four children with spasticity had unusual features. No alternative diagnoses were made. INTERPRETATION Although important to consider in individual cases, comprehensive metabolic testing failed to clarify the aetiology of CP further in this large cohort of children with normal MRIs, even those with atypical features.
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Affiliation(s)
- Jane M Leonard
- Department of Developmental Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
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219
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Jauhari P, Boggula R, Bhave A, Bhargava R, Singh C, Kohli N, Yadav R, Kumar R. Aetiology of intellectual disability in paediatric outpatients in Northern India. Dev Med Child Neurol 2011; 53:167-72. [PMID: 21087235 DOI: 10.1111/j.1469-8749.2010.03823.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To study the aetiology of intellectual disability in patients presenting to hospital and the diagnostic yield of a standardized examination. METHOD Over a 1-year period, the first three children presenting to the paediatric outpatients department (OPD) on 2 selected weekdays with developmental delay, suspected intellectual disability, or school failure were enrolled for study if they satisfied standard definitions of global developmental delay (GDD), or intellectual disability as tested by scales for Indian children: Developmental Assessment for Indian Infants, Binet Karnat Test, and the Vineland Social Maturity Scale (Malin's Adaptation). Detailed history, and physical and neurological examinations were recorded. An algorithmic approach to investigations was followed. Also, neuroimaging, thyroid function, electroencephalograph, karyotyping, and studies for fragile-X syndrome were conducted. Aetiological diagnosis was considered established only if clinical features were supported by investigations. Clinical features associated with a successful aetiological diagnosis were computed. RESULTS A total of 122 children were enrolled in a cross-sectional analytic study (mean age 43.5 mo [SD 40.66]; 84 males, 38 females). Of these, a definite aetiology could be assigned in 66 children (54.1%); 17 prenatal, 38 perinatal/neonatal, and 11 postneonatal. Factors associated with reaching a definite diagnosis included younger age at presentation, presence of seizures, microcephaly, adverse neonatal events, and abnormal motor signs. Clinical history and examination gave important clues to the aetiology in 89 (72.9%) patients. Neuroimaging was abnormal in 91 out of 114 children, with aetiological findings in 48 children. INTERPRETATION Perinatal/neonatal causes predominate as the cause of GDD or intellectual disability in India. The study highlights that a large majority of cases seen here were preventable.
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Affiliation(s)
- Prashant Jauhari
- Department of Paediatrics, Chhatrapati Shahuji Maharaj Medical University, Lucknow, India
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220
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Population-based study of neuroimaging findings in children with cerebral palsy. Eur J Paediatr Neurol 2011; 15:29-35. [PMID: 20869285 DOI: 10.1016/j.ejpn.2010.07.005] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 06/30/2010] [Accepted: 07/01/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND Neuroimaging is currently recommended as a standard evaluation in children with cerebral palsy (CP). AIMS Utilizing imaging findings from a population-based registry (REPACQ), the frequency and proportion of cerebral radiologic abnormalities in children CP over a four year birth cohort was investigated. METHODS Descriptions of CT and MRI studies were extracted from the Registry dataset and classified into 10 distinct categories. RESULTS Two hundred and thirteen children had imaging available (119 males, 94 females, mean age of 44 months [SD. ± 14 months] at Registry inscription). Eighty seven percent of participants had documented cerebral abnormalities, the most common of which were periventricular white matter injury (PVWMI) (19.2%), diffuse gray matter injury (14.6%), cerebral vascular accident (CVA) (11.7%), and cerebral malformation (11.3%). Also, 18.8% of participants had non-specific radiologic findings and 13.1% of participants had normal imaging results. Severe CP (i.e. GMFCS Level IV-V) and spastic quadriplegic CP were significantly associated with the neuroimaging findings of gray matter injury, while spastic hemiplegic CP was association with CVA, and dyskinetic and spastic diplegic CP were both associated with normal and non-specific neuroimaging findings. CONCLUSIONS Specific patterns of neuroimaging findings in children with CP were found to be associated with neurological subtype, CP severity (i.e. GMFCS Level) and other categorical variables.
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221
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Familial recurrence of cerebral palsy with multiple risk factors. Case Rep Pediatr 2011; 2011:307857. [PMID: 22606510 PMCID: PMC3350070 DOI: 10.1155/2011/307857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 12/28/2011] [Indexed: 11/18/2022] Open
Abstract
The recurrence of cerebral palsy in the same family is uncommon. We, however, report on two families with two or more affected siblings. In both families, numerous potential risk factors were identified including environmental, obstetric, and possible maternal effects. We hypothesize that multiple risk factors may lead to the increased risk of recurrence of cerebral palsy in families. Intrinsic and maternal risk factors should be investigated in all cases of cerebral palsy to properly counsel families on the risk of recurrence. Recent studies of genetic polymorphisms associated with cerebral palsy are considered with reference to our observations in these two families.
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222
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Faria AV, Hoon A, Stashinko E, Li X, Jiang H, Mashayekh A, Akhter K, Hsu J, Oishi K, Zhang J, Miller MI, van Zijl PCM, Mori S. Quantitative analysis of brain pathology based on MRI and brain atlases--applications for cerebral palsy. Neuroimage 2010; 54:1854-61. [PMID: 20920589 DOI: 10.1016/j.neuroimage.2010.09.061] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 08/02/2010] [Accepted: 09/24/2010] [Indexed: 01/01/2023] Open
Abstract
We have developed a new method to provide a comprehensive quantitative analysis of brain anatomy in cerebral palsy patients, which makes use of two techniques: diffusion tensor imaging and automated 3D whole brain segmentation based on our brain atlas and a nonlinear normalization technique (large-deformation diffeomorphic metric mapping). This method was applied to 13 patients and normal controls. The reliability of the automated segmentation revealed close agreement with the manual segmentation. We illustrate some potential applications for individual characterization and group comparison. This technique also provides a framework for determining the impact of various neuroanatomic features on brain functions.
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Affiliation(s)
- Andreia V Faria
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Prasad R, Verma N, Srivastava A, Das BK, Mishra OP. Magnetic resonance imaging, risk factors and co-morbidities in children with cerebral palsy. J Neurol 2010; 258:471-8. [PMID: 20953790 DOI: 10.1007/s00415-010-5782-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 07/11/2010] [Accepted: 09/29/2010] [Indexed: 10/18/2022]
Abstract
Cerebral palsy (CP) continues to be a major problem in India. The present study provides an insight into the various clinical and neuroradiological correlates of CP. The study included 102 children with CP and was subjected to magnetic resonance imaging (MRI) of the brain. Forty-seven (46%) patients belonged to the 1-3 years age group and 84 (82%) were born at term. Of 102 children, 39 (38%) were delivered at home. Based on their tone and topographic pattern of weakness, it was found that 47 (46%) had spastic diplegia and 35 (34%) spastic quadriplegia. Hemiplegic, dystonic, and atonic CP accounted for the remaining 20%. The occurrence of severe birth asphyxia, which is rarely seen in developed countries, continues to be a major problem in developing countries, and accounted 64 (62%) of the patients. Cognitive delay (82%) was the most common co-morbidity, followed by seizure disorder (52%), feeding difficulties (22%) and visual abnormalities (29%). Ninety-one (89%) children had an abnormal MRI. Periventricular white matter injury (PWMI) was observed in 48 (47.1%), followed by diffuse encephalopathy (29%). Focal lesions (6%) and malformations (3%) were less common. In children with spastic diplegia, PWMI was the most common MRI abnormality, whereas in spastic quadriplegia, diffuse encephalopathy was most common. MRI scans help in revealing the pathologic basis of CP and had strong correlations with clinical findings.
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Affiliation(s)
- Rajniti Prasad
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India.
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Himmelmann K, Hagberg G, Uvebrant P. The changing panorama of cerebral palsy in Sweden. X. Prevalence and origin in the birth-year period 1999-2002. Acta Paediatr 2010; 99:1337-43. [PMID: 20377538 DOI: 10.1111/j.1651-2227.2010.01819.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of the study was to describe the prevalence and origin of cerebral palsy (CP), which is the tenth report from the western Swedish study. METHODS A population-based study covering 85,737 live births in the area in 1999-2002. Birth characteristics and neuroimaging findings were recorded, prevalence of CP was calculated and aetiology was analysed. RESULTS CP was found in 186 children. The crude prevalence was 2.18 per 1000 live births. The gestational age-specific prevalence for <28 gestational weeks was 55.6 per 1000 live births, whereas it was 43.7 for 28-31 weeks, 6.1 for 32-36 weeks and 1.43 per 1000 for >36 weeks. There was a female majority among children born at term and a male predominance in children born preterm. Hemiplegia accounted for 38%, diplegia for 32%, tetraplegia for 7%, whereas 17% had dyskinetic CP and 5% ataxia. Neuroimaging showed white-matter lesions in 31% and cortical/subcortical lesions in 29%. The aetiology was considered to be prenatal in 36%, peri/neonatal in 42%, whereas it remained unclassified in 21%. CONCLUSION The decrease in CP prevalence observed since the 1980s had ceased. An increase in children born at term and in dyskinetic CP was found. In children born before 28 weeks of gestation, the prevalence decreased significantly. White-matter and cortical/subcortical lesions dominated on neuroimaging.
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Affiliation(s)
- K Himmelmann
- Queen Silvia Children's Hospital, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden.
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225
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Abstract
Cerebral palsy is a heterogeneous syndrome that is the most common form of physical impairment encountered in pediatrics. Its heterogeneity, which is apparent in all aspects of the disorder, challenges our attempts to classify it. Several classification structures do exist that seek to further our understanding of the basic mechanisms and needs associated with this entity. The most long-standing classification approach utilizes the neurologic examination to characterize and stratify the predominant qualitative pattern of motor impairment (i.e., spastic, dyskinetic, ataxic–hypotonic or mixed), and if spastic, the particular limb distribution. The severity of cerebral palsy can be summarized in the domains of gross motor and fine motor skills by the Gross Motor Function Classification System and the Manual Ability Classification System, respectively. Frequently for patients with cerebral palsy, the major health burden may not be that of a neuromotor impairment, but rather that of the associated conditions (i.e., epilepsy, intellectual disability, etc.) affecting the individual. Finally, one may employ a mechanistic approach to stratifying according to imaging results and etiology, which are linked and provide an insight into the pathogenesis and the timing of malformation or acquired injury. While the approaches used in each of these classification schemes are separate, distinct and single axial, inter-relationships are readily apparent. Each of the classification approaches capture only one aspect of a complex disorder and is thus too simplistic. A multimodal classification approach can be employed in a complimentary fashion to provide a more holistic profile of the individual with cerebral palsy.
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Affiliation(s)
- Michael I Shevell
- Room A-514, Montreal Children’s Hospital, 2300 Tupper, Montreal, Quebec H3H 1P3, Canada and Department of Neurology/Neurosurgery & Pediatrics, Division of Pediatric Neurology, McGill University, Quebec, Canada
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Yuan N, Kane P, Shelton K, Matel J, Becker BC, Moss RB. Safety, tolerability, and efficacy of high-frequency chest wall oscillation in pediatric patients with cerebral palsy and neuromuscular diseases: an exploratory randomized controlled trial. J Child Neurol 2010; 25:815-21. [PMID: 20357238 DOI: 10.1177/0883073809350223] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Airway secretions and infections are common in cerebral palsy and neuromuscular diseases. Chest physiotherapy is standard therapy but effort is substantial. High-frequency chest wall oscillation is used in cystic fibrosis but tolerability and safety data in cerebral palsy and neuromuscular disease are limited. A prospective, randomized, controlled trial of high-frequency chest wall oscillation and standard chest physiotherapy was performed in participants with neuromuscular disease or cerebral palsy. Outcome measures included respiratory-related hospitalizations, antibiotic therapy, chest radiographs, and polysomnography. Care-givers were questioned regarding therapy adherence. A total of 28 participants enrolled, 23 completed (12 chest physiotherapy, mean study period 5 months). No adverse outcomes were reported. Adherence to prescribed regimen was higher with high-frequency chest wall oscillation (P = .036). Our data suggest safety, tolerability, and better compliance with high-frequency chest wall oscillation. Improvement in airway clearance may help prevent hospitalizations. Larger controlled trials are required to confirm these results.
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Affiliation(s)
- Nanci Yuan
- Department of Pediatrics, Division of Pulmonology, Stanford University, Palo Alto, California 94304, USA.
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Trends in prevalence of cerebral palsy in children born with a birthweight of 2,500 g or over in Europe from 1980 to 1998. Eur J Epidemiol 2010; 25:635-42. [PMID: 20532622 DOI: 10.1007/s10654-010-9474-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Accepted: 05/27/2010] [Indexed: 10/19/2022]
Abstract
Time trends for cerebral palsy (CP) prevalence in children born > or =2,500 g vary across studies and scarce data exist on trends by subtype of CP. The objective of this study was to describe changes in prevalence of CP in infants born > or =2,500 g between 1980 and 1998 in Europe. Data were collated from the SCPE (Surveillance of Cerebral Palsy in Europe collaboration) common database. Poisson regression was used to test for change in prevalence over time. Birth year and register effects were explored and trends in prevalence were estimated by CP subtype and severity. Four thousand and two children with CP and birthweight > or =2,500 g were recorded in 15 population based-registers. The overall prevalence of CP was 1.16 per 1,000 live births (99% CI, 0.88-1.48) in 1980 and 0.99 (CI, 0.80-1.20) in 1998. The trend was not significant (P = .14), except in two registers. However, there were significant changes in the prevalence of spastic CP subtypes, with a decrease in the bilateral spastic form (P < .001), and an increase in the unilateral spastic form (P = .004). There was a concurrent reduction in neonatal mortality of children with birthweight > or =2,500 g: from 1.7 (CI, 1.4-2.1) to 0.9 (CI, 0.7-1.1) per 1,000 live births. In conclusion, for children born with birthweight > or =2,500 g, the prevalence of CP in Europe was stable in spite of changes by subtype and a significant decrease in neonatal mortality.
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Moore LJS, Allegrante JP, Palma M, Lewin J, Carlson MG. Assessment of Quality of Life Needs of Children With Mild Hemiplegic Cerebral Palsy. CHILDRENS HEALTH CARE 2010. [DOI: 10.1080/02739611003679980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Trivedi R, Agarwal S, Shah V, Goyel P, Paliwal VK, Rathore RKS, Gupta RK. Correlation of quantitative sensorimotor tractography with clinical grade of cerebral palsy. Neuroradiology 2010; 52:759-65. [DOI: 10.1007/s00234-010-0703-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 04/05/2010] [Indexed: 10/19/2022]
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Abstract
This article aims to build capacity between nursing and allied healthcare practitioner staff in highlighting the unique challenges that caring for people with cerebral palsy (CP) brings. It gives an insight into how CP is classified and diagnosed, and briefly outlines issues of political correctness in labelling people with this condition. It covers the complexities of brain development in people with CP, with consideration of the key aetiological contributors to the incidence of the condition. A straightforward approach to unravelling the classification of movement disorders in CP is adopted. It concludes that a multidisciplinary approach to the management of CP, with the nurse at the centre of this holistic approach to patient care, is pivotal to future healthcare provision.
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Feys H, Eyssen M, Jaspers E, Klingels K, Desloovere K, Molenaers G, De Cock P. Relation between neuroradiological findings and upper limb function in hemiplegic cerebral palsy. Eur J Paediatr Neurol 2010; 14:169-77. [PMID: 19272822 DOI: 10.1016/j.ejpn.2009.01.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Revised: 01/26/2009] [Accepted: 01/30/2009] [Indexed: 10/21/2022]
Abstract
The relation between neuroradiological findings and upper limb function was examined in 53 children with hemiplegic cerebral palsy (CP). CT and MRI images of the children were classified into four groups (malformations, periventricular lesions, congenital cortical-subcortical lesions and postnatally acquired lesions). Additionally, each single affected neuroanatomical structure was noted. Clinical assessments included measures of activity (Melbourne Assessment of Unilateral Upper Limb Function and House Classification) and body functions (motor and sensory impairments). Comparative statistics and correlation analysis were used. Three children had a malformation, 28 a periventricular lesion, 14 a cortical-subcortical lesion and eight a postnatally acquired lesion. Children with periventricular lesions obtained the best motor functioning. Within this group, children with pure periventricular lesions performed significantly better compared to mixed lesions. The differences between congenital cortical-subcortical lesions and acquired lesions were not significant. Results further showed that middle cerebral artery infarctions and basal ganglia/thalamic lesions were significantly correlated to a worse performance. The type of lesion determined by the timing of the brain insult, and the location of the lesion distinguish children with hemiplegic CP regarding upper limb function. These insights are valuable for prognosis and may contribute to a better delineation of therapeutic interventions.
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Affiliation(s)
- Hilde Feys
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, 3001 Leuven (Heverlee), Belgium.
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Zarrinkalam R, Russo RN, Gibson CS, van Essen P, Peek AK, Haan EA. CP or not CP? A review of diagnoses in a cerebral palsy register. Pediatr Neurol 2010; 42:177-80. [PMID: 20159426 DOI: 10.1016/j.pediatrneurol.2009.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 07/02/2009] [Accepted: 09/02/2009] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to document the inaccuracy rate of diagnosis of cerebral palsy recorded on the South Australian Cerebral Palsy Register. A total of 402 children born in South Australia from 1993 to 2002 and notified to the Register as having cerebral palsy were identified through the Register database, and 21 children (5.2%) were later identified to have a noncerebral palsy diagnosis. Of these, 5 had either a metabolic or a neurodegenerative disorder and 2 had a syndromic disorder (1 Joubert syndrome and 1 Sotos syndrome); the remaining 14 children had one of the following final diagnoses: developmental delay, gross motor delay, perinatal myositis, spinal subdural and subarachnoid arteriovenous malformation, and Erb's palsy. In 16 of 21 children (76%), the diagnosis was changed at 5 years of age or older. Studies based on population registers may need to take into account the possibility of misclassification, estimated to be at least 5.2% in this study. A complete clinical assessment at the time of diagnosis followed by regular reassessment would enable the clinician to exclude children with alternative diagnoses, which has important implications for clinical management and research based on cerebral palsy registers.
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Affiliation(s)
- Rosa Zarrinkalam
- Department of Paediatric Rehabilitation Medicine, The Women's and Children's Hospital, North Adelaide, SA, Australia
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Krishnamoorthy KS, Eichler FS, Goyal NA, Small JE, Snuderl M. Case records of the Massachusetts General Hospital. Case 3-2010. A 5-month-old boy with developmental delay and irritability. N Engl J Med 2010; 362:346-56. [PMID: 20107221 DOI: 10.1056/nejmcpc0907806] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy. Eur J Paediatr Neurol 2010; 14:45-66. [PMID: 19914110 DOI: 10.1016/j.ejpn.2009.09.005] [Citation(s) in RCA: 157] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 09/15/2009] [Accepted: 09/17/2009] [Indexed: 12/20/2022]
Abstract
An interdisciplinary European group of clinical experts in the field of movement disorders and experienced Botulinum toxin users has updated the consensus for the use of Botulinum toxin in the treatment of children with cerebral palsy (CP). A problem-orientated approach was used focussing on both published and practice-based evidence. In part I of the consensus the authors have tabulated the supporting evidence to produce a concise but comprehensive information base, pooling data and experience from 36 institutions in 9 European countries which involves more than 10,000 patients and over 45,000 treatment sessions during a period of more than 280 treatment years. In part II of the consensus the Gross Motor Function Measure (GMFM) and Gross Motor Function Classification System (GMFCS) based Motor Development Curves have been expanded to provide a graphical framework on how to treat the motor disorders in children with CP. This graph is named "CP(Graph) Treatment Modalities - Gross Motor Function" and is intended to facilitate communication between parents, therapists and medical doctors concerning (1) achievable motor function, (2) realistic goal-setting and (3) treatment perspectives for children with CP. The updated European consensus 2009 summarises the current understanding regarding an integrated, multidisciplinary treatment approach using Botulinum toxin for the treatment of children with CP.
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Preoperative MRI findings and functional outcome after selective dorsal rhizotomy in children with bilateral spasticity. Childs Nerv Syst 2010; 26:191-8. [PMID: 19823844 PMCID: PMC2800177 DOI: 10.1007/s00381-009-0999-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Indexed: 12/02/2022]
Abstract
PURPOSE To identify MRI characteristics that may predict the functional effect of selective dorsal rhizotomy (SDR) in children with bilateral spastic paresis. METHODS We performed SDR in a group of 36 patients. The gross motor functioning measure-66 (GMFM-66) was applied before and after SDR. Available cerebral MRIs were retrospectively classified into three diagnostic groups: periventricular leucomalacia (PVL; n = 10), hydrocephalus (n = 2), and normal (n = 6). In patients with PVL, we scored the severity of the MR abnormalities. We compared the changes in the GMFM-66 after SDR in the diagnostic groups. In patients with PVL, we correlated the severity of the MR abnormalities with the changes in the GMFM-66. RESULTS The mean follow-up period was 5 years and 4 months (range, 1 year and 1 month to 9 years). The best improvement in gross motor function was observed in patients with normal MRI, and the slightest improvement was observed in patients with hydrocephalus. The severity of the PVL did correlate with the GMFM-66 score before SDR but not with the functional effect of SDR. CONCLUSION We conclude that with respect to gross motor skills, the improvements after SDR are good in patients with no MRI abnormalities. In the patients with hydrocephalus, the improvements after SDR were insignificant. In patients with PVL, the improvements were intermediate and did not correlate with the degree of PVL.
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238
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Bale JF, Caplin DA, Bruse JD, Folland D. Practice parameters in child neurology: do pediatricians use them? J Child Neurol 2009; 24:1482-5. [PMID: 19295180 DOI: 10.1177/0883073809332766] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We assessed pediatrician awareness of the parameter ''Evaluating the first non-febrile seizure in children'' and how the concepts of this parameter were incorporated into practice. Although most reported caring for children with seizures, 60% were not aware of the practice parameter. When given the clinical scenario of an otherwise healthy 8-year-old child with a first, unprovoked seizure, management was variable. Most (83%) would obtain an electroencephalography, and many (58%) would order an imaging study, usually a magnetic resonance imaging. However, most were also likely to order laboratory studies that were not indicated given the scenario and the practice parameter. This pilot study suggests that pediatricians may not be aware of this practice parameter and many may not be incorporating evidence-based recommendations regarding the evaluation of children with new-onset seizures.
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Affiliation(s)
- James F Bale
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA.
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239
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Alkhater RA. PATIENT MANAGEMENT PROBLEM. Continuum (Minneap Minn) 2009. [DOI: 10.1212/01.con.0000348893.71844.d6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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HOON ALEXANDERH, STASHINKO ELAINEE, NAGAE LIDIAM, LIN DORISDM, KELLER JENNIFER, BASTIAN AMY, CAMPBELL MICHELLEL, LEVEY ERIC, MORI SUSUMU, JOHNSTON MICHAELV. Sensory and motor deficits in children with cerebral palsy born preterm correlate with diffusion tensor imaging abnormalities in thalamocortical pathways. Dev Med Child Neurol 2009; 51:697-704. [PMID: 19416315 PMCID: PMC2908264 DOI: 10.1111/j.1469-8749.2009.03306.x] [Citation(s) in RCA: 229] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Cerebral palsy (CP) is frequently linked to white matter injury in children born preterm. Diffusion tensor imaging (DTI) is a powerful technique providing precise identification of white matter microstructure. We investigated the relationship between DTI-observed thalamocortical (posterior thalamic radiation) injury, motor (corticospinal tract) injury, and sensorimotor function. METHOD Twenty-eight children born preterm (16 males, 12 females; mean age 5y 10mo, SD 2y 6mo, range 16mo-13y; mean gestational age at birth 28wks, SD 2.7wks, range 23-34wks) were included in this case-control study. Twenty-one children had spastic diplegia, four had spastic quadriplegia, two had hemiplegia, and one had ataxic/hypotonic CP; 15 of the participants walked independently. Normative comparison data were obtained from 35 healthy age-matched children born at term (19 males, 16 females; mean age 5y 9mo, SD 4y 4mo, range 15mo-15y). Two-dimensional DTI color maps were created to evaluate 26 central white matter tracts, which were graded by a neuroradiologist masked to clinical status. Quantitative measures of touch, proprioception, strength (dynamometer), and spasticity (modified Ashworth scale) were obtained from a subset of participants. RESULTS All 28 participants with CP had periventricular white-matter injury on magnetic resonance imaging. Using DTI color maps, there was more severe injury in the posterior thalamic radiation pathways than in the descending corticospinal tracts. Posterior thalamic radiation injury correlated with reduced contralateral touch threshold, proprioception, and motor severity, whereas corticospinal tract injury did not correlate with motor or sensory outcome measures. INTERPRETATION These findings extend previous research demonstrating that CP in preterm children reflects disruption of thalamocortical connections as well as descending corticospinal pathways.
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Affiliation(s)
- ALEXANDER H HOON
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
| | - ELAINE E STASHINKO
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
| | - LIDIA M NAGAE
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - DORIS DM LIN
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - JENNIFER KELLER
- Department of Physical Therapy, Kennedy Krieger Institute, Baltimore, MD, USA
| | - AMY BASTIAN
- Motion Analyses Laboratory, Kennedy Krieger Institute, Baltimore, MD, USA
| | - MICHELLE L CAMPBELL
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
| | - ERIC LEVEY
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
| | - SUSUMU MORI
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - MICHAEL V JOHNSTON
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA, Departments of Neurology, Pediatrics, and Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kruer MC, Blasco PA, Anderson JC, Bardo DME, Pinter JD. Truncal ataxia, hypotonia, and motor delay with isolated rhombencephalosynapsis. Pediatr Neurol 2009; 41:229-31. [PMID: 19664545 DOI: 10.1016/j.pediatrneurol.2009.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 03/25/2009] [Accepted: 04/01/2009] [Indexed: 11/27/2022]
Abstract
We report on a 16-month-old girl with developmental motor delay, microcephaly, and mild truncal ataxia who was revealed to have rhombencephalosynapsis on magnetic resonance imaging. The child was nonsyndromic and exhibited normal cognitive and social abilities for her age, despite neuroimaging findings. As this case demonstrates, motor skills in children with isolated rhombencephalosynapsis may be relatively mildly affected, and cognition may be normal despite the presence of a major central nervous system anomaly. Neuroimaging may be helpful in defining the nature of a child's deficits at an early age, particularly when associated with microcephaly and abnormalities on neurologic examination.
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Affiliation(s)
- Michael C Kruer
- Division of Developmental Pediatrics, Department of Pediatrics, Child Development and Rehabilitation Center, Oregon Health and Science University, 707 SW Gaines Road, Portland, OR 97239, USA.
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243
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Pakula AT, Van Naarden Braun K, Yeargin-Allsopp M. Cerebral Palsy: Classification and Epidemiology. Phys Med Rehabil Clin N Am 2009; 20:425-52. [DOI: 10.1016/j.pmr.2009.06.001] [Citation(s) in RCA: 143] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
A common language on CP has been developed for the European registers by the SCPE (Surveillance of Cerebral Palsy in Europe) working group and the common database allows prevalence analyses on a larger basis. CP prevalence increases with lower birthweight and higher immaturity. Increase of survival after preterm birth has first also increased CP rates. But already in the 80s this trend was reversed for LBW infants, and in the 90 s also for VLBW or very immature infants. The outcome with respect to CP in the group of extremely LBW or immature infants remains a matter of specific concern, as prevalence seems to be rather stable on a high level. CP is caused in more than 80% by brain lesions or maldevelopments which can be attributed to different timing periods of the developing brain. Extent and topography determine the clinical subtype of CP and are related also to the presence and severity of associated disabilities. CP, thus, offers a model to study plasticity of the developing brain. Reorganisation following unilateral lesions is mainly interhemispheric and homotopic. In the motor system, it involves the recruitment of ipsilateral tracts; functionality seems to be limited and decreases already towards the end of gestation. There is no clear evidence for substantial reorganisation in the sensory system. The best compensatory potential is described concerning language function following left hemispheric lesions. Language function reorganized to the right hemisphere eventually seems not to be impaired, this occurs, however, on the expense of primary right hemispheric functions.
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245
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Tervo RC, Asis M. Parents' reports predict abnormal investigations in global developmental delay. Clin Pediatr (Phila) 2009; 48:513-21. [PMID: 19252105 DOI: 10.1177/0009922809332592] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS To identify symptoms reported by parents that predict abnormal laboratory investigations in preschoolers with global developmental delay (GDD). METHODS A cross-sectional descriptive study of 81 boys and 38 girls, with a mean age of 43.5 months (SD = 13.4), with global developmental delay. All parents/guardians completed the following: (1) a semistructured interview about their child and family; (2) the Child Development Inventory (CDI); (3) the Possible Problems Checklist (PPC); and (4) the Child Behavior Checklist 1(1/2)-5 (CBCL). RESULTS There were 61 abnormal results: MRI 37 (31%); high-resolution chromosomes 8 (7%); fragile X molecular testing 4 (3%); and microarray comparative genomic hybridization 12 (10%). A total of 47 children had abnormal tests (40%): none, 72 (60%); one, 36 (30%); two, 8 (7%); three, (3%). Younger children with more developmental delays are more likely to have abnormal tests. They are clumsy, more passive, and less disobedience. They had lower total, externalizing, and internalizing problems scores. The odds of finding an abnormal investigation are increasingly greater as parent's report of language comprehension and social development ratios increase, and decrease in likelihood for every increase in the expressive language and fine motor ratios. INTERPRETATION Parent's reports predict abnormal tests and indicate quantifiable differences requiring investigation.
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Affiliation(s)
- Raymond C Tervo
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, Gillette Children's Specialty Healthcare, St. Paul, Minnesota 55101, USA.
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Jung HY, Ko TS, Kim HD, Yim SY, Kim MO, Hong SK. Korean Academy of Medical Sciences Pediatric Impairment Guideline for brain lesion. J Korean Med Sci 2009; 24 Suppl 2:S323-9. [PMID: 19503690 PMCID: PMC2690078 DOI: 10.3346/jkms.2009.24.s2.s323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2009] [Accepted: 05/06/2009] [Indexed: 11/25/2022] Open
Abstract
The permanent impairment evaluation for children in developmental stage is very difficult and it is even impossible in some cases. The impairment evaluation for developing children has not yet been included in the guideline of the American Medical Association. Due to frequent medical and social demands in Korea, we developed an impairment evaluation guideline for motor impairment, intellectual disability/mental retardation, developmental speech-language disorder and epilepsy caused by pediatric cerebral injuries, or cerebral lesions other than the developmental disorders such as autism. With the help of various literature and foreign institutions, we developed our in order to develop a scientific guideline for pediatric impairment that is suited to Korean cultural background and social condition.
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Affiliation(s)
- Han-Young Jung
- Department of Physical & Rehabilitation Medicine, Inha University College of Medicine, Incheon, Korea
| | - Tae-Sung Ko
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Heung-Dong Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei Universtiy College of Medicine, Seoul, Korea
| | - Shin-Young Yim
- Department of Physical Medicine & Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Myeong-Ok Kim
- Department of Physical & Rehabilitation Medicine, Inha University College of Medicine, Incheon, Korea
| | - Seung-Kwon Hong
- Department of Biomedical & Health Care Informatics, Seoul National University College of Medicine, Seoul, Korea
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247
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Jenks KM, van Lieshout ECDM, de Moor J. The relationship between medical impairments and arithmetic development in children with cerebral palsy. J Child Neurol 2009; 24:528-35. [PMID: 19406754 DOI: 10.1177/0883073809335009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Arithmetic ability was tested in children with cerebral palsy without severe intellectual impairment (verbal IQ >or= 70) attending special (n = 41) or mainstream education (n = 16) as well as control children in mainstream education (n = 16) throughout first and second grade. Children with cerebral palsy in special education did not appear to have fully automatized arithmetic facts by the end of second grade. Their lower accuracy and consistently slower (verbal) response times raise important concerns for their future arithmetic development. Differences in arithmetic performance between children with cerebral palsy in special or mainstream education were not related to localization of cerebral palsy or to gross motor impairment. Rather, lower accuracy and slower verbal responses were related to differences in nonverbal intelligence and the presence of epilepsy. Left-hand impairment was related to slower verbal responses but not to lower accuracy.
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Affiliation(s)
- Kathleen M Jenks
- Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands.
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248
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Bacciu A, Pasanisi E, Vincenti V, Ormitti F, Di Lella F, Guida M, Berghenti M, Bacciu S. Cochlear implantation in children with cerebral palsy. A preliminary report. Int J Pediatr Otorhinolaryngol 2009; 73:717-21. [PMID: 19201488 DOI: 10.1016/j.ijporl.2009.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 01/07/2009] [Accepted: 01/13/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this study is to assess the post-implantation speech perception and intelligibility of speech produced by five profoundly deaf children with cerebral palsy. METHODS This study is derived by a review of a prospectively maintained data collection on all patients entering the cochlear implant program. Five children with cerebral palsy who underwent cochlear implantation participated in this study. Functional outcome was assessed using the Speech Perception Categories and the Speech Intelligibility Rating scale. The follow-up of the series ranged from 12 to 45 months. RESULTS At the last follow-up, two children who were placed into speech perception category 1 (detection of a speech signal) preoperatively progressed to category 6 (open-set word recognition with familiar words) postoperatively. Two children moved from preoperative category 2 (pattern perception) to postoperative category 6. One child placed into category 0 (no detection of speech) preoperatively progressed to category 4 (word identification) postoperatively. Before implantation, three children had connected speech unintelligible, and two subjects had connected speech intelligible to a listener who concentrates and lip-reads. At the last follow-up, one child had connected speech unintelligible, two children had connected speech intelligible to a listener who concentrate and lip-reads, one child had connected speech intelligible to a listener who has little experience of a deaf person's speech, and one child had connected speech intelligible to all listeners. CONCLUSIONS Cochlear implantation allowed these patients to dramatically improve their quality of life, increasing their self-confidence, independence and social integration.
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Affiliation(s)
- Andrea Bacciu
- Department of Otolaryngology, University of Parma, Parma, Italy.
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249
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Abstract
Cerebral palsy is the most prevalent cause of persisting motor function impairment with a frequency of about 1/500 births. In developed countries, the prevalence rose after introduction of neonatal intensive care, but in the past decade, this trend has reversed. A recent international workshop defined cerebral palsy as "a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain." In a majority of cases, the predominant motor abnormality is spasticity; other forms of cerebral palsy include dyskinetic (dystonia or choreo-athetosis) and ataxic cerebral palsy. In preterm infants, about one-half of the cases have neuroimaging abnormalities, such as echolucency in the periventricular white matter or ventricular enlargement on cranial ultrasound. Among children born at or near term, about two-thirds have neuroimaging abnormalities, including focal infarction, brain malformations, and periventricular leukomalacia. In addition to the motor impairment, individuals with cerebral palsy may have sensory impairments, cognitive impairment, and epilepsy. Ambulation status, intelligence quotient, quality of speech, and hand function together are predictive of employment status. Mortality risk increases incrementally with increasing number of impairments, including intellectual, limb function, hearing, and vision. The care of individuals with cerebral palsy should include the provision of a primary care medical home for care coordination and support; diagnostic evaluations to identify brain abnormalities, severity of neurologic and functional abnormalities, and associated impairments; management of spasticity; and care for associated problems such as nutritional deficiencies, pain, dental care, bowel and bladder continence, and orthopedic complications. Current strategies to decrease the risk of cerebral palsy include interventions to prolong pregnancy (eg, 17alpha-progesterone), limiting the number of multiple gestations related to assisted reproductive technology, antenatal steroids for mothers expected to deliver prematurely, caffeine for extremely low birth weight neonates, and induced hypothermia for a subgroup of neonates diagnosed with hypoxic-ischemic encephalopathy.
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Abstract
Cerebral palsy (CP) is a diagnosis of considerable concern to obstetricians, but the diagnosis of CP can be challenging, and may need to be confirmed by an experienced practitioner, ideally a child neurologist or psychiatrist. It is important not to make the diagnosis too early in infancy, especially when the signs are not severe, as resolution of early neuromotor abnormalities does occur, particularly in premature infants. Exclusion of genetic/metabolic disorders presenting with CP-like findings is important. The degree of activity limitation should be characterized; labeling children as having CP on the basis of abnormal examination findings alone without evidence of activity limitation is not useful. Brain imaging can be helpful in pinpointing the location of the underlying brain abnormality and sometimes provides etiologically useful information.
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