Differing risk factors for cerebral palsy in the presence of mental retardation and epilepsy.

Whether the combined diagnosis of cerebral palsy with mental retardation or with mental retardation and epilepsy reflects more severe manifestations of the spectrum of cerebral palsy, or whether these conditions reflect overlapping outcomes related to different exposure, remains an open question. At two centers, in Rome and Conegliano, Italy, 51 children with combined cerebral palsy, mental retardation, and epilepsy, 31 children with both cerebral palsy and mental retardation, and 48 with cerebral palsy alone were identified and examined, and their mothers interviewed. The triple diagnosis group was significantly more likely than the other two groups to have a history of neonatal convulsions and a history of epilepsy in first-degree relatives, but less likely to have a mother's age at delivery greater than 33 years, a birthweight less than 1500 g, or gestational age less than 32 weeks. The dual diagnosis group was more likely than the other two groups to have maternal education of less than 8 years. These data suggest the possibility of different etiopathogenetic pathways for various presentations of cerebral palsy.

[Periventricular leukomalacia in the newborn infant. Clinical and echographic diagnosis and follow-up]. / La leucomalacia periventricolare del neonato. Diagnosi e follow-up clinico ed ecografico.

Periventricular leukomalacia (PVL) is defined as an ischemic lesion of the brain of the preterm infant, characterized by infarction of the deep white matter surrounding the external angle of the lateral ventricles, a watershed area lacking collateral circulation, representing a typical "border zone" of vascular supply. This lesion is considered the neuroanatomic basis of motor and sensory impairments, as spastic diplegia or quadriplegia, mental retardation, visual and auditory deficits. An early diagnosis and the study of the developmental sequence of PVL, are recently become possible by realtime ultrasound scanning. During a period of one year, from 2/1/1986 to 2/1/1987, 136 newborns hospitalized in the Division of neonatology of the Conegliano General Hospital, have been studied by serial ultrasound scans. The incidence of PVL in the whole group was of 2.9% (4 cases); the incidence increased to 5.6% in infants weighing less than or equal to 2.500 gr (median 1.800 gr), and was 12.5% in the newborns less than or equal to 35 weeks of gestational age (median 31.7 weeks g.e.). Females presented PVL in three cases, with a M/F ratio of 1:3. Cranial real-time ultrasound provided a practical and valuable tool for diagnosis and monitoring of PVL, for its accuracy and safety. The sequence of four stage in the evolution of PVL has been confirmed on ultrasound regular scanning: 1) initial echodensity at the external angle of the lateral ventricles, 2) mild normalisation, 3) gradual cavitation and development of cysts, 4) final development of ventriculomegaly.(ABSTRACT TRUNCATED AT 250 WORDS)

Posterior rhizotomies for spasticity in children affected by cerebral palsy.

The Authors report their experience on the surgical treatment of spastic syndromes in children affected by cerebral palsy. The series consists of 21 patients: the mean age is 9.3 years. In 18 patients in whom the clinical picture showed spastic paraparesis a posterior selective lumbar rhizotomy was performed: 3 patients with disabling spastic tetraparesis underwent posterior cervical C1-C3 rhizotomy. The follow-up ranges from 4 months to 3 1/2 years. No mortality nor major complications were observed in the entire series. Clinical results can be considered good on the whole; they are related to the motivation to the movement, perceptive deficits, intellectual impairment.