Sema Saltık, Beril Dönmezer, Müferet Ergüven, Sinem Altınyuva, Özlem Başeskioğlu

Term doğan periventriküler lökomalasili çocukların klinik özellikleri Orijinal Araştırma

Periventriküler lökomalasi PVL sıklıkla prematürelerde gözlenmekte ve bu hastaların klinik özellikleri iyi tanınmaktadır Ancak term doğumda da PVL gelişebileceği bildirilmektedir Bu çalışmada term doğan çocuklarda görülen PVL’nin uzun dönem klinik özelliklerini araştırmayı amaçladık Çalışmaya 11 term yaş ort : 5 1 ± 2 6 yaş 20 preterm yaş ort : 4 ± 1 3 yaş toplam 31 PVL olgusu alındı Tüm olguların prenatal natal postnatal özellikleri psikososyal motor gelişimleri epilepsi varlığı ve kraniyal MRG bulguları incelendi ve her iki gruba ait sonuçlar bağımsız t ve ki kare testleri kullanılarak karşılaştırıldı Term ve preterm gruplar arasında annenin hamilelik yaşı doğumdan sonra ilk hafta içinde nöbet ve epilepsi varlığı psikososyal ve motor gelişimi kraniyal MRG bulguları açısından bir farklılık gözlemlenmedi p gt; 0 05 PVL olgularının psikososyal ve motor gelişimleri birbiriyle ilişkili ancak kraniyal MRG lezyonlarının yaygınlığıyla ilişkisiz bulundu Spastik diparezi preterm olgularda en sık 45 görülen nöromotor bozukluk olmasına rağmen hiçbir term olguda saptanmadı p lt; 0 05 Sonuç olarak term PVL olgularının preterm PVL olgularından farklı nöromotor dağılım gösterebileceği tespit edildi Anahtar Kelimeler: beyin felci periventriküler lökomalasi spastik diparezi

Anahtar Kelimeler:

beyin felci, periventriküler lökomalasi, spastik diparezi

Clinical findings of children born at term with periventricular leukomalacia Original Article

Periventricular leukomalacia PVL is observed predominantly in premature infants and clinical findings in these patients are well recognized PVL has also been reported in children born at term In this study we aimed to evaluate the long term clinical findings in term children with PVL Thirty one cases with PVL that 11 included term mean age: 5 1 ± 2 6 years and 20 preterm born children mean age: 4 ± 1 3 years were studied Their prenatal natal postnatal characteristics physcosocial and motor development epilepsy existence and cranial MRI findings were examined and the results were analyzed by unpaired t and chi square tests No difference was observed between term and preterm children groups in terms of mother’s age at pregnancy seizures in the first week after birth epilepsy existence psychosocial and motor development p gt; 0 05 Although the psychosocial development had been found related to motor development MRI findings weren’t related to psychosocial and motor development Spastic diparesis was the most frequent neuromotor abnormality in preterm children 45 but was not seen in term children p lt; 0 05 Our results showed that the spectrum of neuromotor abnormalities of term children with PVL could represent a distinct clinical entity Kew words: cerebral palsy periventricular leukomalacia spastic diparesis

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Durmazlar N, Oz turk C, Ural B, e t al. Turkish children’s performance on Denver II: effect of sex and mother’s education. Dev Med Child Neurol 1998; 40: 411- 6.
Marret S. Physiolpathology of periventricular leukomalacia. Ev Med Brux. 2003; 24: 416- 9.
Staudt M, Pavlova M, Bohm S, et al. Pyramidal track damage correlates with motor dysfunction in bilateral periventricular leukomalacia. Neuropediatrics 2003; 34: 182- 8.
Sie LT, van der Knaap MS, Oosting J, et al. MR patterns of hypoxic-ischemic brain damage after prenetal, perinatal or postnatal asphyxia. Neuropediatrics 2000; 3: 128- 36.
Shewell MI, Majnemer A, Morin T. Etiologic yield of cerebral palsy: a contemporary case series. Pediatr Neurol. 2003; 28: 352- 9.
Dunin-Wasowicz D, Potakiewicz W, Rowecka-Trzebicka K, et al. Estimate of clinical dynamic in periventricular leukomalacia. Pediatr Pol 1996; 71: 789- 95.
Suzuki J, Ito M, Tomiwa K, et al. A clinical study of cerebral palsy in Shiga; 1977- 1986. III. etiological analysis of various types of cerebral palsy. No To Hattatsu 1999; 31: 329- 35 (abs).
Özmen M. Statik ensefalopatiler. İçinde: Neyzi O, Ertuğrul T (ed). Pediatri. İstanbul: Nobel, 2002: 1378- 81.
Gürses C, Gross DW , Anderm an F, et al. Pe riventri cular leukomalacia and epilepsy: Incidence and seizure pattern. Neurology 1999; 52: 341- 5.
Okumura A, Hayakawa F, Kato T, et al. MRI findings in patients with spastic cerebral palsy I: Correlation with gestational age at birth. Dev Med Child Neurol 1997; 39: 363- 8. Tutulan Bölge
Optik radyasyo tutulum varlığı
Ak madde tutulumu Ciddi Orta Hafif
Term Grup (n: 11) 9 (% 81,8) 16 (% 80) 2 (% 18,1) 6 (% 54,5) 3 (% 27,3) 5 (% 25) 7 (% 35) 8 (% 40)
Korpus kallozumda incelme Ciddi Hafif Yok 4 (% 36,4) 5 (% 45,4) 2 (% 18,1) 4 (% 20) 7 (% 35) 9 (% 45)
Ventrikül genişlemesi Orta-ciddi Hafif Yok - 3 (% 27,3) 8 (% 72,7) 1 (% 5) 6 (% 30) 13 (% 65)
Ventrikül sınırlarında düzensizlik Belirgin Hafif Yok 1 (% 9) 9 (% 81,8) 1 (% 9) 1 (% 5)
*Psikososyal Gelişim Orta derecede geri geri Hafif derecede geri/ normal *Motor Gelişim Ağır derecede geri Orta derecede geri
Hafif derecede geri/normal 1 (% 100) - - 1 (% 6,3) 7 (% 43,8) 8 (% 50) 1 (% 7,1)
*ki kare: 11,6 p<0,05
Türk Pediatri Arşivi 2005; 40: 87- 93
SSK Göztepe Eğitim ve Araştırma Hastanesi, Çocuk Sağlığı ve Hastalıkları Kliniği
Sonomed Tıbbi Görüntüleme Merkezi 1. Volpe JJ. Hypoxic-ischemic encephalopathy: Neuropathology and Pathogenesis. In: Volpe JJ (ed). Neurology of the newborn. USA: Saunders, 2001: 296- 330. 2. Apak S. Hipoksik iskemik ensefalopati İçinde: Dağoğlu T. (ed). Neonatoloji. İstanbul: Nobel, 2000: 573- 86. 3. Aicardi J, Bax M. Cerebral Palsy: In: Aicardi J, Diseases of the nervous system in childhood. London: Mac Keith Press, 1992: 330- 74. 4. Kwong KL, Wong YC, Fong CM, et al. Magnetik resonance imaging in 122 children with spastic cerebral palsy. Pediatr
Neurol 2004; 3: 172- 6. 5.
Hou M, Fan XM, Li YT, et al. Magnetic resonance imaging
findings in children with cerebral palsy. Zhonghua Er Ke Za
Zhi. 2004; 42: 125- 8 (abs). 6.
Ramos Lizana J, Belmonte Martin MJ, Cassinello Garcia E.
Findings on magnetic resonance in spastic cerebral palsy.
Rev Neurol 2001; 32: 908- 15. 7.
Nelson KB, , Swaiman KF, Russman BS. Cerebral Palsy In:
Swaiman KF (ed). Pediatric Neurology. USA: Mosby, 1994: 471- 87. 8.
Okumura A, Kato T, Kuno K, et al. MRI findings in patients
with spastic cerebral palsy II: correlation with type of cerebral
paly. Dev Med Child Neurol 1997; 39: 369- 72. 9.
Miller SP, Shevell MI, Patenaude Y, et al. Neuromotor spectrum
of periventricular leukomalacia in children born at term. Pediatr
Neurol 2000; 23: 155- 9.
Durmazlar N, Oz turk C, Ural B, e t al. Turkish children’s performance on Denver II: effect of sex and mother’s education. Dev Med Child Neurol 1998; 40: 411- 6.
Marret S. Physiolpathology of periventricular leukomalacia. Ev Med Brux. 2003; 24: 416- 9.
Staudt M, Pavlova M, Bohm S, et al. Pyramidal track damage correlates with motor dysfunction in bilateral periventricular leukomalacia. Neuropediatrics 2003; 34: 182- 8.
Sie LT, van der Knaap MS, Oosting J, et al. MR patterns of hypoxic-ischemic brain damage after prenetal, perinatal or postnatal asphyxia. Neuropediatrics 2000; 3: 128- 36.
Shewell MI, Majnemer A, Morin T. Etiologic yield of cerebral palsy: a contemporary case series. Pediatr Neurol. 2003; 28: 352- 9.
Dunin-Wasowicz D, Potakiewicz W, Rowecka-Trzebicka K, et al. Estimate of clinical dynamic in periventricular leukomalacia. Pediatr Pol 1996; 71: 789- 95.
Suzuki J, Ito M, Tomiwa K, et al. A clinical study of cerebral palsy in Shiga; 1977- 1986. III. etiological analysis of various types of cerebral palsy. No To Hattatsu 1999; 31: 329- 35 (abs).
Özmen M. Statik ensefalopatiler. İçinde: Neyzi O, Ertuğrul T (ed). Pediatri. İstanbul: Nobel, 2002: 1378- 81.
Gürses C, Gross DW , Anderm an F, et al. Pe riventri cular leukomalacia and epilepsy: Incidence and seizure pattern. Neurology 1999; 52: 341- 5.
Okumura A, Hayakawa F, Kato T, et al. MRI findings in patients with spastic cerebral palsy I: Correlation with gestational age at birth. Dev Med Child Neurol 1997; 39: 363- 8.
Türk Pediatri Arşivi 2005; 40: 87- 93
Türk Pediatri Arşivi 2005; 40: 87- 93
SSK Göztepe Eğitim ve Araştırma Hastanesi, Çocuk Sağlığı ve Hastalıkları Kliniği
Sonomed Tıbbi Görüntüleme Merkezi 1. Volpe JJ. Hypoxic-ischemic encephalopathy: Neuropathology and Pathogenesis. In: Volpe JJ (ed). Neurology of the newborn. USA: Saunders, 2001: 296- 330. 2. Apak S. Hipoksik iskemik ensefalopati İçinde: Dağoğlu T. (ed). Neonatoloji. İstanbul: Nobel, 2000: 573- 86. 3. Aicardi J, Bax M. Cerebral Palsy: In: Aicardi J, Diseases of the nervous system in childhood. London: Mac Keith Press, 1992: 330- 74. 4. Kwong KL, Wong YC, Fong CM, et al. Magnetik resonance imaging in 122 children with spastic cerebral palsy. Pediatr
Neurol 2004; 3: 172- 6. 5.
Hou M, Fan XM, Li YT, et al. Magnetic resonance imaging
findings in children with cerebral palsy. Zhonghua Er Ke Za
Zhi. 2004; 42: 125- 8 (abs). 6.
Ramos Lizana J, Belmonte Martin MJ, Cassinello Garcia E.
Findings on magnetic resonance in spastic cerebral palsy.
Rev Neurol 2001; 32: 908- 15. 7.
Nelson KB, , Swaiman KF, Russman BS. Cerebral Palsy In:
Swaiman KF (ed). Pediatric Neurology. USA: Mosby, 1994: 471- 87. 8.
Okumura A, Kato T, Kuno K, et al. MRI findings in patients
with spastic cerebral palsy II: correlation with type of cerebral
paly. Dev Med Child Neurol 1997; 39: 369- 72. 9.
Miller SP, Shevell MI, Patenaude Y, et al. Neuromotor spectrum
of periventricular leukomalacia in children born at term. Pediatr
Neurol 2000; 23: 155- 9.
Durmazlar N, Oz turk C, Ural B, e t al. Turkish children’s performance on Denver II: effect of sex and mother’s education. Dev Med Child Neurol 1998; 40: 411- 6.
Marret S. Physiolpathology of periventricular leukomalacia. Ev Med Brux. 2003; 24: 416- 9.
Staudt M, Pavlova M, Bohm S, et al. Pyramidal track damage correlates with motor dysfunction in bilateral periventricular leukomalacia. Neuropediatrics 2003; 34: 182- 8.
Sie LT, van der Knaap MS, Oosting J, et al. MR patterns of hypoxic-ischemic brain damage after prenetal, perinatal or postnatal asphyxia. Neuropediatrics 2000; 3: 128- 36.
Shewell MI, Majnemer A, Morin T. Etiologic yield of cerebral palsy: a contemporary case series. Pediatr Neurol. 2003; 28: 352- 9.
Dunin-Wasowicz D, Potakiewicz W, Rowecka-Trzebicka K, et al. Estimate of clinical dynamic in periventricular leukomalacia. Pediatr Pol 1996; 71: 789- 95.
Suzuki J, Ito M, Tomiwa K, et al. A clinical study of cerebral palsy in Shiga; 1977- 1986. III. etiological analysis of various types of cerebral palsy. No To Hattatsu 1999; 31: 329- 35 (abs).
Özmen M. Statik ensefalopatiler. İçinde: Neyzi O, Ertuğrul T (ed). Pediatri. İstanbul: Nobel, 2002: 1378- 81.
Gürses C, Gross DW , Anderm an F, et al. Pe riventri cular leukomalacia and epilepsy: Incidence and seizure pattern. Neurology 1999; 52: 341- 5.
Okumura A, Hayakawa F, Kato T, et al. MRI findings in patients with spastic cerebral palsy I: Correlation with gestational age at birth. Dev Med Child Neurol 1997; 39: 363- 8.
Türk Pediatri Arşivi 2005; 40: 87- 93
Türk Pediatri Arşivi 2005; 40: 87- 93
SSK Göztepe Eğitim ve Araştırma Hastanesi, Çocuk Sağlığı ve Hastalıkları Kliniği
Sonomed Tıbbi Görüntüleme Merkezi 1. Volpe JJ. Hypoxic-ischemic encephalopathy: Neuropathology and Pathogenesis. In: Volpe JJ (ed). Neurology of the newborn. USA: Saunders, 2001: 296- 330. 2. Apak S. Hipoksik iskemik ensefalopati İçinde: Dağoğlu T. (ed). Neonatoloji. İstanbul: Nobel, 2000: 573- 86. 3. Aicardi J, Bax M. Cerebral Palsy: In: Aicardi J, Diseases of the nervous system in childhood. London: Mac Keith Press, 1992: 330- 74. 4. Kwong KL, Wong YC, Fong CM, et al. Magnetik resonance imaging in 122 children with spastic cerebral palsy. Pediatr
Neurol 2004; 3: 172- 6. 5.
Hou M, Fan XM, Li YT, et al. Magnetic resonance imaging
findings in children with cerebral palsy. Zhonghua Er Ke Za
Zhi. 2004; 42: 125- 8 (abs). 6.
Ramos Lizana J, Belmonte Martin MJ, Cassinello Garcia E.
Findings on magnetic resonance in spastic cerebral palsy.
Rev Neurol 2001; 32: 908- 15. 7.
Nelson KB, , Swaiman KF, Russman BS. Cerebral Palsy In:
Swaiman KF (ed). Pediatric Neurology. USA: Mosby, 1994: 471- 87. 8.
Okumura A, Kato T, Kuno K, et al. MRI findings in patients
with spastic cerebral palsy II: correlation with type of cerebral
paly. Dev Med Child Neurol 1997; 39: 369- 72. 9.
Miller SP, Shevell MI, Patenaude Y, et al. Neuromotor spectrum
of periventricular leukomalacia in children born at term. Pediatr
Neurol 2000; 23: 155- 9.
Durmazlar N, Ozturk C, Ural B, et al. Turkish children’s performance on Denver II: effect of sex and mother’s education. Dev Med Child Neurol 1998; 40: 411- 6.
Marret S. Physiolpathology of periventricular leukomalacia. Ev Med Brux. 2003; 24: 416- 9.
Staudt M, Pavlova M, Bohm S, et al. Pyramidal track damage correlates with motor dysfunction in bilateral periventricular leukomalacia. Neuropediatrics 2003; 34: 182- 8.
Sie LT, van der Knaap MS, Oosting J, et al. MR patterns of hypoxic-ischemic brain damage after prenetal, perinatal or postnatal asphyxia. Neuropediatrics 2000; 3: 128- 36.
Shewell MI, Majnemer A, Morin T. Etiologic yield of cerebral palsy: a contemporary case series. Pediatr Neurol. 2003; 28: 352- 9.
Dunin-Wasowicz D, Potakiewicz W, Rowecka-Trzebicka K, et al. Estimate of clinical dynamic in periventricular leukomalacia. Pediatr Pol 1996; 71: 789- 95.
Suzuki J, Ito M, Tomiwa K, et al. A clinical study of cerebral palsy in Shiga; 1977- 1986. III. etiological analysis of various types of cerebral palsy. No To Hattatsu 1999; 31: 329- 35 (abs).
Özmen M. Statik ensefalopatiler. İçinde: Neyzi O, Ertuğrul T (ed). Pediatri. İstanbul: Nobel, 2002: 1378- 81.
Gürses C, Gross DW, Anderman F, et al. Periventricular leukomalacia and epilepsy: Incidence and seizure pattern. Neurology 1999; 52: 341- 5.
Okumura A, Hayakawa F, Kato T, et al. MRI findings in patients with spastic cerebral palsy I: Correlation with gestational age at birth. Dev Med Child Neurol 1997; 39: 363- 8.
Sema Saltık. Term doğan periventriküler lökomalasili çocukların klinik özellikleri
Sema Saltık. Term doğan periventriküler lökomalasili çocukların klinik özellikleri
Türk Pediatri Arşivi 2005; 40: 87- 93
Türk Pediatri Arşivi 2005; 40: 87- 93