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Yozawitz EG, Cilio MR, Mizrahi EM, Moon JY, Moshé SL, Nunes ML, Plouin P, Zuberi S, Pressler RM. ILAE neonatal seizure framework to aide in determining etiology. Epileptic Disord 2025; 27:64-70. [PMID: 39601188 DOI: 10.1002/epd2.20312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Revised: 10/22/2024] [Accepted: 10/30/2024] [Indexed: 11/29/2024]
Abstract
OBJECTIVE To employ the neonatal seizure framework developed by the International League Against Epilepsy (ILAE) Neonatal Task force to assess its usefulness in determining the etiology of neonatal seizures. METHODS The members of the ILAE Neonatal Task Force evaluated 157 seizures from 146 neonates to determine internal validity and associations between semiology and a specific etiology. RESULTS Provoked neonatal electrographic and electroclinical seizures were due to multiple etiologies. For electroclinical seizures, unilateral clonic seizures were typically seen with vascular etiologies, focal tonic seizures and sequential seizures with genetic etiologies, and myoclonic seizures with inborn errors of metabolism. Electrographic seizures were often seen in hypoxic-ischemic encephalopathy or vascular etiologies. SIGNIFICANCE These data suggest that the ILAE neonatal seizure classification may be used as a bedside tool to aid and guide workup to determine the etiology of seizures.
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Affiliation(s)
- Elissa G Yozawitz
- Isabelle Rapin Division of Child Neurology of the Saul R. Korey Department of Neurology and Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Maria Roberta Cilio
- Department of Pediatrics Saint Luc University Hospital, and Institute of Neuroscience (IoNS), Catholic University of Louvain, Brussels, Belgium
| | - Eli M Mizrahi
- Department of Neurology and Pediatrics Baylor College of Medicine, Houston, Texas, USA
| | - Jee-Young Moon
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Solomon L Moshé
- Isabelle Rapin Division of Child Neurology of the Saul R. Korey Department of Neurology, Department of Pediatrics, and Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Magda L Nunes
- Pontifical Catholic University of Rio Grande Do Sul School of Medicine and Brain Institute (BraIns), Porto Alegre, Rio Grande do Sul, Brazil
| | - Perrine Plouin
- Clinical Neurophysiology Unit in Saint Vincent de Paul and in Necker Hospital, Paris, France
| | - Sameer Zuberi
- Fraser of Allander Neurosciences Unit Royal Hospital for Children Glasgow, Glasgow, UK
| | - Ronit M Pressler
- Clinical Neuroscience, UCL GOS Institute of Child Health and Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Castro Conde JR, Fuentes IQ, Campo CG, Sosa AJ, Millán BR, Expósito SH. EEG findings and outcomes of continuous video-EEG monitoring started prior to initiation of seizure treatment in the perinatal stroke. Early Hum Dev 2018; 120:1-9. [PMID: 29602053 DOI: 10.1016/j.earlhumdev.2018.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/17/2018] [Accepted: 03/22/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND To analyze the findings in the background EEG activity of infants who suffered perinatal stroke. METHODS Eleven neonates born 2009-2014 diagnosed of ischemic stroke by MRI (three of them with multistroke) underwent continuous video-EEG monitoring. Visual and spectral (power spectrum and coherence) analyses of the background EEG was performed in three moments: 1) Onset of EEG recording (prior to initiate seizure treatment), 2) Post-ictal epoch (1-2 h after the last seizure), and 3) one-two days after seizure control. All children aged 2-6 years underwent neurodevelopmental assessment. RESULTS Discontinuity, asymmetry, asynchrony, transients, and relative power spectrum in δ and θ frequency bands increased significantly (p < 0.05) in the post-ictal epoch with respect to onset of EEG recording. After seizure control, discontinuity, asynchrony, and θ power spectrum no longer had significant differences with those found at onset of EEG recording. Significant differences between the ischemic and unaffected hemispheres were found in transients and in β coherence (p = 0.002; p = 0.001, respectively) exclusively in the post-ictal epoch. Seizure burden and time-to-control ranged 5-38 min and 0.5-40 h respectively. Currently, only one child is affected by spastic monoparesis. The intelligence quotients ranged 96-123. CONCLUSIONS The background EEG can undergo significant changes in the post-ictal epoch due to the seizure activity triggered by the perinatal stroke. Most of these EEG changes involve all brain activity and not exclusively the ischemic hemisphere. Many of these modifications in the EEG background reverse following the seizure control. Video-EEG monitoring allows accurate/immediate diagnosis and rapid/intensive treatment of the stroke-associated seizures.
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Affiliation(s)
- José R Castro Conde
- Department of Neonatology, Hospital Universitario de Canarias, Ofra s/n, 38320 La Laguna, Spain; Research Group on Nutrition, Growth, and Child Development, Spain(1).
| | - Itziar Quintero Fuentes
- Department of Clinical Psychology, Psychobiology and Methodology, Faculty of Psychology, Campus de Guajara s/n, 38071 La Laguna, Universidad de La Laguna, Spain; Research Group on Developmental Neuropsychology, Spain(2).
| | | | | | - Beatriz Reyes Millán
- Department of Neonatology, Hospital Universitario Nuestra Señora de La Candelaria, Carretera del Rosario 145, 38010 S/C Tenerife, Spain.
| | - Sergio Hernández Expósito
- Department of Clinical Psychology, Psychobiology and Methodology, Faculty of Psychology, Campus de Guajara s/n, 38071 La Laguna, Universidad de La Laguna, Spain; Research Group on Developmental Neuropsychology, Spain(2).
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Nguyen The Tich S. Place de l’électroencéphalogramme dans la prise en charge de l’accident vasculaire ischémique artériel du nouveau-né. Arch Pediatr 2017; 24:9S41-9S45. [DOI: 10.1016/s0929-693x(17)30330-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pisani F, Pavlidis E, Facini C, La Morgia C, Fusco C, Cantalupo G. A 15-year epileptogenic period after perinatal brain injury. FUNCTIONAL NEUROLOGY 2017; 32:49-53. [PMID: 28380324 DOI: 10.11138/fneur/2017.32.1.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Seizures are a frequent acute neurological event in the neonatal period. Up to 12 to 18% of all seizures in newborns are due to perinatal stroke and up to 39% of affected children can then develop epilepsy in childhood. We report the case of a young patient who presented stroke-related seizures in the neonatal period and then developed focal symptomatic epilepsy at 15 years of age, and in whom the epileptic focus was found to co-localize with the site of his ischemic brain lesion. Such a prolonged silent period before onset of remote symptomatic epilepsy has not previously been reported. This case suggests that newborns with seizures due to a neonatal stroke are at higher risk of epilepsy and that the epileptogenic process in these subjects can last longer than a decade.
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Saliba E, Debillon T, Auvin S, Baud O, Biran V, Chabernaud JL, Chabrier S, Cneude F, Cordier AG, Darmency-Stamboul V, Diependaele JF, Debillon T, Dinomais M, Durand C, Ego A, Favrais G, Gruel Y, Hertz-Pannier L, Husson B, Marret S, N’Guyen The Tich S, Perez T, Saliba E, Valentin JB, Vuillerot C. Accidents vasculaires cérébraux ischémiques artériels néonatals : synthèse des recommandations. Arch Pediatr 2017; 24:180-188. [DOI: 10.1016/j.arcped.2016.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/25/2016] [Accepted: 11/22/2016] [Indexed: 12/01/2022]
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Iimura Y, Sugano H, Nakajima M, Higo T, Suzuki H, Nakanishi H, Arai H. Analysis of Epileptic Discharges from Implanted Subdural Electrodes in Patients with Sturge-Weber Syndrome. PLoS One 2016; 11:e0152992. [PMID: 27054715 PMCID: PMC4824532 DOI: 10.1371/journal.pone.0152992] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 03/22/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Almost two-thirds of patients with Sturge-Weber syndrome (SWS) have epilepsy, and half of them require surgery for it. However, it is well known that scalp electroencephalography (EEG) does not demonstrate unequivocal epileptic discharges in patients with SWS. Therefore, we analyzed interictal and ictal discharges from intracranial subdural EEG recordings in patients treated surgically for SWS to elucidate epileptogenicity in this disorder. METHODS Five intractable epileptic patients with SWS who were implanted with subdural electrodes for presurgical evaluation were enrolled in this study. We examined the following seizure parameters: seizure onset zone (SOZ), propagation speed of seizure discharges, and seizure duration by visual inspection. Additionally, power spectrogram analysis on some frequency bands at SOZ was performed from 60 s before the visually detected seizure onset using the EEG Complex Demodulation Method (CDM). RESULTS We obtained 21 seizures from five patients for evaluation, and all seizures initiated from the cortex under the leptomeningeal angioma. Most of the patients presented with motionless staring and respiratory distress as seizure symptoms. The average seizure propagation speed and duration were 3.1 ± 3.6 cm/min and 19.4 ± 33.6 min, respectively. Significant power spectrogram changes at the SOZ were detected at 10-30 Hz from 15 s before seizure onset, and at 30-80 Hz from 5 s before seizure onset. SIGNIFICANCE In patients with SWS, seizures initiate from the cortex under the leptomeningeal angioma, and seizure propagation is slow and persists for a longer period. CDM indicated beta to low gamma-ranged seizure discharges starting from shortly before the visually detected seizure onset. Our ECoG findings indicate that ischemia is a principal mechanism underlying ictogenesis and epileptogenesis in SWS.
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Affiliation(s)
- Yasushi Iimura
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Hidenori Sugano
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Madoka Nakajima
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Takuma Higo
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Hiroharu Suzuki
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Hajime Nakanishi
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan
| | - Hajime Arai
- Department of Neurosurgery, Epilepsy Center, Juntendo University, Tokyo, Japan
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Zayachkivsky A, Lehmkuhle MJ, Ekstrand JJ, Dudek FE. Ischemic injury suppresses hypoxia-induced electrographic seizures and the background EEG in a rat model of perinatal hypoxic-ischemic encephalopathy. J Neurophysiol 2015; 114:2753-63. [PMID: 26354320 DOI: 10.1152/jn.00796.2014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 09/05/2015] [Indexed: 12/16/2022] Open
Abstract
The relationship among neonatal seizures, abnormalities of the electroencephalogram (EEG), brain injury, and long-term neurological outcome (e.g., epilepsy) remains controversial. The effects of hypoxia alone (Ha) and hypoxia-ischemia (HI) were studied in neonatal rats at postnatal day 7; both models generate EEG seizures during the 2-h hypoxia treatment, but only HI causes an infarct with severe neuronal degeneration. Single-channel, differential recordings of acute EEG seizures and background suppression were recorded with a novel miniature telemetry device during the hypoxia treatment and analyzed quantitatively. The waveforms of electrographic seizures (and their behavioral correlates) appeared virtually identical in both models and were identified as discrete events with high power in the traditional delta (0.1-4 Hz) and/or alpha (8-12 Hz) bands. Although the EEG patterns during seizures were similar in Ha- and HI-treated animals at the beginning of the hypoxic insult, Ha caused a more severe electrographic seizure profile than HI near the end. Analyses of power spectral density and seizure frequency profiles indicated that the electrographic seizures progressively increased during the 2-h Ha treatment, while HI led to a progressive decrease in the seizures with significant suppression of the EEG background. These data show that 1) the hypoxia component of these two models drives the seizures; 2) the seizures during Ha are substantially more robust than those during HI, possibly because ongoing neuronal damage blunts the electrographic activity; and 3) a progressive decrease in background EEG, rather than the presence of electrographic seizures, indicates neuronal degeneration during perinatal HI.
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Affiliation(s)
- A Zayachkivsky
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah; and
| | - M J Lehmkuhle
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah; and
| | - J J Ekstrand
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - F E Dudek
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah; and
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Abstract
The cerebral function monitor is a device for trend monitoring of changes in the amplitude of the electroencephalogram, typically recorded from one or two pairs of electrodes. Initially developed and introduced to monitor cerebral activity in encephalopathic adult patients or during anaesthesia, it is now most widely used in newborns to assess the severity of encephalopathy and for determining prognosis. The duration and severity of abnormalities of the amplitude-integrated electroencephalogram tracing is highly predictive of subsequent neurologic outcome following neonatal hypoxic-ischemic encephalopathy, including in newborns receiving neuroprotective treatment with prolonged moderate hypothermia. The cerebral function monitor is also used for seizure detection and to monitor response to anticonvulsant therapies. Amplitude-integrated electroencephalography compares well with standard electroencephalography when used to assess the severity of neonatal encephalopathy, but a standard electroencephalogram is still required to provide important information about changes in frequency, and in the synchrony and distribution and other characteristics of cerebral cortical activity. The role of the amplitude-integrated electroencephalogram to identify brain injury in preterm infants remains to be determined.
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Affiliation(s)
- Denis Azzopardi
- Centre for the Developing Brain, Perinatal Imaging, King's College London, St Thomas' Hospital, London, UK.
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Low E, Mathieson SR, Stevenson NJ, Livingstone V, Ryan CA, Bogue CO, Rennie JM, Boylan GB. Early postnatal EEG features of perinatal arterial ischaemic stroke with seizures. PLoS One 2014; 9:e100973. [PMID: 25051161 PMCID: PMC4106759 DOI: 10.1371/journal.pone.0100973] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 06/01/2014] [Indexed: 11/18/2022] Open
Abstract
Background Stroke is the second most common cause of seizures in term neonates and is associated with abnormal long-term neurodevelopmental outcome in some cases. Objective To aid diagnosis earlier in the postnatal period, our aim was to describe the characteristic EEG patterns in term neonates with perinatal arterial ischaemic stroke (PAIS) seizures. Design Retrospective observational study. Patients Neonates >37 weeks born between 2003 and 2011 in two hospitals. Method Continuous multichannel video-EEG was used to analyze the background patterns and characteristics of seizures. Each EEG was assessed for continuity, symmetry, characteristic features and sleep cycling; morphology of electrographic seizures was also examined. Each seizure was categorized as electrographic-only or electroclinical; the percentage of seizure events for each seizure type was also summarized. Results Nine neonates with PAIS seizures and EEG monitoring were identified. While EEG continuity was present in all cases, the background pattern showed suppression over the infarcted side; this was quite marked (>50% amplitude reduction) when the lesion was large. Characteristic unilateral bursts of theta activity with sharp or spike waves intermixed were seen in all cases. Sleep cycling was generally present but was more disturbed over the infarcted side. Seizures demonstrated a characteristic pattern; focal sharp waves/spike-polyspikes were seen at frequency of 1–2 Hz and phase reversal over the central region was common. Electrographic-only seizure events were more frequent compared to electroclinical seizure events (78 vs 22%). Conclusions Focal electrographic and electroclinical seizures with ipsilateral suppression of the background activity and focal sharp waves are strong indicators of PAIS. Approximately 80% of seizure events were the result of clinically unsuspected seizures in neonates with PAIS. Prolonged and continuous multichannel video-EEG monitoring is advocated for adequate seizure surveillance.
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Affiliation(s)
- Evonne Low
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Sean R. Mathieson
- Elizabeth Garrett Anderson Institute for Women's Health, University College London Hospital, London, United Kingdom
| | - Nathan J. Stevenson
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Vicki Livingstone
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - C. Anthony Ryan
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Conor O. Bogue
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Janet M. Rennie
- Elizabeth Garrett Anderson Institute for Women's Health, University College London Hospital, London, United Kingdom
| | - Geraldine B. Boylan
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research, Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- * E-mail:
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Kharoshankaya L, Filan PM, Bogue CO, Murray DM, Boylan GB. Global suppression of electrocortical activity in unilateral perinatal thalamic stroke. Dev Med Child Neurol 2014; 56:695-8. [PMID: 24410068 PMCID: PMC4190684 DOI: 10.1111/dmcn.12365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2013] [Indexed: 12/03/2022]
Abstract
We present an unusual case of persistent generalized electroencephalography (EEG) suppression and right-sided clonic seizures in a male infant born at 40(+2) weeks' gestation, birthweight 3240g, with an isolated unilateral thalamic stroke. The EEG at 13 hours after birth showed a generalized very low amplitude background pattern, which progressed to frequent electrographic seizures over the left hemisphere. The interictal background EEG pattern remained grossly abnormal over the next 48 hours, showing very low background amplitudes (<10μV). Magnetic resonance imaging revealed an isolated acute left-sided thalamic infarction. This is the first description of severe global EEG suppression caused by an isolated unilateral thalamic stroke and supports the role of the thalamus as the control centre for cortical electrical activity.
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Affiliation(s)
- Liudmila Kharoshankaya
- Department of Paediatrics and Child Health, University College CorkCork, Ireland,Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity HospitalCork, Ireland,Correspondence to Liudmila Kharoshankaya, Neonatal Brain Research Group, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland. E-mail:
| | - Peter M Filan
- Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity HospitalCork, Ireland,Department of Neonatology, Cork University Maternity HospitalCork, Ireland
| | - Conor O Bogue
- Department of Radiology, Cork University HospitalCork, Ireland
| | - Deirdre M Murray
- Department of Paediatrics and Child Health, University College CorkCork, Ireland,Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity HospitalCork, Ireland
| | - Geraldine B Boylan
- Department of Paediatrics and Child Health, University College CorkCork, Ireland,Neonatal Brain Research Group, Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity HospitalCork, Ireland
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Pyzio-Kowalik M, Wójtowicz D, Skrzek A. Assessing postural asymmetry with a podoscope in infants with Central Coordination Disturbance. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:1832-1842. [PMID: 23523987 DOI: 10.1016/j.ridd.2013.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 02/25/2013] [Accepted: 02/26/2013] [Indexed: 06/02/2023]
Abstract
The aim of this study was to digitally evaluate the incidence and severity of postural asymmetry in infants with Central Coordination Disturbance (CCD) by using a computer-aided podoscope (PodoBaby) from CQ Elektronik System. A sample of 120 infants aged from 3 months (± 1 week) to 6 months (± 1 week) took part in the study, of which 60 were diagnosed with CCD by a neurologist using Vojta's method and the remaining half healthy, non-afflicted infants. The relationships between Vojta's method, as a subjective clinical diagnostic tool for assessing the functional performance of infants with CCD, and the postural asymmetry results recorded with the podoscope, were also defined. Each infant was placed on the podoscope and photographed underneath in two positions: first lying on their back and then on their stomach. A symmetry index was used to calculate body asymmetry, i.e., the percent difference of abnormal body posture by favoring one side of the body to the other. The results confirmed that postural asymmetry assessed by the PodoBaby was in line with the earlier clinical diagnosis using Vojta's method. Statistically significant differences in postural asymmetry were also found between the healthy infants and infants with CCD. In addition, significant relationships were demonstrated in the magnitude and direction of asymmetry in the stomach and back positions.
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