Among the other secondary symptoms of cerebral infantile palsy disturbanees of speech and pseudobulbar disturbances also exhibit a tendency to improve. Such patients usually learn to speak in the end, although it may be quite late in life, and their speech may remain permanently defective. Dysphagia also usually undergoes gradual i mprovement.
The prognosis of epilepsy accompanying cerebral infantile palsy is quite as grave as that of so-called genuine epilepsy. The epilepsy man ifests itself in a great variety of forms, and its relation to the existing palsies is equally variable, as is also the time of its appearance during the course of cerebral infantile palsy. There are numerous cases in which epileptic convulsions form the opening scene of the clinieal pic ture and remain in the foreground until the end: there are other eases which also begin with convulsions and in which the convulsions later cease; and, finally, there are some in which the convulsions do not appear until years after the paralysis. Unfortunately the epileptic attacks which occur in the course of eerebral infantile palsy have little tendency to subside spontaneously. Much more frequently the attacks increase and often are mere prominent in the clinical picture than the palsies. The occurrence of the status epileptieus and sudden death is among the possibilities in such cases. Conversely, it is sometimes pos sible by suitable treatment to convert severe attacks into attacks of shorter duration and lesser severity—into a condition of petit mat. The prominent part which epilepsy plays in many cases of cerebral infantile palsy is a warning to great caution in the prognosis of this kind of cases, even when there appears to be some tendency to im provement in the paralysis.
The prospect of mental development is not much more favorable than the prognosis generally. Although intellectual improvement takes place in many feeble-minded children and is gratefully' accepted by the parents, in most cases of pronounced imbecility the mental impairment is ultimately so great that the child is either unable to go to school at all or goes through with the greatest difficulty-, and the ques tion of an occupation becomes a very serious one. Severe grades of idiocy, when associated with microcephalus and unilateral or bilateral hemiplegia, are practically hopeless. It should be reiterated, however, that a great many cases of cerebral infantile palsy present little or no diminution of the intelligence.
We have already mentioned at the beginning of this section that the diagnosis of cerebral infantile palsy is purely a clinical diagnosis and leaves the question of the anatomical founclation of the condition open. The history, the absence of progressive character in the paralytic phe nomena, and the failure of additional brain symptoms to develop are the determining points for the diagnosis. Hence, slowly developing C£ISCS of brain tumor, of family endogenous palsy, may for a time be confused with cerebral infantile palsy, and brain syphilis may tem porarily or permanently simulate the picture of a cerebral infantile palsy. Spinal and peripheral palsies are distinguished by- the atrophy,
which is limited to definite groups of muscles, the presence of the re actions of degeneration, and absence of the tendon reflexes. Post hemiplegic chorea and athetosis could hardly be mistaken for genuine chorea or tic if the case is under observation for any length of time. On the other hand, the physician should be on the lookout for the re mains of cerebral infantile palsy in all apparently uncomplicated cases of epilepsy- and idiocy-.
We know of no treatment against the cause of cerebral infantile palsy. Cases that respond to iodine and mercury are suspicious; they are probably brain syphilis and not cerebral infantile palsy. The sympto matic treatment consists in electricity, massage and gy-mnastics.
The electric treatntent must be adapted to the peculiarities of the individual case. If the palsies are the most prominent symptoms, the faradic current or the active cathode is employed as in a case of spinal palsy (see poliomyelitis). The electric treatment must be strictly limited to the paralyzed group of muscles, to the exclusion of the antagonistic muscles which are usually hypertonic. If the spasms or posthemiplegic motor disturbances are more prominent. sedative treat ment with the anode is indicated; the anode being either lightly passed over the muscles (labile application) or applied to the end of the ex tremity (stabile application). The cathode rests on the back or the upper portion of the extrernity.
Massage, particularly when combined with passive movements and gymnastic exercises, is much more useful than electricity and is specially adapted to cases of cerebral infantile palsy. It acts very well in over coming beginning contractures, especially when combined with the use of orthopedic apparatus. Warm baths in most cases are followed by subjective and objective improvement of the motility and, combined with artificial movements, are to be recommended. Aeratothermal, saline and carbonic acid baths and sea bathing in the Baltic or Adriatic Seas may also be recommended for children suffering from this disease,.
In general all cases of cerebral infantile palsy in which the prog nosis is not clouded by the existence of a high grade of idiocy or of epilepsy require medicinal treatment for a long time and constant alternation of the various procedures employed.
Quite recently the transplantation of tendon has been tried in this disease (see poliomyelitis). By dividing individual, greatly contracted muscles ancl ingeniously changing the point of insertion, a modification of the muscular mechanism may be brought about.
The medicinal treatment of epilepsy and the educational manage ment of imbecility are discussed under the respective diseases.