History and condition before starting G Therapy:

He, a 14 years old boy is the only child of a non-consanguinous marriage. Maternal and paternal grandparents have insulin-dependent diabetes mellitus. Pregnancy was normal. Baby was delivered by emergency LSCS for prolonged labor. B.W.=4.0 kg. Baby cried after birth. Baby had status epilepticus at age of 21 days lasting for 48 hours-diagnosed as leucine induced hypolglycemia at Jaslok Hospital, Bombay. Blood sugar levels were maintained later on. The baby developed myoclonic epilepsy at 2 years of age and then grand mal epilepsy-finally controlled with Carbamazepine and Gardenal. He never had convulsions in the past 6 months. Bilateral retinal detachment (mild) was noted at 2 years, which improved with steroids. He is presently taking Carbamazepine 200 mg. 1-1/2 -1/2, Gardenal 30 mg. 1-0-1 and Hexinal ¼-0-1/2.

He has been subjected to PT/OT since the early age of 6 months. Parents have also subjected him to Magneto therapy, acupressure and Sicca cells injections – 4 sittings at the age of 4 years. Father says there was significant improvement after sicca cell injections. The child is very sensitive to cold and pain especially finger tips-which become cyanosed when exposed to cold temperatures. When I was examining him, he had just convalesced from a severe attack of gastroenteritis with hematemesis and hence was a little weak and emaciated. Head circumference= 47 cm., cold peripheries, acrocyanosis. Feet-mild equinus and valgus deformity present. No drooling.

Milestones :

• Social smile-1 year, Neck holding- 2 years, Unsupported sitting- 5 years
• Standing & walking with support since 6 months now.
• Speech- Vocalizes. Say 3-4 syllables without any meaning. Poor sleep pattern.

Neurologically :

Alert, cooperative, not much interested in the surroundings. Involuntary movements of face, neck, eyes, hands present constantly.

Vision :

Responds to light. Acute vision- difficult to assess. Hearing good. No squint. Hypertonia noted in all 4 limbs. No contractures except for feet- valgus + equimus. Power U/limbs Grade III/IV + Power in Lower limbs Gr. III/IV + Deep Jerks-brisk, no clonus and plantars.

Sits unsupported for 10-15 minutes. Moves forward very fast by creeping on elbows & abdomen. Can stand and walk with minimal support for 5 minutes. Broad-based gait- no scissorring. Fine motor: can reach for objects, release, transfer. Has a fair hand mouth coordination. Can chew and swallow well. Cannot dress himself. Fine grasp-mature.

General understanding :

• Recognizes parents, waves bye-bye, enjoys being outdoors, watching other children play.
• Does not respond to his name consistently.
• Will not obey commands due to poor understanding of spoken word.
• Sphincters: no control.
• Hypertonia had disappeared. The tone in all 4 limbs seemed normal. He also appeared to have gained some weight.
• Consistently responds to name when called.
• His gait and involuntary movements are the same.
• Had one episode of tonic generalized convulsion lasting for 1minutes 10-12 days after starting G-Therapy no convulsions after that.
• Inspite of the winter here, Shrinivas had warm and pink fingers and toes.

Parents related following improvements to me when asked :

• Restlessness has reduced, he is sleeping more peacefully and for longer periods.
• Initially he used to weep a lot- now that is much reduced.
• He is more responsive to parent’s speech- trying to say a few words himself. Speech is clearer and louder.
• Walking with support for long-now 10-20 minutes.
• Now he is sitting unsupported for prolonged periods half to one hour or so.
• Appetite has also improved.

Dr. Sabiha A. Sayed
(M.B.B.S.,D.C.H)
Date: 29-12-98