Heike Philippi

Parent based language intervention for 2-year-old children with specific expressive language delay: a randomised controlled trial

Objective: The aim of this randomised controlled trial was to evaluate the effectiveness of a short, highly structured parent based language intervention group programme for 2-year-old children with specific expressive language delay (SELD, without deficits in receptive language). Methods: 61 children with SELD (mean age 24.7 months, SD 0.9) were selected between October 2003 and February 2006 during routine developmental check-ups in general paediatric practices, using a German parent-report screening questionnaire (adapted from the MacArthur Communicative Development Inventories). Standardised instruments were used to assess the language and non-verbal cognitive abilities of these children and of 36 other children with normal language development (reference group; mean age 24.6 months, SD 0.8). 58 children with SELD were sequentially randomly assigned to an intervention group (n = 29) or a 12-month waiting group (n = 29). In the intervention group, mothers participated in the 3-month Heidelberg Parent-based Language Intervention (HPLI). All children were reassessed 6 and 12 months after pretest. Assessors were blind to allocation and previous results. Results: 47 children were included in the analysis. At the age of 3 years, 75% of the children in the intervention group showed normal expressive language abilities in contrast to 44% in the waiting group. Only 8% of the children in the intervention group versus 26% in the waiting group met the criteria for specific language impairment (t score ⩽35). Conclusions: By applying the short, highly structured HPLI in children with SELD, the rate of treatment for language impairment at the age of 3 years can be significantly reduced.

Levetiracetam in the treatment of neonatal seizures: A pilot study

PURPOSE At present, neonatal seizures are usually treated with Phenobarbital (PB) despite the limited efficacy and the potential risk this treatment holds for the developing brain. We report here a prospective pilot feasibility study on the use of Levetiracetam as monotherapy in the treatment of neonatal seizures. METHODS Six newborns (body weight>2000 g, gestational age>30 weeks) presenting with neonatal seizures were enrolled. Patients whose seizures were caused by electrolyte disturbances or hypoglycemia, or whose seizures did respond to pyridoxine were excluded. Patients previously treated with other antiepileptic drugs (AEDs), with the exception of single PB doses before and during titration, were excluded. LEV was administered orally, increasing the dose by 10mg/(kg day) over 3 days. Endpoint was the need of any additional AEDs (or PB) after day 3, or 3 months of LEV treatment. A decision regarding further treatment was made on an individual basis and follow-up was documented up to 8 months of age. RESULTS No severe adverse effects were observed. Mild sedation was reported in one infant. All six patients treated with oral LEV became seizure free within 6 days. Five patients remained seizure free after 3 months with ongoing LEV monotherapy. One infant developed pharmacoresistant epilepsy. Seizures relapsed later in the clinical course of two more patients, one of whom was no longer under LEV therapy. DISCUSSION Results from our small patient group indicate that LEV may be an alternative therapeutic option in neonatal seizures.

Infantile postural asymmetry and osteopathic treatment : a randomized therapeutic trial

The aim of this study was to assess the therapeutic efficacy of osteopathic treatment in infants with postural asymmetry. A randomized clinical trial of efficacy with blinded videoscoring was performed. Sixty‐one infants with postural asymmetry aged 6 to 12 weeks (mean 9wks) were recruited. Thirty‐two infants (18 males, 14 females) with a gestational age of at least 36 weeks were found to be eligible and randomly assigned to the intervention groups, 16 receiving osteopathic treatment and 16 sham therapy. After a treatment period of 4 weeks the outcome was measured using a standardized scale (4–24 points). With sham therapy, five infants improved (at least 3 points), eight infants were unchanged (within 3 points), and three infants deteriorated (not more than −3 points); the mean improvement was 1.2 points (SD 3.5). In the osteopathic group, 13 infants improved and three remained unchanged; the mean improvement was 5.9 points (SD 3.8). The difference was significant (p=0.001). We conclude that osteopathic treatment in the first months of life improves the degree of asymmetry in infants with postural asymmetry.

Long-term development of low-risk low birth weight preterm born infants: Neurodevelopmental aspects from childhood to late adolescence

BACKGROUND Most studies on clinical outcome of preterm born infants focus on high-risk infants, whereas little is known about the long-term prognosis of low-risk low birth weight preterm born infants (LBW). AIMS To examine physical growth, school outcome, behavioural aspects, quality of life, and intervention impact on LBW in late adolescence compared to term born controls and to analyse developmental pathways from childhood to adolescence for these groups. STUDY DESIGN In late adolescence 65 LBW and 41 matched term born controls were assessed with a structured telephone interview and standardized questionnaires with regard to physical growth, school career, therapeutic interventions, behavioural aspects, and quality of life. Longitudinal analysis comprised data from birth, infancy, school age, and adolescence. RESULTS Growth in height of LBW was highly variable, but correlated significantly with birth parameters and was below those of controls with regard to percentiles. School enrollment of LBW was more often delayed, and there was a trend toward lower school graduation in LBW. The groups did not differ with regard to general or health-related quality of life and behavioural aspects, but LBW received significantly more therapeutical interventions. CONCLUSIONS In general, LBW showed no major deficits in late adolescence. However, a prolonged school career and a higher demand for therapeutic interventions indicate subtle neurodevelopmental deficits in LBW. This underscores the need for professional follow-up programmes for this majority of preterm born infants.

Kinematic assessment of stereotypy in spontaneous movements in infants

Movement variation constitutes a crucial feature of infant motor development. Reduced variation of spontaneous infant movements, i.e. stereotyped movements, may indicate severe neurological deficit at an early stage. Hitherto evaluation of movement variation has been mainly restricted to subjective assessment based on observation. This article introduces a method for quantitative assessment yielding an objective definition of stereotyped movements which may be used for the prognosis of neurological deficits such as cerebral palsy (CP). Movements of 3-month-old infants were recorded with an electromagnetic tracking system facilitating the analysis of joint angles of the upper and lower limb. A stereotypy score based on dynamic time warping has been developed describing movements which are self-similar in multiple degrees of freedom. For clinical evaluation, this measure was calculated in a group of infants at risk for neurological disorders (n=54) and a control group of typically developing children (n=21) on the basis of spontaneous movements at the age of 3 months. The stereotypy score was related to outcome at the age of 24 months in terms of CP (n=10) or no-CP (n=53). Using the stereotypy score of upper limb movements CP cases could be identified with a sensitivity of 90% and a specificity of 96%. The corresponding score of the leg movements did not allow for valid discrimination of the groups. The presented stereotypy feature is a promising candidate for a marker that may be used as a simple and noninvasive quantitative measure in the prediction of CP. The method can be adopted for the assessment of infant movement variation in research and clinical applications.

Electroencephalographic evolution of hypsarrhythmia: Toward an early treatment option

Purpose:  A retrospective study for a classification of prehypsarrhythmic elecroencephalographies (EEGs) was carried out to enable an early treatment option for West syndrome.

Computer‐based analysis of general movements reveals stereotypies predicting cerebral palsy

To evaluate a kinematic paradigm of automatic general movements analysis in comparison to clinical assessment in 3‐month‐old infants and its prediction for neurodevelopmental outcome.

Quantitative score for the evaluation of kinematic recordings in neuropediatric diagnostics. Detection of complex patterns in spontaneous limb movements.

OBJECTIVE Evaluation of spontaneous infant movements is an important tool for the detection of neurological impairments. One important aspect of this evaluation is the observation of movements which exhibit certain complex properties. This article presents a method to automatically extract segments which contain such complex patterns in order to quantitatively assess them. METHODS Expert knowledge is represented in a principal component model which captures the term complexity as the multivariate interactions in the kinematic chains of the upper and the lower limb. A complexity score is introduced which is used to quantify the similarity of new movements to this model. It was applied to the recordings of 53 infants which were diagnosed by physicians as normal or pathologic. RESULTS Time segments marked as complex (from five infants) by physicians could be detected with a mean accuracy of 0.77 by the automated approach. The median of the best complexity scores of the pathologic group (n = 21) is significantly lower (p = 0.001) than the median of the normal group (n = 27). CONCLUSION Using the complexity score we were able to quantify movement complexity in regard of the understanding of physicians. This could be useful for clinical applications.

Retrospective evaluation of low long-term efficacy of antiepileptic drugs and ketogenic diet in 39 patients with CDKL5-related epilepsy

OBJECTIVE Mutations in the CDKL5 gene cause an early-onset epileptic encephalopathy. To date, little is known about effective antiepileptic treatment in this disorder. METHOD Accordingly, the aim of this retrospective study was to explore the role of different antiepileptic drugs (AEDs) and the ketogenic diet (KD) in the treatment of this rare genetic disorder. We evaluated the efficacy in 39 patients with CDKL5 mutations at 3, 6 and 12 months after the introduction of each treatment. One patient was lost to follow-up after 6 and 12 months. RESULTS The responder rate (>50% reduction in seizure frequency) to at least one AED or KD was 69% (27/39) after 3 months, 45% (17/38) after 6 months and 24% (9/38) after 12 months. The highest rate of seizure reduction after 3 months was reported for FBM (3/3), VGB (8/25), CLB (4/17), VPA (7/34), steroids (5/26), LTG (5/23) and ZNS (2/11). Twelve patients (31%) experienced a seizure aggravation to at least one AED. Most patients showed some but only initial response to various AEDs with different modes of actions. SIGNIFICANCE Considering both age-related and spontaneous fluctuation in seizure frequency and the unknown impact of many AEDs or KD on cognition, our data may help defining realistic treatment goals and avoiding overtreatment in patients with CDKL5 mutations. There is a strong need to develop new treatment strategies for patients with this rare mutation.

Reliability and predictive validity of the Standardized Infant NeuroDevelopmental Assessment neurological scale

To assess reliability and predictive validity of the neurological scale of the Standardized Infant NeuroDevelopmental Assessment (SINDA), a recently developed assessment for infants aged 6 weeks to 12 months.