SUMMARY The urinary and bowel control was studied of 527 children with myelomeningocele aged between four and 18 years. Information was obtained from medical records and by parent questionnaire. 44 had normal urinary control, 50 had a urinary diversion and the remaining 433 had neuropathic bladder without urinary diversion, of whom 31 per cent expressed their bladder manually and 40 per cent used clean intermittent catheterisation (CIC). 60 per cent needed assistance emptying their bladder. Children using CIC were more continent and needed less help, but were more often treated with antibiotics. Of the 527 children, 412 had disturbed bowel control. 212 evacuated their bowels manually, of whom 90 per cent needed assistance. Parents judged urinary incontinence to be very stressful for 37 per cent of the children and faecal incontinence for 33 per cent. The authors conclude that social urinary continence should be defined as the ability to keep dry for three hours or more. RÉSUMÉ Contrôle intestinal et vésical chez les enfants porteurs de spina bifida: une étude nordique Le contrôle urinaire et vésical a étéétudié chez 527 enfants avec myéloméngocèle, âgés de quartre à 18 ans. Les informations ont été obtenues à partir des dossiers médicaux et par un questionnaire proposé aux parents. 44 enfants avaient un contrôle urinaire normal, 50 présentaient une dérivation urinaire, le reste étant 433 vessies neurologiques sans dérivation urinaire; parmi ces derniers cas, la vessie était pressée manuellement dans 31 pour cent des cas et le sondage propre intermittent (CIC) était utilisé dans 40 pour cent des cas. 60 pour cent des enfants avaient besoin d'assistance pour vider leur vessie. Les enfants avec CIC étaient plus continents, demandaient moins d'aide, mais étaient plus souvent traités par antibiotiques. Parmi les 527 cas, le contrôle intestinal était perturbeé adans 412 cas. 212 enfants évacuaient leur rectum manuellement, 90 pour cent d'entre eux avaient besoin d'aide. Les parents jugeaient l'incontinence urinaire difficile à supporter chez 37 pour cent des enfants, l'incontinence rectale chez 33 pour cent. Les auteurs concluent que la continence urinaire peut être socialement définie comme une capacitéà demeurer sec trois heures ou plus. ZUSAMMENFASSUNG Darm‐ und Blasenkontrolle bei Kindern mit Myelomeningocele: eine nordeuropäische Studie Bei 527 Kindern mit Myelomeningocele im Alter zwischen vier und 18 Jahren wurden Blasen‐ und Darmkontrolle untersucht. Die Informationen wurden den Krankenakten und den Fragebögen der Eltern entnommen. 44 hatten normale Urinkontrolle, 50 hatten eine Harnableitung, und die restlichen 433 hatten eine neurogene Blase ohne Harnableitung, 31 Prozent davon drückten ihre Blase manuell aus und 40 Prozent benutzten die sterile intermittierende Katheterisierung (CIC). 60 Prozent waren bei der Blasenentleerung auf Hilfe angewiesen. Kinder, die die CIC benutzten, hatten eine bessere Kontinenz und brauchten weniger Hilfe, sie wurden aber häufiger mit Antibiotika behandelt. Von den 527 Kindern h...

The antiepileptic effect of intravenous immunoglobulin (Sandoglobulin, Sandoz) was investigated in Lennox-Gastaut syndrome by an add-on, placebo-controlled, single-blind trial. Ten patients, aged 4-14 years, with insufficient response to conventional anticonvulsive therapy received placebo and Sandoglobulin 400 mg/kg two times each with an interval of two weeks. The washout period was four weeks and the total observation period 14 weeks, during which parents daily registered number and type of seizures. EEG, in vitro lymphocyte transformation tests and concentrations of immunoglobulins including IgG subclasses were evaluated before and after active treatment. Two children showed an immediate reduction in their high-frequency and invariable seizure activity from 42% to 100% and a less abnormal EEG. In addition, general well-being and intellectual performance was improved. The strongest response was observed in one child with a concomitant finding of a low level of IgG2, the only abnormal immunologic test in this study. The remaining 8 children, who had either a high or a low but variable seizure frequency showed no immediate change as EEG and their general condition was unaffected. We conclude that intravenous immunoglobulin had an immediate and pronounced effect on break-through seizure activity and a simultaneous neurophysiologic effect in 20% of our patients with Lennox-Gastaut syndrome. The effect was not confined to patients with immunologic abnormalities.

Poor upper extremity function is often recorded in meningomyelocele patients. Only 2 of the 25 patients we assessed, 5 to 19 years old, showed normal upper extremity function in the clinical neurological examination and a timed hand function test simulating daily activities. Slow performance with unsystematic variability was typical. Poor hand function correlated strongly with hydrocephalus. A trend towards better performance with increasing age may indicate that the difficulties are overcome in some patients. While patients without hydrocephalus showed a near-normal distribution in the seven subtests, patients with hydrocephalus needed more time than normal children. Patients with shunt-treated hydrocephalus did not cope as well as patients without a shunt. Mean age in the three groups differed and may partly explain the differences.

This study was carried out to evaluate the medical impairments and disability among 527 children with myelomeningocele living in four Nordic countries. The information was extracted form questionnaires and data based on case records. The level of intellectual functioning was fairly high with 76% within normal range (IQ greater than 90). Shunt operations were performed in 68% of the children and 1/3 had had four or more shunt revisions. Twenty-three per cent walked without support. Bladder incontinence was found in 60% of the children whereas 4% were entirely continent. Intermittent catheterisation was used in 36% with higher frequency among girls (48%) than boys (24%). We found a higher incidence of bacteriuria among those who used catheterisation than among those who used manual compression. Bowel control was experienced by 112 (21%) of the children. The overall disability is classified according to Lorbber's 5-graded handicap scale and Lagergren's 3-graded scale. According to Lagergren's scale, 70% suffered form severe overall disability.

Eighty-three children with spastic cerebral palsy (CP) were examined with cranial CT. In 56 cases the CT findings were abnormal. The most frequent abnormality was atrophy, present in 44 patients. The frequency of pathologic CT increased with severity of the CP. Patients with CP of postnatal aetiology more often had abnormal CT than patients with other known causes. Pathologic CT findings were seen more often in patients with seizures than in patients without. Infarctions and hemiatrophy were much more frequent in patients with hemiplegia than in patients with other types of spastic CP. A special kind of central atrophy, called isolated atrophy around in the cella media, is described. This condition was seen in 20% of cases, most often in hemi- and paraplegic patients. Early infarctions in the border areas between the vascular territories of the internal carotid and the posterior cerebral artery may be the reason for this kind of atrophy.