Differential effects of brain lesions and systemic disease on the quality of general movements: a preliminary report.

Abstract

Assessment of the quality of general movements in preterm infants by means of 1-h video recordings is a sensitive method for investigating the integrity of the central nervous system. In two preterm infants, who were followed weekly until term, an abnormal quality of general movements was found, presumably due to systemic disease (bacterial and fungal infections). Both children were neurologically normal at the age of 6 (case A) and 12 months (case B) corrected age. In contrast to abnormal general movements due to a brain lesion, the abnormal quality of general movements in systemic disease is not consistently observable, not even during the 1 h of video recording. The presence, in otherwise abnormal general movements, of remaining rotations, superimposed on flexion and extension of the limbs, appears to be a reliable indication for a favourable outcome. Another abnormality seen in one of the infants was a severe reduction in the number of general movements, but with a normal quality in the remaining few general movements. This indicates that a reduction in quantity of general movements is prognostically not a bad sign, at least not if the quality of the remaining movements is normal. Although the underlying pathophysiologic mechanisms remain unclear, these findings are important in clinical practice. It means that it is possible to discriminate between abnormal general movements due to a cerebral lesion, and abnormal general movements due to systemic disease (infection), provided that the observation period is sufficiently long and a longitudinal developmental trajectory is obtained.