Richard Michaelis

BILATERAL SPASTIC CEREBRAL PALSY‐A COMPARATIVE STUDY BETWEEN SOUTHWEST GERMANY AND WESTERN SWEDEN. II: EPIDEMIOLOGY

Epidemiological data of a collaborative study on children with bilateral spastic cerebral palsy (BSCP) 3 between south‐west Germany and western Sweden are reported. The study period covered the birth 5 years 1975 to 1986. Overall, the rate of BSCP increased during the birth year periods 1975‐77 and 1978‐80, but decreased thereafter. The rise was due to an increase of BSCP in low‐birthweight (LBW) children, especially very LBW (VLBW) children. Mortality rates in LBW, and particularly VLBW, children decreased significantly during the whole study period in both countries. The BSCP rate, after the initial increase, showed a decrease during the second half of the study period in LBW children. Results are interpreted in favour of a predominantly prenatal aetiology in normal birthweight and of a predominantly peri‐ and neonatal aetiology in LBW children.

BILATERAL SPASTIC CEREBRAL PALSY—A COMPARATIVE STUDY BETWEEN SOUTHWEST GERMANY AND WESTERN SWEDEN. I: CLINICAL PATTERNS AND DISABILITIES

The results of a collaborative study of bilateral spastic cerebral palsy (BSCP) between south‐west Germany and western Sweden are reported, comprising 249 children in south‐west Germany and 264 children in western Sweden. A severe gross motor disability was present in 65 per cent of the German and 62 per cent of the Swedish children; learning difficulties or mental retardation in 73 and 76 per cent; active epilepsy in 28 and 26 per cent; and severe visual disability in 20 and 19 per cent, respectively. Severe disabilities were especially pronounced in children with normal birthweights, in whom the most severe subtypes of BSCP were also found. Leg‐dominated BSCP was the predominant subtype among low‐birthweight children, but also occurred in more than half of the normal‐birthweight children. The authors conclude that the two series were comparable, and that reliable results between countries can be obtained if clear‐cut classifications and definitions are used.

Congenital hemiparesis and periventricular leukomalacia : pathogenetic aspects on magnetic resonance imaging

The authors report on the clinical examination and magnetic resonance imaging (MRI) of 41 children (29 term and 12 preterm) whose diagnosis of congenïtal hemiparesis was confirmed after the first year of life. Periventricular leukomalacia was the most predominant MRI finding (found in 15 term and eight preterm infants). The uniform pattern of lesions observed through MRI (without clear correlation with gestational age) suggests a common aetiopathogenesis in this subgroup. Comparison of these MR images with the periventricular leukomalacia observed in preterm children with spastic diplegia supports the thesis that ischaemia occurring between the 28th and 35th weeks of gestation could be the main cause.

The Rett syndrome: Magnetic resonance imaging and clinical findings in four girls

The clinical and laboratory findings in 4 girls with the Rett syndrome are presented. The MRI results at different disease stages with detailed descriptions of the techniques applied-including quantification of T1 and T2 relaxation times in the brain-are reported. There were no pathological signal intensities in T1- or T2-weighted images. Thus, MRI does not provide any significant additional help in the diagnosis of the Rett syndrome. However, it does indicate that disturbances of myelinization or the brain water content are not probable etiologies in this syndrome.

The Concept of Optimality in Evaluating Hazards of Prenatal, Perinatal and Postnatal Complications

Prechtls concept of optimality (1968) was used to study distributions of “reduced optimal conditions” in newborns from different regions, in newborns with prenatal, perinatal, and postnatal complications and in newborns with risk factors in maternal history. The concept was also applied to assess the impact of perinatal and postnatal asphyxia in children suffering from chromosomal aberrations and/or mental retardation, from congenital spastic hemiparesis, and from the fetal alcohol syndrome. No major effects of perinatal and/or postnatal asphyxia on the conditions of these infants could be found. These results suggest that asphyxia occurring in an individual history should not be accepted as the only event or complication causing brain damage in children with developmental disorders.