Minor Neurological Signs Research Articles

Markers of minor brain damage are associated with developmental performance in preschool children

(2002) Developmental Medicine and Child Neurology 44, 323; Gosselin J, Amiel-Tison C, Infante-Rivard C, Fouron C, Fouron JC. . Minor neurological signs and developmental performances in high risk children at...

Neurological soft signs in first-episode psychosis: a systematic review.

Neurological soft signs (NSS) are minor neurological signs indicating non-specific cerebral dysfunction. Their presence has been documented extensively in schizophrenia but not during the first psychotic episode. To review studies that have specifically investigated NSS at the time of the first psychotic episode. A review of studies investigating neurological function in first-episode psychosis, using a clinical examination. Patients with first-episode psychosis show an excess of NSS, particularly in the areas of motor coordination and sequencing, sensory integration and in developmental reflexes. Furthermore, NSS may be associated with a specific laterality pattern. More studies on first-onset schizophrenia are needed, evaluating both sensory and motor neurological domains (scoring separately for the two sides of the body), integrating this knowledge with neuroimaging findings and clarifying the role of NSS as markers of cognitive dysfunction.

Two distinct forms of minor neurological dysfunction: perspectives emerging from a review of data of the Groningen Perinatal Project

Two distinct forms of minor neurological dysfunction: perspectives emerging from a review of data of the Groningen Perinatal Project

Minor neurological signs and developmental performance in high risk children at preschool age.

The aim of this study was to establish correlations between minor neurological findings and developmental performance. A cohort of 72 preschool children was studied (38 females, 34 males; mean age 3 years 8 months, SD 1 year 2 months, range 2 to 5 years) who were considered to be at high risk due to placental insufficiency. The cohort was divided into four categories of neurological status: (1) minimal cerebral palsy (MCP) with independent walking before age 2 years; (2) Amiel-Tison triad (ATT) including imbalance of passive axial tone, phasic stretch reflex in triceps surae, and cranial signs, particularly on the squamous suture; (3) intermediate with one or two of the three ATT signs; and (4) absence of neurological findings. Six subscales of the Griffiths Mental Developmental Scales assessing locomotion, eye-hand coordination, interpersonal skills, language, performance, and practical reasoning were administered. Significant differences were found according to neurological status in three specific domains of development: coordination (F=2.84, p=0.04), language (F=3.65, p=0.02), and practical reasoning (F=3.62, p=0.02). In addition, significant differences were also found in language (L) and practical reasoning (R) performances according to the side of the abnormal stretch reflex: bilateral stretches (L=87.8; R=75.3) or an isolated right stretch (L=95.3; R=83.6) are more strongly associated with impaired developmental performances than an isolated left stretch (L=101.3; R=88.2) with F=2.94; p=0.04 for language and F=3.00, p=0.04 for practical reasoning. We concluded that a short neurological examination, easily performed by pediatricians and family practitioners, can identify permanent markers of minor brain damage occurring before, during, or soon after birth and so anticipate consequences.

Minor neurological signs and developmental performance in high risk children at preschool age

The aim of this study was to establish correlations between minor neurological findings and developmental performance. A cohort of 72 preschool children was studied (38 females, 34 males; mean age 3 years 8 months, SD 1 year 2 months, range 2 to 5 years) who were considered to be at high risk due to placental insufficiency. The cohort was divided into four categories of neurological status: (1) minimal cerebral palsy (MCP) with independent walking before age 2 years; (2) Amiel‐Tison triad (ATT) including imbalance of passive axial tone, phasic stretch reflex in triceps surae, and cranial signs, particularly on the squamous suture; (3) intermediate with one or two of the three ATT signs; and (4) absence of neurological findings. Six subscales of the Griffiths Mental Developmental Scales assessing locomotion, eye‐hand coordination, interpersonal skills, language, performance, and practical reasoning were administered. Significant differences were found according to neurological status in three specific domains of development: coordination (F=2.84,p=0.04), language (F=3.65,p=0.02), and practical reasoning (F=3.62, p=0.02). In addition, significant differences were also found in language (L) and practical reasoning (R) performances according to the side of the abnormal stretch reflex: bilateral stretches (L=87.8; R=75.3) or an isolated right stretch (L=95.3; R=83.6) are more strongly associated with impaired developmental performances than an isolated left stretch (L=101.3; R=88.2) with F=2.94;p=0.04 for language and F=3.00,p=0.04 for practical reasoning. We concluded that a short neurological examination, easily performed by pediatricians and family practitioners, can identify permanent markers of minor brain damage occurring before, during, or soon after birth and so anticipate consequences.

Long-term sensory deficit after Guillain-Barré syndrome

In order to document the sensory deficit still present several years after onset of Guillain-Barré syndrome (GBS) and to determine if the sensory residua have a disrupting effect on daily life, 122 patients were asked to cooperate in a neurological examination and to complete a questionnaire three to six years after onset. On functional assessment 84 patients had no or only minor neurological symptoms or signs, 24 patients showed moderate recovery and 14 patients were left with severe residual signs. On neurological examination, residual sensory deficit was found in the arms of 38 % of the patients and in the legs of 66 % of the patients. Sensory disturbance was experienced as moderate to severe in the arms of 27 % of the patients and in the legs of 40 % of the patients. Muscle aches and cramps were still present in 48 %. There was a statistically significant relation between muscle aches and cramps and objective residual sensory deficit but not with residual weakness. Furthermore, in the group of patients with a pure motor GBS, significantly fewer people suffered from muscle aches and cramps than in the remaining patients (p=0.04). Twenty-five percent of patients changed jobs after their illness, and 44% gave up some leisure activities. It can be concluded that many patients still suffer from sensory deficit, and a considerable number experience these as moderately to seriously disruptive, especially in the legs. Muscle aches and cramps seems to be related to sensory rather than motor dysfunction.

Prenatal alcohol exposure and signs of minor neurological dysfunction at preschool age.

High levels of alcohol consumption during pregnancy affect the development of the baby's central nervous system. Pregnant women were interviewed about their alcohol consumption during pregnancy, when they first visited the maternity hospital in Roubaix, France. Of the 698 women interviewed, 156 of their children were investigated at the age of 4 1/2 years with a standardised examination to assess the effects of prenatal alcohol exposure on neurological status. Two scores were calculated: a posture score, which measured items while the child was standing; and a minor neurological signs score. The posture score was not related to prenatal alcohol exposure. Consumption of 21 drinks/week (3 drinks/day) or more during pregnancy was significantly associated with a higher number of minor neurological signs, after controlling for relevant covariables. Although prenatal alcohol exposure was related to a lower General Cognitive Index (GCI), minor neurological signs were associated with prenatal alcohol exposure after controlling for GCI.

Measurement of neurotransmitter metabolites in the cerebrospinal fluid of phenylketonuric patients under dietary treatment.

Recently many studies have focused on long-term follow-up of phenylketonuria (PKU McKusick 261600) patients, especially regarding discontinuation of diet in adulthood and subsequent possible neurological involvement. Neurological symptoms have been observed in some patients after discontinuation of diet, with improvements after reintroduction of a phenylalanine-restricted diet (Pietz et al 1998). Brain magnetic resonance imaging (MRI) revealed white-matter abnormalities in patients with neurological impairment but also in many patients without neurological symptoms (Burgard et al 1999). Myelin changes observed by brain MRI are similar in early-treated, late-treated and untreated patients, differing only in extension. Neurological investigations of treated adult PKU patients revealed minor neurological signs (tremor, brisk deep tendon reflexes, clumsy motor coordination) indicating the possibility of a specific neurological syndrome in adult PKU patients off diet. Even early-treated phenylketonuric patients show subtle symptoms of CNS damage, in addition to neuropsychological, neurophysiological and brain imaging abnormalities (Pietz et al 1998). Therefore, further investigations are necessary to evaluate the presence of biochemical changes, even in early-treated patients, that could be implicated in the neurological alterations. The aim of our study was to investigate dopamine and serotonin metabolism (homovanillic acid (HVA), and 5-hydroxyindoleacetic acid (5-HIAA), respectively) in early-treated PKU patients with white-matter abnormalities on magnetic resonance imaging.

Sex differences in schizophrenia, a review of the literature.

To comprehensively and critically review the literature on gender differences in schizophrenia. An initial search of MEDLINE abstracts (1966-1999) was conducted using the terms sex or gender and schizophrenia, followed by systematic search of all relevant articles. Males have consistently an earlier onset, poorer premorbid functioning and different premorbid behavioral predictors. Males show more negative symptoms and cognitive deficits, with greater structural brain and neurophysiological abnormalities. Females display more affective symptoms, auditory hallucinations and persecutory delusions with more rapid and greater responsivity to antipsychotics in the premenopausal period but increased side effects. Course of illness is more favorable in females in the short- and middle-term, with less smoking and substance abuse. Families of males are more critical, and expressed emotion has a greater negative impact on males. There are no clear sex differences in family history, obstetric complications, minor physical anomalies and neurological soft signs. This review supports the presence of significant differences between schizophrenic males and females arising from the interplay of sex hormones, neurodevelopmental and psychosocial sex differences.

Encefalopatía aguda autolimitada en relación con el componente antisarampionoso de la vacuna triple vírica

Neurological disorders secondary to the measles component of viral triple vaccine are not frequent. In spite of controversy regarding the cause, the clinical, diagnostic and legal implications are worth considering. We present the case of a 16 month-old baby with a clinical picture of self-limiting acute encephalopathy characterized by cerebellar ataxia and alterations in behavior, accompanied by the clinical signs of attenuated measles. The negative results of complementary tests and an obvious time-relationship with a triple virus vaccination lead us to interpret the condition as being secondary to the measles component of the vaccine. We consider that although there is a low incidence of complications, the index of suspicion is also low, and even lower in cases with only minor neurological signs. It is therefore possible that such reactions are under-reported.

Neurological aspects of adult phenylketonuria.

Phenylketonuria, an autosomal recessively transmitted disorder of amino acid metabolism, is caused by a deficiency of hepatic phenylalanine hydroxylase converting phenylalanine to tyrosine. Thus, phenylalanine accumulates to plasma levels exceeding 1200 mumol/l. Untreated phenylketonuria is characterized by microcephaly, epilepsy, severe mental retardation and, in some cases, progressive supranuclear motor disturbances. These symptoms can largely be prevented by the early start of a phenylalanine-restricted diet. Neurological investigations of treated patients reveal only minor neurological signs, such as tremor or brisk deep tendon reflexes. Magnetic resonance imaging shows white matter abnormalities. However, in single patients, progressive neurological symptoms occurred. Thus, the long-term prognosis of treated phenylketonuria is still under discussion.

Perceptual-motor difficulties and their concomitants in six-year-old children born prematurely

The aims of this follow-up study were: (1) to compare prematurely born and reference children on tests of perceptual-motor competence, neurological functioning, intelligence, reading and behavioural adjustment, (2) to determine whether perceptual-motor problems among children born prematurely ever occur in isolation, (3) to examine the relationship between the extent of perceptual-motor difficulties and contemporaneous problems in other domains of development and, (4) to examine the relationship between the extent of perceptual-motor difficulties and selected neonatal variables. From a total of 219 eligible preterm babies, 156 children met the inclusion/exclusion criteria applicable to this study. On assessments conducted at six years of age, significant differences between premature and reference children were found on all measures. Seventy five children (48%) had perceptual-motor problems. In 15 of these, (10%) no other problems were evident. Children with extensive perceptual-motor problems were more likely to show co-occurring minor neurological signs and problems of cognition, reading and/or behaviour. In addition, these children had been of shorter gestation and had more frequently shown a brain lesion shortly after birth. PsycINFO classification: 3250; 3297

Minor Neurological Signs and Perceptual-Motor Difficulties in Prematurely Born Children

Aim—To examine the spectrum of neurological dysfunction and perceptualmotor diYculties at school age in a cohort of prematurely born children, and the relation of these measures to neonatal brain lesions, intelligence quotient, and behavioural adjustment. Method—One hundred and eighty three children were tested at the age of 6 years using Touwen’s Examination of the Child with Minor Neurological Dysfunction, the Movement Assessment Battery for Children (Movement ABC), the Developmental Test of Visual-Motor Integration (VMI), British Ability Scales, and Rutter Scales. Results—Twenty six children had definite cerebral palsy and one was blind. Of the remaining 156, the proportions falling below the 15th centile point were 31% on Touwen’s Examination, 44% on the Movement ABC,and 17% on the VMI.Forty two passed all three tests. No child with a normal ultrasound scan developed cerebral palsy, whereas nearly all those with major lesions did. Minor lesions, however, were not generally predictive of later outcome. Correlations between the tests were generally low. Conclusions—These findings stress the need to assess neurological and perceptual motor functioning separately at school age and to monitor relationships with other aspects of development. (Arch Dis Child 1997;76:F9‐F14)

An early marker for neurological deficits after perinatal brain lesions

In normal awake infants, fidgety movements are seen from the age of 6 weeks to 20 weeks. The aim of the study was to test the predictive value of absent or abnormal spontaneous movements in young infants for the later development of neurological deficits. In a collaborative study involving five hospitals we collected data on the normal and abnormal quality of fidgety movements of 130 infants and compared it with assessments of neurological development done longitudinally until the age of 2 years. On the basis of ultrasound scans infants were classified as at low-risk or at high-risk of neurological deficits. Infants were videoed for 1 h every week from birth to discharge and then for 15 min every 3 to 4 weeks; quality of general movements was assessed. Repeated neurological assessments were also done until 24 months of corrected age. 67 (96%) of 70 infants with normal fidgety movements had a normal neurological outcome. Abnormal quality or total absence of fidgety movements was followed by neurological abnormalities in 57 (95%) of the 60 infants (49 had cerebral palsy and eight had developmental retardation or minor neurological signs). Specificity and sensitivity of fidgety movement assessment were higher (96% and 95%, respectively) than of ultrasound imaging of the infants' brain (83% and 80%, respectively). Our technique of assessing spontaneous motor activity can identify and distinguish between those infants who require early intervention for neurological abnormalities and those who do not. Our technique is simple, non-intrusive, reliable, quick, and can be done on very young infants.

Minor neurological signs and perceptual-motor difficulties in prematurely born children

AIMTo examine the spectrum of neurological dysfunction and perceptual-motor difficulties at school age in a cohort of prematurely born children, and the relation of these measures to neonatal brain lesions,...

Clinical course, early diagnosis, treatment, and prevention of disease in glutaryl-CoA dehydrogenase deficiency.

Glutaryl-CoA dehydrogenase deficiency (GDD) is a recessively inherited neurometabolic disorder associated with encephalopathic crises and severe extrapyramidal symptoms. Treatment regimens including glucose and electrolyte infusions during acute illnesses, oral carnitine supplementation and/or a low-protein or lysine-restricted diet have been recommended, but their efficacy has been documented only on an anecdotal basis. We conducted a retrospective analysis of 57 patients with proven GDD-relating appearance and severity of neurological disease to age and clinical status at diagnosis, glutaric acid levels in body fluids, and different treatment regimens. Thirty-six patients were diagnosed after the onset of neurological disease (symptomatic group), twenty-one before (presymptomatic group). Carnitine levels were found to be reduced in all patients at diagnosis. In the symptomatic group, macrocephaly had been present around birth and was followed by rapid postnatal head growth in 70% of the children. The patients often showed symptoms such as hypotonia, irritability, and jitteriness followed by an acute encephalopathic crisis occurring on average at 12 months of age. Common neuroimaging findings included frontotemporal atrophy, subependymal pseudocysts, delayed myelination, basal ganglia atrophy, chronic subdural effusions and hematomas. In four patients the latter two findings were initially misinterpreted as resulting from child abuse. Other important misdiagnoses in older siblings who were affected and went undiagnosed include postencephalitic cerebral palsy, dystonic cerebral palsy and sudden infant death syndrome. Metabolic treatment did not convincingly improve the neurological disease, although it may have prevented further deterioration. Symptomatic treatment with baclofen or benzodiazepines was effective in reducing muscle spasms. Children in the presymptomatic group were diagnosed because of familiarity for the disease (n = 13), macrocephaly and/or additional minor neurological signs in infancy (n = 6), or acute encephalopathy, which was fully reversible after prompt treatment (n = 2). After diagnosis, all children were treated with oral carnitine, fluid infusion during intercurrent illnesses and, in addition, a diet was started in 13 of the 21 children. All 21 children except one (born prematurely at 31 weeks) have continued to develop normally up to now. Mean age at report is 6.3 years with a range from 6 months to 14.8 years. In older patients, the neuroradiological changes, present in infancy as in the symptomatic patients, became less prominent and in one girl disappeared. In presymptomatic children with GDD, the onset of neurological disease can be prevented by vigorous treatment of catabolic crises during illnesses together with carnitine supplementation. The importance of dietary therapy remains unclear and needs further evaluation. The potential treatability of GDD calls for increased attention to early presenting signs in order to recognize the disorder and to initiate treatment before the onset of irreversible neurological disease.

Preliminary results of embolisation of nonsurgical intracranial aneurysms with GD coils: The 1st year of their use

We report 28 patients with nonsurgical intracranial aneurysms referred by neurosurgeons for endovascular treatment using platinum detachable coils (GDC, Target Therapeutics, Fremont, Calif., USA). Because of unfavourable anatomical features or failed hyperselective catheterisation, 4 patients were not treated. In the other 24 patients (26 aneurysms) embolisation was successful. No manufacturing defect was detected in the coils used. Complete occlusion of the sac was obtained in 22 of the 26 aneurysms (85%) regardless of their size. The glasgow outcome score was good on discharge in 20 of the 24 patients (83%). The Karnovski score at 3 months after embolisation revealed that 20 patients (83%) lead a normal life, with minor neurological signs. Morbidity related directly to treatment occurred in 2 cases (8%): a superior hemianopia due to mass effect on the optic nerve from a carotid-ophthalmic aneurysm, and hemiparesis due to an embolus. Five transient deficits lasting hours to a few days were related to proven or suspected emboli. No death occurred. Anatomical, technical and clinical data are reported; the mean cost of materials (catheters and coils) per patient and aneurysm was FF 13,500. The mean hospitalisation time was 6.5 days in the neurosurgical department with 2.8 days of intensive care.

Low birthweight and neuromotor development: a population based, controlled study.

The aims of the study were to investigate: (a) the relationship between low birthweight (LBW) and pre-school neuromotor development; and (b) the predictive value of various pre-, peri-, and neonatal factors for neuromotor development in LBW pre-school children. A population based sample of 144 5-year-old LBW children (birthweight < 2000 g) with no major handicaps was compared with a random sample of 163 normal birthweight term controls. Using the Peabody Developmental Motor Scales, impaired performance on the balance scale was seen more often in LBW boys than in controls (odds ratio 5.5, 95% CI 1.5-20.3), while performance on the eye-hand coordination and locomotor scales was comparable for the two groups. LBW girls were comparable to controls on all these scales. On neurological examination, an increased frequency of minor neurological signs was found in LBW boys, while increased ankle tone and/or leg hyperreflexia was more common in LBW girls compared to controls. Small head circumference at birth was associated with an increased frequency of minor neurological signs in LBW boys, and lack of breastmilk in the neonatal period with impaired balance in LBW boys. None of the other pre-, peri- or neonatal factors were predictive of neuromotor development. We conclude that motor functions essential for daily activities are intact in most LBW preschoolers.

Metabolic alterations in the neonate and infant brain during development: evaluation with proton MR spectroscopy.

To evaluate the usefulness of hydrogen-1 magnetic resonance (MR) spectroscopy in the evaluation of the developing brain. Localized MR spectra were obtained with an echo time of 272 msec from the brain of 78 neonates and infants aged 1 week to 100 months. All patients were retrospectively classified into three groups on the basis of neurologic development: abnormal (group 2, n = 21), normal despite minor neurologic signs (group 1, n = 23), and normal (group 0, n = 34). Seventeen patients in group 2 and eight patients in group 1 revealed abnormally low N-acetylaspartate (NAA)/choline or NAA/creatine ratios compared with those obtained in group 0. MR spectroscopy was slightly more useful in the differentiation of patients in groups 2 and 1 (chi 2 test, P < .005) than MR imaging (P < .01). H-1 MR spectroscopy provides prognostic information about the brain in healthy and neurologically damaged infants and augments the value of MR imaging.

Neurological ?soft' signs may identify children with sickle cell disease who are at risk for stroke

Stroke is one of the most frequent complications of sickle cell disease (HbSS), occurring in 7-17% of children. Recent studies recognized more minor lesions on MRI, not associated with clinical signs on standard neurological examination, which however have been found to be a risk factor for developing stroke later. The aim of this study was to evaluate whether minor lesions observed on imaging could be associated with 'soft' neurological signs not detectable on conventional neurological examination. Fourteen children with HbSS were assessed with MRI, standard neurological examination and evaluation of 'soft' signs (Zurich Neuromotor Test) and motor function (Movement ABC). Eight of the 14 children scanned showed lesions on MRI but only 3 of the full cohort were abnormal on standard neurological examination. However, all of the eight children with MRI lesions also showed abnormal signs on at least one of the two tests (Zurich and Movement ABC). All the children with normal MRI were normal on all the tests performed. The sensitivity of Zurich Neuromotor Test and Movement ABC in the group of children with MRI lesions is 0.88 and 0.75, respectively, and increases to 1 when the two tests are used together. The specificity of both tests is 1 even when the tests are used separately. Although the number of cases is small, 'soft' signs may reliably identify the presence of even minor MRI lesions, allow the evaluation of the global incidence of major and minor neurological signs and may also help to identify the population at risk for developing strokes. This population could then be closely monitored and benefit from early intervention.