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Congenital and Acquired Brain Damage and Dysfunction in Childhood

Background

The relationships between problems of learning, behaviour, epilepsy and motor function in children and the underlying disease in their brain are complex. Broadly speaking, there are three patterns that are recognised:

  • Congenital, i.e. present from before birth;
  • Acquired acutely;
  • Acquired slowly and progressively.

It is however the exceptions that tend to detain us and require explanation. Within each group there are conditions in which there is clear evidence of damage to the brain on imaging and others in which no such damage is evident and are perhaps better regarded as examples of brain dysfunction. The time of birth is arbitrary and acquired, acute and chronic processes may start before birth and this needs to be remembered both for children with problems from birth and at birth.

Even when we are sure that damage to the brain is static, there may be apparent deterioration in the child. Four examples of this are:

  • Damage to the cerebral cortex may cause epilepsy which because of either the severity of the attacks or an associated loss of cognitive function (epileptic encephalopathy) may resemble a progressive disease;
  • A behaviour disorder may occur in a child who had not previously shown such problems, without any change in the underlying brain damage but the family perception of the child may change enormously;
  • A problem may be revealed, like language disorder and specific reading difficulty, at the developmental stage at which it would have been expected, e.g. the developmental progress of many children with Down syndrome appears faster in the first six to eight months than later when major difficulties with language may occur;
  • In athetoid cerebral palsy, where there is damage to the basal ganglia, there may be an early phase of lack of movement with increasingly wild extra movements appearing during the latter part of the first and the second year.

Thus some children with non-progressive brain disease may look much more normal when young than later.

If we therefore look at each category and specific examples, some of the problems of definition come into focus and some conditions, which do not fit these simple schemata, can be illustrated. This structure forms the basis along which paediatric neurologists, paediatricians and geneticists work, to provide a diagnosis.

Congenital and acquired disorders View Congenital and acquired disorders

Medical text written January 2002 by Professor B Neville. Last updated February 2007 by Professor B Neville, Professor of Childhood Epilepsy, Institute of Child Health, London, UK.

 

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