Cases Of Cerebral Palsy Research Articles

Two Patients with Spastic Cerebral Palsy Complicating Cervical Spondylotic Myelopathy：Not Only Athetoid Type

We report two cases of spastic cerebral palsy classified as diplegia-type complicated cervical spondylotic myelopathy. Under the Gross Motor Function Classification System (GMFCS), both were classified as Level IV, defined as standing with support, but with difficultly, after the diagnosis of cervical spondylotic myelopathy. Paralysis in both the upper and lower limbs deteriorated and became a form of quadriplegia. In one case, there was no appeal from the patient even after the manifestation of symptoms；diagnosis and surgery were both time consuming, with no improvements in post-operative symptoms including urinary incontinence. In the other case, early diagnosis was possible and operation was scheduled early. The post-operative response was positive, and the patient was able to recover to pre-cervical spondylotic myelopathy conditions. Complications of cervical spondylotic myelopathy is well-known in the athetosis type；however, reports on the spastic type are limited. Here, we report complications of cervical spondylotic myelopathy in spastic cerebral palsy and show that early detection and surgery are important factors in mitigating long-term recovery.

Review of Cerebral Palsy Cases in the University Of Nigeria Teaching Hospital Ituku-Ozalla, Enugu

Background: Cerebral palsy (CP) is a major cause of childhood disability. The objective of this study was to review the causes, types, complications, demographic and clinical characteristics of children with CP over a period of ten years as seen in the physiotherapy (PT) department of the University of Nigeria Teaching Hospital, Ituku-Ozalla Enugu, Nigeria.
 Methods: A retrospective study that reviewed a total of 497 case folders of children with CP. Ethical clearance was obtained from the Health Research Ethics Committee of the University of Nigeria Teaching Hospital, Enugu. The case records were randomly selected, a data retrieval form developed through a two-stage process was used to obtain the required information. Data was analyzed using descriptive statistics and Chi-square tests. Level of significance was set at 0.05.
 Results: Four hundred and ninety-seven cases of children with CP were reviewed. Birth asphyxia (29.9%) and jaundice (28.7%) were the leading causes of CP while spastic CP (56.7%) was the most common type. Motor disorder (67.0%) was the predominant clinical presentation. There was a significant association between type of CP and each of cause (X2 =28.303, p = 0.001), and duration of PT treatment (X2 =31.784, p < 0.0001).
 Conclusion: It was concluded that Birth asphyxia and jaundice are the major cause of CP in this environment. There is a significant association between type of CP and the cause of CP as well as the duration of PT treatment received.Keywords: Review; Cerebral Palsy; Hospital

Obstetric factors associated with uterine rupture in mothers who deliver infants with cerebral palsy

Objective: The aim of the present study was to clarify the obstetric factors associated with uterine rupture in mothers who deliver infants with cerebral palsy (CP) in Japan.Methods: This retrospective case-cohort study reviewed the obstetric characteristics and clinical courses of mothers who experienced uterine rupture and compared those who delivered an infant with CP (cases) with those who delivered an infant without CP (cohort). Data were obtained from the Japan Obstetric Compensation System for CP database (27 cases) and the perinatal database of the Japan Society of Obstetrics and Gynecology (312 cohorts). The subjects included live singleton infants delivered between 2009 and 2014 with a birth weight ≥2000 g and gestation ≥33 weeks.Results: Augmentation was performed 33% in cases and 8% in cohorts (p < .001). The amount of bleeding during surgery was 1819 g in cases and 1096 g in cohorts (p < .001). Length of gestational weeks and neonatal birth weight were significantly higher and Apgar scores and umbilical arterial pH were lower in cases compared to cohorts (p < .001). In cases with CP, 11 cases of uterine rupture involved scarred uteruses. Seven were trial of labor after a previous cesarean. On one hand, 16 cases occurred in unscarred uteruses. Five of the uterine fundal pressure maneuvers and four of tachysystole due to excessive augmentation were reported in association with uterine rupture.Conclusion: Two-third of the relevant obstetric factors for CP associated with uterine rupture were iatrogenic. At least, to reduce CP resulting from delivery-related uterine rupture, reckless delivery management should be avoided.

Deep Learning/Artificial Intelligence and Blood-Based DNA Epigenomic Prediction of Cerebral Palsy.

The etiology of cerebral palsy (CP) is complex and remains inadequately understood. Early detection of CP is an important clinical objective as this improves long term outcomes. We performed genome-wide DNA methylation analysis to identify epigenomic predictors of CP in newborns and to investigate disease pathogenesis. Methylation analysis of newborn blood DNA using an Illumina HumanMethylation450K array was performed in 23 CP cases and 21 unaffected controls. There were 230 significantly differentially-methylated CpG loci in 258 genes. Each locus had at least 2.0-fold change in methylation in CP versus controls with a FDR p-value ≤ 0.05. Methylation level for each CpG locus had an area under the receiver operating curve (AUC) ≥ 0.75 for CP detection. Using Artificial Intelligence (AI) platforms/Machine Learning (ML) analysis, CpG methylation levels in a combination of 230 significantly differentially-methylated CpG loci in 258 genes had a 95% sensitivity and 94.4% specificity for newborn prediction of CP. Using pathway analysis, multiple canonical pathways plausibly linked to neuronal function were over-represented. Altered biological processes and functions included: neuromotor damage, malformation of major brain structures, brain growth, neuroprotection, neuronal development and de-differentiation, and cranial sensory neuron development. In conclusion, blood leucocyte epigenetic changes analyzed using AI/ML techniques appeared to accurately predict CP and provided plausible mechanistic information on CP pathogenesis.

Timing of delivery in women with prior uterine rupture: a decision analysis

Background: Uterine rupture is an obstetric complication with high rates of associated maternal and neonatal morbidity and mortality. However, limited guidance for the timing of delivery in women with a history of prior uterine rupture exists. Objective: To determine the optimal gestational age of delivery in women with prior uterine rupture. Study design: A decision-analytic model was built using TreeAge software to compare the outcomes of repeat cesarean delivery when performed at 32, 33, 34, 35, or 36 weeks gestation in a theoretical cohort of 1000 women with prior uterine rupture. Strategies involved expectant management until a later gestational age accounting for the risks of spontaneous uterine rupture, spontaneous labor, uterine rupture following spontaneous labor, and stillbirth during each successive week that a woman was still pregnant. Maternal outcomes included uterine rupture, hysterectomy, and death. Neonatal outcomes included hypoxic-ischemic encephalopathy, cerebral palsy, and death. Probabilities were derived from the literature and total quality-adjusted life years (QALYs) were calculated. Sensitivity analyses were used to vary model inputs to investigate the robustness of our baseline assumptions. Results: In our theoretical cohort of 1000 pregnant women with a history of prior uterine rupture, cesarean delivery at 34 weeks maximized maternal and neonatal QALYs. Compared to delivery at 36 weeks, delivery at 34 weeks would prevent 38.6 uterine ruptures, 0.079 maternal deaths, 6.10 hysterectomies, and 12.1 neonatal deaths but results in 4.70 more cases of cerebral palsy. Univariate sensitivity analysis found that repeat cesarean at 34 weeks remained the optimal strategy until the probability of spontaneous repeat uterine rupture (baseline estimate: 0.68%) fell below 0.2% or rose above 0.9%, at which point, a strategy of delivery at 35 or 32 weeks became optimal, respectively. However, Monte Carlo simulation demonstrated that delivery at 35 weeks was the optimal strategy 37% of the time, whereas 34 weeks was the optimal strategy 17% of the time. Conclusion: The optimal time for repeat cesarean delivery in women with prior uterine rupture appears to be between 34-0/7 and 35-6/7 weeks gestation.

Cerebral palsy prevalence, subtypes, and associated impairments: a population‐based comparison study of adults and children

To describe the prevalence of cerebral palsy (CP), subtype distribution, motor and intellectual impairment, and epilepsy in adults with CP compared with children with CP. CP subtype and impairment data from the population-based CP register of western Sweden and population data from Statistics Sweden were used to compare surviving adults (n=581; 244 females, 337 males) born between 1959 and 1978, with the same cohort as children (n=723; 307 females, 416 males), andwiththe most recent cohort, born from 2007 to 2010 (n=205; 84 females, 121 males). Prevalence of CP in adults born between 1959 and 1978 was 1.14 per 1000. The occurrence of impairments differed between CP subtypes. Motor and intellectual impairment were closely related, regardless of subtype. Subtype distribution among survivors differed significantly from the original cohorts (p=0.002), and the most recent cohort (p<0.01), tetraplegia and dyskinetic CP being less common in survivors. Severe motor impairment, intellectual disability, and epilepsy were less common among survivors than in the original cohorts (p=0.004, p=0.002, p=0.037) and the most recent cohort (p=0.004, p=0.008, p<0.01). Data on prevalence, subtype distribution, and impairments in children with CP are not applicable to adults with CP. Population-based studies of adults with CP are needed. Cerebral palsy (CP) subtypes are differently distributed in adults compared to children. The prevalence of impairments in adults with CP is related to CP subtype. Spastic tetraplegia and dyskinetic CP are less common in adults than children. Severe motor impairment, intellectual disability, and epilepsy are less common in adults.

Comorbidities associated with cerebral palsy in children presenting at department of Pediatrics, K. T. children hospital Rajkot, India

Background: Cerebral palsy is a diagnostic term used to describe a group of motor syndromes resulting from disorder of early brain development. It describes a group of permanent disorders of the development of brain and posture causing activity limitation. The magnitude of cerebral palsy in our country is 2 to 2.5 per thousand live birth. The objective is to study co-morbidities associated in cerebral palsy patients.Methods: It was a hospital based cross sectional study carried out in KT Children Hospital, PDU Medical College, Rajkot for 1 year (April 2017-April 2018). Sample size: minimum 100 cases. Selection of subject: All the children suffering from cerebral palsy presenting at KT Children hospital, P.D.U. Medical college Rajkot, Gujarat. Cases were evaluated by history, clinical examination and necessary investigations.Results: From data collected in present study most common variety of Cerebral Palsy is spastic type (72.5%) followed by, dyskinetic (16%), ataxic (7%), and hypotonic (4.5%) type. Within spastic type; diplegic (48%) is the most common variety. Caesarean section delivered cases are more predisposed to Cerebral palsy in present study which might be due to other risk factors associated with it. Gender and consanguinity showed not major significance in association with CP child. Most of Cerebral palsy cases in present study were born full term (81.5%) and of normal birth weight (78.5%). The most common comorbidities in present study were cognitive impairment (77%) followed by epilepsy (38%), visual impairment (10%), hearing disability (9%) thyroid dysfunction (3%) and G.I. disturbances (2%). Perinatal asphyxia is the most common history finding in Cerebral palsy cases including in present study, followed by seizures during infancy, pathological jaundice, neonatal sepsis and history of NICU admission for any cause.Conclusions: Cerebral palsy in developing countries has a higher prevalence and different clinical profile regarding severity and associated disability. The perinatal and high-quality neonatal care together with physical therapy and rehabilitation programs have a significant role in preventing comorbidities in cerebral palsy cases, which is still lacking in developing countries.

Metabolomic Profiling of Cerebral Palsy Brain Tissue Reveals Novel Central Biomarkers and Biochemical Pathways Associated with the Disease: A Pilot Study.

Cerebral palsy (CP) is one of the most common causes of motor disability in childhood, with complex and heterogeneous etiopathophysiology and clinical presentation. Understanding the metabolic processes associated with the disease may aid in the discovery of preventive measures and therapy. Tissue samples (caudate nucleus) were obtained from post-mortem CP cases (n = 9) and age- and gender-matched control subjects (n = 11). We employed a targeted metabolomics approach using both 1H NMR and direct injection liquid chromatography-tandem mass spectrometry (DI/LC-MS/MS). We accurately identified and quantified 55 metabolites using 1H NMR and 186 using DI/LC-MS/MS. Among the 222 detected metabolites, 27 showed significant concentration changes between CP cases and controls. Glycerophospholipids and urea were the most commonly selected metabolites used to develop predictive models capable of discriminating between CP and controls. Metabolomics enrichment analysis identified folate, propanoate, and androgen/estrogen metabolism as the top three significantly perturbed pathways. We report for the first time the metabolomic profiling of post-mortem brain tissue from patients who died from cerebral palsy. These findings could help to further investigate the complex etiopathophysiology of CP while identifying predictive, central biomarkers of CP.

Japan Obstetric Compensation System for Cerebral Palsy: Strategic system of data aggregation, investigation, amelioration and no-fault compensation.

The Japan Obstetric Compensation System for Cerebral Palsy (JOCS-CP), which investigates, develops preventive mechanisms and awards monetary compensation, to cases of cerebral palsy was urgently introduced in 2009 in response to growing concern about Japan's deteriorating perinatal care and low birthrate. Under the political leadership, the Japan Council for Quality Health Care launched the JOCS-CP with support of various stakeholders. The JOCS-CP features of no-fault-based compensation which was discussed decades ago in the Japan Medical Association aiming at financial aid to patient and family and early settlement of dispute. As of 2017, 2233 petitions had been approved by the Review Committee for compensation. All the approved cases were consecutively put on analysis in the Investigation Committee which has compiled more than 1000 Investigative Reports. The reports were delivered not only to the childbirth facility but to the guardians/families. Survey revealed that most of childbirth facility and the guardians/families responded in favor of the reports. With regard to amelioration of profound cerebral palsy, the Prevention Report has been published on annual basis through analysis of all the Investigative Reports. The Prevention Reports and other educational materials were produced and distributed not only among medical professionals but among pregnant women. It is notable that the number of lawsuit filing related to obstetrics demonstrated rapid decrease compared to that of other medical specialties. The JOCS-CP could be described as a social experiment. It was overhauled in 2015 but deserves further discussion on reform for evolving into better system.

Anorexia and supracondylar fracture of the femur following surgery for bilateral lower limb joint contracture in a case of severe cerebral palsy with mental retardation: a case report.

Objective: Postoperative management of children having cerebral palsy (CP) with mental retardation is difficult. This report presents a case of severe CP with mental retardation, which resulted in anorexia and condylar fracture of the femur following a surgery for bilateral lower limb joint contracture.Case report: A 14-year-old male was diagnosed with CP having severity of Gross Motor Functional Classification System Level V, and severe mental retardation. Due to bilateral spasticity in hip adduction, knee flexion, and valgus of the feet, tenotomies of the adductors of both hips, bilateral lengthening of the hamstrings and bilateral tenotomy of the peroneal tendons were performed. At 4 weeks postoperatively, knee casts were used; thereafter, knee extension braces were attached for 12 weeks. After surgery, he showed severe anorexia for 8 weeks and weight loss of 8.8 kg (from 35.2 kg to 26.4 kg) during the 4 months of hospitalization. Six months postoperatively, he was diagnosed with supracondylar fracture of the right femur.Discussion: Severe CP with mental retardation requires attention to the physical symptoms caused by stress related to the hospitalization, surgery, fixation by casts, and braces. Moreover, care must be taken not to increase the risk of fracture by fixation or immobility of the postoperative cast, because it can lead to the progression of low bone mineral density.

Clinical, brain imaging, and electroencephalogram evaluation of cases of cerebral palsy with epilepsy

Background Cerebral palsy (CP) is a chronic disorder of movement and posture. It is the result of a nonprogressive damage of immature nervous system caused by several factors that have occurred in prenatal, perinatal, or postnatal periods. Epilepsy is one of the most common problems among patients with CP. Objectives The aim of the study was to evaluate patients with epileptic CP by clinical findings, electroencephalogram (EEG), as well as cranial MRI findings. Patients and methods This cross-sectional study was conducted on 70 patients, seen at pediatric neurology clinics at Al-Azhar University Hospitals. All patients were subjected to detailed medical history, detailed general and neurological examination, EEG, and MRI brain. Result Spastic quadriplegia was the most common type, seen in 29 (41.4%) cases. Generalized tonic–clonic seizure was the most common type of convulsion in our cases (42.9%). EEG abnormalities were commonly seen in CP with epilepsy (78.6%). The most common MRI scan abnormalities in epileptic children with CP were brain atrophy. Conclusion Spastic quadriplegia is the most common type of CP associated with seizures. EEG is a useful tool in detecting types of electrical discharges. MRI is the most useful tool in detecting the etiology of CP.

Cranial MR characteristics of Cerebral Palsy cases and correlation of findings with clinical results.

Ali A, Yalçın R, Ünlüer-Gümüştaş A. Cranial MR characteristics of Cerebral Palsy cases and correlation of findings with clinical results. Turk J Pediatr 2019; 61: 525-537. The aim of this study was to compare cranial Magnetic Resonance (MR) imaging findings in cerebral palsy (CP) patients with clinical findings and evaluate damage ascribed to prenatal, natal and postnatal reasons by preterm, term or postterm characteristics. One thousand, one hundred CP patients registered at Dr. Ayten Bozkaya State Hospital of Cerebral Palsy Children and Rehabilitation Center from 2007 to 2010 were included in the study retrospectively. Cranial MR images studied in Bursa State Hospital Radiology Unit were evaluated by `a single senior MRI radiologist`. The most common abnormality was cerebral atrophy (80.2%) followed by periventricular leukomalacia (PVL) (49.9%). The most common type was spastic tetraplegia (67.9%), and the second most common type was hypotonic CP (15.6%). The percentage of congenital central nervous system (CNS) abnormality was 14.09%. The most common abnormality was corpus callosum (CC) agenesis and colpocephaly (2.3%). The least common conditions were cortical dysplasia, heterotopia and rhombencephalosynapsis. The percentage of cases born to consanguineous parents was 19.2%. In Hypoxic Ischemic Encephalopathy (HIE) patients born to consanguineous parents, PVL was cystic and moderate. Consanguineous marriage was statistically significant in the patients with cortical dysplasia and heterotopia (p < 0.04), delay in myelination (p < 0.001) and thalamus involvement (p < 0.008). Consanguineous marriage was also statistically significant in spastic diparetic (p < 0.017), hypotonic (p < 0.001) and bedridden patients (p < 0.006). The presence of both congenital CNS anomaly and PVL was only revealed in spastic tetraparetic type. Twentynine% of the cases were premature, while 66.4% were term children. Low birth weight (32.7%) constituted a risk factor for all clinical types, except mixed type CP. The percentage of patients with natal causes only was 21.5%. Kernicterus, cerebrovascular causes and HIE accounted for 6.3%, 2.9% and 54.4% of the cases, respectively. This study may indicate the importance of consanguineous marriage, natal and postnatal care properties as the underlying causes of CP beyond the clinical management related to delivery and allow us to identify strategies for possible measures.

20: Induction of labor versus expectant management at 39 weeks: a cost-effectiveness analysis

A recent study found that induction of labor at 39 weeks for low-risk women was not associated with an increased risk of adverse neonatal outcomes. We sought to examine the cost-effectiveness and outcomes associated with induction of labor at 39 weeks versus expectant management. A cost-effectiveness model using TreeAge software was designed to compare outcomes in women who were induced at 39 weeks versus expectantly managed. We used a theoretical cohort of 1.6 million women, the approximate number of nulliparous term births in the US annually that are considered low risk. Outcomes included mode of delivery, preeclampsia, macrosomia, intrauterine fetal demise, permanent brachial plexus injury, cerebral palsy, and neonatal death, in addition to cost and quality-adjusted life years (QALY) for both the woman and neonate. Probabilities were derived from the literature, and a cost-effectiveness threshold was set at $100,000/QALY. In our theoretical cohort of 1.6 million women, induction of labor resulted in 49,449 fewer cesarean deliveries and 79,152 fewer cases of preeclampsia. Additionally, we found that induction of labor resulted in 795 fewer cases of intrauterine fetal demise and 49 fewer neonatal deaths, despite 50 more cases of brachial plexus injury and 54 cases of moderate cerebral palsy (Table 1). Induction of labor resulted in increased costs, but increased QALYs with an incremental cost-effectiveness ratio of $97,501 per QALY. Univariate sensitivity analysis demonstrated that induction of labor was cost-effective until the cost of induction exceeded $2000 (Figure 1). In our theoretical cohort, induction of labor in nulliparous term women at 39 weeks of gestation resulted in improved outcomes, but increased costs. The cost-effectiveness ratio was marginally cost effective, but would lead to an additional $2.26 billion of health care costs. Whether individual clinicians and healthcare systems offer routine induction of labor at 39 weeks will need to depend on local capacity and patient preferences.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Comparison of Cerebral Palsy Severity Between 2 Eras of Antenatal Magnesium Use

This before-and-after cohort analysis assesses whether implementing a recommendation of antenatal magnesium use at an institutional level in 2009 resulted in fewer subsequent cases of moderate or severe cerebral palsy.

Rise &amp; Fall of Fetal Heart Rate, the Principle of Fetal Monitoring: Hypoxia Index prevents Cerebral Palsy

As FHR rises by the fetal brain excitation with fetal movement, and FHR falls by the excitation of fetal vagus nerve center with hypoxic stimulation, hypoxic grade is numerically known by the hypoxia index, which is the sum of FHR deceleration duration (min) divided by the lowest FHR (bpm), and multiplied by 100, where all of 6 cerebral palsy cases’ hypoxia index were 25 or more, while the hypoxia index of all 16 no cerebral cases were 24 or less, thus, cerebral palsy is prevented, if the hypoxia index is 24 or less in full course of fetal monitoring. It is the first numeric threshold setting to prevent cerebral palsy in 50 years’ history of fetal monitoring.

Risk of cerebral palsy by gestational age among pregnancies at-risk for preterm birth

Objective: Our objective was to describe cerebral palsy (CP) incidence stratified by gestational age (GA) groups within a group at risk for spontaneous preterm birth (sPTB).Study design: This is a secondary analysis of a large study of magnesium for neuroprotection. Nonanomalous, singleton gestations complicated by preterm premature rupture of membranes (PPROM) or preterm labor (PTL) were included. Infants that developed CP were compared to controls that did not. The incidence of CP was stratified by GA groups. A logistic regression model was fit to adjust for confounders.Results: Of 1747 included pregnancies, 75 (4.3%) were affected by CP. Increasing GA at delivery was associated with lower rates of CP (RR 0.96, 95% CI 0.95–0.97; p<.0001). The most significant risk factor for CP was neonatal sepsis while the most significant protective factors were magnesium and antibiotic exposure. In the adjusted analysis, magnesium exposure (aRR 0.52, 95% CI 0.33–0.84; p = .007) and antibiotic exposure (aRR 0.52, 95% CI 0.28–0.95; p = .034) remained protective.Conclusion: The risk of CP among populations at high risk for sPTB decreases with advancing GA. While the majority of cases of CP occurred in children born <34 weeks, residual risk persisted thereafter. The effect of magnesium exposure is most pronounced before 28 weeks.

Risk management and provider liabilities in infantile cerebral palsy based on malpractice litigation cases

AimInfantile cerebral palsy (CP) severely affects the survival and quality of life of infants. CP is typically caused by multiple factors, leading to causal uncertainty of the role of medical errors in CP and resulting in frequent medical disputes. No relevant research exists on risk management and malpractice liabilities in CP, including in China. MethodA retrospective analysis of 400 CP malpractice litigation cases from 18th June 1999 to 23rd November 2017, collected from China Judgments Online, included basic case information, CP risk factors, medical errors, medical malpractice liability determination, and compensation. ResultsUp to 63.5% of infants with CP were affected by asphyxia, followed by hypoxic-ischemic encephalopathy (63.3%), neonatal infection (52.3%) and intracranial hemorrhage (36.0%). Most (89.1%) of civil judgments resulted in liability for medical errors, with the highest proportion of ultimate liability. The three most frequent medical errors were failure of completing delivery in time (30.2%), incomplete assessment of birth process detection (28.8%), and nonstandard medical records (25.3%). Each case involved 2.5 medical errors on average. No difference in the distribution of medical errors between premature and full-term CP infants (P > 0.05) was found. Compensation for damage was awarded in 91.4% of claims, and the mean value of compensation was $73,506. The mean value of the total actual loss of the family was $128,198. InterpretationContradictions between the doctors and patients were prominent in malpractice CP litigation cases, with a total loss of $3.97 billion attributable to new CP cases in China in 2017. Asphyxia was the most frequent risk factor for CP since it may easily draw the attention of the sufferer's family. Medical service providers did not pay attention to risk management in preterm infants. The importance of fetal monitoring and standardized medical record writing should be emphasized.

Comorbidity of infantile cerebral palsy and benign epileptiform EEG discharges of childhood in dizygotic twins

The article presents a clinical case of infantile cerebral palsy combined with BEDC (with no epileptic seizures) in dizygotic twins. The case supports the hypothesis of genetic nature of the BEDC patterns. The variety of EEG characteristics and clinical courses of the disease in children with cerebral palsy and BEDC are reviewed. Correct interpretation of the EEG findings provides an accurate prognosis of seizures and cognitive functions, as well as the patient management tactics. In these patients, continuous video EEG monitoring (both awake and sleeping) is recommended for a long-time follow-up.

Decreasing prevalence of cerebral palsy in birth cohorts in South Carolina using Medicaid, disability service, and hospital discharge data, 1996 to 2009.

Since cross-sectional trends of 8-year-old cerebral palsy (CP) birth prevalence based on record review were stable from 1985 to 2002 in Metropolitan Atlanta, we examined birth cohort trends using administrative data sets promptly. Among 755433 live births from 1996 to 2009 in South Carolina, 2080 received CP diagnosis by age 4 years from linked Medicaid claims with International Classification of Diseases, Ninth Revision codes 343.X (contributing 1061 [51%] unique cases), hospital discharge data (57 [3%] unique cases), and Department of Disabilities and Special Needs program (64 [3%] unique cases). Trends were assessed using negative binominal regression. Including 3.7 percent of cases who died before age 4 years, CP prevalence per 1000 live births decreased significantly from 3.6 in 1996 to 2.1 in 2006 (-3.0% average annual change; 95% confidence interval -4.4 to -1.6). The overall prevalence was 2.8 per 1000 live births, 46.0 per 1000 very-low-birthweight (VLBW) live births, and 53.0 per 1000 VLBW 1-year survivors. Disparities and downward trends persisted across subgroups with higher rates among non-Hispanic black infants than non-Hispanic white and among males compared to females. Downward CP prevalence rates and persistent disparities remain in South Carolina. Further research should validate this methodology, including early deaths, and develop broad surveillance systems to inform clinical practices and etiology. Birth cohort cerebral palsy (CP) prevalence decreased in South Carolina from 1996 to 2009. CP prevalence was higher in very-low-birthweight infants, non-Hispanic blacks, and males. Three administrative data sets captured 2080 patients with CP in South Carolina. Medicaid claims contributed 51% of unique cases of CP to the cohort. CP diagnoses included 76 patients who died before age 4 years.

A machine learning approach to identify cases of cerebral palsy using the UK primary care database

BackgroundCerebral palsy is a complex condition that can manifest in different ways, and diagnosis is likely to be under-recorded in primary care databases. This study aimed to identify potential unrecorded cases based on other available information in patients' medical records. MethodsA machine learning approach was used to identify likely cases of cerebral palsy in live births between Jan 1, 1990, and April 30, 2016, in the Clinical Practice Research Datalink (CPRD), a UK primary care database. Firstly, we made a preliminary selection of predictor variables (medical and drug codes) by comparing their relative frequencies associated with known cases and with the remaining non-cases; secondly, we reduced the number of variables using the random forest method based on a resampled balanced population; thirdly, we used a logistic regression model with selected codes to predict the probability for cerebral palsy; and lastly, the medical records of identified likely cases were manually reviewed with expert clinical knowledge to validate the cases. Scientific approval for this study was given by the CPRD Independent Scientific Advisory Committee. FindingsOf 485 709 live births, 664 (0·14%) were initially identified as known cases of cerebral palsy using 43 validated diagnostic codes. 175 of 31 605 codes in the records were discovered more frequently in known cases of cerebral palsy than in non-cases. 35 of the most informative codes (eg, skeletal muscle relaxants, prematurity, and being seen in paediatric clinic) were selected and used to build the logistic prediction model, which yielded 787 most likely cases (with predicted probability for cerebral palsy ≥0·975). On the basis of evidence of both motor disorder and brain injury, after manual review of medical records, 405 children were validated as cases additional to the known cases, resulting in a cerebral palsy prevalence of 0·22% in live births, which is comparable to existing evidence. InterpretationData-driven schemes, such as random forests, have the potential of identifying the most informative predictors in a cost-effective way to reliably identify potential unrecorded cases of cerebral palsy or other complex medical conditions in primary care databases. FundingEconomic and Social Research Council (grant ref ES/L007517/1).