1219 Spastic diplegia in term infants

A recent survey of children, adolescents and young adults attending schools for learners with special educational needs focused on the sub-group formally assessed as being spastic diplegic. This form of bilateral, leg-dominated cerebral palsy (CP) may also affect fine-motor function, and cognitive deficits and corticovisual impairments are not uncommonly associated. Specialist paediatricians, sub- specialists in neonatology, developmental paediatricians and therapists working with such children typically associate spastic diplegia with very low birthweight/extreme prematurity, with the CP following on observations of periventricular leucomalacia, often with intraventricular haemorrhage, in the neonatal period. Of interest to the therapists treating the affected children and adolescents in this study was whether there might be evidence of fewer cases over the past decade or two as a result of the numerous advances in neonatal care. Fifty subjects were identified in four facilities, ranging in age from 7-20 years, and forty agreed to participate. Birthweight as recorded by parents ranged from 600g to 3,4kg, and gestational age from ~25 – 40 weeks. Important findings were that subjects born at term or preterm were equally represented in this sample of spastic diplegics, and that apart from the significant effects on functional mobility, visuomotor integration and visual perception were also affected. Whereas at the time of assessment there was no correlation between severity of neurological manifestations and birthweight or gestation, infants born prematurely spent up to 4 months in hospital postnatally whereas the term infants were typically discharged within days of birth. This suggests that the latter were largely asymptomatic at birth and that in contrast to the perinatal nature of the insult in the preterm group, the neurological insult in the term infants had most likely occurred some time before delivery. There is no doubt that this small sample is biased towards a subset with access to such schools, and also biased towards more severely affected patients with spastic diplegia. There are almost certainly many others in mainstream schools, and likely also some who are more affected and without access to the educational system. However the important points made are that the condition is not confined to survivors of preterm birth, and healthcare providers and educators managing such patients should be aware of the extent of the problems related to visual perception and visuomotor integration.

Read more:
S Afr Med J 2012; 102: 299-302
J Child Neurol 2007; 22: 282-8
Pediatrics 2006; 118: 690-7