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12 results on '"MESH: Cerebral Palsy"'

1. Determining the technical and clinical factors associated with pain for children undergoing botulinum toxin injections under nitrous oxide and anesthetic cream

Author

Ronan Garlantézec, Philippe Le Moine, Virginia Blajan, Jérémie Lefranc, Sylvain Brochard, Olivier Rémy-Néris, Laetitia Houx, Mathieu Lempereur, S. Peudenier, Service de médecine physique et de réadaptation, Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Laboratoire de Traitement de l'Information Medicale (LaTIM), Université européenne de Bretagne - European University of Brittany (UEB)-Télécom Bretagne-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Mines-Télécom [Paris] (IMT), Département de santé publique [Brest], Hôpital Augustin Morvan-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), and Université européenne de Bretagne - European University of Brittany (UEB)-Université de Brest (UBO)-Télécom Bretagne-Institut Mines-Télécom [Paris] (IMT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)

Subjects
Male, Lidocaine, Administration, Topical, Nitrous Oxide, 0302 clinical medicine, Botulinum toxin, MESH: Child, Medicine, Prospective Studies, Topical anesthetic, Anesthetics, Local, Botulinum Toxins, Type A, Child, MESH: Nitrous Oxide, Gross Motor Function Classification System, General Medicine, Pain scale, MESH: Infant, MESH: Injections, Intramuscular, MESH: Administration, Topical, 3. Good health, Neuromuscular Agents, Child, Preschool, Anesthesia, Drug Therapy, Combination, Female, MESH: Pain, medicine.drug, medicine.medical_specialty, MESH: Cerebral Palsy, Adolescent, Analgesic, MESH: Paraplegia, Pain, MESH: Anesthetics, Local, Injections, Intramuscular, Prilocaine, Cerebral palsy, 03 medical and health sciences, 030225 pediatrics, Humans, MESH: Adolescent, Paraplegia, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, MESH: Humans, business.industry, MESH: Botulinum Toxins, Type A, Cerebral Palsy, MESH: Child, Preschool, Infant, medicine.disease, MESH: Male, MESH: Prospective Studies, Surgery, MESH: Prilocaine, MESH: Drug Therapy, Combination, MESH: Lidocaine, Pediatrics, Perinatology and Child Health, MESH: Neuromuscular Agents, Neurology (clinical), business, MESH: Female, 030217 neurology & neurosurgery
Abstract

International audience; AIMS: To determine technical and clinical factors associated with pain when using an analgesic protocol with 50% nitrous oxide/oxygen and anesthetic cream (lidocaine and prilocaine, Emla(®)) for children with cerebral palsy undergoing botulinum toxin injections. METHODS: Monocentric prospective study including 50 children newly injected with a mean age of 6.6 years (± 4.32, range 1-18) and 199 injected muscles. Pain was evaluated using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). The following variables were noted: gender, age, weight, Gross Motor Function Classification System, type of cerebral palsy (hemiplegic, diplegic, tetraplegic), muscles injected and severe cognitive impairment. The procedure was broken down into three phases for the purpose of pain evaluation: puncture, muscle localization using electrostimulation and injection of botulinum toxin. RESULTS: The mean CHEOPS score was 8.16 (± 3.5) and 38% of scores were above the therapeutic threshold of 9. The injection phase was significantly more painful (6.77 ± 3.30) than the puncture (4.88 ± 2.03) and localization (5.46 ± 2.68) phases. The adductor muscles were less painful than other muscles. Children with more severe cognitive impairment seemed to perceive higher levels of pain than the others. Other clinical factors were not associated with pain score. CONCLUSION: Clinical characteristics seem not strongly correlated to the success or failure of the 50% nitrous oxide/oxygen-Emla(®) protocol and this pain treatment protocol does not prevent equally all phases of botulinum toxin injections. Future research on the products and its dilution might help to reduce pain level.

Published
2011
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2. Mild musculoskeletal and locomotor alterations in adult rats with white matter injury following prenatal ischemia

Author

Delcour, Maxime, Russier, Michael, Xin, Dong, Massicotte, Vicky, Barbe, Mary, Coq, Jacques-Olivier, Coq, Jacques‐olivier, Unité de Neurobiologie des canaux Ioniques et de la Synapse (UNIS - Inserm U1072), and Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
[SDV]Life Sciences [q-bio], Physiology, MESH: Rats, Sprague-Dawley, Hindlimb, Nerve Fibers, Myelinated, MESH: Animals, Newborn, Rats, Sprague-Dawley, MESH: Pregnancy, Pregnancy, MESH: Animals, Treadmill, Gait, MESH: Muscle, Skeletal, MESH: Infant, Newborn, MESH: Posture, MESH: Motor Activity, MESH: Nerve Fibers, Myelinated, Astrogliosis, medicine.anatomical_structure, Prenatal Exposure Delayed Effects, Hypoxia-Ischemia, Brain, Female, Psychology, Infant, Premature, Locomotion, MESH: Infant, Premature, MESH: Cerebral Palsy, MESH: Rats, Posture, MESH: Locomotion, Ischemia, Motor Activity, MESH: Prenatal Exposure Delayed Effects, Cerebral palsy, White matter, Developmental Neuroscience, medicine, Animals, Humans, Muscle, Skeletal, MESH: Humans, Cerebral Palsy, MESH: Gait, Infant, Newborn, medicine.disease, Rats, Disease Models, Animal, Animals, Newborn, MESH: Hypoxia-Ischemia, Brain, MESH: Disease Models, Animal, Ankle, MESH: Female, Neuroscience, Developmental Biology
Abstract

Early brain injury including white matter damage (WMD) appears strongly correlated to perinatal hypoxia-ischemia and adverse neurological outcomes in preterm survivors. Indeed, WMD has been widely associated with subtle to major motor disturbances, sensory, behavioral and cognitive impairments in preterm infants who afterward develop cerebral palsy (CP). Prenatal ischemia (PI) has been shown to reproduce the main features of WMD observed in preterm infants. The present study was aimed at determining in adult rats the impact of PI on brain axons, musculoskeletal histology and locomotor activity. PI was induced by unilateral intrauterine artery ligation at E17 in pregnant rats. We found axonal degeneration and reactive astrogliosis in several white matter regions of adult PI rats. We found mild myopathic and secondary joint changes, including increased variability in myofiber size in several hind limb muscles, decreased myofibers numbers but increased Pax 7 cells and myofiber size in the gastrocnemius, and mild knee and ankle chondromalacia. Although treadmill locomotion appeared normal, several kinematic parameters, such as stride length, amplitude, velocity and leg joint angles were altered in adult PI rats compared to shams. Using intra- and inter-group variability of kinematic parameters, PI seemed to impair the maturation of locomotion on the treadmill. In addition, PI rats exhibited spontaneous hyperactivity in open-field test. Musculoskeletal changes appeared concomitant with mild impairments in gait and posture. Our rodent model of WMD based on PI reproduces the mild motor deficits and musculoskeletal changes observed in many preterm infants with a perinatal history of hypoxia-ischemia, and contributes towards a better understanding of the interplay between brain injury, musculoskeletal histopathology and gait disturbances encountered subsequently.

Published
2011
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3. Screw augmentation for spinopelvic fixation in neuromuscular spine deformities: technical note

Author

Arnaud Dubory, Aurélien Courvoisier, Houssam Bouloussa, Baptiste Morel, Raphaël Vialle, Manon Bachy, Service de pédiatrie orthopédique [CHU Trousseau], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Santé, Plasticité, Motricité (TIMC-IMAG-SPM), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), Centre Hospitalier Universitaire [Grenoble] (CHU), and Service de Radiologie [CHU Trousseau]

Subjects
Male, MESH: Neuromuscular Diseases, medicine.medical_treatment, [SDV]Life Sciences [q-bio], MESH: Postural Balance, 0302 clinical medicine, Pedicle Screws, MESH: Postoperative Period, MESH: Child, Orthopedics and Sports Medicine, Postoperative Period, Prospective Studies, MESH: Pedicle Screws, Child, Postural Balance, 030222 orthopedics, MESH: Pelvic Bones, MESH: Scoliosis, Neuromuscular Diseases, medicine.anatomical_structure, surgical procedures, operative, Scoliosis, Spinal fusion, MESH: Sacrum, Female, Paraplegia, musculoskeletal diseases, Sacrum, medicine.medical_specialty, MESH: Cerebral Palsy, Adolescent, Augmentable screw, MESH: Paraplegia, Cerebral palsy, MESH: Braces, 03 medical and health sciences, Pelvic obliquity, medicine, Spinopelvic fixation, MESH: Muscular Dystrophy, Duchenne, Humans, Pelvic Bones, Pelvis, MESH: Adolescent, Braces, MESH: Humans, business.industry, Cerebral Palsy, [SCCO.NEUR]Cognitive science/Neuroscience, medicine.disease, equipment and supplies, MESH: Spinal Fusion, Sagittal plane, MESH: Prospective Studies, MESH: Male, Surgery, Muscular Dystrophy, Duchenne, Bisphenol-a-glycidyl dimethacrylate, Spinal Fusion, Neuromuscular scoliosis, business, Spastic quadriplegia, MESH: Female, 030217 neurology & neurosurgery
Abstract

The primary goal of curve correction in neuromuscular patients is to restore coronal and sagittal trunk balance, including the pelvis, to maximize sitting balance. For several years, it has been a common practice to inject polymeric cement into osteoporotic bone through specially designed, perforated pedicle screws in an effort to enhance screw stability. Therefore, we started using the association of a spinopelvic fixation with S1 pedicle screw augmentation, using bisphenol-a-glycidyl dimethacrylate composite resin in neuromuscular patients with pelvic obliquity, technique in neuromuscular patients to improve pedicle screw stability of our pelvic construct. Ten patients undergoing spinopelvic fixation for a neuromuscular spinal deformity were enrolled in the study. Clinical and radiographic data were analyzed and presented. Minimal follow-up took place at 6 months to assess early complications. Five patients were diagnosed with spastic quadriplegia secondary to cerebral palsy, four had Duchenne’s muscular dystrophy, and one had a T5-level traumatic flaccid paraplegia. Preoperative PO ranged from 8° to 34° (mean 19.16°). Postoperative PO ranged from 0° to 6.3° (mean 1.6°). After surgery, all patients returned to a full-time sitting position between days 5 and 12 without the need for additional bracing. No mechanical failure of the construct was noted during follow-up. We used sacral pedicle screw augmentation as a reliable tool to strengthen spinopelvic fixation in neuromuscular scoliosis without increasing the intraoperative morbidity. In our practice, sacral screw augmentation can definitely enhance PO correction obtained by a posterior procedure.

Published
2015
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4. Neonatal infection and 5-year neurodevelopmental outcome of very preterm infants

Author

Y. Aujard, Monique Kaminski, Béatrice Larroque, Antoine Burguet, Pierre-Yves Ancel, Stéphane Marret, Rachel Vieux, Gérard Thiriez, Ayoub Mitha, Patrick Truffert, Catherine Arnaud, Pascal Boileau, Laurence Foix-L’Hélias, Gilles Cambonie, Jean-Christophe Rozé, Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants (UMR_S 953), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris-Sud - Paris 11 (UP11), Unité de Néonatalogie, Hôpital Jeanne de Flandre [Lille], Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps (LEASP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité d'Epidémiologie Clinique, CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Service de pédiatrie néonatale et réanimation - neuropédiatrie [CHU Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Endothélium microcirculatoire cérébral et lésions du système nerveux central au cours du développement (Néovasc), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institute for Research and Innovation in Biomedicine (IRIB), Normandie Université (NU)-Normandie Université (NU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Neonatal Intensive Care Unit (NICU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Robert Debré, Service Pédiatrie, Hôpital Saint-Jacques-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Unité d'Epidémiologie et Recherche Clinique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Néonatalogie, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve, Service Pédiatrique, Hôpital du Bocage, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service de Médecine Néonatale, Université de Nantes (UN), CIC - Nantes, Université de Nantes (UN)-IFR26-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de Recherche Epidémiologique sur la Qualité des Soins, Université de Lille, Droit et Santé, EPIPAGE study group, Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service Epidémiologie clinique et santé publique [CHU Toulouse], Pôle Santé publique et médecine publique [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de pédiatrie [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service de pédiatrie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Debs, Nayla, Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants ( UMR_S 953 ), Université Paris-Sud - Paris 11 ( UP11 ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Épidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps, Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service de pédiatrie néonatale et réanimation - neuropédiatrie [Rouen], CHU Rouen-Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ) -Hôpital Charles Nicolle [Rouen], Endothélium microcirculatoire cérébral et lésions du système nerveux central au cours du développement ( Néovasc ), Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ) -Institute for Research and Innovation in Biomedicine ( IRIB ), Normandie Université ( NU ) -Normandie Université ( NU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Neonatal Intensive Care Unit ( NICU ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Robert Debré, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université de Franche-Comté ( UFC ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Beaujon, Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Hôpital Arnaud de Villeneuve, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ) -Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ) -Centre Hospitalier de Poissy Saint-Germain (CHIPS), Université de Nantes ( UN ), and Université de Nantes ( UN ) -IFR26-Institut National de la Santé et de la Recherche Médicale ( INSERM )

Subjects
Male, Pediatrics, MESH : Infant, Premature, Diseases, Developmental Disabilities, Infant, Premature, Diseases, Neuropsychological Tests, MESH : Child, Preschool, MESH : Cerebral Palsy, Cohort Studies, 0302 clinical medicine, MESH : Cross-Sectional Studies, Risk Factors, MESH: Risk Factors, MESH: Gestational Age, Infant, Very Low Birth Weight, MESH : Female, MESH: Infant, Very Low Birth Weight, 030212 general & internal medicine, Longitudinal Studies, MESH : Infant, Very Low Birth Weight, MESH : Infectious Disease Transmission, Vertical, MESH: Longitudinal Studies, MESH: Sepsis, MESH: Cohort Studies, MESH : Longitudinal Studies, education.field_of_study, Cross Infection, MESH: Infant, Newborn, neurodevelopmental outcome, MESH : Infant, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Neuropsychological Tests, MESH : Risk Factors, MESH: Infant, MESH: Infant, Premature, Diseases, 3. Good health, MESH : Neuropsychological Tests, MESH: Infectious Disease Transmission, Vertical, population-based study, Child, Preschool, Cohort, Gestation, Female, MESH : Sepsis, France, MESH : Cross Infection, Cohort study, medicine.medical_specialty, MESH: Cerebral Palsy, MESH : Male, Population, MESH : Cohort Studies, Gestational Age, MESH : Infant, Newborn, MESH : Developmental Disabilities, Cerebral palsy, 03 medical and health sciences, MESH : Cognition Disorders, MESH: Cross-Sectional Studies, 030225 pediatrics, Sepsis, medicine, cohort study, Humans, neonatal infection, very preterm infants, education, MESH : France, MESH: Humans, business.industry, Cerebral Palsy, MESH : Humans, MESH: Child, Preschool, Infant, Newborn, Infant, MESH: Cross Infection, Odds ratio, medicine.disease, Confidence interval, Infectious Disease Transmission, Vertical, MESH: Male, MESH: France, Neonatal infection, MESH: Cognition Disorders, Cross-Sectional Studies, MESH: Developmental Disabilities, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Pediatrics, Perinatology and Child Health, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Cognition Disorders, MESH: Female, MESH : Gestational Age
Abstract

OBJECTIVE:To determine whether neonatal infections are associated with a higher risk of adverse neurodevelopment at 5 years of age in a population-based cohort of very preterm children.METHODS:We included all live births between 22 and 32 weeks of gestation, from 9 regions in France, in 1997 (EPIPAGE study). Of the 2665 live births, 2277 were eligible for a follow-up evaluation at 5 years of age: 1769 had a medical examination and 1495 underwent cognitive assessment. Cerebral palsy and cognitive impairment were studied as a function of early-onset sepsis (EOS) and late-onset sepsis (LOS), after adjustment for potential confounding factors, in multivariate logistic regression models.RESULTS:A total of 139 (5%) of the 2665 live births included in the study presented with EOS alone (without associated LOS), 752 (28%) had LOS alone (without associated EOS), and 64 (2%) displayed both EOS and LOS. At 5 years of age, the frequency of cerebral palsy was 9% (157 of 1769) and that of cognitive impairment was 12% (177 of 1495). The frequency of cerebral palsy was higher in infants with isolated EOS (odds ratio [OR]: 1.70 [95% confidence interval (CI): 0.84−3.45]) or isolated LOS (OR: 1.71 [95% CI: 1.14−2.56]) than in uninfected infants, and this risk was even higher in cases of combined EOS and LOS (OR: 2.33 [95% CI: 1.02−5.33]). There was no association between neonatal infection and cognitive impairment.CONCLUSIONS:Neonatal infections in these very preterm infants were associated with a higher risk of cerebral palsy at the age of 5 years, particularly in infants presenting with both EOS and LOS.

Published
2013
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5. VIP-induced neuroprotection of the developing brain

Author

Pierre Gressens, Paulina Sokolowska, Leslie Schwendimann, Sandrine Passemard, Gressens, Pierre, Physiopathologie, conséquences fonctionnelles et neuroprotection des atteintes du cerveau en développement, Université Paris Diderot - Paris 7 (UPD7)-IFR2-Institut National de la Santé et de la Recherche Médicale (INSERM), PremUp Foundation, Institut de Recherche pour le Développement (IRD)-Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Diderot - Paris 7 (UPD7)-CHI Créteil-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Réanimation et Pédiatrie Néonatales, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Robert Debré-Centre de référence Maladies Métaboliques, Unité fonctionnelle de génétique clinique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Robert Debré-Université Paris Diderot - Paris 7 (UPD7), Institute for Medical Biology, Polska Akademia Nauk = Polish Academy of Sciences (PAN), Institute for Reproductive and Developmental Biology, Imperial College London-Hammersmith campus, Université Paris Diderot - Paris 7 ( UPD7 ) -IFR2-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut de Recherche pour le Développement ( IRD ) -Université Paris-Sud - Paris 11 ( UP11 ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris Diderot - Paris 7 ( UPD7 ) -CHI Créteil-Université Paris Descartes - Paris 5 ( UPD5 ) -Sorbonne Universités-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Robert Debré-Centre de référence Maladies Métaboliques, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Robert Debré-Université Paris Diderot - Paris 7 ( UPD7 ), Polska Akademia Nauk ( PAN ), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Descartes - Paris 5 (UPD5)-CHI Créteil-Institut de Recherche pour le Développement (IRD)-Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Diderot - Paris 7 (UPD7)

Subjects
MESH: Signal Transduction, Vasoactive intestinal peptide, Excitotoxicity, medicine.disease_cause, MESH : Cerebral Palsy, 0302 clinical medicine, Drug Discovery, MESH : Neuroprotective Agents, MESH : Neuronal Plasticity, MESH: Animals, MESH: Neuronal Plasticity, 0303 health sciences, Neuronal Plasticity, MESH: Vasoactive Intestinal Peptide, Brain, MESH: Receptors, Vasoactive Intestinal Peptide, Type II, MESH: Neuroprotective Agents, medicine.anatomical_structure, Neuroprotective Agents, Receptors, Vasoactive Intestinal Peptide, Type II, neuroprotection, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], VPAC receptor, Signal transduction, medicine.symptom, excitotoxicity, hormones, hormone substitutes, and hormone antagonists, Signal Transduction, Vasoactive Intestinal Peptide, medicine.medical_specialty, MESH: Cerebral Palsy, Brain damage, Biology, Neuroprotection, Article, preterm infant, White matter, 03 medical and health sciences, MESH: Brain, Internal medicine, Neuroplasticity, medicine, Animals, Humans, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], 030304 developmental biology, MESH : Signal Transduction, Pharmacology, MESH: Humans, Cerebral Palsy, MESH : Humans, Hyperintensity, MESH : Receptors, Vasoactive Intestinal Peptide, Type II, NAP, Endocrinology, MESH : Brain, [ SDV.NEU ] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], plasticity, MESH : Animals, MESH : Vasoactive Intestinal Peptide, Neuroscience, 030217 neurology & neurosurgery
Abstract

International audience; Excitotoxicity is a key molecular mechanism of perinatal brain damage and is associated with cerebral palsy and long term cognitive deficits. VIP induces a potent neuroprotection against perinatal excitotoxic white matter damage. VIP does not prevent the initial appearance of white matter lesion but promotes a secondary repair with axonal regrowth. This plasticity mechanism involves an atypical VPAC2 receptor and BDNF production. Stable VIP agonists mimic VIP effects when given systemically and exhibit a large therapeutic window. Unraveling cellular and molecular targets of VIP effects against perinatal white matter lesions could provide a more general rationale to understand the neuroprotection of the developing white matter against excitotoxic insults.

Published
2011

6. Bilateral pallidal deep brain stimulation for the treatment of patients with dystonia-choreoathetosis cerebral palsy: a prospective pilot study

Author

Vidailhet, Marie, Yelnik, Jerome, Lagrange, Christelle, Fraix, Valerie, Grabli, David, Thobois, Stephane, Burbaud, Pierre, Welter, Marie-Laure, Xie-Brustolin, Jin, Braga, Maria-Clara Coelho, Ardouin, Claire, Czernecki, Virginie, Klinger, Hélène, Chabardes, Stephan, Seigneuret, Eric, Mertens, Patrick, Cuny, Emmanuel, Navarro, Soledad, Cornu, Philippe, Benabid, Alim-Louis, Le Bas, Jean-Francois, Dormont, Didier, Hermier, Marc, Dujardin, Kathy, Blond, Serge, Krystkowiak, Pierre, Destée, Alain, Bardinet, Eric, Agid, Yves, Krack, Paul, Broussolle, Emmanuel, Pollak, Pierre, Renseigné, Non, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (CRICM), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), CIC AP-HP (pitie-Salpetriere)/inserm, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), UM des troubles du mouvement, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de neurologie, Service de Neurochirurgie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Institut des sciences cognitives Marc Jeannerod - Centre de neuroscience cognitive - UMR5229 (CNC), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Physiologie et physiopathologie de la signalisation cellulaire (PPSC), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-CHU Bordeaux [Bordeaux]-Centre National de la Recherche Scientifique (CNRS), Département de Neurologie [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-IFR70-CHU Pitié-Salpêtrière [APHP], Service de neurologie, Hospices Civils de Lyon (HCL)-Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL), Centre De Référence National 'Syndrome Gilles de la Tourette', Pôle des Maladies du Système Nerveux [CHU Pitié-Salpêtrière], Service de neurologie C [Hôpital Pierre Wertheimer - HCL], Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Université de Lyon, Département de neurochirurgie, Service de Neurochirurgie [Hopital Pierre Wertheimer - HCL], Laboratoire d'Electronique et des Technologies de l'Information (CEA-LETI), Direction de Recherche Technologique (CEA) (DRT (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Grenoble Alpes (UGA), RMN biomédicale : de la cellule à l'homme (RBCH), Université Pierre Mendès France - Grenoble 2 (UPMF)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-DIR CENTRALE DU SSA-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de neuro-radiologie [CHU Pitié-Salpêtrière], Equipe NEMESIS - Centre de Recherches de l'Institut du Cerveau et de la Moelle épinière (NEMESIS-CRICM), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Service de neuroradiologie, Neurology, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer (JPArc - U837 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université Lille 2 - Faculté de Médecine, Service de neurologie [Amiens], CHU Amiens-Picardie, Département de neurologie[Lille], Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre de Neuro-Imagerie de Recherche (CENIR), Fédération des Maladies du Système Nerveux, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Neurologie [CHU Pitié-Salpêtrière], IFR70-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Commissariat à l'énergie atomique et aux énergies alternatives - Laboratoire d'Electronique et de Technologie de l'Information (CEA-LETI), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Service de Neuroradiologie [CHU Pitié-Salpêtrière], Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de neuroradiologie [Lyon], Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U1172 Inserm - U837 (JPArc), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Lille Nord de France (COMUE)-Université de Lille, Fédération de neurologie 4, Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-CHU Bordeaux [Bordeaux]-Centre National de la Recherche Scientifique (CNRS), Département de neurologie [Lille], Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de neurochirurgie générale et stéréotaxique fonctionnelle, Hôpital Roger Salengro [Lille]-Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), PHRC National - Cerebral Palsy Foundation - Fondation Motrice/APETREIMC- INSERM - Dystonia national Network - Medtronic, Issartel, Jean-Paul, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut des sciences cognitives Marc Jeannerod - Centre de neuroscience cognitive - UMR5229 (ISC-MJ), Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U837 (JPArc), Université Lille Nord de France (COMUE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Center for NeuroImaging Research-Human MRI Neuroimaging core facility for clinical research [ICM Paris] (CENIR), Institut du Cerveau = Paris Brain Institute (ICM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Laboratoire Creatis, Compte Général, Centre de Recherche et d'Application en Traitement de l'Image et du Signal (CREATIS), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-École Supérieure Chimie Physique Électronique de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-École Supérieure Chimie Physique Électronique de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, MESH: Globus Pallidus, MESH: Dystonia, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, medicine.medical_treatment, [INFO.INFO-IM] Computer Science [cs]/Medical Imaging, Choreoathetosis, Pilot Projects, Athetosis/complications/*therapy, Severity of Illness Index, Functional Laterality, Magnetic Resonance Imaging/methods, MESH: Magnetic Resonance Imaging, MESH: Basal Ganglia, Disability Evaluation, MESH: Athetosis, Dystonia/complications/*therapy, 0302 clinical medicine, [INFO.INFO-TS]Computer Science [cs]/Signal and Image Processing, Cerebral Palsy/complications/*therapy, Basal ganglia, Prospective Studies, Basal Ganglia/pathology, Dystonia, 0303 health sciences, MESH: Statistics, Nonparametric, Chorea/complications/*therapy, MESH: Disability Evaluation, [PHYS.MECA.ACOU]Physics [physics]/Mechanics [physics]/Acoustics [physics.class-ph], 3. Good health, [INFO.INFO-TI] Computer Science [cs]/Image Processing [eess.IV], MESH: Young Adult, [INFO.INFO-TI]Computer Science [cs]/Image Processing [eess.IV], [PHYS.PHYS.PHYS-MED-PH]Physics [physics]/Physics [physics]/Medical Physics [physics.med-ph], Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], medicine.symptom, [PHYS.MECA.ACOU] Physics [physics]/Mechanics [physics]/Acoustics [physics.class-ph], Psychology, [SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing, Adult, Deep Brain Stimulation/*methods, medicine.medical_specialty, Deep brain stimulation, MESH: Cerebral Palsy, [INFO.INFO-TS] Computer Science [cs]/Signal and Image Processing, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, Statistics, Nonparametric, [SDV.IB.MN] Life Sciences [q-bio]/Bioengineering/Nuclear medicine, Cerebral palsy, Young Adult, 03 medical and health sciences, Physical medicine and rehabilitation, MESH: Severity of Illness Index, Severity of illness, medicine, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Humans, Spasticity, MESH: Functional Laterality, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Neurostimulation, [SPI.SIGNAL] Engineering Sciences [physics]/Signal and Image processing, 030304 developmental biology, Globus Pallidus/*physiology, [SPI.ACOU]Engineering Sciences [physics]/Acoustics [physics.class-ph], [SDV.IB] Life Sciences [q-bio]/Bioengineering, [SPI.ACOU] Engineering Sciences [physics]/Acoustics [physics.class-ph], [PHYS.PHYS.PHYS-MED-PH] Physics [physics]/Physics [physics]/Medical Physics [physics.med-ph], MESH: Chorea, MESH: Humans, MESH: Adult, medicine.disease, MESH: Pilot Projects, MESH: Male, MESH: Prospective Studies, ddc:616.8, nervous system diseases, [SDV.IB.IMA] Life Sciences [q-bio]/Bioengineering/Imaging, Physical therapy, Neurology (clinical), MESH: Deep Brain Stimulation, MESH: Female, 030217 neurology & neurosurgery
Abstract

International audience; BACKGROUND: Cerebral palsy (CP) with dystonia-choreoathetosis is a common cause of disability in children and in adults, and responds poorly to medical treatment. Bilateral pallidal deep brain stimulation (BP-DBS) of the globus pallidus internus (GPi) is an effective treatment for primary dystonia, but the effect of this reversible surgical procedure on dystonia-choreoathetosis CP, which is a subtype of secondary dystonia, is unknown. Our aim was to test the effectiveness of BP-DBS in adults with dystonia-choreoathetosis CP. METHODS: We did a multicentre prospective pilot study of BP-DBS in 13 adults with dystonia-choreoathetosis CP who had no cognitive impairment, little spasticity, and only slight abnormalities of the basal ganglia on MRI. The primary endpoint was change in the severity of dystonia-choreoathetosis after 1 year of neurostimulation, as assessed with the Burke-Fahn-Marsden dystonia rating scale. The accuracy of surgical targeting to the GPi was assessed masked to the results of neurostimulation. Analysis was by intention to treat. FINDINGS: The mean Burke-Fahn-Marsden dystonia rating scale movement score improved from 44.2 (SD 21.1) before surgery to 34.7 (21.9) at 1 year post-operatively (p=0.009; mean improvement 24.4 [21.1]%, 95% CI 11.6-37.1). Functional disability, pain, and mental health-related quality of life were significantly improved. There was no worsening of cognition or mood. Adverse events were related to stimulation (arrest of the stimulator in one patient, and an adjustment to the current intensity in four patients). The optimum therapeutic target was the posterolateroventral region of the GPi. Little improvement was seen when the neurostimulation diffused to adjacent structures (mainly to the globus pallidus externus [GPe]). INTERPRETATION: Bilateral pallidal neurostimulation could be an effective treatment option for patients with dystonia-choreoathetosis CP. However, given the heterogeneity of motor outcomes and the small sample size, results should be interpreted with caution. The optimum placement of the leads seemed to be a crucial, but not exclusive, factor that could affect a good outcome. FUNDING: National PHRC; Cerebral Palsy Foundation: Fondation Motrice/APETREIMC; French INSERM Dystonia National Network; Medtronic.

Published
2009
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7. Psychological problems in children with cerebral palsy: a cross-sectional European study

Author

Jérôme Fauconnier, Susan Ishøy Michelsen, Marco Marcelli, Heather O Dickinson, Melanie White-Koning, Vicki McManus, Kathryn Parkinson, Jackie Parkes, Ute Thyen, Eva Beckung, Allan Colver, Catherine Arnaud, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), Financement européen, and SPARCLE

Subjects
Male, Pediatrics, Cross-sectional study, MESH: Sick Role, MESH: Comorbidity, Comorbidity, Personality Assessment, Social Environment, Disability Evaluation, MESH: Health Surveys, 0302 clinical medicine, Quality of life, Mental Retardation, MESH: Risk Factors, Risk Factors, MESH: Mental Retardation, MESH: Child, Developmental and Educational Psychology, Child, Referral and Consultation, MESH: Social Environment, MESH: Child Behavior Disorders, Intelligence quotient, MESH: Disability Evaluation, Sick Role, Europe, Psychiatry and Mental health, Female, MESH: Pain, Psychology, Social Adjustment, medicine.medical_specialty, MESH: Cerebral Palsy, Pain, Child Behavior Disorders, MESH: Personality Assessment, Peer Group, Cerebral palsy, MESH: Referral and Consultation, 03 medical and health sciences, MESH: Cross-Sectional Studies, Intellectual Disability, 030225 pediatrics, medicine, Humans, Affective Symptoms, Sibling, Psychiatry, MESH: Affective Symptoms, MESH: Humans, Cerebral Palsy, Siblings, MESH: Peer Group, Social environment, Odds ratio, medicine.disease, MESH: Social Adjustment, Health Surveys, MESH: Male, MESH: Siblings, Cross-Sectional Studies, Pediatrics, Perinatology and Child Health, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Europe, MESH: Female, 030217 neurology & neurosurgery
Abstract

Udgivelsesdato: 2008-Apr OBJECTIVES: To describe psychological symptoms in 8-12-year-old children with cerebral palsy; to investigate predictors of these symptoms and their impact on the child and family. DESIGN: A cross-sectional multi-centre survey. PARTICIPANTS: Eight hundred and eighteen children with cerebral palsy, aged 8-12 years, identified from population-based registers of cerebral palsy in eight European regions and from multiple sources in one further region. MAIN OUTCOME MEASURES: The Strengths and Difficulties Questionnaire (SDQ)(P4-16) and the Total Difficulties Score (TDS) dichotomised into normal/borderline (TDS < or = 16) versus abnormal (TDS > 16). STATISTICAL ANALYSIS: Multilevel, multivariable logistic regression to relate the presence of psychological symptoms to child and family characteristics. RESULTS: About a quarter of the children had TDS > 16 indicating significant psychological symptoms, most commonly in the domain Peer Problems. Better gross motor function, poorer intellect, more pain, having a disabled or ill sibling and living in a town were independently associated with TDS > 16. The risk of TDS > 16 was odds ratio (OR) = .2 (95% CI: .1 to .3) comparing children with the most and least severe functional limitations; OR = 3.2 (95%CI: 2.1 to 4.8) comparing children with IQ < 70 and others; OR = 2.7 (95% CI: 1.5 to 4.6) comparing children in severe pain and others; OR = 2.7 (95% CI:1.6 to 4.6) comparing children with another disabled sibling or OR = 1.8 (95%CI: 1.2 to 2.8) no siblings and others; OR = 1.8 (95% CI: 1.1 to 2.8) comparing children resident in a town and others. Among parents who reported their child to have psychological problems, 95% said they had lasted over a year, 37% said they distressed their child and 42% said they burdened the family at least 'quite a lot'. CONCLUSIONS: A significant proportion of children with cerebral palsy have psychological symptoms or social impairment sufficiently severe to warrant referral to specialist services. Care must be taken in the assessment and management of children with cerebral palsy to ensure psychological problems are not overlooked and potentially preventable risk factors like pain are treated effectively. The validity of the SDQ for children with severe disability warrants further assessment.

Published
2008
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8. Parent-reported quality of life of children with cerebral palsy in Europe

Author

Susan Ishøy Michelsen, Eva Beckung, Allan Colver, Ute Thyen, Melanie White-Koning, Jackie Parkes, Jérôme Fauconnier, Marco Marcelli, Heather O Dickinson, Vicki McManus, Kathryn Parkinson, Catherine Arnaud, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), Financement européen, and SPARCLE

Subjects
Questionnaires, Male, Pediatrics, Cross-sectional study, Developmental Disabilities, MESH: Logistic Models, Severity of Illness Index, MESH: Linear Models, 0302 clinical medicine, Social Desirability, MESH: Child, Sickness Impact Profile, Surveys and Questionnaires, Adaptation, Psychological, Parent-Child Relations, Child, 4. Education, Gross Motor Function Classification System, Adaptation, Physiological, Disabled Children, Europe, MESH: Sickness Impact Profile, Female, Psychosocial, Clinical psychology, MESH: Parent-Child Relations, medicine.medical_specialty, MESH: Cerebral Palsy, MESH: Social Support, Cerebral palsy, 03 medical and health sciences, Social support, MESH: Cross-Sectional Studies, Quality of life (healthcare), MESH: Social Desirability, MESH: Severity of Illness Index, 030225 pediatrics, Severity of illness, medicine, MESH: Adaptation, Psychological, Humans, MESH: Humans, business.industry, MESH: Questionnaires, Cerebral Palsy, MESH: Quality of Life, Social Support, medicine.disease, MESH: Adaptation, Physiological, MESH: Male, Cross-Sectional Studies, Logistic Models, MESH: Developmental Disabilities, El Niño, MESH: Disabled Children, Pediatrics, Perinatology and Child Health, Linear Models, Quality of Life, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Europe, business, MESH: Female, 030217 neurology & neurosurgery
Abstract

OBJECTIVE. The goal was to determine whether the type and severity of the child's impairments and the family's psychosocial, social, and economic characteristics influence parent-reported child quality of life across the spectrum of severity of cerebral palsy. METHODS. Our population-based, cross-sectional survey conducted in 2004 to 2005 involved 818 children with cerebral palsy, 8 to 12 years of age, from 7 countries (9 regions) in Europe. Child quality of life was assessed through parent reports by using the Kidscreen questionnaire, and data were analyzed separately for each of its 10 domains. RESULTS. The parental response rates were >93% for all domains except one. Gross motor function and IQ level were found to be associated independently with quality of life in most domains. However, greater severity of impairment was not always associated with poorer quality of life; in the moods and emotions, self-perception, social acceptance, and school environment domains, less severely impaired children were more likely to have poor quality of life. Pain was associated with poor quality of life in the physical and psychological well-being and self-perception domains. Parents with higher levels of stress were more likely to report poor quality of life in all domains, which suggests that factors other than the severity of the child's impairment may influence the way in which parents report quality of life. CONCLUSIONS. The parent-reported quality of life for children with cerebral palsy is associated strongly with impairment. However, depending on the areas of life, the most severely impaired children (in terms of motor functioning or intellectual ability) do not always have the poorest quality of life.

Published
2008
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9. Determinants of child-parent agreement in quality-of-life reports:A European study of children with cerebral palsy

Author

Jérôme Fauconnier, Ute Thyen, Giorgio Schirripa, Melanie White-Koning, Jackie Parkes, Susan Ishøy Michelsen, Eva Beckung, Allan Colver, Catherine Arnaud, Vicki McManus, Kathryn Parkinson, Heather O Dickinson, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), Financement européen, and SPARCLE

Subjects
Male, Parents, Questionnaires, Pediatrics, Multivariate analysis, Intelligence, 0302 clinical medicine, MESH: Communication Disorders, Social Desirability, Surveys and Questionnaires, MESH: Child, Proxy report, 030212 general & internal medicine, Parent-Child Relations, Proxy (statistics), Child, media_common, Age Factors, MESH: Stress, Psychological, Europe, Communication Disorders, Income, Female, MESH: Pain, Clinical psychology, medicine.medical_specialty, MESH: Parent-Child Relations, MESH: Cerebral Palsy, Adolescent, media_common.quotation_subject, MESH: Social Support, Pain, MESH: Multivariate Analysis, Cerebral palsy, 03 medical and health sciences, Social support, Quality of life (healthcare), MESH: Social Desirability, 030225 pediatrics, Perception, medicine, Humans, MESH: Intelligence, Socioeconomic status, MESH: Adolescent, MESH: Age Factors, MESH: Parents, MESH: Humans, business.industry, MESH: Questionnaires, Cerebral Palsy, MESH: Quality of Life, Social Support, MESH: Income, medicine.disease, MESH: Male, Pediatrics, Perinatology and Child Health, Multivariate Analysis, Quality of Life, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Europe, business, MESH: Female, Stress, Psychological
Abstract

OBJECTIVES. The differences between child self-reports and parent proxy reports of quality of life in a large population of children with cerebral palsy were studied. We examined whether child characteristics, severity of impairment, socioeconomic factors, and parental stress were associated with parent proxy reports being respectively higher or lower than child self-reports of quality of life. METHODS. This study was conducted in 2004–2005 and assessed child quality of life (using the Kidscreen questionnaire, 10 domains, each scored 0–100) through self-reports and parent proxy reports of 500 children aged 8 to 12 years who had cerebral palsy and were living in 7 countries in Europe. RESULTS. The mean child-reported scores of quality of life were significantly higher than the parent proxy reports in 8 domains, significantly lower for the finances domain, and similar for the emotions domain. The average frequency of disagreement (child-parent difference greater than half an SD of child scores) over all domains was 64%, with parents rating their child's quality of life lower than the children themselves in 29% to 57% of child-parent pairs. We found that high levels of stress in parenting negatively influenced parents’ perception of their child's quality of life, whereas the main factor explaining parents’ ratings of children's quality of life higher than the children themselves is self-reported severe child pain. CONCLUSIONS. This study shows that the factors associated with disagreement are different according to the direction of disagreement. In particular, parental well-being and child pain should be taken into account in the interpretation of parent proxy reports, especially when no child self-report of quality of life is available. In the latter cases, it may be advisable to obtain additional proxy reports (from caregivers, teachers, or clinicians) to obtain complementary information on the child's quality of life.

Published
2007
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10. Self-reported quality of life of 8-12-year-old children with cerebral palsy: a cross-sectional European study

Author

Catherine Arnaud, Jackie Parkes, Kathryn Parkinson, Giorgio Schirripa, Jérôme Fauconnier, Ute Thyen, Susan Ishøy Michelsen, Eva Beckung, Allan Colver, Ulrike Ravens-Sieberer, Heather O Dickinson, Vicki McManus, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), Financement européen, and SPARCLE

Subjects
Questionnaires, Male, Pediatrics, Cross-sectional study, Severity of Illness Index, 0302 clinical medicine, Quality of life, Surveys and Questionnaires, MESH: Child, Child, 10. No inequality, education.field_of_study, 4. Education, General Medicine, humanities, Europe, Female, MESH: Pain, Clinical psychology, medicine.medical_specialty, MESH: Cerebral Palsy, Population, MESH: Social Support, Pain, Cerebral palsy, MESH: Social Class, 03 medical and health sciences, Social support, MESH: Cross-Sectional Studies, 030225 pediatrics, MESH: Severity of Illness Index, Severity of illness, medicine, Humans, education, MESH: Humans, business.industry, Cerebral Palsy, Public health, MESH: Questionnaires, Social Support, MESH: Quality of Life, medicine.disease, MESH: Male, Cross-Sectional Studies, Social Class, El Niño, Quality of Life, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Europe, business, MESH: Female, 030217 neurology & neurosurgery
Abstract

Udgivelsesdato: 2007-Jun-30 BACKGROUND: Little is known about the quality of life (QoL) of disabled children. We describe self-reported QoL of children with cerebral palsy, factors that influence it, and how it compares with QoL of the general population. METHODS: 1174 children aged 8-12 years were randomly selected from eight population-based registers of children with cerebral palsy in six European countries and 743 (63%) agreed to participate; one further region recruited 75 children from multiple sources. Researchers visited these 818 children. 318 (39%) with severe intellectual impairment could not self-report; 500 (61%) reported their QoL using KIDSCREEN, an instrument with scores in ten domains, each with SD=10. Multivariable regression was used to relate QoL to impairments, pain, and sociodemographic characteristics. Comparisons were made with QoL data from the general population. FINDINGS: Impairments were not significantly associated with six KIDSCREEN domains. Comparison of least and most able groups showed that severely limited self-mobility was significantly associated with reduced mean score for physical wellbeing (7.6, 95% CI 2.7-12.4); intellectual impairment with reduced mean for moods and emotions (3.7, 1.5-5.9) and autonomy (3.3, 0.9-5.7); and speech difficulties with reduced mean for relationships with parents (4.5, 1.9-7.1). Pain was common and associated with lower QoL on all domains. Impairments and pain explained up to 3% and 7%, respectively, of variation in QoL. Children with cerebral palsy had similar QoL to children in the general population in all domains except schooling, in which evidence was equivocal, and physical wellbeing, in which comparison was not possible. INTERPRETATION: Parents can be reassured that most children aged 8-12 years with cerebral palsy will have similar QoL to other children. This finding should guide social and educational policy to ensure that disabled children participate fully in society. Because of its association with QoL, children's pain should be carefully assessed.

Published
2007
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11. Assessment of data quality in a multi-centre cross-sectional study of participation and quality of life of children with cerebral palsy

Author

Vicki McManus, Ute Thyen, Susan Ishøy Michelsen, Giorgio Schirripa, Jérôme Fauconnier, Jacqueline Parkes, Catherine Arnaud, Heather O Dickinson, Kathryn Parkinson, Eva Beckung, Allan Colver, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), Financement européen, and SPARCLE

Subjects
Male, Questionnaires, Research design, MESH: Registries, Psychometrics, Cross-sectional study, MESH: Logistic Models, Walking, Social Environment, 0302 clinical medicine, Quality of life, Surveys and Questionnaires, Sickness Impact Profile, MESH: Child, Registries, Child, 10. No inequality, MESH: Social Environment, education.field_of_study, lcsh:Public aspects of medicine, MESH: Research Design, MESH: Bias (Epidemiology), Disabled Children, Europe, MESH: Sickness Impact Profile, Research Design, Bias (Epidemiology), Female, Research Article, medicine.medical_specialty, MESH: Cerebral Palsy, MESH: Social Support, Population, Cerebral palsy, 03 medical and health sciences, Social support, MESH: Cross-Sectional Studies, Bias, MESH: Psychometrics, SDG 3 - Good Health and Well-being, 030225 pediatrics, medicine, Humans, MESH: Walking, Family, Psychiatry, education, MESH: Family, MESH: Humans, business.industry, Cerebral Palsy, MESH: Questionnaires, Public Health, Environmental and Occupational Health, Social Support, MESH: Quality of Life, lcsh:RA1-1270, medicine.disease, MESH: Male, Cross-Sectional Studies, Logistic Models, MESH: Disabled Children, Quality of Life, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Europe, Biostatistics, business, MESH: Female, 030217 neurology & neurosurgery, Demography
Abstract

Background SPARCLE is a cross-sectional survey in nine European regions, examining the relationship of the environment of children with cerebral palsy to their participation and quality of life. The objective of this report is to assess data quality, in particular heterogeneity between regions, family and item non-response and potential for bias. Methods 1,174 children aged 8–12 years were selected from eight population-based registers of children with cerebral palsy; one further centre recruited 75 children from multiple sources. Families were visited by trained researchers who administered psychometric questionnaires. Logistic regression was used to assess factors related to family non-response and self-completion of questionnaires by children. Results 431/1,174 (37%) families identified from registers did not respond: 146 (12%) were not traced; of the 1,028 traced families, 250 (24%) declined to participate and 35 (3%) were not approached. Families whose disabled children could walk unaided were more likely to decline to participate. 818 children entered the study of which 500 (61%) self-reported their quality of life; children with low IQ, seizures or inability to walk were less likely to self-report. There was substantial heterogeneity between regions in response rates and socio-demographic characteristics of families but not in age or gender of children. Item non-response was 2% for children and ranged from 0.4% to 5% for questionnaires completed by parents. Conclusion While the proportion of untraced families was higher than in similar surveys, the refusal rate was comparable. To reduce bias, all analyses should allow for region, walking ability, age and socio-demographic characteristics. The 75 children in the region without a population based register are unlikely to introduce bias.

Published
2006
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12. Case gender and severity in cerebral palsy varies with intrauterine growth

Author

Jarvis, S, Glinianaia, S, Arnaud, C, Fauconnier, J, Johnson, A, McManus, V, Topp, M, Uvebrant, P, Cans, C, Krageloh-Mann, I, on, b, Institute of Health and Society, Newcastle University [Newcastle], Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), Financement européen, and SPARCLE

Subjects
Male, Pediatrics, Walking, Severity of Illness Index, Cohort Studies, Fetal Development, Disability Evaluation, 0302 clinical medicine, MESH: Gestational Age, Odds Ratio, Birth Weight, MESH: Cohort Studies, Fetal Growth Retardation, MESH: Disability Evaluation, Gestational age, 3. Good health, Child, Preschool, Original Article, Female, MESH: Fetal Development, Cohort study, medicine.medical_specialty, MESH: Cerebral Palsy, Birth weight, MESH: Fetal Growth Retardation, Gestational Age, Cerebral palsy, MESH: Sex Ratio, 03 medical and health sciences, 030225 pediatrics, MESH: Severity of Illness Index, Severity of illness, medicine, Humans, MESH: Walking, Sex Ratio, Risk factor, MESH: Birth Weight, Pregnancy, MESH: Humans, business.industry, Cerebral Palsy, MESH: Child, Preschool, Odds ratio, medicine.disease, MESH: Male, MESH: Odds Ratio, MESH: Cognition Disorders, Pediatrics, Perinatology and Child Health, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Cognition Disorders, business, MESH: Female, 030217 neurology & neurosurgery
Abstract

Background: There is an unexplained excess of cerebral palsy among male babies. There is also variation in the proportion of more severe cases by birth weight. It has recently been shown that the rate of cerebral palsy increases as intrauterine size deviates up or down from an optimum about one standard deviation heavier than population mean weight-for-gestation. Aims: To determine whether the gender ratio or the severity of cases also varies with intrauterine size. Methods: A total of 3454 cases of cerebral palsy among single births between 1976 and 1990 with sufficient data to assign case severity (based on intellectual impairment and walking ability) and to compare weight-for-gestation at birth to sex specific fetal growth standards, were aggregated from nine separate registers in five European countries. Results: The greater the degree to which growth deviates either up or down from optimal weight-for-gestation at birth, the higher is the rate of cerebral palsy, the larger is the proportion of male cases, and the more severe is the functional disability. Compared to those with optimum growth the risk of more severe cerebral palsy in male babies is 16 times higher for those with a birth weight below the 3rd centile and four times higher when birth weight is above the 97th centile. In contrast, for mild cerebral palsy in female babies the excess risks at these growth extremes are about half these magnitudes. Conclusions: Among singleton children with cerebral palsy, abnormal intrauterine size, either small or large, is associated with more severe disability and male sex.

Published
2005
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