Lewis Rosenbloom

Growth patterns in a population of children and adolescents with cerebral palsy

This study examined growth of children and adolescents with cerebral palsy (CP) who received services from the California Department of Developmental Services from 1987 to 2002. In all, 141 961 measurements of height and weight were taken from 24920 patients with CP (14103 males, 10817 females). Centiles of weight and height were determined by age, sex, and five levels of functional ability ranging from fully ambulatory to unable to walk, crawl, or feed self, and fed via gastrostomy tube. Resulting charts of height and weight centiles were compared with Centers for Disease Control and Prevention weight and height charts for the general population of the US. Centiles of height and weight of patients with CP were close to those of the general population for the highest functioning groups with CP, but lagged substantially for other groups. Presence of a feeding tube was associated with greater height and weight in the lowest functioning groups, with centiles for weight being 2 to 5kg higher for those with gastrostomy tubes. The charts may assist in early identification of nutritional or metabolic difficulties beyond what might be expected for patients with similar functional disabilities.

Survival in cerebral palsy in the last 20 years : signs of improvement?

This study investigated the possibility of improved survival in cerebral palsy (CP) over a 20‐year period. Participants were 47 259 persons with CP receiving services from the State of California between 1983 and 2002. The person–year approach was used. This asks whether the probability of dying in a given calendar year changes over the study period after age and severity of disability are taken into account. An appreciable improvement over time was found in children with severe disabilities and in adults who required gastrostomy feeding. In these groups, mortality rates fell by 3.4% per year. Therefore, life expectancies reported in earlier studies should be increased by approximately 5 years if adjustments to 2002 mortality rates are made. For other persons with CP there was, at most, a small improvement over the 20‐year period. The results suggest there have been improvements in the treatment and care of the most medically fragile children. Gastrostomy feeding has become much more widespread over the past two decades, and the improved survival of persons with gastrostomies may reflect better understanding of their requirements.

Life expectancy in cerebral palsy: an update

This paper clarifies and updates some issues of life expectancy in cerebral palsy. These are: (1) the definition of life expectancy and how it is calculated; (2) the secular trends that have occurred since the data for the 1998 paper were collected; (3) revised estimates reflecting improvements of some of the analytical methods and statistics provided in that paper; (4) comparison of life expectancies among countries; (5) issues regarding quality of care; and (6) consideration of prospective life expectations in addition to current life expectancy.

Disintegrative Psychosis in Childhood

Ten children with disintegrative psychosis are described. In three cases the age at onset preceded 2 1/2 years, but in all other respects they are considered to fulfil the necessary diagnostic criteria. A high incidence of associated life‐stress triggering factors is reported and their significance is discussed.

Efficacy and tolerability of topiramate in childhood and adolescent epilepsy: a clinical experience

A 3-year retrospective review was undertaken of the use of topiramate in 51 children aged 3-16 years with partial and generalized epilepsies who attended a tertiary referral epilepsy centre in a large childrens hospital. The mean follow-up period was 19 months (range 6-33 months). Twenty-six children (51%) were still receiving topiramate at the time of their last review. Fifteen children (29%) showed a greater than 50% reduction in their seizure frequency and four children (8%) became seizure free, three on topiramate monotherapy. The drug appeared to be most effective in children with moderate learning difficulties with 75% showing an improvement in seizure control compared with 25% of children with normal educational functioning. Topiramate was withdrawn in 25 patients. The reasons for withdrawal included adverse effects in 20, lack of effect in three and worsening of seizures in two patients. Adverse side effects were reported in 57% of the 51 patients. The majority of the side effects were related to behavioural and cognitive difficulties, with less-common side effects including anorexia, weight loss and headaches.

Vigabatrin in intractable childhood epilepsy: A retrospective study

The effects of vigabatrin were studied over a 6-month period in 43 patients with intractable epilepsy. Children with complex partial seizures, with or without secondary generalization, responded best with more than one-half achieving a greater than 50% reduction; generalized tonic-clonic seizures also improved but there was no significant change in absence or myoclonic seizures. Four patients are seizure-free on monotherapy with vigabatrin. The drug was well tolerated with few side effects.

Non-accidental Injury: a Two-year Study in Central Liverpool

In the two years following the implementation in Liverpool of a case conference system for dealing with non‐accidental injury to children, 76 children were discussed at 73 such conferences. Factors in both the children and their families were identified as predisposing to non‐accidental injury, notably male sex, illegitimacy, low birthweight, previous injuries in the children, the mothers having become pregnant at an early age, and the families having environmental stress factors. The evolving role of the case conference system in providing support for affected families is discussed.

Lamotrigine for Intractable Childhood Epilepsy: a Preliminary Communication

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CEREBRAL PALSY IN LOW-BIRTHWEIGHT INFANTS. II, SPASTIC DIPLEGIA: ASSOCIATIONS WITH FETAL IMMATURITY1

Twenty children with spastic diplegia identified by clinical assessment among a representative cohort of 1048 survivors with a birthweight of 2000g or less. Data from hospital case–records were used to investigate which perinatal conditions might differentiate infants with diplegia from other low‐birthweight survivors. Even allowing for a strong association with lower gestational age, diplegic “B children were more likely to have suffered respiratory disease, necrotising enterocolitis and fits in the neonatal period, than children without cerebral palsy. Among preterm infants, diplegia differed from hemiplegia mainly in a lack of significant association with recorded maternal characteristics and markers of intrapartum stress. Important determinants of diplegia were not identified, but the results suggest that infants born both immature and relatively immature for their gestational age have the highest risk of diplegia. Factors that influence the rate of fetal development may be implicated in the aetiology of diplegia in both preterm and fullterm infants.

Recent trends in cerebral palsy survival. Part II: individual survival prognosis

The aim of the study was to determine survival probabilities and life expectancies for individuals with cerebral palsy based on data collected over a 28‐year period in California.