The relation of abnormal soft neurologic signs and EEG abnormalities to the severity of malnutrition was investigated in 208, 8-10 year old male school children at the Nutrition Section, Department of Paediatrics, and the Section of Neurology, Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India. No child had a history of birth anoxia, head injury, or drug ingestion. Seven motor tasks were tested for soft neurologic signs: 1) Finger tapping, 2) successive finger movements, 3) toe tapping, 4) heel toe tapping, 5) repetitive hand patting, 6) alternating hand pronation supination, 7) alternating hand flexion extension. Both dominant and nondominant limbs were evaluated. Choreoathetoid movements were examined as a child walked 20 steps on inverted feet (Fog test). There was a strong correlation between nutritional status and performance of motor tasks in both hands and a progressive increase in abnormalities with increased severity of malnutrition. Of 71 children with normal nutritional status 4.2% were positive for soft neurological signs whereas in 79 children with moderate malnutrition 87.3% were positive for neurological abnormalities and 50% showed a positive Fog test with choreoathetoid movements. The EEG pattern in 16 children with soft neurological signs showed abnormalities in the form of slow and sharp waves, particularly in the frontal lobe, but also in the parietal and temporal lobes. Motor deficits were more marked on the contralateral side of the EEG abnormality. [1]

COMMENT. The same authors have shown that malnourished children are at risk for depressed cognitive function, learning disabilities, and poor achievement at school. In the present paper they emphasize the occurrence of soft neurologic signs and EEG abnormalities in relation to poor nutrition. The influence of early malnutrition on subsequent behavioral development, learning disabilities, and soft neurologic signs has also been stressed by other authors [2]. Perhaps the term minimal brain dysfunction (MBD) in relation to hyperactive children with learning disabilities was discarded prematurely in favor of ADHD. The pediatric neurologists role in the diagnosis and treatment of children with behavior and learning disabilities has been usurped to some extent by the increasing interests of the psychologists and developmental pediatricians. The importance of pediatric neurology and the recognition of symptoms and signs of brain dysfunction in these patients should receive more emphasis, and nutrition and diet in nervous system disorders of children is a field for further investigation. [3]