History and condition before starting G Therapy:

She was seen by me on 6th November 98. She is a product of non consanguinous marriage with normal birth history. She was developing normally till 1 year of age-recognized parents well, said a few words and was walking few steps without support. She had an episode of high grade fever with convulsions at 1 year age. Seizure lasted for almost two hours. She was admitted for 4 days, lumbar puncture was done. (unfortunately, any details about this episode and hospital findings are not available). After this event, parents noticed regression in milestones.

She lost parental recognition, speech, developed tremors of head, neck and truncal ataxia while walking with involuntary, continuous movement of hands. She lost all voluntary use of the hands. Chewing and swallowing has become difficult. She was on Serenace for 1 year which was stopped 1 year before coming here.

On examination :

Head circumference=47 cm. Pallor ++.

• Marked continuous involuntary movements of UL-viz. wringing, clenching and unclenching of hands, intermittent sighing, facial grimacing, deviation of eyes, twisting of mouth and clenching of teeth.
• Tremors of neck (head nodding), in standing position tremors of trunk. Generalized hypotonia of all four limbs was noted.
• Deep jerks present-slightly exaggerated. Babinski’s negative. No ankle clouns.
• She is unable to rise to sitting from supine position nor come to stand from sitting position. When made to sit- sits unsupported for long with legs stretched in front of her. Can turn prone on her own but does not attempt to creep. No grasping or release.
• Short attention span. May or may not respond to name.
• No parental recognition.
• May say 2 or 3 words without any meaning attached to it.

CT Scan November 98:– Normal.

EEG: Global background slowing.

After G Therapy for 1 month:

She was reevaluated by me on 17.12.98.

• One noteworthy finding was her attempt at initiating purposeful movements of the hands (tries to grasp or touch the rattle or pick the sweet from the floor, makes 2-3 attempts though she is not successful in holding the object).
• Spontaneous response to name noted.
• According to mother sighing and tremors have increased, though hand movements (frequency) has reduced.
• Responding better to mother now.
• Chewing still poor.

Dr. Sabiha A. Sayed
M.B.B.S.,D.C.H)
Date:17-12-98