Bilateral Spastic Cerebral Palsy—a Comparative Study Between Southwest Germany and Western Sweden. I: Clinical Patterns and Disabilities

Abstract

SUMMARY The results of a collaborative study of bilateral spastic cerebral palsy (BSCP) between south‐west Germany and western Sweden are reported, comprising 249 children in south‐west Germany and 264 children in western Sweden. A severe gross motor disability was present in 65 per cent of the German and 62 per cent of the Swedish children; learning difficulties or mental retardation in 73 and 76 per cent; active epilepsy in 28 and 26 per cent; and severe visual disability in 20 and 19 per cent, respectively. Severe disabilities were especially pronounced in children with normal birthweights, in whom the most severe subtypes of BSCP were also found. Leg‐dominated BSCP was the predominant subtype among low‐birthweight children, but also occurred in more than half of the normal‐birthweight children. The authors conclude that the two series were comparable, and that reliable results between countries can be obtained if clear‐cut classifications and definitions are used. RÉSUMÉ IMC spastique bilatérale: étude de population comparant l'Allemagne du Sud‐Ouest et la Suède occidentale. I: Aspects cliniques et incapacités Les résultats d'une étude en collaboration portant sur l'IMC, spastique bilatérale (BSCP) en Allemagne du Sud‐Ouest et Suède occidentale sont rapportés; l'étude portait sur 249 enfants pour l'Allemagne du Sud‐Ouest et 264 enfants pur la Suède occidentale. Une incapacité motrice sévère était présente chez 65 pour cent des enfants allemands et 62 pour cent des enfants suédois; les difficultés d'apprentissage ou le retard mental dans respectivement 73 et 76 pour cent des cas; l'épilepsie active dans 28 el 26 pour cent; et l'incapacité visuelle sévère dans respectivement 20 et 19 pour cent des cas. Les déficits sévères étaient spécialement prononcés chez les enfants à poids de naissance normal, chez qui les soustypes de BSCP les plus graves étaient également rencontrés. Une BSCP prédominant aux members inférieurs était le soustype prédominant chez les enfants de faible poids de naissance, mais apparaissait également dans plus de la moitié des cas d'enfants à poids de naissance normal. Les auteurs concluent que les deux séries étaient comparables et que des comparaisons fidèles entre pays peuvant ětre obtenues si des classifications et des définitions précises sont utilisées. ZUSAMMENFASSUNG Bilaterale spastische Cerebralparese: eine Vergleiclisstudie zwischen Sudwestdeutschland und Westschweden. I: Klinische Muster und Behinderungen Es werden die Ergebnisse einer kollaborativen Studie über bilaterale spastische Cerebralparese (BSCP) zwischen Sudwestdeutschland und Westschweden dargestellt; 249 deutsche und 264 schwedische Kinder wurden untersucht. Schwere grobmotorische Behinderungen fand man bei 65 Prozent der deutschen und 62 Prozent der schwedischen Kinder; Lernschwierigkeiten oder geistige Retardierung bei 73 bzw. 76 Prozent; aktive Epilepsie bei 28 bzw. 26 Prozent; und schwere Sehstörungen bei 20 bzw 19 Prozent. Schwere Behinderungen waren besonders ausgeprägt bei Kindern mit normalem Geburtsgewicht, b...

Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers

“…The traditional clinical terminology used to describe the subtypes of CP has been confusing (Ingram 1984), and the standard form for describing children with a central motor deficit is an attempt to avoid these terms (Evans et al 1989). A similar but more precise approach was used in the collaborative work done by groups in Göteborg and Tübingen (Krageloh-Mann et al 1993).…”

Factors Associated With Epilepsy in Children With Periventricular Leukomalacia

“…22 Because the 2 pathologies have similar etiologies and are associated with spastic diparesis and leg-dominant quadriparesis, they continue to be combined under the umbrella term of periventricular leukomalacia. 23 Two of the previously reported series of patients with cerebral palsy and periventricular leukomalacia [1][2][3][4][5][6][7][8][9] have included cohorts with periventricular leukomalacia detected through routine imaging studies of the whole cerebral palsy population. Carlsson et al 6 identified 34 subjects with periventricular leukomalacia from a population base of 600 000; it is not clear from their report whether any of their cohort had any other radiologic findings.…”

“…7,9 Epilepsy occurs in most individuals with large cortical lesions, whether unilateral or bilateral, pathologies usually associated with arm-dominant quadriparesis or hemiparesis. 1,11,12 Although less common, epilepsy is nevertheless a significant complication for children with periventricular leukomalacia, with reported incidence figures of 16.0% to 47%. 6,9,13 The main patterns of cerebral palsy in children with periventricular leukomalacia are spastic diparesis and This article reports an analysis of risk factors for epilepsy in children with radiologically confirmed periventricular leukomalacia.…”

“…U nprovoked epileptic seizures frequently develop in children with cerebral palsy. [1][2][3][4][5][6][7][8] In general, the incidence of epilepsy increases with the severity of clinical involvement: rates of epilepsy are consistently higher in patients with spastic quadriparetic and hemiparetic patterns than in those with diparesis. The incidence of epilepsy in cerebral palsy also varies with the type of radiologic pathology 6,7,9,10 and tends to be higher when the pathology is more severe.…”

Gross and fine motor function and accompanying impairments in cerebral palsy

“…14 The Surveillance of Cerebral Palsy in Europe (SCPE) has therefore decided to use a simplified classification for spastic children of uni-or bilateral CP. 15,16 The SCPE has also developed a reference manual with a hierarchal diagnostic tree for CP and its subtypes, 16 which offers relatively good reliability (kappa 0.63; Surman G, personal communication 2003). Moreover, the SCPE constructed the concept of 'severe CP' by combining severe motor disability, i.e.…”