Cerebral palsy in Ibadan, Nigeria

Clinical Profile of Pediatric Neurology Disorders: A Study From a Semi-Urban Medical College in Northwestern India

Introduction: Neurological disorders are characterized by dysfunction in any part of the nervous system and are a major cause of disability among children and adolescents in developing countries, just as it is in India. There is a lack of information on the prevalence of neurological disorders in developing countries due to the lack of quality health information and a lack of awareness of these disorders. This local study aims to provide an understanding of the profile and characteristics of neurological disorders in children that will aid in the development and implementation of preventive healthcare strategies.

Methods: A retrospective observational study was conducted in the Department of Pediatrics. All pediatric neurology patients' data were retrieved from January 2020 to December 2020.

Results: Of the 12,782 children seen in the pediatric outpatient department (OPD), 133 (1.04%) had neurological disorders and about 65% were male. Childhood seizures 92 (69%) and developmental delay 13 (9.7%) were the most common neurological conditions, although there was an overlap of the conditions.

Conclusion: This study provides some valuable information about common neurological disorders in children. Seizures, cerebral palsy, and developmental delay were the most common neurological disorders in children.

Astrocytes and Microglia in Stress-Induced Neuroinflammation: The African Perspective

Background: Africa is laden with a youthful population, vast mineral resources and rich fauna. However, decades of unfortunate historical, sociocultural and leadership challenges make the continent a hotspot for poverty, indoor and outdoor pollutants with attendant stress factors such as violence, malnutrition, infectious outbreaks and psychological perturbations. The burden of these stressors initiate neuroinflammatory responses but the pattern and mechanisms of glial activation in these scenarios are yet to be properly elucidated. Africa is therefore most vulnerable to neurological stressors when placed against a backdrop of demographics that favor explosive childbearing, a vast population of unemployed youths making up a projected 42% of global youth population by 2030, repressive sociocultural policies towards women, poor access to healthcare, malnutrition, rapid urbanization, climate change and pollution. Early life stress, whether physical or psychological, induces neuroinflammatory response in developing nervous system and consequently leads to the emergence of mental health problems during adulthood. Brain inflammatory response is driven largely by inflammatory mediators released by glial cells; namely astrocytes and microglia. These inflammatory mediators alter the developmental trajectory of fetal and neonatal brain and results in long-lasting maladaptive behaviors and cognitive deficits. This review seeks to highlight the patterns and mechanisms of stressors such as poverty, developmental stress, environmental pollutions as well as malnutrition stress on astrocytes and microglia in neuroinflammation within the African context.

Determinants of Cerebral Palsy in Pediatric Patients in Northern Ethiopia: A Hospital-Based Study

Introduction

Cerebral palsy is the most common neurologic disorder of childhood with lifelong implications in majority of patients. Knowledge of the determinants of cerebral palsy is important for accurate mobilization of resources in obstetric, perinatal, and infant care besides implementation of prevention systems. In Ethiopia, however, this knowledge gap exists as there are no published studies on determinants of cerebral palsy in the country.

Objective

To assess the determinants of cerebral palsy in pediatric patients attending Ayder Comprehensive Specialized Referral Hospital between April 2019 and August 2019.

Methods

An unmatched case-control study was conducted among 50 pediatric cerebral palsy patients and 100 controls, pediatric patients without cerebral palsy or other motor or central nervous system illnesses, attending Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia. The data were analyzed using SPSS version 27.

Results

Significant factors were operative vaginal delivery (AOR: 9.49, 95% CI: 1.31-68.88), central nervous system infections (AOR: 0.02, 95% CI: 0-0.58), neonatal admissions (AOR: 0.13, 95% CI: 0.03-0.61), and unknown maternal education status (AOR: 18.64, 95% CI: 2.15-161.73).

Conclusion

Operative vaginal delivery, central nervous system infections in infancy, neonatal hospital admissions, and unknown maternal education status were found to be significant determinants for cerebral palsy. This knowledge aids focused hospital and regional health bureau development and implementation of prevention strategies for cerebral palsy, besides improvement of obstetric and neonatal healthcare services, and provides baseline data to the scientific community for further research.

Evaluation of risk factors for cerebral palsy

Background

Cerebral palsy (CP) has been identified as one of the most important and common causes of childhood disabilities worldwide and is often accompanied by multiple comorbidities. CP is defined as a group of disorders of the development of movement and posture, causing activity limitation that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The objective of our study was to describe main clinical pattern and motor impairments of our patients, and to evaluate the presence of risk factors and if there is a relation to the type of cerebral palsy.

Methods

Children with cerebral palsy were retrospectively enrolled over 2 years from the neurology outpatient clinics. Cerebral palsy risk factors and motor impairments were determined through caregiver interviews, review of medical records, and direct physical examination.

Results

One thousand children with cerebral palsy were enrolled. Subjects were 64.4% male, with a median age of 2.5 years. The risk factors for cerebral palsy in our study were antenatal (21%), natal and post-natal (30.5%), post-neonatal (17.1%), and unidentified (31.4%). Antenatal as CNS malformation (26.6%), maternal DM (17.6%), prolonged rupture of membrane (11.9%), maternal hemorrhage (10.4%), and pre-eclampsia (4.7%). Natal and post-natal as hypoxic ischemic encephalopathy (28.5%), infection (16.3%), hyperbilirubinemia (12.7%), cerebrovascular accidents (8.8%), meconium aspiration (6.2%), and intracranial hemorrhage. Post-neonatal as CNS infection (34.5%), cerebrovascular accidents (28.6%), sepsis (23.9%), and intracranial hemorrhage (8.7%).

Conclusions

Cerebral palsy has different etiologies and risk factors. Further studies are necessary to determine optimal preventative strategies in these patients.

The effect of visual support strategies on the quality of life of children with cerebral palsy and cerebral visual impairment/perceptual visual dysfunction in Nigeria: study protocol for a randomized controlled trial

BACKGROUND

Cerebral visual impairment (CVI), including perceptual visual dysfunction (PVD), is common in children with cerebral palsy (CP). Inventories of questions relating to practical aspects of visual perception in everyday life, in particular the closed-ended Insight Questions Inventory (IQI), can be used to assess CVI/PVD. Studies linking responses to the inventory with specific visual support strategies, aimed at modifying the child's environment and/or behaviour to minimize the impact of the CVI/PVD, have been piloted. The IQI and tailored strategies have not been used in an African population, nor have they been tested in a controlled trial. This trial will compare the effectiveness of the IQI and linked visual support strategies versus general supportive treatments on the quality of life of children with CVI/PVD and CP through a randomized controlled trial.

METHODS/DESIGN

This is a prospective, double-blind, parallel-arm, randomized controlled trial. The primary outcome is change in quality of life scores between the two arms of the trial at 6 weeks, assessed using the Paediatric Quality of Life Inventory (PedsQL) generic 4.0 and CP 3.0 module. All children will undergo baseline assessment including the Open Questions Inventory, IQI, PedsQL 3.0, PedsQL 4.0 generic, and the Strengths and Difficulties Questionnaire (SDQ). Eligible children with CP aged 4 years to < 16 years will be stratified and blocked by the age groups 4-9 and 10 to < 16 years and by Gross Motor Function Classification System (GMFCS) levels 1-3 and 4-5. Families in the intervention arm will receive tailored insight visual support strategies and telephone calls during the 6-week trial period. The control arm will receive standard treatment and the intervention after the 6-week trial period. Follow-up interviews will be performed in both arms at 6 weeks with a repeat administration of the PedsQL CP 4.0 and 3.0, the IQI and the SDQ. Secondary outcomes include a change in functional vision.

DISCUSSION

This randomized controlled trial will provide evidence of the effectiveness of this intervention for children with CP in a resource-poor setting.

TRIAL REGISTRATION

Pan African Clinical Trials Registration, PACTR201612001886396 . Registered on 3 December 2016.

Effect of a 10-Week Aquatic Exercise Training Program on Gross Motor Function in Children With Spastic Cerebral Palsy

Introduction. Cerebral palsy (CP) is caused by an injury to the developing brain, and abnormal gross motor function is a hallmark of CP. Properly structured exercises on land have been reported to be effective in improving functional performance in children with CP while only few have been documented on aquatic therapy. Objective. To investigate the effect of a 10-week aquatic exercise training program on gross motor function in children with spastic CP. Methods. Thirty participants aged 1 to 12 years were randomized into the experimental and control groups. Both groups received manual passive stretching and functional training exercises, depending on their level of motor impairment, either in water (temperature 28°C to 32°C) or on land. Each exercise training session lasted for about 1 hour 40 minutes, twice per week for 10 weeks in both groups. Measurement of gross motor function was done using Gross Motor Function Measure (GMFM-88) at baseline and after 4 weeks, 8 weeks, and 10 weeks of intervention. Both groups were compared for differences in change in gross motor function using Mann-Whitney U test. The level of significance was set at P < .05. Results. Only the experimental group showed significant improvement (P < .05) in all dimensions of gross motor function except for walking, running, and jumping (P = .112). Statistically significant difference (P < .05) was found between both groups for all dimensions of gross motor function after 10 weeks of intervention. Conclusion. Aquatic exercise training program is effective in the functional rehabilitation of children with spastic CP.

Severity of motor dysfunction in children with cerebral palsy seen in Enugu, Nigeria

Introduction

Children with cerebral palsy (CP) have gross motor dysfunction (GMD) of varying degrees of severity. The Gross Motor Function Classification System (GMFCS) is widely used internationally to classify children with CP into functional severity levels. There are few reports on the use of GMFCS in Nigeria to determine the severity of motor dysfunction in children with CP. This study aims to classify children with CP in Enugu on the basis of severity of their GMD in order to ascertain their management needs.

Methods

The study was a cross sectional observational study and sample selection was by consecutive recruitment. One hundred (100) children with CP aged 9 – 96 months, attending two Pediatric Neurology Clinics in Enugu, were consecutively recruited. Relevant history was taken including modalities of treatment received. Neurological examination was done and the GMFCS manual was used to classify the children into levels of severity.

Results

GMD varied in severity in the patients from mild (47%) (GMFCS levels I & II) to moderate (7%) (GMFCS levels III) and to severe (46%) (GMFCS levels IV & V). Those in levels I – III (54%) were ambulatory while those in levels IV & V (46%) were non-ambulatory. Of the 53 that required mobility assistive device, only 6 (11.3%) were using one.

Conclusion

More than half of CP patients seen in Enugu were ambulatory with mild to moderate motor dysfunction based on the GMFCS. Only a few of our patients are appropriately rehabilitated with augmentative interventions.

Clinical Profile of Pediatric Neurological Disorders: Outpatient Department, Khartoum, Sudan

BACKGROUND

There is no available data from Sudan reflecting the magnitude of the neurological disorders and disabilities in the pediatric age-group. This study aims to evaluate the pattern of neurological disorders among Sudanese children.

PATIENTS AND METHODS

This is a retrospective survey of children with epilepsy and other neurodisability disorders seen at pediatric neurology outpatient clinic, during the period from January 2007 to August 2013. The data of 9600 patients were analyzed.

RESULTS

A total of 6019 patients were included in the study. The majority of the patients had epilepsy that amounted to 52.8%, followed by cerebral palsy (19.1%), congenital anomalies of the central nervous system (6.2%), neuromuscular disorders (3.2%), stroke (2.4%), ataxia and movement disorders (1.9%), assumed genetic syndromes (1.2%), and others.

CONCLUSION

Neurological disorders constitute a major cause of chronic morbidity in pediatric age-group.

Pediatric Cerebral Palsy in Africa: Where Are We?

Cerebral palsy is the most common cause of physical disability in children worldwide. However, little is reported on this condition in the African context. Doctors from 22 countries in Africa, and representatives from a further 5 countries outside Africa, met to discuss the challenges in the evaluation and management of children with cerebral palsy in Africa and to propose service needs and further research. Basic care is limited by the poor availability of diagnostic facilities or medical personnel with experience and expertise in managing cerebral palsy, exacerbated by lack of available interventions such as medications, surgical procedures, or even regular therapy input. Relevant guidelines are lacking. In order to guide services for children with existing disabilities, to effectively target the main etiologies and to develop preventive strategies for the continent, research priorities must include multicenter collaborative studies looking at the prevalence, risk factors, and treatment of cerebral palsy.

Motor severity in children with cerebral palsy studied in a high-resource and low-resource country

OBJECTIVES

To compare the patterns of motor type and gross motor functional severity in preschool-aged children with cerebral palsy (CP) in Bangladesh and Australia.

METHODS

We used comparison of 2 prospective studies. A total of 300 children with CP were aged 18 to 36 months, 219 Australian children (mean age, 26.6 months; 141 males) recruited through tertiary and community services, and 81 clinic-attendees born in Bangladesh (mean age, 27.5 months; 50 males). All children had diagnosis confirmed by an Australian physician, and birth and developmental history collected on the Physician Checklist. All children were classified by the same raters between countries using the Gross Motor Function Classification System (GMFCS), and motor type and distribution.

RESULTS

There were more children from GMFCS I-II in the Australian sample (GMFCS I, P < .01; III, P < .01; V, P = .03). The patterns of motor type also differed significantly with more spasticity and less dyskinetic types in the Australian sample (spasticity, P < .01; dystonia, P < .01; athetosis, P < .01). Birth risk factors were more common in the Bangladesh sample, with risk factors of low Apgar scores (Australia, P < .01), lethargy/seizures (Australia, P = .01), and term birth (Bangladesh, P = .03) associated with poorer gross motor function. Cognitive impairments were significantly more common in the Bangladesh children (P < .01), and visual impairments more common in Australia (P < .01).

CONCLUSIONS

Patterns of functional severity, motor type, comorbidities, etiology, and environmental risk factors differed markedly between settings. Our results contribute to understanding the patterns of CP in low-resource settings, and may assist in optimizing service delivery and prioritizing appropriate early interventions for children with CP in these settings.

Pediatric cerebral palsy in Africa: a systematic review

Cerebral palsy is a common neurologic problem in children and is reported as occurring in approximately 2-2.5 of 1000 live births globally. As is the case with many pediatric neurologic conditions, very little has been reported on this condition in the African context. Resource-limited settings such as those found across the continent are likely to result in a different spectrum of etiologies, prevalence, severity as well as management approaches. This review aims to establish what has been reported on this condition from the African continent so as to better define key clinical and research questions.

[Neonatal morbidity and mortality in a low-resource urban district hospital of Douala, Cameroon]

INTRODUCTION

In countries with limited health-care resources, achieving the fourth Millennium Development Goal recommended by the WHO requires the reduction of neonatal mortality. Interventions at different levels of the community and the health-care system are needed, including in district hospitals.

METHOD

This was a descriptive study in the neonatal unit of the District Hospital of Bonassama/Douala in Cameroon that analyzed neonatal mortality and morbidity to discover possible intervention levers. The clinical, sociodemographic, and outcome data of hospitalized newborns were recorded from November 2009 to May 2012. The analysis was performed anonymously.

RESULTS

During 29 months, 813 infants were hospitalized; 71% were delivered naturally and 16% by cesarean section. Globally, 20% were premature, 55% were male, and 24% had a birth weight of less than 2500 g. At admission, 35% of the infants had hyperthermia and 29% hypothermia. The most common diagnoses were early infection (77%), late infection (22%), jaundice (17%), early adaptation disorders (18%), and hypoxic-ischemic encephalopathy (2.2%). The hospital mortality rate was 8% and the main diagnoses associated with death were: low birth weight, prematurity, hypothermia, and early adaptation disorders with and without encephalopathy. No excess mortality was found for neonates treated for infection.

CONCLUSION

In developing sub-Saharan countries, the main causes of neonatal mortality must be taken care of by hospitals at a peripheral district level. Epidemiological knowledge of neonatal diseases at the peripheral level (district) allows for an estimation of the requirements in terms of competence and equipment. Specific needs for transfer to a superior care unit can be estimated but the high transfer risk and the limited resources of the referral center should be taken into account.

Changes in the clinical spectrum of cerebral palsy over two decades in North India--an analysis of 1212 cases

BACKGROUND

Clinical spectrum of cerebral palsy (CP) is different in developing and developed countries. We evaluated the clinical profile, etiological factors and co-morbidities of children with CP in North India, and compared with our previous study.

METHODS

1212 children with CP registered in last 10 years in our rehabilitation center were compared with our previous study of 1000 children from same center.

RESULTS

Spastic quadriplegia is the commonest type of CP (51.5%) although lesser than previous decade (61%). Birth asphyxia remains the main (51.98%) etiological factor as earlier (45.3%). CP due to CNS infections decreased from 63.5% to 57.4%, due to bilirubin-encephalopathy remained same (∼30%). Speech problems (83.7%), microcephaly (64.27%), seizures (44.5%) and intellectual disability (38.61%) are common co-morbidities. Common neuroimaging findings include hypoxic-ischemic changes and periventricular leucomalacia.

CONCLUSION

The spectrum of CP is evolving in the developing countries with an increase in diplegic and a decrease in quadriplegic CP.

Cerebral palsy among children seen in the neurology clinic of Federal Medical Centre (FMC), Asaba

Cerebral palsy (CP) is a non-progressive disorder of motor function caused by irreversible damage to the immature brain. The disorder may be associated with seizure, mental retardation, visual and hearing defects. This study was designed to determine the types of CP, the risk factors and the co-morbidities associated with the disorder. Records of patients who were seen in the neurology clinic were kept for two years (June 2009-July 2011). Medical history and examination were essentially used to determine risk factors, antenatal care and co-morbidities. Data was analyzed using SPSS soft-ware. CP made up 45 % of 60 neurological cases and 0.006 % of 4,873 patients seen in the clinic with a male to female ratio of 1.1:1. Birth asphyxia was the commonest risk factor for the development of the disorder while seizure disorder among others was the commonest co-morbid state.

Magnetic resonance imaging, risk factors and co-morbidities in children with cerebral palsy

Cerebral palsy (CP) continues to be a major problem in India. The present study provides an insight into the various clinical and neuroradiological correlates of CP. The study included 102 children with CP and was subjected to magnetic resonance imaging (MRI) of the brain. Forty-seven (46%) patients belonged to the 1-3 years age group and 84 (82%) were born at term. Of 102 children, 39 (38%) were delivered at home. Based on their tone and topographic pattern of weakness, it was found that 47 (46%) had spastic diplegia and 35 (34%) spastic quadriplegia. Hemiplegic, dystonic, and atonic CP accounted for the remaining 20%. The occurrence of severe birth asphyxia, which is rarely seen in developed countries, continues to be a major problem in developing countries, and accounted 64 (62%) of the patients. Cognitive delay (82%) was the most common co-morbidity, followed by seizure disorder (52%), feeding difficulties (22%) and visual abnormalities (29%). Ninety-one (89%) children had an abnormal MRI. Periventricular white matter injury (PWMI) was observed in 48 (47.1%), followed by diffuse encephalopathy (29%). Focal lesions (6%) and malformations (3%) were less common. In children with spastic diplegia, PWMI was the most common MRI abnormality, whereas in spastic quadriplegia, diffuse encephalopathy was most common. MRI scans help in revealing the pathologic basis of CP and had strong correlations with clinical findings.

Análise dos efeitos da utilização da tala seriada em crianças portadoras de paralisia cerebral: uma revisão sistemática da literatura

OBJETIVOS: realizar uma revisão sistemática da literatura através da seleção e análise criteriosa de artigos científicos que investigaram os efeitos da tala seriada em crianças com diagnóstico clínico de paralisia cerebral espástica. MÉTODOS: busca sistemática na literatura foi realizada no período de março a agosto de 2004, nas bases de dados eletrônicas Medline, Lilacs e PEDro publicados nas línguas inglês e português, no período de 1980 a 2004. O nível de evidência dos artigos estudados foi qualificado utilizando-se a escala Magee. RESULTADOS: os quatro artigos incluídos nessa revisão preencheram todos os critérios de inclusão e foram classificados como fracos de acordo com a escala Magee (índice de concordância Kappa K=1,0) devido às limitações metodológicas apresentadas. CONCLUSÕES: as evidências utilizadas nessa revisão sistemática não apresentam nível que possa suportar a utilização clínica da tala seriada em crianças com paralisia cerebral. Futuras pesquisas devem ser realizadas em observância à necessidade de maior rigor metodológico dos estudos para a fundamentação da prática baseada em evidência.