Neuropsychologic impairment in bilateral cerebral palsy.
ABSTRACT The lower-than-average cognitive performance of individuals with bilateral cerebral palsy found in previous studies does not always refer to an abnormal performance or clinically significant impairment. We aimed to establish the percentage of persons with bilateral cerebral palsy who present neuropsychologic impairment, and its relationship to perinatal data and motor signs. Forty children, adolescents, and adults (age range, 6-38 years; 15 females and 25 males) with bilateral cerebral palsy were neuropsychologically assessed. Vocabulary was impaired in 85% of participants, language comprehension in 13-48%, visuoperceptual abilities in 60%, visuospatial abilities in 90%, short-term memory in 21-58%, declarative memory in 47-67%, and praxis comprehension in 20%, with executive deficits in 58-74%. Perinatal data (intrauterine growth and birth weight) contributed to explaining memory impairment. Among cerebral palsy subtypes (spastic, mixed, and dyskinetic), forms of impairment differed only in short-term verbal memory. No persons with dyskinetic cerebral palsy experienced impairment in immediate memory or working visual memory. We conclude that visuospatial deficit is the most frequent impairment in people with bilateral cerebral palsy. Moreover, short-term memory impairment seems sensitive to perinatal complications, and differs among bilateral cerebral palsy subtypes.
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ABSTRACT: To determine the effects of birthweight and gestational age on the risk of cerebral palsy for multiple and singleton births. Children on the North East Thames Regional Health Authority Interactive Child Health System, born between 1 January 1980 and 31 December 1986, and notified as having cerebral palsy, were included. Cases of postneonatal onset, of known progressive, or non-cerebral pathology and with only mild signs were excluded. Rates and relative risks were calculated using the most complete data, which related to 1985-86, and comprised 102,059 singletons and 2367 twins. Logistic regression was used to examine the associations between being a twin, gestational age, and birthweight. The crude rate per 1000 survivors at 1 year of age was 1.0 in singletons and 7.4 in twins. The relative risk was greatest in twins weighing more than 2499 g (4.5). However, after adjusting for reduced birthweight of twins it was the relative risk of twins weighing less than 1400 g that was significantly increased. Logistic regression confirmed that lower fetal growth, lower gestational age, and being a twin are all independent risk factors for cerebral palsy. The increased risk to twins of cerebral palsy is not entirely explained by their increased risk of prematurity and low birthweight.Archives of Disease in Childhood - Fetal and Neonatal Edition 12/1996; 75(3):F178-82. · 3.45 Impact Factor
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ABSTRACT: Language development during the first five years is reported for 114 high-risk preterm children (20 with varying degrees of cerebral palsy) and 97 healthy term children. Most stages of language development occurred at slightly later ages among the neurologically unimpaired preterm children than among those born at term. Preterm children with cerebral palsy were more delayed and had more articulation defects compared with neurologically unimpaired preterm children. Girls were more advanced in early language development and showed less articulation defects than boys. The perinatal optimality score was significantly correlated with the ages at which the stages of language development were reached, and with language performance at five years in preterm children, but much less in term children. Birthweight and gestational age were negatively correlated with language development at all ages. Socio-economic status and birth order had an age-related influences on language development, but no correlation was found with the number of minor congenital malformations.Developmental Medicine & Child Neurology 07/1986; 28(3):333-50. · 2.68 Impact Factor
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ABSTRACT: The aim of this study is to further clarify the relation between the pattern of cognitive impairment in spastic diplegic children born preterm and MRI features of cerebral lesions. The cognitive profile by Wechsler Scale of a sample of 30 children aged 6 years, 8 months to 14 years, 7 months was assessed, and the correlations between the Full Scale, Verbal, and Performance IQ and periventricular leukomalacia features on MRI were investigated. A significant difference was observed between the mean Verbal and Performance IQ, indicating a specific failure in the visuoperceptual functions of spastic diplegic children born preterm. Periventricular leukomalacia was detected in all children. The severity of ventricular dilatation, the degree and extent of white matter reduction, optic radiation involvement, and the thinning of the posterior corpus callosum correlated significantly with the Full Scale and Performance IQ: no correlation was observed between the Verbal IQ and any of the MRI features analyzed. In spastic diplegic children, an MRI examination between the ages of 1 and 2 years may be helpful in predicting a specific neuropsychological pattern of dysfunction and in defining an early intervention program.Pediatric Neurology 11/1996; 15(3):207-12. · 1.42 Impact Factor