A Survey of 400 cases of cerebral palsy in childhood

Abstract

A survey of cases of cerebral palsy among children in the Midlands is described. Four hundred cases were examined; the group appeared to be a representative sample of all types of cerebral palsy. The incidence of cerebral palsy among the school-age population of certain towns is probably about 1 per 1,000. Among 349* cases of congenital cerebral palsy there were 290 cases of spastic paralysis (83%), 36 athetoids (10%), 17 mixed cases (5 %), three cases of ataxia, two of flaccid paralysis, and one of rigidity and tremor. The relative incidence of spastic paralysis and athetosis is discussed, with special reference to the figures given in other published series. The aetiology of congenital cerebral palsy is discussed. Evidence from this series suggests that athetosis is usually the result of birth injury or asphyxia or of neonatal jaundice, whether due to Rh iso-immunization or not. Birth injury probably causes some cases of spastic paralysis, while others are the result of genetic or intrauterine factors. We found no evidence that asymmetrical spastic paralysis is more likely to be due to birth injury than to symmetrical paralysis. Fifty-one cases of acquired cerebral palsy were examined. These comprised 19 cases of kernicterus, 14 of acute infantile hemiplegia, 11 post-meningitic palsies, two other infective cases, four cases of progressive spastic paralysis, and one of posttraumatic hemiplegia. The aetiology of acute infantile hemiplegia is discussed; it is suggested that vascular accidents are the usual cause of this condition. All but two cases over the age of 3 years were examined by a psychologist and the intelligence was assessed in all but 14 cases, using the method of Stanford-Binet (T.M.L.). The I.Q. was 70 or over in 51% of cases, between 50 and 69 in 23%, and below 50 in 26%. No significant difference in the mean I.Q. of spastics and athetoids was found. The mean I.Q. of the various groups varied inversely with the severity of the physical handicap; thus the mean I.Q. of spastic quadriplegics was significantly lower than that of the hemiplegics or paraplegics.