There is now substantial evidence to suggest that the presence of inflammatory molecules within the fetal circulation and brain is associated with damage to vulnerable oligodendrocyte precursor cells before 32 weeks' gestation and long-term white matter damage (WMD); however, the nature of the inflammatory stimulus remains unclear. The common association between ascending bacterial infection from the vagina, haematogenous spread of periodontal organisms, chorioamnionitis, preterm delivery, and neonatal brain injury provides indirect clinical evidence supporting an important role for bacteria. Animal experiments in which live bacteria, or endotoxins, lead to the classical focal necrotic lesions of periventricular leukomalacia add further support to this concept. The isolation of bacteria-specific DNA from only a small proportion of cases where there is evidence of histological chorioamnionitis, suggests that there may be non-bacterial causes of fetal inflammation. Viruses make attractive alternative candidates; they are a common cause of maternal pyrexia, can cross the placenta (e.g. cytomegalovirus and rubella), are known to cause WMD and microcephaly, and are difficult to isolate. A recent study of viral DNA in stored neonatal blood spot specimens suggested a possible link between viral exposure and later cerebral palsy, particularly in preterm babies. Dammann and Leviton have been even more specific, identifying maternal pestivirus (PV) infection as a hypothetical cause of WMD in preterm neonates.

We know how important it is to diagnose epilepsy correctly, but how to do so is surprisingly little validated. An inadequate history and misinterpretation of the electroencephalogram (EEG) are the major reasons 4 to 26% of children and adults in European studies are misdiagnosed with epilepsy. Error rates are not available for most countries, or for more precise diagnoses of seizure types, epilepsy syndrome, and cause.

Foreword 2

Session 1: Wednesday, 13.00–15.00 3

Oral presentations

Session 2: Thursday, 11.00–12.30 7

Poster presentations

Session 3: Thursday, 13.30–15.00 37

Oral presentations

Session 4: Friday, 08.30–10.30 40

Oral presentations

Thursday, 08.30–10.00 44

Video presentations

Index 47

Foreword 2

Session 1: Friday, 11.00–12.30 3

Free Paper Sessions A

Session 2: Friday, 2.15–3.00 13

Free Paper Sessions B

Session 3: Friday, 3.30–5.00 20

Workshops A

Session 4: Saturday, 11.00–12.15 23

Free Paper Sessions C

Session 5: Sunday, 9.00–10.30 32

Workshops B

Session 6: Sunday, 11.00–12.30 34

Workshops C

Poster presentations 36

Index 45

Historically, observation of infant behaviour has been fundamental to the understanding of developmental neurology and ontogenetic adaptation. Darwin's account of his infant son's development is an evocative example. More recently, assessment of the quality of spontaneous general movements (GM) in the fetus and young infant has advanced insight into the development and integrity of the nervous system. How can these observations contribute to the diagnosis of neurodisability? Does this model have useful clinical applications?

One privilege of working in the health service today is the enormous range of effective therapies available to us. Advances in surgical techniques, tools, and materials have been more than matched by the vast number of pharmaceutical products addressing an ever wider range of conditions. Even for conditions where treatments have been available for many years, newer agents may be more potent, have less adverse or unwanted effects, and be easier to take than their predecessors. This is a huge contribution by the pharmaceutical industry.

The September bulletin of the British Paediatric Surveillance Unit (BPSU) stated that the Sir Peter Tizard research bursary has been awarded to a proposed epidemiological survey of paediatric idiopathic intracranial hypertension (IIH), also known as benign intracranial hypertension or pseudotumour celebri. IIH can lead to visual failure but is treatable. Its diagnosis, natural history, and medical and surgical management in childhood remain controversial.

Major conceptual advances in the area of paediatric neurosciences have been made in the last few years, mainly due to both molecular genetics, whereby the neurological phenotypes are now tentatively correlated with specific genotypes, and functional neuroimaging, whereby the neurological signs can be mapped to specific regions or circuits in the brain.

Foreword 2

Oral Presentations 3

Posters 23

Index 53

‘Normal’ comes from the latin norma, a carpenter's square, and in mediaeval times meant something at a right angle or perpendicular. A few centuries later it came to mean conforming to a standard and was used in physics to refer to the average of a set of variables. If the variable concerned, such as head size or IQ, is continuous and has a normal distribution, by convention the normal range has come to include values falling within two standard deviations either side of the mean – defining about 4.6% of the population as abnormal. By a similar approach, if the variable has a skewed distribution, such as the age of walking, those lying outside the 2nd and 98th centiles are often defined as abnormal, while the normal is equated to the average. This can also lead to misunderstandings, as, for example, in some child-rearing books when parents are told that the normal age of walking is 12 months, which can mistakenly imply that the 50% of children, who by definition are not walking at that age, are abnormal.

Foreword 2

Free Papers

Session A: Musculoskeletal/Gait 3

Session B: Nutrition/Bone Density 7

Session C: Abnormal Tone and Movement 11

Session D: Developmental Pediatrics 15

Session E: Activities/Participation/Quality of Life 19

Session F: Therapy 22

Scientific Posters 26

Audio-Visual Program 45

Plenary Free Paper Session 46

Index 50

Good medical care is safe, effective, and timely, and requires adequate numbers of physicians with the ability, commitment, and circumstances to provide it. Although referrals to specialists clearly vary considerably among different countries and health care systems, there is current evidence that demand for pediatric specialty care in the US is likely to increase during the next two decades. This projected growth, however, is not expected to be uniform among the various subspecialties.

Eliasson et al. are to be warmly congratulated on the publication of their excellent paper ‘The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability’ in this issue of Developmental Medicine and Child Neurology.

Professionals actively engaged in clinical trials involving patients with neurological damage must applaud researchers/clinicians who are willing to test popular clinical practices of equivocal or undetermined evidence. Kerr et al.'s study (p 870) is a major undertaking with sound scientific methodology. It is the fourth study published in DMCN in recent years that has failed to demonstrate the efficacy of neuromuscular electrical stimulation (NMES) in enhancing muscle force generation or improved functional ability of children with cerebral palsy (CP).

Duchenne muscular dystrophy is the most common life-limiting muscle disorder of childhood. Survival has improved, largely due to more effective orthopaedic and respiratory management. However, abnormal cardiac muscle function (cardiomyopathy) develops in most patients by the age of 18 years and can cause heart failure, leading to 10–40% of deaths. This percentage may be increasing as management of the respiratory complications becomes more successful. As a result, in 2003 a European group recommended an ECG and echocardiogram at diagnosis, then every 2 years until the age of 10, and annually thereafter. If progressive abnormalities occurred they recommended treatment with angiotensin-converting enzymes (ACE) inhibitors and, if needed, beta-blockers. They commented that there was no evidence behind these recommendations and called for multicentre trials. At the end of 2005, the Cardiology section of the American Academy of Pediatrics published similar recommendations and commented on the minimal evidence base. However, as shown by the review article by English and Gibbs in this issue, not all cardiologists agree with these guidelines.

Adeli suit treatment (AST) is a pertinent and timely topic for research. Many families and clinicians are interested in the outcomes of treatment using the Adeli suit, but the rehabilitation community does not have adequate scientific support for its use as a generally accepted treatment for cerebral palsy (CP). Very little research has been completed around non-traditional treatments such as AST. The study reported in this issue of DMCN by Bar-Haim et al. compared the use of AST and traditional neurodevelopment treatment (NDT) in children with CP.

A Mac Keith Multidisciplinary Meeting formulated the following consensus statement concerning postural management for children with cerebral palsy (CP) based on evidence from clinical experience and scientific literature:

Definition: A postural management programme is a planned approach encompassing all activities and interventions which impact on an individual's posture and function. Programmes are tailored specifically for each child and may include special seating, night-time support, standing supports, active exercise, orthotics, surgical interventions, and individual therapy sessions.

The recently proposed definition and classification of cerebral palsy (CP) is still up for debate – see the correspondence in this issue – and additional comments via the Castang website are warmly invited before the final version is completed next month (www.castangfoundation.net/workshops_washington_public.asp). The Castang Foundation funds ‘research into the causes of CP and other neurodevelopmental disorders leading to their prevention’. Rightly, the document does not specify the ‘non-progressive disturbances’ to which CP is attributed, with the exception of cerebral dysplasia. It is unclear why this should be picked out since in developed countries white matter disorders and perinatal vascular events currently appear more common. Data from other parts of the world are less available, but emphasize the continuing importance of post-neonatal causes. As the relative importance of different disturbances changes with medical knowledge, geography, and over time, a non-specific definition is understandable.

The good news in the paper from Dolk and colleagues is that the severity of disabilities and overall rates of cerebral palsy (CP) in very low birthweight infants born in Northern Ireland decreased during the 1990s. This followed an increase in the 1980s, observed in many places following the introduction of assisted ventilation to neonatal intensive care. However, according to their paper the CP rates for births <1000g were still higher between 1994 and1997 than those observed in the early 1980s.

Each year Developmental Medicine and Child Neurology (DMCN) invites the President Elect of the American Academy for Cerebral Palsy and Developmental Medicine (AAPCDM) to compose a guest editorial. As we mark the 60th anniversary of the Academy, I welcome the opportunity to make a few observations on the emergence of the internet as a medium that, within the space of two decades, has had an increasing influence upon both medical research and its dissemination throughout the world. Although the Academy's founding fathers certainly recognized that communication was the key to future progress, it is unlikely that they could have imagined what was ahead in terms of instantaneous information exchange or how that capability would promote collaboration at great distances, speed up the decoding of the human genome, and empower patients with information that previously had largely been the province of academia. This September, portions of our annual meeting will be webcast from Boston to 10 locations in four different countries around the world. Individuals who cannot attend the meeting in person will have an opportunity to view the lectures, and then, in special sessions, to engage in real-time exchanges with many of the presenters. In addition, the AACPDM now presents a monthly 1-hour webcast for entitled members concentrating on timely subjects by world-renowned authorities.