SUMMARY This is a prospective observational study of a consecutive series of 34 children with spastic cérébral palsy treated at a single center. 10 had spastic quadriplegia and 24 had spastic diplegia. AH were followed for at least one year. After selective dorsal rhizotomy (SDR), all children received one month of physical therapy at the center and were prescribed a program of physical therapy in their community. The children were assessed before and one year after SDR and physical therapy, using the Ashworth Scale, deep tendon reflex response, range of motion and the Gross Motor Function Measure. The results show that there is often a decrease in lower‐extremity spasticity and functional improvement after SDR with physical therapy, but that there is considerable variability in outcome. Randomized prospective clinical trials with masked objective outcome measures are needed to determine the efficacy of SDR. RÉSUMÉ Le rôle des radicotomies dorsales séleclives dans l' IMOC:évaluation critique d' une série clinique prospective L'article résume une observation prospective d' une série consécutive de 34 enfants IMOC traites dans un meme centre. 11 y avait 10 cas de tetraplegie spastique et 24 cas de diplégie spastique. Le suivi fut au minimum d' un an. Après radicotomie dorsale sélective (SDR), tous les enfants beneficierent d'un mois de kinesitherapie (PT) au centre et recurent une prescription de PT a domicile. Une evaluation des enfants fut faite avant et un an aprés la SDR et le PT, par l'Schelle d'Ashworth, l'etude des reflexes osteo‐tendineux, l'étendue des mouvements et une mesure de l'efficience motrice globale. Les resultats montrerent qu'il y eut souvent une diminution de la spasticite aux extremites inferieures et une amelioration fonctionnelle apres SDR et PT, mais avec une variabilite considerable du devenir. Des essais cliniques prospectifs et randomises avec mesure du devenir en aveugle, sont souhaitables pour determiner l' efficacite de la SDR. RESUMEN Papel de la rizotomia dorsal selectiva en la pardtisis cerebral. Evaluación de unas series clinicas prospectivas Se trata de un estudio de una prospectiva observacional de unas series conseciftivas de 34 niños con parálisis cérébral espástica (PC) tratados en un unico centro. 10 tenian una cuadriplegia espástica y 24 una diplegia espastica. Todos los casos fueron seguidos por lo menos durante un aflo. Despues de una rizotomia dorsal selectiva (RDS) todos los niños siguieron un mes de fisioterapia (FT) en el centro y se les prescribio un programa de FT en su comunidad. Los niños fueron evaluados antes y un aflo despues de RDS y FT utilizando la cscala Ashworth, respuesta refleja tendinosa, amplitud de movimiento y la Gross Motor Function Measure (medición de la función motora grosera). Los resultados mostraron que habia una disminucion de la espasticidad en las extremidades inferiores y una mejoria funcional despues de RDS y FT, pero que habia una gran variedad en el curso. Son necesarios estudios prospectivos randomizados con mediciones objectivas de cu...

Ethanol was orally administered once per week to 54 gravid pigtailed macaques (Macaca nemestrina) in doses of 0.0, 0.3, 0.6, 1.2, 1.8, 2.5 or 4.1 gm/kg from the 1st week in gestation or in doses of 2.5, 3.3 or 4.1 gm/kg from the 5th week. Mean maternal peak plasma ethanol concentrations (MPPEC's) ranged from 24 +/- 6 mg/dl at the 0.3 g/kg dose to 549 +/- 71 mg/dl at the 4.1 g/kg dose. Thirty-three live born infants were assessed for abnormalities of physical and behavioral development. Ocular pathology, neuropathologic and neurochemical assessements were done on 31 animals at 6 months postnatal age. Microphthalmia was noted in three of the 26 animals exposed to ethanol. Retinal ganglion cell loss was significantly associated with intra-uterine ethanol exposure. Microphthalmia and retinal ganglion cell loss was observed in both the delayed and full-gestational exposed animals. No structural anomalies were found in the brains via gross inspection or light microscopy. Chemical abnormalities in the striatal nuclei were identified. Striatal dopamine concentrations increased with increasing MPPEC exposure (0-249 mg/dl) among animals exposed weekly to ethanol throughout gestation. Striatal dopamine concentrations decreased with increasing MPPEC exposure (260-540 mg/dl) among animals whose weekly exposure to ethanol was delayed until the 5th week of gestation. The same pattern of association was also noted between MPPEC and ultrastructural alterations in the caudate nucleus. The extent of ultrastructural alterations increased with increasing MPPEC among the full-gestational exposed animals and decreased with increasing MPPEC among the delayed-dose animals.

A preliminary investigation of immune host response was conducted in a group of fetal alcohol-exposed nonhuman primates (Macaca nemestrina) who were part of a broader ongoing study of ethanol teratogenicity. The mothers of the offspring received weekly oral doses of ethanol (1.8 g/kg) for the first 3 or 6 or the entire 24 weeks of gestation. A control group received sucrose solution weekly throughout pregnancy. Four of the 18 ethanol-exposed animals (22%) died or were euthanized after infectious disease or failure to thrive during the first year of life; none of the seven control animals died. This imbalance in survival prompted the present review of immune function in the remaining offspring. Parameters assessed included: (1) white blood cell count (WBC), (2) peripheral blood leucocyte subsets (CD4+, CD8+, CD20+, and CD11c+), (3) T-cell proliferation after activation with phytohemagglutinin (PHA), staphylococcus enterotoxin B (SEB), and tetanus toxoid (TT), (4) phagocytic activity of monocytes, and (5) serum immunoglobulin levels and serum antibody titers after TT vaccination. Mean T-cell proliferation to TT was significantly decreased (p = 0.01) in all ethanol-exposed animals relative to controls, with near-significant decreases (p = 0.06) in response to SEB in the ethanol-exposed animals. Lymphocyte proliferation in response to PHA was not altered. Ethanol-exposed animals had significantly lower TT titers than controls after initial vaccination and booster. WBC, leukocyte subsets, serum immunoglobulins, and monocyte phagocytic activity were not significantly different from control values. These preliminary observations suggest that T-cell proliferation and antigen-specific memory responses may be altered in offspring exposed to weekly doses of ethanol in utero and warrant further evaluation for confirmation.