Effects of recombinant growth hormone (GH) replacement and psychomotor and cognitive stimulation in the neurodevelopment of GH-deficient (GHD) children with cerebral palsy: a pilot study

Abstract

Cerebral palsy (CP) is the main cause of physical disability in childhood and is an important health issue that has a strong socioeconomic impact. There is no effective treatment for CP and therapeutic approaches report only partial benefits for affected people. In this study we assessed the effects of growth hormone (GH) treatment combined with psychomotor and cognitive stimulation in the neurodevelopment of children with CP and GH deficiency (GHD). The study was carried out in 11 patients (7 boys and 4 girls; 4.12 ± 1.31 years) with GHD and CP who were treated with recombinant GH (rGH) and psychomotor and cognitive stimulation during 2 months. Battelle Developmental Inventory Screening Test (BDIST) was performed 2 months before commencing GH treatment, just before commencing GH administration, and after 2 months of combined treatment involving GH and cognitive stimulation. Psychomotor and cognitive status did not change during the period in which only cognitive stimulation was performed; however, significant improvements in personal and social skills, adaptive behavior, gross motor skills and total psychomotor abilities, receptive and total communication, cognitive skills and in the total score of the test (P < 0.01), and in fine motor skills and expressive communication (P < 0.02) were observed after the combined treatment period. Therefore, GH replacement together with psychomotor and cognitive stimulation seem to be useful for the appropriate neurodevelopment of children with GHD and CP.

Growth Hormone Deficiency: Is It Just a Problem of Growth Impairment? Part I

“…Data from our group indicate that in a large number of children with cerebral palsy, 70% of them lacked normal GH secretion [78]. We do not know if this GHD is a consequence of the neonatal injury or if it occurs as a result of the high spasticity that leads to a deficient production of IGF-I, but in any case GH administration in these children is very useful and helps to the kinesitherapy and the recovery of lost brain functions [40,79]. Similar recoveries, after GH administration and rehabilitation, have been seen in traumatic brain injuries [35-37, 39, 41-44, 47] and after a stroke, both in rats [48] and humans [80,81].…”

“…IGF-I is also synthesized in the CNS [29], and its expression, induced by GH, has been detected in neural stem cells from fetal human forebrains [30]. Both GH and IGF-I play a very important reparative role after a brain injury, a hypothesis postulated a long time ago [31] and later proved by many preclinical and clinical studies, regardless of whether the experimental animals or human patients were GHD or not [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49].…”

A Rare Case of Aicardi-Gouti&egrave;res Syndrome Who Showed a Positive Evolution after Being Treated with Growth Hormone, High Doses of Melatonin and Neurorehabilitation

“…We treated him according to our protocols for children with cerebral palsy, both in terms of medication received (GH and MT) and neurorehabilitation [22,23]. GH was prescribed not only because of the low height of the patient and low plasma IGF-I values, a very common finding in children with cerebral palsy [24], but also for the known effects of the hormone on brain repair after a damage [25][26][27][28], particularly on cognition, executive functions and working memory [27,[29][30][31][32].…”

Platelet-Rich Plasma in a Patient with Cerebral Palsy

“…Neuroprotective and neuroregeneration stimulator effects were observed in these patients managed with synthetic growth hormone (HGF), which results in functional improvement, especially in the cognitive field (e.g., memory, language, ability to perform complex tasks, and acquisition of new skills). In these patients, the neuronal degenerative effect has been accompanied by a marked qualitative and quantitative decrease in plasmatic growth factors like HGFIGF-1-VEGD, PDGF, and TGF-B [8,9], regulated by the hypothalamic-pituitary axis that produces a neuroprotective effect, and by the neurotropic effect of chemotaxis, cell differentiation, and neuroplasticity on neuronal tissue. However, treatment with synthetic growth hormone is costly, not only from the economic standpoint, but also from the clinician’s viewpoint.…”