Temporal trends in cerebral palsy by impairment severity and birth gestation

Abstract

AIM Our aim was to build on previous research indicating that rates of cerebral palsy (CP) in the Australian state of Victoria are declining, and examine whether severity of impairments is also decreasing.METHOD Data on individuals with CP were extracted from the Victorian Cerebral PalsyRegister for birth years 1983 to 2009. The yearly rates of dichotomized categories for gross motor function, motor laterality, intellectual impairment, and epilepsy per 1000 neonatal survivors and proportions in the CP cohort were tabulated and plotted by birth gestation. Linear regression modelling was used to fit prediction curves; likelihood ratio tests were used to test for differences in trends between impairment severity groups.RESULTS Since the mid-1990s, CP rates declined in neonatal survivors of birth at all gestations. Our data suggest that the decreasing CP rates were associated with relatively greater decreases in the rates of Gross Motor Function Classification System levels III to V, bilateral CP, epilepsy, and intellectual impairment (all p<0.005). Some variation was seen between birth gestation groups.

Cerebral palsy after assisted reproductive technology: a cohort study

“…While prevalence was increased for all late preterm (32-36wks) infants compared with those born at term, additional increased risk for ART infants was solely seen in those born very preterm (<32wks) (ART CP 127.7/1000 live births; naturally conceived CP 51.9/1000 live births). The median gestational age in all singletons born very preterm after ART was lower (27wks, interquartile range 24-30) than those naturally conceived (29wks, interquartile range [26][27][28][29][30]. We explored whether additional risk for CP remained for very preterm singletons born after ART after accounting for possible differences in gestation age distribution between the ART and naturally conceived births.…”

“…A significantly lower risk of epilepsy was seen, replicating findings from a Danish IVF cohort. 10 Although based on small numbers, this finding is plausible given that epilepsy is more common in children with CP born at or near term, 27 and the majority (81%) of our ART-CP cases were born preterm. Despite a known increased risk of congenital anomalies after ART, 17 we observed no difference in the presence of congenital anomalies between our ART and naturally conceived CP cohorts.…”

“…Elective Caesarean 528 (27) 26 810 (13) 374 (41) 428 (27) 1321 ( (2) 1565 (1) 105 (12) 113 (7) 466 (9) 32-36…”

Single-level selective dorsal rhizotomy for spastic cerebral palsy

“…In one study of children who were mostly GMFCS level IV, there was no significant benefit of SDR combined with physiotherapy compared with physiotherapy alone (33). More recently Ingale et al have suggested that SDR was more effective at reducing spasticity than ITB in children (GMFCS [4][5] requiring ITB pump replacement (20). ITB pump has other advantages over SDR in that it is reversible and is effective at treating any concurrent dystonia, which is more likely to be found in patients with GMFCS level IV or V. Ingale et al suggested that SDR could be a viable option for patients with pump infections or who require a battery change (20).…”

“…Currently it is most commonly performed for the treatment of spastic cerebral palsy (CP) in children. CP affects approximately 2-3 in 1,000 people in developed nations (2)(3)(4), but the prevalence and severity of CP in developed nations may be decreasing due to more effective perinatal care (5). By comparison there is an approximately threefold higher incidence in developing nations due to poorer antenatal, perinatal and postnatal care and facilities (2).…”