Two male patients (a child and an adult) with congenital mirror movement were studied using functional MRI (fMRI) and transcranial magnetic stimulation (TMS). Bilateral primary sensorimotor cortices were activated during unilateral hand gripping on fMRI when the child patient was 8 years old and the adult was 37 years old. Bilateral motor evoked potentials were induced from the hand and forearm muscles after TMS of each hemisphere. Bilateral motor responses were also induced from the arm muscles in the adult patient. Bilateral motor responses had short and similar latencies. Contralateral motor responses to TMS were smaller than ipsilateral ones in the hand muscles, while contralateral responses were larger than ipsilateral ones in the arm muscles. Contralateral hand motor responses reduced in amplitude or disappeared with increasing age while in the child patient, mirror movements decreased gradually. Our results suggest that bilateral activation of the primary sensorimotor cortices during intended unilateral hand movement and bilateral motor responses to TMS account, at least in part, for the pathophysiology of congenital mirror movement. Reduction of contralateral hand motor responses may be related to the decrease in mirror movements during development.

A female child presenting with acute flaccid paraparesis at 18 months was found to have a dermal sinus in combination with a dermoid cyst and a myxopapillary ependymoma of the cauda equina and conus medullaris. A possible embryologic relation between these lesions is discussed.

Subdural hemorrhage (SDH) detected postnatally in the newborn infant is usually related to trauma at the time of vaginal delivery. With improvement in obstetric methods, the incidence of this problem has declined. However, with advances in obstetric ultrasonography, it has been recognized that SDH may occur in utero before the onset of delivery. Intrauterine SDH remains a rare event. A review of the literature revealed only 32 cases to date (Tables I and II). Neonatal SDH is venous in origin and associated with trauma in most cases. Etiopathogenesis of neonatal SDH is explained by shearing of bridging veins or other venous structures caused by trauma. Instrumental delivery (forceps or vacuum extraction) causes distortion of the infant's cranium with elongation of the falx and angulation of the tentorium, leading to tearing of posterior fossa venous structures and bleeding into the subdural space. Rupture or tearing of large venous channels, such as the great vein of Galen, straight or transverse sinus or falx laceration with rupture of the sagittal sinus, result in accumulation of blood in both the supratentorial and infratentorial compartments. However, etiopathogenesis of intrauterine SDH is less certain. The fetus is usually well protected from direct abdominal trauma by maternal structures and amniotic fluid. Fetal intracranial vessels may be susceptible to shearing or acceleration/deceleration forces because of the following features: first, the head is large and neck muscles weak; this allows more rotational movement with angular acceleration. Second, the subarachnoid space is larger, allowing the brain to move within the cranium easily. Third, the fetal brain has a higher water content that increases its mass and allows it to develop more momentum when acceleration is applied. These unique conditions could make the fetus more susceptible to developing subdural hematomas and allow the development of subdural hematomas without obvious trauma.

Children with attention-deficit–hyperactivity disorder (ADHD) have difficulties with motor control, inhibition of motor responses, motor flexibility, and motor preparedness. We proposed that motor abnormalities in ADHD might result, at least in part, from an abnormal neuronal oscillatory mechanism necessary for motor temporal regulation. The aim of this study was to assess pacing in children with ADHD, by testing for rhythmic abnormalities of motor activity using a tapping test. Twenty-seven children (21 males, six females; aged 6 to 14 years 6 months; mean age 11 years 4 months, SD 2 years 2 months) diagnosed with ADHD according to DSM-IV clinical criteria, and 33 controls (25 males, eight females; aged 6 to 14 years 6 months; mean 11 years 1 month, SD 2 years 2 months), underwent a finger-tapping test requiring rhythmic responses to frequencies from 1 to 6Hz. All participants who were treated on a daily basis with methylphenidate (n=22) were medication-free on the day of the test. Most of the children with ADHD responded at a constant rate regardless of stimulus frequency, a phenomenon only seen in a small number of the controls. This specific error pattern, also seen in Parkinson's disease, has been attributed to an abnormal oscillatory mechanism mediated by dopaminergic fronto-striatal circuitry, which might also be pathophysiologically relevant for ADHD.

The aim of this study was to evaluate the effect of electrical stimulation (ES) on the function of the upper extremities in children with cerebral palsy (CP). The participants were 12 children (seven females and five males) with spastic hemiplegia (mean age 5 years 7 months, SD 3 years 9 months). Indications were weak wrist dorsiflexion and elbow extension. The ES was given at sensory level (20–40 minutes) on the infraspinatus muscle and on the wrist dorsiflexors during 12 regularly scheduled physical and occupational therapy sessions (during 4–5 weeks). The Goal Attainment Scale, the Zancolli classification of hand function, muscle testing according to Daniels and Worthington, and King hypertonicity scale were used for evaluation. Assessments were made twice before (between 4 weeks) and twice after (between 12 weeks) the stimulation period except the King hypertonicity scale, which was used once before and 3 months after the stimulation period. Active elbow extension, wrist dorsiflexion, and forearm supination with the elbow flexed and extended improved when the results of assessments before ES were compared with those made immediately before (p<0.001) and three months after (p<0.01) this treatment. Results of this pilot uncontrolled study suggest that ES at sensory level can be used as an adjunct to physiotherapy and/or occupational therapy in children with spastic hemiplegia. These results will be used as basis for further research.

The objective of the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) Evidence Reports is to provide the biomedical research and clinical practice communities with the current state of evidence about various interventions for the management of developmental disabilities. The AACPDM evidence reports aggregate all that has been published about outcomes of an intervention for a medical condition, gauge the credibility (i.e. strength of the internal validity) of that evidence, and identify gaps in our scientific knowledge. Methodology for developing and procedures for approving these systematic reviews can be found on the internet at www.aacpdm.org in the AACPDM Database of Evidence Reports which contains initial and updated reports.