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Bonnefoy-Mazure A, De Coulon G, Lascombes P, Bregou A, Armand S. A 10.5-year follow-up of walking with unilateral spastic cerebral palsy. J Child Orthop 2023; 17:173-183. [PMID: 37034199 PMCID: PMC10080234 DOI: 10.1177/18632521231154975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/25/2022] [Indexed: 04/11/2023] Open
Abstract
Purpose The purpose of this study was to describe gait evolution in patients with unilateral spastic cerebral palsy (USCP) using modified Gait Profile Score (mGPS without hip rotation), Gait Variable Score (GVS), walking speed, and the observed effects of single-level surgery (SLS) after 10 years. Methods Fifty-two patients with USCP (Gross Motor Function Classification System I) and data from two Clinical Gait Analyses (CGAs) were included. The evolution of patients' mGPS, GVS, and walking speed were calculated. Two "no surgery" and "single-level surgery" patient categories were analyzed. Paired t-tests were used to compare the data between CGAs and as a function of treatment category. Pearson's correlations were used to examine relationships between baseline values and evolutions in mGPS and walking speed. Results Mean ages (SD) at first and last CGAs were 9.3 (3.2) and 19.7 (6.0) years old, respectively, with an average follow-up of 10.5 (5.6) years. Mean mGPS for the patients' affected side was significantly lower at the last CGA for the full cohort: baseline = 8.5° (2.1) versus follow-up = 7.2° (1.6), effect size = 0.73, p < 0.001. Significant improvements in mGPS and GVS for ankle and foot progression were found for the SLS group. The mGPS change and mGPS at baseline (r = -0.79, p < 0.001) were negatively correlated. Conclusions SLS patients demonstrated a positive long-term change in gait pattern over time. The group that had undergone surgery had worse gait scores at baseline than the group that had not, but the SLS group's last CGA scores were relatively closer to those of the "no surgery" group. Level of evidence This was a retrospective comparative therapeutic study (level III).
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Affiliation(s)
- Alice Bonnefoy-Mazure
- Willy Taillard Laboratory of
Kinesiology, Geneva University Hospitals and University of Geneva, Geneva,
Switzerland
- Alice Bonnefoy-Mazure, Willy Taillard
Laboratory of Kinesiology, Geneva University Hospitals and University of Geneva,
Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
| | - Geraldo De Coulon
- Pediatric Orthopedic Service,
Department of Child and Teenage Medicine, Geneva University Hospitals and University
of Geneva, Geneva, Switzerland
| | | | - Aline Bregou
- Pediatric Orthopedic Service,
Department of Child and Adolescent Medicine, Lausanne University Hospital and
University of Lausanne, Lausanne, Switzerland
| | - Stéphane Armand
- Willy Taillard Laboratory of
Kinesiology, Geneva University Hospitals and University of Geneva, Geneva,
Switzerland
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Hollis A, Cole L, Zewdie E, Metzler MJ, Kirton A. Bilateral actigraphic quantification of upper extremity movement in hemiparetic children with perinatal stroke: a case control study. J Neuroeng Rehabil 2021; 18:172. [PMID: 34915898 PMCID: PMC8680110 DOI: 10.1186/s12984-021-00962-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hemiparetic cerebral palsy impacts millions of people worldwide. Assessment of bilateral motor function in real life remains a major challenge. We evaluated quantification of upper extremity movement in hemiparetic children using bilateral actigraphy. We hypothesized that movement asymmetry correlates with standard motor outcome measures. METHODS Hemiparetic and control participants wore bilateral wrist Actiwatch2 (Philips) for 48 h with movement counts recorded in 15-s intervals. The primary outcome was a novel statistic of movement asymmetry, the Actigraphic Movement Asymmetry Index (AMAI). Relationships between AMAI and standard motor outcomes (Assisting Hand Assessment, Melbourne Assessment, and Box and Block Test [BB]) were explored with Pearson or Spearman correlation. RESULTS 30 stroke (mean 11 years 2 months (3 years 10 months); 13 female, 17 male) and 23 control (mean 11 years 1 month (4 years 5 months); 8 female, 15 male) were enrolled. Stroke participants demonstrated higher asymmetry. Correlations between AMAI and standard tests were moderate and strongest during sleep (BB: r = 0.68, p < 0.01). CONCLUSIONS Standard tests may not reflect the extent of movement asymmetry during daily life in hemiparetic children. Bilateral actigraphy may be a valuable complementary tool for measuring arm movement, potentially enabling improved evaluation of therapies with a focus on child participation.
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Affiliation(s)
- Asha Hollis
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Lauran Cole
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ephrem Zewdie
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Megan J Metzler
- Clinical Neurosciences, Alberta Children's Hospital, Calgary, Canada
| | - Adam Kirton
- Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada. .,Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada. .,Pediatric Neurology, Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B6A8, Canada.
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Abd El-Nabie WA, Attia MA. Immediate effect of maximal treadmill walking on muscle fatigue and postural stability in children with cerebral palsy. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2019. [DOI: 10.4103/bfpt.bfpt_26_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hoei-Hansen CE, Laursen B, Langhoff-Roos J, Rackauskaite G, Uldall P. Decline in severe spastic cerebral palsy at term in Denmark 1999-2007. Eur J Paediatr Neurol 2019; 23:94-101. [PMID: 30241693 DOI: 10.1016/j.ejpn.2018.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 06/02/2018] [Accepted: 08/30/2018] [Indexed: 01/12/2023]
Abstract
AIM To analyse trends in prevalence and severity of cerebral palsy (CP) in Denmark in birth years 1999-2007 and compare with previous periods. METHOD Data has been collected uniformly in the Danish cerebral palsy national register nationwide since 1995. Rates in the time periods 1999-2001, 2002-2004 and 2005-2007 covering 585,393 births were analysed by gestational age and subtypes. RESULTS Total number of CP cases in the period was 1165. The overall prevalence of CP decreased significantly from 2.1 in 1999-2001 to 1.8 in 2005-2007 per 1000 livebirths (p = 0.022). The decline was only significant for children born at term (p = 0.007) but not for the preterm (p = 0.44). The decline in children born at term was based on a decrease in bilateral spastic CP (n = 117 in years 1999-2001 and n = 59 in 2005-2007). Multidisciplinary obstetric skills training with neonatal resuscitation in Denmark was initiated in 2003 and timely associated with the decrease. The prevalence of unilateral spastic CP the prevalence did not change, but in the two last time periods more children had a right-sided than left-sided unilateral spastic CP. CONCLUSION The decline in rate of CP seen in 2005-2007 as compared to 1999-2001 was mainly based on fewer cases of severe spastic CP in term infants. We hypothesize that improved neonatal resuscitation in the delivery room may be partly responsible for the decrease. In premature children the decline was not significant in this time period, but has been dramatically decreasing in the years before the time period here analysed.
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Affiliation(s)
| | - Bjarne Laursen
- National Institute of Public Health University of Southern Denmark, Denmark
| | - Jens Langhoff-Roos
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Gija Rackauskaite
- Department of Paediatrics, Skejby University Hospital, Aarhus, Denmark
| | - Peter Uldall
- Department of Paediatrics, Copenhagen University Hospital, Rigshospitalet, Denmark
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Saleh E, Dahan-Oliel N, Montpetit K, Benaroch T, Yap R, Barakat N, Mulcahey MJ. Functional Gains in Children With Spastic Hemiplegia Following a Tendon Achilles Lengthening Using Computerized Adaptive Testing-A Pilot Study. Child Neurol Open 2018; 5:2329048X18811452. [PMID: 30456216 PMCID: PMC6238195 DOI: 10.1177/2329048x18811452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 08/30/2018] [Accepted: 10/14/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose: This pilot study evaluated the outcomes of tendon Achilles lengthening in 12 children (mean age: 11.2 years) with spastic hemiplegia. Methods: Cerebral Palsy Computer Adaptive Tests, the timed up-and-go, the Gross Motor Function Measure, the Gillette Functional Assessment Questionnaire, and the Pediatric Outcomes Data Collection Instrument were administered at baseline and at 6, 12, and 24 months postsurgery. Results: Significant improvement at the latest follow-up (12-24 months following surgery) was seen in all domains of the Cerebral Palsy Computer Adaptive Test: activity (P = .017), lower extremity (P = .005), global (P = .005), pain (P = .005), and fatigue (P = .028), as well as in the Gross Motor Function Measure-standing domain (P = .02) and the mobility domain of the Pediatric Outcomes Data Collection Instrument (P = .04). Conclusion: These findings indicate that the tendon Achilles lengthening improved functional outcome in these children as measured by tests of physical function, walking speed, and activity performance.
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Affiliation(s)
- Eli Saleh
- Université de Montréal, Montreal, Quebec, Canada
| | - Noémi Dahan-Oliel
- Shriners Hospital for Children, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | | | | | - Rita Yap
- Shriners Hospital for Children, Montreal, Quebec, Canada
| | - Nadia Barakat
- Shriners Hospitals for Children, Philadelphia, PA, USA
| | - M J Mulcahey
- Shriners Hospitals for Children, Jefferson School of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
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Camerota F, Galli M, Cimolin V, Celletti C, Ancillao A, Blow D, Albertini G. Neuromuscular taping for the upper limb in Cerebral Palsy: A case study in a patient with hemiplegia. Dev Neurorehabil 2014; 17:384-7. [PMID: 24087981 DOI: 10.3109/17518423.2013.830152] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess quantitatively the effects of Neuromuscular Taping (NMT) on the upper limb in a female child with left hemiplegia, due to Cerebral Palsy (CP). METHODS The patient underwent NMT on cervical level, shoulder and hand only of the plegic upper limb, followed by physical therapy. Kinematic data of upper limbs during reaching task were collected before (PRE) and after 2 weeks of treatment (POST). RESULTS After the intervention, the affected limb improved in terms of movement duration, Average Jerk and Number of Unit Movements indices, indicating a faster, smoother and less segmented movement. Improvements appeared at the ranges of motion of the upper limb joints, both at shoulder and elbow joints. No significant changes were globally displayed for the unaffected arm. CONCLUSION NMT seems to be a promising intervention for improving upper limb movement in patients with CP. Further investigations are certainly needed to assess effectively the effects of the intervention in this pathological state.
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Affiliation(s)
- Filippo Camerota
- Physical Medicine and Rehabilitation Division, Orthopaedic Department, Umberto I Hospital, Sapienza University , Rome , Italy
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Use of botulinum toxin in the treatment of ankle plantar flexor spasticity in children with cerebral palsy. J Pediatr Orthop B 2014; 23:517-22. [PMID: 25171568 DOI: 10.1097/bpb.0000000000000098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to assess the effects of botulinum on spasticity of gastrocnemius and soleus muscles. Forty-one children with spastic cerebral palsy were assessed (muscle tone, range of motion of ankle joint extension with straightened and bent knee, and gait pattern using the Physician Rating Scale) before administration and 2, 6, and 13 weeks after. Changes on Physician Rating Scale and dorsiflexion with extended knee were significant after 2, 6, and 13 weeks. Differences in the remaining parameters were significant after the first two check-ups. Over 90% of the changes were positive. This research confirms the effectiveness of botulinum in reducing spasticity, increasing the range of motion, and improving the gait pattern.
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Jung YJ, Jang SH, Yeo SS, Lee E, Kim S, Lee DG, Kim HS, Son SM. Medial lemniscus lesion in pediatric hemiplegic patients without corticospinal tract and posterior thalamic radiation lesion. Eur Neurol 2012; 67:211-6. [PMID: 22414658 DOI: 10.1159/000335872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 12/11/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Using diffusion tensor imaging (DTI), we investigated the state of medial lemniscus (ML), corticospinal tract (CST), and posterior thalamic radiation (PTR), which were expected as probable reasons for clinical hemiplegia in pediatric patients, especially those who showed impaired fine motor control and proprioception, but no definite motor weakness or spasticity. METHODS We recruited 13 hemiplegic patients and 8 age-matched healthy control subjects. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) for the bilateral ML, CST, and PTR were calculated and compared between the affected hemisphere of the patient (AP), the unaffected hemisphere of the patient (UP), and the mean value of the bilateral hemispheres in control subjects (MC). RESULTS FA and ADC values for the CST and PTR did not differ significantly between the AP, UP, and MC subgroups (p > 0.05). However, the FA value for the ML in AP showed a significant decrease, compared with that in UP (p = 0.012) and MC (p = 0.047). DTT for the CST and PTR showed preserved integrity and ML in the UP also had continuity to the cortex; however, ML in AP showed disruption. CONCLUSIONS Using DTI, we demonstrated that the ML lesion might be related to clinical hemiplegia in pediatric patients.
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Affiliation(s)
- Yong Jae Jung
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Okurowska-Zawada B, Kułak W, Otapowicz D, Sienkiewicz D, Paszko-Patej G, Wojtkowski J. Quality of life in children and adolescents with cerebral palsy and myelomeningocele. Pediatr Neurol 2011; 45:163-8. [PMID: 21824563 DOI: 10.1016/j.pediatrneurol.2011.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 04/18/2011] [Indexed: 10/17/2022]
Abstract
The aim of this study was to compare health-related quality of life in children with cerebral palsy and with myelomeningocele. Fifty-seven children with spastic cerebral palsy and 34 patients with myelomeningocele aged 5-16 years were included in the study. Their mothers completed standardized measures on the Revidierter Kinder Lebensqualitätsfragebogen (KINDL-R) parent questionnaire. The 2 groups were demographically comparable. The children with cerebral palsy were classified more frequently into levels II (n = 24) and III (n = 18) of the Gross Motor Function Classification System. Other patients were classified into levels IV (n = 5) and V (n = 10). Three patients with myelomeningocele were community walkers, 10 could walk with assistive devices, and 21 used a wheelchair. Lesion level was thoracic in 13 patients, lumbar in 17, and sacral in 4. Twenty-nine patients (85.3%) with myelomeningocele had hydrocephalus, and 27 had a shunt. Parents in the both studied groups reported similar overall quality of life of their children in the dimensions of physical and emotional well-being, self-esteem, family, friends, and school. No significant correlations between the quality-of-life scores and age, walking ability, and mental development of the studied groups were found.
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Abstract
PURPOSE The objective was to investigate the clinical features of schizencephaly in children with spastic cerebral palsy. MATERIAL AND METHODS The present study included 180 children with cerebral palsy, spastic tetraplegia, diplegia, and hemiplegia. All magnetic resonance (MR) scans were obtained using a 1.5 T MR scanner with the use of a standard circularly polarized head coil. RESULTS Significant abnormalities relevant to cerebral palsy were evident on MRI in 95%. Periventicular leukomalacia was detected more frequently in children with spastic diplegia than in other patients. Cerebral atrophy was found more often in tetraplegic patients. Porencephalic cysts were detected more often in children with spastic hemiplegia. Congenital brain anomalies were evident in 20 (11.1%) children with spastic cerebral palsy. Twelve patients had schizencephaly with cerebral palsy. Children with spastic diplegia and tetraplegia had bilateral schizencephaly; patients with spastic hemiplegia only had unilateral schizencephaly. Most patients with schizencephaly had epilepsy. CONCLUSIONS Schizencephaly occurred more often in patients with spastic hemiplegia. Early detection of brain abnormalities in children with cerebral palsy may help in the prognosis and in the introduction of appropriate therapy.
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Galli M, Cimolin V, Rigoldi C, Tenore N, Albertini G. Gait patterns in hemiplegic children with Cerebral Palsy: comparison of right and left hemiplegia. RESEARCH IN DEVELOPMENTAL DISABILITIES 2010; 31:1340-1345. [PMID: 20674265 DOI: 10.1016/j.ridd.2010.07.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 06/15/2010] [Accepted: 07/06/2010] [Indexed: 05/29/2023]
Abstract
The aims of this study are to compare quantitatively the gait strategy of the right and left hemiplegic children with Cerebral Palsy (CP) using gait analysis. The gait strategy of 28 right hemiparetic CP (RHG) and 23 left hemiparetic CP (LHG) was compared using gait analysis (spatio-temporal and kinematic parameters) and considering the hemiplegic classification based on four gait strategies. Our results demonstrated that velocity was a significant parameter to differentiate RHG and LHG: all hemiplegic types revealed in fact that RHG walked with higher velocity than LHG. The ankle strategy displayed an increased number of differences between RHG and LHG from hemiplegia of Type I to Type III. In all the comparison, the LHG showed the less physiological gait pattern. As for knee kinematics, differences between right and left hemiplegic gait pattern were evidenced only in children with hemiplegia Type II: the LHG walked with a more flexed knee at initial contact, marked hyperextension in midstance and reduced knee flexion ability in the swing phase. The hip strategy was quite normal in both groups in hemiplegia Type I. In the other two types, LHG showed a limited extension ability in midstance in comparison to RHG. In conclusion, our data revealed that RHG and LHG were in general characterised by different gait patterns, evidencing a general a progression of involvement in the different types of hemiplegia; in particular in all the hemiplegic types the LHG patients revealed a more severe involvement than the RHG individuals and the differences were more evident at the distal joints, especially at the ankle joint.
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Affiliation(s)
- Manuela Galli
- Bioengineering Department, Politecnico di Milano, p.zza Leonardo Da Vinci 32, via Golgi 39, 20133 Milano, Italy
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Kulak W, Sobaniec W, Smigielska-Kuzia J, Kubas B, Walecki J. A comparison of spastic diplegic and tetraplegic cerebral palsy. Pediatr Neurol 2005; 32:311-7. [PMID: 15866431 DOI: 10.1016/j.pediatrneurol.2005.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2004] [Revised: 12/28/2004] [Accepted: 01/24/2005] [Indexed: 11/26/2022]
Abstract
The aim of this study was to compare spastic diplegic and tetraplegic cerebral palsy. Thirty-eight children had spastic diplegic cerebral palsy and 48 spastic tetraplegic cerebral palsy. Risk factors of cerebral palsy, seizures, severity of cerebral palsy, electroencephalogram, and magnetic resonance imaging findings were analyzed. Gestational history, low birth weight, and perinatal pathologies were present in similar percentages in both groups. Lower values of the Apgar score were recorded more often in the tetraplegic cerebral palsy group than the diplegic group. The children with spastic diplegia were classified more frequently into levels I and II of the Gross Motor Function Classification System, but patients with spastic tetraplegia were classified more frequently into levels IV and V. Similarly, mental retardation was observed more frequently in the patients with spastic tetraplegia. In magnetic resonance imaging, periventricular leukomalacia was detected in a higher proportion of children with spastic diplegia than in patients with tetraplegia. Cerebral atrophy occurred more frequently in the tetraplegic group compared with diplegic patients. Twenty-four (50.0%) children with spastic tetraplegia had epilepsy compared with six children with spastic diplegia. The incidence of intractable epilepsy was higher in the tetraplegic patients than in the children with spastic diplegia.
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Affiliation(s)
- Wojciech Kulak
- Department of Pediatric Neurology and Rehabilitation, University of Białystok, Białystok, Poland
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