Background: Selective dorsal rhizotomy (SDR) is a well accepted neurosurgical procedure performed for the relief of spasticity interfering with motor function in children with spastic cerebral palsy (CP). The goal is to improve function, but long-term outcome studies are rare. The aims of this study were to evaluate long-term functional outcomes, safety and side effects during five postoperative years in all children with diplegia undergoing SDR combined with physiotherapy.

The prevalence, clinical features and gross motor function of children with cerebral palsy in southern Sweden were investigated. The study covered the birth year period 1990–1993, during which 65514 livebirths were recorded in the area. On the census date (1 January 1998), 68 366 children born in 1990‐1993 lived in the area. The study comprised 167 children, 145 of them born in Sweden and 22 born abroad. The livebirth prevalence was 2.2 per 1000, and the prevalence including children born abroad was 2.4 per 1000. The distribution according to gestational age, birthweight and subdiagnoses was similar to that in earlier Swedish studies, except for a higher rate of dyskinetic syndromes in this study. Conclusion: The point prevalence of cerebral palsy was 2.4 and the livebirth prevalence was 2.2. Children born abroad had a higher prevalence and were more often severely disabled. Severe disability was often combined with associated impairments such as mental retardation, epilepsy and visual impairment.

The gross motor function and disabilities in children with cerebral palsy in southern Sweden were investigated and related to clinical features. The study covered the birth year period 1990‐1993 and comprised 167 children, 145 of them born in Sweden and 22 born abroad. The clinical features and gross motor function were analysed at a mean age of 6.8 y. Clinical features were obtained from a continuing healthcare follow‐up programme. Gross motor function was classified according to the Gross Motor Function Classification System (GMFCS). Walking independently was possible for 86% of the hemiplegic, 63% of the pure ataxic, 61% of the diplegic and 21% of the dyskinetic children. None of the tetraplegic children was able to walk. The classification of gross motor function revealed that 59% of the children were categorized into levels I and II (mildly disabled), 14% into level III (moderately disabled) and 27% into levels IV and V (severely disabled). Children born abroad were more severely disabled. Conclusion: The standardized age‐related classification system GMFCS enabled a specific description of gross motor function in relation to clinical features. Significant differences between GMFCS levels and subgroups of diagnosis, aetiology, intellectual capacity, epilepsy and visual impairment were found.

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...

SUMMARY Twenty six adolescents with myelomeningocele have been followed from birth: they comprise the whole population born with myelomeningocele between 1964 and 1967 in one Swedish medical district. 18 have severe physical handicaps, and although there are equal numbers of males and females, more females have severe handicaps. 22 of the 26 have been educated in normal schools (19 in normal classes), but learning difficulties are common. Three other adolescents are mildly mentally retarded and one is severely so. Only seven have complete urinary continence. 19 take part in leisure‐time activities, but many felt they had poor social contact with their schoolmates and one in three were competent in activities of daily living. In general, self‐concept was poor and many had inadequate knowledge about sexuality and the cause of their handicap. Recently established Handicapped Adult Teams have proved important in providing a link between the adolescent and public services dealing with health, education, employment and social services. RÉSUMÉ Conditions de vie pour des adolescents avec myéloméningocèle Vingt‐six adolescents avec myéloméningocèle ont été suivis á partir de la naissance: ils constituaient la totalité de la population née avec myéloméningocèle entre 1964 et 1967 dans un district médical suédois. 18 avaient des handicaps moteurs graves, et quoiqu'il y ait eu un nombre égal de garcons et de filles, plus de filles présentaient des handicaps graves. 22 des 26 cas avaient été élevés dans des écoles normales (19 dans des classes normales), mais les difficultès d'apprentissage étaient habituelles. Trois autres adolescents présentaient un retard mental modéré et un, un retard sévère. Seulement sept cas présentaient une continence urinaire complète. 19 adolescents participaient à des activités de distractions, mais beaucoup ressentaient un contact social médiocre avec leurs camarades de classe et un sur trois était indépendant dans les activités de la vie journalière. En général l'autoappréciation était médiocre et beaucoup des sujets avaient une connaissance inadéquate de la sexualité et de la cause de leur handicap. Les regroupements pour handicapés adultes récemment mis en place se sont rélévés importants en fournissant un lien entre l'adolescent et les services publics s'occupant de santé, d'éducation, d'emploi ou de service social. ZUSAMMENFASSUNG Lebensbedingungen für Erwachsene mil Myelomeningocele 26 Jugendliche mit Myelomeningocele wurden von Geburt an kontrolliert: das sind alle Patienten mit Myelomeningocele, die zwischen 1964 und 1967 in einem medizinischen Distrikt in Schweden geboren wurden. 18 haben schwere körperliche Behinderungen, und obwohl die Anzahl der männlichen und weiblichen Patienten gleich ist, gibt es mehr weibliche mit schweren Behinderungen. 22 der 26 Patienten werden in normalen Schulen unterrichtet (19 besuchen die regulären Klassen), aber es treten häufig Lernschwierigkeiten auf. Drei weitere Jugendliche sind gering und einer ist schwer geistig retardiert. Nur sieben haben eine vol...

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.

SUMMARY The white blood cell count and the erythrocyte sedimentation rate were studied in 180 hospital patients with a clear‐cut diagnosis of pertussis. In children below 6 months, the white blood cell picture favoured a diagnosis of pertussis in only one out of every four or five cases during the first 3 weeks of the disease, but not later. In children over 6 months, absolute leucocytosis and lymphocytosis were noted in the majority during the first 2 weeks of the disease (leucocytosis in 63 % and lymphocytosis in 71 %). During the third and fourth weeks changes in the white cells supported the diagnosis of pertussis in 80% and 50%, respectively. Marked leucocytosis (more than 50,000 leucocytes per mm3. of blood) was noted in 8 cases. I n uncomplicated pertussis the erythrocyte sedimentation rate is usually normal or subnormal and does not appear to vary with the patient's age or the week of the disease.

The prognosis in medulloblastoma has often been reported to be gloomy, and five-year survival rates of approximately 25% are often reported. In recent years, however, some centers have published results that indicate a possible cure rate of 60% or even more. During the years 1946-1975, 50 children received radiotherapy for medulloblastoma at the University Hospital, Lund, Sweden. During this period the target volume had been defined in three different ways, whereas the target-absorbed dose had not differed. When only the demonstrated tumor was treated, the ten-year survival rate was 5%. If the spinal subdural space also was included, it rose to 25%, and when the whole subdural space was treated in addition to the demonstrated tumor, the projected ten-year survival rate was 53%. It is apparent that the target volume in the radiotherapy of medulloblastoma should include not only the demonstrated tumor but also the whole subdural space from the tip of the frontal lobes down to and including the second sacral segment. The size of the target-absorbed dose to be aimed at is not settled, but should consider not only the cure rate but also the performance status of the survivors. It seems from the present series that an absorbed dose of 45 Gy in not more than 30 fractions over six weeks to the demonstrated tumor and 30 Gy in 20 fractions over four weeks to the subdural space resulted in a fair frequency of tumor healing and minimal side effects. The delivery of this complicated treatment demands a high degree of precision in the technique. In this material the performance status of the children was not affected by the radiation treatment.