Cerebral Palsy Patients Research Articles

Current Concept and Management of Spastic Hip in Children: A Narrative Review.

Cerebral palsy (CP) is a non-progressive motor condition that hinders the development of movement and posture. One of the common problems faced in CP is spastic hips, which can cause discomfort, deformity, and functional restrictions. This review article seeks to offer a thorough summary of the most recent methods for treating spastic hips in cerebral palsy patients. Additionally, it describes the success and potential risks of various conservative and surgical procedures. It also looks at new treatments and potential avenues for managing this complicated ailment.

Alterations in Satellite Cell Differentiation from Young Patients with Cerebral Palsy

Cerebral Palsy (CP) is one of the most common lifelong conditions leading to childhood physical disability, affecting approximately 1.6 in 1000 live births. Literature reported muscle alterations of CP patients in comparison to Typically Developing (TD) children such as fibrotic tissue accumulation and reduced Satellite Cell (SC) numbers with altered fusion capacity. To better understand the observed CP muscle phenotype, we quantified and investigated SC-progenitors of the Medial Gastrocnemius from young patients with CP (n=17, aged 3-9 years, GMFCS levels I-III) and age-matched TD children (n=12). We found an increased myotube diameter and a higher amount of nucleus clusters in CP-derived myotubes compared to TD-derived myotubes. Additionally, these nucleus accumulations were larger and less linear in SCs from children with CP compared to TD. Further, no altered expression levels of multiple genes associated with SC differentiation, fusion and nuclear positioning involved in other muscle disorders have been observed. In conclusion, we unprecedently quantified altered differentiation features of SCs from CP muscles with unaltered gene hallmarks of myopathies. Further research would be needed to elucidate pathophysiological mechanisms related to the altered SC properties observed in CP muscles and its impact on in vivo muscle functioning.

Effects of non-immersive virtual reality intervention on children with spastic cerebral palsy: a meta-analysis and systematic review.

This review aimed to assess the effectiveness of non-immersive virtual reality intervention compared to traditional rehabilitation in improving the functions of the upper and lower extremities, balance, and social participation among children with spastic cerebral palsy. We used librarian-designed searches of 10 databases to identify research articles on randomized controlled trials that assessed the effectiveness of non-immersive virtual reality in intervening spastic cerebral palsy patients up to 4/15/2023. Independent evaluation was conducted by two trained investigators using the evaluation criteria of RCT quality indicated in the Cochrane Manual of Assessment 'risk- of- bias tool.' The PEDro scale was used to evaluate the method and quality of the literature. 21 research articles involving 779 patients with spastic cerebral palsy were included. Significant differences between the non-immersive virtual reality rehabilitation and traditional rehabilitation groups were observed in all indicators, except for the Jebsen-Taylor Hand Function Test. Non-immersive virtual reality intervention is effective in improving the function of the lower extremity, balance, and social participation in children with spastic cerebral palsy, but its effect on upper limb function is still controversial.

Electrical Stimulation for Children with Cerebral Palsy: A Meta-analysis for Randomized Controlled Trials.

Different types of electrical stimulation (ES) showed diverse effects on children with cerebral palsy (CP). Previous studies reported inconsistent results for effects of ES on children with CP. The present study aimed to conduct a meta-analysis to summarize these diverse results. We searched for studies exploring effects of ES on children with CP in databases (PubMed and Web of Science) from their inception until December 2022. Standard mean differences (SMDs) and 95% confidence intervals (CIs) were computed using STATA 12.0 software. The meta-analysis included 19 randomized controlled trials (including 265 CP patients in test group and 263 CP patients in corresponding control group). The study showed an increased improvement in gross motor function, walking speed, step length, and daily living activities in ES group compared with corresponding control group with random effects models (gross motor function: SMD = 2.04, 95% CI = 1.43-2.65; walking speed: SMD = 3.71, 95% CI = 1.49-5.92; step length: SMD = 1.89, 95% CI = 0.65-3.13; daily living activities: SMD = 5.18, 95% CI = 3.04-7.31), whereas the study showed no significant difference in change of muscle strength between ES group and the corresponding control group with a random effects model (SMD = 0.42, 95% CI = -0.12 to 0.97). The study demonstrated that ES might be used as therapy to improve gross motor function, gait, and daily living activities in children with CP.

Design and Implementation of a Portable Knee Actuator for the Improvement of Crouch Gait in Children with Cerebral Palsy.

Common manifestation of spastic Cerebral Palsy (CP) are abnormal gait pathologies. These conditions require greater energy expenditure to successfully ambulate and are linked with significant deterioration in joint health and childhood musculoskeletal development. Crouch gait presents with knee hyperflexion throughout stance due to extensor muscle weakness and spasticity in flexor muscles stemming from neurological damage. The goal of this study was to develop a wearable cable-driven robotic system that applies controlled perturbation to the knee joint during overground walking in children with CP. Two children with spastic CP were recruited in this pilot study. They were tested in two conditions, i.e., applying knee resistance vs. knee assistance during overground walking. Kinematic and EMG data were recorded during overground walking. Data indicated that it was feasible to apply controlled knee perturbation torque during overground walking in children with crouch and preliminary results showed an improvement in crouch gait pattern in children with CP after one session of walking with the robotic system.Clinical Relevance- This study might have a potential clinical significance modifying neuromuscular control of CP patients with Crouch Gait.

Safety and Effectiveness of Percutaneous Endoscopic Gastrostomy in Children

Objective: To determine the safety and effectiveness of percutaneous endoscopic gastrostomy in Paediatrics population. Study Design: Prospective longitudinal study. Place and Duration of Study: Department of Pediatric Gastroenterology, Pak Emirates Military hospital, Rawalpindi Pakistan, from Mar 2014 till Dec 2017. Methodology: Total 40 children who underwent percutaneous gastrostomy at the Paediatric gastroenterology department were included in the study. Patients were followed up for a period for 6 months. Demographic data, indications, weight gainand complications were noted for 6 months after the procedure. Results: Forty patients were enrolled and there were 23(57.5%) males with mean age of 39.8±20.2 months. Swallowing difficulty 23(47.5%) was the major indication followed by poor weight gain 10(25%), prolonged nasogastric tube feeding8(20%) and frequent aspirations 3(7.5%). Majority 32(80%) had underlying diagnosis of cerebral palsy. In six months follow up, 38(95%) children had an increment in weight (mean weight gain 1.89±1.0Kg). Early feed at 6 hours after procedure was tolerated by 38(95%) of patients. The majority of children did not have any complications and only few were observed to havewound infection, vomiting, and irritability in 3(7.50%), 1(2.50%) and 3(7.50%) respectively. Conclusion: Percutaneous endoscopic gastrostomy placement is a minimally invasive, safe and effective feeding technique for neurologically impaired children, especially cerebral palsy patients requiring long term assisted feeding.

The Relationship Between Speech Delay with Cerebral Palsies in Children at Rs Haji Medan

Speech delay in children is a condition in which the child's expressive language development is inappropriate or below his age. The incidence of speech delay for Indonesian children who are not in school yet reaches 5–10%. There are more male children with speech disorders than females. The causes of speech delay can be hearing loss, cerebral palsy, low thinking ability, or autism. Cerebral palsy patients may experience uncontrollable movements and muscle spasms in the mouth. This will have an impact on the development of children's speech. This research is a descriptive-analytical study with a cross-sectional approach. The subjects of this study are patients with cerebral palsy in RS Haji Medan, with a total sample size of 132 people. Data analysis using the Chi-square tes. There was a significant relationship between speech delay and cerebral palsy among pediatric patients in RS Haji Medan. The result using Fisher’s exact test showed a P value less than 0.05, which validated the hypothesis. There was a significant relationship between speech delay and cerebral palsy among pediatric patients in RS Haji Medan.

Abnormal gait partitioning and real-time recognition of gait phases in children with cerebral palsy

ObjectiveSince the gait of children with cerebral palsy (CP) lacks distinct foot event characteristics, it’s difficult to accurately distinguish the key gait events, especially in the stance phase. To solve the problem of gait phase detection for children with CP, a unique gait classification system is designed to detect the walking maneuvers during a gait cycle. This system can detect all gait phases of CP patients, and send the kinematic information to a rule-based algorithm through a series of sensors installed in the legs to identify the salient features of the signal. MethodsIn the light of the quasi-stiffness gait phase transformation as the classification guide, two sets of motion signal feature sets are extracted from the leg feature signals of 10 CP children, and two gait stage recognition algorithms are proposed to divide the six gait sub-phases. ResultsThe proposed algorithms of peak-zero-based angular velocity and thresholding-based angular realize the effective recognition of gait phases, especially for the stance phase. ConclusionThe proposed methods have the potential to obtain correct decoding of motion information and recognize gait phases. Significance: This study provides a new idea to solve the problem of difficult identification of gait phase for children with CP, which can be applied to a behavior-driven lower limb exoskeleton robot system for assisting walking and gait correction.

Effect of Whole Body Vibration Therapy on Spasticity, Balance, Fine and Gross Motor Functions in Patients with Spastic Cerebral Palsy: A Systematic Review of RCTs

Context: Cerebral palsy is condition that is caused by neurological damage, which leads to problems in the somatosensory systems. It can cause spasticity in the involved muscles leading to poor function, limitations in range of motion, poor balance and coordination. Therapeutic use of whole-body vibration therapy for the management of the mentioned symptoms have been reported in the literature. This review study examines the effect of whole-body vibration on spasticity, balance and function and summarizes the effective protocols of whole-body vibration therapy for the cerebral palsy patients. Methods: Three following databases were searched comprehensively: Pubmed, PEDro and Cochrane. The selection criteria for the research papers were based on; (1) human studies with Patient-Intervention-Comparison-Outcomes-Study design (PICOS) method, according to which, P = spastic cerebral palsy; I = Whole Body Vibration; C = comparison with conventional/traditional physiotherapy; O = dynamic balance, spasticity, functional balance, fine and gross motor hand function, hand grip strength, Balance Quantification and Range of Motion; and S = Randomized controlled trials, (2) Published in English Language (3) Full Text Available (4) The PEDro scale on which the score is greater than 4 out of 10. Results: Nine RCTs were included based on the inclusion criteria. This systematic review showed that whole body vibration therapy can produce positive therapeutic effects on spasticity, balance, fine and gross motor function, muscle strength and range of motion. This modality can be used independently or in combination with the conventional physical therapy. No harm has been reported in the literature. Conclusion: It can be concluded that whole body vibration therapy is safe, cost effective and fairly simple therapeutic modality that can be used at home or in clinical settings to produce a significant change in spasticity, static and dynamic balance, motor function and range of motion. Keywords: Balance, Cerebral Palsy, Motor Function, Spasticity, Whole body vibration therapy

Machine learning-based prediction of joint moments based on kinematics in patients with cerebral palsy

Joint moments during gait provide valuable information for clinical decision-making in patients with cerebral palsy (CP). Joint moments are calculated based on ground reaction forces (GRF) using inverse dynamics models. Obtaining GRF from patients with CP is challenging. Typically developed (TD) individuals' joint moments were predicted from joint angles using machine learning, but no such study has been conducted on patients with CP. Accordingly, we aimed to predict the dorsi-plantar flexion, knee flexion–extension, hip flexion–extension, and hip adduction-abduction moments based on the trunk, pelvis, hip, knee, and ankle kinematics during gait in patients with CP and TD individuals using one-dimensional convolutional neural networks (CNN). The anonymized retrospective gait data of 329 TD (26 years ± 14, mass: 70 kg ± 15, height: 167 cm ± 89) and 917 CP (17 years ± 9, mass:47 kg ± 19, height:153 cm ± 36) individuals were evaluated and after applying inclusion–exclusion criteria, 132 TD and 622 CP patients with spastic diplegia were selected. We trained specific CNN models and evaluated their performance using isolated test subject groups based on normalized root mean square error (nRMSE) and Pearson correlation coefficient (PCC). Joint moments were predicted with nRMSE between 18.02% and 13.58% for the CP and between 12.55% and 8.58% for the TD groups, whereas with PCC between 0.85 and 0.93 for the CP and between 0.94 and 0.98 for the TD groups. Machine learning-based joint moment prediction from kinematics could replace conventional moment calculation in CP patients in the future, but the current level of prediction errors restricts its use for clinical decision-making today.

System identification: a feasible, reliable and valid way to quantify upper limb motor impairments

BackgroundUpper limb impairments in a hemiparetic arm are clinically quantified by well-established clinical scales, known to suffer poor validity, reliability, and sensitivity. Alternatively, robotics can assess motor impairments by characterizing joint dynamics through system identification. In this study, we establish the merits of quantifying abnormal synergy, spasticity, and changes in joint viscoelasticity using system identification, evaluating (1) feasibility and quality of parametric estimates, (2) test–retest reliability, (3) differences between healthy controls and patients with upper limb impairments, and (4) construct validity.MethodsForty-five healthy controls, twenty-nine stroke patients, and twenty cerebral palsy patients participated. Participants were seated with the affected arm immobilized in the Shoulder-Elbow-Perturbator (SEP). The SEP is a one-degree-of-freedom perturbator that enables applying torque perturbations to the elbow while providing varying amounts of weight support to the human arm. Participants performed either a ‘do not intervene’ or a resist task. Elbow joint admittance was quantified and used to extract elbow viscosity and stiffness. Fifty-four of the participants performed two sessions to establish the test–retest reliability of the parameters. Construct validity was assessed by correlating system identification parameters to parameters extracted using a SEP protocol that objectifies current clinical scales (Re-Arm protocol).ResultsFeasibility was confirmed by all participants successfully completing the study protocol within ~ 25 min without reporting pain or burden. The parametric estimates were good with a variance-accounted-for of ~ 80%. A fair to excellent test–retest reliability was found (ICC = 0.46-0.98) for patients, except for elbow stiffness with full weight support (ICC = 0.35). Compared to healthy controls, patients had a higher elbow viscosity and stiffness during the ‘do not intervene’ task and lower viscosity and stiffness during the resist task. Construct validity was confirmed by a significant (all p<0.03) but weak to moderate (r = 0.36-0.50) correlation with parameters from the Re-Arm protocol.ConclusionsThis work demonstrates that system identification is feasible and reliable for quantifying upper limb motor impairments. Validity was confirmed by differences between patients and controls and correlations with other measurements, but further work is required to optimize the experimental protocol and establish clinical value.

Risk Factors for Mortality in Patients With Cerebral Palsy: A Systematic Review and Meta-Analysis.

Cerebral palsy (CP) is a developmental and physical disorder with different degrees of severity. Since CP manifests itself in early childhood, numerous research studies have concentrated on children with CP. Patients with CPencounter different severity of motor impairments attributed to the damage or disturbance to the fetal or infant developing brain, which begins in early childhood and persists through adulthood. Patients with CP are more prone to mortality compared to the general population. This systematic review and meta-analysis aimed to assess the risk factors that predict and influence mortality in patients with CP. Systematic search for studies assessing the risk factors for mortality in CP patients that were conducted from 2000 to 2023 in Google Scholar,PubMed, and Cochrane Library was performed. R-One Group Proportion was used for statistical analysis and Newcastle-Ottawa Quality Assessment Scale (NOS) for quality appraisal. Of the 1791 total database searches, nine studies were included. Based on the NOS tool for quality appraisal, seven studies were of moderate quality, and two studies were rated as of high quality. The risk factors included pneumonia and other respiratory infections, neurological disorders, circulatory diseases, gastrointestinal infections, and accidents. Pneumonia (OR = 0.40, 95% CI = 0.31 - 0.51), neurological disorders (OR = 0.11, 95% CI = 0.08 - 0.16), respiratory infections (OR = 0.36, 95% CI = 0.31 - 0.51), cardiovascular and circulatory diseases (OR = 0.11, 95% CI = 0.04 - 0.27), gastrointestinal and metabolic causes (OR = 0.12, 95% CI = 0.06 - 0.22), and accidents (OR = 0.05, 95% CI = 0.04 - 0.07) were the risk factors assessed. It was concluded that multiple factors predict the risk of mortality in patients with CP. Pneumonia and other respiratory infections are associated with a high risk of mortality. Cardiovascular and circulatory diseases, gastrointestinal and metabolic disorders, and accidents are strongly linked to mortality in CP patients.

Unsupervised machine learning effectively clusters pediatric spastic cerebral palsy patients for determination of optimal responders to selective dorsal rhizotomy

Selective dorsal rhizotomy (SDR) can reduce the spasticity in patients with spastic cerebral palsy (SCP) and thus improve the motor function in these patients, but different levels of improvement in motor function were observed among patients after SDR. The aim of the present study was to subgroup patients and to predict the possible outcome of SDR based on the pre-operational parameters. A hundred and thirty-five pediatric patients diagnosed with SCP who underwent SDR from January 2015 to January 2021 were retrospectively reviewed. Spasticity of lower limbs, the number of target muscles, motor functions, and other clinical parameters were used as input variables for unsupervised machine learning to cluster all included patients. The postoperative motor function change is used to assess the clinical significance of clustering. After the SDR procedure, the spasticity of muscles in all patients was reduced significantly, and the motor function was promoted significantly at the follow-up duration. All patients were categorized into three subgroups by both hierarchical and K-means clustering methods. The three subgroups showed significantly different clinical characteristics except for the age at surgery, and the post-operational motor function change at the last follow-up in these three clusters was different. Three subgroups clustered by two methods could be identified as “best responders”, “good responders” and “moderate responders” based on the increasement of motor function after SDR. Clustering results achieved by hierarchical and K-means algorithms showed high consistency in subgrouping the whole group of patients. These results indicated that SDR could relieve the spasticity and promote the motor function of patients with SCP. Unsupervised machine learning methods can effectively and accurately cluster patients into different subgroups suffering from SCP based on pre-operative characteristics. Machine learning can be used for the determination of optimal responders for SDR surgery.

Rectal prolapse in a 30-year-old bladder stone male patient: A case report

Rectal prolapse occurs most commonly in children and middle-aged and elderly women and is relatively rare in young men and is occasionally caused by bladder stones. Severe rectal prolapse, bilateral hydronephrosis, and renal insufficiency caused by bladder stones are rare in a 30-year-old man. We report the case of a 30-year-old male patient with cerebral palsy who presented with a large bladder stone that resulted in severe rectal prolapse, bilateral hydronephrosis, and renal insufficiency. Following a definitive diagnosis, the bladder stone was successfully removed, and his kidney function returned to normal. We assessed the patient's nutritional status and stone composition and concluded that the main cause was malnutrition. Rectal prolapse is a rare clinical manifestation of bladder stones, particularly in young adults. Cerebral palsy patients are a vulnerable group in society because of their intellectual disabilities and communicative impairments. Accordingly, besides taking care of their daily diet, abnormal signs in their bodies should receive the doctors' attention in a timely manner.

Caractéristiques cliniques, épidémiologiques et facteurs associés aux fonctions motrices globales chez les enfants atteints de paralysie cérébrale au Nord-ouest du Maroc

The objective is to study the epidemiological and clinical profile and determine the factors associated with gross motor function in cerebral palsy patients. We conducted a descriptive cross-sectional study with prospective collection of patients (between 0–16 years old) who were diagnosed as cerebral palsy and referred for possible treatment at the reception and rehabilitation center for maladjusted children during the period. from July 01, 2021 to 01 June, 2022. Patients with progressive encephalopathy and those with genetic neurological pathology were excluded. A total of 117 children meeting the inclusion criteria were recruited. The male sex was the most represented with a sex ratio of 1.60. The mean age at diagnosis was 26.9 (±12.46) months or 2.24 years. The aetiologies found were mainly perinatal with a frequency of 67%, mainly dominated by prematurity. Spastic cases were the most dominant (71.4%), topographically, (73.2%) of our population was quadriplegic, on the GMFCS, children classified as grade IV and V tend to represent two thirds of our population. population. CT abnormalities were found in 83.8 % of patients who were able to perform a brain scan. In total, 63.6 % of patients presented with seizures as an associated disorder. The main aetiologies of cerebral palsy are perinatal causes mainly dominated by prematurity, neonatal asphyxia and sequelae of kernicterus, health programs should focus on areas aimed at improving prevention, care and education of the various stakeholders.

The Oral Health of Cerebral Palsy Patients in Pakistan: A Neglected Domain

The Oral Health of Cerebral Palsy Patients in Pakistan: A Neglected Domain

The Reliability of Intraoperative Hip Arthrography in Cerebral Palsy Hip Reconstruction

Background: This study investigates surgeon interpretation of intraoperative hip arthrography after femoral osteotomy to guide decision-making regarding addition of concomitant pelvic osteotomy (PO) for Cerebral Palsy (CP) hip reconstruction.Methods: Ten orthopaedic surgeons reviewed preoperative radiographic images of 21 children with CP, undergoing hip reconstruction. Surgeons recorded if PO was indicated after 1) reviewing the preoperative radiographs. Raters who exhibited poor reliability (kappas <0.60) were excluded from arthrogram analysis. Agreement in decision-making was evaluated by estimating the concordance across six raters with respect to changing their recommendation after reviewing the arthrogram images by estimating Fleiss's kappa coefficient.Results: Intra-rater reliability for the three surgeons who conducted repeat evaluations was substantial to almost perfect (k=0.67, 0.86, 1.00). Pairwise inter-rater reliability for radiographic decision was moderate to almost perfect with kappa values ranging from 0.56 to 0.87. In 20 of 32 hip evaluations, at least 5 of 6 raters recommended PO after reviewing the radiograph, 64% of the cohort (122/192). However, upon reviewing the arthrogram images, only 45% (86/192) of reviewers recommended a PO. Attending surgeons changed their decisions away from PO in 35% of cases overall while fellows changed their decisions in only 7% of cases. Further radiographic characterization of the labrum position demonstrated substantial agreement (kappa=0.73; 95% CI=0.48-0.98) and almost perfect agreement regarding presence of dye pool (kappa=0.85; 95% CI=0.50-1.00).Conclusions: Interpretation of intraoperative hip arthrography to guide addition of PO in CP hip reconstruction is reliable with moderate agreement according to experience level and with substantial retest reliability.Level of Evidence: Level IVKey Concepts•Arthrograms can be helpful to determine hip stability during hip reconstruction in cerebral palsy patients.•The reliability of the interpretation of arthrograms is an important area of study.•Decision-making in neuromuscular hip reconstruction is not standardized across surgeons or institutions.

Hip reconstruction in children with cerebral palsy: does magnitude of surgery influence complications and outcomes?

Children with cerebral palsy (CP) and neuromuscular hip dysplasia (NMHD) frequently require hip reconstruction including femoral and pelvic osteotomies. Outcomes and complications in CP patients with NMHD who underwent varying degrees of hip reconstruction surgeries were examined. Ninety-nine patients with a diagnosis of CP who underwent surgical management of NMHD over a 15-year period (2005-2020) were reviewed. Three patient cohorts with varying degrees of surgery were analyzed including: (1) unilateral femoral osteotomy with pelvic osteotomy; (2) bilateral femoral osteotomy with unilateral pelvic osteotomy; and (3) simultaneous bilateral femoral osteotomy and bilateral pelvic osteotomy. Data points included operative (OR) time, length of stay (LOS), estimated blood loss (EBL), and transfusion requirement. Complications during the perioperative and postoperative periods were identified and graded by severity. Increased EBL, need for transfusion, OR time, and LOS were observed more frequently in patients undergoing bilateral reconstruction. Complication rates were high for all three cohorts, with 87% of cases in the bilateral pelvic osteotomy cohort experiencing ≥1 complication. However, 90% of these were considered grade I or II and required no or minimal intervention. The average postoperative migration index at final follow-up for treated hips was significantly less in bilateral pelvic osteotomy cases. Patients with CP and bilateral NMHD can be safely managed with bilateral simultaneous comprehensive reconstruction. The data presented in this study can help both surgeons and families anticipate a more accurate postoperative course. Level of evidence: III.

Catatonia and Neuroleptic Malignant Syndrome in Patients With Cerebral Palsy: Two Case Reports and a Systematic Review of the Literature.

Patients with cerebral palsy, a group of movement disorders with motor, and possibly communication and behavioral features that mimic catatonic signs, may benefit from efforts to improve the detection and treatment of comorbid catatonia. Given that cerebral palsy frequently co-occurs with conditions associated with catatonia, such as autism spectrum disorder, epilepsy, intellectual disability, and mood and psychotic disorders, lifetime prevalence of catatonia in this population may be high. This study aimed to systematically review the literature on catatonia and the related condition of neuroleptic malignant syndrome (NMS) in patients with cerebral palsy while presenting 2 additional cases of catatonia. We used the terms "cerebral palsy" in combination with "catatoni∗," related terms for catatonia, and "neuroleptic malignant syndrome" to query Ovid MEDLINE (1948 to November 28, 2022), PsycINFO, Cumulative Index to Nursing, and Allied Health Literature, and Embase for applicable case reports. The Neuroleptic Malignant Syndrome Information Service database was also manually searched. In addition to our 2 catatonia reports, we identified 10 reports of catatonia in patients with cerebral palsy, as well as 8 reports of NMS. Patients with both conditions responded well, and sometimes rapidly, to treatment. Notably, of the 5 patients with catatonia and cerebral palsy who received electroconvulsive therapy, 2 developed recurrent self-limited hyperthermia posttreatment. We also identified several cases of baclofen withdrawal, which can be life threatening because of seizure risk, presenting with NMS-like features in patients with cerebral palsy who had malfunctioning intrathecal baclofen pumps for spasticity management. Given frequent comorbidity of conditions associated with catatonia in patients with cerebral palsy, as well as routine treatment with medications that can induce NMS, such as metoclopramide and anticholinergics, catatonia and NMS may be underreported in the cerebral palsy patient population, despite being highly treatable. Possible underdiagnosis of catatonia in patients with cerebral palsy may be because of misattribution of overlapping features between the 2 conditions to cerebral palsy. Clinicians should be aware of possible recurrent self-limited fever when using electroconvulsive therapy to treat patients with catatonia and cerebral palsy while also being vigilant for intrathecal baclofen withdrawal when encountering NMS-like features in patients with cerebral palsy.

Intensive Rehabilitation is better when it is combined with Tizanidine in Spastic Cerebral Palsy- A Randomized Clinical Trial

Background: To find out the combined efficacy of Tizanidine and intensive rehabilitation in the treatment of spastic cerebral palsy. Methods: This randomized clinical trial was conducted over 70 patients in Sir Salimullah Medical College Hospital from January 2022 to December 2022.The patient satisfying the inclusion and exclusion criteria was randomly enrolled into two groups; Group- A (Case) included 35 patients received only intensive rehabilitation and Group- B (Control). included 35 patients who received Tizanidine (2mg) orally at a dose of 1 mg given at bed time under 10 years and 2 mg 10 years or more, then after 1 week maintenance dose was 0.3 mg/kg/day three times daily in combination with intensive rehabilitation 1 hour daily five times a week for 24 weeks. All patients were followed up at 4 weeks interval and were evaluated for a total of 24 weeks. Combination of Tizanidine and intensive rehabilitation has superior efficacy in reducing tone in spastic cerebral palsy over only rehabilitation measured by using Modified ashworth scale (p&lt;0.001). Results: Combination of Tizanidine and intensive rehabilitation is improved in physician rating scale crouch (p&lt;0.0001) and foot contact, (p&lt;0.0001) and also improvement in gross motor function (p&lt;0.01). Conclusion: Combination of Tizanidine and intensive rehabilitation group has superior efficacy than only rehabilitation group for reduction of generalized spasticity regarding muscle tone, range of motion of the joint and improvement of gait in cerebral palsy patients. Bangladesh J Medicine 2023; 34(2): 98-104