PHYSICAL AND INTELLECTUAL GROWTH IN CHILDREN WITH CEREBRAL PALSY AND EPILEPSY
M. Pietrzak, B. Galas-Zgorzalewicz, B. Gurda, A. Kluczynski, B. Steinborn, A. Toczko, J. Sowifiska (Department of Developmental Neurology University of Medical Sciences, Poznan, Poland)
The purpose of this study was to evaluate the impact of two chronic illnesses epilepsy and cerebral palsy on the physical and intellectual development of affected children. We used the data from the register of cerebral palsy and epilepsy held in our Department covering the population of children and adolescents in the city of Poznan.
We found that cerebral palsy was in great majority of children accompanied by other symptoms of brain injury like epilepsy (27,9%), impaired hearing (6%), visual problems (50.1%), delayed speech development (47,9%). 55% of children with cerebral palsy performed below normal range in the tests of intellectual development. The physical growth varied largely in those children. The most frequently found abnormalities were the head circumference below 10th percentile (31,1%), body weight below 10th percentile (20,6%) and above 90th percentile (25,7%). 70% of children in whom cerebral palsy was complicated by symptomatic epilepsy presented all of the developmental parameters measured below 10th percentile. Epilepsy did not affect the physical growth and the intellectual development was delayed in one third of children suffering from this disease.
The intellectual deficits were more pronounced in children who had seizures early in infancy. The intellectual development is delayed in considerable number of children with cerebral palsy and with epilepsy, while only the cerebral palsy has an impact on physical growth. The growth of children who suffer from both of these conditions is particularly disturbed.
COMPREHENSIVE TREATMENT OF CEREBRAL PALSY
Chang II Park (Yonsei University, Seoul, Korea)
Cerebral palsy is a condition caused by damage to the brain, usually occurring before, during or shortly after birth. In Korea, the prevalence of cerebral palsy is 2.7/1,000 live births and 47.1/1,000 neonates with risk factors. In early 1980, an epidemiologic study showed the most frequent type of cerebral palsy was athetoid (55.2%) and the second most frequent was spastic type (40.2%). But a study in 1992 showed spastic type was the most common (77.0%) and the frequency of athetoid type had declined (9.9%). There are several associated disorders such as seizures (32.7%), speech disturbance (68.4%) and mental retardation (39.7%), etc. Making a definite diagnosis of cerebral palsy is not easy, especially before the child's first birthday. According to a study by C.I.Park et al., the most significant signs in detecting brain dysfunction before 6 months of age are developmental delay, abnormal muscle tone and abnormal Vojta's postural reactions. Recently, it has been founded that radiological studies such as brain MRI and SPECT images are helpful in detecting cerebral palsy in infants with high risk factors. Early identification of cerebral palsy and appropriate management programs can help to lessen the disability. There are various treatment methods, including: physical therapy, occupational therapy, speech therapy, special education, medication, assistive devices and orthoses, neuromuscular block and various types of operation: selective dorsal rhizotomy and orthopedic surgery. The formulation of an early diagnosis and a proper treatment system for cerebral palsy are very important.