Cases Of Cerebral Palsy Research Articles

The Clinical and Experimental Study Acupuncture for Children with Cerebral Palsy

Objective One: To investigate the effect of JianPiYiShen and TongDuXingNaoAcupuncture on brain plasticity and motor development in children with cerebral palsy. Two: To evaluate the effect and mechanism of acupuncture and moxibustion on cerebral palsy. Three: The nerve repair effect of acupuncture on cerebral palsy. Methods: In this study, 146 cases of brain injury and 1078 cases of cerebral palsy were included by randomized controlled study with ICF (GMFM, Peabody fine motor function, Gesell, muscle tension, joint activity, ADL, TCD, skull B ultrasound, head CT / MRI, SPECT, DTI) evaluation method. Results: One: the recovery rate of extracellular space (92.3%) was significantly higher than that of the control group (70.8%) (P <0.05), TCD total efficiency (79.3%) was significantly higher than that in the control group (51.8%) (P <0.05). Acupuncture to promoting the development of neurological and cognitive movement under 6 months children, effectively reduce the neurological sequelae.Two: The total effective rate of the children with cerebral palsy was 87% in the acupuncture group, which was significantly higher than that of the control group (P <0.01). The total effective rate of CT / MRI was 59.55% in the acupuncture group and 13.25% higher than that in the control group (P <0.01). The total effective rate was 91.3% in the 1 year follow-up group, which was significantly higher than that in the control group (P <0.01). the FA value of white matter fiber bundle was significantly higher than that of acupuncture at 60 times (P <0.05). The recovery rate of ultrasonous brain injury (86.7%) in acupuncture group was significantly higher than that in control group (64.4%) (P <0.05). The recovery rate of SPECT in acupuncture group was 96.4%, which was significantly higher than that in the control group (P <0.01). Conclusion: Acupuncture rehabilitation not only promote the development of white matter and gray matter in children with cerebral palsy, but also promote the brain function of children with cerebral palsy remodeling and compensation, and promote social adaptation, language and other cognitive function development, children with cerebral palsy movement and Fine motor function development and recovery, improve the children’s self-care ability

Neuroradiologic Features Associated With Severe Restriction of Functional Mobility in Children With Cerebral Palsy in North India.

Few studies have focused on magnetic resonance imaging (MRI) brain findings associated with functional mobility in cerebral palsy. To determine association between MRI findings and Gross Motor Functional Classification System (GMFCS) levels in cerebral palsy. Prospective-observational study conducted in Pediatric Neurology Clinic at a public teaching hospital, Northern India. First 3 new cases of cerebral palsy were enrolled on particular neuro-clinic day per week for 1 year. Functional mobility was classified according to GMFCS. Association between MRI findings, cerebral palsy type, and GMFCS levels were evaluated using χ2 test. A total of 138 cases (mean age 2.71 [SD = 1.91] years; male [64.5%]) were enrolled. Reported types of cerebral palsy were as follows: spastic quadriplegia (47.8%), spastic diplegia (28.35%), spastic hemiplegia (11.6%), extrapyramidal (6.5%), and ataxic/hypotonic (5.8%). GMFCS were classified into level 1 (13%), level 2 (7.2%), level 3 (4.3%), level 4 (10.9%), and level 5 (64.5%). Spastic quadriplegia and extrapyramidal cerebral palsy were significantly associated with higher (severe) levels (IV and V), whereas spastic diplegia and hemiplegia were significantly associated with lower (mild) levels (I-III) of GMFCS. MRI features of periventricular white matter injury, deep gray matter injury, basal ganglia and thalamic changes, and superficial gray matter injury were significantly associated with severe levels of GMFCS (V and IV). MRI was normal in 8 children (5 = mild category, 3 = severe category). Severe cerebral palsy is most often associated with spastic quadriplegia, extrapyramidal cerebral palsy, superficial gray matter lesions, deep gray matter lesions, and periventricular white matter injury. This information is useful for anticipating and addressing the needs of children with cerebral palsy and for prognostication.

Behavioral Smoking Cessation Counseling During Pregnancy: A Cost-Effectiveness Analysis.

To examine the cost effectiveness of using behavioral smoking cessation counseling during pregnancy. We designed a decision-analytic model using TreeAge Pro 2020 software to compare the cost effectiveness and outcomes among women who received behavioral smoking cessation counseling compared with women who received usual care during pregnancy. We used a theoretical cohort of 285,000 women, the approximate number of pregnant women who smoke each year in the United States. Outcomes included maternal abstinence from smoking, fetal growth restriction, stillbirth, preterm delivery, neonatal death, and cerebral palsy, in addition to cost and quality-adjusted life-years (QALYs) for both the woman and the neonate. All model inputs were derived from the literature, and a willingness-to-pay threshold was set at $100,000 per QALY. Sensitivity analyses were performed to determine the robustness of baseline assumptions. In our theoretical cohort, behavioral smoking cessation counseling compared with usual care was associated with 9,019 additional women stopping smoking during pregnancy (34,604 vs 25,585). Smoking cessation counseling also resulted in 911 fewer cases of fetal growth restriction, 20 fewer stillbirths, 250 fewer preterm deliveries, 11 fewer neonatal deaths, and one less case of cerebral palsy. Using behavioral smoking cessation counseling interventions during pregnancy led to better outcomes despite higher costs, with an incremental cost-effectiveness ratio of $71,658 per QALY, which was below our willingness-to-pay threshold of $100,000 per QALY, making the intervention cost effective. Sensitivity analyses demonstrated that the counseling intervention was cost effective at probabilities of smoking cessation greater than 11.6% (baseline input: 12.1%) or the cost of the behavioral intervention was less than $475.21 (baseline input: $368.78). Behavioral smoking cessation counseling during pregnancy was associated with fewer adverse neonatal outcomes and was cost effective. Increasing utilization of such interventions and increasing insurance coverage of this care are important initiatives to improve outcomes in this at-risk population.

Perinatal Stroke: A Practical Approach to Diagnosis and Management.

Perinatal stroke is a focal vascular brain injury that occurs from the fetal period to 28 days of postnatal age. With an overall incidence of up to 1 in 1,000 live births, the most focused lifetime risk for stroke occurs near birth. Perinatal stroke can be classified by the timing of diagnosis, vessel involvement, and type of injury. Timing of diagnosis may be in the acute neonatal period or retrospectively after a period of normal development, followed by abnormal neurologic findings, with the injury presumed to have occurred around the time of birth. Strokes may be arterial or venous, ischemic, and/or hemorrhagic. Within these classifications, 6 perinatal stroke diseases are recognizable, based on clinical and radiographic features. Morbidity is high in perinatal stroke, because it accounts for most cases of hemiparetic cerebral palsy, with disability lasting a lifetime. Additional complications include disorders of sensation and vision, language delays, cognitive and learning deficits, epilepsy, and mental health consequences that affect the entire family. Advances in neonatal neurocritical care may afford opportunity to minimize brain injury and improve outcomes. In the chronic timeframe, progress made in neuroimaging and brain mapping is revealing the developmental plasticity that occurs, informing new avenues for neurorehabilitation. This review will summarize the diagnosis and management of each perinatal stroke disease, highlighting their similarities and distinctions and emphasizing a patient- and family-centered approach to management.

Safety and Efficacy of Sildenafil Citrate to Reduce Operative Birth for Intrapartum Fetal Compromise at Term: A Phase 2 Randomized Controlled Trial

(Am J Obstet Gynecol. 2020;222:401–414) Intrapartum fetal compromise, or fetal distress, is a major cause of perinatal death and hypoxic-ischemic encephalopathy in low- to middle-income countries, and causes 1 in 5 cases of cerebral palsy in high-income countries. The only proven interventions for intrapartum fetal compromise are emergency cesarean delivery or emergency delivery by instrumental vaginal birth, both of which carry significant risks. Sildenafil citrate increases fetal and uteroplacental blood flow and is an effective treatment for adult and newborn pulmonary hypertension. This study evaluated the efficacy and safety of sildenafil citrate in reducing the rate of emergency cesarean delivery or instrumental vaginal birth for intrapartum fetal distress.

Tracheal stenosis due to cervicothoracic hyperlordosis in patients with cerebral palsy treated with posterior spinal fusion: a report of the first two cases

BackgroundSpinal deformity is frequently identified in patients with cerebral palsy (CP). As it progresses, tracheal stenosis often develops due to compression between the innominate artery and anteriorly deviated vertebrae at the apex of the cervicothoracic hyperlordosis. However, the treatment strategy for tracheal stenosis complicated by spinal deformity in patients with CP remains unknown.Case presentationThis study reports two cases: a 19-year-old girl (case 1) and a 17-year-old girl (case 2), both with CP at Gross Motor Function Classification System V. Both patients experienced acute oxygen desaturation twice within the past year of their first visit to our department. X-ray and computed tomography revealed severe scoliosis and cervicothoracic hyperlordosis causing tracheal stenosis at T2 in case 1 and at T3-T4 in case 2, suggesting that their acute oxygen desaturation had been caused by impaired airway clearance due to tracheal stenosis. After preoperative halo traction for three weeks, both patients underwent posterior spinal fusion from C7 to L5 with Ponte osteotomy and sublaminar taping at the proximal thoracic region to correct cervicothoracic hyperlordosis and thoracolumbar scoliosis simultaneously. Postoperative X-ray and computed tomography revealed that the tracheal stenosis improved in parallel with the correction of cervicothoracic hyperlordosis. Case 1 did not develop respiratory failure 1.5 years after surgery. Case 2 required gastrostomy postoperatively due to severe aspiration pneumonia. However, she developed no respiratory failure related to impaired airway clearance at one-year follow-up.ConclusionsWe present the first two cases of CP that developed tracheal stenosis caused by cervicothoracic hyperlordosis concomitant with progressive scoliosis and were successfully treated by posterior spinal fusion from C7 to L5. This enabled us to relieve tracheal stenosis and correct the spinal deformity at the same time. Surgeons must be aware of the possibility of coexisting tracheal stenosis in treating spinal deformity in patients with neurological impairment because the surgical strategy can vary in the presence of tracheal stenosis. This study demonstrated that some patients with CP with acquired tracheal stenosis can be treated with spinal surgery.

Molecular Diagnostic Yield of Exome Sequencing in Patients With Cerebral Palsy

Cerebral palsy is a common neurodevelopmental disorder affecting movement and posture that often co-occurs with other neurodevelopmental disorders. Individual cases of cerebral palsy are often attributed to birth asphyxia; however, recent studies indicate that asphyxia accounts for less than 10% of cerebral palsy cases. To determine the molecular diagnostic yield of exome sequencing (prevalence of pathogenic and likely pathogenic variants) in individuals with cerebral palsy. A retrospective cohort study of patients with cerebral palsy that included a clinical laboratory referral cohort with data accrued between 2012 and 2018 and a health care-based cohort with data accrued between 2007 and 2017. Exome sequencing with copy number variant detection. The primary outcome was the molecular diagnostic yield of exome sequencing. Among 1345 patients from the clinical laboratory referral cohort, the median age was 8.8 years (interquartile range, 4.4-14.7 years; range, 0.1-66 years) and 601 (45%) were female. Among 181 patients in the health care-based cohort, the median age was 41.9 years (interquartile range, 28.0-59.6 years; range, 4.8-89 years) and 96 (53%) were female. The molecular diagnostic yield of exome sequencing was 32.7% (95% CI, 30.2%-35.2%) in the clinical laboratory referral cohort and 10.5% (95% CI, 6.0%-15.0%) in the health care-based cohort. The molecular diagnostic yield ranged from 11.2% (95% CI, 6.4%-16.2%) for patients without intellectual disability, epilepsy, or autism spectrum disorder to 32.9% (95% CI, 25.7%-40.1%) for patients with all 3 comorbidities. Pathogenic and likely pathogenic variants were identified in 229 genes (29.5% of 1526 patients); 86 genes were mutated in 2 or more patients (20.1% of 1526 patients) and 10 genes with mutations were independently identified in both cohorts (2.9% of 1526 patients). Among 2 cohorts of patients with cerebral palsy who underwent exome sequencing, the prevalence of pathogenic and likely pathogenic variants was 32.7% in a cohort that predominantly consisted of pediatric patients and 10.5% in a cohort that predominantly consisted of adult patients. Further research is needed to understand the clinical implications of these findings.

855 Universal screening for vasa previa: a cost-effectiveness analysis

We sought to examine the cost effectiveness and outcomes associated with universal vasa previa screening during pregnancy. A cost-effectiveness model using TreeAge Pro 2020 software was designed to compare outcomes and costs in women who received universal vasa previa screening versus women who received no vasa previa screening during pregnancy. We used a theoretical cohort of 3,945,000, the approximate number of live births each year in the U.S. Outcomes included stillbirth, intrapartum death, neonatal death, and cerebral palsy, in addition to cost and quality-adjusted life years (QALYs) for both the woman and the neonate. Probabilities were derived from the literature, and a cost-effectiveness threshold was set at $100,000/QALY. Sensitivity analyses were performed to determine the robustness of baseline assumptions. In our theoretical cohort, universal vasa previa screening was a cost-effective strategy. Universal screening for vasa previa resulted in 1,499 fewer cases of missed vasa previa (Table 1). Universal screening for vasa previa resulted in fewer intrapartum deaths and cases of cerebral palsy. Universal screening for vasa previa resulted in increased effectiveness and increased costs with an incremental cost-effectiveness ratio of $82,272/QALY. This was below the willingness-to-pay threshold of $100,000/QALY, making universal screening cost effective. Sensitivity analysis demonstrated that universal vasa previa screening was cost effective as long as the sensitivity of transvaginal ultrasound for detecting vasa previa was greater than 81% (Figure 1). Universal vasa previa screening during pregnancy is a cost-effective strategy and decreases the risk of adverse neonatal outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

849 Optimal time of delivery in the setting of fetal growth restriction at the 3rd percentile

The SMFM recently published guidance regarding delivery timing for fetal growth restriction (FGR) that differed for pregnancies where the estimated fetal weight (EFW) was at the 3rd centile or below. The purpose of this study was to determine the optimal timing of delivery in pregnancies complicated by FGR at the 3rd centile or less diagnosed at 34 weeks gestational age (GA) in the setting of normal fetal vascular Doppler assessment. A decision-analytic model was created using TreeAge software to determine the optimal GA of delivery in the theoretical cohort of 10,000 cases of singleton 3rd centile FGR diagnosed via ultrasound at 34 weeks. The model options ranged from delivery at 34 weeks up to expectant management until 39 weeks’ gestation. Outcomes included stillbirth, neonatal death (NND), and cerebral palsy (CP). In addition, quality-adjusted life years (QALY) were estimated, accounting for both maternal and neonatal utilities. All probabilities were derived from the literature. Delivery at 38 weeks would prevent 5 cases of neonatal death and 24 cases of cerebral palsy as compared to delivery at 37 weeks, while waiting until 39 weeks would result in 19 more stillbirths (Table 1). Overall, the model showed that optimal GA for delivery of 3rd centile FGR was 38 weeks, which maximized total QALYs. Sensitivity analysis revealed that expectant management until 38 weeks was the optimal delivery strategy until the risk of stillbirth in third percentile IUGR fetuses increased by more than 19.7%, when delivery at 36 weeks was optimal. Weighing the risks of prematurity against the outcomes of stillbirth, NND, and CP, the optimal GA to deliver 3rd centile FGR diagnosed at 34 weeks with normal Doppler findings is 38 weeks. However, there are tradeoffs between stillbirth and neonatal short- and long-term outcomes and these findings can be used to counsel regarding a range of clinical management approaches in a shared medical decision-making approach to care.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

693 Transabdominal cerclage vs. vaginal cerclage: a cost-effectiveness analysis

Patients with recurrent pregnancy loss due to cervical insufficiency often receive a vaginal cerclage (VC). The MAVRIC trial demonstrated the superior efficacy of transabdominal cerclage (TAC) compared with VC for those with a history of a prior failed VC. However, the TAC is costly and may have other complications. In this study, we evaluated the cost-effectiveness of performing TAC versus VC for patients with a history of VC failure. We used TreeAge to construct a decision-analytic model to compare patient outcomes between those who received a TAC to those who received VC. Our theoretical cohort contained 20,000 patients, the approximate number of pregnancies with prior VC failure per year in the US. We assumed that all patients with TAC undergo cesarean delivery. Outcomes were wound infection in TAC, cesarean delivery, previable delivery, stillbirth, neonatal death, maternal mortality, and cerebral palsy. We derived all values from literature including MAVRIC for cerclage outcomes and discounted QALYs at a rate of 3%. To further assess our model, we performed univariate sensitivity analyses. In our theoretical cohort, TAC was associated with a decrease in 3,363 previable deliveries, 261 neonatal deaths, and 236 cases of cerebral palsy. However, TAC was associated with an additional 11,656 cesarean deliveries, 1 maternal mortality, and 870 wound infections (Table 1). TAC was a cost-effective strategy as it resulted in increased QALYs (despite increased costs) and an incremental cost-effectiveness ratio (ICER) of $3,007/QALY. Sensitivity analyses demonstrated that TAC was cost-effective over a wide range of the probabilities for cesarean delivery, neonatal death, and previable delivery. In this study, TAC was a cost-effective strategy to prevent previable deliveries and improve neonatal outcomes, but required additional cesarean deliveries and increased costs. We found that TAC is a cost-effective strategy and may be considered for patients with a history of VC failure.

Cost-effectiveness of influenza vaccination during pregnancy

Objective To assess the cost-effectiveness of influenza vaccination for all pregnant patients in the United States. Methods We designed a cost-effectiveness model to compare outcomes and costs in pregnant patients who received the inactivated, trivalent influenza vaccine to those who did not. We used a theoretical cohort of 4 million patients, the number of individuals giving birth in the United States per year. We assumed that H1N1 and A or B type influenza were of equal incidence based on seasonal variation from the past ten years. Our outcomes include acquiring H1N1, acquiring A or B type influenza, maternal death, stillbirth, infant death, preterm birth, and cerebral palsy in addition to cost and quality-adjusted life years (QALYs). Probabilities were derived from the literature and QALYs generated at a discount rate of 3%. Sensitivity analyses were performed to assess the robustness of our model. Results In our theoretical cohort of 4 million pregnant patients, the influenza vaccination strategy was associated with 1632 fewer stillbirths (24,332 in the vaccine strategy vs. 25,964 in the no vaccine strategy), 120 fewer maternal deaths (284 vs. 404), 340 fewer infant deaths (5608 vs. 5948), 32,856 fewer preterm births (403,896 vs. 436,752), and 641 fewer cases of moderate cerebral palsy (12,388 vs. 13,029). Additionally, the vaccination strategy corresponded to savings of $3.7 billion ($63.3 billion vs. $67.0 billion) and increased QALYs of 81,696 (226,852,076 vs 226,770,380). Therefore, it was considered a dominant strategy. Univariate sensitivity analysis demonstrated that the vaccine is cost saving until vaccine cost passes $900, far above the current cost of $12.16. In addition, we used sensitivity analysis to vary seasonal proportions of H1N1 to A or B type influenza. The vaccine was cost saving and increased QALYs for any proportion of H1N1 to A or B type influenza including when H1N1 was absent. Conclusion We demonstrate that in a cohort of 4 million patients, the influenza vaccine may save $3.7 billion per year, improve maternal and infant outcomes, and reduce morbidity and mortality. Our study provides further evidence that providers should strongly recommend that pregnant patients receive their annual influenza vaccine.

Cost effectiveness of buprenorphine vs. methadone for pregnant people with opioid use disorder

Objective To assess the cost effectiveness of buprenorphine versus methadone in the management of opioid use disorder (OUD) during pregnancy. Methods We designed a decision-analytic model to evaluate the costs and outcomes associated with buprenorphine compared to methadone for pregnant people with OUD. We used a theoretical cohort of 22,400 pregnant people, which is an estimation of pregnancies affected by OUD per year in the United States. Outcomes included maternal retention in maintenance treatment, neonatal opioid withdrawal syndrome, preterm birth, fetal growth restriction, cerebral palsy, and maternal overdose in addition to cost and quality-adjusted life-years (QALYs). We used a willingness-to-pay threshold of $100,000/QALY. All model inputs were derived from the literature and varied in sensitivity analyses to assess the robustness of our baseline inputs. Results In our theoretical cohort, treatment of OUD with buprenorphine during pregnancy resulted in 2413 fewer cases of neonatal opioid withdrawal syndrome, 1089 fewer preterm births, 299 fewer cases of fetal growth restriction, 32 fewer stillbirths, and 13 fewer cases of cerebral palsy compared to methadone treatment. Despite lower rates of retention, buprenorphine treatment saved nearly 123 million healthcare dollars and resulted in 558 additional QALYs, making it the dominant strategy compared to methadone treatment. Our findings were robust over a wide range of assumptions. Conclusion Our data suggest that buprenorphine should be considered a cost effective treatment option for OUD in pregnancy, as it is associated with improved neonatal outcomes compared to methadone despite the risk of treatment discontinuation.

Motor function and white matter connectivity in children cooled for neonatal encephalopathy

Therapeutic hypothermia reduces the incidence of severe motor disability, such as cerebral palsy, following neonatal hypoxic-ischaemic encephalopathy. However, cooled children without cerebral palsy at school-age demonstrate motor deficits and altered white matter connectivity. In this study, we used diffusion-weighted imaging to investigate the relationship between white matter connectivity and motor performance, measured using the Movement Assessment Battery for Children-2, in children aged 6–8 years treated with therapeutic hypothermia for neonatal hypoxic-ischaemic encephalopathy at birth, who did not develop cerebral palsy (cases), and matched typically developing controls. Correlations between total motor scores and diffusion properties in major white matter tracts were assessed in 33 cases and 36 controls. In cases, significant correlations (FDR-corrected P < 0.05) were found in the anterior thalamic radiation bilaterally (left: r = 0.513; right: r = 0.488), the cingulate gyrus part of the left cingulum (r = 0.588), the hippocampal part of the left cingulum (r = 0.541), and the inferior fronto-occipital fasciculus bilaterally (left: r = 0.445; right: r = 0.494). No significant correlations were found in controls. We then constructed structural connectivity networks, for 22 cases and 32 controls, in which nodes represent brain regions and edges were determined by probabilistic tractography and weighted by fractional anisotropy. Analysis of whole-brain network metrics revealed correlations (FDR-corrected P < 0.05), in cases, between total motor scores and average node strength (r = 0.571), local efficiency (r = 0.664), global efficiency (r = 0.677), clustering coefficient (r = 0.608), and characteristic path length (r = -0.652). No significant correlations were found in controls. We then investigated edge-level association with motor function using the network-based statistic. This revealed subnetworks which exhibited group differences in the association between motor outcome and edge weights, for total motor scores (P = 0.0109) as well as for balance (P = 0.0245) and manual dexterity (P = 0.0233) domain scores. All three of these subnetworks comprised numerous frontal lobe regions known to be associated with motor function, including the superior frontal gyrus and middle frontal gyrus. The subnetwork associated with total motor scores was highly left-lateralised. These findings demonstrate an association between impaired motor function and brain organisation in school-age children treated with therapeutic hypothermia for neonatal hypoxic-ischaemic encephalopathy.

Association of Motor Function and Neuroimaging in Cerebral Palsy: A Cross-sectional Study

Introduction: Cerebral Palsy (CP) is one of the most common causes of disability in children. Neuroimaging is useful in determining structural or functional relationships in children with CP. It provides an opportunity to link various CP types to the localisation of the brain maldevelopment or lesion. Aim: To study association of motor function and brain structure on neuroimaging Magnetic Resonance Imaging (MRI) in CP children. Materials and Methods: This cross-sectional observational study was conducted in a tertiary care hospital from August 2015 to December 2016. A total of 50 diagnosed cases of CP were included after satisfying inclusion and exclusion criteria. After detailed history and clinical examination, MRI of brain was advised. All parameters were assessed in terms of Gross Motor Functional Classification System (GMFCS), Manual Ability Classification System (MACS) and MRI Grading. Categorical variables were presented as numbers and percentage and association was checked using Chi-square test or Fischer’s-exact test. A p-value of &lt;0.05 was considered statistically significant. Results: Patients with CP in the study ranged from 2-12 years with mean age of 5.43 (±2.58) years. Out of 50 cases, 30 (60%) were in the age group of 2-5 years, 17 (34%) were in the age group of 6-10 years and three (6%) were in the age group of 11-12 years. Out of 50 enrolled cases, maximum cases were having GMFCS level 3 (n=14) and MACS level 2 (n=15). There was significant positive association (p-value &lt;0.05) between GMFCS level and grading of MRI. Similar significant association was observed for analysis of association of MACS level and MRI Grading. Conclusion: The present study highlighted that there was a significant association between extent and type of brain lesion and motor functions (GMFCS and MACS levels). Type and extent of brain lesion helps clinician to understand prognosis of functional motor outcome in CP children.

Risk Factors Associated with Epilepsy among Children with Cerebral Palsy

Background: Cerebral Palsy(CP) is a major cause of childhood disability and is more prevalent in the more socioeconomically deprived populations of the world. Epilepsy is said to occur in 15-90% of children with CP and this causes additional economic and psychological stress on affected children and their family.&#x0D; Materials and Methods: This cross sectional case control study was conducted in paediatric neurology OPD of Dhaka Medical College Hospital &amp; BSMMU from July 2008 to June 2009. Four hundred children with CP were included in this study &amp; CP with epilepsy was taken as case and CP without epilepsy as control. Medical records of these patients were reviewed and analyzed.&#x0D; Results: 150 children studied had associated epilepsy, giving a prevalence rate of 37.5%. Epilepsy most commonly affected children with spastic quadriplegia (43.5%). GTCS was more common of epilepsy in spastic quadriplegic CP and partial seizure common in spastic hemiplegic CP. After logistic regression analysis significant positive correlation was found between LBW (OR, 0.428), post-natal CNS infection (OR, 0.416) with occurrence of epilepsy in CP cases. Statistically significant positive correlation was not found between prematurity, neonatal jaundice, neonatal convulsion, neonatal sepsis as a risk factor to develop epilepsy in CP.&#x0D; Conclusion: Among CP cases epilepsy is most common in spastic quadriplegic CP and GTCS is more common type of epilepsy in spastic quadriplegic CP. LBW and postnatal CNS infection significantly increase the risk of epilepsy in CP cases. Prematurity, neonatal jaundice, neonatal convulsion does not increase the risk of developing epilepsy in CP.&#x0D; Bangladesh J Child Health 2020; VOL 44 (2) :92-96

Chronic compensated iron deficiency anaemia in a 12-year-old cerebral palsy child

A 12-year-old male child, known case of cerebral palsy (CP), presented as a case of severe anaemia with congestive heart failure to the paediatric casualty. The child was worked up for the same and investigations revealed chronic compensated iron deficiency anaemia. The child was treated with blood transfusions, anti-heart failure medications and was discharged on oral iron. Special care and follow up are required for the nutritional needs of CP children as often they are neglected leading to catastrophic presentations.

Genetic Variants Account for About 14% of Cerebral Palsy Cases.

American Journal of Medical Genetics Part AVolume 185, Issue 1 p. 9-10 THE AJMG SEQUENCE: DECODING NEWS AND TRENDS FOR THE MEDICAL GENETICS COMMUNITY BY ROXANNE NELSON Genetic Variants Account for About 14% of Cerebral Palsy Cases First published: 16 December 2020 https://doi.org/10.1002/ajmg.a.61646Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume185, Issue1January 2021Pages 9-10 RelatedInformation

The Association Study of IL-23R Polymorphisms With Cerebral Palsy in Chinese Population.

Background: Cerebral palsy (CP) is a syndrome of non-progressive motor dysfunction caused by early brain development injury. Recent evidence has shown that immunological abnormalities are associated with an increased risk of CP.Methods: We recruited 782 children with CP as the case group and 770 healthy children as the control group. The association between IL-23R single nucleotide polymorphisms (SNPs; namely, rs10889657, rs6682925, rs1884444, rs17375018, rs1004819, rs11805303, and rs10889677) and CP was studied by using a case–control method and SHEsis online software. Subgroup analysis based on complications and clinical subtypes was also carried out.Results: There were differences in the allele and genotype frequencies between CP cases and controls at the rs11805303 and rs10889677 SNPs (Pallele = 0.014 and 0.048, respectively; Pgenotype = 0.023 and 0.008, respectively), and the difference in genotype frequency of rs10889677 remained significant after Bonferroni correction (Pgenotype = 0.048). Subgroup analysis revealed a more significant association of rs10889677 with CP accompanied by global developmental delay (Pgenotype = 0.024 after correction) and neonatal encephalopathy (Pgenotype = 0.024 after correction).Conclusion: The present results showed a significant association between IL-23R and CP, suggesting that IL-23R may play a potential role in CP pathogenesis.

Status Dystonicus in Children with Secondary Dystonia: Reporting 3 Cases of Cerebral Palsy, Leigh Disease and Molybodynum Co Factor Deficiency

Objective: Patients with primary and secondary dystonic syndromes occasionally develop severe episodes of generalized dystonia and rigidity which is known as status dystonicus (SD) or dystonic storm. This is a frightening hyperkinetic movement disorder and it is an emergency. Marked, rapid exacerbation of dystonia requires prompt intervention and admission in the hospital. It is critical to recognize early and differentiate dystonic storm from other hyperkinetic movement disorder as it may lead to metabolic complications such as rhabdomyolysis, leading to acute renal failure. This paper has been written to describe three cases of SD, all having secondary dystonia with different etiologies to highlight the mode of presentation, diagnosis, treatment and outcome.&#x0D; Methodology: We report 3 cases of severe secondary dystonia culminating in SD necessitating management in hospital setting. All the three cases were admitted in a tertiary care hospital and evaluated.&#x0D; Results: One patient was treated in intensive care unit. In brief 1st case was a 5 year boy with dyskinetic CP who was treated with trihexiphenidyl (THP), baclofen and midazolam infusion. Second case was a 15 month old boy, diagnosed case of mitochondrial encephalopathy (Leigh disease) who was treated with THP, baclofen, haloperidol, clonazepam and infusion midazolam. The third case was a 13 month old boy, diagnosed case of Molybdenum Cofactor deficiency who was treated with THP, tizanidine but they refused to take midazolam.&#x0D; Conclusion: In this case series, three cases with SD with different etiology have been described with clinical features, modalities of treatment and outcome.

First trimester fasting plasma glucose screen in advanced maternal age women: a cost-effectiveness analysis

Background The prevalence of preexisting type 2 diabetes mellitus (T2DM) in the United States is on the rise. Women of advanced maternal age (AMA, ≥35 years) are more likely to have preexisting T2DM in pregnancy because glucose intolerance increases with age. Diabetes in pregnancy is associated with significant maternal and neonatal morbidity and mortality, and earlier treatment initiation improves pregnancy outcomes. However, maternal age is not currently recognized as an independent risk factor that warrants diabetes screening prior to the traditional screen at 24–28 weeks gestation. Objective To evaluate the cost-effectiveness of screening all AMA women with a first trimester fasting plasma glucose (FPG) test for earlier diagnosis and management of preexisting T2DM. Study design A decision-analytic model was created to compare pregnancy outcomes in AMA women who undergo a first trimester FPG test vs third trimester oral glucose tolerance test alone. Probabilities were obtained from the literature. Outcomes examined included preeclampsia, preterm delivery, macrosomia, shoulder dystocia, brachial plexus injury (BPI), intrauterine fetal demise (IUFD), cerebral palsy, and neonatal death. The cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio of the first trimester screening strategy were examined as well. Sensitivity analyses and a Monte Carlo simulation were performed to test the model’s robustness. Results In AMA women, screening for preexisting T2DM in the first trimester with an FPG test resulted in fewer cases of preeclampsia, preterm delivery, BPI, IUFD, cerebral palsy, and neonatal death compared to performing a third trimester oral glucose tolerance test alone, and is cost-effective. Monte Carlo analysis incorporating the distribution of all probabilities showed that first trimester FPG screening remained cost-effective as long as the incremental cost of initiating diabetes treatment in the first trimester was less than $150,000 and the cost of the FPG screen was less than $2700. Conclusion Compared to third trimester oral glucose tolerance test alone, performing a first trimester FPG screen in AMA women is cost-saving and more effective.