The Origin of the Cerebral Palsies: Contribution of Population-Based Neuroimaging Data

Abstract

Background Surveillance of cerebral palsy in Europe (SCPE) presents the first population-based results on neuroimaging findings in children with cerebral palsy (CP) using a magnetic resonance imaging classification system (MRICS). Method MRIs of children with CP born between 1999 and 2009 from 18 European countries were analyzed. MRICS identifies patterns of brain pathology according to timing during brain development which was analyzed with respect to CP subtypes and gestational age. Results MRIs or written reports from 3,818 children were available. The main clinical characteristics were similar to the 5,415 without such data. Most frequent was predominant white matter injury (49%), followed by predominant gray matter injury (21%). Maldevelopments were found in 11% of cases. Miscellaneous findings were present in 8.5% and normal findings in 10.6%. MRI patterns of children with unilateral spastic, bilateral spastic, and dyskinetic CP were mainly lesional (77, 71, and 59%, respectively), whereas children with ataxic CP had more maldevelopments, miscellaneous, and normal findings (25, 21, and 32%, respectively). In children born preterm, predominant white matter injury was most prevalent (80% in children born <32 weeks of gestation). Conclusion Analysis of MRI in the European CP database identified CP as a mainly lesional condition on a large population basis, maldevelopments were relatively uncommon. An exception was ataxic CP. Children born preterm mostly presented with a lesion typical for their gestational age (GA) at birth. The decreasing prevalence of CP in this group suggests that progress in perinatal and neonatal medicine may lead to a reduction of these lesions.

Trends in Prevalence and Severity of Pre/Perinatal Cerebral Palsy Among Children Born Preterm From 2004 to 2010: A SCPE Collaboration Study

“…Using the SCPE database, Horber and coll. recently published that more than 80% of the children born <32 weeks GA had predominant white matter injury ( 28 ). Children born <32 weeks had fewer maldevelopments, a lesser proportion of gray matter injuries and consequently a greater proportion of predominant white matter injuries than children born MPT (32–36 weeks).…”

“…A very first analysis using the MRI Classification System (MRICS) developed and validated by the Surveillance of Cerebral Palsy in Europe (SCPE) collaboration ( 27 ) showed a very clear lesional pattern in children born VPT with 80% having predominant white matter lesions (such as periventricular leucomalacia or sequelae of hemorrhage). Data also suggested that this proportion increases with decreasing GA at birth ( 28 ).…”

Neuroimaging Patterns and Function in Cerebral Palsy—Application of an MRI Classification

“…The structure-function relationship with regard to neuroimaging findings and CP has previously been addressed by the SCPE in the Reference and Training Manual 1 (14) and in a previous study (13), where the distribution of MRI patterns was reported by different gestational ages and CP subtypes.…”

“…One is the MRI classification system (MRICS), developed by the Surveillance of Cerebral Palsy in Europe, SCPE (11,12). A first report of European population-based results of the MRICS was recently published (13). The quality of the MRICS data relies on training of the register partners, who, guided by the Reference and Training Manual and annual exchange and discussions, do the classification of MRI reports and scans and are instructed to classify the neuroimaging pattern which most likely is the cause of the CP.…”

The Cerebral Palsies—Using a Common Language in Research Allows New Insights

“…6 In this issue, the first analysis of magnetic resonance imaging (MRI) in the European CP database confirms on a large population basis, that CP is mainly due to lesions which are considered acquired during second or third trimester of pregnancy or around birth, and that maldevelopments are arising during embryonic and early foetal life are relatively uncommon. 7 In preterm-born children, lesions typical for their gestational age at birth were by far predominant. This is especially interesting with respect to the epidemiological evidence of a decrease in CP morbidity.…”