Bjørn Ellertsen

Physical Exercise in Women with Intractable Epilepsy

Summary: Fifteen women with pharmacologically intractable epilepsy were given physical exercise (aerobic dancing with strength training and stretching) for 60 min, twice weekly, for 15 weeks. Seizure frequency was recorded by the patients for 3–7 months before the intervention, during the intervention period, and for 3 months after the intervention. Medication and other known seizure‐influencing factors were kept as constant as possible. Self‐reported seizure frequency was significantly reduced during the intervention period. The exercise also led to reduced level‐of subjective health complaints, such as muscle pains, sleep problems, and fatigue. The exercise reduced plasma cholesterol ratio and increased maximum O2 uptake. Because most of the patients were unable to continue the exercise on their own after the intervention period, the exercise effects were not maintained during the follow‐up period. The patients were not unwilling to continue the exercise, but it was not sufficient to offer them the possibility of continuing similar types of exercise. We believe that 15 weeks is too short a time to establish a life‐style change and that continued physical exercise for these patients requires a well‐organized and supportive program, requiring experienced and dedicated instructors.

Cognitive development of term small for gestational age children at five years of age

AIM To assess the relative significance for cognitive development of small for gestational age, parental demographic factors, and factors related to the child rearing environment. METHODS IQ of a population based cohort of 338 term infants who were small for gestational age (SGA) and without major handicap, and a random control sample of 335 appropriate for gestational age (AGA) infants were compared at 5 years of age. RESULTS The mean non-verbal IQ was four points lower, while the mean verbal IQ was three points lower for the children in the SGA group. The results were not confounded by parental demographic or child rearing factors. However, parental factors, including maternal non-verbal problem solving abilities, and child rearing style, accounted for 20% of the variance in non-verbal IQ, while SGA versus AGA status accounted for only 2%. The comparable numbers for verbal IQ were 30 and 1%. Furthermore, we found no evidence that the cognitive development of SGA children was more sensitive to a non-optimal child rearing environment than that of AGA children. Maternal smoking at conception was associated with a reduction in mean IQ comparable to that found for SGA status, and this effect was the same for SGA and AGA children. The cognitive function of asymmetric SGA was comparable to that of symmetric SGA children. CONCLUSIONS Our findings indicate that child cognitive development is strongly associated with parental factors, but only marginally associated with intrauterine growth retardation.

Parental factors in cognitive outcome of non-handicapped low birthweight infants.

A population based cohort of 144 children weighing less than 2000 g who were without major handicap, and a random control sample of 163 children born at term and weighing over 3000 g were investigated. The aim was to assess the relative importance for cognitive development at 5 years of age, of birthweight, parental demographic factors, and factors related to the environment in which the child was reared. The mean non-verbal IQ was 6.1 points lower (95% CI, 2.3 to 10) for the low birthweight (LBW) group, but the difference was reduced to 4.8 points (95% CI, 1.1 to 8.5) after adjusting for confounding parental demographic and childrearing factors. The verbal IQ was similar for the two groups after such adjustment. Paternal education was the main confounding variable, and demographic factors such as parental education and family income were much stronger predictors of child IQ than birthweight or factors related to the childrearing environment. There was no evidence that the cognitive development of low birthweight children was more sensitive to a non-optimal childrearing environment than that of normal birthweight children. These findings indicate that the risk of impaired cognitive development increases with decreasing socioeconomic status, and that this risk is much larger than, and independent of, the small risk attributable to low birthweight.

Behavioral problems in low-birthweight preschoolers.

Preschool behavior of a population‐based sample of 144 5‐year‐old children with birthweights less than 2000g (LBW) was compared with a random sample of 163 normal‐birthweight term controls. The Personality Inventory for Children and the Yale Childrens Inventory were completed by the mothers, and child behavior during psychometric testing was assessed. Nineteen per cent of the LBW children compared to 4% of controls had behavioral problems as defined by abnormal scores on more than three behavioral measures. The LBW children were more often socially insecure. anxious and difficult to manage, but inattention and hyperactivity were not prominent. The LBW children were not more sensitive to the negative impact of parental risk factors than nonnal‐birthweight children.

Personality and behaviour in eight‐year‐old, non‐handicapped children with birth weight under 1500 g

Personality and behavioural characteristics of a population‐based cohort of 29 very low‐birth‐weight (VLBW) infants were compared with those of 29 matched, term controls at eight years of age. The VLBW infants were born to families of lower socioeconomic status (p = 0.04) and had a lower mean IQ (93 versus 104, p = 0.008) and motor abilities (p = 0.028). Based on the questionnaire personality inventory for children, the VLBW children had more learning difficulties and school coping problems, and the VLBW boys had more conduct and emotional problems than the controls. Except for conduct problems, these differences persisted after controlling for socioeconomic status. Generally, there were significant relationships between behaviour, IQ and motor abilities. In conclusion, VLBW may be a risk factor for the development of school coping and behavioural problems independent of socioeconomic status but often coexist with impaired cognitive and neuromotor function.

Neuropsychological performance in low birth weight preschoolers: a population-based, controlled study

Abstract The aim was to evaluate neuropsychological performance and its pre-, and perinatal predictors in low birth weight (LBW) preschool children. A population-based sample of 137 5-year-old children with birth weights less than 2000 g and without major handicaps was compared with a random sample of 152 normal birth weight term controls. Main assessment tools were all subscales from the Wechsler Preschool and Primary Scale of Intelligence Revised, subscales from the Illinois Test of Psycholinguistic Abilities and tests of manual dexterity and figure copying. The LBW children showed significantly lower mean scores compared to controls on tests of visuo-spatial and visuo-motor abilities, but were comparable to controls in other areas, confounding parental factors were controlled for. 14 of the LBW children, there were signs of maternal chorio-amnionitis. Twelve of these had premature rupture of membranes lasting more than 24 h. These 14 children had a mean performance IQ of 87 (SD 5) compared to 100 (SD 15) for the LBW children without maternal signs of chorio-amnionitis (P = 0.001). Having a small head circumference at birth was a less powerful, but statistically significant predictor of impaired performance. Conclusion Low birth weight is associated with impaired performance on visuo-spatial and visuo-motor tasks. Signs of maternal chorio-amnionitis and a small head circumference at birth may be risk factors for such impairment.

Cognitive performance in a low birth weight cohort at 5 and 11 years of age

The objective of this study was to evaluate cognitive functions, changes over time, and prenatal, perinatal, and neonatal predictors in low birth weight children. A cohort of 130 low birth weight children was compared with 131 control children. A neuropsychologic test battery including subtests from the Wechsler Intelligence Scale for Children-Revised and the Illinois Test of Psycholinguistic Abilities, Knox Cube Test, Grooved Pegboard Test, Finger, and Foot Tapping was used. School performance was assessed using the Child Behavior Check List. Low birth weight children were comparable with control children in areas of verbal and visuo-spatial function, distractibility, and motor tempo, when parental factors were controlled for. An apparent association between breast milk feeding and child intelligence quotient was rendered insignificant when confounding parental factors were controlled for. None of the other identifiable prenatal, perinatal, or neonatal predictors were significantly related to cognitive outcome or school problems at 11 years of age. No differences were found in cognitive functions between those weighing less than 1500 g and 1500-2000 g. Motor problems and low verbal intelligence quotient at 5 years of age in the low birth weight children (previously published data) each doubled the risk of presenting a school problem at 11 years of age. Our findings are encouraging for low birth weight children regarding testable cognitive consequences and less encouraging regarding ability of cognitive test to identify school problems.

Neuropsychologic and motor function in small-for-gestation preschoolers.

The aim of this study was to evaluate neuropsychologic and motor performance in term small-for-gestation preschool children. A patient-based sample of 311 5-year-old children with birth weights less than the fifteenth percentile for gestation was compared with a random sample of 321 appropriate-for-gestation control subjects. The main assessment tools were subscales from the Wechsler Preschool and Primary Scale of Intelligence Revised, subscales from the Illinois Test of Psycholinguistic Abilities, tests of manual dexterity and figure copying, and the Peabody Developmental Motor Scales. The small-for-gestation children had mean scores on tests of visuospatial and visuomotor abilities that were one fourth standard deviation lower than appropriate-for-gestation control subjects and slightly lower scores on manual dexterity. The small-for-gestation children were comparable to appropriate-for-gestation children regarding motor performance. We therefore conclude that the neuropsychologic and neuromotor performance in preschool years of term small-for-gestation children is reassuring.

EMG feedback in the treatment of myofascial pain dysfunction syndrome

The effect of electromyographic (EMG) biofeedback on frontalis and masseter muscle activity was compared with control conditions in two groups of patients with a diagnosis of myofascial pain dysfunction (MPD) syndrome. Patients were selected on the basis of clinical symptoms, radiographic evaluation, and a clinical examination. Depressed patients and patients with signs of a pathological condition in the temporomandibular joint were excluded. Both the experimental (EXP) and the control (CON) group went through two base-line screening sessions before treatment of the EXP group was started. Treatment consisted of eight biofeedback sessions, given twice a week for 4 weeks. Feedback was presented visually on a monitor. Treatment did not include any relaxation training. Control evaluations of both groups took place 1 week, 3 months, and 6 months after the end of treatment. The EXP group was able to reduce EMG levels in frontalis and masseter muscles significantly during training sessions. Follow-up data showed significantly reduced frontalis EMG levels in the EXP group after 3 and 6 months but not in the CON group. Both groups improved subjectively, as judged by reports on pain intensity and duration, but this improvement was significantly more pronounced in the EXP group. Objective clinical indices recorded throughout the study were uncorrelated with EMG changes or subjective reports. It is concluded that biofeedback training facilitated muscular relaxation and self-regulation in the EXP group and that visual EMG feedback, consisting of a patterning of frontalis and masseter muscle activity, can be recommended as an integrated part of MPD syndrome treatment.

Low birthweight and neuromotor development: a population based, controlled study

The aims of the study were to investigate: (a) the relationship between low birthweight (LBW) and preschool neuromotor development; and (b) the predictive value of various pre‐, peri‐, and neonatal factors for neuromotor development in LBW pre‐school children. A population based sample of 144 5‐year‐old LBW children (birthweight <2000g) with no major handicaps was compared with a random sample of 163 normal birthweight term controls. Using the Peabody Developmental Motor Scales, impaired performance on the balance scale was seen more often in LBW boys than in controls (odds ratio 5.5, 95% CI 1.5‐20.3), while performance on the eye‐hand coordination and locomotor scales was comparable for the two groups. LBW girls were comparable to controls on all these scales. On neurological examination, an increased frequency of minor neurological signs was found in LBW boys, while increased ankle tone and/or leg hyperreflexia was more common in LBW girls compared to controls. Small head circumference at birth was associated with an increased frequency of minor neurological signs in LBW boys, and lack of breastmilk in the neonatal period with impaired balance in LBW boys. None of the other pre‐, peri‐ or neonatal factors were predictive of neuromotor development. We conclude that motor functions essential for daily activities are intact in most LBW preschoolers.