Risk of stroke among patients with cerebral palsy: a population‐based cohort study

Abstract

LHIDLongitudinal Health Insurance Data AIM The aim of the study was to investigate the risk of stroke in patients with cerebral palsy (CP), based on nationwide data in Taiwan. RESULTS Patients with CP were more likely to suffer stroke than the comparison population, after adjusting for potential confounding factors (adjusted hazard ratio: 2.17; 95% confidence interval [CI]: 1.74-2.69). The hazard ratio of stroke was 4.78 (95% CI: 3.18-7.17) and 1.57 (95% CI: 1.20-2.05) for patients with CP aged 50 years and under, and over 50 years respectively. METHODINTERPRETATION Cerebral palsy is a risk factor or marker for stroke that is independent of traditional stroke risk factors. Further research in this area is warranted.Cerebral palsy (CP) is defined as a group of permanent disorders of the development of movement and posture, which causes activity limitation, and is attributed to nonprogressive disturbances that occur in the developing fetal or infant brain. 1 Clinical manifestations include motor deficits, perceptive disturbances, cognitive impairment, and behavioural and emotional disorders.1 A common classification is based on abnormal muscle tone, including spastic, dyskinetic, and ataxic types.1 The worldwide prevalence of CP is 2.0 to 2.5 per 1000 live births.2 The precise aetiology of CP remains unknown, but preterm birth is considered to be a major risk factor.3 Cerebral palsy can be a severe neurological disability that disturbs movement, posture, neuromuscular control, and often results in dysphagia, epilepsy, and osteoporosis.According to the latest data released by the Center for Disease Control and Prevention's National Center for Health Statistics, stroke was the fourth leading cause of death in the United States in 2008. In Taiwan, stroke was the third major cause of death in 2010, and accounted for 7% of total deaths that year. It places an enormous cost and burden on Taiwan's national health care system. 4 One community-based Taiwanese cohort study reported that the incidence of stroke for people aged over 35 years was 3.32 per 1000 for males and 4.67 per 1000 for females. 5There are well-known risk factors for stroke such as hypertension, diabetes, hyperlipidaemia, smoking, obesity, and urbanization level.6 Some evidence supports the theory that inflammation and chronic infection may also play an essential role in stroke.7 A previous study showed that the death rates for cerebrovascular disease were three times as high in the CP population compared with the general population.8 Studies regarding the relationship between CP and stroke have not yet been explored thoroughly. To our knowledge, no previous study with large patient samples has been conducted to evaluate the risk of stroke in patients with CP. The purpose of the current study was to assess the hypothesis that CP is a risk factor for stroke by using a large-scale nationwide Taiwanese database. METHOD Study participants and designThis is a prospective matched cohort study. The data used in this study were obtained from the Longitudinal Heal...

The risk, burden, and management of non‐communicable diseases in cerebral palsy: a scoping review

“…Of these, one only investigated the risk of stroke 118 and one was a cross-sectional study using self-reported presence of disease as the outcome. Only two studies so far have directly compared the risk of NCDs between adults with and without CP.…”

“…When directly compared with children having typical development, two out of three studies reported that a lower percentage of children with CP met guidelines 94,102,105. Burden of NCD among people with CP Seven studies reporting on the burden of NCDs among people with CP were identified(Table II): three crosssectional studies44,84,117 and four cohort studies [118][119][120][121]. Burden of NCD among people with CP Seven studies reporting on the burden of NCDs among people with CP were identified(Table II): three crosssectional studies44,84,117 and four cohort studies [118][119][120][121].…”

“…Similarly, fewer adults with CP met published physical activity guidelines compared with adults without CP (24.4% vs 53.7%) 106. Three examined the risk of NCDs44,84,118 and four examined the risk of death due to NCDs among people with CP. Three examined the risk of NCDs44,84,118 and four examined the risk of death due to NCDs among people with CP.…”

“…Burden of NCD among people with CP Seven studies reporting on the burden of NCDs among people with CP were identified(Table II): three crosssectional studies44,84,117 and four cohort studies [118][119][120][121]. All studies included females and males; three included adults only44,84,119 and four included adults and children 117,118,120,121. 117,119-121 Sample sizes ranged from 341 to 40 482 people with CP.…”

Role of Spider Cage in Motor Control in Cerebral Palsy

“…Exact cause of cerebral palsy is still unknown; however brain damage can occur before birth, during the birth and after the birth. Pregnancy disorders are considered leading cause before birth [4]. Birth asphyxia, prematurity, neonatal infections and traumatic brain injury are some important causes in cerebral palsy [5].…”