小兒腦性麻庫之臨床觀察

Clinical Observation of Cerebral Palsy in Children

林雨亭(Yeu-Tyng Lin) ； 沈淵瑶(Ein-Yiao Shen) ； 黃富源(Fu-Yuan Huang)

《Acta Paediatrica Sinica》 28卷6期 (1987/12) Pp. 457-463

摘要

馬偕醫院小兒科，收集最近7年來長期追綜的65例腦性麻痺患者，說其臨床所見提出綜合性的分析。發病原因，產前、產中及產後因素各佔34%，31%及35%；臨床分類以痙孿型單側麻痺最多(37%)；腦部電腦斷層攝影及超音波檢查，以單側大腦半球萎縮最多(20%)；腦電波圖檢查，異常者佔57%；復健治療，1歲前就開始接受治療的病人療效較明顯。結論：腦性麻痺的預防重於治療，一旦病兒懷疑有此病之傾向，則要早期確定診斷與治療。

並列摘要

Cerebral palsy is defined as a nonprogressive disorder of motion and posture due to brain insult or injury occurring in the period of early brain growth. A total of 65 cases of cerebral palsy, diagnosed from August 1978 to July 1985, with sufficient data and regular follow-up, were studied retrospectively. The patients included 45 boys and 20 girls, in the age range of 1 year to 7 years and 8 months. Complete physical and neurological examinations were done; family, pregnancy and birth histories and other relevant records were reviewed. Laboratory studies including inborn error screening tests, thyroid profile and other laboratory tests-were done to exclude congenital hypothyroidism and other inborn metabolic disorders. Brain CT scans and/or brain sonograms were performed in 40 cases to rule out central nervous system degenerative disorders and neoplasms as well as to define the underlying cerebral pathology. Electroencephalograms were also obtained in 47 cases, with an abnormal finding in 27 cases (57%).
The cases of cerebral palsy in 65 children were prenatal in 34%, perinatal in 31%, and postnatal in 35%. Cerebral palsy was classified according to Minear. It included spastic hemiplegia, spastic diplegia, spastic quadriplegia, athetosis, ataxia, hypotonia, and mixed cerebral palsy. Spastic hemiplegia (37%) was the most commonly seen, and half of the cases were caused by postnatal factors.
The measure used for rehabilitation was that originally developed by Bobath. The patients with spastic hemiplegia had more favorable outcome after physical therapy (relatively better gait and fewer contractures). As cerebral palsy is distressing to afflicted persons and their families and costly to society, prevention should be given a high priority. If the high-risk children have delayed motor milestones or persistence of primitive reflexes, cerebral palsy should be considered.

並列關鍵字

cerebral palsy ； brain CT scan ； electroencephalogram ； physical therapy