早产儿和足月儿脑性瘫痪的临床特征

目的探讨早产儿和足月儿脑性瘫痪(CP)的临床特征,确定脑损伤的病因与时间,为病因预防提供依据。方法回顾性分析2005年9月-2007年8月在安徽医科大学第一附属医院小儿神经康复中心住院的267例CP患儿的围生期脑损伤高危因素、临床特点、头颅CT和MRI表现。早产儿组102例。28周≤胎龄<37周;出生体质量1000～4000g,平均2228.82g。足月儿组165例。37周≤胎龄<42周;出生体质量2100～4600g,平均3250.18g。计量资料采用频数分布及中位数,计数资料采用频数分布、百分构成比及χ2检验进行描述与分析。结果早产儿组痉挛型双瘫高于足月儿组(χ2=7.93P<0.01),足月儿组偏瘫型(χ2=8.17P<0.01)和共济失调型(χ2=4.21P<0.05)高于早产儿组。高危因素主要顺位依次为窒息、低出生体质量、黄疸、颅内出血和双胎。早产儿组并2种以上高危因素,病理性黄疸,双胎,低出生体质量的情况较多;而足月儿组并窒息、颅内出血较多。早产儿组癫高于足月儿组(χ2=10.37P<0.01)。除癫癎外,早产儿和足月儿并发症的差异均无显著性意义(Pa>0.05)。头颅影像学方面早产儿组CP集中表现为脑室周围白质软化,足月儿CP影像学异常分布范围较广。结论早产儿和足月儿在CP类型构成、高危因素、并发症和头颅影像学方面均有差异。对早产儿早期随访、早期干预,有利于CP的早期诊断和治疗。     

脑性瘫痪伴临床下癫痫样放电临床特征分析

目的探讨脑性瘫痪患儿伴发临床下癫痫样放电的临床特征及相关危险因素。方法对2004年1月-2007年12月期间在青岛市残疾儿童医疗康复中心治疗的279例脑瘫患儿进行详细的病史采集、脑电图及影像学检查、认知功能评定,分析不同类型脑瘫患儿临床下癫疴样放电的伴发率及脑电图表现,采用Logistic逐步回归分析显示认知水平、影像学改变、新生儿期惊厥史、出生胎龄及合并症等因素,对脑瘫伴发临床下癫痫样放电的影响。结果18．64％（52／279）的脑瘫患儿伴发了临床下癫疴样放电,痉挛型偏瘫患儿的发生率最高（36．36％）,四肢瘫患儿最低（6．25％）。所有脑瘫类型均以局灶性或多灶性放电占多数。不同DQ／IQ水平局灶性与全面性放电的比例差异无统计学意义。皮层损伤及存在合并症是脑瘫伴发临床下疴样放电的危险因素,而认知水平、新生儿期惊厥史及出生胎龄与之无明显关系。结论脑性瘫痪常伴发临床下癫痫样放电,尤其见于痉挛型偏瘫,以局灶性或多灶性放电多见。皮层受损及存在合并症对脑瘫伴发临床下疴样放电有预测价值。     

早产和低出生体重及小于胎龄儿与脑性瘫痪发病的关系

目的 明确早产、低出生体重及小于胎龄儿(SGA)与脑性瘫痪(简称脑瘫)的关联程度。方法 1997年5—7月对江苏省7个市的1～6岁儿童进行了现况普查,共查305263名,并对其胎龄、出生体重及胎龄别出生体重与脑瘫的关系进行了分析。结果 本组儿童共发现脑瘫484例,发生率为1．59‰。早产儿及过期产儿脑瘫发生率相对危险性(RR)分别为足月儿的25．16倍及2．40倍;低出生体重及巨大儿的脑瘫发生率RR分别为正常出生体重儿的19．63倍及1．34倍;SGA及大于胎龄儿(LGA)脑瘫发生率RR为适于胎龄儿(AGA)的4．34倍及0．84倍。先按胎龄别出生体重分层再按胎龄分组,发现各层内早产儿脑瘫发生率均较足月儿高,RR最高AGA层为28．34倍,其次LGA层为21．41倍,最低SGA层为9．29倍,各层内过期产儿脑瘫发生率也较足月儿高,RR最高AGA层为2．63倍,其次SGA层为1．90倍,最低LGA层为1．55倍;先按胎龄分层再按胎龄别出生体重分组发现各层内SGA脑瘫发生率均较AGA高,RR最高足月儿层为4．41倍,其次过期产儿层为3．19倍,最低早产儿层为1．45倍,各层内LGA脑瘫发生率均不比AGA高,除足月儿层相近为0．98倍外,早产儿及过期产儿层均较AGA低,RR分别为0．74倍和0．58倍。按胎龄大小及胎龄别出生体重大小联合分成9组进行比较,发现多数组脑瘫发生率均较足月AGA组高,RR按次序为早产SGA40．99倍、早产AGA28．34倍、早产LGA21．08倍、过期SGA8．39倍、足月SGA4．41倍、过期AGA2．63倍、过期LGA1．53倍、足月LGA0．98倍;前6组差异均有显著性,后2组倍数接近1．0,差异无显著性。结论 早产及SGA两种因素均与小儿脑瘫发生率增加关联,这两个因素分别为小儿脑瘫独立的危险因素;过期产与脑瘫的关联很弱,LGA则与脑瘫的发生率增加无关。     

足月儿早产儿痉挛型脑性瘫痪CT的对比研究

目的：研究足月儿与早产儿痉挛型脑性瘫痪的CT表现。方法：回顾性分析88例痉挛型脑性瘫痪患儿CT表现,分早产儿和足月儿两组分析,其中46例足月儿,42例早产儿。结果：88例痉挛型脑性瘫痪患儿CT表现的阳性率78.4%(69/88)。主要是脑室周围白质软化(PVL)后遗改变,为47/88例,其中足月儿17例,早产儿30例,两组差异有显著性意义(P<0.05);PVL白质减少可发生于侧脑室体中前部、侧脑室体后部、侧脑室三角区、半卵圆中心,两组间白质减少和侧脑室扩大部位差异无显著性意义;而侧脑室形态不规则扩大在早产儿30例中有7例,足月儿侧脑室扩大未见不规则改变,两组差异有显著性意义(P<0.05)。结论：痉挛型脑性瘫痪CT主要表现为PVL后遗改变,早产儿出现PVL和重度PVL的概率明显大于足月儿。     

脑性瘫痪合并癫(疒间)的临床特征及危险因素探讨

目的探讨脑性瘫痪患儿伴发癫癎的临床特点及其相关危险因素。方法对2004-01—2005-12期间青岛市残疾儿童医疗康复中心治疗的185例脑瘫患儿进行详细的病史采集、脑电图以及影像学检查、认知功能评定,分析不同类型脑瘫患儿癫癎的伴发率、发作类型、发病年龄等临床特征,采用Logistic逐步回归分析验证性别、出生体重、新生儿期惊厥史、围生期高危因素、认知水平、影像学改变等因素对合并癫癎的影响效应。结果25.9%(48/185例)脑瘫患儿伴发了癫癎,脑瘫类型包括痉挛型四肢瘫、偏瘫、双瘫、混合型、失调型和不随意运动型。这6型脑瘫患儿癫癎伴发率依次为58.97%、31.58%、16.07%、20.69%、12.5%和7.14%;伴发癫癎的患儿中29例(60.42%)在1岁内发病,而痉挛偏瘫和失调型脑瘫伴发癫癎发病都在1岁之后。Logistic回归分析发现产时高危因素、新生儿期惊厥史、IQ/DQ低下、影像学显示皮质受损均是伴发癫癎的危险因素,早产、新生儿疾病、孕期因素与伴发癫癎无明显关系,而单纯脑白质损伤是脑瘫伴发癫癎的保护性因子。结论癫癎是脑瘫患儿的常见并发症,尤其见于四肢瘫和偏瘫,往往较早发病,以婴儿痉挛和部分性发作为主要类型。新生儿期惊厥史、IQ/DQ低下、皮质受损对脑瘫患儿伴发癫癎有预示价值。     

脑性瘫痪患儿的临床类型与动态脑电图分析

目的　探讨脑性瘫痪患儿的临床类型与动态脑电图特征间的关系。方法　采用美国康泰公司KT98- 2 0 0 0A型 2 4h动态脑电图系统 (2 4hAEEG) ,对 96例脑瘫患儿进行动态脑电图检查 ,分析各型脑瘫脑电图特征。结果　脑瘫患儿的动态脑电图总异常率为 82 .2 9% ,痉挛型脑瘫脑电图异常率和样放电检出率最高 ;手足徐动型脑电图异常率最低 ,脑瘫并癫、智力障碍、小头畸形的动态脑电图异常率高。结论　脑瘫患儿的动态脑电图异常率与脑瘫类型及并发症有关     

脑性瘫痪患儿150例血清TORCH抗体检测的意义

目的分析150例脑性瘫痪(脑瘫)患儿的TORCH抗体检测结果,为防治提供依据。方法对150例1个月~3岁脑瘫患儿采用间接酶联免疫吸附方法进行TORCH-IgG检测,1~6个月患儿同时检测TORCH-IgM。分析比较阳性与阴性患儿间的高危因素、脑瘫分型、并发症、头颅CT、脑干听觉诱发电位、眼底检查、脑电图等情况。结果共检测出TORCH-IgG阳性患儿58例(阳性率38.58%);阳性中以巨细胞病毒(CMV)为最常见,其次为弓形体(TOX);母子TORCH阳性符合率达85.71%。高危因素中阳性患儿以窒息、早产、黄疸、低体质量为多见,阴性患儿以窒息、早产、颅内出血为主。脑瘫分型在阳性患儿以痉挛型四肢瘫和偏瘫多见,而阴性患儿以痉挛性双瘫和偏瘫为多见。阳性患儿并发症较阴性患儿多,尤以智力低下为最明显。阳性患儿的头颅CT、脑干听觉诱发电位、眼底检查、脑电图异常率明显较阴性患儿高。结论TORCH感染是婴幼儿脑瘫的重要病因之一,对孕妇、新生儿及婴幼儿常规进行TORCH抗体检测是防治脑瘫发生的重要措施之一。     

脑性瘫痪患儿智能结构及其与高危因素的关系

脑性瘫痪 (简称脑瘫 )患儿的智能水平比正常儿显著延迟 ,但从智能结构看 ,并不像精神发育迟滞患儿那样全面低下 ,其各能区发育明显不均衡[1] 。本研究对不同临床类型脑瘫患儿智能结构进行比较 ,并探讨其与高危因素的关系。对象和方法1 对象 :2 0 0 0年 3月～ 2 0 0 1年 6月住院的脑瘫患儿 167例 ,诊断与分型符合第一届全国脑瘫座谈会诊断标准[2 ] 。年龄分布 :1～ 2岁 69例 ,2～ 3岁 5 1例 ,3岁以上 (发育年龄 <3岁 ) 4 7例。临床类型 :手足徐动型 (徐动 ) 62例 ,痉挛型双瘫(双瘫 ) 66例 ,双瘫加徐动 (双 +徐 ) 16例 ,痉挛型四肢瘫 (四肢瘫 …     

脑性瘫痪伴临床下癫癎样放电临床特征分析

目的 探讨脑性瘫痪患儿伴发临床下癫癎样放电的临床特征及相关危险因素.方法 对2004年1月-2007年12月期间在青岛市残疾儿童医疗康复中心治疗的279例脑瘫患儿进行详细的病史采集、脑电图及影像学检查、认知功能评定,分析不同类型脑瘫患儿临床下癫癎样放电的伴发率及腩电图表现,采用Logistic逐步回归分析显示认知水平、影像学改变、新生儿期惊厥史、出生胎龄及合并症等因素,对脑瘫伴发临床下癫癎样放电的影响.结果 18.64%(52/279)的脑瘫患儿伴发了临床下癫癎样放电,痉挛型偏瘫患儿的发生率最高(36.36%),四肢瘫患儿最低(6.25%).所有脑瘫类型均以局灶性或多灶性放电占多数.不同DQ/IQ水平局灶性与全面性放电的比例差异无统计学意义.皮层损伤及存在合并症是脑瘫伴发临床下癎样放电的危险因素,而认知水平、新生儿期惊厥史及出生胎龄与之无明显关系.结论 脑性瘫痪常伴发临床下癫癎样放电,尤其见于痉挛型偏瘫,以局灶性或多灶性放电多见.皮层受损及存在合并症对脑瘫伴发临床下癎样放电有预测价值.     

脑性瘫痪的头颅CT,MRI及SPECT改变与病因关系

对29例脑瘫患儿行头颅CT、MRI及SPECT检查，并进行分析。本组脑瘫病因主要是宫内及出生时窒息、早产低体重儿、核黄疸三大因素。CT异常率79．3％，弥散性脑萎缩、脑软化灶等为主要的CT改变。MRI异常26例，异常率89％，以弥漫性脑萎缩、脑软化灶、脑白质发育不良等为主要的MRI改变。SPECT异常27例，异常率93％，脑局部血流灌注减少为主要改变。认为CT和MRI及SPECT检查对脑瘫病因学诊断有重要价值。     

CT and MR patterns of hypoxic ischemic brain damage following perinatal asphyxia

The objectives were to study the clinical and neurological abnormalities in children with cerebral palsy and to attempt to correlate the signs with radiological abnormalities detected by CT scan and/or MRI of the brain. In a prospective, hospital-based study, 65 children with cerebral palsy were examined neurologically and their perinatal history was reviewed. Their cranial CT scan, and/or magnetic resonance images were studied. The association between the gestational ages, perinatal history, neurological deficits, and the radiological appearances were studied. Of the 24 preterm-born and 41 term-born children, 23 had spastic diplegia; 57 per cent of these children has significant periventricular leucomalacia, which was more common among preterm-born children. Of the 13 children with hemiplegia, 12 had unilateral lesions on neuroimaging. Spastic tetraplegia was associated with extensive, bilateral, diffuse brain damage. Extrapyramidal cerebral palsy was far more common among term-born infants and 80 per cent of these showed significant abnormalities in the basal ganglia region. Ataxic cerebral palsy was an uncommon variety and there was no significant correlation between neurological signs and abnormalities on brain imaging. In conclusion, the radiological findings were closely related to the type of cerebral palsy and the neurological deficit except in the ataxic type. We believe that CT and MRI imaging are helpful in understanding the pathology and the timing of the lesion in cerebral palsy.     

Changing Panorama of Cerebral Palsy in Children of Low Birth Weight

Of 2,840 out-patients who visited the Tokyo Metropolitan Kita Rehabilitation Center in 1965, 1968, 1970, 1973, 1975 and 1978, 278 children with cerebral palsy (CP) of low birth weight were studied to analyse changes in type of CP in relation to gestational week, birth weight, perinatal factors and subsequent complications. 1. The incidence of handicap associated with low birth weight in new out-patients had not changed. 2. The number of doubly handicapped CP patients was gradually increasing while number of uncomplicated CP patients was gradually decreasing. 3. The number of children with tension athetosis was remarkably decreasing; the number of children with spastic quadriplegia was gradually increasing. Increase in number of the spastic type was found especially in the group whose birth weight was over 1,500 gm. and gestational week over 37 weeks. The numbers of spastic diplegia and hemiplegia patients had not significantly changed. 4. In the athetoid group, the complication of severe jaundice was apparently decreasing since 1970 while the number of asphyxia cases was gradually increasing. In the spastic group, there were no remarkable changes in the perinatal complications. 5. Of spastic quadriplegia patients 78.3% were of IQ of less than 67 while 33.3% of spastic hemiplegia and 23.5% of spastic diplegia patients had IQs of less than 67.31.4% of the athetoid type had IQs of less than 67. 6. In the asphyxia group, 34 of 82 children with low birth weight CP (41.5%) had epilepsy. Our results suggest that the causes of brain damage in low birth weight infants are not merely preventable perinatal factors, but are due to a more complex interaction of prenatal and perinatal factors.     

Development of very low birth weight infants: A regional study of 371 survivors

We re-examined 371 infants with birth weights less than 1501 g at a corrected age of 18–20 months. This sample amounted to 91% of such infants admitted to one of the six neonatal intensive care units in Hamburg between July 1983 and 1986. The neurological examination and a developmental evaluation using the Griffith Developmental Scale revealed higher rates of abnormalities than in most other studies. Fifty-five children (14.8%) suffered from cerebral palsy, classified in 45 as spastic diplegia, in 5 as spastic tetraplegia, in 1 as spastic hemiplegia and in 4 as dystonia. Of the children, 41 (11%) showed minor neurological deviations (hyperactivity, clumsiness, intention tremor). The development of 30 children (8%) without neurological abnormalities was moderately retarded (DQ 80-89, corrected for gestational age [GA]). Nineteen children (5%) were severely retarded (DQ<80, corrected for GA) and four children (1.5%) were blind due to retrolental fibroplasia. An isolated delay of speech development was found in 5 children. Seventy children (18.9%) had a major and 87 children (23.5%) a minor handicap.     

The changing panorama of cerebral palsy in Sweden. IX. Prevalence and origin in the birth-year period 1995-1998

AIM: This is the ninth report from the western-Swedish study of the prevalence and origin of cerebral palsy. METHODS: A population-based study covering the 88 371 live births in the area in 1995-1998. Birth characteristics, neuroimaging findings and risk factors in children with cerebral palsy were recorded, prevalence was calculated, and aetiology was analysed. RESULTS: The study comprised 170 children with cerebral palsy, i.e. a prevalence of 1.92 per 1000 live births. Excluding eight post-neonatally derived cases, the gestational age-specific prevalences were 77 per 1000 for children born before 28 wk of gestation, 40 for children born at 28-31 wk, 7 for children born at 32-36 wk and 1.1 for children born after 36 wk of gestation. Spastic hemiplegia, diplegia and tetraplegia accounted for 38%, 35% and 6%, respectively, dyskinetic cerebral palsy for 15%, and ataxia for 6%. For the first time, hemiplegia was now most common, due to the decline in preterm diplegia. There was a further increase in full-term dyskinetic cerebral palsy. The origin of cerebral palsy in children born at term was considered to be prenatal in 38%, peri/neonatal in 35% and unclassifiable in 27%, while in children born preterm it was 17%, 49% and 33%, respectively. CONCLUSION: The decreasing trend from the period 1991-1994 continued, both in children born at term and especially in those born preterm. However, the increase in dyskinetic cerebral palsy in children born at term was a matter of concern. In this group, a perinatal hypoxic ischaemic encephalopathy had been present in 71%.     

Early diagnosis of spastic diplegia, spastic hemiplegia, and quadriplegia

A retrospective study examined early neurodevelopmental behaviors of children with spastic diplegia, spastic hemiplegia, and quadriplegia (spastic, athetoid, or mixed) who had been followed up longitudinally in a high-risk infant follow-up clinic. Compared with peers with normal outcomes, children with all three types of cerebral palsy had significantly lower scores on the Bayley Mental Scale at 4 months of age; children with hemiplegia and quadriplegia also scored significantly lower on the Bayley Motor Scale. On the Movement Assessment of Infants at 4 months of age, the children with hemiplegia and quadriplegia showed significantly higher risk scores than the nonhandicapped group. The Movement Assessment of Infants was more than three times as sensitive as the Bayley Motor Scale in detecting motor abnormalities in 4-month-old infants with diplegia and more than twice as sensitive in detecting early abnormalities of hemiplegia. At 1 year of age, however, the Bayley Motor Scale was extremely sensitive in picking up motor deficits in children with all three types of cerebral palsy.     

Impact of cerebral palsy in patients discharged from neonatal intensive care units

AIM: The aim of this study was to assess the impact and the peculiarities of cerebral palsy (CP) in children discharged from our neonatal intensive care unit (NICU) from January 1998 to April 2004. METHODS: A total of 2 303 children were discharged from our NICU during this period and 1 912 were followed up for 1 year through neurological examination (traditional, Brazelton, general movements) and cranial ultrasound (US); high-risk newborns were evaluated with brain magnetic resonance imaging (MRI) too. RESULTS: In 65 children (3.4% of the follow-up group) were diagnosed CP, and classified as follows: 21 (32%) diplegia, 19 (29%) quadriplegia, 20 (31%) hemiplegia, 4 (6%) double hemiplegia, 1 (2%) dyskinetic form. In diplegia and quadriplegia prevailed low birth weight infants (less than or equal to 2,500 g) and preterm infants, while in hemiplegia prevailed normal birthweight infants (greater than 2,500 g) and infants at term. The main MRI findings were: in diplegia 82% periventricular white matter lesions; in quadriplegia 94% periventricular and/or subcortical white matter lesions; in hemiplegia 95% bilateral periventricular or subcortical white matter lesions, predominating on contralateral cerebral hemisphere; in double hemiplegia 100% periventricular and/or subcortical white matter lesions, 100% enlargement of subarachnoid spaces; in dyskinetic form 100% basal ganglia lesions. CONCLUSIONS: The impact of CP in children discharged from our NICU, in agreement with the literature, is higher than in the total population of newborns, thus it is very important to evaluate carefully high-risk newborns during hospitalization and follow-up, through neurological examination and radiologic imaging (US, MRI), for an accurate and early treatment.     

Spastic cerebral palsy: Changes in birthweight and gestational age

The birthweight and gestational age frequency distributions for spastic cerebral palsy (CP) cases and their controls were obtained from the Western Australian CP register. Following the introduction of neonatal intensive care, spastic CP rates have fallen amongst heavier (?2500 g) infants and remained steady or risen amongst low birthweight (LBW: <2500 g) infants.The expected bimodality of both the birthweight and gestational age distributions for spastic diplegia cases was obvious in these data. Marked peaks occurred at 1500 g and 31 weeks and 3000 g and 39 weeks. The numbers of heavier, term diplegics fell between 1961–1965 and 1971–1975, and thus there were proportionally more preterm LBW diplegics more recently. The reasons for the fall in the heavier diplegics need investigation.Spastic hemiplegic and quadriplegic cases were more like the controls but with distributions skewed to the left. More of these individuals were more recently small for gestational age (SGA: <2500 g and over 37 weeks gestation). This highlights the importance of intrauterine damage in these two groups of spastic CP individuals.     

Neurosurgical options in cerebral palsy

The main movement disorders in cerebral palsy (CP) are spasticity, dystonia, athetosis and chorea. Their neurosurgical treatments have improved dramatically in the past two decades. Focal spasticity can now be effectively treated with peripheral selective neurectomies, spastic diplegia with lumbar dorsal rhizotomies, and generalized spasticity with continuous intrathecal baclofen (ITB) infusion. Dystonic CP is usually generalized and can be treated with ITB; refractory cases may respond to deep brain stimulation. There are presently no effective neurosurgical options for athetosis, although deep brain stimulation shows promise for choreiform CP.     

Intrauterine growth in children with cerebral palsy

The risk of cerebral palsy in connection with intrauterine growth retardation has been analysed in a case-control study. The case series comprised 519 children with cerebral palsy born in 1967-1982 in the west health-care region of Sweden and the control series 445 children born during the same years in the same region. The risk of cerebral palsy in small-for-gestational-age infants was significantly increased in term and moderately preterm infants. The highest proportion among infants with cerebral palsy born at term was found in tetraplegia, followed by diplegia and dyskinetic cerebral palsy. It was concluded that small for gestational age on the one hand reflects early prenatal brain damage, and on the other mediates prenatal risk factors compatible with foetal deprivation of supply and also potentiates adverse effects of birth asphyxia and neonatal hypoxia.