Incidencia y tipo de parálisis cerebral en una cohorte de prematuros con edad gestacional menor de 28 semanas / Incidence of cerebral palsy in a cohort of preterm infants with a gestational age of less than 28 weeks

No disponible

[Levels of amino acids in cerebral spinal fluid in children with cerebral palsy].

OBJECTIVE: To study the changes of amino acids in cerebral spinal fluid (CSF) in children with spastic or athetotic cerebral palsy (CP) by examining CSF levels of glutamic acid (Glu), gamma-aminobutyric acid (GABA) and aspartate (ASP). METHODS: CSF samples were obtained from 13 children with spastic CP, from 14 children with athetotic CP, and from 10 children without central nervous system and infectious diseases (control group). CSF levels of Glu, GABA and ASP were determined by high-performance liquid chromatography. RESULTS: CSF levels of GABA, ASP and Glu in the control group were 13.04+/-2.19, 10.21+/-0.45 and 8.41+/-2.26 micromol/L, respectively. Compared with the control group, CSF GABA levels in the spastic and the athetotic CP groups (8.02+/-2.03 and 10.01+/-2.68 micromol/L respectively) significantly decreased (P<0.01), whereas CSF levels of Glu (20.99+/-8.15 and 28.77+/-17.62 micromol/L respectively) and Asp (13.53+/-3.93 and 14.02+/-2.88 micromol/L respectively) in the spastic and the athetotic CP groups significantly increased (P<0.01). There were statistical differences in the GABA level between the spastic and the athetotic CP groups (P<0.05). In children with spastic CPCSF Glu level was positively correlated to muscle tension. CONCLUSIONS: CSF excitatory amino acid levels increased, while CSF inhibitory amino acid levels decreased in children with CP. There were differences for CSF amino acid levels in different types of CP. The changes of amino acid levels may contribute to the pathogenesis of CP.

[Clinical, tomographic and immunogenetic study of patients with infantile cerebral palsy].

A neurovisual and immunogenetic study of patients with different forms of cerebral palsy was conducted. Morphological peculiarities of each form were described. A frequent combination of pathology of cerebrospinal fluid spaces and periventricular area with disruption of neuronal migration and development of brain mass and volume was found. HLA-typing revealed a significant association of the disease with antigen B13. An association of cerebral palsy with particular genetically determined vulnerability of fetal brain to lesions disrupting genetic program for neuroontogenesis is suggested.

Dopa-responsive dystonia simulating cerebral palsy.

Five patients presented in infancy or early childhood with various combinations of pyramidal and extrapyramidal signs with normal cognitive function. Their perinatal courses were unremarkable. In each patient, initial impressions listed by several examiners included spastic diplegia or cerebral palsy. Later in each course, either extrapyramidal features or progression suggested dopa-responsive dystonia. In 4 of the 5 children, cerebrospinal fluid was obtained and disclosed reduced levels of biopterin, neopterin, and homovanillic acid in all 4. Levodopa therapy resulted in prompt improvement with normal function returning within 6 months. The disappearance of the "spasticity," extensor plantar responses, and extrapyramidal signs, following levodopa therapy, confirmed the diagnosis of doparesponsive dystonia in these patients. Three had apparently sporadic disease; the other 2 were siblings with an affected paternal grandmother. Three had onset in infancy with delayed sitting and walking before the appearance of overt dystonia; infantile onset is infrequent in dopa-responsive dystonia. The other 2 had normal milestones, but developed gait disorders with prominent imbalance in early childhood. The diagnosis of dopa-responsive dystonia should be considered in children with unexplained or atypical "cerebral palsy."

[The cerebrospinal fluid pathways in infantile cerebral palsy]. / Likvornye puti golovnogo i spinnogo mozga pri detskom tserebral'nom paraliche.

Liquor routes of the brain and spine were examined in 16 children aged 2 to 12 with infantile cerebral paralysis by radioisotope cistern-myelography with Tc99m-DTPK. Simultaneous imaging of liquor tract pathology in the brain and spine helped distinguish three variants of liquorodynamic abnormalities in infantile cerebral paralysis characterized by various combinations of disorders, in CSF circulation, resorption, and formation of routes for additional CSF discharge. The role of CSF routes involvement in the brain and spine in the formation of a pathologic pattern in infantile cerebral paralysis is analyzed.

Childhood psychosis and monoamine metabolites in spinal fluid.

Determination of monoamine metabolites was accomplished in the spinal fluid of 22 psychotic children and in 22 sex- and almost-age-matched "normal" controls. Also, specimens from groups of mentally retarded children and children with progressive encephalopathy or meningitis were used for comparison. The psychotic children showed raised levels of homovanillic acid. Thirteen children diagnosed as autistic by Rutter's criteria showed isolated increase of this metabolite. In the group of 9 children with other psychoses, both the level of homovanillic acid and that of 5-hydroxy-indoleacetic acid was raised. The comparison with the group of "simply" mentally retarded children and results within the psychotic group revealed that the increased concentration of monoamines was not attributable to mental retardation per se.

Ventricular fluid homovanillic acid and 5-hydroxyindoleacetic acid concentrations in patients with movement disorders.

Ventricular fluid concentrations of homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA), the respective metabolites of dopamine and serotonin, were measured in 57 patients undergoing thalamotomy for relief of movement disorders. The diseases included were Parkinson disease, dystonia, cerebral palsy, multiple sclerosis, and posttraumatic or posthypoxic encephalopathy. Untreated parkinsonian patients had the lowest mean HVA level (119 ng per milliliter). Patients with multiple sclerosis or with posttraumatic or posthypoxic encephalopathy with both intellectual impairment and bilateral motor involvement had lower mean HVA levels (197 and 177 ng per milliliter, respectively) than cerebral palsy patients with bilateral motor disease (233 ng per milliliter), dystonia patients (246 ng per milliliter), or multiple sclerosis patients with normal intellect (376 ng per milliliter). The data suggest that diffuse cerebral disease may lead to diminished dopaminergic activity. Ventricular fluid 5-HIAA levels were similar in all groups of patients. Chronic cerebellar stimulation markedly increased ventricular fluid HVA and 5-HIAA levels, indicating that cerebellar stimulation affected cerebral dopaminergic and serotonergic systems.

Protein patterns of the cerebrospinal fluid in children with cerebral palsy.

Cerebrospinal fluid in 69 children with cerebral palsy (CP) of different etiology was examined by an improved method of agarose-gel electrophoresis. The protein pattern was normal in 12 cases only. In children with CP caused by congenital and postnatal infections raised psi-globulin fractions and the appearance of oligoclonal phi-globulin bands were the most obvious finding. In patients with CP due to malformations or perinatal brain damage and in children with CP of unknown etiology decreased prealbumin and increased albumin values were combined with hydrocephalus e vacuo in about half of the cases. Less frequent changes of the beta-globulin fractions were found, an increase of the beta-fraction being more rare than a decrease of the tau-globulin.