Identification of etiology for developmental delay is useful in many aspects: enhance understanding of caregiver since the treatment plan and prognosis may depend on the etiology; the information provided with etiology may acquire further genetic counselling and family planning. Without definite brain lesions present in brain imaging studies, it may be difficult to identify cerebral palsy, a well-known cause of motor delay especially for those with minimal dysfunction. Also, perinatal history may not be enough to explain the etiology of motor developmental delay. In this study, we evaluated the magnetic resonance imaging and chromosome analysis to identify the etiology of children referred for motor developmental delay.
Material and Methods
Clinical reports of children who visited the outpatient clinic of rehabilitation medicine for motor developmental delay from Jan, 2009 to May, 2015 were reviewed retrospectively. Subjects were included if the last functional evaluation was performed in ages older than 18 months and were clinically diagnosed as motor developmental delay. For accurate identification of etiology, all available functional assessments, brain imaging studies, and genetic studies were collected for analyses. Classification of MRI findings is described in Table 1. Additional results of cognitive and language evaluations were also included if available. Motor delay was defined as ‘mild’ if child of developmental delay was capable of independent walking by 18 months of age. ‘Severe’ motor delay, on the other hand, was defined as not capable of independent walking by 18 months of age.
Results
Of all 1158 patients who had reported motor developmental delay registered at CHA Bundang Medical Center, 13 patients did not have brain magnetic resonance imaging study. Findings of brain MRI are summarized in Table 2. Thirty-six percent of those with Brain MRI had normal findings whereas 41% had evidence of hypoxic ischemic encephalopathy including periventricular leukomalacia, focal and extensive encephalomalacia, lesions of basal ganglia, thalamus, and deep brain white matter. Brain anomalies were found in 4.2% and included malformation of cortical development, anomalies of corpus callosum, brainstem, and cerebellum. Most of those with normal brain findings had mild motor delay; however, 32.9% have severe motor delay that hinders independent walking (Table 3). Of 419 children with normal brain findings, only 25% children had low birth weights and 40% did not have any spasticity or change of tone. Forty-four percent of those had genetic studies and 17.8% of these results showed genetic abnormalities that were not considered as normal variation.
Discussion
Although cerebral palsy is the major cause of motor developmental delay in children, the rest still remain without definite cause. The effort to find the etiology of motor developmental delay in children should be pursued for better care.
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