Неврология, нейропсихиатрия, психосоматика (May 2014)
Childhood dysphasias in patients with late sequelae of perinatal central nervous system lesion
Abstract
The aim of the study was to explore condition of the nervous system in different types of childhood dysphasia (CD), to compare the brain bio-electric activity to the level of cerebral blood flow, severity of neurological disorders, and neuropsychophysiological parameters, to identify the intact links of brain organization in children with minimal brain dysfunction (MBD), sensorineural hearing loss (SNHL), and spastic forms of infantile cerebral palsy (ICP). Patients and methods. 505 Children aged 4–8 years were examined: 218 with MBD, 73 with SNL, and 214 with spastic forms of ICP. The patients were divided into two groups: preschool age, 4–6 years (110 children with MBD, 29 with SNHL, and 116 with ICP) and early school age, 7–8 years (108 children with MBD, 44 with SNHL, and 98 with ICP). The group of preschool age children with spastic forms of ICP comprised 42 children with double hemiplegia (DHP), 36 with spastic hemiplegia (SHP), and 38 with spastic diplegia (SDP). The early school age group comprised 32 children with DHP, 37 with SHP, and 29 with SDP. All children underwent general clinical and neurological examination, computerized electroencephalography (EEG), neuropsychophysiological and speech testing, transcranial Doppler ultrasonography, and if required, computed tomography (CT) and magnetic resonance imaging (MRI) of the brain. To clarify the mechanisms of cerebral disintegration in children with signs of epileptiform activity, in the day-time EEG recording, extended video-EEG monitoring was performed for 12–14 h with mandatory recording of nocturnal sleep. Condition of the audio-verbal sphere in children with SNL was examined using an original computer program, Speech_Audiometry.Results and discussion. The rate of the motor type CD upon MBD was demonstrated to be 77.6%; the mixed type CD predominated in children with SNHL and ICP: 82.2 and 66.2%, respectively. Upon spastic forms of ICP, a combination of CD with symptoms of dysarthria and oral dyspraxia was detected in 84% of cases. A mutually aggravating effect of the main clinical manifestations on the nature and intensity of speech development disorders was revealed, especially when a child had two or more active pathological processes in the CNS. A number of clinical-neurophysiological and neuropsychological correlations with different types and versions of CD were found, which allows one to perform computerized support of rehabilitation of these children and to develop differentiated approaches to treatment.
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