Cinco años de seguimiento de tratamiento no invasivo para lesiones auto-infligidas en un niño con parálisis cerebral / Five year follow-up of non-invasive treatment for self-inflicted oral trauma in a child with cerebral palsy

ABSTRACT Introduction: Cerebral palsy involves loss or impairment of motor function attributed to non-progressive disturbances occurring in the developing fetal or infant brain. Self-inflicted oral trauma is a recurrent parafunctional habit in individuals with cerebral palsy. Objective: Describe two treatment modes for self-inflicted oral trauma in a 6-year-old male patient with cerebral palsy over a 5-year follow-up period. Case presentation: The child had been having pain due to injuries to the mouth floor and lingual frenum regions. Initially, low-level laser therapy was applied to accelerate the healing process of the wounds. Five years later, the child started to present worse oral injuries and placement of a fixed oral appliance was proposed. Intraoral examination showed that the wounds had healed completely in response to the oral appliance. Conclusions: Different therapies may be useful to control the recurrence of self-inflicted oral injuries(AU)

RESUMEN Introducción: La parálisis cerebral provoca una pérdida o deterioro de la función motora atribuida a trastornos no progresivos del desarrollo cerebral fetal o infantil. La lesión autoinfligida es un hábito parafuncional recurrente en personas con parálisis cerebral. Objetivo: Describir dos modalidades de tratamiento para las lesiones autoinfligidas en un niño de 6 años de edad con parálisis cerebral durante un periodo de seguimiento de 5 años. Presentación del caso: El niño presentaba dolor debido a lesiones en la región del suelo de la boca y el frenillo lingual. Inicialmente se aplicó terapia con láser de baja intensidad para acelerar el proceso de cicatrización de las heridas. Cinco años más tarde el niño empezó a presentar lesiones bucales más severas, por lo que se propuso la colocación de un dispositivo oral fijo. El examen intraoral mostró que las lesiones habían cicatrizado completamente en respuesta al dispositivo oral instalado. Conclusiones: Diferentes terapias pueden ser útiles para controlar la recurrencia de las lesiones orales autoinfligidas(AU)

Mecanismos de lesión cerebral en niños prematuros / Mechanisms of brain injury of the premature baby

Los nacimientos prematuros son uno de los principales indicadores de salud de un país. Están asociados a una alta mortalidad e importante morbilidad en niños con parálisis cerebral y otros trastornos del neurodesarrollo, incluyendo problemas cognitivos y del aprendizaje. Los principales tipos de lesión encefálica en los recién nacidos prematuros son: a) las lesiones de la sustancia blanca, generalmente asociadas a alteraciones neuronales y axonales en la corteza cerebral y otras zonas de sustancia gris; b) hemorragias intracraneanas que incluyen las de la matriz germinal, intraventriculares e intraparenquimatosas y c) del cerebelo. Las lesiones de sustancia blanca incluyen la leucomalacia periventricular quística, no quística (con focos de necrosis microscópicos) y lesiones difusas de sustancia blanca, no necróticas. Estas lesiones tienen múltiples factores etiológicos. Las características anatómicas y fisiológicas de las estructuras vasculares periventriculares predisponen a la sustancia blanca a ser muy vulnerable a las situaciones de isquemia cerebral y, en interacción con factores infecciosos/inflamatorios, activan a las microglías generando estrés oxidativo (por liberación de radicales libres del oxígeno y del nitrógeno), liberación de citoquinas proinflamatorias, liberación de glutamato, fallo energético y alteración de la integridad vascular. Todo lo anteriormente mencionado genera una particular vulnerabilidad de los pre-oligodendrocitos que termina alterando la mielinización. La hipoxia-isquemia también puede producir necrosis neuronal selectiva en diferentes regiones encefálicas. La matriz germinal es un área altamente vascularizada en la región subependimaria periventricular con una estructura capilar muy frágil que la predispone a las hemorragias.

Preterm birth is one of the main country health indicators. It is associated with high mortality and significant morbidity in preterm newborns with cerebral palsy and potential long-term neurodevelopmental disabilities like cognitive and learning problems. The main lesions could be: a) white matter injuries, generally associated with cortical and other regions of grey matter neuronal-axonal disturbances; b) intracranial hemorrhage that includes germinal matrix, intraventricular and parenchymal, c) cerebellum injuries. The white matter lesions include cystic and non-cystic (with microscopic focal necrosis) periventricular leukomalacia and non-necrotic diffuse white matter injury. Multiple etiologic factors are associated with these injuries. Anatomical and physiological characteristics of periventricular vascular structures predispose white matter to cerebral ischemia and, interacting with infection/inflammation factors, activate microglia, generating oxidative stress (mediated by free oxygen and nitrogen radicals), pro-inflammatory cytokine and glutamate toxicity, energetic failure and vascular integrity disturbances. All these factors lead to a particular vulnerability of pre-oligodendrocytes that will affect myelination. Hypoxia-ischemia also may produce selective neuronal necrosis in different cerebral regions. Germinal matrix is a highly vascularized zone beneath ependymal or periventricular region that constitutes a capillary bed with a particular structural fragility that predispose it to hemorrhage.

Prevalence of early spinal deformity in children with gmfcs v cerebral palsy / Prevalência da deformidade espinhal precoce em crianças com paralisia cerebral gmfcs v / Prevalencia de deformidad espinal temprana en niños con parálisis cerebral gmfcs v

ABSTRACT Objective: Spastic cerebral palsy (sCP) is a cause of early onset scoliosis, although there are no data on its prevalence. Our objective was to determine the prevalence of early onset neuromuscular spinal deformities (SD) in severely compromised children with sCP. Methods: Cross-sectional quantitative, observational, exploratory, and descriptive study. Review of clinical records. Inclusion criteria: age 2 to 5 years, sCP, level V of the GMFCS, residents in our province. X-ray blind reading by 2 observers. The Student t test was used for parametric data and the chi-square test for non-parametric data. Level of statistical significance: p < 0.05. Results: Thirty-eight cases of 158 registered were included. Average age: 3 years 7 months (2 years - 5 years 2 months). Sex: 21 male/17 female. The predominant etiologies were perinatal: 21 (55.3%), and the prevalent nutritional status was eutrophic: 28 cases (73.7%). SD was very frequent: 32 patients (84.2%) without statistical differences between sexes; there were 20 kyphoscoliosis, 1 lordoscoliosis, 6 scoliosis, 5 hyperkyphosis. Mean angular values: 23.9° (10°- 50°) for the frontal plane deformities and 58° (9°- 92º) for the sagittal deformities. Seventeen patients (44.7%) had average pelvic obliquity of 15° (2°- 30°) without differences in patients with and without SD. There was no association between SD and etiology, digestive disorders, seizures, nutritional status, hip excentration, or limb deformities. Conclusions: The prevalence of SD in children up to 5 years old with severe sCP is high: 84.2% (32/38 cases). The orthopedic profile is children with sCP of any etiology at GMFCS level V, with multiple disabilities and independently of associated limb deformities. Level of evidence I; Diagnostic Studies - Investigating a Diagnostic Test: Testing of previously developed diagnostic criteria on consecutive patients (with universally applied reference "gold" standard).

RESUMO Objetivo: A Paralisia Cerebral espástica (PCe) é uma das causa de escoliose precoce,, embora não existam dados da prevalência. Nosso objetivo foi determinar a prevalência das deformidades espinhais (DE) neuromusculares de início precoce em crianças PCe severamente comprometidas. Métodos: Estudo quantitativo transversal, exploratório e descritivo, observacional. Revisão de prontuários. Critérios de inclusão: idade 2 a 5 anos, PCe, nível V do GMFCS, domiciliado na nossa província. Leitura cega das radiografias por 2 observadores. Foram utilizados o teste T de Student para dados paramétricos e, para o não-paramétricos, o chi-quadrado. Nível de significância estatística: p < 0.05. Resultados: 38 casos de 158 achados foram incluídos. Idade média: 3 anos 7 meses (2 anos - 5 anos 2 meses). Sexo: 21 homens/17 mulheres. Predominaram as causas perinatais: 21 (55,3%), e o estado nutricional prevalecente foi o eutrofico: 28 casos (73,7%). A DN foi muito frequente: 32 casos (84,2%), e nenhuma diferença estatística entre os sexos; houve 20 cifoescoliose, 6 escolioses, 1 lordoescoliose, 5 hipercifose. Valores médios angulares: 23.9° (10°- 50°) para as deformidades frontais e 58° (9°- 92º) para as sagitais. Dezessete casos (44,7%) apresentavam obliquidade pélvica média de 15° (2°-30°); não há diferenças em pacientes com e sem DE. Não havia nenhuma associação entre a DE e etiologia, distúrbios digestivos, convulsões, estado nutricional e luxação dos quadris ou deformidades dos membros. Conclusões: A prevalência de DE em crianças de até 5 anos com PCE severa é alta: 84.2% (32/38 casos). O perfil ortopédico são todas crianças GMFCS V, de qualquer etiologia, com diferentes deficiências e independentemente das deformidades dos membros associados. Nível de evidência I; Estudos diagnósticos - Investigação de um exame para diagnóstico. Teste de critérios diagnósticos desenvolvidos anteriormente em pacientes consecutivos (com padrão de referência "ouro" aplicado).

RESUMEN Objetivo: Evaluar la influencia de la técnica MIS-TLIF sobre los parámetros espinopélvicos de pacientes sometidos a artrodesis lumbar. Objetivo: La parálisis cerebral espástica (PCe) es una causa de escoliosis de comienzo temprano, aunque no existen datos de su prevalencia. Nuestro objetivo fue determinar la prevalencia de las deformidades espinales (DE) neuromusculares de comienzo temprano en niños con PCe severamente comprometidos. Métodos: Estudio transversal cuantitativo, observacional, exploratorio y descriptivo. Revisión de historias clínicas. Criterios de inclusión: edad 2 a 5 años, PCe, nivel V del GMFCS, domiciliados en nuestra provincia. Lectura a ciegas de radiografías por 2 observadores. Se usó el test t de Student para datos paramétricos y el chi-cuadrado para los no paramétricos. Nivel de significación estadística: p < 0,05. Resultados: Treinta y ochos casos de 158 registrados fueron incluidos. Edad promedio: 3 años 7 meses (2 años - 5 años 2 meses). Sexo: 21 varones/17 mujeres. Las etiologías predominantes fueron perinatales: 21 (55,3%), y el estado nutricional prevalente el eutrófico: 28 casos (73,7%). La DE fue muy frecuente: 32 pacientes (84,2%), sin diferencias estadísticas entre sexos; hubo 20 cifoescoliosis, 1 lordoescoliosis, 6 escoliosis, 5 hipercifosis. Valores angulares medios: 23,9° (10°- 50°) para las deformidades frontales y 58° (9° - 92°) para las sagitales. Diecisiete pacientes (44,7%) presentaron oblicuidad pélvica promedio de 15° (2°- 30°), sin diferencias en pacientes con y sin DE. No hubo asociación entre DE y etiología, trastornos digestivos, convulsiones, estado nutricional, excentración de caderas ni deformidades de miembros. Conclusiones: La prevalencia de DE en niños de hasta 5 años con PCe severa es alta: 84,2% (32/38 casos). El perfil ortopédico es de niños con PCe V del GMFCS de cualquier etiología, con diversas discapacidades e independientemente de las deformidades asociadas de los miembros. Nivel de Evidencia I; Estudios de diagnósticos - Investigación de un examen para diagnóstico. Pruebas de criterios de diagnósticos desarrollados anteriormente en pacientes consecutivos (con estándar de referencia "oro" aplicado).

Profil épidémiologique et clinique des paralysies cérébrales à Abidjan en Côte d'Ivoire

Introduction : Dans bien des pays en développement, la situation des maladies neuropédiatriques et notamment des paralysies cérébrales, n'est pas clairement documentée. Le but de cette étude était de décrire les caractéristiques épidémiologiques et cliniques des paralysies cérébrales à Abidjan afin de contribuer à une meilleure connaissance de l'affection. Patients et méthodes : Il s'est agi d'une étude rétrospective, descriptive, sur une période de quatre ans, de 2013 à 2016, dans l'unité de consultation de Neurologie du Centre Hospitalier Universitaire de Yopougon à Abidjan. Elle a concerné 136 enfants, âgés de 1 mois à 15 ans, reçus et suivis en consultation de Neuropédiatrie pour paralysie cérébrale. La paralysie cérébrale a été retenue sur la présence de troubles du développement psychomoteur constatés avant l'âge de 2 ans, associés à des lésions cérébrales à l'imagerie encéphalique. Résultats : La paralysie cérébrale représentait 38,5% des pathologies neuropédiatriques. L'âge moyen était de 33,3 mois avec une prédominance masculine. Un petit poids de naissance était observé chez 23,5% des enfants et 5,9% étaient nés prématurés. Les formes spastiques étaient les plus rencontrées (83,1%). L'épilepsie et les troubles du langage étaient souvent associés à la paralysie cérébrale (61% et 22,8%). Les causes périnatales étaient plus fréquentes (47,1%) et la souffrance cérébrale était l'étiologie périnatale majoritaire (76,6%). Conclusion : La paralysie cérébrale est l'une des maladies neuropédiatriques les plus fréquentes à Abidjan. Les causes sont essentiellement périnatales, notamment l'asphyxie dont la prévention pourrait réduire la survenue de nouveaux cas

Twin-twin transfusion syndrome: neurodevelopment of infants treated with laser surgery / Síndrome de transfusão feto-fetal: neurodesenvolvimento de lactentes tratados com cirurgia a laser

ABSTRACT Objective To assess the neurodevelopmental functions of survivors of twin-twin transfusion syndrome (TTTS) treated by fetoscopic laser coagulation (FLC), during the first year of life, comparing them to a control group; and to verify the influence of specific variables on neurodevelopment. Method This was a prospective, longitudinal study. The sample comprised 33 monochorionic diamniotic twins who underwent FLC for treatment of TTTS and 22 full-term infants of single-fetus pregnancies. Bayley Scales of Infant and Toddler Development Screening Test were used for evaluation. Prenatal, perinatal and postnatal information were obtained. Results There was an increased frequency of infants in the TTTS group with inadequate performance compared to the control group. The identified variables (fetal donor, low economic income and cardiorespiratory disease) negatively impacted expressive communication and fine motor skills. Conclusion Although through follow-up is recommended in all TTTS survivors, particular attention is required for the high-risk group as defined in this study.

RESUMO Objetivo Avaliar o desenvolvimento neurológico de sobreviventes da sindrome de transfusão feto-fetal (STFF) submetidos à coagulação a laser por fetoscopia (CLF), durante o primeiro ano de vida, comparando estes ao grupo controle; e verificar a influência de variáveis específicas no desenvolvimento. Método Tratou-se de estudo prospectivo, longitudinal. A amostra foi composta por 33 gêmeos diamnióticos monocoriônicos submetidos à CLF para tratamento da STFF e 22 lactentes a termo de gestação única. Bayley Scales of Infant and Toddler Development Screening Test foram utilizadas para avaliação. Informações pré-natal, perinatal e pós-natal foram coletadas. Resultados Houve maior número de lactentes com desempenho inadequado no grupo STFF do que no controle. As variáveis identificadas (feto doador, baixa renda econômica e doença cárdio-respiratória) influenciaram negativamente a comunicação expressiva e as habilidades motoras finas. Conclusão Embora o acompanhamento seja recomendado para todos lactentes com STFF, especial atenção deve ser dada àqueles que apresentam fatores de risco.

Estudo comparativo entre enzimas utilizadas no metabolismo de medicamentos em pacientes com paralisia cerebral e anestésicos odontológicos / Comparative study of the enzymes involved in drug metabolism in patients with cerebral palsy and dental anesthetics

A administração conjunta de dois ou mais fármacos é uma situação comum na prática clínica e pode criar efeitos terapêuticos indesejados. Podem surgir interações como alteração na biotransformação através de enzimas microssomais criando metabólitos tóxicos. O objetivo deste estudo foi comparar enzimas microssomais utilizadas no metabolismo de medicamentos de uso contínuo em pacientes com PC e anestésicos locais. Esta pesquisa é um estudo quantitativo com abordagem descritiva, realizado através de coleta de dados de prontuários de pacientes em tratamento no Lar Escola São Francisco (LESF) em parceria com a Universidade Cruzeiro do Sul (UNICSUL). Foram avaliados prontuários de pacientes com paralisia cerebral independente do sexo, idade e tipo de paralisia cerebral. A amostra foi constituída de 348 prontuários examinados, sendo 147 (42,2,%) do sexo feminino e 201 (57,8%) pacientes do sexo masculino. A idade variou de 5 a 16 anos (média = 9,6 DP±5,4). Do total da amostra, 79% necessitavam de tratamento odontológico, com anestesia local. Quanto ao uso de medicamentos, 170 (49%) da amostra faziam uso de medicamentos neurolépticos. Concluiu-se que o cuidado na co-administração de lidocaína, anestésico local empregado na Odontologia e drogas anticonvulsivantes, diminuirá os riscos de hepatotoxocidade, uma vez que ambos utilizam a mesma enzima microssomal. Assim, sugere-se o uso de sais anestésicos que utilizem outro citocromo como P450 CYP1A2, dentre eles a mepivacaína, articaína e bupvacaína...

Co-administration of two or more drugs is a common situation in clinical practice that can promote undesirable therapeutic effects. Interactions may occur, such as changes in biotransformation in which microsomal enzymes produce toxic metabolites. This study compared microsomal enzymes used in the metabolism of drugs in continuous use in patients with CP and local anesthetics. The research is a quantitative study with a descriptive approach conducted by collecting data from medical records of patients at the Lar Escola São Francisco (LESF) in partnership with the Cruzeiro do Sul University (UNICSUL). Records of patients with cerebral palsy were evaluated regardless of sex, age, and type of cerebral palsy. The sample consisted of 348 records, of which 201 (57.8%) were males. Patient age ranged from 5 to 16 years-old (mean = 9.6, SD ±5.4). Of the total sample, 79% required dental treatment under local anesthesia. Regarding drug use, 170 (49%) of the sample were being administered neuroleptic drugs. It was concluded that the caution in lidocaine co-administration, a local anesthetic applied in Dentistry, and anticonvulsants, will decrease the risks of hepatotoxicity, seeing that both use the same microsomal enzyme. It is suggested the use of anesthetics that utilized other cytochrome as P450 CYP1A2, among them mepivacaine, articaine, and bupivacaine...

Profil epidemiologique et clinique des infirmites motrices cerebrales au centre hospitalier universitaire de Bobo-Dioulasso (Burkina Faso)

Introduction : L'infirmite motrice cerebrale est la premiere cause du handicap moteur chez l'enfant. Objectif : Decrire les profils epidemiologique et clinique de l'infirmite motrice cerebrale chez les enfants vus en consultation au Centre Hospitalier Universitaire de Bobo-Dioulasso. Materie( et methode : Il s'est agi d'une etude transversale descriptive a collecte prospective conduite dans le service de medecine physique du Centre Hospitalier Universitaire de Bobo-Dioulasso sur une periode d'un an; allant du 1er Juillet 2012 au 30 Juin 2013. Notre population d'etude se composait de tous les enfants ages de 0 a 15 ans; recus en consultation durant la periode de l'etude et presentant un tableau d'infirmite motrice cerebrale. Resu(tats : L'analyse a concerne 174 patients dont 106 garcons et 68 filles. L'age moyen a l'inclusion etait de 32;79 mois. Les facteurs etiologiques etaient domines par la prematurite (34;5%) et l'anoxie cerebrale (25;86%).Les principaux tableaux cliniques etaient la diplegie (50%);la tetraplegie (19;54%);l'hemiplegie (14;37%); la monoplegie (10;34%) et la triplegie (5;75%). Les signes associes les plus frequents etaient les crises comitiales (15%); les troubles oculaires (12;6%); les difficultes auditives (10%). Conc(us ion : De par sa frequence et son potentiel incapacitant; l'infirmite motrice cerebrale constitue un problememajeur de sante publique au Burkina Faso.Sa prise en charge en milieu africainest lourdement grevee par l'automedication et la traditherapie

Parálisis cerebral / Cerebral palsy

Parálisis cerebral es un término que define una serie de trastornos motores de origen cerebral, no progresivos que constituyen la causa más frecuente de discapacidad motora en la infancia. No obstante ser una denominación “antigua”, no ha perdido vigencia ni valor si se le utiliza como término sindromático que supone un estudio etiológico acucioso y una conducta terapéutica que incluye múltiples áreas de intervención y de especialistas coordinados a fin de lograr la máxima funcionalidad posible del niño desde el punto de vista motor, intelectual, de comunicación y la máxima integración social, teniendo en cuenta que el grado de desarrollo de una sociedad se mide por el cuidado que otorga a sus minusválidos.

Cerebral palsy (CP) results from a static brain lesion during pregnancy or early life and remains the most common cause of physical disability in children. Despite being an "old" name, it has not lost its usefulness if used as syndromic term that implies a thorough etiologic study and a therapeutic approach that includes multiple areas of intervention and coordinated work of specialists in order to achieve the maximum possible functionality, optimizing motor, intellectual, communication and social integration, considering that the degree of development of a society is measured by the care given to its disabled people.

Técnica calcáneo-stop con elongación de tendones peroneos en el pie plano de pacientes con parálisis cerebral infantil / Technique calcaneo-stop par élongation des tendons péroniers du pied plat chez les patients atteints de paralyse cérébrale infantile / Calcaneal-stop technique with lengthening of the peroneal tendons in the flat foot of infant cerebral palsy patients

Introducción: los pies planos del niño constituyen un motivo de gran preocupación por los padres, probablemente el más frecuente de consulta en ortopedia infantil. Objetivos: evaluar la técnica calcáneo-stop con elongación de los tendones peroneos en el tratamientodel pie plano paralítico de paciente con parálisis cerebral infantil. Métodos: se realizó un estudio de intervención, prospectivo y autopareado, que incluyó nueve pacientes con edad entre 4-14 años intervenidos quirúrgicamente, en el periodo comprendido entre el 1 de septiembre de 2011 y 31 de agosto de 2012, en el Complejo Científico Ortopédico Internacional Frank País. Resultados: predominaron los pacientes del sexo masculino (66,6 por ciento), entre 4-9 años (55,6 por ciento), color de la piel blanca (100,0 por ciento) y con ambos miembros afectados (100 por ciento). Todos los pacientes se caracterizaron por compromiso funcional, grado de afección III o IV del plantigrama y parámetros radiográficos de severidad. En el posoperatorio se obtuvo una reducción significativa del grado de afección (de 100 por ciento con grado III o IV a 66,7 por ciento con plantígrada normal y ninguno con grado III o IV; p< 0,001) y mejoría de los parámetros radiográficos (ángulo de Moreau-Costa-Bartani [MCB]: 146 ± 11(0) vs 129 ± 7(0); p< 0,001 y ángulo astrágalo-calcáneo: 33 ± 4(0) vs 24±4(0); p< 0,001). Las complicaciones fueron todas menores y en una pequeña proporción de los pacientes (n= 3; 33,4 por ciento). El grado de satisfacción de los padres y el buen resultado quirúrgico de la técnica fueron elevados. Conclusiones: la técnica calcáneo-stop con elongación de los tendones peroneos es una buena opción terapéutica en pacientes con parálisis cerebral infantil y pie plano, por sus escasas complicaciones y buenos resultados quirúrgicos(AU)

Introduction: flat foot of the child is a great concern for the parents and the most frequent reason to go to the pediatric orthopedist's. Objectives: to evaluate the calcaneal-stop technique with lengthening of the peroneal tendons in treating the flat foot of infant cerebral palsy patient. Methods: a prospective, self-paired and intervention study was conducted in nine patients aged 4 to 14 years, who were operated on in the period of September 1st 2011 through August 31st 2012 in Frank Pais international scientific orthopedic complex center. Results: males (66.6 percent), 4-9 years-olds (55.6 percent), Caucasians (100 percent) and both limbs affected (100 percent) prevailed. All the patients presented functional compromise, degree III or IV in the plantigram and radiographic indicators for severity. In the postoperative period, there was significant reduction of the degree of disease (from 100 percent with degree III or IV to 66.7 percent with normal plantigrade and none of them with grade III or IV p< 0.001) and better radiographic indicators (Moreau-Costa-Bartani angle (MCB): 146 ± 110 vs 129 ± 70; p< 0.001) and astragalus-calcaneal angle: 33 ± 40 vs 24 ± 40; p< 0,001). Minor complications were observed in a small portion of patients (n= 3 for 33.4 percent). The level of satisfaction of the parents was high and the surgical result of this procedure was very good. Conclusions: the calcaneal-stop technique with lengthening of the peroneal tendons is a good therapeutic choice for patients with infant cerebral palsy and flat foot because of minor complications and good surgical results(AU)

Introduction: le pied plat chez l'enfant constitue une préoccupation pour les parents, et c'est probablement l'affection la plus fréquemment traitée aux services d'orthopédie infantile. Objectifs: le but de cette étude est d'évaluer la technique calcaneo-stop par élongation des tendons péroniers dans le traitement du pied plat du patient atteint de paralyse cérébrale infantile. Méthodes: une étude interventionnelle, prospective et auto-comparée de neuf patients âgés de 4 à 14 ans, traités chirurgicalement entre le 1e septembre 2011 et le 31 août 2012 au Complexe scientifique international d'orthopédie Frank Pais, a été réalisée. Résultats: on a trouvé que les patients du sexe masculin (66.6 pourcent), blancs (100.0 pourcent), âgés de 4-9 ans (55.6 pourcent) et avec une affection bilatérale (100.0 pourcent) étaient en prédominance. Tous les patients ont montré un trouble du fonctionnement, grade III ou IV en plantigrade, et des paramètres radiographiques de sévérité. Dans l'étape postopératoire, il y a eu une réduction significative du grade de l'affection (100 de grade III ou IV à 66.7 pourcent en plantigrade normale, et 0 pourcent de grade III ou IV ; (p< 0.001), et une amélioration des paramètres radiographiques (angle de Moreau-Costa-Bartani (MCB): 146 ± 11° vs. 129 ± 7°; p< 0.001, et angle astragalo-calcanéen: 33 ± 4° vs. 24 ± 4° ; p< 0.001). Le taux de complications a été faible, et la proportion de patients affectés insignifiante (n= 3; 33.4 pourcent). Le degré de satisfaction des parents et les bons résultats de la technique chirurgicale ont été élevés. Conclusions: dû à son faible taux de complications et à ses très bons résultats chirurgicaux, la technique calcaneo-stop par élongation des tendons péroniers s'érige comme traitement de choix pour les patients atteints de paralyse cérébrale infantile et de pied plat(AU)

Encefalopatía por Kernicterus. serie clínica / Kernicterus (bilirubin encephalopathy): case reports

Introducción: La ictericia es común en los recién nacidos (RN). Niveles de bilirrubina a partir de 20 mg/dL (en RN de término) pueden causar parálisis cerebral coreoatetósica, hipoacusia sensorioneural, trastornos de la mirada y displasia del esmalte dental, cuadro clínico conocido como kernicterus. Objetivo: Describir 5 casos de kernicterus controlados en una Unidad de Neurología, entre los años 2002-2012. Casos clínicos: Se presentan 5 niños con edades gestacionales entre 35 y 39 semanas, con peso de nacimiento rango 2.580 y 4.250 g y niveles de bilirrubina entre 24 y 47 mg/dL. Dos RN estaban en su domicilio cuando iniciaron la encefalopatía aguda. Todos se trataron con fototerapia y en 3 casos se realizó además exanguineotransfusión. La edad del diagnóstico de kernicterus fluctuó entre los 12 días y 10 años (3 pacientes se diagnosticaron en etapa neonatal) con una resonancia magnética que demostró impregnación de ganglios basales. Todos evolucionaron con trastornos del movimiento de severidad variable. En 3 pacientes se diagnosticó hipoacusia sensorioneural y en dos hubo trastornos de la mirada. Los test psicométricos evaluaron retraso cognitivo en 3 pacientes y desarrollo normal en los restantes. Conclusión: El kernicterus en una enfermedad devastadora que aún está presente en la realidad nacional. Es una causa de parálisis cerebral prevenible, por lo cual es necesario educar a los padres, población y equipo de salud para la detección precoz y tratamiento oportuno de la hiperbilirrubinemia neonatal.

Introduction: Jaundice is common in newborn babies (NB). Bilirubin levels of 20 mg/dL or higher may cause choreoathetoid cerebral palsy, sensorineural hearing loss, eye disorders and enamel dysplasia in term infants; clinical picture compatible with kernicterus. Objective: To describe five cases of kernicterus treated at a Neurology Unit between 2002 and 2012. Case reports: Five cases of babies with gestational ages between 35 and 39 weeks, birth-weight ranging from 2580 to 4250 grams and bilirubin levels between 24 and 47 mg/dL are presented. Two infants were at home when acute encephalopathy developed, all were treated with phototherapy and 3 of them underwent exchange transfusion. The age of diagnosis of kernicterus was between 12 days to 10 years; three patients were diagnosed in neonatal period through MRI that revealed basal ganglia impregnation. All patients evolved presenting movement disorders of varying severity. Three of them were diagnosed with sensorineural hearing impairments and two presented eye disorders. Psychometric tests showed cognitive delay in three patients and normal development in the remaining children. Conclusion: Kernicterus in a devastating disease present in the national reality. It is a preventable cause of cerebral palsy; therefore, it is necessary to educate parents, population and health care professionals about neonatal hyperbilirubinemia early detection and treatment.

Parálisis cerebral infantil / Cerebral palsy

La parálisis cerebral infantil (PCI) es un síndrome cuyo origen está localizado en el Sistema Nervioso Central (SNC), primera neurona o neurona motora superior; eso implica que casi todos los niños con PCI presentan, además de los defectos de la postura y movimiento,otros trastornos asociados. Es la causa más frecuente de discapacidad motriz en la edad pediátrica. Han transcurrido casi 2 siglos de estudios sobre PCI. La frecuencia de PCI en los países desarrollados afecta a 1,2 – 2,5 de cada 1.000 Recién nacidos vivos (RNV), enVenezuela no se cuenta con estadísticas. El peso y la edad de gestación son los factores más relacionados con la presencia de PCI. Es deplorable la carencia de estudios neuropatológicos relevantes y confiables. Los mecanismos íntimos de su etiopatogenia sondesconocidos. La clasificación más útil es la clínica. Este síndrome debe ser sospechado lo más temprano posible (antes de 18 meses). Su diagnóstico es clínico (historia clínica y exploración), intentando siempre buscar su origen y hacer un seguimiento neuroevolutivohasta los 7 años de vida. Descartar enfermedades neurodegenerativas y metabólicas, igual que enfermedades neuromusculares (neurona motora inferior). El tratamiento debe ser integral, multi-interdisciplinario planificado y coordinado, teniendo como objetivo mejorar la calidad de vida de estos niños. Prevenir embarazos precoces, consanguinidad, incumplimiento del control prenatal y desnutrición materna. En la actualidad más del 90% de los niños con PCI sobreviven hasta la edad adulta.

The ICP (infant cerebral palsy) is a syndrome whose origin is located in the Central Nervous System (CNS), first neuron or upper motor neuron, that means that almost all children with ICP also exhibit defects of posture, movement and other associated disorders. It is the most common cause of physical disability in children. It has been nearly two centuries of studies on ICP. The frequency of ICP in developed countries affecting 1.2 - 2.5 in 1000 live births; in Venezuela we do not have statistics. The weight and gestational age are the more common factors related to the presence of ICP, is deplorable the lack of relevant and reliable neuropathological studies. The precise mechanisms underlying its pathogenesis are unknown. The most useful classification is the clinic. This syndrome should be suspected asearly as possible (before 18 months). The diagnosis is clinical (clinical history and examination), always trying to find its origin and a neurodevelopmental tracing up to 7 years. Dismiss neurodegenerative and metabolic diseases, as well as neuromuscular diseases (lower motor neuron). The treatment must be integral, planned, coordinated, multi and interdisciplinary. The objective must be to improve thequality of life of these children, preventing early pregnancy, consanguinity, breach of prenatal control and maternal malnutrition. Nowdays over 90% of children with ICP survive into adulthood.

Low Apgar scores at 5 minutes in a low risk population: maternal and obstetrical factors and postnatal outcome / Baixos índices de Apgar no quinto minuto de vida em população de baixo risco: fatores maternos e obstétricos e resultados pós-natais

OBJECTIVE: To evaluate the association between Apgar scores of less than seven at five minutes (AS5min < 7) and antenatal factors and postnatal outcomes. METHODS: A retrospective cohort and case-control study of 27,252 consecutive term newborns in a low risk obstetrical population between January 2003 and December 2010. Maternal and infant databases were reviewed from all cases with AS5min < 7 (n = 121; 0.4%) and 363 cases with AS5min > 7 at 5 minutes who were randomly selected by a computer program. The main outcomes were neonatal death, newborn respiratory distress, need for orotracheal intubation and neonatal intensive care unit (NICU), and hypoxic-ischemic-encephalopathy. RESULTS: After multiple regression analysis, repeated late decelerations on cardiotocography (OR: 2.4; 95% CI: 1.4-4.1) and prolonged second stage of labor (OR: 3.3; 95% CI: 1.3-8.3) were associated with AS5min < 7, as well as neonatal respiratory distress (OR: 3.0; 95% CI: 1.3-6.9), orotracheal intubation (OR: 2.5; 95% CI: 1.2-4.8), need for NICU (OR: 9.5; 95% CI: 6.7-16.8), and hypoxic-ischemic-encephalopathy (OR: 14.1; 95% CI: 3.6-54.7). No other antenatal factors were associated with AS5min < 7 (p > 0.05). CONCLUSION: Repeated late decelerations and prolonged second stage of labor in the low-risk population are predictors of AS5min < 7, a situation associated with increased risk of neonatal respiratory distress, need for mechanical ventilatory support and NICU, and hypoxic-ischemic-encephalopathy.

OBJETIVO: Avaliar a associação entre índice de Apgar menor que sete no 5º minuto, os fatores pré-natais e resultados pós-natais. MÉTODOS: Trata-se de estudo retrospectivo com 27.252 recém-nascidos em maternidade escola com população de baixo risco obstétrico, de janeiro de 2003 a dezembro de 2010. Prontuários de todos os casos com índice de Apgar < 7 no 5º minuto (n = 121; - 0,4%) e de 363 casos com Apgar > 7 no 5º minuto, escolhidos ao acaso, foram revisados. Os principais desfechos estudados foram: óbito neonatal, insuficiência respiratória neonatal, necessidade de intubação orotraqueal e de unidade terapia intensiva (UTI) neonatal e encefalopatia hipóxico-isquêmica. RESULTADOS: Após análise de regressão múltipla, desacelerações tardias (DIP II) (OR: 2,4; IC95%: 1,4-4,1) e período expulsivo prolongado (OR: 3,3; IC 95%: 1,3-8,3) se associaram com Apgar < 7 no 5º minuto; assim como com insuficiência respiratória ao nascimento (OR: 3,0; IC 95%: 1,3-6,9), intubação traqueal (OR: 2,5; IC 95%: 1,2-4,8), necessidade de UTI neonatal (OR: 9,5; IC 95%: 6,7-16,8) e encefalopatia hipóxico-isquêmica (OR: 14,1; IC 95%: 3,6-54,7). Nenhuma outra variável prénatal se associou com Apgar < 7 no 5º minuto (p < 0,05). CONCLUSÃO: DIP II e período expulsivo prolongado estão associados com Apgar < 7 no 5º minuto em população obstétrica de baixo risco; situação essa relacionada com maior risco de insuficiência respiratória no parto, necessidade de suporte ventilatório e encefalopatia hipóxico-isquêmica.

Factores antenatales de riesgo de parálisis cerebral / Prenatal risk factors of cerebral palsy

Se ha considerado que las causas antenatales constituyen la gran mayoría de las causas de parálisis cerebral (PC) en países industrializados. Realizar una actualización sobre los factores antenatales de riesgo de PC fue el objetivo de este trabajo. En la etiología de la PC se debe partir de la diferenciación entre factores de riesgo causales e indicadores tempranos de enfermedad. A su vez, existen causas conocidas, factores de riesgo y patrones causales de PC, estos últimos no bien conocidos aún. Dentro de las causas antenatales de PC se encuentran las infecciones, malformaciones, accidentes cerebro vasculares isquémicos, enfermedades genéticas y trastornos metabólicos. Muchos patrones causales de PC tienen un origen prenatal, sin embargo, no se debe sobrevalorar el papel de las causas antenatales, puesto que análisis actuales a partir de estudios neuroimaginológicos y epidemiológicos muestran que el momento causal antenatal está presente solo en aproximadamente un tercio de los casos con PC congénita. La determinación de factores de riesgo de PC constituye únicamente un acercamiento inicial en la creación y/o confirmación de hipótesis causales, y su utilidad es limitada cuando lo que se persigue es la prevención a nivel poblacional. Si bien han sido determinados múltiples factores de riesgo causales de PC, todavía queda un gran camino por recorrer en el estudio de su etiopatogenia

It has been considered that the prenatal causes are the main provoking cerebral palsy (CP) in industrial countries. The aim of present paper was to update the prenatal risk factors of CP. The etiology of this entity came from the differentiation among the causal and early indicators risk factors of disease. At the same time, there are known causes, risk factors and causal patterns of CP, these latter are even so not known. Included in prenatal causes of CP are the infections, malformations, ischemic strokes, genetic diseases and metabolic disorders. Many causal patterns of CP have as prenatal origin; however, we must not to overestimate the role of prenatal causes since the current analyses from neuro-imaging and epidemiological studies show that the prenatal causal moment is present in only a third of cases presenting with congenital CP. The determination of CP risk factors is solely a initial approach in creation and/or confirmation of causal hypotheses and its usefulness is limited when the aim is the prevention at population scale. Although many causal risk factors of CP have been determined, still there is a long way for covering in study of its pathogeny

Asociación entre factores perinatales y neonatales de riesgo y parálisis cerebral / Association between the perinatal and neonatal risk factors and cerebral palsy

Se presenta una actualización sobre los factores perinatales y neonatales de riesgo de parálisis cerebral congénita, cuyas causas perinatales no deben ser minimizadas, si se tienen en cuenta los hallazgos de los estudios imaginológicos recientes. De cualquier manera, la contribución relativa de las diferentes causas y factores de riesgo que intervienen en la ocurrencia de parálisis cerebral puede variar en dependencia de condiciones contextuales específicas, pues es ésta un síndrome de etiología múltiple

Present paper is an updating on the perinatal and neonatal risk factors related to the congenital cerebral palsy whose perinatal causes not must to be minimized, if we take into account the recent imaging studies' findings. Anyhow, the relative contribution of the different causes and risk factors involved in the occurrence of cerebral palsy may change depending on the specific contextual conditions, because it is a multiple etiology syndrome

Corioamnionitis histológica y morbimortalidad neonatal: aproximación al síndrome de respuesta inflamatoria fetal / Chorioamnionitis neonatal morbidity: approach to fetal inflammatory response syndrome

Antecedentes: El síndrome de respuesta inflamatoria fetal (SRIF) es una entidad relacionada con la presencia de inflamación intrauterina y suele asociarse a infección intraamniótica. Su consecuencia más grave es la lesión cerebral y posterior desarrollo de parálisis cerebral. Objetivo: Evaluar la relación entre el síndrome de respuesta inflamatoria fetal y el desarrollo de complicaciones neonatales. Método: Estudio descriptivo y retrospectivo, realizado en el Hospital Universitario La Paz de Madrid, buscando una aproximación al SRIF desde la corioamnionitis histológica/funiculitis. El grupo de estudio constituido por 35 gestaciones simples pretérmino recogidas durante el primer semestre de 2008 y en las que la anatomía patológica de la placenta y anexos ovulares demostró la presencia de una corioamnionitis histológica y/o funiculitis. Resultados: Siete casos (20 por ciento) presentaban clínica sospechosa de infección intraamniótica, si bien en 28 gestantes (80 por ciento) existían factores de riesgo asociados al síndrome de respuesta inflamatoria fetal. Mortalidad perinatal en el grupo estudiado fue de 11,4 por ciento (4 casos). Sólo en 2 pacientes (5,7 por ciento) se pudo relacionar la muerte con el SRIF. En 28 recién nacidos (80 por ciento) se encontró algún tipo de patología, siendo la misma inherente a dicho síndrome en 17 casos (48,6 por ciento), destacando sepsis neonatal (40 por ciento), leucomalacia periventricular (14,3 por ciento) y displasia broncopulmonar (5,7 por ciento). Conclusión: Se comprueba el alto riesgo neonatal del SRIF. El conocimiento de esta condición, abre una serie de controversias diagnósticas y terapéuticas que obliga a una reevaluación de los protocolos actuales de manejo de la amenaza de parto pretérmino y la rotura prematura de membranas de pretérmino.

Background: The fetal inflammatory response syndrome (FIRS) is an entity related to intrauterine inflammation which is commonly associated with intraamniotic infection. The most serious consequence is the neurologic damage and the subsequent development of cerebral palsy. Aims: To evaluate the relationship between the fetal inflammatory response syndrome and the development of neonatal complications. Method: Descriptive and retrospective study realized in "La Paz" University Hospital of Madrid, looking for an approximation to the FIRS from histologic chorioamnionitis/funisitis. Group of study constituted by 35 single preterm gestations collected during the first semester of 2008 and in which the pathologic anatomy study of the placenta and annexes showed the presence of histological corioamnionitis and / or funisitis. Results: Suspicious clinic was found in 7 cases (20 percent) but in 28 cases (80 percent) risk factors associated to FIRS were present. Perinatal mortality found was 11.4 percent (4 cases). Only in 2 cases (5.7 percent) the cause was relationated with FIRS. Pathology associated was found in 28 newborn (80 percent), being 17 cases (48.6 percent) pathology associated with the fetal inflammatory response syndrome, enhancing neonatal sepsis (40 percent), periventricular leukomalacia (14.3 percent), and bronchopulmonar dysplasia (5.7 percent). Conclusion: It is verified that FIRS enteals a high neonatal risk. The knowledge of this entity opens some diagnostic and therapeutic controversies. Current management protocols of preterm labor and preterm premature rupture of membranes should be revised.

Estrategia de intervención para la prevención de la parálisis cerebral en niños pretérminos en Matanzas / Intervention strategy to prevent brain paralysis in pre-term children in Matanzas

En la provincia de Matanzas ha aumentado la incidencia de nacimientos de niños con peso < 1 500 gramos , lo cual pudiera acompañarse de un aumento en la prevalencia de parálisis cerebral congénita en los próximos años. Nuestro objetivo fue desarrollar un plan de acción dirigido a la prevención y control de los principales factores de riesgo de Parálisis Cerebral congénita en niños pretérminos que nacen en la Provincia de Matanzas. Se propone una estrategia de intervención mediante el establecimiento de medidas concretas para la prevención y control de los principales factores de riesgo de Parálisis Cerebral congénita identificados en niños pretérminos nacidos en Matanzas: enfermedades maternas, amenaza de parto pretérmino, inducción del parto, depresión al nacer, sepsis, infección y ventilación mecánica neonatal. La ejecución de una intervención a nivel poblacional dirigida al control de los factores de riesgo de Parálisis Cerebral congénita en niños pretérminos debe tener un impacto positivo en el control de la frecuencia de aparición de esta entidad, pero el éxito de la misma requiere de la acción coordinada del médico, el sistema de salud y las instancias gubernamentales.

The incidence of children born with < 1 500 grams has increased at the province of Matanzas. It might be accompanied with an increase in the prevalence of congenital cerebral paralysis in few years. Our objective was developing a plan of actions addressed to prevent and control the main risk factors of congenital cerebral paralysis in preterm children born at the province of Matanzas. We propose an intervention strategy stating concrete measures to prevent and control the main risk facts of congenital cerebral paralysis identified in preterm children born in Matanzas: maternal diseases, preterm delivery menace, and delivery induction, depression at birth, sepsis, infection and neonatal mechanic ventilation. Putting into practice an intervention at the population level directed to control the risk facts of congenital cerebral paralysis in preterm children should have a positive impact in controlling the frequency of the entity´s emergency, but it's success requires the coordinated action of the doctor, the health system and the government instances.

Parto, encefalopatia neonatal e paralisia cerebral / Birth, neonatal encephalopathy and cerebral palsy

O conceito fortemente arraigado entre médicos e leigos de que o parto, em especial o trauma de parto, é uma causa frequente de paralisia cerebral na infância como consequência de encefalopatia neonatal, foi estabelecido em meados do século 19, e permaneceu incontestado até os dias atuais. O incremento exponencial das taxas de cesariana não se acompanhou de redução proporcional dos casos de paralisia cerebral na infância. Os autores fazem uma revisão da literatura sobre a patogênese da encefalopatia neonatal e paralisia cerebral e suas relações com o período intraparto.

The expert and no expert concept that birth, especially birth trauma, is a frequent cause of cerebral palsy as a consequence of neonatal encephalopathy, was established in the middle of the 19th century and remained unclallenged until nowadays. The exponential increase at cesarean section rates did not result in a significant decrease of children's cerebral palsy rates. The authors perform a revision of literature about neonatal encephalopathy and cerebral palsy and its relationships with intrapartum events.

Common handicap conditions in special school children of Karachi

To describe the proportion, to explore the causes leading to handicap and to assess the abilities of handicapped children. The design of our study is cross sectional analytical. The subjects were handicapped children of Imran Rehabilitation Center, DEWA School and Shaheed-e-millat School. The Inclusion criteria was children aged 5-15 years suffering from Cerebral Palsy, Mental Retardation, Visual Impairment and Hearing Impairment. The Exclusion criteria included those children whose mothers declined to give us the information and those children whose mothers couldn't make it to the handicap school. The duration of our research was 7 months from March to October 2009. Sample size was 108 children. Sampling technique was non-probability purposive sampling.Data collection procedure was Closed ended Questionnaire having some Open ended questions. We conducted a research that showed that the most prevalent condition was Cerebral Palsy in 38% [p=0.05] of the children. The major risk factor for cerebral palsy were Caesarean section in 41.46% [p=0.002] and delayed crying of the baby soon after birth in 51.06% [p=0.00] of the cases. The risk factor for visual impairment were lack of iron and folic acid supplements during pregnancy in 52.94% [p=0.00] and instrumental delivery in 50% [p=0.00] of the subjects. The risk factor for hearing impairment was drug exposure during pregnancy in 37.03% [p=0.00] of the cases. Our research showed that the most prevalent handicap condition was Cerebral Palsy. The major risk factors for cerebral palsy were found to be Caesarean section and delayed crying of the baby soon after birth. The risk factors for visual impairment were identified to be lack of iron and folic acid supplements during pregnancy and instrumental delivery. The risk factors for hearing impairment were found to be drug exposure during pregnancy

Efectos neurológicos de la ligadura de la carótida común izquierda e hipoxia inducida en ratas neonatas / Neurological effects by occlusion of the carotid artery and induced hypoxia in newborn rats

BACKGROUND: Hypoxic-ischemic encephalopathy is a cause of disability in the infant population. One of the most used animal models in the hypoxic-ischemic encephalopathy in immature brain is the preparation of Levine applied by Rice in newborn rats and consists of the bond of the left common carotid artery followed by induced hypoxia. The objective of this investigation was to study the neurological effects of the bond of the left common carotid and induced hypoxia in newborn rats. METHODS: Five control rats, five sham rats and five rats with hypoxic-ischemic lesion by means of the application of Levine's preparation at 7 days of age were used. On day 42, all rats were evaluated by time of grasping, posterior reflex test and analysis of the spontaneous locomotor activity (number of bipedal movements, number of stepped stalls, grooming time). RESULTS: The lesioned group presented less grasping time, lower number of positive responses to the posterior reflex and lower number of stepped stalls (p = 0.024, 0.002 and 0.0001, respectively). There were no statistically significant differences in grooming time or number of bipedal movements. CONCLUSIONS: Newborn rats in whom Levine preparation was applied presented clinical alterations that may resemble some of the signs that accompany infantile cerebral palsy (grasp problems, wrong response to postural reflexes and alteration in locomotion).

Cerebral palsy in Jordan: clinical and neuroimaging characteristics

To evaluate the diagnostic findings of neuroimaging in patients with cerebral palsy and if there is any specific finding correlated to certain types of Cerebral Palsy. Case records of 158 patients diagnosed to have cerebral palsy attending the pediatric neurology and neurodevelopmental clinics at King Hussein Medical Center and King Abdullah University Hospital over 2 years period, 2006 and 2007, were studied retrospectively with reference to their clinical characteristics and their correlation to the neuroimaging [MRI and CT scan] findings. A total of 158 cases with cerebral palsy were included in the study, 84 [53%] males, 74 [47%] females, 41 [26%] preterm and 117 [74%] full- term babies. Spastic cerebral palsy was seen in 112[70.8%] with spastic quadriplegia being the commonest seen in 63[40%]. Hypotonic ataxic type present in 22[14%], dyskinetic 15[9.4%] and mixed cerebral palsy in 9[5.6%]. Abnormal neuroimaging findings were seen on MRI in 125[79%], while in CT scan in 113[71%]. Specific neuroimaging findings were seen suggesting brain asphyxia in 40[25%], congenital brain anomaly in 22[14%], intracranial hemorrhage in 10[6%], vascular and infectious causes in 29[18.5%], unknown/Isolated brain atrophy in 26[16.5%], and periventricular leukomalacia in 31[20%]. The most common single etiology identified was birth asphyxia 40[25%], and the second is periventricular leukomalacia which was identified in 31 patients [20%]. Nonspecific brain atrophy was considered as nonspecific finding, that was found most often in patients with dyskinetic CP 5/15[33%], and in patients with spastic quadriplegia 15/63[24%] as compared to other groups. The principle contribution of imaging is to the understanding of etiology and pathogenesis, including ruling in or out conditions that may have implicated a genetic counseling, such as malformations. MRI is a more sensitive test than CT in detecting brain abnormalities