P11.2 Gross motor function in 2.5 years old children with cerebral palsy (CP) born extremely preterm

Poster sessions problems. Six percent (6%) experienced feeling of difference, and 2% blamed their condition for not being successful in making new relationships. Three percent (3%) considered it hard to find a partner and to get married and 4% believed to be less attractive to opposite sex. Five percent (5%) were reluctant towards having children. The answers were mostly satisfying, however certain percentage undoubtedly felt stigma. Our goal is to recognize those very patients because they need assistance despite absence of seizures. P10.7 Stigma in epilepsy: Should we clean our own backyard first? J. Radic1 *, P. Vukelic1 , A. Milardovic1 , I. Vlasic-Cicvaric1 , I. Prpic1 . 1 University Hospital Rijeka and Medical faculty of Rijeka, Department of Pediatrics, Rijeka, Croatia Background: Medical students represent not only a bettereducated section of society, but also the very ones that will treat people with epilepsy (PWE). Stigma is considered to be major factor that deteriorates quality of life in PWE. Thus it is important that, first of all, they have exact knowledge and appropriate attitude towards the disease. Aim: We wanted to evaluate knowledge, attitude and perception of medical students about epilepsy, at first and sixth academic year. Methods: We used an anonymous questionnaire which included knowledge, attitude and perception about epilepsy. There were 103 first year and 64 final year medical students, 64% females and 36% males. Results and Conclusion: Epilepsy was considered untreatable by 5.98% responders (9.3% 1st year vs. 1.6% 6th year), while 2.99% thought it was contagious (only 1st year student) and 1.19% thought it was mental disease (only 1st year student). Furthermore, 17.36% of students replied that PWE are isolated and ignored by society. Also, 30.53% wouldn’t employ PWE, 76.64% wouldn’t allow PWE to babysit their children and only 51.49% would marry PWE. There was no difference between answers regarding gender. Statistical difference was found between 1st and 6th year students mostly in questions regarding intrapersonal aspects of stigma. In the majority of questions, first year medical students expressed more misperception of epilepsy as a disease and more stigma regarding PWE. These finding suggests that there is an inverse relationship between knowledge and stigma. In order to eliminate stigma by informing society, we must start with ourselves. P10.9 Munchausen’s syndrome in the modern pediatric psychoneurology and ethics A. Anatolievich Shevchenko1 *. 1 Department of childrens psychoneurology, Institute of Pediatrics, Obstetrics and Gynecology Academy of medical sciences of Ukraine, Kiev, Ukraine Munchausen’s syndrome is one of the forms of personality disorder and behaviour disorder when an individual or parents (most commonly, mothers) address a doctor complaining of neurological and somatic symptoms, either imaginary (false) or intentionally fake, and stating that they are signs of a real distress. This problem is particularly urgent and acute in relation to children. The children may stop visiting school, they willingly agree to hospitalization to day and night clinics for conducting a lot of additional examinations. The mothers “inducing” illnesses in their children as a rule suffer from lack of psychological support in the family; they are unhappy in their marriages and some of them suffer from mental disorders. The overwhelming majority of them were in the childhood exposed to physical or mental abuse. These sicknesses artificially induced in children, are very

S75 difficult to cure. The children in this case undergo a large number of unnecessary medical manipulations which can inflict upon them an adverse health effect, including their mental condition. It should be noted that the impact of a mental abuse upon development of a child can result in more serious consequences than a physical abuse. The problem has also an ethic side in view of the fact that in all the models of interrelationship between the doctor and the patient (liberational, paternalistic, interpretational, and technological) envisage the maintenance of the basis bioethical principle − respect for the patient’s autonomy, frank communication and honesty, the lack of which is expressed by “Barons Munchausen”. Therefore, all the above mentioned shows the seriousness of management of such patients, as well as the necessity to work out and create legal, ethic and psychological resolutions as to the protection of health professionals from possible incidents.

P11. Special topics in neurodevelopment − Autism; Cerebral palsy; Neurodevelopment of premature & perinatally injured children P11.1 Osteopenia in children with cerebral palsy can be treated with oral alendronate S. Vurucu1 *, M.S. Paksu2 , A. Karaoglu1 , A.O. Karacalioglu1 , O. Yesilyurt1 , B. Unay1 , R. Akin1 . 1 Gulhane Military Medical Academy, Department of pediatric neurology, Ankara, Turkey, 2 Ondokuz Mayis University Faculty of Medicine, Department of Pediatrics, MD, Turkey Introduction: Cerebral palsy is one of the most common reasons of osteopenia in childhood. Patients have a significantly decreased bone mineral density and painful fractures with minor traumas are common. This situation restricts patient activity and decreases life quality. Biphosphonates in the treatment of childhood osteoporosis are increasingly being used. This study aimed to evaluate the efficacy of oral alendronate treatment in children with cerebral palsy. Materials and Methods: 26 children (16 boys and 10 girls) aged 3 to 17 years who had quadriplegic cerebral palsy and osteopenia were included in the study. The patients received alendronate (1 mg/kg/week), calcium (600 mg/day), and vitamin D3 (400 U/day) over a year. A complete blood count, kidney and liver functional tests, plasma calcium, phosphate and alkaline phosphatase levels, and lumbar vertebral bone mineral density were measured before and after treatment. Data compiled before and after treatment was compared statistically. Results: Compared with pre-treatment values, bone mineral density, serum calcium, and phosphate levels of the patients statistically increased and alkaline phosphatase levels decreased after treatment. No patient needed to interrupt treatment because of side effects. Conclusion: Oral alendronate at a dose of 1 mg/kg/week for the treatment of osteopenia in children with cerebral palsy was found to be safe and effective. P11.2 Gross motor function in 2.5 years old children with cerebral palsy (CP) born extremely preterm M. Hafstrom1 *, E. Rehn1 . 1 Sahlgrenska Academy, University of Gothenburg, Sweden Background: Previous studies of extremely preterm born infants have shown an incidence of CP of about 10%. The diversity of CP is well described. The GMFCS classification system describes the gross motor function on basis of selfinitiated movements in children with CP.

S76 Aim of the study: To describe the severity of CP in a population based group of extremely preterm born infants in terms of GMFCS classification and co morbidity Methods: All infants born before 27 weeks of gestation in Sweden during a three year period are included in a prospective observational study (the Swedish EXPRESS study). In the regional cohort from Vastra Gotaland with a total of ¨ ¨ 52299 live born infants a total of 82 children born extremely preterm were eligible to examine at the age of 30 months. Of these, 77 children had a neurological examination and a developmental assessment (Bayley III). Results: CP was found in nine children. Five had a GMFCS level of I-II, one had level III and three a level of IV-V. Of the 6 children with a GMFCS level of I-III five had an IQ score above 70. The three children with a very limited motor function all also had a severe cognitive dysfunction. Two children had epilepsy, five had a ventriculoperitoneal shunt and two had a gastrostomy. Conclusion: The functional ability in this group of children born extremely preterm with CP is very diverse. P11.3 Long-term developmental and educational attainment of a cohort of children with isolated fetal ventriculomegaly (IVM) A. Dakson1 , R. Kumar2 , R. Newton1 *, S. Russell3 . 1 Department of Paediatric Neurology, Royal Manchester Children’s Hospital, Oxford Road, Manchester. M13 9WL, United Kingdom, 2Alder Hey Children’s Hospital, West Derby Eaton Road, Liverpool, L12 2AP, United Kingdom, 3 Department of radiology, St Mary’s fetal management unit, Manchester Children’s Hospital, Manchester, M13 9WL, United Kingdom Background: IVM is defined as an increase of ventricular atrial width of  10 cm without evidence of congenital infection, structural or chromosomal abnormality. The reported incidence of neurodevelopmental impairment is 0.0 19.0% but there are no long-term follow-up data. Aim: To evaluate the educational and main neurodevelopmental outcomes in children with antenatal IVM. Materials and Methods: A postal questionnaire defining neurodevelopmental, medical and educational outcome was sent to families of eligible cases from St. Mary’s Fetal Management Unit. Outcome was related to the degree of IVM (mild or moderate/severe; resolving/regressive, stable or progressive). Results: 167 foetuses with IVM were identified (mean ventricular size: 13.2±4.3 cm; mean-23.5 weeks); 49 of these aborted, 44 therapeutically. We located 84 families and 39 (46.9%) returned questionnaires and 9 (28.2%) underwent a standardized clinical assessment: 25 males, 14 females; mean age 12.6±2.8 years (range:9.0 19.2) and mean maternal age 29.3±5.4 (range:15.9 38.8). In addition, 64% (95% CI, 48.4 77.3%) with IVM required additional educational support and 25.6% (95% CI, 14.6 41.1%) attended a special needs school. Delayed walking (mean 16.3±7.1 months) was seen in 41% (95% CI, 27.1 56.6%). Epilepsy was reported in 12.8% (95% CI, 5.6 26.7%). A significant association was found between moderate and severe IVM additional educational support (P = 0.004) and delayed walking (P = 0.006). Conclusion: These long-term data show that IVM confers a significant risk of long-term neurodevelopmental impairment, which should inform parental choice on pregnancy management.

Poster sessions P11.4 Outcome of nerve reconstruction surgery in perinatal brachial plexus injury − the Irish experience N. McSweeney1 *, L. Morrisson2 , D. Hynes3 , J. Malone4 , K. Cronin5 , B.J. Lynch6 . 1The Central Remedial Clinic, Clontarf, Dublin, Ireland, 2 Department of Physiotherapy, The Central Remedial Clinic, Clontarf, Ireland, 3 Department of Orthopaediac Surgery, The Central Remedial Clinic, The Children’s University Hospital, Temple Street, Ireland, 4 Deparment of Occupational Therapy, The Central Remedial Clinic, Clontarf, Ireland, 5 Department of Hand Surgery, The Central Remedial Clinic, The Children’s University Hospital, Clontarf, Ireland, 6 Department of Paediatric Neurology, The Childrens’ University Hospital, Dublin, Ireland Objectives: To report the outcome of nerve reconstruction surgery in a cohort of Irish cases with perinatal brachial plexus injury over a 15-year period. Methods: Retrospective chart and database review of all children with brachial plexus injury who attend the Central Remedial clinic (CRC) for assessment and management. Results: Twenty-six cases (23 term, 13 male, 13 right upper limb) had nerve reconstruction surgery between 1995 2009. Median age of assessment was 3 months. Four had fracture clavicle, 3 fractured humerus. Twelve were group 4 Narakas classification. Twelve of eighteen had an abnormal MRI cervical spine (avulsed nerve root, pseudomeningocele, abnormal signal change). Six with normal brachial plexus on imaging were subsequently found to have evidence of neuroma, rupture or avulsed nerve roots at surgery. Median age at surgery was 7mths. Median length of follow up was 3 yrs 2wks (1mth−14 yrs). Seventy per cent had improved shoulder abduction, 67% improved elbow flexion and 64% had improved wrist extension. Of the group 4 lesions, 5/12 had M3 (partial range antigravity power) shoulder abduction, 6/12 M3 elbow flexion and 3/12 M3 wrist extension at follow up. Of the group 3 lesions (n = 14), half had M3 shoulder abduction, 8/14 had M3 elbow flexion and 9/14 had M3 wrist extension at follow up. Conclusion: We report improved function, power and range of movement at follow up. Level and severity of injury correlated with outcome. MRI was not very useful as a predictor of nerve root injury. P11.5 Danish children with cerebral palsy have the highest participation among 7 European countries P. Uldall1 *, S. Ishøj Michelsen2 , E. Flachs2 , P. Due2 . Rigshospitalet Neuroped 5003 2100 ø Denmark, 2 SIF, Syddansk universitet Copenhagen, Denmark

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The European SPARCLE study meets a growing interest of evaluating children with disabilities according to quality of life and participation in life situations. The aim of this presentation is to report on Danish children with cerebral palsy in the SPARCLE study (1) participation and physical, social and attitudinal environment (2) their parent’s view of the social security system and (3) international differences in participation and environment needed for children with cerebral palsy. 115 Danish children with cerebral palsy age 8 to 12 years and their families (in total 818 European families were included). Measures used were the Life-H instrument measuring participation, the Frequency of Participation Questionnaire and the European Child Environment Questionnaire. Danish children with cerebral palsy aged 8 to 12 had a high level participation in everyday life and participated as often in for example sports as Danish children in the general population. The environment often fulfilled the needs of these children. Danish children with cerebral palsy had a much higher participation, compared with children