Rehabilitation of young children with movement disorders and epilepsy: rational approach and efficacy

Introduction. Epilepsy is one of the most common chronic nervous system disorders. Epilepsy in a child requiring physical, psychological and speech therapy significantly reduces its scope and decreases the likelihood of recovery.

The aim of the study was to assess the efficacy and safety of a rehabilitation programme for young children with movement disorders and concomitant epilepsy.

Materials and methods. Simple randomization was used to divide 123 children aged 9–24 months into four groups: three main groups and one comparison group. Patients in group 1 received traditional massage, excluding the cervical region, as their rehabilitation. Patients in group 2 received kinesiotherapy (Vojta therapy) in addition to traditional massage. Children in group 3 participated in a comprehensive programme, including traditional massage and kinesiotherapy (Vojta therapy). Children in the control group did not receive rehabilitation.

Results. A statistically significant improvement in the psychomotor development parameters was observed after a course of medical rehabilitation. It was more significant when the epileptic focus was localized in the right hemisphere or the patient had generalized epilepsy. The outcome was less favourable in multifocal epilepsy and when the epileptic focus was present on the convex surface of the left hemisphere. The third group noted a statistically significant improvement in the GMFCS scores by the end of the comprehensive rehabilitation course. There were no epileptic seizures seen on repeat EEG recordings during the medical rehabilitation and one month after its completion.

Conclusion. A comprehensive approach to planning a course of rehabilitation ensures its efficacy. The location of the epileptic focus and the distribution of epileptic activity along the convex surface of the brain determines the outcome of medical rehabilitation. An increased epileptiform activity index on EEG without signs of clinical deterioration requires more careful patient monitoring but, nevertheless, is not a reason to completely cancel rehabilitation measures.