Prognostic Predictors for Ambulation in Thai Children With Cerebral Palsy Aged 2 to 18 Years

Prevalence and related factors of epilepsy in children and adolescents with cerebral palsy: a systematic review and meta-analysis

Objective

To study the worldwide prevalence and associated factors of epilepsy in children and adolescents with Cerebral Palsy (CP) and to analyze the differences between various subgroups.

Method

We identified all potential studies on the prevalence of epilepsy in children and adolescents with CP from PubMed, Web of Science, and Embase. The search time was from the establishment of the database to November 2022. Randomized effects meta-analysis models were used to calculate the prevalence of epilepsy in CP. Subgroup analysis and meta-regression were utilized to further explore heterogeneity between articles and prevalence disparities between subgroups. The funnel plot and Egger's test were used to investigate potential publication bias.

Results

Seventy-two articles, comprising 53,969 children and adolescents with CP, were included in this study. The results indicated a total epilepsy prevalence of 38.0% (95% CI: 34.8%-41.2%) in CP. The prevalence of epilepsy was 46.4% (95% CI: 41.4%-51.5%) in clinical sample-based studies and 31.6% (95% CI: 28.7%-34.5%) in population-based studies. Meta-regression demonstrated that the sample source, neonatal seizure, family history of epilepsy, EEG or cranial imaging abnormalities, intellectual/cognitive impairment, and topographical types of CP were heterogeneous contributors to the epilepsy prevalence in CP.

Conclusion

Approximately one-third of children and adolescents with CP have epilepsy, and the sample source can significantly impact the total prevalence of epilepsy. Neonatal seizures, family history of epilepsy, EEG abnormalities, cranial imaging abnormalities, severe intellectual disability, and quadriplegia may be contributing factors to epilepsy comorbid in CP. Further study is required to verify the strength of these associations with epilepsy. This study aids in identifying the clinical characteristics of young people with CP at risk of developing epilepsy, which may assist clinicians in the early prevention and diagnosis of epilepsy within this population.Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=367766, identifier CRD42022367766.

Eylem Gözlem Terapisi ile Unilateral Serebral Palsili Çocuklarda Üst Ekstremite Fonksiyonelliğinin Geliştirilmesi

Eylem Gözlem Terapisi (EGT) hareketlerin izlenmesi sonrası aynı hareketlerin taklit edilmesi ile merkezi sinir sistemi restorasyonunu destekleyen nörorehabilitasyon temelli bir tedavi yaklaşımıdır. Serebral palsi, parkinson, inme, ortopedik yaralanmalar, alzheimer ve konuşma bozuklukları gibi pek çok hastalıkta, fonksiyonu gerçekleştiren nöral yapıları aktive etmek için nörofizyolojik mekanizmadan yararlanan yeni bir rehabilitasyon yaklaşımı olarak bilinir. Sağlıklı bireylerde ve nörolojik veya ortopedik etkilenimi olan bireylerde yapılan araştırmalar; EGT uygulamasının gözlemcinin motor sisteminde kolaylaştırmayı indüklediği ve eylem-algı eşleştirme mekanizmasını desteklediği bilinir. Bu derleme, Serebral Palsi (SP) tanılı çocuklarda üst ekstremiteye yönelik uygulanan EGT programlarının kullanımı ve etkinliği ile ilgili mevcut bilgileri gözden geçirmek amacıyla planlanmıştır. EGT kullanımının farklı koşullara kolayca adapte edilebilmesi, nöral plasitisiteyi destekleyerek motor öğrenmeyi fasilite etmesi ve ekonomik olması nedeniyle, SP’li çocukların üst ekstremite rehabilitasyonunda kullanımının uygun olduğu; ancak protokol, süre ve uygulama şekli açısından optimal uygulama prensiplerinin belirlenebilmesi için daha detaylı çalışmalara ihtiyaç olduğu düşünülmektedir.

Risk Factors for Daytime or Combined Incontinence in Children with Cerebral Palsy

PURPOSE

We identify risk factors for daytime or combined urinary incontinence in children with cerebral palsy.

MATERIALS AND METHODS

A cross-sectional case-control study was conducted including children with cerebral palsy with or without daytime or combined urinary incontinence from the CP-Reference Center at Ghent University Hospital and 2 associated special education schools. Factors were subdivided in 3 clusters of demographic and general medical data, cerebral palsy classification, and bladder and bowel dysfunction. Data were obtained using uroflowmetry with electromyography testing, a nonvalidated questionnaire and bladder diaries. Univariate and multivariate analyses were performed for variables and clusters, respectively. A final associative logistic model including all clusters was developed.

RESULTS

The study included 34 incontinent children and 45 continent children. Daytime or combined urinary incontinence was associated with intellectual disability (OR 7.69), swallowing problems (OR 15.11), use of external aids (OR 27.50) and use of laxatives (OR 13.31). Daytime or combined urinary incontinence was positively associated with dyskinesia (OR 5.67) or combined spasticity and dystonia (OR 4.78), bilateral involvement (OR 4.25), Gross Motor Function Classification System level IV (OR 10.63) and V (OR 34.00), and severe impairment in manual (OR 24.27) or communication skills (OR 14.38). Lower maximum voided volume (OR 0.97) and oral fluid intake (OR 0.96) influenced daytime or combined urinary incontinence negatively. Pathological uroflow curves were not significantly associated with incontinence. The final model defined functional impairment, intellectual disability and oral fluid intake as predictive factors for daytime or combined urinary incontinence.

CONCLUSIONS

Risk analysis revealed functional impairment, intellectual disability and fluid intake as important factors influencing continence in a child with cerebral palsy.

The Gross Motor Function Classification System Family Report Questionnaire: reliability between special-education teachers and caregivers

AIM

The aim of this study was to investigate the reliability of the Thai Gross Motor Function Classification System Family Report Questionnaire (GMFCS-FR) and the possibility of special-education teachers and caregivers in the community using this system in children with cerebral palsy (CP).

METHOD

The reliability was examined by two teachers and two caregivers who classified 21 children with CP aged 2 to 12 years. A GMFCS-FR workshop was organized for raters. The teachers and caregivers classified the mobility of 362 children. The rater reliability was analysed using the weighted kappa coefficient. The possibility of using the GMFCS-FR is reported. The reliability of using the GMFCS-FR in the community was analysed by the intraclass correlation coefficient.

RESULTS

The intrarater reliability ranged from 0.91 to 1.00. The interrater reliability between teachers was 0.85 (95% confidence interval [CI] 0.69-0.97) and between caregivers was 0.84 (95% CI 0.70-0.97). Ninety-seven percent of raters used the Thai GMFCS-FR correctly. The overall intraclass correlation coefficient between raters was 0.90 (95% CI 0.88-0.92).

INTERPRETATION

The Thai GMFCS-FR is a reliable system for classifying the motor function of young children with CP by teachers and caregivers in the community.

Can Clinical Assessment of Locomotive Body Function Explain Gross Motor Environmental Performance in Cerebral Palsy?

Gross Motor Function Classification System has discriminative purposes but does not assess short-term therapy goals. Locomotion Stages (LS) classify postural body functions and independent activity components. Assessing the relation between Gross Motor Function Classification System level and Locomotion Stages will make us understand if clinical assessment can explain and predict motor environmental performance in cerebral palsy. A total of 462 children were assessed with both scales. High reliability and strong negative correlation (-0.908) for Gross Motor Function Classification System and Locomotion Stages at any age was found. Sensitivity was 83%, and specificity and positive predictive value were 100% within the same age range. Regression analysis showed detailed probabilities for the realization of the Gross Motor Function Classification System depending on the Locomotion Stages and the age group. Postural body function measure with Locomotion Stages is reliable, sensitive, and specific for gross motor function and able to predict environmental performance.