Epilepsy in Cerebral Palsy: A Brief Narrative Review

Abstract

Cerebral palsy is defined as “A group of permanent 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 motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior, by epilepsy, and by secondary musculoskeletal problems [1].” Between 30-40% of people with cerebral palsy also have epilepsy [2-4]. Some of the risk factors for developing epilepsy include low birth weight, low APGAR scores, seizures in the neonatal period and first year of life, positive imaging findings, severity of cerebral palsy, intellectual disability and spasticity. Children with epilepsy and cerebral palsy often experience their first seizure before 2 years of age, and may have a higher risk for refractory epilepsy and status epilepticus. Anti-seizure medications are the mainstay of treatment, and are typically chosen based upon the epilepsy syndrome, seizure type, side effect profile and EEG findings. If two or more anti-seizure medications fail to control seizures, early evaluation for surgical options, which could potentially be curative, should be pursued. This review article examines the pathophysiology of cerebral palsy and epilepsy, summarizes recent literature about risk factors for developing epilepsy, clinical and EEG features, treatment outcomes in children with epilepsy and CP, and discusses management strategies.

Responsive Neurostimulation Effects Significant Seizure Reduction Without Resection in Medically Refractory Epilepsy Involving Occipital Networks. A Retrospective Review of a Case Series

“…[6][7][8][9][10]11] Occipital lobe seizures may occur as in these noted cases as intractable epilepsy where patients take multiple anti-seizure medications yet continue to have episodic seizures and in particular the risk of hospitalization and need for multiple anti-seizure medications are features that the literature highlight in cerebral palsy. [15][16][17] There may be a noted subset of patients whose clinical course with non convulsive occipital onset seizures in the ICU population that may be associated with various genetic factors such as POLG and or neuroimaging changes, and photic stimulation induced seizures that may be otherwise associated with good and benign prognosis as long as such stimuli are avoided have also been described. [18][19][20] Clinical features are due to the specific cortical localization of the seizures and may involve blinking, visual symptoms including visual field deficits, illusions such as Palinopsia or image repetition and involve Eye pain, Nystagmus, involuntary eye movement, and other features such as Nausea, and headaches that are particularly associated with the pre or postictal phases and there is a postulated potential interrelationship of migraine with the spreading cortical depression of Liao along with genetic factors impacting vasomotor tone and associations with cellular effects and occipital lobe epilepsy.…”