Paralisia cerebral hemiparetica : aspectos evolutivos, plasticidade cerebral e especialização hemisferica

AUTOR(ES)
DATA DE PUBLICAÇÃO

1999

RESUMO

We have studied the hemispheric specialization in patients with hemiparetic cerebral palsy, correlating some neurological functions with the computerized tomography (TC) findings. We have folIowed 125 children (54% male and left hemiparesis in 54%) tduring a mean period of six years. We used two classifications: a) clinical, which considered motor function, cognitive function, evo/ution of epilepsy, and the e/ectroencepha/ogram (EEG); and, b) neuroimaging, based on type and extension of the lesion by TC as ~elI as MRI in 44 patients. Based on TC the folIowing groups were constituted: group I (GI) = normal (20%); GIl = unilateral ventricular enlargement (14.5%); GIll = cortico/subcortical clastic lesions (40%); GlV = hemispheric atrophy and other findings (10.5%); GV = central nervous system (CNS) malformations (15%). The folIowing associated neurological diagnosis were found: neurodevelopmental delay (62%), speech delay (58%), mental retardation (45%), epilepsy (38%), microcephaly (28%) and sensory deficits (15% subdivided as visual deficiency (Vj;)) = 11 % and auditory deficiency = 4%). Left hemiparesis was significantly associated with VD or microcephaly. Left hemipat;etic children predominated on GI and GV and right hemiparetic patients, on GID and GIV. The findings of clinical evaluations were tabulated for the initial and final visits. We. then analyzed statistical differences of clinical parameters between the two visits for each of the five groups defined by TC. We found a significant improvement of cognitive and motor functions as welI as a global scbre of alI functions on groups I, III ançl IV. In I addition, we found a significant improvement on motor function and EEG on groulD, 11, and only for EEG on group V. Patients with larger lesions were less likely to improve. We also compared clinical assessments of the two visits for patients grouped into left and right hemisphere lesions. We found that cognitive function statisticalIy improved in patients with left hemisphere lesions and conversely, tqe motor function improved significantly in those with right hemisphere lesions. In conclusion, our data showed that children with CNS malformations or extensive CNS lesions usually have less improvement than children who have other types of early CNS lesions. Associated diagnosis, the type and the extension of the lesion interfere with recovery. Finally, we found that patients with left hemisphere lesions are more likely to recover cognitive functions, and those with right hemisphere lesions are more likely to improve motor functions

ASSUNTO(S)

desenvolvimento cognitivo aprendizagem motora crianças - desenvolvimento epilepsia

ACESSO AO ARTIGO

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