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In this chapter and the next we consider the effects of growth, maturation, and aging on the nervous system These are elaborated in some detail because certain aspects of neurologic diseases are meaningful only when viewed against the background of these natural age-linked changes Developmental diseases of the nervous system, ie, malformations and diseases that are acquired in the intrauterine period of life, are considered in Chap 38

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In the case of the waterfall chart type, I had to do a couple of additional configuration changes, but I used the same stacked column to start, and then just worked with the colors within the series to make them invisible, creating a floating center section I created that type of chart in about five minutes With a little touch-up, I achieved the finished product The next illustration shows the configuration for the top section of the waterfall chart I didn t really make the section invisible but rather made it blend with the background so that the color is the same as the background color That s the trick

The establishment of a biologic time scale of human development requires observation, under standardized conditions, of a large number of normal individuals of known ages and testing them for measurable items of behavior Because of individual variations in the tempo of development, it is equally important to study the growth and development of any one individual for a prolonged period If these observations are to be correlated with stages of neuroanatomic development, the clinical and morphologic data must be expressed in units that are comparable Early in life, age periods are dif cult to ascertain because of the special dif culty in xing the time of conception The average human gestational period is 40 weeks (280 days), but birth may occur with survival as early as 28 or as late as 49 weeks (a time span of almost 5 months), and the extent of nervous system development will vary accordingly After birth, any given item of behavior or structural differentiation must always have two reference points: (1) to a particular item of behavior that has already been achieved, and (2) to units of chronologic time or duration of life of the organism The chronologic or biologic scale assumes special signi cance in early prenatal life During that period development proceeds at such a rapid pace that small units of time weigh heavily and the organism appears to change literally day by day In infancy, the tempo of development slows somewhat but is still very rapid in comparison with later childhood The neurologist will nd it advantageous to organize his knowledge of normal development and disease around the timetables for human growth and development listed in Tables 28-1 and 28-2 In addition, the last decade has brought startling advances in the understanding of the genetic and molecular control of neural development That topic is beyond the scope of this chapter, although the important subject of the mutations relevant to the developmental diseases of the nervous system are considered in Chap 38.

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cessive period of life This information is reviewed brie y in the following paragraphs and is summarized in Table 28-2 It must be kept in mind that development of the nervous system does not proceed stepwise, from one period to the next, but is continuous from conception to maturity The sequences of development are much the same in all infants, although the rate may vary Any given behavioral function, in order to be expressed, must await the development of its neural substrate Furthermore, at any given moment in development, several measurable functions appear in parallel, and it is often their dissociation that acquires clinical signi cance Embryonal and Fetal Periods What we know of the nervous system in the germinal and embryonal periods has been derived from the study of a relatively small number of abortuses that have come into the hands of anatomists Neuroblastic differentiation, migration, and neuronal multiplication are already well under way in the rst 3 weeks of embryonic life The control of each of these phases (and, later, of connectivity of neurons) is determined by the genome of the organism Primitive cells destined to become neurons originate in or close to the neuroepithelium of the neural tube These cells proliferate at an astonishingly rapid rate (250,000 per minute, according to Cowan) for a circumscribed period (several days to weeks) They become transformed into bipolar neuroblasts, which migrate in a series of waves toward the marginal layer of what is to become the cortex of the cerebral hemispheres The rst glial cells also appear very early and provide the scaffolding along Table 28-1 Time scale of stages in human growth and development

Prenatal Ovum Embryo Fetus Premature infant Birth Neonate Infancy Early childhood (preschool) Later childhood (prepubertal) Adolescence Puberty (average)

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A large body of knowledge has accumulated concerning the functional and structural status of the nervous system during each suc493

From 0 to 280 days From 0 to 14 days From 14 days to 9 weeks From 9 weeks to birth From 27 to 37 weeks Average 280 days First 4 weeks after birth First year From 1 to 6 years From 6 to 10 years Girls, 8 or 10 to 18 years Boys, 10 or 12 to 20 years Girls, 13 years Boys, 15 years

Reproduced by permission from Lowrey GH, Growth and Development of Children, 8th ed Chicago, Year Book, 1986

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