Magnetic resonance imaging findings and the clinical characteristics of children with cerebral palsy at a public sector hospital in Gauteng Province, South Africa

Abstract

Background. Cerebral palsy (CP) is a common cause of physical impairment in children. Brain magnetic resonance imaging (MRI) can define different neuropathological patterns of brain injury in CP. There are limited data available on MRI findings of children with CP in Africa. 
 Objective. To describe the clinical characteristics, risk factors and MRI findings of children with CP attending a developmental clinic at a tertiary hospital in South Africa; and to assess possible associations between the clinical characteristics and pathogenic neuro-imaging patterns. 
 Methods. This was a retrospective cross-sectional study. The cohort of 112 children was identified from the clinic’s REDcap database. Clinical information was obtained from existing medical records of the patients. Findings from brain MRI reports were classified according to the MRI classification system (MRICS) for CP. The MRI reports were rated independently by two study investigators. A descriptive analysis was conducted. 
 Results. A total of 112 patient files and MRI brain reports were reviewed. Spastic CP was the most common type of CP (n=75%). The most common perinatal risk factors included prematurity (31%) and low birthweight (28%). Nineteen (17%) children acquired CP after the neonatal period. CP sub-type showed a significant association with functional motor impairment classified as per the gross motor function classification system (GMFCS), p<0.001. Predominant grey matter injury (PGMI) was the most common pathogenic MRI pattern identified (30%). The radiological findings (per MRICS) had a significant association with both the CP sub-type (p<0.005) and functional impairment according to the GMFCS (p<0.001). 
 Conclusion. Standardised classification of neuro-imaging findings can assist in defining the pathogenesis and clinical manifestations of CP.

Clinical characteristics and rehabilitation potential in children with cerebral palsy based on MRI classification system

“…In 2016, the Surveillance of Cerebral Palsy in Europe (SCPE) group introduced the MRI classification system (MRICS), which has been validated as both applicable and reliable for communication across various CP registers ( 3 ). Subsequently, multiple studies have explored the relationship between MRICS patterns and CP type, functional impairment, and comorbidities, yielding inconsistent conclusions ( 4 – 8 ). For example, most studies have identified white matter injury as the most common type, whereas in Africa it was grey matter injury because the main etiology of CP there were birth asphyxia and bilirubin encephalopathy ( 8 ).…”

“…Subsequently, multiple studies have explored the relationship between MRICS patterns and CP type, functional impairment, and comorbidities, yielding inconsistent conclusions ( 4 – 8 ). For example, most studies have identified white matter injury as the most common type, whereas in Africa it was grey matter injury because the main etiology of CP there were birth asphyxia and bilirubin encephalopathy ( 8 ). Unilateral spastic paralysis was associated with grey matter injury, but it was more common in white matter injury in Horber's study ( 4 ).…”