Cognitive Profiles and Visuoperceptual Abilities in Preterm and Term Spastic Diplegic Children With Periventricular Leukomalacia

Abstract

Although relations between the extent of periventricular leukomalacia and neuropsychological performance in preterm children with spastic diplegia have been extensively investigated, studies on term children with spastic diplegia are rare. The authors examined 15 preterm children and 9 term children with spastic diplegia, all of whom had periventricular leukomalacia as a main magnetic resonance imaging (MRI) finding (excluding full-term spastic diplegic children with other MRI findings). Cognitive abilities (Griffith scale) and visuoperceptual abilities (Developmental Test of Visual Perception) were compared in the 2 groups and related to periventricular leukomalacia severity. Cognitive performance was substantially similar in the 2 groups. However, the overall Developmental Test of Visual Perception scores were below normal in the preterm and were normal in the term children; furthermore, visuoperceptual abilities were differentially affected in the preterm children, with visuomotor abilities more compromised than nonmotor visuoperceptual abilities. These children had similar cognitive performance and MRI findings, so the greater visuoperceptual compromise in the preterm group suggests a direct influence of prematurity, which may have adversely influenced the reorganization of visual centers and pathways following the initial developmental insult. The strabismus present in most preterm children would also have contributed to their greater visuoperceptual compromise. The authors conclude that the management of preterm and term children should differ, with concentration on visuoperceptual skills and rehabilitation in the former.

Periventricular leukomalacia in very low birth weight preterm neonates with high risk for neonatal sepsis

“…Atualmente, a leucomalácia periventricular (LPV) é o principal problema neurológico que atinge o prematuro extremo. Aproximadamente 25% dos recém-nascidos com peso de nascimento inferior a 1.500 g e que recebem alta apresentam déficit motor permanente moderado ou grave, como diplegia espástica; na idade escolar, 25 a 50% das crianças que tiveram diagnóstico de LPV manifestam déficit cognitivo e de aprendizado [3][4][5] .…”

The Instrumented Fetal Sheep as a Model of Cerebral White Matter Injury in the Premature Infant

“…Perinatal WMI (including periventricular leukomalacia) was the most common finding, which was seen in almost half (42.5%) of the affected children [22]. WMI is not exclusively associated with prematurity and it is increasingly appreciated in term infants [23][24][25]. Infants with complex congenital heart disease are at particular risk for WMI and delayed brain maturation [26][27][28].…”

Aspects of birth history and outcome in diplegics attending specialised educational facilities

“…Some of these results differ from others that have shown similarities in later cognitive functioning for term and preterm SD subjects but more visuoperceptual problems in those born preterm. 19 In our study the VMI-z and VIS-z-scores were slightly lower for the preterm than the for the term group (means of -2.35 v. -2.1), but this was not statistically significant. Therefore this difference from the literature might have been the result of a relatively small sample size.…”

“…24 Recent studies suggest that more effort must be directed towards diagnosis and management of the visual dysfunction in survivors of PVL. 19,25 These barriers to learning require specialised teaching strategies and skills. The children in this group also demonstrated considerable limitations in mobility at school and in the community.…”