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Huroy M, Behlim T, Andersen J, Buckley D, Fehlings D, Kirton A, Pigeon N, Mishaal RA, Wood E, Shevell M, Oskoui M. Stability of the Gross Motor Function Classification System over time in children with cerebral palsy. Dev Med Child Neurol 2022; 64:1487-1493. [PMID: 35941090 DOI: 10.1111/dmcn.15375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 01/31/2023]
Abstract
AIM To assess the stability of the Gross Motor Functional Classification System (GMFCS) in children with cerebral palsy (CP) from time of preliminary diagnosis (~2 years of age) to time of diagnosis (~5 years of age), and to examine factors associated with reclassification. METHOD We conducted a longitudinal study using a sample from the Canadian CP Registry. Stability was analysed by using the percentage of agreement between timepoints and a weighted prevalence and bias adjusted kappa statistic. Univariate and multivariate logistic regressions were performed to identify variables associated with reclassification. RESULTS The study included 1670 children (857 males, 713 females) with a mean age of 11 years 4 months (SD 4 years, range 3 years 5 months-20 years 1 month) at time of data extraction (3rd September 2019), of which 1435 (85.9%) maintained a stable GMFCS, with a weighted kappa of 0.91 (95% confidence interval 0.89-0.92). Univariate logistic regression showed that initial GMFCS level, CP subtype, and the presence of cognitive impairment were associated with the likelihood of change in the GMFCS level (p < 0.1). In the multivariate analysis, however, the likelihood was associated with initial GMFCS level only (odds ratio 7.10-8.88, p < 0.00). INTERPRETATION The GMFCS has good stability in early childhood. For the majority of children, it is predictive of their long-term motor function. WHAT THIS PAPER ADDS The Gross Motor Function Classification System (GMFCS) rating in early childhood is stable over time. There is no directionality in the reclassification of the GMFCS. The initial GMFCS level was related to the likelihood of change in follow-up GMFCS level.
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Affiliation(s)
- Menal Huroy
- Faculty of Medicine, McGill University, QC, Canada
| | - Tarannum Behlim
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, QC, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Darcy Fehlings
- Department of Paediatrics, University of Toronto, Bloorview Research Institute, Toronto, ON, Canada
| | - Adam Kirton
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Nicole Pigeon
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Ram A Mishaal
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | | | - Michael Shevell
- Department of Pediatrics and Neurology and Neurosurgery, McGill University, QC, Canada
| | - Maryam Oskoui
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, QC, Canada.,Department of Pediatrics and Neurology and Neurosurgery, McGill University, QC, Canada
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Boulos MI, Murray BJ, Muir RT, Gao F, Szilagyi GM, Huroy M, Kiss A, Walters AS, Black SE, Lim AS, Swartz RH. Periodic Limb Movements and White Matter Hyperintensities in First-Ever Minor Stroke or High-Risk Transient Ischemic Attack. Sleep 2017; 40:2753280. [PMID: 28329254 DOI: 10.1093/sleep/zsw080] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Study Objectives Emerging evidence suggests that periodic limb movements (PLMs) may contribute to the development of cerebrovascular disease. White matter hyperintensities (WMHs), a widely accepted biomarker for cerebral small vessel disease, are associated with incident stroke and death. We evaluated the association between increased PLM indices and WMH burden in patients presenting with stroke or transient ischemic attack (TIA), while controlling for vascular risk factors and stroke severity. Methods Thirty patients presenting within 2 weeks of a first-ever minor stroke or high-risk TIA were prospectively recruited. PLM severity was measured with polysomnography. WMH burden was quantified using the Age Related White Matter Changes (ARWMC) scale based on neuroimaging. Partial Spearman's rank-order correlations and multiple linear regression models tested the association between WMH burden and PLM severity. Results Greater WMH burden was correlated with elevated PLM index and stroke volume. Partial Spearman's rank-order correlations demonstrated that the relationship between WMH burden and PLM index persisted despite controlling for vascular risk factors. Multivariate linear regression models revealed that PLM index was a significant predictor of an elevated ARWMC score while controlling for age, stroke volume, stroke severity, hypertension, and apnea-hypopnea index. Conclusion The quantity of PLMs was associated with WMH burden in patients with first-ever minor stroke or TIA. PLMs may be a risk factor for or marker of WMH burden, even after considering vascular risk factors and stroke severity. These results invite further investigation of PLMs as a potentially useful target to reduce WMH and stroke burden.
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Affiliation(s)
- Mark I Boulos
- L.C. Campbell Cognitive Neurology Research Unit, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada.,Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Brian J Murray
- L.C. Campbell Cognitive Neurology Research Unit, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada.,Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ryan T Muir
- L.C. Campbell Cognitive Neurology Research Unit, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Fuqiang Gao
- L.C. Campbell Cognitive Neurology Research Unit, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Gregory M Szilagyi
- L.C. Campbell Cognitive Neurology Research Unit, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Menal Huroy
- L.C. Campbell Cognitive Neurology Research Unit, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Alexander Kiss
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Arthur S Walters
- Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN
| | - Sandra E Black
- L.C. Campbell Cognitive Neurology Research Unit, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada.,Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Andrew S Lim
- L.C. Campbell Cognitive Neurology Research Unit, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada.,Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Richard H Swartz
- L.C. Campbell Cognitive Neurology Research Unit, Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada.,Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
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Berezuk C, Ramirez J, Gao F, Scott CJM, Huroy M, Swartz RH, Murray BJ, Black SE, Boulos MI. Virchow-Robin Spaces: Correlations with Polysomnography-Derived Sleep Parameters. Sleep 2015; 38:853-8. [PMID: 26163465 DOI: 10.5665/sleep.4726] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 10/24/2014] [Indexed: 12/14/2022] Open
Abstract
STUDY OBJECTIVES To test the hypothesis that enlarged Virchow-Robin space volumes (VRS) are associated with objective measures of poor quality sleep. DESIGN Retrospective cross-sectional study. SETTING Sunnybrook Health Sciences Centre. PATIENTS Twenty-six patients being evaluated for cerebrovascular disease were assessed using polysomnography and high-resolution structural magnetic resonance imaging. MEASUREMENTS AND RESULTS Regionalized VRS were quantified from three-dimensional high-resolution magnetic resonance imaging and correlated with measures of polysomnography-derived sleep parameters while controlling for age, stroke volume, body mass index, systolic blood pressure, and ventricular cerebrospinal fluid volume. Sleep efficiency was negatively correlated with total VRS (rho = -0.47, P = 0.03) and basal ganglia VRS (rho = -0.54, P = 0.01), whereas wake after sleep onset was positively correlated with basal ganglia VRS (rho = 0.52, P = 0.02). Furthermore, VRS in the basal ganglia were negatively correlated with duration of N3 (rho = -0.53, P = 0.01). CONCLUSIONS These preliminary results suggest that sleep may play a role in perivascular clearance in ischemic brain disease, and invite future research into the potential relevance of Virchow-Robin spaces as an imaging biomarker for nocturnal metabolite clearance.
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Affiliation(s)
- Courtney Berezuk
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute (SRI), University of Toronto, Canada.,Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada.,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Canada
| | - Joel Ramirez
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute (SRI), University of Toronto, Canada.,Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada.,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Canada
| | - Fuqiang Gao
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute (SRI), University of Toronto, Canada.,Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada.,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Canada
| | - Christopher J M Scott
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute (SRI), University of Toronto, Canada.,Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada.,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Canada
| | - Menal Huroy
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute (SRI), University of Toronto, Canada.,Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada.,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Canada
| | - Richard H Swartz
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute (SRI), University of Toronto, Canada.,Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada.,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Canada.,Institute of Medical Science, Faculty of Medicine, School of Graduate Studies University of Toronto, Toronto, Canada.,Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Canada
| | - Brian J Murray
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute (SRI), University of Toronto, Canada.,Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada.,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Canada.,Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Canada
| | - Sandra E Black
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute (SRI), University of Toronto, Canada.,Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada.,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Canada.,Institute of Medical Science, Faculty of Medicine, School of Graduate Studies University of Toronto, Toronto, Canada.,Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Canada
| | - Mark I Boulos
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute (SRI), University of Toronto, Canada.,Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada.,Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Canada.,Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Canada
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