Abstracts

Rationale: Physical therapists in a tertiary referral centre who examine adolescents with refractory epilepsy and Intellectual Disability (ID) witness that these children develop an asymmetrical posture during childhood and puberty. This posture differs from typical scoliosis, the children rather seeming to be out of the perpendicular, in the sagittal plane as well as in the transversal plane. No cause has been found for this asymmetry. Consecutive assessments were performed in 2000 and 2006 to investigate whether it had a progressive nature.Methods: 13 adolescents (11F:2M, all on polypharmacy, mean age 17 years, range 13-23 yrs) with severe, refractory epilepsy and ID were examined in 2000 with a standardized measuring tool, using digital photography and measurement of deviation from perpendicular lines through reference points of the body (Lammers A et al, Epilepsia 2000;vol.41:suppl.7, 181). Measurements were repeated in 2006 for 8 patients (all female, mean age 23 years, range 19-29 yrs) who were available for follow-up. 2006 assessment was compared to 2000, each patient serving as his own control. Paired t-test was used to show statistical significance.Results: See table. In 4 patients the asymmetrical posture increased, in the other 4 patients it decreased. Other than length, the only other parameter that increased significantly on group-level (p=0.023) was the Da, indicating an increase in the distance between the perpendicular line from the meatus externus and the lateral edge of the acromioclavicular joint. Clinically this means that the patients head protrudes more in relation to the upper part of the trunk. No relation was seen with epilepsy classification, seizure type or use of antiepileptic drugs. There is a possible relation with physical therapy, that had been given to the patients in which the asymmetry did not increase.Conclusions: Asymmetrical posture in adolescent individuals with refractory epilepsy and ID may increase or decrease over time. This study does not reveal the cause for the development of asymmetry. Given that on group-level the asymmetry did not show a tendency to increase, it apparently manifests itself earlier in childhood, before adolescence begins. Physical therapy appears to have beneficiary effects, and should be sought at an earlier stage to identify and treat children prone to asymmetry.