JUVENILE PARESIS

A brain disorder caused by congenital syphilis.In the juvenile form of paresis the spirochete infection is transmitted from mother to fetus after the fifth month of pregnancy. The incubation period is about the same length as for adult paresis, and the onset of symptoms generally occurs between the fifth and twentieth years, but most frequently between the ages of ten and twelve. Prior to the outbreak of the disorder, however, about one third of these children are somewhat retarded in mental development.The first signs of juvenile paresis are usually confusion, restlessness, and purposeless behavior. Visual disturbances, motor inco-ordination, and convulsions are also common symptoms. As the disease progresses, memory, judgment, and comprehension are increasingly impaired. Mental and physical deterioration are gradual, and the child has no insight into his condition. The apathetic, depressed, and euphoric personality reactions which characterize adult paresis do not develop in juvenile form.The course of the disease is longer than in adult paresis, averaging about five years from the appearance of symptoms to the terminal stages in which the child becomes mute, untidy, emaciated, and finally dies. The basic treatment is penicillin, but it is less effective with the child than with the adult form of the disease.Although juvenile paresis was at one time the major cause of stillbirths, early infant mortality, and congenital blindness, it is now relatively rare in this country. The Wassermann test for pregnant women, and the efficacy of penicillin treatment for syphilis in adults are primarily responsible for this major change. See SYPHILIS, GENERAL PARESIS.Illustrative Case: Kaybee J. was admitted to the psychiatric hospital at age sixteen following a series of convulsive seizures. From that time he presented a serious management problem. The family had been unable to care for him at home, or to understand what he said. When he was taken to the Probate Court, he attempted to take off his clothes. At the hospital it was necessary to restrain him in bed because he attacked the attendants and tried to bite them. He turned his head from side to side, and mumbled unintelligibly. He was incontinent and continually soiled the bed. He did not respond to questions, although he said something about being “crazy.” He was completely out of contact with his environment.After twenty-five years, the patient is practically mute, although he makes sounds when watching television. Sometimes he becomes upset while watching the programs, and gets up and fights; otherwise he sitsquietly all day long. The patient has exhibited some homosexual characteristics, and attendants find it necessary to watch him at all times. It is impossible to communicate with him. There is no judgment or insight. Occasionally the patient has convulsive seizures. (Kisker, 1964)