Mental retardation in Duchenne muscular dystrophy

OBJECTIVE

To survey the medical literature directed to the study of cognitive dysfunction in patients with Duchenne muscular dystrophy through description of the milestones of neurological development and psychometric tests for quantifying intelligence.

SOURCES

Non-systematic review of aspects of cognition in Duchenne muscular dystrophy in the major medical scientific bases: MEDLINE, LILACS, SciELO and Cochrane Library.

SUMMARY OF THE FINDINGS

Patients with Duchenne muscular dystrophy exhibited delay in walking and language development, which correlated with lower scores on future intelligence tests. There is marked impairment in the verbal subtests.

CONCLUSIONS

Average IQ has standard deviation below the average of the population. The greater the cognitive impairment, the worse aspects related to morbidity and mortality in the disease will be.

Moebius syndrome and holoprosencephaly following exposure to misoprostol

Moebius syndrome is a rare disease characterized by congenital facial paralysis and abducens palsy. Involvement of other cranial nerves, orofacial dysmorphism, and limb abnormalities are frequently associated. Reported here is the case of a 10-month-old child born with Moebius syndrome and presenting with holoprosencephaly, following exposure in utero to misoprostol. To our knowledge, this is the first published case report describing this association. The etiologic hypotheses of Moebius syndrome are also discussed.

Early diagnosis of abnormal development of preterm newborns: assessment instruments

OBJECTIVE

To review the literature regarding screening psychomotor tests for the early identification of developmental problems.

SOURCES

A search on SciELO, PubMed and Google Scholar was performed using the terms "prematurity," "developmental delay," "cerebral palsy," "early diagnosis" and "evaluation tests."

SUMMARY OF THE FINDINGS

A total of 455 references were listed, and 174 studies were selected for this review based on title, relevance, and abstract. Only original and electronically available material, from 1985 forward, with information on design, applicability, and psychometric properties of those tests was included.

CONCLUSIONS

Screening tests are important to speed the beginning of treatment measures in order to allow for better developmental outcome. Among the many tests that can be employed for this purpose, the DENVER II and the Alberta Infant Motor Scale are the most often used in Brazilian studies. The Movement Assessment of Infants is starting to be used in our country. Two other tests are recommended in the literature due to their high sensibility and specificity: the Test of Infant Motor Performance and the General Movements.

Transtorno do déficit de atenção e hiperatividade (TDAH): aspectos relacionados à comorbidade com distúrbios da atividade motora

A presente revisão aborda aspectos fisiopatológicos e clínicos referentes ao Transtorno do Déficit de Atenção com Hiperatividade (TDAH), em especial aqueles que concernem à associação desse transtorno com o Distúrbio do Desenvolvimento da Coordenação (DDC). Utilizou-se a base de dados Medline para levantamento de artigos indexados a partir de 1965 até 2004. Aos artigos selecionados dessa forma, outros foram obtidos pela relevância atribuída a eles nas fontes iniciais. A pré-disposição hereditária desse transtorno é indiscutível, bem como a presença da disfunção nora-drenégica e dopaminérgica no córtex pré-frontal e suas conexões. Apesar desse conhecimento, o diagnóstico da condição se baseia em dados clínicos. As associações mórbidas ocorrem em cerca de metade dos indivíduos, sendo as principais comorbidades de natureza psiquiátrica. A presença de uma comorbidade pode modificar a terapêutica e o prognóstico. O Distúrbio do Desenvolvimento da Coordenação, condição também de diagnostico clínico, confere pior prognóstico às crianças que partilham ambos os quadros. Recomenda-se que uma busca ativa de condições associadas seja realizada em cada criança diagnosticada como portadora de TDAH.

Juvenile human T lymphotropic virus type 1-associated myelopathy

We report the cases of 5 adolescents with human T lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis, acquired in all but 1 case from the mother. The first symptom in all patients was difficulty in running, which was present for many years before the final diagnosis was made. Follow-up showed an indolent progression, regardless of treatment strategy.