Hip surveillance in children with cerebral palsy. Impact on the surgical management of spastic hip disease.
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We studied prospectively the impact of a hip surveillance clinic on the management of spastic hip disease in children with cerebral palsy in a tertiary referral centre. Using a combination of primary clinical and secondary radiological screening we were able to detect spastic hip disease at an early stage in most children and to offer early surgical intervention. The principal effect on surgical practice was that more preventive surgery was carried out at a younger age and at a more appropriate stage of the disease. The need for reconstructive surgery has decreased and that for salvage surgery has been eliminated. Displacement of the hip in children with cerebral palsy meets specific criteria for a screening programme. We recommend that hip surveillance should become part of the routine management of children with cerebral palsy. The hips should be examined radiologically at 18 months of age in all children with bilateral cerebral palsy and at six- to 12-monthly intervals thereafter. A co-ordinated approach by orthopaedic surgeons and physiotherapists may be the key to successful implementation of this screening programme. (+info)
Cerebral palsy in twins: a national study.
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BACKGROUND: Cerebral palsy is more common in twins than singletons. Among twins, if one twin suffers a fetal death or dies in infancy, the prevalence of cerebral palsy in the surviving co-twin is considerably increased, and those from like-sex pairs are particularly at high risk. AIM: To compare birthweight specific cerebral palsy prevalence in like-sex and unlike-sex twins where both twins survive infancy and to provide a comparative and composite picture of cerebral palsy prevalence according to whether a co-twin died or where both twins survived. METHODS: Parents of twins born in England and Wales in 1994 and 1995 completed a booklet with open ended questions asking whether their twins had any medical, physical, visual, genetic, or chromosomal problems. Any mention of cerebral palsy, hemiplegia, diplegia, or quadriplegia allowed the child to be included as a case of cerebral palsy. Birthweight specific prevalence rates of cerebral palsy were determined for like and unlike-sex twins in birthweight groups < 1000 g, 1000-1499 g, 1500-1999 g, 2000-2499 g, and > or = 2500 g. RESULTS: When both twins survived infancy, like-sex were at greater risk of cerebral palsy than unlike-sex twins, but the difference was not statistically significant. If both twins survived infancy, the birthweight specific prevalence of cerebral palsy was significantly less than if the co-twin had died. CONCLUSIONS: Among the generality of twins, like-sex compared with unlike-sex twins are at greater risk of cerebral palsy particularly if one twin suffers a fetal or infant death. Although it is not possible to subdivide the twins according to zygosity, it is postulated that monozygosity and, specifically, monochorionicity may be the crucial feature that leads to the higher prevalence of cerebral impairment among like-sex twins. (+info)
Public perceptions of cerebral palsy.
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Neurologic disorders are often described in terms that relate to symptoms rather than specific etiologic factors. Such descriptive terms are confusing to healthcare professionals and to the parents of children in whom these disorders are diagnosed. Cerebral palsy is one example of a descriptive term that is applied to a disorder that is heterogeneous in its etiology, morbidity, and mortality. A random sampling of 100 adults selected from the waiting room of a suburban ambulatory pediatrics office associated with the University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine (Stratford, NJ) was surveyed with a 20-item questionnaire on their perceptions of the term cerebral palsy and its associated disability and prognosis. Subjects' responses suggest that a percentage of the general population holds several misconceptions about the disorder, including the belief that the disorder has a genetic etiology (40%) and that affected children cannot speak (20%), die earlier than unaffected children (57%), and cannot hold jobs as adults (20%) should they survive to adulthood. A small percentage of subjects believe that cerebral palsy is infectious (4%) and that parents should restrict their children from associating with those affected (3%). Our study population was somewhat homogenous in that most respondents were educated and most were middle to upper-middle class. Yet, even in this population, the term cerebral palsy is ambiguous to many and may have negative connotations. Further studies are needed to address whether a higher frequency of negative perceptions are present in more socioeconomically diverse populations. (+info)
S100B protein in biological fluids: a tool for perinatal medicine.
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The diagnosis of perinatal insults currently relies on adequate documentation of general medical and obstetric factors and on radiologic and laboratory assessments. The measurement of brain constituents such as S100B protein may offer an alternative and direct indicator of cell damage in the nervous system when clinical and radiologic assessments are still silent and has the additional advantage of providing a quantitative indicator of the extent of brain lesions. S100B protein has been measured by several immunoassays in biological fluids (i.e., cerebrospinal fluid, blood, amniotic fluid, and urine) from fetuses and newborns at high risk of perinatal brain damage. S100B protein in biological fluids increased at an early stage when standard monitoring procedures were still silent in the study populations that later developed brain damage. S100B concentration was also significantly correlated with the extent of brain lesions. S100B protein appears to satisfy the criteria for a marker for brain injuries in perinatal medicine: (a) simple to perform measurements with good reproducibility; (b) detection in a variety of biological fluids, possibly reducing perinatal stress related to testing; (c) possible use in longitudinal monitoring because of its 1-h half-life; and (d) well-established use as an early and quantitative marker of brain lesions/damage. Finally, because of the neurotrophic role putatively played by S100B, its measurement in biological fluids at pre-/perinatal ages makes it a candidate for the laboratory evaluation of brain maturation. (+info)
A national two year follow up study of extremely low birthweight infants born in 1996-1997.
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OBJECTIVE: To study neurodevelopmental outcome in a two year cohort of extremely low birthweight (ELBW) infants at 18 months corrected age, to compare the development of the ELBW infant subcohort with that of control children, and to find risk factors associated with unfavourable outcome. STUDY DESIGN: All 211 surviving ELBW infants (birth weight < 1000 g) born in Finland in 1996-1997 were included in a national survey. The ELBW infants (n = 78) who were born and followed in Helsinki University Hospital belonged to a regional subcohort and were compared with a control group of 75 full term infants. A national follow up programme included neurological, speech, vision, and hearing assessments at 18 months of corrected age. Bayley infant scale assessment was performed on the subcohort and their controls at 24 months of age. Risk factors for unfavourable outcome were estimated using logistic and linear regression models. RESULTS: The prevalence of cerebral palsy was 11%, of all motor impairments 24%, of ophthalmic abnormalities 23%, and of speech delay 42%. No impairment was found in 42% of children, and 18% were classified as severely impaired. The prevalence of ophthalmic abnormalities decreased with increasing birth weight and gestational age, but the prevalence of other impairments did not. In the subcohort, a positive correlation was found between the date of birth and Bayley scores. CONCLUSION: Ophthalmic abnormalities decreased with increasing birth weight and gestational age, but no other outcome differences were found between birthweight groups or in surviving ELBW infants born at 22-26 weeks gestation. The prognosis in the regional subcohort seemed to improve during the short study period, but this needs to be confirmed. (+info)
An epidemiological study of caries in a group of children with cerebral palsy.
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The results of an epidemiological study of caries in a group of 103 children with cerebral palsy between 5 and 20 years of age and treated in Nen Deu Hospital (Barcelona, Spain) are presented. The CAOD (caries, absent teeth, filled teeth) and ICO indices (caries, filled teeth) were evaluated in the permanent and deciduous dentition, respectively. (+info)
Epilepsy in children with cerebral palsy.
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OBJECTIVES: To study the occurrence, associated factors, nature and prognosis of seizures in children with cerebral palsy (CP). DESIGN: A prospective, descriptive, hospital-based, case-control study. SETTING: Tertiary level University Teaching Hospitals in the Al Ain Medical District, United Arab Emirates. PATIENTS: Fifty-six children with CP and seizures seen in the neurodevelopmental clinics at Al Ain and Tawam University Hospitals during the period of 1997-1999 were studied (group 1). Two control groups of 35 children with CP without seizures (group 2) and 50 children with seizures but no CP (group 3) were also studied. RESULTS: Spastic tetraplegia was the commonest type of CP associated with seizures whereas spastic diplegia was the commonest variety of CP in group 2. Most children with CP had an early onset of seizures within the first year of life as against those without CP. The children in group 1 had a higher incidence of neonatal seizures (42.9% vs. 29.4% in group 2 and 0% in group 3), presence of significant developmental delay (98.2% vs. 20.0% in group 3), occurrence of significant abnormalities on brain imaging (94.6% vs. 19.6% in group 3) and a need for use of more than 1 antiepileptic drug (66.1% vs. 30.0% in group 3). Over half of children in the study group presented with generalized tonic clonic seizures; the electroencephalogram (EEG) showed focal epileptic discharges with or without secondary generalization in 39.3%. The overall outcome of seizures in children with CP was poor needing prolonged course of anticonvulsant medications, polytherapy and higher incidence of refractory seizures and admissions for status epilepticus compared to the control group. CONCLUSIONS: Cerebral palsy is associated with a higher incidence of seizure disorders, which, in a majority, has its onset in the neonatal period; brain imaging showed abnormal pathology in most affected children, which possibly accounts for the tendency to more refractory seizures in these children. (+info)
Stress and adaptation in mothers of children with cerebral palsy.
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OBJECTIVE: To assess the importance of disability severity and child functional status as predictors of maternal depressive symptoms and the moderating effects of maternal appraisal, social support, and family income on the relationship between disability factors (severity and functional status) and maternal depressive symptoms. METHOD: Mothers of 270 children with cerebral palsy completed surveys on their appraisal of the child's disability, social support, and family demographics. Physicians assessed the severity of the disability and the child's functional status. RESULTS: Thirty percent of the mothers had depressive symptoms above the cutoff on a depression screening instrument. Disability severity and child's functional status did not predict maternal depression. Perceived social support moderated the relationship between the child's functional status and maternal depressive symptoms. CONCLUSIONS: Mothers of children with cerebral palsy may be at risk for depression. Interventions that take into account the moderating effects of social support may increase maternal adaptation. (+info)