Clinical presentation, associated disorders and aetiological moments in Cerebral Palsy: a Dutch population-based study.

PURPOSE: Cerebral Palsy (CP) contains varying clinical presentations, associated disorders and aetiological moments. Quantitative data and trends on these aspects were lacking in The Netherlands. METHOD: Within a population-based study on prevalence, presentation and functioning of Dutch children with CP born in the years 1977-1988, individual history taking, examination and medical file checking was done by experienced clinicians. Clinical subtypes, motor disability, important co-morbidity (mental retardation, visual disability and epilepsy) were recorded, aetiological moments identified if possible. By comparing the four most recent years with the earlier years possible trends were studied. RESULTS: A quarter of children beforehand recorded as CP did not meet inclusion criteria after individual examination. Spastic subtypes accounted for over 90% of all CP cases: bilateral spastic cerebral palsy as a group are the majority although spastic hemiplegia is percentage-wise the largest individual clinical subtype. Epilepsy and mental retardation are common. Clinical patterns and associated disorders remained rather constant comparing earlier to more recent birth years. CONCLUSIONS: An early diagnosis of CP may be challenged. General clinical patterns remained rather constant in following years, as did most studied items. Even if this study revealed a prevalence rise, no aspect stood out as a possible explanation for this prevalence rise. Comparable studies performed elsewhere showed similar findings.

Prevalence of cerebral palsy in The Netherlands (1977-1988).

Children with cerebral palsy (CP) and their families often make strong demands on diagnostic, therapeutic, technical and social facilities. Prevalence estimates are needed to improve treatment and services. As recent Dutch data are not available, the present study aimed to assess the population prevalence of CP in the Netherlands. A representative Dutch area with 1.2 million inhabitants of which 172,000 were born between 1977 and 1988 was studied. To ascertain the children with CP from these birth years, medical practices (such as rehabilitation centres, paediatric and child neurological departments) were consecutively asked to contact their (supposed) CP cases. Next, a parents' organisation and finally regional news media assisted in the ascertainment. In total, 170 'supposed' CP cases underwent an expert examination. Of these 170, 127 children proved to be definite CP-cases, yielding a 'crude' average prevalence of 0.74 per 1,000 inhabitants (95% CI: 0.61-0.87). Under-ascertainment was recognised and quantified. Accordingly, the population prevalence of CP over the birth year period 1977-1988 was calculated as 1.51 per 1,000 inhabitants (average over the 12 birth years). The calculated CP prevalence rose significantly over time: from 0.77 (1977-1979) to 2.44 (1986-1988). This trend is in accordance with other studies.

[Partial blocking of the tibial nerve with phenol as treatment of gait disorders due to pes equinus in central paralysis]. / Partiële blokkade van de nervus tibialis met fenol als behandeling van loopstoornissen door een spitsvoet bij centrale parese.

Partial chemical neurolysis by means of a peripheral nerve block induced with a phenol solution can result in decreasing local muscle hypertonia of central origin. In case of a walking disability resulting from a spastic or dystonic equinovarus position of the ankle the phenol block of the tibial nerve may be a valuable treatment that improves walking ability. The technique of the procedure is explained. A phenol block is induced only after a favourable result of a trial block with a local anaesthetic. In the group of 19 patients who underwent tibial nerve block given by the author in the period 1987-1989 there appears to exist a correlation between the functional results and the extent to which the patient had been active in walking prior to the nerve block. A group of 6 'sitters' and 'hardly walking' patients had poor to moderate results, a group of 13 'walkers' had moderate, good and excellent results. The difference in functional outcome is ascribed by the author to a better possibility to actually utilise a muscular balance improved by the phenol block. In the early--recovery--phase of stroke rehabilitation a phenol block of the tibial nerve may well be useful in cases with equinovarus position of the ankle which interferes with therapeutic exercise and functional progress.