Cerebral Palsy

Summary: continuing hormonal imbalances can worsen symptoms and addressing those imbalances may improve them.

Pak J Biol Sci. 2011 Apr 1;14(7):433-40.

Growth hormone deficiency in children and adolescents with cerebral palsy: relation to gross motor function and degree of spasticity.

Hamza RT, Ismail MA, Hamed AI.

Source

Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

Abstract

Children with Cerebral Palsy (CP) often have poor linear growth during childhood with short final height. Thus, we aimed to assess serum growth hormone (GH), insulin like growth factor-1 (IGF-1) and insulin like growth factor binding protein-3 (IGFBP-3) levels among CP patients and their relation to each of gross motor function and degree of spasticity. Fifty CP children and adolescents were studied in comparison to 50 healthy age-, sex- and pubertal stage-matched children and adolescents. All subjects were subjected to clinical evaluation, Intelligence Quotient (IQ) assessment and measurement of serum GH, IGF-1 and IGFBP-3. All auxological and hormonal parameters were significantly lower among cases. Fifty two% of cases were GH-deficient and 62% had reduced IGF-land IGFBP-3 levels. Gross Motor Function Measure- 88 (GMFM-88) score correlated negatively with each of basal (r = -0.71, p = 0.02) and peak stimulated GH (r =-0.88, p = <0.001); IGF-1 (r = -0.64, p = 0.04) and IGFBP-3 (r = -0.69, p = 0.031). There were significant negative correlations between the degree of spasticity assessed by Modified Ashworth Scale and each of basal (r = -0.61, p = 0.032) and peak stimulated GH (r = -0.78, p = 0.01); IGF-1 (r = -0.65, p = 0.041) and IGFBP-3 (r = -0.62, p = 0.035). Growth Hormone Deficiency (GHD) is prevalent in children with CP and could be one of the causes of their short stature.

PMID: 21902055

Dev Med Child Neurol. 2011 Oct;53(10):933-7. doi: 10.1111/j.1469-8749.2011.04045.x.

The motor repertoire of extremely low-birthweight infants at term in relation to their neurological outcome.

DE Vries N, Bos A.

Source

Department of Paediatrics, Leeuwarden Medical Centre, Leeuwarden Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.

Abstract

Aim The aim of this study was to assess the motor repertoire of extremely low-birthweight infants at term-equivalent age (TEA), in relation to their neurological outcome. Method Using Prechtl's method, we assessed both the quality of general movements and a detailed motor optimality score in 13 extremely low-birthweight infants (four males; nine females; mean gestational age 27.9wks, SD 2.9wks; mean birthweight 798g, SD 129g) at TEA, and related them to general movements at the age of 3 months after term and neurological outcome at the age of 2 years 6 months. Results At TEA, 10 of the 13 infants had abnormal general movements. All infants showed abnormal leg lifting with extended legs; nine showed stiff movements, three showed cramped movements, and two showed cramped synchronized general movements. At 3 months, three infants still had abnormal general movements. Concurrent movements were abnormal in nine infants owing to monotony and jerkiness. Abnormal posture was seen in seven infants. None developed cerebral palsy; one infant showed cognitive and motor delay. Neurological outcome was not related to general movement quality and optimality score at TEA. Interpretation Abnormal general movements at TEA are common in extremely low-birthweight infants. General movements often appear stiff and cramped with extended legs. At the age of 3 months after term, general movements are mostly normal, but concurrent movements are not. Nevertheless, these abnormalities do not imply an impaired neurological outcome such as cerebral palsy.

© The Authors. Developmental Medicine & Child Neurology © 2011 Mac Keith Press.

PMID: 21896004

Ugeskr Laeger. 2011 Mar 28;173(13):962-5.

[Evidence exists for prophylactic magnesium sulphate as a neuroprotector in premature births].

[Article in Danish]

Wolf HT, Hegaard HK, Huusom L, Greisen G, Hedegaard M.

Source

Medicinsk Afdeling, Nykøbing Falster Sygehus, 4800 Nykøbing Falster, Denmark. trapwolf@hotmail.com

Abstract

Preterm birth increases the child's risk of cerebral palsy. Observational studies as well as randomized studies find that magnesium sulphate given to women in preterm birth decreases such risk. A Cochrane meta-analysis of the randomized studies shows no change in mortality, whereas some observational studies find a mortality decrease. It is important to identify the neuroprotective mechanism and to decide whether these results are relevant in the current Danish obstetrical practice. Should we use magnesium sulphate now or should questions about doses, time of administration and maternal side effects be answered first?

PMID: 21453636

Ann Trop Paediatr. 2010;30(3):181-96.

A review of the incidence and prevalence, types and aetiology of childhood cerebral palsy in resource-poor settings.

Gladstone M.

Source

Department of Community Child Health, Alder Hey Children's NHS Foundation Trust, Liverpool, UK. mgladstone@btinternet.com

Abstract

BACKGROUND:

With 80% of children with disabilities living in resource-poor settings, it is likely that there is a high prevalence of cerebral palsy (CP) and neurological impairment in these settings. The prevalence and incidence rates of disability, in particular of children with CP in resource-poor settings, are difficult to access and clarify.

AIM:

To review the recent literature relating to the prevalence, incidence, type and aetiology of cerebral palsy in low-income settings.

METHODS:

A systematic search of studies published between 1990 and 2009 was performed using PubMed, Cinahl on Ovid, the Cochrane database, SCOPUS and information from international disability organisations. All studies with information about neurodisability, CP or disability in resource-poor settings were included. Titles and/or abstracts of all studies were reviewed and full texts of relevant studies were obtained.

RESULTS:

Disparities in methodology, age range, classification systems and populations made studies difficult to compare. Population-based studies provided rates of childhood disability of 31-160/1000. When using limited age ranges of 2-9 years with the Ten Question Questionnaire, rates were 82-160/1000 for children disability and 19-61/1000 for neurological impairment. Rates of CP in population-based settings in China and India gave figures of 2-2.8/1000 births, similar to western settings. Hospital-based studies of CP showed increased rates of spastic quadriplegia rather than diplegia or hemiplegia and possibly increased rates of meningitis, jaundice and asphyxia and lower rates of low birthweight and prematurity in CP populations. These studies were small and not case-controlled or population-based.

CONCLUSIONS:

Rates of CP and neurological impairment are difficult to obtain in resource-poor settings. Methods of identifying children with CP and causal factors and the effects of disability need to be better classified in order to improve management and help shape preventive measures.

PMID: 20828451

Ther Clin Risk Manag. 2011;7:199-206. Epub 2011 May 30.

Effects of recombinant growth hormone (GH) replacement and psychomotor and cognitive stimulation in the neurodevelopment of GH-deficient (GHD) children with cerebral palsy: a pilot study.

Devesa J, Alonso B, Casteleiro N, Couto P, Castañón B, Zas E, Reimunde P.

Source

Medical Center "Proyecto Foltra", Cacheiras (Teo), A Coruña, Spain;

Abstract

Cerebral palsy (CP) is the main cause of physical disability in childhood and is an important health issue that has a strong socioeconomic impact. There is no effective treatment for CP and therapeutic approaches report only partial benefits for affected people. In this study we assessed the effects of growth hormone (GH) treatment combined with psychomotor and cognitive stimulation in the neurodevelopment of children with CP and GH deficiency (GHD). The study was carried out in 11 patients (7 boys and 4 girls; 4.12 ± 1.31 years) with GHD and CP who were treated with recombinant GH (rGH) and psychomotor and cognitive stimulation during 2 months. Battelle Developmental Inventory Screening Test (BDIST) was performed 2 months before commencing GH treatment, just before commencing GH administration, and after 2 months of combined treatment involving GH and cognitive stimulation. Psychomotor and cognitive status did not change during the period in which only cognitive stimulation was performed; however, significant improvements in personal and social skills, adaptive behavior, gross motor skills and total psychomotor abilities, receptive and total communication, cognitive skills and in the total score of the test (P < 0.01), and in fine motor skills and expressive communication (P < 0.02) were observed after the combined treatment period. Therefore, GH replacement together with psychomotor and cognitive stimulation seem to be useful for the appropriate neurodevelopment of children with GHD and CP.

PMID: 21691590