ABSTRACT
Neurological examinations were made of 67 children and adults with congenital iodine-deficiency disorder (endemic cretinism) in four rural villages in highland Ecuador. There was a distinct and readily identifiable pattern of neurological deficits. These included, to varying degrees: deaf-mutism or lesser degrees of bilateral hearing-loss or dysarthria; spasticity, particularly involving the proximal lower extremities; mental deficiency of a characteristic type; and rigidity and bradykinesia. Not all of these elements were found in all cases. Less common features were strabismus, kyphoscoliosis and frontal-lobe signs. There were exceptional cases with hypotonia. In contrast, cerebellar function was largely spared, as were functions of emotion and attention, vegetative and autonomic functions, social interaction, and probably memory, except in the most severely involved.
Subject(s)
Congenital Hypothyroidism/etiology , Developing Countries , Iodine/deficiency , Nervous System Diseases/etiology , Adolescent , Adult , Basal Ganglia Diseases/etiology , Child , Child, Preschool , Congenital Hypothyroidism/genetics , Deafness/etiology , Ecuador , Female , Humans , Infant , Intellectual Disability/etiology , Intelligence , Male , Middle Aged , Muscle Hypotonia/etiology , Muscle Spasticity/etiology , Neurocognitive Disorders/etiology , Neuromuscular Diseases/etiology , Rural PopulationABSTRACT
Twelve children with severe chronic behavior disorders who benefited from treated with lithium carbonate over an extended period of time (6 to 33 months) are described. Behavioral features common to all included hostility, aggressiveness, and distractibility. Nine had cyclic mood swings, with periods of withdrawal and periods of manic excitement; six of these had neurovegetative disorders. These nine children may have manic-depressive disease of childhood. Three children had no cyclic symptoms, though their hostile and aggressive behavior was similar to that of the cyclic group; they responded similarly to lithium. Family histories were strongly positive for manic-depressive disease, depression, and alcoholism. A double-blind placebo-controlled crossover study in four patients supported the specific behavioral effect of lithium.