Function and neuroimaging in cerebral palsy: a population-based study

Abstract

AIM The aim of this population-based study was to describe function in cerebral palsy (CP) in relation to neuroimaging.METHOD Motor function, accompanying impairments, and neuroimaging (86 by magnetic resonance imaging, 74 by computed tomography) were studied in 186 children born in western Sweden between 1999 and 2002 (96 males, 90 females; age range at data collection 4-8y).RESULTS Forty per cent of the children had unilateral spastic CP, 39% bilateral, 16% dyskinetic CP, and 5% ataxia. Fifty-one per cent were in level I of the Gross Motor Function Classification System (GMFCS), 14% in level II, 3% in level III, 11% in level IV, and 22% level V. Forty per cent of the children were in level I of the Manual Ability Classification System 19% were in II, 9% at III, 8% in IV, and 24% in level V. Seventy-six per cent of the children with white-matter lesions were in GMFCS levels I and II, whereas 67% with basal ganglia lesions were in levels IV and V. Learning disability* (45%), epilepsy (44%), and visual impairment (17%) were most common in children with brain maldevelopment, and cortical ⁄ subcortical or basal ganglia lesions. Speech was impaired in 49% of the children, absent in 30%, and 6% had a neuropsychiatric diagnosis. Compared with children born between 1991 and 1998, the numbers of those in GMFCS level I increased (p=0.007), as did those with epilepsy (p=0.015).INTERPRETATION Neuroimaging improves the understanding of the neuroanatomical basis for function in CP. Type and severity of motor impairment and accompanying impairments are related to the timing of lesions.Children with cerebral palsy (CP) often have functional impairments and activity restrictions added to the motor impairment and, in the most recent definition by Bax et al., 1 problems relating to cognition, communication, behaviour, and sensation are recognized. Several studies have described how the accompanying impairments can be more disabling than the motor impairment. [2][3][4] The occurrence of accompanying impairments such as epilepsy, learning disability, or impaired vision has been shown to correlate with the severity of the motor impairment. 2-4 Communication may also be impaired 5 and more subtle sensory and cognitive problems become apparent over time. There is also emerging evidence of neuropsychiatric and behavioural disorders. 1,6,7 Therefore, screening for these conditions should be part of the assessment of a child with CP. 8 In the past decade, improved neuroimaging has provided an opportunity to link the various CP types to specific aetiological periods and to the localization of the brain maldevelopment or lesions. Previous studies of the relation between motor function and neuroimaging have shown an association between focal periventricular white-matter lesions or focal cortical ⁄ subcortical lesions and less severe motor impairments, while children with a more diffuse encephalopathy, including basal ganglia lesions, were more likely to have severe motor impairments. 9,10 Today, children with CP have other risk factors and...

Comparação das habilidades auditivas e visuais em paralíticos cerebrais diplégicos

“…The consequence of this association can interfere with the oculomotor coordination, complex visual cognitive functions, showing a close relation between the degree of motor impairment and the extent of PVL [9][10][11] . Studies have shown that presence of epilepsy, learning difficulties and/or vision impairment correlate with the severity of motor impairment 6,12,13 .…”

“…Studies involving memory in D-CP report these individuals tend to have losses 7,11,15 and the incidence of visuoperceptive, visuospatial and visuoconstructive changes is high [5][6][7][8]11,12,15 , which may interfere with the storage of information.…”

“…Studies focusing on the visual skills demonstrated that visuospatial, visuoperceptive and visuoconstructive deficits may be present, interfering with the analytical capacity of visual stimuli and their integration 6,8,9,17,19,20 .…”

“…Significance level was p≤ 0.05. Table 1 shows the distribution, according to descriptive measures, of Mean, Median, Minimum leukomalacia (PVL) [4][5][6] . In PVL, the pyramidal tract is affected, featuring an ischemic damage in the periventricular region, limited to the dorsal and lateral tracts, along the lateral ventricles.…”

Current Issues in Diagnosis and Treatment of Cognitive Disorders in Children With Cerebral Palsy

“…Известно, что в 60% случаев детская неврологическая инвалидность связана с патологией перинатального периода, при этом 24% составляют пациенты с дет-ским церебральным параличом (ДЦП) [3]. По данным зарубежных авторов, заболеваемость ДЦП отмечает-ся в пределах 2,9-5 (в среднем 2,5) на 1000 детей [4,5]. В России распространенность ДЦП -2,2-3,3, в Москве -1,9 на 1000 детей.…”