Upper limb motor function in young adults with spina bifida and hydrocephalus

OBJECTIVE

The objective of the study was to measure upper limb motor function in young adults with spina bifida meningomyelocele (SBM) and typically developing age peers.

METHOD

Participants were 26 young adults with SBM, with a Verbal or Performance IQ score of at least 70 on the Wechsler scales, and 27 age- and gender-matched controls. Four upper limb motor function tasks were performed under four different visual and cognitive challenge conditions. Motor independence was assessed by questionnaire.

RESULTS

Fewer SBM than control participants obtained perfect posture and rebound scores. The SBM group performed less accurately and was more disrupted by cognitive challenge than controls on limb dysmetria tasks. The SBM group was slower than controls on the diadochokinesis task. Adaptive motor independence was related to one upper limb motor task, arm posture, and upper rather than lower spinal lesions were associated with less motor independence.

CONCLUSIONS

Young adults with SBM have significant limitations in upper limb function and are more disrupted by some challenges while performing upper limb motor tasks. Within the group of young adults with SBM, upper spinal lesions compromise motor independence more than lower spinal lesions.

Saccades in children with spina bifida and Chiari type II malformation

BACKGROUND

Saccades are essential for optimal visual function. Chiari type II malformation (CII) is a congenital anomaly of the cerebellum and brainstem, associated with spina bifida.

OBJECTIVE

To investigate the effects of CII on saccades and correlate saccadic parameters with brain MRI measurements.

METHODS

Saccades were recorded in 21 participants with CII, aged 8 to 19, using an infrared eye tracker. Thirty-nine typically developing children served as controls. Participants made saccades to horizontal and vertical target steps. Nineteen participants with CII had MRI. Regression analyses were used to investigate the effects of spinal lesion level, number of shunt revisions, presence of nystagmus, and midsagittal MRI measurements on saccades.

RESULTS

Saccadic amplitude gains, asymptotic peak velocities, and latencies did not differ between the control and CII groups (p > 0.01). No significant differences were found between saccadic gains, asymptotic peak velocities or latencies, and spinal lesion level, number of shunt revisions, presence of nystagmus, or MRI measurements.

CONCLUSIONS

Saccades were normal in most participants with Chiari II malformation (CII). Neural coding of saccades is robust and is typically not affected by the anatomic deformity of CII.

Should children with Bell's palsy be treated with corticosteroids? A systematic review

The objective of this study was to evaluate the effect of corticosteroids in the treatment of pediatric Bell's palsy. A systematic review of trials that included pediatric (< 16 years old) cases with Bell's palsy and involved the use of steroids was conducted. Eight trials were identified, five of which were randomized, and prednisone was used in six trials, whereas corticotropin was used in the other two. The methods of randomization and allocation concealment of the treatments used were rarely reported. Only one trial was done exclusively in children; none of the other seven trials analyzed the pediatric cases separately. Four trials reported some benefit from steroids. The pediatric trial did not provide evidence for benefit from corticosteroids. There was substantial heterogeneity in the population and interventions used; hence a meta-analysis was not done. Based on this systematic review, we do not recommend the routine use of steroids in children with Bell's palsy.

Idiopathic "benign" intracranial hypertension: case series and review

Idiopathic "benign" intracranial hypertension is an uncommon but important cause of headache that can lead to visual loss. This study was undertaken to review our experience in the diagnosis and management of idiopathic intracranial hypertension, giving special attention to treatments used. A retrospective chart review was conducted on 32 patients diagnosed with idiopathic intracranial hypertension between 1984 and 1995. Subjects included 23 females and ranged in age from 2 to 17.5 years. Headache was the most common symptom, followed by nausea and vomiting, double vision, and visual loss. Papilledema was the most common sign. Others were VIth cranial nerve palsy and compromised visual acuity at or within 3 months of presentation. Management included administration of acetazolamide or corticosteroids, lumboperitoneal shunt, optic nerve fenestration, and repeat lumbar puncture. Treatment combinations were used in 40% of cases. During follow-up, headache, papilledema, and decreased visual acuity persisted for longer than 10 months in a significant number of patients. We conclude that idiopathic intracranial hypertension causes significant short- and long-term morbidity with no proven effective treatment available. A prospective study is needed to establish the indications for treatment and the efficacy of the treatments used.

Peripheral and autonomic nervous system involvement in chronic GM2-gangliosidosis

GM2-gangliosidosis (McKusick 268800 and 272800) is a rare hereditary, progressive disorder of ganglioside metabolism caused by deficiency of lysosomal beta-hexosaminidase (EC 3.2.1.52) activity. It is characterized by severe central nervous system involvement. Involvement of the peripheral and autonomic nervous system has been suspected but rarely documented in published case reports in the chronic form of the disease. Four patients, aged 24-29 years, with chronic GM2-gangliosidosis were examined prospectively for evidence of peripheral and autonomic nervous system dysfunction. All had nerve conduction studies, sympathetic skin responses and cardiac monitoring during the head tilt-table test. Three patients had objective evidence of autonomic dysfunction with abnormal sympathetic nervous skin responses and axonal sensorimotor polyneuropathy. None of the patients had evidence of significant cardiovascular autonomic dysfunction on the head tilt-table test. The peripheral and autonomic nervous system may be involved in patients with chronic GM2-gangliosidosis. In some cases, this may be clinically significant. On the other hand, cardiovascular autonomic instability is apparently not a significant problem in young adult patients with the disease.

Is the prophylactic use of antiepileptic drugs in Sturge-Weber syndrome justified?

Sturge-Weber syndrome (SWS) is a rare neurocutaneous syndrome. Epilepsy is one of its most common features and is usually the first neurological manifestation. Adequate control of epilepsy assumes major importance in SWS as the early onset of seizures and severe seizures are associated with developmental regression and hemiparesis. Recent advances in neuroimaging have helped in making preclinical and early diagnosis in SWS. The author proposes treating newly diagnosed patients with severe SWS with antiepileptic drugs (AEDs) before the onset of epilepsy. This may help prevent the development of hemiplegia and the developmental problems that may ensue.

Benign intracranial hypertension or communicating hydrocephalus: factors in pathogenesis

Benign intracranial hypertension and communicating hydrocephalus are uncommon but important disorders that affect cerebrospinal fluid dynamics. They have clinical similarities but their management is usually different. The factors determining which of the two disorders will develop include brain compliance, the state of the cranial sutures, the nature of the insult and its magnitude. I propose that the time course of the pathological events leading to presentation may be a further factor to consider in the pathogenesis and management of these disorders.

Migraine and sickle-cell disorders: is there a cause for concern?

Migraine and sickle-cell disease are common diseases, and may coexist in the same individual. Such a chance association is potentially dangerous because the two disorders may act synergistically to cause major neurological complications which may be permanent and contribute to the well-known mortality of sickle-cell disease. In theory, it is possible to minimize the risk of adverse sequelae of this combination of common maladies.