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Gong C, Liu A, Lian B, Wu X, Zeng P, Hao C, Wang B, Jiang Z, Pang W, Guo J, Zhou S. Prevalence and related factors of epilepsy in children and adolescents with cerebral palsy: a systematic review and meta-analysis. Front Pediatr 2023; 11:1189648. [PMID: 37576141 PMCID: PMC10416728 DOI: 10.3389/fped.2023.1189648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Objective To study the worldwide prevalence and associated factors of epilepsy in children and adolescents with Cerebral Palsy (CP) and to analyze the differences between various subgroups. Method We identified all potential studies on the prevalence of epilepsy in children and adolescents with CP from PubMed, Web of Science, and Embase. The search time was from the establishment of the database to November 2022. Randomized effects meta-analysis models were used to calculate the prevalence of epilepsy in CP. Subgroup analysis and meta-regression were utilized to further explore heterogeneity between articles and prevalence disparities between subgroups. The funnel plot and Egger's test were used to investigate potential publication bias. Results Seventy-two articles, comprising 53,969 children and adolescents with CP, were included in this study. The results indicated a total epilepsy prevalence of 38.0% (95% CI: 34.8%-41.2%) in CP. The prevalence of epilepsy was 46.4% (95% CI: 41.4%-51.5%) in clinical sample-based studies and 31.6% (95% CI: 28.7%-34.5%) in population-based studies. Meta-regression demonstrated that the sample source, neonatal seizure, family history of epilepsy, EEG or cranial imaging abnormalities, intellectual/cognitive impairment, and topographical types of CP were heterogeneous contributors to the epilepsy prevalence in CP. Conclusion Approximately one-third of children and adolescents with CP have epilepsy, and the sample source can significantly impact the total prevalence of epilepsy. Neonatal seizures, family history of epilepsy, EEG abnormalities, cranial imaging abnormalities, severe intellectual disability, and quadriplegia may be contributing factors to epilepsy comorbid in CP. Further study is required to verify the strength of these associations with epilepsy. This study aids in identifying the clinical characteristics of young people with CP at risk of developing epilepsy, which may assist clinicians in the early prevention and diagnosis of epilepsy within this population.Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=367766, identifier CRD42022367766.
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Affiliation(s)
- Chao Gong
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Annan Liu
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Beibei Lian
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Xixi Wu
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Pei Zeng
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Chaoli Hao
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Bobo Wang
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
| | - Zhimei Jiang
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
- Jiamusi University Affiliated No.3 Hospital, Jiamusi, China
| | - Wei Pang
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
- Jiamusi University Affiliated No.3 Hospital, Jiamusi, China
| | - Jin Guo
- College of Rehabilitation Medicine, Jiamusi University, Jiamusi, China
- Jiamusi University Affiliated No.3 Hospital, Jiamusi, China
| | - Shaobo Zhou
- School of Science, Faculty of Engineering and Science, University of Greenwich, Medway Campus Central Avenue, Chatham Maritime, Kent, England
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Viswanath M, Jha R, Gambhirao AD, Kurup A, Badal S, Kohli S, Parappil P, John BM, Adhikari KM, Kovilapu UB, Sondhi V. Comorbidities in children with cerebral palsy: a single-centre cross-sectional hospital-based study from India. BMJ Open 2023; 13:e072365. [PMID: 37429681 DOI: 10.1136/bmjopen-2023-072365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
OBJECTIVE To describe the comorbidities in children with cerebral palsy (CP) and determine the characteristics associated with different impairments. DESIGN Cross-sectional study. SETTING Tertiary care referral centre in India. PATIENTS Between April 2018 and May 2022, all children aged 2-18 years with a confirmed diagnosis of CP were enrolled by systematic random sampling. Data on antenatal, birth and postnatal risk factors, clinical evaluation and investigations (neuroimaging and genetic/metabolic workup) were recorded. MAIN OUTCOME MEASURES Prevalence of the co-occurring impairments was determined using clinical evaluation or investigations as indicated. RESULTS Of the 436 children screened, 384 participated (spastic CP=214 (55.7%) (spastic hemiplegic=52 (13.5%); spastic diplegia=70 (18.2%); spastic quadriplegia=92 (24%)), dyskinetic CP=58 (15.1%) and mixed CP=110 (28.6%)). A primary antenatal/perinatal/neonatal and postneonatal risk factor was identified in 32 (8.3%), 320 (83.3%) and 26 (6.8%) patients, respectively. Prevalent comorbidities (the test used) included visual impairment (clinical assessment and visual evoked potential)=357/383(93.2%), hearing impairment (brainstem-evoked response audiometry)=113 (30%), no understanding of any communication (MacArthur Communicative Development Inventory)=137 (36%), cognitive impairment (Vineland scale of social maturity)=341 (88.8%), severe gastrointestinal dysfunction (clinical evaluation/interview)=90 (23%), significant pain (non-communicating children's pain checklist)=230 (60%), epilepsy=245 (64%), drug-resistant epilepsy=163 (42.4%), sleep impairment (Children's Sleep Habits Questionnaire)=176/290(60.7%) and behavioural abnormalities (Childhood behaviour checklist)=165 (43%). Overall, hemiparetic and diplegic CP and Gross Motor Function Classification System ≤3 were predictive of lesser co-occurring impairment. CONCLUSION CP children have a high burden of comorbidities, which increase with increasing functional impairment. This calls for urgent actions to prioritise opportunities to prevent risk factors associated with CP and organise existing resources to identify and manage co-occurring impairments. TRIAL REGISTRATION NUMBER CTRI/2018/07/014819.
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Affiliation(s)
- Maya Viswanath
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | - Ruchika Jha
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | | | - Arjun Kurup
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | - Sachendra Badal
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | - Sarvesh Kohli
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | - Parvathi Parappil
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | - Biju M John
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
| | | | - Uday Bhanu Kovilapu
- Department of Radiodiagnosis, Armed Forces Medical College, Pune, Maharashtra, India
| | - Vishal Sondhi
- Department of Pediatrics, Armed Forces Medical College, Pune, Maharashtra, India
- Department of Radiodiagnosis, Armed Forces Medical College, Pune, Maharashtra, India
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Shea J, Nunally KD, Miller PE, Difazio R, Matheney TH, Snyder B, Shore BJ. Hip Reconstruction in Nonambulatory Children With Cerebral Palsy: Identifying Risk Factors Associated With Postoperative Complications and Prolonged Length of Stay. J Pediatr Orthop 2021; 40:e972-e977. [PMID: 33045159 DOI: 10.1097/bpo.0000000000001643] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study is to examine the relationship between preoperative comorbidities, surgical complications, and length of stay (LOS) after hip reconstruction in nonambulatory children with cerebral palsy (CP). METHODS This single-center retrospective cohort study included 127 patients undergoing hip surgery between 2007 and 2016 who were diagnosed with CP (GMFCS IV/V). The cohort was 54% Gross Motor Function Classification System (GMFCS) V with an average age at surgery of 9 years (range, 3-19 y). Preoperative comorbidities included: presence of a gastrostomy tube, respiratory difficulty requiring positive-pressure ventilation or tracheostomy, history of seizures, and nonverbal status. Complications were dichotomized into major and minor complications according to severity. Multivariable general linear modeling was used to identify factors associated with complications and prolonged LOS. RESULTS The median LOS in the hospital was 6 days (intequartile range, 5-9 d). The majority of procedures (72%) involved both the femur and acetabulum and 82% of surgeries were performed bilaterally. Patients who experienced a major complication were mostly GMFCS level V and were more likely to spend time in intensive care unit than postanesthetic care unit (P=0.001). Multivariable analysis for a major complication determined that the addition of each comorbid risk fact increased the odds of developing a major complication by 2.6 times (odds ratio, 2.64; 95% confidence interval, 1.56-4.47; P<0.001) regardless of GMFCS level. Multivariable analysis for prolonged LOS determined that major complications (P<0.001), bilaterality (P=0.01), age (P=0.02), female sex (P=0.01), and GMFCS V (P<0.001) were all factors that increased LOS. Migration percentage, acetabular index odds ratio, and pelvic obliquity were not associated with prolonged LOS or the presence of a major complication. CONCLUSIONS From our analysis, the authors found that a patient's premorbid comorbidities were more predictive of the likelihood of sustaining a major complication than their GMFCS level. Identifying high-risk patients preoperatively may help reduce complications and LOS, which ultimately will improve the quality of care the authors deliver to nonambulatory children with CP undergoing hip reconstruction surgery. LEVEL OF EVIDENCE Level III-retrospective cohort study.
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Affiliation(s)
| | | | | | | | - Travis H Matheney
- Department of Orthopaedic Surgery.,Harvard Medical School, Boston Children's Hospital, Boston, MA
| | - Brian Snyder
- Department of Orthopaedic Surgery.,Harvard Medical School, Boston Children's Hospital, Boston, MA
| | - Benjamin J Shore
- Department of Orthopaedic Surgery.,Harvard Medical School, Boston Children's Hospital, Boston, MA
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Incidence of Pediatric Venous Thromboembolism After Elective Spine and Lower-Extremity Surgery in Children With Neuromuscular Complex Chronic Conditions: Do we Need Prophylaxis? J Pediatr Orthop 2020; 40:e375-e379. [PMID: 31821246 DOI: 10.1097/bpo.0000000000001483] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The incidence of venous thromboembolism (VTE) after elective surgery in children with mobility impairments, including those with a neuromuscular complex chronic condition (NCCC), is unknown. Therefore, our objectives were to assess the incidence of VTE after elective spine and lower-extremity surgery in children with NCCC. METHODS A retrospective analysis of children with NCCC undergoing elective lower-extremity and/or spinal surgeries from 2005 to 2009 included in the Pediatric Health Information Systems Plus (PHIS+) database. VTE during hospitalization for surgery was assessed through abstraction and review of ultrasound (U/S) and computed tomography results by 2 independent reviewers. VTEs related to pre-existing central venous catheters were excluded. RESULTS There were 4,583 children with NCCC who underwent orthopaedic surgery during the study period at 6 centers. Most were male (56.3%), non-Hispanic whites (72.7%), and had private insurance (52.2%). The most common NCCC diagnoses were cerebral palsy (46.7%), brain and spinal cord malformations (31.1%), and central nervous system degenerative conditions (14.5%). Forty children (0.9%) underwent U/S to assess VTE. Eighteen children (0.4%) underwent computed tomography to assess VTE. Four children (with cerebral palsy) had a positive U/S for a lower-extremity VTE (10-18 y of age), yet 2 had their VTE before surgery. Therefore, the adjusted VTE rate for children with NCCC undergoing orthopaedic lower-extremity or spine surgery was 4 per 10,000 (2 cases per 4583 surgeries). Each of the 2 cases had a known coagulation disorder preoperatively. Only 10% of the cohort used compression devices, 3% enoxaparin, and 1.6% aspirin for prophylaxis. CONCLUSION The rate of non-central-venous-catheter-related VTE associated with orthopaedic surgery in children with NCCC is very low and lower than rates reported in healthy children. SIGNIFICANCE To our knowledge, this is the first multi-institutional study reporting the incidence of VTE in children with NCCCs undergoing elective hip and spine surgery. These data support no additional prophylaxis is required in children with NCCC undergoing elective hip and spine surgery unless other known risk factors are also present.
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Karatoprak E, Sözen G, Saltık S. Risk factors associated with epilepsy development in children with cerebral palsy. Childs Nerv Syst 2019; 35:1181-1187. [PMID: 31011806 DOI: 10.1007/s00381-019-04152-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/08/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Epilepsy is one of the most common and important comorbidity among patients with cerebral palsy (CP). The purpose of this study was to determine the risk factors predicting the development of epilepsy considering prenatal, perinatal, and natal characteristics; associated impairments; and cranial imaging findings in our patient population with cerebral palsy at a tertiary center in Istanbul, Turkey. METHODS This retrospective study consisted of 234 children aged between 3 and 18 years of age. Children were divided into two groups as CP patients with epilepsy (126 patients) and CP patients without epilepsy (108 patients). Demographic features and clinical and cranial magnetic resonance imaging (cMRI) findings were compared between the two groups. RESULTS Presence of family history of epilepsy, history of neonatal seizure especially in the first 72 h of life, quadriplegic type of CP, severe degree of gross motor function and fine motor disorders, and moderate to severe mental retardation or psycho-social developmental delay were determined as risk factors for the development of epilepsy in CP patients. Also, an increased risk of epilepsy was detected in term infants and appropriate for gestational age (2500-4000 g) infants. On the other hand, presence of parental consanguinity, being born from a primiparous mother, age of mother at birth, mode of delivery, presence of multiple gestation and labor problems, history of follow-up in neonatal intensive care unit and intubation, and cMRI findings were not significant risk factors for the development of epilepsy in CP. CONCLUSION Predicting epilepsy development by determining the risk factors in patients with CP might be useful because knowing the risk factors could provide close follow-up of these patients for epilepsy.
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Affiliation(s)
- Elif Karatoprak
- Faculty of Medicine, Department of Pediatric Neurology, Medeniyet University, Istanbul, Turkey.
| | - Gülhan Sözen
- Department of Pediatric Neurology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Sema Saltık
- Cerrahpasa Faculty of Medicine, Department of Pediatric Neurology, Istanbul University, Istanbul, Turkey
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Exploring diseases and syndromes in neurology case reports from 1955 to 2017 with text mining. Comput Biol Med 2019; 109:322-332. [PMID: 31128466 DOI: 10.1016/j.compbiomed.2019.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND A large number of neurology case reports have been published, but it is a challenging task for human medical experts to explore all of these publications. Text mining offers a computational approach to investigate neurology literature and capture meaningful patterns. The overarching goal of this study is to provide a new perspective on case reports of neurological disease and syndrome analysis over the last six decades using text mining. METHODS We extracted diseases and syndromes (DsSs) from more than 65,000 neurology case reports from 66 journals in PubMed over the last six decades from 1955 to 2017. Text mining was applied to reports on the detected DsSs to investigate high-frequency DsSs, categorize them, and explore the linear trends over the 63-year time frame. RESULTS The text mining methods explored high-frequency neurologic DsSs and the relationships between them from 1955 to 2017. We detected more than 18,000 unique DsSs and found 10 categories of neurologic DsSs. While the trend analysis showed the increasing trends in the case reports for top-10 high-frequency DsSs, the categories had mixed trends. CONCLUSION Our study provided new insights into the application of text mining methods to investigate DsSs in a large number of medical case reports that occur over several decades. The proposed approach can be used to provide a macro level analysis of medical literature by discovering interesting patterns and tracking them over several years to help physicians explore these case reports more efficiently.
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Chamudot R, Parush S, Rigbi A, Horovitz R, Gross-Tsur V. Effectiveness of Modified Constraint-Induced Movement Therapy Compared With Bimanual Therapy Home Programs for Infants With Hemiplegia: A Randomized Controlled Trial. Am J Occup Ther 2018; 72:7206205010p1-7206205010p9. [DOI: 10.5014/ajot.2018.025981] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. We examined the effectiveness of modified constraint-induced movement therapy (mCIMT) in treating infants with hemiplegic cerebral palsy and compared therapy outcomes with a nonconstraining bimanual therapy (BIM) of equal intensity.
METHOD. In a single-blinded randomized controlled trial, 33 infants with hemiplegia (mean corrected age = 11.1 mo, standard deviation = 2.2) received either mCIMT (n = 17) or BIM (n = 16). Both interventions included home programs encouraging the use of the affected hand during daily 1-hr play sessions for 8 wk. Outcome measures were administered pre- and posttreatment and included the Mini-Assisting Hand Assessment for babies and the Functional Inventory. At baseline, parents also filled out the Dimensions of Mastery Questionnaire.
RESULTS. Both groups demonstrated a significantly large and equal improvement in hand and gross motor function posttreatment (p < .001) and high treatment compliance.
CONCLUSION. mCIMT and BIM are equally effective methods for treating infants with hemiplegia.
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Affiliation(s)
- Rena Chamudot
- Rena Chamudot, PhD, OT, is Lecturer, School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel, and Occupational Therapy Director, Dvorah Agmon Pre-School Development Center, Jerusalem, Israel. At the time of the study, she was Doctoral Student, School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Israel;
| | - Shula Parush
- Shula Parush, PhD, OT, is Professor Emeritus, School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amihai Rigbi
- Amihai Rigbi, PhD, is Senior Lecturer, Faculty of Education, and Research Authority, Beit Berl Academic College, Kfar-Sava, Israel
| | - Roni Horovitz
- Roni Horovitz, MSc, OTR/L, is OTD Candidate, Boston University, Boston, MA. At the time of the study, she was Graduate Student, School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Varda Gross-Tsur
- Varda Gross-Tsur, PhD, MD, is Professor of Pediatrics, Neuropediatric Unit, Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel, and the Hebrew University of Jerusalem, Jerusalem, Israel
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The Role of the Pediatric Neurologist in the Care of Children With Neurodevelopmental Disabilities. Pediatr Neurol 2018; 88:3-9. [PMID: 30318285 DOI: 10.1016/j.pediatrneurol.2018.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/05/2018] [Indexed: 11/24/2022]
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Interdisciplinary Management of a Class III Anterior Open Bite Malocclusion in a Patient With Cerebral Palsy. J Oral Maxillofac Surg 2018; 76:2648.e1-2648.e15. [PMID: 30193117 DOI: 10.1016/j.joms.2018.07.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/09/2018] [Accepted: 07/31/2018] [Indexed: 11/23/2022]
Abstract
Dentofacial disharmony in patients with cerebral palsy (CP) can lead to low self-esteem and functional limitations. However, medical and behavioral challenges in patients with developmental disorders often prevent dental practitioners from offering the necessary treatment. This report describes the clinical interdisciplinary management of a 20-year-old man with CP, including orthodontic, periodontal, and orthognathic surgery therapy. The patient presented with the chief complaint of having difficulty chewing, was wheelchair dependent, had poor orofacial muscle control, and exhibited a Class III malocclusion with a skeletal anterior open bite. The lower midline was shifted 3 mm to the right, there was severe maxillary spacing, and the patient had gingival overgrowth. A combined orthodontic, periodontal, and orthognathic surgery treatment approach was chosen to meet the patient's interdisciplinary needs. Because of his physical limitations, it was necessary to avoid complicated and prolonged orthodontic treatment mechanics. Interdisciplinary therapy improved the patient's oral function, periodontal health, and facial esthetics and led to a good occlusion, which remained stable 1 year after treatment. Regardless of the treatment challenges, combined orthodontic and surgical therapy in the present patient with CP led to favorable treatment results and improved the patient's self-esteem, confidence in social interactions, and speaking and chewing abilities.
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Liu X, Fu X, Dai G, Wang X, Zhang Z, Cheng H, Zheng P, An Y. Comparative analysis of curative effect of bone marrow mesenchymal stem cell and bone marrow mononuclear cell transplantation for spastic cerebral palsy. J Transl Med 2017; 15:48. [PMID: 28235424 PMCID: PMC5324263 DOI: 10.1186/s12967-017-1149-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 02/17/2017] [Indexed: 12/15/2022] Open
Abstract
Background Bone marrow mesenchymal stem cells (BMMSCs) and bone marrow mononuclear cells (BMMNCs) are both used to treat spastic cerebral palsy. However, the differences in therapeutic effect remain unknown. Methods A total of 105 patients with spastic cerebral palsy were enrolled and randomly assigned to three groups: the BMMSC group, the BMMNC group and the control group. Patients in both transplantation groups received four intrathecal cell injections. Patients in the control group received Bobath therapy. The gross motor function measure (GMFM) and the fine motor function measure (FMFM) were used to evaluate the therapeutic efficacy before transplantation and 3, 6, and 12 months after transplantation. Results Three months after cell transplantation, scores in the A dimension of GMFM and the A and C dimensions of FMFM scores in the BMMSC group are all higher than those of the BMMNC and the control groups (P < 0.05). Six months after cell transplantation, scores in the A, B dimensions of GMFM and the A, B, C, D, and E dimensions of FMFM scores in the BMMSC group are higher than those of the BMMNC and the control groups (P < 0.05). Twelve months after cell transplantation, scores in the A, B, and C dimensions of GMFM and the A, B, C, D, and E dimensions of FMFM scores in the BMMSC group are all higher than those of the BMMNC and the control groups (P < 0.05). No obvious adverse effects were investigated during follow-up. Conclusions BMMSC transplantation for the treatment of cerebral palsy is safe and feasible, and can improve gross motor and fine motor function significantly. In addition, compared with BMMNC, the motor function of children improved significantly in terms of gross motor and fine motor functions. Electronic supplementary material The online version of this article (doi:10.1186/s12967-017-1149-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xuebin Liu
- Department of Cell Transplantation, General Hospital of Chinese people's Armed Police Forces, Beijing, 100039, China
| | - Xiaojun Fu
- Department of Cell Transplantation, General Hospital of Chinese people's Armed Police Forces, Beijing, 100039, China
| | - Guanghui Dai
- Department of Cell Transplantation, General Hospital of Chinese people's Armed Police Forces, Beijing, 100039, China
| | - Xiaodong Wang
- Department of Cell Transplantation, General Hospital of Chinese people's Armed Police Forces, Beijing, 100039, China
| | - Zan Zhang
- Department of Cell Transplantation, General Hospital of Chinese people's Armed Police Forces, Beijing, 100039, China
| | - Hongbin Cheng
- Department of Cell Transplantation, General Hospital of Chinese people's Armed Police Forces, Beijing, 100039, China
| | - Pei Zheng
- Department of Cell Transplantation, General Hospital of Chinese people's Armed Police Forces, Beijing, 100039, China
| | - Yihua An
- Department of Cell Transplantation, General Hospital of Chinese people's Armed Police Forces, Beijing, 100039, China.
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Zelnik N, Lahat E, Heyman E, Livne A, Schertz M, Sagie L, Fattal-Valevski A. The Role of Prematurity in Patients With Hemiplegic Cerebral Palsy. J Child Neurol 2016; 31:678-82. [PMID: 26500242 DOI: 10.1177/0883073815610430] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 09/14/2015] [Indexed: 12/23/2022]
Abstract
A multicenter retrospective study was conducted to investigate the perinatal factors, imaging findings and clinical characteristics of hemiplegic cerebral palsy with a particular focus on children born prematurely. Our cohort included 135 patients of whom 42% were born prematurely; 16% were extreme premature infants who were born at 30 weeks or earlier. Nineteen (14%) were twins. Right hemiplegia was slightly more common and accounted for 59% of the patients. Imaging findings of intraventricular hemorrhage and periventricular leukomalacia were more prevalent in premature children whereas stroke, porencephaly, cerebral hemorrhage and cerebral atrophy were more evenly distributed in both term-born and prematurely-born children (p< 0.01). The overall prevalence of epilepsy in the cohort was 26% with no differences in full-term compared to prematurely-born children. Regardless of the gestational birth age, intellectual deficits were more common in the presence of comorbidity of both hemiplegia and epilepsy (p< 0.05).
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Affiliation(s)
- Nathanel Zelnik
- Carmel Medical Center, Pediatric Neurology Unit, Haifa, Israel
| | - Eli Lahat
- Assaf Harofeh Medical Center, Pediatric Neurology Unit, Zerifin, Israel
| | - Eli Heyman
- Assaf Harofeh Medical Center, Pediatric Neurology Unit, Zerifin, Israel
| | - Amir Livne
- Assaf Harofeh Medical Center, Pediatric Neurology Unit, Zerifin, Israel
| | - Mitchell Schertz
- Meuhedet, Child Development & Pediatric Neurology Service, Haifa, Israel
| | - Liora Sagie
- Tel Aviv Sourasky Medical Center, Pediatric Neurolgy Unit, Tel Aviv, Israel
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Cognitive and motor aspects of a coincidence-timing task in Cerebral Palsy children. Neurosci Lett 2015; 602:33-7. [DOI: 10.1016/j.neulet.2015.06.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 06/02/2015] [Accepted: 06/22/2015] [Indexed: 11/18/2022]
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Longstaff H, Khramova V, Portales-Casamar E, Illes J. Sharing with More Caring: Coordinating and Improving the Ethical Governance of Data and Biomaterials Obtained from Children. PLoS One 2015; 10:e0130527. [PMID: 26132205 PMCID: PMC4488593 DOI: 10.1371/journal.pone.0130527] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 05/21/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction Research on complex health conditions such as neurodevelopmental disorders increasingly relies on large-scale research and clinical studies that would benefit from data sharing initiatives. Organizations that share data stand to maximize the efficiency of invested research dollars, expedite research findings, minimize the burden on the patient community, and increase citation rates of publications associated with the data. Objective This study examined ethics and governance information on websites of databases involving neurodevelopmental disorders to determine the availability of information on key factors crucial for comprehension of, and trust and participation in such initiatives. Methods We identified relevant databases identified using online keyword searches. Two researchers reviewed each of the websites and identified thematic content using principles from grounded theory. The content for each organization was interrogated using the gap analysis method. Results Sixteen websites from data sharing organizations met our inclusion criteria. Information about types of data and tissues stored, data access requirements and procedures, and protections for confidentiality were significantly addressed by data sharing organizations. However, special considerations for minors (absent from 63%), controls to check if data and tissues are being submitted (absent from 81%), disaster recovery plans (absent from 81%), and discussions of incidental findings (absent from 88%) emerged as major gaps in thematic website content. When present, content pertaining to special considerations for youth, along with other ethics guidelines and requirements, were scattered throughout the websites or available only from associated documents accessed through live links. Conclusion The complexities of sharing data acquired from children and adolescents will only increase with advances in genomic and neuro science. Our findings suggest that there is a need to improve the consistency, depth and accessibility of governance and policies on which these collaborations can lean specifically for vulnerable young populations.
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Affiliation(s)
- Holly Longstaff
- National Core for Neuroethics, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vera Khramova
- National Core for Neuroethics, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elodie Portales-Casamar
- Centre for Molecular Medicine and Therapeutics at the Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Judy Illes
- National Core for Neuroethics, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
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Huntsman R, Lemire E, Norton J, Dzus A, Blakley P, Hasal S. The differential diagnosis of spastic diplegia. Arch Dis Child 2015; 100:500-4. [PMID: 25700542 DOI: 10.1136/archdischild-2014-307443] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 10/29/2014] [Indexed: 12/11/2022]
Abstract
Spastic diplegia is the most common form of cerebral palsy worldwide. Many disorders mimic spastic diplegia, which can result in misdiagnosis for the child with resultant negative treatment and family counselling implications. In this paper, the authors provide a brief review of spastic diplegia and the various disorders in the differential diagnosis. We also provide a diagnostic algorithm to assist physicians in making the correct diagnosis.
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Affiliation(s)
- Richard Huntsman
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Edmond Lemire
- Division of Medical Genetics, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jonathon Norton
- Division of Neurosurgery, Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Anne Dzus
- Division of Pediatric Orthopedics, Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Patricia Blakley
- Division of Developmental Pediatrics, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Simona Hasal
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Kakooza-Mwesige A, Forssberg H, Eliasson AC, Tumwine JK. Cerebral palsy in children in Kampala, Uganda: clinical subtypes, motor function and co-morbidities. BMC Res Notes 2015; 8:166. [PMID: 25902796 PMCID: PMC4421914 DOI: 10.1186/s13104-015-1125-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 04/15/2015] [Indexed: 01/13/2023] Open
Abstract
Background Cerebral palsy (CP) is a common chronic childhood disorder worldwide. There is limited information about the CP panorama in sub-Saharan Africa. Our aim was to describe the clinical subtypes, gross and fine motor functions and presence of co-morbidities in a group of children with CP attending a tertiary hospital in Uganda. Methods Children with CP in the age range of 2-12 years visiting the paediatric CP clinic at Mulago Hospital, Kampala, were enrolled. Screening and inclusion were based on a three-stage procedure: i) Two screening questions from the Ten Question Screen; ii) Clinical assessments adapted from the Surveillance for Cerebral Palsy in Europe (SCPE); iii) Clinical examinations and diagnoses of subtype, severity level and co-morbidities. Caregivers were interviewed using questionnaires to provide information on child’s medical history and co-morbidities. Co-morbidity scores were calculated for each child. Results One hundred and thirty five children with CP were enrolled (72 males, 63 females, median age 3 years 5 months, IQR-2 years 4 months-5 years 6 months). Bilateral spastic type was commonest (45%); moderate impairment in gross motor function was present in 43%, with comparable numbers (37%) in the mild and severely impaired fine motor function groups. The severe gross and fine motor function levels were seen in the bilateral spastic and dyskinetic CP subtypes. Signs of learning disability (75%) and epilepsy (45%) were the commonest co-morbidities. Higher co-morbidity scores were obtained in children with dyskinetic CP and severe levels of gross and fine motor function. There was a significant difference in distribution of the co-morbidity scores between the CP subtypes, gross motor and fine motor function levels (p <0.001). Signs of speech and language impairments were associated with bilateral spastic CP and severe gross and fine motor dysfunction (p < 0.05). Conclusions Bilateral spastic CP was the main clinical subtype, with signs of learning disability and epilepsy as major causes of co-morbidity. The severity of gross and fine motor function levels was related to severity of clinical CP subtypes. Our findings imply a higher occurrence of birth asphyxia or post natally acquired infections. Improvement in emergency obstetric and postnatal care may reduce this burden. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1125-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Angelina Kakooza-Mwesige
- Department of Paediatrics & Child Health, Makerere University College of Health Sciences, P O Box 7072, Kampala, Uganda. .,Department of Women's & Children's Health, Astrid Lindgren Children's Hospital, Neuropediatric Research Unit, Karolinska Institutet, Stockholm, Sweden.
| | - Hans Forssberg
- Department of Women's & Children's Health, Astrid Lindgren Children's Hospital, Neuropediatric Research Unit, Karolinska Institutet, Stockholm, Sweden.
| | - Ann-Christin Eliasson
- Department of Women's & Children's Health, Astrid Lindgren Children's Hospital, Neuropediatric Research Unit, Karolinska Institutet, Stockholm, Sweden.
| | - James K Tumwine
- Department of Paediatrics & Child Health, Makerere University College of Health Sciences, P O Box 7072, Kampala, Uganda.
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16
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A diagnostic approach for cerebral palsy in the genomic era. Neuromolecular Med 2014; 16:821-44. [PMID: 25280894 DOI: 10.1007/s12017-014-8331-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 09/24/2014] [Indexed: 12/12/2022]
Abstract
An ongoing challenge in children presenting with motor delay/impairment early in life is to identify neurogenetic disorders with a clinical phenotype, which can be misdiagnosed as cerebral palsy (CP). To help distinguish patients in these two groups, conventional magnetic resonance imaging of the brain has been of great benefit in "unmasking" many of these genetic etiologies and has provided important clues to differential diagnosis in others. Recent advances in molecular genetics such as chromosomal microarray and next-generation sequencing have further revolutionized the understanding of etiology by more precisely classifying these disorders with a molecular cause. In this paper, we present a review of neurogenetic disorders masquerading as cerebral palsy evaluated at one institution. We have included representative case examples children presenting with dyskinetic, spastic, and ataxic phenotypes, with the intent to highlight the time-honored approach of using clinical tools of history and examination to focus the subsequent etiologic search with advanced neuroimaging modalities and molecular genetic tools. A precise diagnosis of these masqueraders and their differentiation from CP is important in terms of therapy, prognosis, and family counseling. In summary, this review serves as a continued call to remain vigilant for current and other to-be-discovered neurogenetic masqueraders of cerebral palsy, thereby optimizing care for patients and their families.
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17
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Functional and fixed orthodontic treatment in a child with cerebral palsy. Am J Orthod Dentofacial Orthop 2014; 145:523-33. [DOI: 10.1016/j.ajodo.2013.06.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 06/01/2013] [Accepted: 06/01/2013] [Indexed: 11/24/2022]
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Levy-Zaks A, Pollak Y, Ben-Pazi H. Cerebral palsy risk factors and their impact on psychopathology. Neurol Res 2014; 36:92-4. [DOI: 10.1179/1743132813y.0000000290] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Musselman KE, Stoyanov CT, Marasigan R, Jenkins ME, Konczak J, Morton SM, Bastian AJ. Prevalence of ataxia in children: a systematic review. Neurology 2014; 82:80-9. [PMID: 24285620 PMCID: PMC3873624 DOI: 10.1212/01.wnl.0000438224.25600.6c] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 11/04/2013] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of childhood ataxia resulting from both genetic and acquired causes. METHODS A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement. Five databases were searched for articles reporting a frequency measure (e.g., prevalence, incidence) of ataxia in children. Included articles were first grouped according to the World Health Organization (WHO) regions and subsequently classified according to etiology (genetic, acquired, or mixed). Each article was assessed for its risk of bias on the domains of sampling, measurement, and analysis. Incidence values were converted to prevalence estimates whenever possible. European prevalence estimates for different etiologies of ataxia were summed to gauge the overall prevalence of childhood ataxia. RESULTS One hundred fifteen articles were included in the review. More than 50% of the data originated from the Europe WHO region. Data from this region also showed the least susceptibility to bias. Little data were available for Africa and Southeast Asia. The prevalence of acquired ataxias was found to vary more greatly across regions than the genetic ataxias. Ataxic cerebral palsy was found to be a significant contributor to the overall prevalence of childhood ataxia across WHO regions. The prevalence of childhood ataxias in Europe was estimated to be ∼26/100,000 children and likely reflects a minimum prevalence worldwide. CONCLUSIONS The findings show that ataxia is a common childhood motor disorder with a higher prevalence than previously assumed. More research concerning the epidemiology, assessment, and treatment of childhood ataxia is warranted.
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Affiliation(s)
- Kristin E Musselman
- From the Department of Neuroscience (K.E.M., A.J.B.), Johns Hopkins School of Medicine, Baltimore, MD; Kennedy Krieger Institute (K.E.M., R.M., A.J.B.), Baltimore, MD; Johns Hopkins Bloomberg School of Public Health (C.T.S.), Baltimore, MD; Department of Clinical Neurological Sciences (M.E.J.), Western University, London, Ontario, Canada; School of Kinesiology (J.K.), University of Minnesota, Minneapolis; and Department of Physical Therapy (S.M.M.), University of Delaware, Newark
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Abd El-Kafy EM, Elshemy SA, Alghamdi MS. Effect of constraint-induced therapy on upper limb functions: a randomized control trial. Scand J Occup Ther 2013; 21:11-23. [PMID: 24325594 DOI: 10.3109/11038128.2013.837505] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS Children with congenital hemiparesis have unilateral upper extremity involvement, limiting their ability in unilateral or bilateral manual tasks, thus negatively influencing their participation in daily activities. Constraint-induced movement therapy (CIMT) has been shown to be promising for improving upper-limb functions in children with cerebral palsy. Clinical assessments may be needed to quantify and qualify changes in children's performance following its application. METHODS This study investigated the effectiveness of a child-friendly form of CIMT to improve upper extremity functional performance. Thirty congenitally hemiparetic children aged 4-8 years were randomly assigned to receive either a CIMT program (study group) or a conventional non-structured therapy program (control group). The programs were applied for both groups for six hours daily, five days weekly for four successive weeks. The Pediatric Arm Function Test, Quality of Upper Extremity Skills Test, and isokinetic muscular performances of shoulder flexors, extensors, and abductors expressed as peak torque were used to evaluate immediate and long-lasting efficacy of CIMT. RESULTS The results showed improvement in the involved upper extremity performances in different evaluated tasks immediately post-CIMT program application compared with the control group. These improvements continued three months later. CONCLUSION Pediatric CIMT with shaping produced considerable and sustained improvement in the involved upper extremity movements and functions in children with congenital hemiparesis.
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Affiliation(s)
- Ehab Mohamed Abd El-Kafy
- Department of Physical Therapy for Disturbances of Growth and Developmental Disorders in Children and its Surgery, Faculty of Physical Therapy, Cairo University , Giza , Egypt
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Lin S, Li T, Zhu D, Ma C, Wang Y, He L, Zhu C, Xing Q. The association between GAD1 gene polymorphisms and cerebral palsy in Chinese infants. CYTOL GENET+ 2013. [DOI: 10.3103/s0095452713050071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Therapeutic potential of umbilical cord mesenchymal stromal cells transplantation for cerebral palsy: a case report. Case Rep Transplant 2013; 2013:146347. [PMID: 23533920 PMCID: PMC3603664 DOI: 10.1155/2013/146347] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 02/13/2013] [Indexed: 12/27/2022] Open
Abstract
Cerebral palsy is the most common motor disability in childhood. In current paper, we first report our clinical data regarding administration of umbilical cord mesenchymal stem cells (MSCs) transplantation in treatment of cerebral palsy. A 5-year-old girl with cerebral palsy was treated with multiple times of intravenous and intrathecal administration of MSCs derived from her young sister and was followed up for 28 months. The gross motor dysfunction was improved. Other benefits included enhanced immunity, increased physical strength, and adjusted speech and comprehension. Temporary low-grade fever was the only side effect during the treatment. MSCs may be a safe and effective therapy to improve symptoms in children with cerebral palsy.
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Ellenberg JH, Nelson KB. The association of cerebral palsy with birth asphyxia: a definitional quagmire. Dev Med Child Neurol 2013; 55:210-6. [PMID: 23121164 DOI: 10.1111/dmcn.12016] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to investigate whether current literature provides a useful body of evidence reflecting the proportion of cerebral palsy (CP) that is attributable to birth asphyxia. METHOD We identified 23 studies conducted between 1986 and 2010 that provided data on intrapartum risks of CP. RESULTS The proportion of CP with birth asphyxia as a precursor (case exposure rate) varied from less than 3% to over 50% in the 23 studies reviewed. The studies were heterogeneous in many regards, including the definitions for birth asphyxia and the outcome of CP. INTERPRETATIONS Current data do not support the belief, widely held in the medical and legal communities, that birth asphyxia can be recognized reliably and specifically, or that much of CP is due to birth asphyxia. The very high case exposure rates linking birth asphyxia to CP can probably be attributed to several factors: the fact that the clinical picture at birth cannot specifically identify birth asphyxia; the definition of CP employed; and confusion of proximal effects - results - with causes. Further research is needed.
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Affiliation(s)
- Jonas H Ellenberg
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Racine E, Bell E, Shevell M. Ethics in neurodevelopmental disability. HANDBOOK OF CLINICAL NEUROLOGY 2013; 118:243-63. [PMID: 24182383 DOI: 10.1016/b978-0-444-53501-6.00021-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neurodevelopmental disabilities, like autism spectrum disorders and cerebral palsy are a common health problem in children. Given the impact of these conditions on children, families, and healthcare and social systems, the care of developmentally challenged children raises questions related to values and ethical principles. We review the common features of neurodevelopmental disorders that help understand the associated ethical questions. We focus on three major areas where ethical questions arise for clinicians and those involved in making decisions for or caring for these children: (1) the principles of decision-making and autonomy as they relate to developmental disability; (2) the issues related to quality of life that have long intersected with developmental disability; and (3) the use of unproven therapies and diagnostics that are particularly controversial given the extent that neurodevelopmental disabilities impact children and their families, yet active treatments options are limited.
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Affiliation(s)
- Eric Racine
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, Montreal, Canada; Department of Medicine and Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada; Departments of Neurology and Neurosurgery, McGill University, Montreal, Canada.
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Flett PJ, Baulderstone D, Russo R, Davies RP. Spinal arteriovenous malformation presenting as spastic monoplegic cerebral palsy in a child. J Paediatr Child Health 2012; 48:71-4. [PMID: 20546106 DOI: 10.1111/j.1440-1754.2010.01743.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A case of spinal arterio-venous malformation (AVM) initially diagnosed as unilateral cerebral palsy (CP) is reported. The presentation was of a long-standing spastic monoparesis of the left leg, with initial response to Botulinum toxin injections to the calf and tibialis posterior muscles. This was followed by progressive deterioration occurring over a 3-month period before further investigation and definitive diagnosis at 7 years. Imaging demonstrated a large extra-medullary spinal AVM compressing the mid-thoracic cord. This was successfully managed by embolisation with a non-adhesive polymer: ethylene-vinyl alcohol copolymer injected into the dominant feeding vessel. This case highlights the need to consider alternative diagnoses when a child with a diagnosis of CP presents with atypical clinical features such as monoparesis and has worsening or altered clinical signs. Moreover, a normal magnetic resonance imaging brain scan and the absence of ipsilateral upper limb neurological signs or functional impairment should raise suspicion even in the context of static lower limb signs. A literature review was performed on the management of spinal AVM in children and this will be is discussed.
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The effects of multiple pre- and perinatal risk factors on the occurrence of cerebral palsy. A Norwegian register based study. Eur J Paediatr Neurol 2012; 16:56-63. [PMID: 22104566 DOI: 10.1016/j.ejpn.2011.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Revised: 09/17/2011] [Accepted: 10/23/2011] [Indexed: 11/21/2022]
Abstract
AIMS To examine the effects of multiple risk factors on cerebral palsy (CP). MATERIALS/METHODS For 176,591 Norwegian infants born 1996-98 and surviving the early neonatal period, data on a number of potential pre- and perinatal risk factors (RFs) for CP were available in the Medical Birth Registry of Norway. For 241 children with CP detailed clinical data were available in the Norwegian CP registry. RESULTS In children born at term, 31% had no RF, and none had five or more, while in children born preterm, 9% had no RF in addition to prematurity (p < 0.001 vs. term), and 5% had five or more (p < 0.02 vs. term). In both groups, few children shared the same combination of RFs. Interdependent sequences were more often observed among children born preterm than at term (p < 0.001 vs. term). The most detrimental effect was observed for the combination of maternal disease and low 5-min Apgar score, registered in 11.2% of children with CP. The combination of maternal disease and premature birth had an interaction contrast ratio of 9.25 (CI: 3.56; 14.94), which may be consistent with biological interaction. CONCLUSIONS The majority of children with CP born at term most likely had an antenatal or single cause, suggesting individual susceptibility to an injury. The majority of children born preterm, had combinations or sequences of antenatal and perinatal risk factors as the most likely cause of CP.
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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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Boog G. [Cerebral palsy and perinatal asphyxia (II--Medicolegal implications and prevention)]. ACTA ACUST UNITED AC 2011; 39:146-73. [PMID: 21354846 DOI: 10.1016/j.gyobfe.2011.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 01/18/2011] [Indexed: 01/18/2023]
Abstract
Obstetric litigation is a growing problem in developed countries and its escalating cost together with increasing medical insurance premiums is a major concern for maternity service providers, leading to obstetric practice cessation by many practitioners. Fifty-four to 74 % of claims are based on cardiotocographic (CTG) abnormalities and their interpretation followed by inappropriate or delayed reactions. A critical analysis is performed about the nine criteria identified by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics in their task force on Neonatal Encephalopathy and Cerebral Palsy: four essential criteria defining neonatal asphyxia and five other suggesting an acute intrapartum event sufficient to cause cerebral palsy in term newborns. The importance of placental histologic examination is emphasized in order to confirm sudden catastrophic events occurring before or during labor or to detect occult thrombotic processes affecting the fetal circulation, patterns of decreased placenta reserve and adaptative responses to chronic hypoxia. It may also exclude intrapartum hypoxia by revealing some histologic patterns typical of acute chorioamnionitis and fetal inflammatory response or compatible with metabolic diseases. Magnetic resonance imaging (MRI) of the infant's damaged brain is very contributive to elucidate the mechanism and timing of asphyxia in conjunction with the clinical picture, by locating cerebral injuries predominantly in white or grey matter. Intrapartum asphyxia is sometimes preventable by delivering weak fetuses by cesarean sections before birth, by avoiding some "sentinel" events, and essentially by responding appropriately to CTG anomalies and performing an efficient neonatal resuscitation. During litigation procedures, it is necessary to have access to a readable CTG, a well-documented partogram, a complete analysis of umbilical cord gases, a placental pathology and an extensive clinical work-up of the newborn infant including cerebral MRI. Malpractice litigation in obstetric care can be reduced by permanent CTG education, respect of national CTG guidelines, use of adjuncts such as fetal blood sampling for pH or lactates, regular review of adverse events in Clinical Risk Management (CRM) groups and periodic audits about low arterial cord pH in newborns, admission to neonatal unit, the need for assisted ventilation and the decision-to-delivery interval for emergency operative deliveries. Considering the fast occurrence of fetal cerebral hypoxic injuries, and thus despite an adequate management, many intrapartum asphyxias will not be preventable. Conversely, well-documented hypoxic-ischemic brain insults during the antenatal period do not automatically exclude intrapartum suboptimal obstetric care.
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Affiliation(s)
- G Boog
- Service de gynécologie-obstétrique, hôpital Mère-et-Enfant, CHU de Nantes, 38 boulevard Jean-Monnet, Nantes cedex 1, France.
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Majnemer A, Shevell M, Hall N, Poulin C, Law M. Developmental and functional abilities in children with cerebral palsy as related to pattern and level of motor function. J Child Neurol 2010; 25:1236-41. [PMID: 20299697 DOI: 10.1177/0883073810363175] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Abilities among school-aged children with cerebral palsy with different patterns and levels of motor function were evaluated. Children within spasticity patterns (33 with quadriplegia, 25 with hemiplegia, 19 with diplegia) and Gross Motor Function Classification System levels were compared (level I, walking = 47%; level II-III, restricted ambulation = 18%; level IV-V, wheelchair needs = 34%,). Outcomes included measures of intelligence, behavior, motor, and functional limitations (communication, daily living, socialization). Motor performance and prosocial behaviors were lower for children with quadriplegia (F = 16.13, 12.71; P < .0001), with no differences for behavioral difficulties between spasticity groups. Prosocial behaviors were different between level IV-V and other groups (F = 16.25, P < .0001). Functional limitations were more likely for children with quadriplegia (P < .0001), but not diplegia or hemiplegia, and for children in level IV-V, but similar for level I and level II-III. Children with quadriplegia, or level IV-V, are more likely to exhibit limitations, whereas children with better motor function (I-III), hemiplegia, or diplegia, exhibit diverse capabilities. A holistic assessment approach is essential to ensure that limitations are addressed comprehensively.
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Affiliation(s)
- Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Quebec, Canada.
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Abstract
Because of increasing interest in conducting large-scale, multicenter investigations into the epidemiology of cerebral palsy and its prevention and treatment, efforts have been made to establish a standard definition and classification systems for cerebral palsy. In recent years there has also been increased focus on measurement of functional status of patients and new classifications for gross and fine motor function have been developed. The purpose of this article is to update the orthopaedic community on the current classification systems for patients with cerebral palsy. This information will be of value to surgeons in determining patients' suitability for certain treatments and will also assist them in reviewing current literature in cerebral palsy.
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Affiliation(s)
- Susan A Rethlefsen
- Childrens Orthopaedic Center, Childrens Hospital Los Angeles, Los Angeles, CA 90027, USA
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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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Pinchefsky E, Al-Macki N, Shevell M. Term intra-partum asphyxia: an analysis of acute non-specific supportive criteria and non-CNS organ injury. Eur J Paediatr Neurol 2010; 14:313-9. [PMID: 19811936 DOI: 10.1016/j.ejpn.2009.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 09/01/2009] [Accepted: 09/03/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the frequencies and relationships of non-specific non-essential diagnostic criteria and non-CNS organ system injury in term intra-partum asphyxia. METHODS All children with term intra-partum asphyxia encountered in a single pediatric neurology practice with at least two years follow-up and an abnormal neurologic outcome were identified. RESULTS A total of 40 children (28 males, 12 females) were identified. Twenty-four had moderate NE and sixteen severe NE. The mean number of non-specific non-essential diagnostic criteria (out of a possible 7) was 4.75+/-1.39 SD. Sixty percent had five or more criteria and all criteria were present in only 10% of newborns. The mean number of non-CNS organ systems affected was 2.88+/-1.96 SD (out of a possible 6). Ten percent of our sample showed no evident non-CNS organ injury acutely. CONCLUSION Most asphyxiated neonates failed to consistently satisfy all elements of present consensus statements.
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Affiliation(s)
- Elana Pinchefsky
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Affiliation(s)
- Michael I Shevell
- Department of Neurology/Neurosurgery, McGill University, Montreal Children's Hospital-McGill University Health Centre, Montreal, Quebec, Canada
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[Cerebral palsy and perinatal asphyxia (I--diagnosis)]. ACTA ACUST UNITED AC 2010; 38:261-77. [PMID: 20378389 DOI: 10.1016/j.gyobfe.2010.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Accepted: 02/12/2010] [Indexed: 11/23/2022]
Abstract
Cerebral palsy (CP) is a group of disorders of the development of movement and posture, causing activity limitations, that are attributed to nonprogressing disturbances that occurred in the developing fetal or infant brain. The motor abnormalies are often accompanied by disturbances of sensation, perception, cognition, behavior and/or by a seizure disorder. The prevalence of CP has not decreased in developed countries over the past 30 years, despite the widespread use of electronic fetal heart rate monitoring and a 5- to 6-fold increase in the cesarean delivery rate. In the term newborn, CP may be attributed to perinatal asphyxia in case of metabolic acidosis in the cord blood (pH<7,00 and base deficit>12 mmol/L), followed by a moderate or severe neonatal encephalopathy within 24 hours and a further neurological impairement characterized by spastic quadriplegia and dyskinesia/dystonia. Dating the time of fetal asphyxia during delivery is possible when there are acute catastrophic complications during labor and unexpected acute or progressive fetal heart rate anomalies after a normal admission test, when there is a need for intensive neonatal resuscitation, a multi-organ failure within 72 hours of birth and visualization of acute non focal cerebral abnormalities, mainly by early magnetic resonance imaging (MRI). MRI sequences show either a brain-damaged pattern of the central basal ganglia, thalami and posterior limbs of internal capsules with relative cortical sparing, in acute, near-total asphyxial insults manifested by a continuous bradycardia or a pattern of cortical injury in the watershed zones and relative sparing of the central grey matter, in prolonged partial asphyxia, manifested by late or atypical variable decelerations with progressive fetal tachycardia, loss of reactivity and absent fluctuation. Prolongation of either type of asphyxial insult results in more global brain damage. In order to differentiate a CP occurring after perinatal asphyxia from other neurological sequelae in relation with infection, hemorrhage, stroke, malformations, genetic or metabolic diseases, it is essential that a definitive information from the brain by MRI and an extensive histological examination of the placenta are at disposal.
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Xiang B, Zhu H, Shen Y, Miller DT, Lu K, Hu X, Andersson HC, Narumanchi TM, Wang Y, Martinez JE, Wu BL, Li P, Li MM, Chen TJ, Fan YS. Genome-wide oligonucleotide array comparative genomic hybridization for etiological diagnosis of mental retardation: a multicenter experience of 1499 clinical cases. J Mol Diagn 2010; 12:204-12. [PMID: 20093387 DOI: 10.2353/jmoldx.2010.090115] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To assess the clinical utility of genome-wide oligonucleotide arrays in diagnosis of mental retardation and to address issues relating to interpretation of copy number changes (CNCs), we collected results on a total of 1499 proband patients from five academic diagnostic laboratories where the same 44K array platform has been used. Three of the five laboratories achieved a diagnostic yield of 14% and the other two had a yield of 11 and 7%, respectively. Approximately 80% of the abnormal cases had a single segment deletion or duplication, whereas the remaining 20% had a compound genomic imbalance involving two or more DNA segments. Deletion of 16p11.2 is a common microdeletion syndrome associated with mental retardation. We classified pathogenic CNCs into six groups according to the structural changes. Our data have demonstrated that the 44K platform provides a reasonable resolution for clinical use and a size of 300 kb can be used as a practical cutoff for further investigations of the clinical relevance of a CNC detected with this platform. We have discussed in depth the issues associated with the clinical use of array CGH and provided guidance for interpretation, reporting, and counseling of test results based on our experience.
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Affiliation(s)
- Bixia Xiang
- University of Miami Miller School of Medicine, Mailman Center for Child Development, Room 7050, 1601 Northwest 12th Avenue, Miami, FL 33136, USA
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Clark M, Harris R, Jolleff N, Price K, Neville BGR. Worster-Drought syndrome: poorly recognized despite severe and persistent difficulties with feeding and speech. Dev Med Child Neurol 2010; 52:27-32. [PMID: 19824895 DOI: 10.1111/j.1469-8749.2009.03475.x] [Citation(s) in RCA: 21] [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 Worster-Drought syndrome (WDS), or congenital suprabulbar paresis, is a permanent movement disorder of the bulbar muscles causing persistent difficulties with swallowing, feeding, speech, and saliva control owing to a non-progressive disturbance in early brain development. As such, it falls within the cerebral palsies. The aim of this study was to describe the physical and neuropsychological profiles of children with WDS. METHOD Forty-two children with WDS (26 males, 16 females; mean age 7y 10mo, SD 3y 1mo; range 2y 6mo to 16y 5mo) were studied prospectively using a standard protocol. RESULTS All of the children had severe bulbar dysfunction; 36 out of 42 had feeding difficulties and 23 of 38 had unintelligible speech, which was poorly compensated for by augmentative communication. There were accompanying disturbances in cognition (mean non-verbal IQ 59), behaviour (12/40 attention-deficit-hyperactivity disorder [ADHD]), social communication (8/42 autism), and epilepsy (12/39). The severity of bulbar dysfunction and impact of additional impairments made it difficult to use formal assessments. INTERPRETATION WDS causes severe and persistent bulbar dysfunction that is often accompanied by additional impairments, as in other cerebral palsies. Speech prognosis is particularly poor. Early diagnosis with appreciation of the underlying neurology would encourage critical evaluation of interventions and long-term planning to improve outcome.
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Affiliation(s)
- Maria Clark
- Great Ormond Street Hospital for Children NHS Trust, London, UK
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Cheatham CL, Sesma HW, Bauer PJ, Georgieff MK. The development of declarative memory in infants born preterm. ADVANCES IN CHILD DEVELOPMENT AND BEHAVIOR 2010; 38:111-35. [PMID: 21207807 DOI: 10.1016/b978-0-12-374471-5.00005-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Neurodevelopmental disabilities are collectively a common problem in child health that frequently prompts neurologic assessment and intervention. They are a group of heterogeneous conditions that share a disturbance in the acquisition of basic developmental skills in a chronologically appropriate manner. Lacking uniform diagnostic means of ascertainment, their recognition depends on fulfilling present consensus opinion regarding the various subtypes now recognized. Distinctive subtypes of neurodevelopmental disabilities can be accurately diagnosed according to present consensus conceptualization. Dual diagnosis of neurodevelopmental disabilities in the same child is possible, given present opinion. It can be expected that these conceptualizations will be dynamic and guide ongoing research efforts that will elucidate basic mechanisms, effective therapeutic interventions, and evaluate outcomes.
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Affiliation(s)
- Michael I Shevell
- Departments of Neurology/Neurosurgery & Pediatrics, McGill University, Montreal Children's Hospital-McGill University Health Centre, Quebec, Canada.
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Al-Macki N, Miller SP, Hall N, Shevell M. The spectrum of abnormal neurologic outcomes subsequent to term intrapartum asphyxia. Pediatr Neurol 2009; 41:399-405. [PMID: 19931160 DOI: 10.1016/j.pediatrneurol.2009.06.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 06/09/2009] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to describe the spectrum of possible abnormal neurologic outcomes in term infants with intrapartum asphyxia and to identify those clinical factors associated with the later occurrence of cerebral palsy. All children with term intrapartum asphyxia encountered in a single pediatric neurologic practice with at least 2 years of follow-up and an abnormal neurologic outcome were identified. Abnormal outcomes were grouped into those with or without cerebral palsy. A total of 40 children (28 male, 12 female) met study criteria. Of these, 23 developed cerebral palsy; the remaining 17 children developed an abnormal neurologic outcome that did not include cerebral palsy. A more severe grade of neonatal encephalopathy, a higher number of neonatal seizures, the neonatal use of phenytoin, diffuse abnormalities on imaging, and abnormal findings on neurologic examination at neonatal discharge were all significantly (P<0.05) associated with an abnormal outcome that included cerebral palsy. Abnormal neurologic outcomes other than cerebral palsy subsequent to term intrapartum asphyxia may occur. It appears that a more severe grade of apparent initial clinical injury is more likely to result in an outcome featuring cerebral palsy.
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Affiliation(s)
- Nabil Al-Macki
- Department of Neurology and Neurosurgery, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec H3H 1P3, Canada
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Shevell MI, Dagenais L, Hall N. The relationship of cerebral palsy subtype and functional motor impairment: a population-based study. Dev Med Child Neurol 2009; 51:872-7. [PMID: 19416339 DOI: 10.1111/j.1469-8749.2009.03269.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Traditionally, cerebral palsy (CP) had been classified according to the distribution and quality of motor impairment. A standardized functional classification of gross motor skills has recently been validated - the Gross Motor Function Classification System (GMFCS). The relationship between the neurological subtype of CP and GMFCS level remains undefined in CP. METHOD The Quebec Cerebral Palsy Registry (Registre de la paralysie cérébrale au Québec [REPACQ]) over a 4-year birth interval (1999-2002 inclusive) identified 301 children with CP. Information on both CP subtype and GMFCS level was available for 243 children (138 males, 105 females) with final data extraction at a mean age of 44 months (SD 14mo, range 24-79mo). Proportions of children with a particular CP subtype at GMFCS levels I to III versus levels IV to V were determined and compared. RESULTS CP subtype versus GMFCS levels I to III or IV to V was distributed proportionally as follows: spastic diplegic, 51/52 (98%) versus 1/52 (2%); spastic quadriparetic, 20/85 (24%) versus 65/85 (76%); spastic hemiplegic, 76/77 (99%) versus 1/77 (1%); dyskinetic, 4/16 (25%) versus 12/16 (75%); other (triplegic or ataxic-hypotonic), 10/13 (77%) versus 3/13 (23%). These distributions (proportions) all yielded significant (p<0.001) Pearson chi(2) values. INTERPRETATION Neurological subtype is a powerful predictor of functional status related to ambulation. This has implications for counseling families.
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Affiliation(s)
- Michael I Shevell
- Departments of Neurology/Neurosurgery and Pediatrics, McGill University, Montreal, Quebec, Canada.
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Ashwal S, Michelson D, Plawner L, Dobyns WB. Practice parameter: Evaluation of the child with microcephaly (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2009; 73:887-97. [PMID: 19752457 DOI: 10.1212/wnl.0b013e3181b783f7] [Citation(s) in RCA: 172] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To make evidence-based recommendations concerning the evaluation of the child with microcephaly. METHODS Relevant literature was reviewed, abstracted, and classified. RECOMMENDATIONS were based on a 4-tiered scheme of evidence classification. RESULTS Microcephaly is an important neurologic sign but there is nonuniformity in its definition and evaluation. Microcephaly may result from any insult that disturbs early brain growth and can be seen in association with hundreds of genetic syndromes. Annually, approximately 25,000 infants in the United States will be diagnosed with microcephaly (head circumference <-2 SD). Few data are available to inform evidence-based recommendations regarding diagnostic testing. The yield of neuroimaging ranges from 43% to 80%. Genetic etiologies have been reported in 15.5% to 53.3%. The prevalence of metabolic disorders is unknown but is estimated to be 1%. Children with severe microcephaly (head circumference <-3 SD) are more likely ( approximately 80%) to have imaging abnormalities and more severe developmental impairments than those with milder microcephaly (-2 to -3 SD; approximately 40%). Coexistent conditions include epilepsy ( approximately 40%), cerebral palsy ( approximately 20%), mental retardation ( approximately 50%), and ophthalmologic disorders ( approximately 20% to approximately 50%). RECOMMENDATIONS Neuroimaging may be considered useful in identifying structural causes in the evaluation of the child with microcephaly (Level C). Targeted and specific genetic testing may be considered in the evaluation of the child with microcephaly who has clinical or imaging abnormalities that suggest a specific diagnosis or who shows no evidence of an acquired or environmental etiology (Level C). Screening for coexistent conditions such as cerebral palsy, epilepsy, and sensory deficits may also be considered (Level C). Further study is needed regarding the yield of diagnostic testing in children with microcephaly.
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Affiliation(s)
- Stephen Ashwal
- Division of Child Neurology, Department of Pediatrics, Loma Linda University School of Medicine, CA, USA
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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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Graham EM, Ruis KA, Hartman AL, Northington FJ, Fox HE. A systematic review of the role of intrapartum hypoxia-ischemia in the causation of neonatal encephalopathy. Am J Obstet Gynecol 2008; 199:587-95. [PMID: 19084096 DOI: 10.1016/j.ajog.2008.06.094] [Citation(s) in RCA: 319] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 05/06/2008] [Accepted: 06/30/2008] [Indexed: 10/21/2022]
Abstract
The object of this review was to determine the incidence, morbidity, and mortality of an umbilical arterial pH < 7.0; the incidence of hypoxic-ischemic encephalopathy; and the proportion of cerebral palsy associated with intrapartum hypoxia-ischemia in nonanomalous term infants. A systematic review of the English language literature on the association between intrapartum hypoxia-ischemia and neonatal encephalopathy was conducted by using Pubmed and Embase. For nonanomalous term infants, the incidence of an umbilical arterial pH < 7.0 at birth is 3.7 of 1000, of which 51 of 297 (17.2%) survived with neonatal neurologic morbidity, 45 of 276 (16.3%) had seizures, and 24 of 407 (5.9%) died during the neonatal period. The incidence of neonatal neurologic morbidity and mortality for term infants born with cord pH < 7.0 was 23.1%. The incidence of hypoxic-ischemic encephalopathy is 2.5 of 1000 live births. The proportion of cerebral palsy associated with intrapartum hypoxia-ischemia is 14.5%. The vast majority of cases of cerebral palsy in nonanomalous term infants are not associated with intrapartum hypoxia-ischemia.
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Majnemer A, Shevell M, Law M, Birnbaum R, Chilingaryan G, Rosenbaum P, Poulin C. Participation and enjoyment of leisure activities in school-aged children with cerebral palsy. Dev Med Child Neurol 2008; 50:751-8. [PMID: 18834388 DOI: 10.1111/j.1469-8749.2008.03068.x] [Citation(s) in RCA: 230] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this study was to characterize participation in leisure activities in children with cerebral palsy (CP) and identify determinants of greater involvement. Ninety-five children of school age (9y 7mo [SD 2y 1mo]) with CP were recruited, and participation was evaluated with the Children's Assessment of Participation and Enjoyment in a subset (67/95; 42 males, 25 females) who could actively participate in completion of the assessment. Most had mild motor dysfunction (Gross Motor Function Classification System: 59% level I, 23% level II, 18% levels III-V) and had a spastic subtype of CP (23 hemiplegia, 17 diplegia, 16 quadriplegia, 11 other). Biomedical, child, family and environmental predictor variables were considered in the analysis. Results demonstrated that these children were actively involved in a wide range of leisure activities and experienced a high level of enjoyment. However, involvement was lower in skill-based and active physical activities as well as community-based activities. Mastery motivation and involvement in rehabilitation services enhanced involvement (intensity and diversity) in particular leisure activities, whereas cognitive and behavioral difficulties, activity limitations, and parental stress were obstacles to participation.
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Affiliation(s)
- Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.
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Abstract
Classification of the quality and topographical pattern of motor impairment is used to describe cerebral palsy (CP). As an adjunct to a study characterizing the quality of life and participation of school-age children with C P, initial and follow-up classification of CP were compared. A cohort of 93 children (58 males, 35 females) were initially assessed at a mean age of 2 years 6 months (SD 2y 2mo) and re-assessed at 9 years 4 months (SD 2y 2mo) with a mean interval of 6 years 6 months (SD 2y 4mo) between assessments. Sixty children had Gross Motor Function Classification System levels I-III. All but one of the children were still classified has having CP at follow-up. Type of CP documented remained constant in 67 children (72%; 95% confidence interval 62-80). Clinical factors that were statistically significant (p<0.05) as possible predictors of CP subtype change were original classification of a non-spastic subtype or a non-spastic quadriparetic subtype. Change in CP subtype occurs in an appreciable minority of children with CP, which is likely to reflect a combination of intrinsic and extrinsic influences. Such change may challenge efforts to monitor the effects of interventions in this population.
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Affiliation(s)
- Michael I Shevell
- Neurology/Neurosurgery and Pediatrics, McGill University, Montreal, Quebec, Canada.
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Krägeloh-Mann I, Horber V. The role of magnetic resonance imaging in furthering understanding of the pathogenesis of cerebral palsy. Dev Med Child Neurol 2007; 49:948. [PMID: 18039244 DOI: 10.1111/j.1469-8749.2007.00948.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hayakawa F, Okumura A, Kato T, Maruyama K, Kubota T, Suzuki M, Iwata S, Tsuji T, Watanabe K. Interpretation scheme for nonexpert pediatricians evaluating magnetic resonance images of children with cerebral palsy. Pediatr Neurol 2007; 37:331-7. [PMID: 17950418 DOI: 10.1016/j.pediatrneurol.2007.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2007] [Revised: 05/15/2007] [Accepted: 06/13/2007] [Indexed: 11/19/2022]
Abstract
This study evaluated the usability of our MRI interpretation scheme among pediatricians with different skill levels in evaluating MRI of patients with cerebral palsy. We divided MRI findings into three groups: no abnormalities, pre/perinatally acquired lesions, and other abnormalities. Pre/perinatally acquired lesions were divided into six subgroups. Other abnormalities included brain malformations, ventriculomegaly, atrophic changes, and other unclassifiable abnormalities. We compared the interpretations of eight participants, i.e., three nonexpert pediatricians, two junior pediatric neurologists, and three senior pediatric neurologists, in evaluating magnetic resonance images of 73 children with cerebral palsy. The degree of agreement was substantial or near perfect for all participants. When limited to pre/perinatally acquired lesions, the degree of agreement was near perfect for all but one participant. The rate of correct diagnosis did not differ greatly according to participants' experience with pre/perinatally acquired lesions. For patients with basal ganglia thalamic lesions, multicystic encephalomalacia, and posthemorrhagic porencephaly, the rate of correct diagnosis increased according to participants' experience. Pre/perinatally acquired lesions can be appropriately interpreted by nonexpert pediatricians utilizing our interpretation scheme.
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Affiliation(s)
- Fumio Hayakawa
- Department of Pediatrics, Okazaki City Hospital, Okazaki, Japan
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Majnemer A, Shevell M, Rosenbaum P, Law M, Poulin C. Determinants of life quality in school-age children with cerebral palsy. J Pediatr 2007; 151:470-5, 475.e1-3. [PMID: 17961687 DOI: 10.1016/j.jpeds.2007.04.014] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Revised: 01/16/2007] [Accepted: 04/10/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize the quality of life of children with cerebral palsy from the parents' and children's perspectives. STUDY DESIGN Ninety-five children were recruited; a parent, and when feasible, the child also completed the Child Health Questionnaire and Pediatric Quality of Life Inventory. A range of predictor variables was measured relating to impairments, activity limitations, personal and environmental factors. RESULTS Mean age was 9.3 +/- 2.1 years; 63.2% were male, and almost half had mild motor impairment (47% Gross Motor Function Classification System level I). Mean physical well-being (Child Health Questionnaire) was 39.6 +/- 16.9 with 50% <40; and mean psychosocial well-being was 43.0 +/- 11.3 with 53.8% <40. Similarly, with the Pediatric Quality of Life Inventory, 61% had summary scores <1 SD. Scores of parents and their children were significantly correlated (physical: r = .59, P < .0001; psychosocial: r = .39, P = .01); however, children rated themselves higher. CONCLUSIONS Results indicate that quality of life is highly variable in children with cerebral palsy, with about half experiencing a life quality similar to typically developing children. Motor and other activity limitations are indicators of physical but not psychosocial well-being. Family functioning, behavioral difficulties, and motivation are important predictors of social-emotional adaptation. Determinants of life quality may guide resource allocation and health promotion initiatives to optimize health of the child and family.
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Affiliation(s)
- Annette Majnemer
- School of Physical & Occupational Therapy, McGill University, Montreal, Quebec, Canada.
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