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Panda S, Singh A, Kato H, Kokhanov A. Cerebral Palsy: A Current Perspective. Neoreviews 2024; 25:e350-e360. [PMID: 38821909 DOI: 10.1542/neo.25-6-e350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/25/2023] [Accepted: 01/09/2024] [Indexed: 06/02/2024]
Abstract
Cerebral palsy (CP) is the most common cause of motor disability in children. Insults to the brain at different times lead to diverse injuries. As a result, CP is an extremely heterogeneous clinical diagnosis, presenting differently in each individual and at various ages. With improving survival rates of preterm newborns, increasing active resuscitation of extremely preterm newborns, and widespread availability of extensive genetic testing soon after birth, it is imperative to focus on earlier diagnosis and long-term outcomes of CP. CP is primarily classified into 4 categories based on type of motor impairment, functional ability, distribution, and etiology. As the understanding of CP has evolved significantly in the last 2 decades, the methods of early detection of CP have consequently advanced. Appropriate diagnosis is essential for proper education and counseling of affected families, and introduction of therapeutic interventions as early as possible. In this review, we focus on early brain development and provide an overview of the etiology, classification, diagnosis, early therapeutic options, and prognosis of CP.
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Affiliation(s)
- Sanjeet Panda
- Department of Pediatrics, Division of Neonatology, Texas Tech University Health Sciences Center El Paso, El Paso, TX
| | - Ajay Singh
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Houston, TX
| | - Hugo Kato
- Department of Pediatrics, Division of Neonatology, Texas Tech University Health Sciences Center El Paso, El Paso, TX
| | - Artemiy Kokhanov
- Department of Pediatrics, Division of Neonatology, Texas Tech University Health Sciences Center El Paso, El Paso, TX
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2
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Cabezas-López M. How Is Cerebral Palsy Different from Other Childhood Neurological Disorders? JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2023. [DOI: 10.1007/s40817-023-00140-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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3
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Allen J, Zareen Z, Doyle S, Whitla L, Afzal Z, Stack M, Franklin O, Green A, James A, Leahy TR, Quinn S, Elnazir B, Russell J, Paran S, Kiely P, Roche EF, McDonnell C, Baker L, Hensey O, Gibson L, Kelly S, McDonald D, Molloy EJ. Multi-Organ Dysfunction in Cerebral Palsy. Front Pediatr 2021; 9:668544. [PMID: 34434904 PMCID: PMC8382237 DOI: 10.3389/fped.2021.668544] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022] Open
Abstract
Cerebral Palsy (CP) describes a heterogenous group of non-progressive disorders of posture or movement, causing activity limitation, due to a lesion in the developing brain. CP is an umbrella term for a heterogenous condition and is, therefore, descriptive rather than a diagnosis. Each case requires detailed consideration of etiology. Our understanding of the underlying cause of CP has developed significantly, with areas such as inflammation, epigenetics and genetic susceptibility to subsequent insults providing new insights. Alongside this, there has been increasing recognition of the multi-organ dysfunction (MOD) associated with CP, in particular in children with higher levels of motor impairment. Therefore, CP should not be seen as an unchanging disorder caused by a solitary insult but rather, as a condition which evolves over time. Assessment of multi-organ function may help to prevent complications in later childhood or adulthood. It may also contribute to an improved understanding of the etiology and thus may have an implication in prevention, interventional methods and therapies. MOD in CP has not yet been quantified and a scoring system may prove useful in allowing advanced clinical planning and follow-up of children with CP. Additionally, several biomarkers hold promise in assisting with long-term monitoring. Clinicians should be aware of the multi-system complications that are associated with CP and which may present significant diagnostic challenges given that many children with CP communicate non-verbally. A step-wise, logical, multi-system approach is required to ensure that the best care is provided to these children. This review summarizes multi-organ dysfunction in children with CP whilst highlighting emerging research and gaps in our knowledge. We identify some potential organ-specific biomarkers which may prove useful in developing guidelines for follow-up and management of these children throughout their lifespan.
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Affiliation(s)
- John Allen
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland.,Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | | | - Samantha Doyle
- Department of Clinical Genetics, Birmingham Women's Hospital, Birmingham, United Kingdom
| | - Laura Whitla
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Zainab Afzal
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Maria Stack
- Children's Health Ireland at Crumlin, Dublin, Ireland.,Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Orla Franklin
- Children's Health Ireland at Crumlin, Dublin, Ireland.,Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Andrew Green
- Children's Health Ireland at Crumlin, Dublin, Ireland.,Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Adam James
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland.,Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Timothy Ronan Leahy
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Shoana Quinn
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Basil Elnazir
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - John Russell
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Sri Paran
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Patrick Kiely
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Edna Frances Roche
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland.,Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Ciara McDonnell
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland.,Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland.,Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | - Louise Baker
- Children's Health Ireland at Temple St. Dublin, Dublin, Ireland
| | | | - Louise Gibson
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - Stephanie Kelly
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Denise McDonald
- Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Eleanor J Molloy
- Discipline of Pediatrics, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland.,Trinity Research in Childhood Centre, Trinity College Dublin, Dublin, Ireland.,Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland.,Children's Health Ireland at Crumlin, Dublin, Ireland.,Department of Neonatology, The Coombe Women and Infants University Hospital, Dublin, Ireland
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Chen A, Dyck Holzinger S, Oskoui M, Shevell M. Losing a diagnosis of cerebral palsy: a comparison of variables at 2 and 5 years. Dev Med Child Neurol 2020; 62:83-88. [PMID: 31273776 DOI: 10.1111/dmcn.14309] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2019] [Indexed: 01/08/2023]
Abstract
AIM This study aims to identify characteristics at 2 years of age that differ between children with confirmed cerebral palsy (CP) and a non-CP diagnosis by 5 years of age. METHOD This was a retrospective cohort analysis. A CP diagnosis may be considered a 'probable' diagnosis at 2 years, which is often 'confirmed' at 4 or 5 years, particularly in the context of CP registries. A total of 1683 children with a diagnosis of CP or probable CP at 2 years of age were identified from the Canadian Cerebral Palsy Registry, of whom 48 received a non-CP diagnosis at 5 years ('non-confirmed CP'). Perinatal adversity, preterm birth status, Gross Motor Function Classification System (GMFCS) level, presence of comorbidities, magnetic resonance imaging (MRI) findings, and initial CP motor type were compared between the two groups by univariate and logistic regression analyses. RESULTS χ2 analysis and multivariate analysis both confirmed that children with a non-CP diagnosis by 5 years of age were more likely to have a normal MRI (χ2 odds ratio [OR]=7.8, 95% confidence interval [CI]=3.8-16.1; OR=5.4, 95% CI=2.4-12.5), ataxic-hypotonic (χ2 OR=10.1, 95% CI=4.9-21.2; OR=6.1, 95% CI=2.2-16.2) or dyskinetic CP (χ2 OR=2.7, 95% CI=1.2-5.9; OR=2.9, 95% CI=1.0-7.6), born at term (χ2 OR=3.7, 95% CI=1.7-8.0; OR=3.6, 95% CI=1.0-12.1), and lack perinatal adversity (χ2 OR=4.1, 95% CI=1.6-10.7; OR=3.4, 95% CI=1.0-11.7). INTERPRETATION Normal MRI, ataxic-hypotonic or dyskinetic CP, lack of perinatal adversity, and term birth are associated with a higher odds of non-CP diagnosis by 5 years of age, thus potentially enhancing diagnostic work-up. WHAT THIS PAPER ADDS Normal magnetic resonance imaging (MRI) at 2 years was associated with a non-cerebral palsy (CP) diagnosis by 5 years. Diagnosis of ataxic-hypotonic or dyskinetic CP motor subtype at 2 years was associated with a non-CP diagnosis by 5 years. Perinatal adversity and preterm birth were rarer with a non-CP diagnosis by 5 years.
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Affiliation(s)
- Anjellica Chen
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sasha Dyck Holzinger
- Canadian Cerebral Palsy Registry, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Maryam Oskoui
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada.,Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Michael Shevell
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada.,Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
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Zouvelou V, Yubero D, Apostolakopoulou L, Kokkinou E, Bilanakis M, Dalivigka Z, Nikas I, Kollia E, Perez-Dueñas B, Macaya A, Marcé-Grau A, Voutetakis A, Anagnostopoulou K, Kekou K, Sofocleus C, Veltra D, Kokkinis X, Fryssira H, Torres RJ, Amstrong J, Santorelli FM, Artuch R, Pons R. The genetic etiology in cerebral palsy mimics: The results from a Greek tertiary care center. Eur J Paediatr Neurol 2019; 23:427-437. [PMID: 30799092 DOI: 10.1016/j.ejpn.2019.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/20/2019] [Accepted: 02/07/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Non-progressive genetic disorders may present with motor dysfunction resembling cerebral palsy (CP). Such patients are often characterized as CP mimics. The purpose of this work was to delineate the clinical manifestations and molecular findings of CP mimic patients, with the ultimate goal to offer specific disease-modifying therapy and genetic counseling. METHODS Retrospective study of 47 patients diagnosed with CP and no acquired etiology. Chart review of clinical, neuroradiological, biochemical and molecular data was performed. RESULTS 31,91% of patients manifested with features resembling dyskinetic CP, 19,14% spastic CP, 10,63% ataxic CP and 38,30% mixed CP. In 23 patients molecular diagnosis was reached and included 5 hereditary spastic paraplegia genes (SPG) in spastic CP mimics; HPRT1, TH, QDPR, DDC in dystonic CP mimics; ADCY5 and NIKX2-1 in choreic CP mimics; CANA1A in ataxic CP mimics; and SPG, PDHA1, NIKX2-1, AT, SLC2A1 and SPR in mixed CP mimics. In 14 patients, the etiological diagnosis led to specific treatment. CONCLUSIONS CP mimics show a number of features that differ from classic CP and can be used as diagnostic clues, including presence of mixed motor features, minor dysmorphic features, oculogyric movements, multiple features of autonomic dysfunction, and acquired microcephaly. A more stringent use of the concept of CP focused on acquired lesions during the perinatal and infancy periods, and excluding disorders that could be of genetic origin, could contribute to a purer use of the term. Identification of a specific genetic cause for CP mimics may in certain cases lead to etiologic treatment.
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Affiliation(s)
- Vasiliki Zouvelou
- First Department of Pediatrics, Agia Sofia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Delia Yubero
- Department of Clinical Biochemistry, Institut de Recerca Sant Joan de Déu, Sant Joan de Deu Hospital, Center for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
| | - Loukia Apostolakopoulou
- First Department of Pediatrics, Agia Sofia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftheria Kokkinou
- First Department of Pediatrics, Agia Sofia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Manolis Bilanakis
- First Department of Pediatrics, Agia Sofia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Zoi Dalivigka
- Pediatric Rehabilitation Unit, "Pan & Aglaia's Kyriakou" Children's Hospital, Greece
| | - Ioannis Nikas
- Radiology Department, Agia Sofia Children's Hospital Hospital, Athens, Greece
| | - Elissavet Kollia
- First Department of Pediatrics, Agia Sofia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Belen Perez-Dueñas
- Pediatric Neurology Research Group Vall d'Hebron Research, Institute Autonomous University of Barcelona Barcelona, Spain
| | - Alfons Macaya
- Pediatric Neurology Research Group Vall d'Hebron Research, Institute Autonomous University of Barcelona Barcelona, Spain
| | - Anna Marcé-Grau
- Pediatric Neurology Research Group Vall d'Hebron Research, Institute Autonomous University of Barcelona Barcelona, Spain
| | - Antonis Voutetakis
- First Department of Pediatrics, Agia Sofia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Kiriaki Kekou
- Medical Genetics, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Christalena Sofocleus
- Medical Genetics, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Danae Veltra
- Medical Genetics, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Xaralabos Kokkinis
- Medical Genetics, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Helen Fryssira
- Medical Genetics, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Rosa J Torres
- La Paz University Hospital Health Research Institute (FIBHULP), IdiPaz, Madrid, Spain; Center for Biomedical Network Research on Rare Diseases (CIBERER), ISCIII, Spain
| | - Judith Amstrong
- Department of Clinical Biochemistry, Institut de Recerca Sant Joan de Déu, Sant Joan de Deu Hospital, Center for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
| | - Filippo M Santorelli
- Molecular Medicine and Neurogenetics, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Rafael Artuch
- Department of Clinical Biochemistry, Institut de Recerca Sant Joan de Déu, Sant Joan de Deu Hospital, Center for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
| | - Roser Pons
- First Department of Pediatrics, Agia Sofia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece.
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6
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Carneiro NCR, Monteiro LR, Pordeus IA, Borges-Oliveira AC. Oral sucking habits among children with Down syndrome and cerebral palsy. SPECIAL CARE IN DENTISTRY 2017; 37:176-180. [DOI: 10.1111/scd.12231] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Natália Cristina Ruy Carneiro
- Faculty of Dentistry, Department of Pediatric Dentistry and Orthodontics; Universidade Federal de Minas Gerais; Belo Horizonte Brazil
| | - Luisa Ribeiro Monteiro
- Faculty of Dentistry, Department of Social and Preventive Dentistry; Universidade Federal de Minas Gerais; Belo Horizonte Brazil
| | - Isabela Almeida Pordeus
- Faculty of Dentistry, Department of Pediatric Dentistry and Orthodontics; Universidade Federal de Minas Gerais; Belo Horizonte Brazil
| | - Ana Cristina Borges-Oliveira
- Faculty of Dentistry, Department of Social and Preventive Dentistry; Universidade Federal de Minas Gerais; Belo Horizonte Brazil
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7
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Buizer AI, van Schie PEM, Bolster EAM, van Ouwerkerk WJ, Strijers RL, van de Pol LA, Stadhouder A, Becher JG, Vermeulen RJ. Effect of selective dorsal rhizotomy on daily care and comfort in non-walking children and adolescents with severe spasticity. Eur J Paediatr Neurol 2017; 21:350-357. [PMID: 27908676 DOI: 10.1016/j.ejpn.2016.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/12/2016] [Accepted: 09/20/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND In non-walking children with severe spasticity, daily care can be difficult and many patients suffer from pain. Selective dorsal rhizotomy (SDR) reduces spasticity in the legs, and therefore has the potential to improve daily care and comfort. AIM To examine effects of SDR on daily care and comfort in non-walking children with severe spasticity due to different underlying neurological conditions. METHODS Medical history, changes in daily care and comfort and satisfaction with outcome were assessed retrospectively in non-walking children who underwent SDR in our center, with a mean follow-up of 1y 7m (range 11m-4y 3m). All eligible patients (n = 24, years 2009-2014) were included. RESULTS Mean age at SDR was 12y 4m (SD 4y 3m, range 2y 8m-19y 3m). Associated orthopaedic problems were frequent. Seven patients underwent scoliosis correction in the same session. Most improvements were reported in dressing (n = 16), washing (n = 12) and comfort (n = 10). Median score for satisfaction was 7 on a scale of 10 (range 1-9). SDR resulted in reduction of spasticity in leg muscles. In nine patients dystonia was recorded post-operatively, mainly in children with congenital malformations and syndromes. INTERPRETATION SDR is a single event intervention that can improve daily care and comfort in non-walking children with severe spasticity, and can safely be combined with scoliosis correction. Despite the improvements, satisfaction is variable. Careful attention is necessary for risk factors for dystonia, which may be unmasked after SDR.
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Affiliation(s)
- A I Buizer
- Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - P E M van Schie
- Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - E A M Bolster
- Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - W J van Ouwerkerk
- Department of Neurosurgery, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - R L Strijers
- Department of Clinical Neurophysiology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - L A van de Pol
- Department of Child Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - A Stadhouder
- Department of Orthopaedic Surgery, Research Institute MOVE, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - J G Becher
- Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - R J Vermeulen
- Department of Neurology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
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8
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Çifter M, Cura N. Orthodontic treatment and follow-up of a patient with cerebral palsy and spastic quadriplegia. Am J Orthod Dentofacial Orthop 2016; 150:670-678. [DOI: 10.1016/j.ajodo.2015.10.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 10/01/2015] [Accepted: 10/01/2015] [Indexed: 10/20/2022]
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10
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Andersen EW, Leventer RJ, Reddihough DS, Davis MR, Ryan MM. Cerebral palsy is not a diagnosis: A case report of a novel atlastin-1 mutation. J Paediatr Child Health 2016; 52:669-71. [PMID: 27333849 DOI: 10.1111/jpc.13200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Erik W Andersen
- Children's Neurosciences Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Richard J Leventer
- Children's Neurosciences Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria
| | - Dinah S Reddihough
- Department of Developmental Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria
| | - Mark R Davis
- Department of Diagnostic Genomics, PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Monique M Ryan
- Children's Neurosciences Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria
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Huntsman R, Lemire E, Norton J, Dzus A, Blakley P, Hasal S. The differential diagnosis of spastic diplegia. Arch Dis Child 2015; 100:500-4. [PMID: 25700542 DOI: 10.1136/archdischild-2014-307443] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 10/29/2014] [Indexed: 12/11/2022]
Abstract
Spastic diplegia is the most common form of cerebral palsy worldwide. Many disorders mimic spastic diplegia, which can result in misdiagnosis for the child with resultant negative treatment and family counselling implications. In this paper, the authors provide a brief review of spastic diplegia and the various disorders in the differential diagnosis. We also provide a diagnostic algorithm to assist physicians in making the correct diagnosis.
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Affiliation(s)
- Richard Huntsman
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Edmond Lemire
- Division of Medical Genetics, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jonathon Norton
- Division of Neurosurgery, Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Anne Dzus
- Division of Pediatric Orthopedics, Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Patricia Blakley
- Division of Developmental Pediatrics, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Simona Hasal
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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12
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Smithers-Sheedy H, Badawi N, Blair E, Cans C, Himmelmann K, Krägeloh-Mann I, McIntyre S, Slee J, Uldall P, Watson L, Wilson M. What constitutes cerebral palsy in the twenty-first century? Dev Med Child Neurol 2014; 56:323-8. [PMID: 24111874 DOI: 10.1111/dmcn.12262] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2013] [Indexed: 11/28/2022]
Abstract
AIM Determining inclusion/exclusion criteria for cerebral palsy (CP) surveillance is challenging. The aims of this paper were to (1) define inclusion/exclusion criteria that have been adopted uniformly by surveillance programmes and identify where consensus is still elusive, and (2) provide an updated list of the consensus concerning CP inclusion/exclusion when a syndrome/disorder is diagnosed. METHOD Data were drawn from an international survey of CP registers, the New South Wales CP Register (1993-2003), the Western Australian CP Register (1975-2008), and the Surveillance of CP in Europe (SCPE; 1976-1998). An expert panel used a consensus building technique, which utilized the SCPE 'decision tree' and the original 'What constitutes cerebral palsy?' paper as frameworks. RESULTS CP surveillance programmes agree on key clinical criteria pertaining to the type, severity, and origin of motor disorder in CP. Further work is warranted to reach agreement for (1) minimum age of survival and maximum age of postneonatal brain injury, and (2) metabolic disorders with highly variable clinical courses/responses to treatment. One hundred and ninety-seven syndromes/disorders were reviewed and advice on their inclusion/exclusion is provided. INTERPRETATION What constitutes CP will continue to evolve as diagnostics improve. Surveillance programmes throughout the world are committed to addressing their differences regarding inclusion/exclusion criteria for the umbrella term CP.
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Affiliation(s)
- Hayley Smithers-Sheedy
- Cerebral Palsy Alliance Research Institute, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; School of Medicine, University of Notre Dame, Sydney, NSW, Australia
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13
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Olney RS, Doernberg NS, Yeargin-Allsopp M. Exclusion of progressive brain disorders of childhood for a cerebral palsy monitoring system: a public health perspective. JOURNAL OF REGISTRY MANAGEMENT 2014; 41:182-189. [PMID: 25803631 PMCID: PMC4427048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Cerebral palsy (CP) is defined by its nonprogressive features. Therefore, a standard definition and list of progressive disorders to exclude would be useful for CP monitoring and epidemiologic studies. METHODS We reviewed the literature on this topic to 1) develop selection criteria for progressive brain disorders of childhood for public health surveillance purposes, 2) identify categories of disorders likely to include individual conditions that are progressive, and 3) ascertain information about the relative frequency and natural history of candidate disorders. RESULTS Based on 19 criteria that we developed, we ascertained a total of 104 progressive brain disorders of childhood, almost all of which were Mendelian disorders. DISCUSSION Our list is meant for CP surveillance programs and does not represent a complete catalog of progressive genetic conditions, nor is the list meant to comprehensively characterize disorders that might be mistaken for cerebral palsy. The criteria for progressive disorders that we developed could be applied by public health investigators in the future, as more children with very rare conditions are followed and new candidate disorders are identified.
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Affiliation(s)
- Richard S. Olney
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC)
| | - Nancy S. Doernberg
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC)
| | - Marshalyn Yeargin-Allsopp
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC)
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14
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Aziz M, Vassallo G. Cerebral palsy: An overview and the role of a paediatric neurologist in the evaluation of children with complex needs for cochlear implant. Cochlear Implants Int 2013. [DOI: 10.1179/1467010013z.000000000102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Katz CRT. Integrated approach to outpatient dental treatment of a patient with cerebral palsy: a case report. SPECIAL CARE IN DENTISTRY 2012; 32:210-7. [PMID: 22943774 DOI: 10.1111/j.1754-4505.2012.00267.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The large number of oral manifestations associated with motor disorders in patients with cerebral palsy (CP) makes the dentist an indispensable member of the multidisciplinary team caring for this population. This case report presents an 11-year-old girl with spastic CP who had severe motor impairment, and a description of her care illustrates the importance of integrated care for patients with CP who are receiving outpatient dental treatment. It was determined that the use of adaptations based on knowledge of CP supported the outpatient dental treatment. The integrated approach used during dental treatment enabled the application of knowledge from the fields of dentistry, physical therapy, and speech therapy to provide for a better quality of life for the patient and, consequently, the caregiver through the improvement in the patient's oral and general health.
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Genetic [corrected] insights into the causes and classification of [corrected] cerebral palsies. Lancet Neurol 2012; 11:283-92. [PMID: 22261432 DOI: 10.1016/s1474-4422(11)70287-3] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cerebral palsy-the most common physical disability of childhood-is a clinical diagnosis encompassing a heterogeneous group of neurodevelopmental disorders that cause impairments of movement and posture that persist throughout life. Despite being commonly attributed to a range of environmental factors, particularly birth asphyxia, the specific cause of cerebral palsy remains unknown in most individuals. A growing body of evidence suggests that cerebral palsy is probably caused by multiple genetic factors, similar to other neurodevelopmental disorders such as autism and intellectual disability. Recent advances in next-generation sequencing technologies have made possible rapid and cost-effective sequencing of the entire human genome. Novel cerebral palsy genes will probably be identified as more researchers and clinicians use this approach to study individuals with undiagnosed neurological disorders. As our knowledge of the underlying pathophysiological mechanisms of cerebral palsy increases, so will the possibility of developing genomically guided therapeutic interventions.
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Leonard JM, Cozens AL, Reid SM, Fahey MC, Ditchfield MR, Reddihough DS. Should children with cerebral palsy and normal imaging undergo testing for inherited metabolic disorders? Dev Med Child Neurol 2011; 53:226-32. [PMID: 21291466 DOI: 10.1111/j.1469-8749.2010.03810.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIM For the 9% to 16% of children with cerebral palsy (CP) who have normal brain imaging, further testing for metabolic and/or genetic conditions has been recommended. This study aimed to identify a cohort of children with CP with normal magnetic resonance imaging (MRI), clinically review and describe the cases, and assess the value of testing for inherited metabolic disorders in these children. METHOD Children with congenital CP born from 1999 to 2005 were selected from a population register. Normal MRI reports were identified and the scans reassessed. Children whose scans were performed before 18 months were excluded, as were children with spastic CP (Gross Motor Function Classification System [GMFCS] level I). The remainder were reviewed clinically and offered investigations. RESULTS Of 730 children identified, 515 had available imaging and 54 were confirmed as normal. Cases with non-spastic CP and those with milder clinical severity were more likely to have normal imaging. Twenty-three children (17 males, six females; mean age 6 y 11 mo, SD 1 y 10 mo, range 3 y 0 mo to 10 y 0 mo) were reviewed clinically and offered investigations. Twelve children had spasticity (11 with diplegia, one quadriplegia), three had dyskinesia, five ataxia, and three hypotonia. Two children functioned in GMFCS level I, 11 in level II, seven in level III and three in level IV. Four children with spasticity had unusual features. No alternative diagnoses were made. INTERPRETATION Although important to consider in individual cases, comprehensive metabolic testing failed to clarify the aetiology of CP further in this large cohort of children with normal MRIs, even those with atypical features.
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Affiliation(s)
- Jane M Leonard
- Department of Developmental Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
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Influence of age on step activity patterns in children with cerebral palsy and typically developing children. Arch Phys Med Rehabil 2011; 91:1891-6. [PMID: 21112431 DOI: 10.1016/j.apmr.2010.08.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Revised: 07/07/2010] [Accepted: 08/05/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To document the influence of age on step activity patterns in children with cerebral palsy (CP) and typically developing (TD) children. DESIGN Cross-sectional. SETTING All step activity data were collected in free-living environments. PARTICIPANTS Children with CP (n=27; age, 4-18y; 22 boys, 5 girls; Gross Motor Function Classification System levels I and II) and 27 age- and sex-matched TD children were recruited through public advertisements and contacts with local clinicians. CP and TD participants were stratified into younger (<10y; n=14) and older (10-18y; n=13) age groups. INTERVENTION Daily step activity was monitored using a step activity monitor that was individually programmed to account for the gait characteristics of each participant. Step activity data were collected in 1-minute epochs during waking hours on 3 weekdays and 1 weekend day. Stored data were analyzed to yield average values of daily step activity, percentage of inactive time (0 steps) over the entire day, and percentage of total daily active time spent in low step activity (1-15 steps/min), medium step activity (16-40 steps/min), and high step activity (>40 steps/min). MAIN OUTCOME MEASURES Daily step activity, percentage of inactive time, and percentage of active time spent in low-, moderate-, and high-intensity step activity. RESULTS A significant (P<.05) interaction was observed between age (younger, older) and condition (CP, TD) for daily step activity, percentage of inactive time, and percentage of active time spent in low- and high-intensity step activity. The main effect of age was significant for each physical activity measure except for relative high-intensity step activity, and the main effect of condition was significant for all physical activity measures. Follow-up analyses (P<.025) revealed that older children with CP took fewer daily steps and displayed higher relative levels of inactivity and low-intensity activity and lower relative levels of high-intensity activity compared with older TD children. Older children with CP also exhibited lower daily step activity, demonstrated higher relative levels of inactivity and low-intensity activity, and displayed lower relative levels of moderate-intensity activity compared with younger children with CP. CONCLUSIONS Compared with younger children with CP and age- and sex-matched TD youth, older youth with CP generally displayed step activity patterns typified by lower levels of physical activity and a greater degree of inactivity. These findings highlight the need to provide multiple opportunities for adolescents with CP to engage in a variety of physical activities that are appropriate to their needs, abilities, and preferences and that can aid in maintaining functional mobility, health, and quality of life.
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Miamoto CB, Ramos-Jorge ML, Pereira LJ, Paiva SM, Pordeus IA, Marques LS. Severity of malocclusion in patients with cerebral palsy: Determinant factors. Am J Orthod Dentofacial Orthop 2010; 138:394.e1-394.e5. [DOI: 10.1016/j.ajodo.2010.03.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 03/01/2010] [Accepted: 03/01/2010] [Indexed: 11/30/2022]
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Zarrinkalam R, Russo RN, Gibson CS, van Essen P, Peek AK, Haan EA. CP or not CP? A review of diagnoses in a cerebral palsy register. Pediatr Neurol 2010; 42:177-80. [PMID: 20159426 DOI: 10.1016/j.pediatrneurol.2009.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 07/02/2009] [Accepted: 09/02/2009] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to document the inaccuracy rate of diagnosis of cerebral palsy recorded on the South Australian Cerebral Palsy Register. A total of 402 children born in South Australia from 1993 to 2002 and notified to the Register as having cerebral palsy were identified through the Register database, and 21 children (5.2%) were later identified to have a noncerebral palsy diagnosis. Of these, 5 had either a metabolic or a neurodegenerative disorder and 2 had a syndromic disorder (1 Joubert syndrome and 1 Sotos syndrome); the remaining 14 children had one of the following final diagnoses: developmental delay, gross motor delay, perinatal myositis, spinal subdural and subarachnoid arteriovenous malformation, and Erb's palsy. In 16 of 21 children (76%), the diagnosis was changed at 5 years of age or older. Studies based on population registers may need to take into account the possibility of misclassification, estimated to be at least 5.2% in this study. A complete clinical assessment at the time of diagnosis followed by regular reassessment would enable the clinician to exclude children with alternative diagnoses, which has important implications for clinical management and research based on cerebral palsy registers.
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Affiliation(s)
- Rosa Zarrinkalam
- Department of Paediatric Rehabilitation Medicine, The Women's and Children's Hospital, North Adelaide, SA, Australia
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Guerreiro PO, Garcias GDL. Diagnóstico das condições de saúde bucal em portadores de paralisia cerebral do município de Pelotas, Rio Grande do Sul, Brasil. CIENCIA & SAUDE COLETIVA 2009; 14:1939-46. [DOI: 10.1590/s1413-81232009000500036] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Accepted: 12/20/2007] [Indexed: 11/22/2022] Open
Abstract
Paralisia cerebral (PC) é uma lesão encefálica estática, definida como uma desordem não progressiva dos movimentos e postura. Está comumente associada com epilepsia e anormalidades da fala, audição, visão e retardo mental. Embora os portadores de paralisia cerebral necessitem de cuidados especiais na prevenção de problemas bucais, no contexto da assistência odontológica, as informações da literatura são contraditórias quanto à incidência de doenças bucais em pacientes com paralisia cerebral. A fim de determinar as condições de saúde bucal e fatores associados, realizou-se um levantamento epidemiológico em 41 crianças portadoras de paralisia cerebral. As variáveis avaliadas foram: aspectos socioeconômicos, fatores de risco para o desenvolvimento de doenças bucais, acesso a serviços odontológicos, índice de cárie, doença periodontal, presença de má oclusão e fluorose dentária. As crianças examinadas apresentaram índices elevados de alteração gengival e experiência de cárie, principalmente na dentição decídua, e má oclusão severa, fatores que indicam a necessidade de intervenção precoce, seja com programas educativos e preventivos como de assistência curativa. O estudo mostrou que, além da necessidade quantitativa de atendimento, também se faz necessário melhorar a qualidade das consultas desses pacientes.
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Abstract
Cerebral palsy (CP) is one of the most common conditions we follow in our pediatric neurology offices. This review will hopefully convince you that the care of children with CP extends far beyond the diagnosis. The review addresses issues surrounding diagnosis, coimpairments, prognosis, and family-centeredness of care. It will also deal with routine office follow-up to prevent or identify complications, management of spasticity and other morbidities, alternative and complementary therapies, and finally transition.
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Affiliation(s)
- Ellen Wood
- IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
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Griffin HC, Fitch CL, Griffin LW. The causal pathway model and cerebral palsy. Neonatal Netw 2004; 23:43-7. [PMID: 15612420 DOI: 10.1891/0730-0832.23.6.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article reviews possible prenatal, perinatal, and postnatal causes of cerebral palsy. The interactive effects of various causes are evaluated. Groups of intervention strategies are then presented based on the causal pathway model.
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Affiliation(s)
- Harold C Griffin
- Department of Special Education, College of Education, East Carolina University, Greenville, NC 27858, USA.
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Abstract
Two children aged 10 and 13 years with initially static motor problems, diagnosed as cerebral palsy, were found to have respiratory chain defects after developing a progressive course and multisystem involvement. Mitochondrial cytopathies should be considered in the differential diagnosis of cerebral palsy.
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Affiliation(s)
- S R Mordekar
- Department of Paediatric Neurology, Sheffield Children's Hospital, Western Bank, Sheffield, United Kingdom.
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Abstract
Cerebral palsy (CP) registers appear to be appropriate tools for answering questions regarding the prevalence and characteristics of this common childhood disability. Registers are population databases issuing from multiple sources, relying on a clear definition and inclusion and exclusion criteria of CP, and requiring a mix of skills with the collaboration of obstetricians, pediatricians, and epidemiologists. In Europe alone there are 18 different CP registers or population data collections on CP, and collaborative research efforts exist through a European network. Data collection on CP has also been done in Australia (register), the United States (surveys), and Canada (register). Beside monitoring trends, other public health contributions of CP registers might be to reduce the frequency of CP and to improve the quality of life of children with CP. CP registers are useful to clinicians by enabling them to identify subgroups of children requiring specific etiologic investigations, and also to provide more accurate information to the parents of children with CP.
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Affiliation(s)
- Christine Cans
- Registre des Handicaps de l'Enfant et Observatoire Perinatal, University Joseph Fourier, Grenoble, France
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Abstract
Though epilepsy occurs in 15-90% of children with cerebral palsy (CP) its clinical course is not well defined. We therefore conducted studies of 198 children with CP seen in Pediatric Neurology Department of the Medical Academy in Białystok between 1994 and, 2001. The aim was to evaluate the risk factors, incidence and prognosis of epilepsy in CP. The overall epilepsy incidence was 41.4%. Epilepsy most commonly affected children with spastic tetraplegia 65.6%. Low birth weight, neonatal seizures, seizures during the first year of life, family history of epilepsy, severity of CP and computer tomography findings were found to be related to significantly increased risk of epilepsy in children with CP in the logistic regression analysis. Intractable epilepsy occurred in 51.2%, while in spastic tetraplegia it was even higher (60%). Controlled epilepsy was observed in 83.3% of spastic diplegia and in 72.7% of spastic hemiplegia. Polytherapy was commonly used in children with spastic tetraplegia 59.5%. Partial seizures secondarily generalized, infantile spasms and Lennox-Gastaut syndrome were the most frequently observed seizures in epileptic children with CP. Epilepsy is common in children with CP and has poor prognosis.
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Affiliation(s)
- Wojciech Kułak
- Department of Pediatric Neurology, Medical Academy in Białystok, 15-274 Białystok, ul. Waszyngtona 17, Poland.
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