Objective: To compare the effects of early and late treatment and to evaluate the contributing factors for the therapeutic outcome in cerebral palsy children.

Method: Three hundred twenty four children with delayed development including cerebral palsy who were admitted to the Department of Rehabilitation at Yonsei University Medical Center from January 1992 to December 1995 were studied. They were divided into two groups according to the initiation of treatment: early and late treatment groups. Early treatment was defined as treatment started at or before 6 months and the late treatment was after 6 months. They were also divided into groups according to the diagnosis, responsiveness to treatment and initial motor quotient. And then the motor developments during the follow-up period between each groups were compared as the effects of treatment.

Results: The development of the motor milestone was faster in the early treatment group than in the late treatment group. The group which initially showed a higher motor quotient had a higher response rate to the treatment and a faster development of the motor milestone than the group with a lower motor quotient.

Conclusion: These results suggest that the initiation of treatment and the severity of delayed development are important contributing factors for an outcome of treatment.

Objective: To evaluate the characteristics of speech-language development and to find out the relationship between them and radiological findings, and mental/motor developmental quotient in the children with cerebral palsy and other delayed development.

Method: Fifty-eight children with cerebral palsy or delayed development were evaluated with Bayley scales of infant development, brain magnetic resonance imaging (MRI), and single photon emission computerized tomography (SPECT). At the same time, the speech-language development using several evaluation batteries was assessed.

Results: Most of the children with cerebral palsy or delayed development showed delay in speech-language development. There was no relationship between speech-language development and presence of the lesion on brain MRI or SPECT, and mental/motor developmental quotient.

Conclusion: Speech-language development was delayed in most of the children with cerebral palsy or other delayed development. Therefore, early interventions for speech-language development and comprehensive speech therapy are required for improving functional outcome in these children.

Objective: To investigate the effect of epilepsy and neonatal seizure on development in children with cerebral palsy (CP) or delayed development (DD).

Method: The subjects were 135 patients with CP or DD. Development was evaluated by Bayley Scale of Infant Development II (BSID II). Epilepsy was diagnosed on the base of clinical features, past history and electroencephalography.

Results: The incidence of epilepsy was 18.4% in CP, and 37.8% in DD. Spastic quadriplegia of CP has the highest incidence of epilepsy (38.4%). First seizure attack was occurred before 6 months old of age in 66.7% of CP with epilepsy and in 64.3% of DD with epilepsy. The prevailing type of epilepsy was generalized seizure in DD (57.1%), partial seizure in CP (50.0%). The group with epilepsy had lower psychomotor and mental development quotient on BSID II than the group without epilesy (p＜0.05). Polytherapy was more used to control epilepsy than monotherapy. Valproate (50.0%), phenobarbital (37.5%), carbamazepine (31.3%) were commonly used drugs for controlling epilepsy.

Conclusion: The epilpesy has a negative effect on psychomotor and mental development in the children with CP or DD.

In 1965 Gillespie reported a new syndrome of bilateral aniridia, cerebellar ataxia, and oligophrenia (mental retardation). This new syndrome was named Gillespie syndrome. Since then only 17 cases of Gillespie syndrome have been reported in UK, Brazil, Ireland, Belgium, Australia, and US. A case of Gillespie syndrome was not reported in Korea.

A 4 year-old girl has triad of Gillespie syndrome, which are partial aniridia, cerebellar ataxia and mental retardation. We confirmed this with ophthalmologic examination, brain MRI, and developmental delay. We report the typical manifestation of Gillespie syndrome in a 4 year-old girl with the brief review of literature.

Early diagnosis of cerebral palsy may help to provide early therapeutic intervention.

The early treatment of cerebral palsy is critical in the prevention of deformity and promotion of normal movement patterns. However, it is difficult to identify those who are at substantial risk of cerebral palsy before the age of one, particularly in its mild and moderate forms. The purpose of this study was to analyze and establish an efficient early diagnostic tool for cerebral palsy. The subjects in this study were 247 infants selected from outpatients at the Rehabilitation Hospital of Yonsei University from December, 1987 to March, 1996. The infants had problems in motor development or a past history of perinatal risks and all were under one year of corrected age.

The assessments included a structured developmental history taken from the child's parents, evaluation of motor development status, and neurological examiniations including assessment of muscle tone, several primitive reflexes and Vojta's postural reactions. These infants were assessed every 2∼3 months. According to the findings of developmental milestones, muscle tone, and Vojta's postural reactions, we divided the patients into high and low risk groups.

The final diagnosis confirmed that 126 children had cerebral palsy, 43 children had other diagnoses while 78 children turned out to be normal.

We found that diagnosis of cerebral palsy during the first six months of postnatal period relied mainly on abnormal muscle tone, Vojta's postural reactions, developmental motor delay, a positive finding of asymmetric tonic neck reflex and a negative finding of optical righting reaction. The sensitivity and specificity of the evaluation methods were 91.1% and 66.7%, respectively in the first six months of postnatal period.

In conclusion, we have proved that the delayed motor development, abnormal muscle tone and abnormal Vojta's postural reactions are very valuable tools for the early diagnosis of cerebral palsy.