| 1. |
- Dahlseng, Magnus O, et al.
(författare)
-
Gastrostomy tube feeding of children with cerebral palsy: variation across six European countries.
- 2012
-
Ingår i: Developmental Medicine and Child Neurology. - : Wiley. - 0012-1622. ; 54:10, s. 938-944
-
Tidskriftsartikel (refereegranskat)abstract
- Aim To compare the prevalence of gastrostomy tube feeding (GTF) of children with cerebral palsy (CP) in six European countries. Method Data on 1295 children (754 males, 541 females; mean age 5y 11mo, range 11y 2mo, min 6mo, max 11y 8mo) with CP born from 1999 to 2001 were collected from geographically defined areas in six European countries; four of the areas covered the whole country. Distribution of CP was unilateral 37%, bilateral 51%, dyskinetic 8%, and ataxic 4%. Sixty children were classified in Gross Motor Function Classification System (GMFCS) levels I and II, 6 in level III and 34 in levels IV and Vas Outcome measures were GTF, age at placement, feeding difficulties and the children's height and weight for age standard deviation scores (z-scores). Results The use of GTF among all children with CP was highest in western Sweden (22%, 95% confidence interval [CI] 16-29), and lowest in Portugal (6%, 95% CI 3-10), northern England (6%, 95% CI 3-9) and in Iceland (3%, 95% CI 0-13; p<0.001). The difference between areas was greater among children in GMFCS levels IV and V (non-ambulant); in this group, lower height z-scores were more prevalent in the areas with lower prevalence of GTF. The children's age at placement of gastrostomy also varied between areas (p<0.002). Interpretation The observed differences in the use of GTF may reflect differences in access to treatment or clinical practice, or both. Our results suggest that the use of GTF may improve growth in height and weight among children with more severely affected gross motor function - the group most likely to have associated feeding difficulties.
|
|
| 2. |
- Abrahamsson, Jonas, 1954, et al.
(författare)
-
Interleukin 6, but not tumour necrosis factor-alpha, is a good predictor of severe infection in febrile neutropenic and non-neutropenic children with malignancy.
- 1997
-
Ingår i: Acta Paediatrica. - 0803-5253. ; 86:10, s. 1059-1064
-
Tidskriftsartikel (refereegranskat)abstract
- Interleukin-6 (IL6), tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) are important mediators of the inflammatory response in human infection. The aim of this study was to determine the relationship between serum levels of IL6, TNF-alpha, IFN-gamma and CRP in febrile children with malignant disease, and relate these levels to aetiology of fever, presence of neutropenia and the effect of untreated malignancy.
|
|
| 3. |
- Eek, Meta N, et al.
(författare)
-
Intrathecal baclofen in dyskinetic cerebral palsy: effects on function and activity.
- 2018
-
Ingår i: Developmental medicine and child neurology. - : Wiley. - 1469-8749 .- 0012-1622. ; 60:1, s. 94-99
-
Tidskriftsartikel (refereegranskat)abstract
- To investigate the effect of intrathecal baclofen (ITB) on function and activity in dyskinetic cerebral palsy (CP).A retrospective cohort study of records from 25 children (15 males, 10 females; mean age 10y 11mo, SD 4y 9mo). Five were classified in Gross Motor Function Classification level IV and 20 in level V. Parents were interviewed about activities in daily life, sitting, communication, pain, sleep, and gross and fine motor function. Differences before and 1 year after ITB were graded as positive, no change, or negative. Assessments of dystonia (using the Barry-Albright Dystonia Scale) and muscle tone (Ashworth Scale) were made. Joint range of motion (ROM) was measured.Both dystonia and increased muscle tone, present in all participants before ITB, decreased after (p<0.001). Passive ROM was restricted, with no difference after. Parents reported improvements in activities in daily life (p<0.001), sitting (p<0.001), communication (p<0.001), and fine motor function (p=0.013), but no change in gross motor function. Before ITB, pain and disturbed sleep were reported. There was a reduction in pain (p=0.002) and sleep improved (p=0.004) after ITB.After ITB in individuals with dyskinetic CP, improvements were found in sitting, communication, and fine motor skills. There was a reduction in dystonia and muscle tone, and pain and sleep improved.Intrathecal baclofen can affect specific aspects of functioning in dyskinetic cerebral palsy. Sitting, communication, and fine motor function improved. Dystonia and spasticity were reduced. Pain was reduced and sleep improved.
|
|
| 4. |
- Himmelmann, Kate, 1959, et al.
(författare)
-
Access to Intrathecal Baclofen Treatment for Children with Cerebral Palsy in European Countries: An SCPE Survey Reveals Important Differences.
- 2020
-
Ingår i: Neuropediatrics. - : Georg Thieme Verlag KG. - 1439-1899 .- 0174-304X. ; 51:2, s. 129-134
-
Tidskriftsartikel (refereegranskat)abstract
- The aim is to study access to intrathecal baclofen (ITB) for children with cerebral palsy (CP) in Europe, as an indicator of access to advanced care.Surveys were sent to CP registers, clinical networks, and pump manufacturers. Enquiries were made about ITB treatment in children born in 1990 to 2005 by sex, CP type, level of gross motor function classification system (GMFCS) and age at the start of treatment. Access to ITB was related to the country's gross domestic product (GDP) and % GDP spent on health.In 2011 population-based data from Sweden, Norway, England, Portugal, Slovenia, and Denmark showed that 114 (3.4%) of 3,398 children with CP were treated with ITB, varying from 0.4 to 4.7% between centers. The majority of the children were at GMFCS levels IV-V and had bilateral spastic CP. In Sweden, dyskinetic CP was the most commonly treated subtype. Boys were more often treated with ITB than girls (p=0.014). ITB was reported to be available for children with CP in 25 of 43 countries. Access to ITB was associated with a higher GDP and %GDP spent on health (p<0.01). Updated information from 2019 showed remaining differences between countries in ITB treatment and sex difference in treated children was maintained.There is a significant difference in access to ITB for children with CP across Europe. More boys than girls are treated. Access to ITB for children with CP is associated with GDP and percent of GDP spent on health in the country.
|
|
| 5. |
- Himmelmann, Kate, 1959, et al.
(författare)
-
The panorama of cerebral palsy in Sweden part XIII shows declining prevalence in birth-years 2011-2014
- 2022
-
Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 112:1, s. 124-131
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: To describe epidemiology and characteristics of cerebral palsy (CP) in western Sweden 1954-2014. Methods: Population-based study covering 105 935 live births in the area in 2011-2014. Birth characteristics, neuroimaging findings and outcome were analysed and prevalence calculated. Non-parametric methods were used for group comparisons. Results: CP was diagnosed in 192 children. Crude prevalence had decreased to 1.81 per 1000 live births (p = 0.0067). Gestational age-specific prevalence for <28 gestational weeks was 74.8 per 1000 live births, 46.6 for 28-31 weeks, 5.8 for 32-36 weeks and 1.1 per 1000 for >36 weeks of gestation. Hemiplegia, found in 36.2%, had declined (p = 0.03). Diplegia was found in 36.2% and tetraplegia 5.3%. Dyskinetic CP accounted for 18.6% and ataxia for 3.7%. Neuroimaging revealed maldevelopments in 14%, white matter lesions in 44%, cortical/subcortical lesions in 13% and basal ganglia lesions in 17%. Prenatal aetiology was considered in 34%, peri- or neonatal in 48%, while in 18% aetiological period remained unclassified. Motor outcome in children who needed neonatal care had improved (p = 0.04). Motor function in dyskinetic CP had improved compared to previous cohorts (p = 0.008). Conclusion: The prevalence of CP has declined, mainly in term-born and in hemiplegia, and motor severity has changed compared to previous cohorts.
|
|
| 6. |
- Nilsson, Stefan, 1972, et al.
(författare)
-
A rectally administered combination of midazolam and ketamine was easy, effective and feasible for procedural pain in children with cerebral palsy.
- 2017
-
Ingår i: Acta Paediatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 106:3, s. 458-462
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate how effective a combination of rectally administered midazolam and racemic ketamine was for reducing pain in paediatric cerebral palsy patients receiving intramuscular injections of botulinum neurotoxin A. The feasibility and safety of the pain relief were also explored.Children with cerebral palsy, aged 1-18 years, were recruited from a regional paediatric rehabilitation unit between April 2012 and May 2014. Pain intensity, feasibility, total time spent in the clinic and side effects were registered. Pain scores were recorded by parents and healthcare professionals using different pain scales.We recorded 128 procedures in 61 children. The median scores were two (range 0-10) for pain intensity and nine (range 0-10) for feasibility. The median treatment time in the outpatient unit was 3.25 hours and the most common side effects were nausea, pain and sleep disturbance. Gross motor function levels showed a negative correlation with the pain scores. This method could be an alternative to nitrous oxide/oxygen mixture for patients who do not tolerate inhalation analgesia.Rectally administered midazolam and racemic ketamine provided effective pain relief for paediatric cerebral palsy outpatients receiving painful injections and was a viable alternative to inhalation analgesia. This article is protected by copyright. All rights reserved.
|
|
| 7. |
- Påhlman, Magnus, 1965
(författare)
-
Autism and ADHD in children with cerebral palsy
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BACKGROUND: Autism spectrum disorder (autism) and attention-deficit/hyperactivity disorder (ADHD) are likely underdiagnosed in children with cerebral palsy (CP). Early identification of impairments is important for adequate understanding and support. AIMS: To estimate the prevalence of autism and ADHD in CP in a total population of school-aged children with CP. To describe the associations between autism/ADHD and sex, gestational age, CP type, motor function, intellectual disability (ID), other associated impairments, epilepsy and neuroimaging findings in children with CP. METHODS: A well-defined total population of 264 children with CP from the CP register of western Sweden was examined. All available medical records were scrutinised for diagnosed impairments. Parents to all children were invited to complete a comprehensive questionnaire to detect signs of autism and ADHD. Further, children without full concordance between clinical diagnoses and screening outcome for autism/ADHD were assessed. Results were merged with existing information about already assessed children. Neuroimaging findings were compared in regard to the presence of autism and/or ADHD. RESULTS: One third of the 264 children were already diagnosed with autism and/or ADHD (autism 18%, ADHD 21%). Screening was positive to a much higher extent (autism 35%, ADHD 50%). Further neuropsychiatric assessments revealed additionally 19 children meeting diagnostic criteria for autism and/or ADHD. The group that completed screening and assessment comprised 200 children. In total 90 of these 200 children (45%) were diagnosed with autism and/or ADHD; 15% with autism only, 15% with ADHD only and 15% with both autism and ADHD. ID, present in 51%, was the main predictor of autism and ADHD, while both autism and ADHD were mainly independent of gross motor severity and CP type. Autism and ADHD were common in all neuroimaging patterns. However, autism was more prevalent in children with white matter injury, and ADHD in children having sustained middle cerebral artery infarction. CONCLUSION: Autism and ADHD are very common in children with CP and should be regarded as two main associated impairments in CP. The high prevalence of autism and ADHD emphasises the need to screen and, if indicated, further assess all children with CP for these impairments. Further studies, including neuroimaging, may help us better understand the strong association between CP and autism/ADHD.
|
|
| 8. |
- Påhlman, Magnus, 1965, et al.
(författare)
-
Autism and attention-deficit/hyperactivity disorder in children with cerebral palsy: high prevalence rates in a population-based study.
- 2021
-
Ingår i: Developmental medicine and child neurology. - : Wiley. - 1469-8749 .- 0012-1622. ; 63:3, s. 320-327
-
Tidskriftsartikel (refereegranskat)abstract
- To assess a total population of school-age children with cerebral palsy (CP) for autism and attention-deficit/hyperactivity disorder (ADHD) with a view to determining their prevalence and to relate findings to motor function, intellectual disability, and other associated impairments.Of 264 children, born between 1999 and 2006, from the CP register of western Sweden, 200 children (109 males, 91 females, median age at assessment 14y, range 7-18y) completed comprehensive screening and further neuropsychiatric clinical assessments.Ninety children (45%) were diagnosed with autism, ADHD, or both, 59 (30%) were diagnosed with autism, and 60 (30%) were diagnosed with ADHD. Intellectual disability was present in 51%. Two-thirds had autism, ADHD, and/or intellectual disability. In regression models, autism was mainly predicted by intellectual disability (odds ratio [OR]=4.1) and ADHD (OR=3.2), and ADHD was predicted by intellectual disability (OR=2.3) and autism (OR=3.0). Autism was more common in children born preterm (OR=2.0). Gross motor function was not associated with autism. ADHD prevalence was low in children with severe motor impairment, possibly due to diagnostic limitations.Autism and ADHD were common in this population of children with CP and were mainlyindependent of motor severity and CP type. The strongest predictor of autism/ADHD was intellectual disability. Assessment for autism and ADHD is warranted as part of the evaluation in CP.
|
|
| 9. |
- Påhlman, Magnus, 1965, et al.
(författare)
-
Autism spectrum disorder and attention-deficit/hyperactivity disorder in children with cerebral palsy: results from screening in a population-based group.
- 2020
-
Ingår i: European Child and Adolescent Psychiatry. - : Springer Science and Business Media LLC. - 1018-8827 .- 1435-165X. ; 29, s. 1569-1579
-
Tidskriftsartikel (refereegranskat)abstract
- Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are more common in children with cerebral palsy (CP) than in the general population, but may still be underdiagnosed. This study aimed to estimate screen-positive ASD and ADHD in a population-based group of 264 school-aged children with CP born 1999–2006 from the CP register of western Sweden. Validated parent-completed questionnaires were used at a median age of 12 years 11 months (range 8–17 years). Three different scales were used to detect signs of ASD and ADHD, respectively. Response rate was 88% (232/264). In 19 children, all in the most disabled group, the screening procedure was not feasible due to too few questionnaire items completed, leaving 213 for analyses. One third (74/213) of the children screened positive for ASD and half of the children (106/213) for ADHD, which was about twice as often as ASD/ADHD diagnoses had been clinically identified. Children with intellectual disability, epilepsy and/or impaired speech ability more often screened positive for ASD as well as ADHD. Severe motor impairment was more frequently associated with screen-positive ASD, but not ADHD. Neither sex nor CP type was associated with screen-positive ASD/ADHD. In conclusion, school-aged children with CP very often screened positive for ASD and/or ADHD. The prevalence of ASD and ADHD is most likely underestimated in children with CP. These screening findings require further investigations.
|
|
| 10. |
- Påhlman, Magnus, 1965, et al.
(författare)
-
Neuroimaging findings in children with cerebral palsy with autism and/or attention-deficit/hyperactivity disorder: a population-based study
- 2022
-
Ingår i: Developmental Medicine and Child Neurology. - : Wiley. - 0012-1622 .- 1469-8749. ; 64:1, s. 63-69
-
Tidskriftsartikel (refereegranskat)abstract
- Aim To compare neuroimaging patterns according to the Magnetic Resonance Imaging Classification System (MRICS) in children with cerebral palsy (CP) with and without autism and/or attention-deficit/hyperactivity disorder (ADHD). Method This population-based study assessed 184 children (97 males, 87 females) with CP born from 1999 to 2006 from the CP register of western Sweden, who had completed comprehensive screening and clinical assessment for neuropsychiatric disorders and undergone neuroimaging. Results Autism (total prevalence 30%) and ADHD (31%) were common in all neuroimaging patterns, including normal. Autism and ADHD were not more prevalent in children with bilateral than unilateral lesions, contrary to other associated impairments. Children with predominant white matter injury, related to insults in the late second or early third trimester, had the highest prevalence of autism (40%). Children who had sustained a middle cerebral artery infarction had the highest prevalence of ADHD (62%). Interpretation Although autism and ADHD are common regardless of neuroimaging patterns, timing and localization of insult appear to be of importance for the occurrence of autism and ADHD in children with CP. Neuroimaging may be of prognostic value for these associated impairments. Further in-depth neuroimaging studies may lead to a better understanding of the association between CP and neuropsychiatric disorders.
|
|
