Survey of Neurological Disorders in Children Aged 9-15 Years in Northern India.

The prevalence of neurological disorders in resource-poor settings, although likely to be high, is largely unexplored. The prevalence and risk factors for neurological disorders, including epilepsy and intellectual, motor, vision, and hearing deficits, in children aged 9 to 15 years in the community were investigated. A new instrument was developed, validated, and used in a 2-stage community survey for neurological disorders in Lucknow, India. Screen-positives and random proportion of screen-negatives were validated using predefined criteria. Prevalence of different neurological disorders was calculated by weighted proportions. Of 6431 children screened, 221 were positive. A total of 214 screen-positives and 251 screen-negatives were validated. Prevalence of neurological disorders was 31.3 per 1000 children of this age group (weighted 95% confidence interval = 16.5, 46.4). The final model for risk factors included age, mud house, delayed cry at birth, and previous head injury. The prevalence of neurological disorders is high in this region. Predictors of neurological disorders are largely modifiable.

Prevalence and risk factors for neurological disorders in children aged 6 months to 2 years in northern India.

AIM: To study prevalence and risk factors for neurological disorders--epilepsy, global developmental delay, and motor, vision, and hearing defects--in children aged 6 months to 2 years in northern India. METHOD: A two-stage community survey for neurological disorders was conducted in rural and urban areas of Lucknow. After initial screening with a new instrument, the Lucknow Neurodevelopment Screen, screen positives and a random proportion of screen negatives were validated using predefined criteria. Prevalence was calculated by weighted estimates. Demographic, socio-economic, and medical risk factors were compared between validated children who were positive and negative for neurological disorders by univariate and logistic regression analysis. RESULTS: Of 4801 children screened (mean age [SD] 15.32mo [5.96]; 2542 males, 2259 females), 196 were positive; 190 screen positives and 269 screen negatives were validated. Prevalence of neurological disorders was 27.92 per 1000 (weighted 95% confidence interval 12.24-43.60). Significant risk factors (p≤0.01) for neurological disorders were higher age in months (p=0.010), lower mean number of appliances in the household (p=0.001), consanguineous marriage of parents (p=0.010), family history of neurological disorder (p=0.001), and infants born exceptionally small (parental description; p=0.009). On logistic regression, the final model included age (p=0.0193), number of appliances (p=0.0161), delayed cry at birth (p=0.0270), postneonatal meningoencephalitis (p=0.0549), and consanguinity (p=0.0801). INTERPRETATION: Perinatal factors, lower socio-economic status, and consanguinity emerged as predictors of neurological disorders. These factors are largely modifiable.

West syndrome: response to valproate.

UNLABELLED: Management of West syndrome is unsatisfactory. In our clinic we observed that a significant proportion of patients respond to usual dose of valproate. OBJECTIVE: To prospectively assess the efficacy of valproate in controlling infantile spasms in West syndrome. METHODS: Consecutive patients presenting with West syndrome to the Pediatric Neurology Clinic or general outpatient department (OPD) were enrolled for study. Those who were not on any treatment were given valproate in a dose of 30 mg/kg/day while awaiting investigations. Patients were followed up every 2 weeks. Predefined criteria for definition of West syndrome and response were used. Those showing partial/poor response or relapse on valproate were given hormonal therapy. RESULTS: One hundred children with West syndrome were enrolled. Ninety one children were started on valproate. Of these 36 (39.5%) showed a good response, but seven later relapsed while on same dose of valproate and three were lost to follow up. Later age at onset and typical hypsarrhythmia on EEG were associated with good sustained response to valproate while a history of delayed cry at birth was associated with partial or poor response. Sixty two patients who responded poorly to or relapsed on valproate were put on hormonal treatment in addition. Of these 36 (58.1%) had a good response but 11 later relapsed after stopping treatment and two were lost to follow up. CONCLUSION: Valproate may have a role in treatment of West syndrome in a selected group of patients.

Hospital and community validation of a screening instrument for detection of neurodisability in Indian children aged 6 months to 2 years.

OBJECTIVE: To develop and validate a screening instrument for neurological disorders in children aged 6 months to 2 years in the community. METHODS: A comprehensive parent-administered instrument was developed to screen for hearing, vision, seizures, motor deficits and development in Indian children aged 6-24 months. This was tested for reliability and validated in the hospital setting by comparing with pre-decided gold standards. It was then used in a community survey in a two-phase design in which all screen positives and a random sample of screen negatives were validated. RESULT: The screening instrument had overall sensitivity, specificity and positive predictive values of 95.8, 68.1 and 76.1%, respectively, in the hospital setting. In the field setting, these figures changed to 95.4, 51.8 and 20.6%, respectively. The reasons for this are discussed. CONCLUSION: Community surveys must use a two-phase design to get the true prevalence. A falsely high prevalence will be computed if only a single-phase design or hospital validation is used.

Aetiology of intellectual disability in paediatric outpatients in Northern India.

AIM: To study the aetiology of intellectual disability in patients presenting to hospital and the diagnostic yield of a standardized examination. METHOD: Over a 1-year period, the first three children presenting to the paediatric outpatients department (OPD) on 2 selected weekdays with developmental delay, suspected intellectual disability, or school failure were enrolled for study if they satisfied standard definitions of global developmental delay (GDD), or intellectual disability as tested by scales for Indian children: Developmental Assessment for Indian Infants, Binet Karnat Test, and the Vineland Social Maturity Scale (Malin's Adaptation). Detailed history, and physical and neurological examinations were recorded. An algorithmic approach to investigations was followed. Also, neuroimaging, thyroid function, electroencephalograph, karyotyping, and studies for fragile-X syndrome were conducted. Aetiological diagnosis was considered established only if clinical features were supported by investigations. Clinical features associated with a successful aetiological diagnosis were computed. RESULTS: A total of 122 children were enrolled in a cross-sectional analytic study (mean age 43.5 mo [SD 40.66]; 84 males, 38 females). Of these, a definite aetiology could be assigned in 66 children (54.1%); 17 prenatal, 38 perinatal/neonatal, and 11 postneonatal. Factors associated with reaching a definite diagnosis included younger age at presentation, presence of seizures, microcephaly, adverse neonatal events, and abnormal motor signs. Clinical history and examination gave important clues to the aetiology in 89 (72.9%) patients. Neuroimaging was abnormal in 91 out of 114 children, with aetiological findings in 48 children. INTERPRETATION: Perinatal/neonatal causes predominate as the cause of GDD or intellectual disability in India. The study highlights that a large majority of cases seen here were preventable.

Correlation between developmental quotients (DASII) and social quotient (Malin's VSMS) in Indian children aged 6 months to 2 years.

AIM: To determine correlation between developmental quotients (DQ) (DASII) and social quotients (SQ) (Malin's Vineland Social Maturity Scale (VSMS)). METHODS: Malin's VSMS and DASII were done in 135 children aged 6 months to 2 years. SQ and DQ motor and mental were correlated using Pearson's correlation coefficient (r). Mean SQ and DQ and age equivalent scores were compared. RESULTS: Correlation coefficients between SQ and DQ (mental and motor were 0.849 and 0.791, respectively. Social age correlated highly with mental age (r = 0.906). Mean SQ was higher than mean DQa. CONCLUSION: SQ tends to be higher than DQ and correlates best with DQ mental.

Development and validation of a new Lucknow Development Screen for Indian children aged 6 months to 2 years.

A chart was prepared using selected milestones from Baroda norms of Bayley Scales of Infant Development and Gesell's schedules on y-axis and age in months on x-axis. A child failing to achieve any milestone to the left of the chronological age was screen positive. Interrater and test-retest reliability were calculated. For validation, the screen was administered to mothers of 142 children aged 6 to 24 months attending Pediatric Outpatients or Neurology Clinic of CSM Medical University, Lucknow, India. Acutely ill children were excluded. A full Developmental Assessment Scale for Indian infants was then done on the same children. Sensitivity and specificity were 95.9% and 73.1%, respectively. It is concluded that Lucknow Development Screen can be effectively used for screening in the community.