Hypotonia

[Guest guest]

There have been several posts re: hypotonia and I thought I

should respond on this subject. There are various etiologies

(causes) of hypotonia (low muscle tone). It can be " central "

coming from the brain, or it can be related to muscle (a

myopathy). Most of your children have the type that is central and

in many cases is associated with low tone in the body (usually

the trunk), the cheeks, the tongue and the palate. It is the

benign, congenital hypotonia that is usually nonprogressive

(doesn't get worse over time), and is there from birth. Some

babies are actually " floppy. " Hypotonia can also be associated

with a sensory motor integration disorder. Some children with

cerebral palsy start out with low tone but then develop spasticity

and have abnormal reflexes. Cerebral palsy children often have

speech problems due to paralysis of the speech muscles (a

dysarthria), which is different than the motor planning difficulties

of oral/verbal apraxia. To make things more confusing, CP kids

can have an apraxia, but it is not their typical, primary problem.

Hypotonia improves with PT and mild cases may improve with

maturation. You can also see hypotonia assocated with certain

syndromes, like Prader Willi Syndrome, which require diagnosis

by a devekopmental prediatrician, pediatric physiatrist or

neurologist. Diagnosis is important in this case because it can

be diagnosed by chromosomal analysis.

Marilyn Agin, M.D.

Medical Director CHERAB Foundation

http://www.apraxia.cc

[Guest guest]

Reposting for those on " Web Only " due to messages not appearing.

There have been several posts re: hypotonia and I

thought I should respond on this subject. There are

various etiologies (causes) of hypotonia (low muscle

tone). It can be " central " coming from the brain, or

it can be related to muscle (a myopathy). Most of

your children have the type that is central and

in many cases is associated with low tone in the body

(usually the trunk), the cheeks, the tongue and the

palate. It is the benign, congenital hypotonia that

is usually nonprogressive (doesn't get worse over

time), and is there from birth. Some babies are

actually " floppy. " Hypotonia can also be associated

with a sensory motor integration disorder. Some

children with cerebral palsy start out with low tone

but then develop spasticity and have abnormal

reflexes. Cerebral palsy children often have

speech problems due to paralysis of the speech muscles

(a dysarthria), which is different than the motor

planning difficulties of oral/verbal apraxia. To make

things more confusing, CP kids can have an apraxia,

but it is not their typical, primary problem.

Hypotonia improves with PT and mild cases may improve

with maturation. You can also see hypotonia assocated

with certain syndromes, like Prader Willi Syndrome,

which require diagnosis by a devekopmental

prediatrician, pediatric physiatrist or neurologist.

Diagnosis is important in this case because it can be

diagnosed by chromosomal analysis.

Marilyn Agin, M.D.

Medical Director CHERAB Foundation

http://www.apraxia.cc

[Guest guest]

>

>My 3 year-old son was diagnosed with what the doctor called at the time

> " hypotonia " (and " hypertonia " ) at 1 year old. He's been receiving various

>therapies since. He has low tone in the upper body and some high tone in

>his

>legs/arms. He was 5 weeks premature and only 4lbs. 10oz. He has recently

>been diagnosed with Apraxia.

>My question is: what is the difference between " hypotonia " and Cerebral

>Palsy? My neurologist has told us that hypotonia (and hypertonia, which is

>tightness in the muscles) is just another name for Cerebral Palsy (which

>has

>varying degrees from mild to severe). He said that Cerebral Palsy is a

>muscle disorder that is neurologically based. He now refers to my son as

>having " mild Cerebral Palsy " and interchanges the term with hypotonia.

>Thanks,

>Michele

Hi Michele:

The term " cerebral palsy " , " cerebral paralysis " , etc. are historic terms

that describe a nonprogressive disorder of motor control (movement,etc.) of

prenatal origen (from before birth). It is vaguely defined and covers a lot

of different causes for the problem. Most children with this problem have

high tone (hypertonia) which is also called spasticity.

Children born prematurely, like your child, are at higher risk for CP than

the general population. Not all motor tone abnormalities are CP, nor do all

children with CP have similar problems with tone.

As CVA is associated with problems of motor control of the mouth and pharynx

(the back of your throat), it is logical that some children with CP will

have problems in this area of motor control as well.

The other reason that your doctor may be using the CP term is for enhanced

reimbursement from your insurer - they are more willing to pay for a " hard "

diagnosis like CP than a " soft " diagnosis of apraxia.

Larry Laveman, MD

Consultant, CHERAB

http://www.apraxia.cc

_________________________________________________________________

[Guest guest]

Hello Caroline;

You mentioned hypotonia in your recent email. I have a friend whose son is

on the spectrum and has serious low muscle tone. Did Dr G do anything

special for your son (re the hypotonia) or did you see the improvements in

his reflexes/muscle tone as a direct result of the protocol itself?

Thanks for the information.

Suzanne

From: Caroline Glover <sfglover@...>

Reply-

< >

Subject: Re: Can you have without the constant sickness?

Date: Wed, 01 Jan 2003 17:12:35 -0500

Lans,

My son was not sick more than what I thought was the " normal " amount, and I

don't think he ever had an ear infection (maybe once... can't remember which

child had one once). We were not on antibiotics all that much, either.

He did have asthma (and a major family history of allergies and asthma).

He did have hypotonia (low muscle tone... floppy), but Dr. G seems to have

fixed that. This alone was a medical miracle. My son is the only child in

his specialist's practice (she sees mostly kids with cerebral palsy) to EVER

have gained reflexes after not having them. My son's pediatrician and this

aforementioned pediatric specialist are both excited about what Dr. Goldberg

is doing. This is real medicine.

My son's dx was " PDD/NOS " like yours, but I suspect if we had him dx'd now,

he would likely end up more in a " quiet " ADD category. He is in a separate

public school class for gifted children (is in second grade reading at the

sixth grade level), and has made IMMENSE progress in the past year under Dr.

Goldberg's care. I would say that his main struggles in school are social,

gym class, and interpreting what he has read (he can answer " What color was

Susie's ball? " , but questions such as " Why didn't Susie want to play with

April? " are more difficult for him to figure out). I mention this because

in the past year, I have seen the missing skills start to flood in. Without

Dr. Goldberg, I doubt that my son could have stayed in the gifted program...

the more analytical skills start being needed in school around third grade,

and he would have been left behind.

He is very affectionate and compassionate.

We have seen measurable improvements in my son's lab work (such as having

consistently low WBC count and then having it normalize after starting

Valtrex). We found, thanks to Dr. G looking for it (nobody else ever

bothered), that my son had a consistently high ASO titer. We have started

antibiotics for that (and saw an almost immediate improvement in

connectedness). We will see if we can get that titer down.

It is sometimes, as you have read, two steps forward, one step back, but our

overall progress has been forward, and since starting the first antifungal,

we have probably NEVER had a day WORSE than we had before we started

treating our son for . His " bad " days are fewer, milder, and further

between.

Best of luck in deciding what to do for your child.

Caroline