Feeding problems in children with cerebral palsy.

OBJECTIVE: To determine the magnitude and extent of feeding problems in children with cerebral palsy (CP) and to evaluate the effectiveness of nutritional interventions. DESIGN: Prospective hospital based interventional study. METHOD: Children with cerebral palsy of either sex were enrolled randomly and their parents were interviewed for their perception about feeding problems, nutritional status and for their views about the expected outcome of feeding problems. Each case was assessed for feeding problems based on Gisel and Patrick feeding skill score; for nutritional status by measurement of weight, skinfold thickness (at biceps, triceps, suprailiac and subscapular), mid arm circumference and caloric intake; neurologically for type and severity of cerebral palsy and for developmental age by Gasell s developmental scale. Equal number of age and sex matched controls were included for comparison of nutritional status and developmental quotient. Various rehabilitation procedures were applied and their response was observed in the followup ranging from 3-10 months. RESULTS: One hundred children (76 boys and 24 girls) with cerebral palsy of mean age 2.5 years (range 1 to 9 years) and mean developmental age of 7.6 months (range 1 to 36 months) were included in the study. Oral motor dysfunction (OMD) was found in all cases and in each category. Spastic quadriplegic cerebral palsy (SQCP) and hypotonic patients had significantly poor feeding skill score (p < 0.001). Mean duration of feeding session was 31.5 minutes (range 10-60 minutes). Main food of children with cerebral palsy consisted of liquid and semisolid diet. Children with poor OMD were unable to take solid food. Cases with seizures had significantly more feeding problems than those without seizures (p < 0.001). Parental awareness about feeding problems of their children was significantly low and they overestimated the nutritional status of their children. Anthropometric indicators were significantly lower than controls (p < 0.001). Spastic quadreparesis, hypotonia and poor feeding skill score had negative effect on nutritional status. Thirty per cent parents of cerebral palsy patients were pessimistic about the possibility of any improvement in feeding problems. After nutritional rehabilitation, good improvement was seen in feeding problems, OMD and nutritional status. CONCLUSION: Nutritional status of children with cerebral palsy is poor due to summation of several factors. Therefore, they should be thoroughly assessed for feeding problems and nutritional status in order to start timely nutritional rehabilitation which can significantly improve their nutritional status and quality of life.

Epilepsy in children with cerebral palsy.

This article deals with the clinical profile of children with cerebral palsy and epilepsy, and to study the clinical predictors of response to anti-epileptic drugs. It is a prospective hospital based follow-up study. All the children who presented with cerebral palsy and history of seizure (other than neonatal seizures) over a period of one year were included. Seizures were classified according to ILAE classification. An EEG was obtained in all cases. Neuroimaging was done in all patients. Eighty-five patients were studied and followed for minimum of 12 months. Perinatal factors accounted for 62 (72.3%) cases. The motor deficits seen were quadriparesis (n = 64), hemiplegia (n = 12) and diplegia (n = 9). Associated mental retardation was seen in 80.9% patients with quadriparesis. A predominance of generalised epilepsy was seen with generalised tonic clonic seizures (32.9%) followed by mycolonic seizures (30.6%) and localisation related epilepsy (24.7%). The patients with quadriparesis were more likely to have generalised epilepsy and 52.4% of them required two or more anti-epileptic drugs for control of seizures. Patients with hemiplegia had localisation related epilepsy in 83.3% of cases. On multivariate analysis presence of quadriparesis, microcephaly, mental retardation and myoclonic epilepsy were found to predict the poor response to AED. Epilepsy in patients with cerebral palsy is of severe nature and difficult to control. Presence of quadriparesis, mental retardation and myoclonic seizures was predictive of poor response to anti- epileptic drugs.

Goldenhar syndrome with rare associations.

Goldenhar syndrome is a malformation complex involving the structures arising from first and second branchial arches, the first pharyngeal pouch, first branchial cleft and primordia of the temporal bone. Though the syndrome itself is not very rare, the presence of polydactyly and hydrocephalus, which are rare associations, prompted us to report this case.

Paralytic poliomyelitis (1989-1994): report from a sentinel center.

OBJECTIVE: To study the trends of paralytic poliomyelitis in pre Pulse Polio Immunization period. SETTING: Hospital based sentinel surveillance. METHODS: Analysis of 6704 line-listed poliomyelitis cases from January 1989 to December 1994 attending the Department of Physical Medicine and Rehabilitation. RESULTS: 85% of all cases reported in Delhi were from this center. A decline in alternate year peaks was observed from 1621 cases in 1990 to 1062 cases in 1994. There was an increase in proportion of cases with poliomyelitis in fully vaccinated children from 14% to 22.9%. Polio type I virus was the commonest isolated virus in all the years except 1993, when type II was isolated in 38.7% of cases. CONCLUSION: Despite improvement in immunization coverage, the study reveals that a large number of children (67.2%) who suffer from poliomyelitis are unvaccinated. This stresses need to intensify and sustain high level of immunization coverage with effective vaccine.

Paralytic poliomyelitis 1976-1988: report from a Sentinel Centre.

Kalawati Saran Children's Hospital, New Delhi, is the Sentinel Centre for poliomyelitis in the Northern region and 52-76% of cases of acute poliomyelitis from the Union Territory of Delhi are registered here. In this paper, data from this hospital for the last 13 years is presented. A detailed analysis of 1874 cases seen during the year 1987 is also presented. Inspite of large scale vaccination being carried out, the total number of cases have not shown a corresponding decline. The incidence of acute polio in Delhi has not declined over the years: it was 14.7/100,000 population in 1976 and 15.25 100,000 in 1988. There has been no change in the epidemiology of the disease over the years, except that the disease among the fully vaccinated children has increased from 1.3% in 1979 to 13.9% in 1988. Inspite of a decade of use of the oral polio vaccine there has been no significant reduction in the incidence of the disease, and urgent alternative strategies are needed.

Spinal muscular atrophy: some easy clues to diagnosis.

Seven cases of benign form of spinal muscular atrophy were studied to evaluate the importance of detecting hand tremors, muscle fasciculation, evertion of foot and ECG tremors to distinguish these cases from muscular dystrophy. Taken in combination, diagnosis of all the seven cases was possible without the need for application of more sophisticated and invasive investigations, e.g., EMG, nerve conduction study, CPK levels and muscle biopsy.