Spastic Quadriplegic Cerebral Palsy Research Articles

Helicobacter pylori Infection in Children With Cerebral Palsy: A Cross-Sectional Study

BackgroundChildren with cerebral palsy (CP) frequently have associated disorders and complications, including gastrointestinal problems. Helicobacter pylori is a common infection worldwide, frequently associated with gastrointestinal manifestations. MethodsTo estimate the prevalence of H. pylori infection in children with CP, a cross-sectional study over an eight-month period was performed in the pediatric neurology outpatient clinic of Tanta University Hospital. The study included 100 patients with CP aged two to 17 years. All patients were tested for H. pylori antigen in stool by enzyme-linked immunosorbent assay. ResultsThe mean age of studied children with CP was 7.03 ± 4.1 years; there were 57 males and 43 females. Spastic quadriplegic CP was the most common type of CP (34%). Forty-five children with CP were positive for H. pylori antigen in stool. Intellectual disability (ID), low sociodemographic scoring system, semisolid diet, and Eating and Drinking Ability Classification System (EDACS) levels 4 and 5 were significant predictors of H. pylori infection (odds ratio of 1.86, 2.63, 12, and 1.77, respectively, P < 0.05). Vomiting, abdominal pain, and gastrointestinal tract bleeding were significantly more frequent in H. pylori-infected children with CP than noninfected children with CP (P value < 0.05) ConclusionH. pylori is a relatively common infection among children with CP. The main risk factors for H. pylori infection were low socioeconomic level, ID, semisolid diet, and EDACS levels 4 and 5.

Effects of Therapeutic Dosing through Enriched Environment on Gross Motor Function in Spastic Quadriplegic Cerebral Palsy

Background: Cerebral palsy differs in every child in terms of impairments, activity limitations and participation restrictions, so intervention should be designed in a way which is specific to every child and is constantly adjusted according to the needs of the child. Level appropriate selection of dosage (frequency, type, time, intensity) of treatment plays a vital role in treatment efficacy. Objective: To investigate the effects of therapeutic dosing through age-appropriate enriched environment on gross motor function in spastic quadriplegic cerebral palsy. Methods: In this RCT, 82 spastic cerebral palsy children were randomly allocated to two groups. Group A received level appropriate enriched environmental inputs consisting of motor and sensory enriched play environment with therapeutic dosing (20-25 minutes intermittently, 5 hours per day, 5 days a week for 24 weeks) along with Neurodevelopmental Technique. The goal was to promote participant’s self-generated movements, exploration of the environment and successful task completion. Group B received clinical based regular physical therapy consisting of NDT. Guidance was given to parents on how to carry out a home program. Data was collected at the end of 5 months on GMFM scale to check improvement in gross motor function. Results: The data was analyzed using Mann Whitney U test. There was statistically significant difference between the two groups. Group A showed improvement in gross motor function (p value&lt;0.05) whereas improvement in group B was not as significant (p-value&gt;0.05). Conclusion: This study concluded that optimal dosage of an intervention along with parent/caregiver education started at an early age resulted in significant functional improvements in spastic quadriplegic cerebral palsy children. These improvements were observed not only in body functions but also in active involvement and participation of the child.

Improving swallowing function in a child with cerebral palsy: A single case study on the efficacy of intervention strategies

The study explored the efficacy of Oromotor exercises and proprioceptive neuromuscular facilitation (PNF) to improve swallowing abilities pre- and post-behavioral intervention in a child with cerebral palsy (CP). A 4-year-old female child diagnosed with global developmental delay secondary to spastic quadriplegic CP and poor feeding skills was taken up for study. Oro-motor stimulation and PNF with taste, temperature, and texture were used. Therapy was given twice a week for 30 min. Pre- and post-intervention, a detailed Oro motor and feeding evaluation was performed. Post-therapy evaluation revealed significant increase in body weight, oromotor movements, International Dysphagia Diet Standardization Initiative, Eating Drinking Ability Classification System level, frequency of water, and meal intake. The intense application of oromotor and PNF stimulation seemed to have effected significant improvements in feeding and swallowing abilities which translated to increased weight and positive parental feedback. This might have been responsible for positive outcomes seen in the present study as well.

Evaluation of Hearing Status in Various Type of Cerebral Palsy Children in a Tertiary Hospital

Background: Cerebral palsy (CP) in children are frequently associated with sensorineural pathology.&#x0D; Objectives: To assess the severity of hearing impairment in children with CP and correlate the auditory impairment with different types of CP.&#x0D; Materials &amp; Methods: This cross-sectional study was conducted in the Department of Pediatric neurology and Autolaryngiology- Head and Neck Surgery BSMMU, during March to September 2011. Diagnosed CP patients were included consecutively. After taking informed written consent, proper history and clinical examinations was done and severity of hearing loss was assessed.&#x0D; Results: Among the 50 children with CP, Tympanometry result revealed that negative middle ear pressure was present in 32% in spastic quadriplegia(SQ), 24% in spastic hemiplegia (SH), 16% in spastic diplegia (SD) and 24% in mixed type. Eustachian tube dysfunction was present in 62.5% in spastic hemiplegia. In TOAE result 52% were pass and 48% were referred and ABR were suggested. On the basis of result of TOAE, those were referred, initially they were encountered as hearing impairment in this study. Among them, in SQ were 18%, SH were 12% and mixed. Follow up auditory brain stem response revealed mild, moderate and severe sensorineural hearing loss were 8% in spastic quadriplegic type and the spastic diplegia and athetoid group were 2% only mild, Moderate sensorineural hearing were 2% in spastic hemiplegia group.&#x0D; Conclusion: Spastic Quadriplegic cerebral palsy patients had the maximum incidence of hearing impairment. Perinatal asphyxia and prematurity were the main risk factor of hearing impairment.&#x0D; BANGLADESH J CHILD HEALTH 2022; VOL 46 (1) : 19-22

Satisfactory Improvement in Lifestyle of a Spastic Quadriplegic Cerebral Palsy Patient through Cranial Surgery

Several treatment options may help improve daily functioning in children with cerebral palsy (CP). However, these treatments cannot prevent early death or enable them to lead independent life without support. CP is a progressive disease, and even in its milder form, conditions such as Parkinson's disease, epilepsy, and stroke may develop even after 25 years. A new era of curable treatment has emerged for CP, utilizing bilateral cranioplasty and duraplasty (Tanfarid Procedure). This case report describes a successful case where this procedure was employed. During the surgery, after the removal of cranial bones through craniotomy, the absence of dural pulsation was observed, indicating elevated intracranial pressure. After duraplasty, normal brain pulsation was observed, indicating that intracranial pressure had normalized. In patients with CP, premature closure of sutures and thickening of skull bones lead to a reduced intracranial volume, which hinders proper brain growth and eventually results in brain atrophy, widened Sylvian issures, and widened sulci accompanied by the loss of brain parenchymal tissue. These findings were also evident in the patient's brain CT scan. In this case, cranioplasty and duraplasty provided adequate space for the brain to grow . The treatment of CP patients typically involves a multidisciplinary approach, which can be expensive. However, the procedure utilized in this case is affordable for economically disadvantaged individuals in this country. While a second cranial surgery may be required in some cases, the expenses associated with it are significantly lower compared to a lifetime of physiotherapy and other supportive treatments. Additionally, the outcomes are very promising.KYAMC Journal Vol. 14, No. 02, July 2023: 105-108.

The Difficulty Detecting Tuberculosis in a Child with Post-COVID-19 and Cerebral Palsy.

When hypostatic pneumonia is present at the same time as COVID-19 pneumonia, the clinical course is almost always prolonged (prolonged-COVID-19) due to persistent inflammation, long-term anti-inflammatory syndrome, followed by immune exhaustion, i.e., by immunosuppression and catabolic syndrome. In the immunosuppression phase, viral reactivation can be accompanied by a secondary infection, which, in this case, is pulmonary tuberculosis. Pulmonary tuberculosis in post-COVID-19 patients and in patients with spastic quadriplegic cerebral palsy does not have a typical clinical course nor laboratory, radiological, immunological, microbiological, or fiberbronchoscopic pathohistological confirmation. Due to this, the treatment of pulmonary tuberculosis was not carried out on time, postponed after the unsuccessful treatment of sepsis, post-COVID-19, and other accompanying viral (adenovirus, RSV) and bacterial (streptococcus viridans) infections. The treatment of pulmonary tuberculosis was possible only "ex juvantibus" (trial) post-COVID-19. It becomes imperative to search for a new, more precise and reliable diagnostic test for the detection of tuberculosis bacillus.

Splints and a Task-oriented Approach Improve Upper Extremity Function in Children with Spastic Quadriplegic Cerebral Palsy

To investigate the combined impact of splints and Task-Oriented Approach(TOA) on Upper Extremity (UE) skills in children with Motor learning and motor movement execution were both necessary for the development of upper extremity (UE) skills. The UEs' musculoskeletal stability was necessary for the execution of motor motions. Spasticity, a frequent issue in kids with cerebral palsy (CP), can hinder and limit participant ability and activity. In this study, we investigated how task-oriented approach (TOA) intervention and splints could benefit quadriplegic CP children with spastic upper limbs. To evaluate the combined impact of splints and TOA vs the individual effects of splints and TOA on UE’s skills. Using a quasi-experimental design, 15 kids were chosen using inclusion and exclusion criteria and then randomly allocated to one of three groups, A, B, or C, each consisting of five kids. During the four-week intervention program, children in Group A received splints together with TOA, children in Group B received splints, and children in Group C received TOA. The results of the PDMS-2 Peabody Developmental Motor Scales 2nd edition, PDMS-2 standardized test evaluation were used to examine each kid one week before and immediately after the four-week intervention. The statistical findings showed that when the intervention was concentrated on TOA together with the usage of splint and the full groups were compared to each other, there is a significant observable improvement in UE's abilities function in children with spastic quadriplegic CP group A comparing to group B and group C children. This study found that the assumption of motor learning, which states that an adequate neuromotor system combined with repeated practice will develop motor skills, is true when the goal of a treatment plan for children with quadriplegic CP is to develop UE skills.

The effect of zinc sulphate in a cerebral palsy child: A Case Report

Cerebral palsy (CP) is a prevalent neurodevelopmental condition characterized by permanent movement and posture disorders, affecting young children worldwide. Zinc, an essential trace element with crucial roles in immune function and neuronal development, has shown potential neuroprotective effects in preclinical studies. Despite this evidence, human trials investigating the effect of zinc in children with CP remain limited. This case study examines the impact of zinc supplementation in a four-year-old child diagnosed with moderate spastic quadriplegic CP. The patient received standard physiotherapy alongside oral zinc supplementation and a balanced diet for six months. Significant improvements were observed in motor function, muscle tone, balance, concentration, and fatigue within two weeks of zinc intervention. Continued progress was seen at four and eight weeks, indicating potential benefits of zinc as an adjunct therapy in managing CP. However, further research and larger clinical trials are warranted to validate these findings and determine optimal dosages. This study contributes to the growing body of knowledge in pediatric neurology and suggests the potential role of zinc in improving outcomes for children with cerebral palsy.

Resting energy expenditure in children and adolescents with cerebral palsy: accuracy of available prediction formulas and development of population-specific methods.

Energy requirements are difficult to estimate in children with cerebral palsy (CP). Resting energy expenditure (REE), necessary to implement personalized nutritional interventions, is most commonly estimated using prediction formulae since indirect calorimetry, the reference method, is not available in all nutrition units. The aims of the present study were: (1) to evaluate the accuracy of the most commonly used REE prediction formulae developed for healthy children, in children with CP; (2) to assess the accuracy of the REE population-specific formula for CP children proposed in our preliminary report; (3) to develop new population-specific methods. REE was measured by indirect calorimetry in 100 children and adolescents with spastic quadriplegic cerebral palsy (SQCP) and estimated on the basis of predictive formulas selected by the clinicians [World Health Organization (WHO), Harris-Benedict, Schofield weight, Schofield weight & height, Oxford, Mifflin formulae and a population-specific formula for CP children developed in our preliminary report]. 100 children with SQCP (35 girls, 35%) classified as level V according to gross motor function classification system (GMFCS-V); 64% with oral nutrition, 29% total enteral nutrition (nasogastric tube feeding, percutaneous endoscopic gastrostomy, percutaneous endoscopic transgastric jejunostomy) and 7% mixed nutrition. The median (IQR) REE was 41.96 (17.5) kcal/kg/day.Statistical analysis highlighted a proportional bias between the indirect calorimetry and all considered predictive formulae for REE determination. By studying the relationship between the bias and the mean values of REE, specific conversion equations were obtained. With a pre-specified model having as predictors the variable weight and the variable Triceps Skinfold (TSF) and, as response the variable REE measured by indirect calorimetry, a predictive nomogram was developed to estimate the REE in this population of children. We suggest using predictive formulae for healthy children with caution, and where possible carrying out indirect calorimetry to assess REE in children with CP. However, we propose a new tool which could be developed to become an additional help for assessment of REE in the clinical practice.Future objectives will be to obtain a larger sample size, in a multicenter perspective study, to build a specific predictive model for the REE of the studied population.

Pengaruh Terapi Mandiri Oleh Orang Tua Terhadap Kelurusan Tengah Tubuh Anak CP Spastic Quadriplegia

Background: Cerebral palsy (CP) is a disorder of movement and posture during the growth and development of children that is not progressive. One type of CP is spastic quadriplegia with one of the problems, namely the alignment of the middle body that is not optimal. This will result in increased spasticity and impaired respiratory and digestive functions. Research method: one group pre and posttest design on 10 children with CP spastic quadriplegia who experience difficulties in orienting the mid-body alignment in the supine position in the happy CP family community in Surabaya. Parents are taught how to massage the back and lie on their back according to the alignment of the middle of the body, then the parents independently massage the child's back for 15 minutes, 2x per day for 14 days. Proof of treatment is done by video call. Measuring instrument with GMFM dimension A (supine and roll) in percent. Results: The subjects in this study totaled 10 children with CP spastic quariplegia with an average age of 2.9 ± 1.1 years with a total of 5 male and 5 female subjects. The mean pre-treatment GMFM value was 0.38 ± 0.8% and the mean GMFM increased post-treatment, namely 4.2 ± 1.2 %, with a significant Wilcoxon test at 0.003. Conclusion: independent therapy by parents in the form of back muscle massage and position adjustment affects the mid-body alignment of children with CP Spastic Quadriplegia.

Effect of intrathoracic oscillations on pulmonary functions in children with cerebral palsy

ObjectivesThis study was aimed at investigating the effects of intrathoracic oscillations on pulmonary function in children with spastic quadriplegic cerebral palsy. MethodsThis study comprised 24 boys and girls 6–8 years of age with spastic quadriplegic cerebral palsy. According to the modified Ashworth scale, the degree of spasticity was 2 to 2+. The children were able to sit independently and follow instructions. The children were randomly divided into a study group and control group. A spirometer was used to examine each child before and after 6 weeks. Children in the control group received traditional chest physiotherapy (postural drainage and percussion), whereas children in the study group underwent quake device training. For 6 weeks, both groups received four sessions per week. After treatment, the results were collected. Paired t-test and independent-samples t-test were applied to compare the means for each group. p-values <0.05 were considered significant. ResultsThe post-treatment results of forced expiratory volume at 1 s, peak expiratory flow, forced vital capacity, and the ratio of forced expiratory volume at 1 s to forced vital capacity demonstrated significant differences favoring the study group over the control group (p < 0.001, p < 0.001, p = 0.002, and p = 0.023, respectively). ConclusionIntrathoracic oscillations may improve pulmonary function in children with quadriplegic cerebral palsy.

Prevalence, birth, and clinical characteristics of dyskinetic cerebral palsy compared with spastic cerebral palsy subtypes: A Norwegian register-based study.

To study the prevalence, birth, and clinical characteristics of children with dyskinetic cerebral palsy (CP) in Norway compared with spastic quadriplegic CP and other spastic CP subtypes. Data on children born from 1996 to 2015 were collected from the Norwegian Quality and Surveillance Registry for Cerebral Palsy and the Medical Birth Registry of Norway. One hundred and seventy (6.8%) children had dyskinetic CP. The birth prevalence decreased during 1996 to 2015 from 0.21 to 0.07 per 1000 livebirths (p < 0.001). Dyskinetic CP was more often associated with term/post-term birth, and motor and associated impairments were more severe compared with spastic bilateral and unilateral CP, but less severe than spastic quadriplegic CP. On neuroimaging, grey matter injuries were most prevalent in dyskinetic CP (mainly basal ganglia/thalamus) and spastic quadriplegic CP (mainly cortico-subcortical), white matter injuries in spastic bilateral, and white and grey matter injuries were equally common in spastic unilateral CP. Normal neuroimaging and brain maldevelopment were present in 25% of children with dyskinetic CP. The decrease in birth prevalence of dyskinetic CP was probably due to improved antenatal and perinatal care. Potential sentinel events at term were more common in dyskinetic CP than other spastic CP subtypes. However, probable antenatal aetiologies were most prevalent. Motor and associated impairments were less severe in children with dyskinetic CP compared with spastic quadriplegic CP. Birth prevalence of those with dyskinetic and spastic bilateral cerebral palsy (CP) in Norway decreased between 1996 and 2015. Potential sentinel events at term were more common in dyskinetic CP. Nonetheless, probable antenatal aetiologies were most prevalent in dyskinetic CP. Basal ganglia/thalamus lesions were more common in dyskinetic than spastic quadriplegic CP. Motor and associated impairments were milder in dyskinetic than spastic quadriplegic CP.

Hearing and Visual Impairment in Children with Cerebral Palsy, A Study in Tertiary Level Hospital in Bangladesh

Background: Cerebral palsy (CP) is a diagnostic term used to describe a group of motor syndromes resulting from disorders of early brain development. CP remains unexplained in most cases and is typically diagnosed outside the neonatal period. Visual impairment decreases the quality of life and hearing impairment hampers linguistic development. This study aimed to observe the visual and hearing impairment of children with cerebral palsy associated with developmental disabilities. Material Methods: This is a cross-sectional observational descriptive study carried out in the department of Paediatric Neurology CMH Dhaka from March 2018 to February 2022. The participants (N=120) were from birth to 12 years of age. Detailed information was obtained in each case according to protocol. The pediatric neurologist based on the study definition crosschecked the diagnosis. The hearing assessment was done with the help of an Otolaryngologist in the department of Otolaryngology and the ophthalmological evaluation was done with the help of an ophthalmologist of the department of ophthalmology of CMH Dhaka. Hearing impairment, Ophthalmological motor disturbance, and developmental disabilities were correlated. A convenience sampling technique was used in this study. Relevant data were collected from hospital records. All the information was recorded in the fixed protocol. Collected data were classified, edited, coded, and entered into the computer for statistical analysis by using SPSS 2021. Results: In this study, among the 120 children with CP, the mean age of the study was 5.57(SD±3.89) age range of 2-12 years Males were 82(68%) and females were 38(32%), male-female ratio (sex M: F 2.15: 1). Spastic quadriplegia constitutes the predominant group 59(49%), followed by Spastic diplegia 21(18%), Spastic hemiplegia 20(17.5%), dyskinetic CP 09(8%), 7(6%) were mixed CP and 4(3%) were hypotonic CP. Hearing impairment was found in 87 (72%) cases and visual impairment was detected in 92(76%). Among them, the child with Spastic Quadriplegic (83%) and diplegic CP (62%) children had a hearing impairment. Regarding vision, no fix and follow were observed in 69(57%) cases. Among the studied CP child (n=120) 16 children (13.33%) had normal eye finding and 104 (86%) had abnormal eye findings. Refractive error (32.5%) and Squint (19%) were the most common ocular defect among studied patients. Other ocular defect were nystagmus(10%), optic atrophy(12.5%), microphthalmia(10%), corneal opacity(3%), optic hypoplasia(4.1%), cataract(2.5%), pigmentary retinopathy(5%), retro-lental fibroplasias(3.3%) and ptosis(2.5%). In children with hypotonic (athetoid) and mixed CP, almost all (11 of 11) children had visual impairment. Spastic quadriplegic CP children (80%) and Spastic diplegic CP children (90%) had one or more domains of visual impairment. Conclusion: Cerebral Palsy is a non-progressive various form of neurological disorder in children. Early visual screening and hearing assessment can help CP children to minimize mental retardation, learning difficulties, and speech delay.

Multisystem compensations and consequences in spastic quadriplegic cerebral palsy children.

Spastic quadriplegic cerebral palsy (CP) is a permanent neuromuscular disorder causing limitation on all four limbs following a lesion on the developing brain. Most children with spastic quadriplegic CP are identified to be Gross Motor Function Classification System (GMFCS) level V, thus they have more comorbidities compared to other types at lower levels. Spastic quadriplegic CP is characterized by weak and inactive postural muscles of the neck and trunk, hence, they will undergo a total body extension as a compensatory mechanism leading to an atypical movement pattern, that give rise to multisystem consequences that reduce their quality of life. The relationship between atypical movement patterns, compensatory strategies, and multisystem consequences have not yet been explored. In fact, these multisystem consequences aggravate their condition and make movement much more atypical, forming a vicious cycle. This review aimed to provide a summary and highlight the mechanism of atypical movement pattern, multisystem compensations, and consequences in spastic quadriplegic CP children. It is true that central nervous system (CNS) lesion in CP is non-progressive, however the multisystem consequences may impair overall function over time. An understanding of how compensatory strategy and multisystem consequences in spastic quadriplegic CP offers the opportunity to intervene as early as possible to improve their quality of life.

Dry needling with electrical stimulation for the treatment of a pediatric patient with spastic cerebral palsy: a case report

The patient was a 6-year-old child with spastic quadriplegic cerebral palsy (CP) categorized with the gross motor function classification system (GMFCS) as a level IV and a Modified Modified Ashworth Scale (MMAS) of 2 for the bilateral hamstring and hip adductor muscles, and 3 for the bilateral gastrocnemius muscles. This patient’s limited range of motion significntly affected the caregiver’s ability to perform activities of daily living (ADLs). Dry needling (DN) is considered a standard treatment (TX) when treating adults with poor range of motion. This article aims to place intramuscular electrical stimulation (IMES), the delivery of an electrical current through a monofilament needle into targeted trigger points (TrPs) within the context of treating children with spastic CP. Following IMES TXs over 32 months that totaled 12 left hamstring TXs, 13 right hamstring TXs, 13 hip adductor TXs, 21 left gastrocnemius TXs, and 18 right gastrocnemius TXs, the patient demonstrated an increase in passive range of motion (PROM) of the hamstring, hip adductors, and gastrocnemius muscles. These gains equated to ease in ADLs. Both the Pediatric Evaluation of Disability Inventory (PEDI, PEDI-Caregiver Assistance Scale) and the Goal Attainment Scale (GAS) demonstrated decreased caregiver burden. The child’s GMFCS level and the MMAS did not change. Further data collection related to treating children with spasticity using IMES is indicated to validate this type of TX with this patient population.

OROFACIAL MANIFESTATIONS OF SPASTIC QUADRIPLEGIC CEREBRAL PALSY: CASE REPORT

Cerebral palsy can be defined as a chronic disorder of posture and movement. The spastic quadriplegic modality is the most serious condition of this disease, involving the lower and upper limbs, with impairment of the innervations that control the movements of the mouth, tongue, and pharynx. A male patient, previously diagnosed with spastic quadriplegic cerebral palsy, was seen at a specialized university dental service for patients with special needs. During the clinical examination, it was found that the patient had swollen gums, with bleeding at the time of stimulation; his state of oral hygiene was regular and performed by caregivers. The patient also had atresia of the palate and abnormal lips. During treatment, the oral environment was adequate, with supragingival scraping, prophylaxis, and subsequent placement of an orthodontic appliance. The patient was cooperative throughout the treatment, despite his poor health.

Comparison of intrathecal baclofen pump insertion and selective dorsal rhizotomy for nonambulatory children with predominantly spastic cerebral palsy.

In nonambulatory children with predominantly spastic cerebral palsy (CP), the authors compared care needs, symptom burden, and complications after surgical treatment with either intrathecal baclofen (ITB) pump insertion or selective dorsal rhizotomy (SDR). The patients were treated at two Canadian centers with variability in practice pertaining to these surgical options. The authors performed a retrospective analysis of nonambulatory children with predominantly spastic quadriplegic or diplegic CP who underwent treatment with ITB or SDR. These two strategies were retrospectively assessed by comparing patient data from the two treatment groups for demographic characteristics, outcomes, and complications. A partial least-squares analysis was performed to identify patient phenotypes associated with outcomes. Thirty patients who underwent ITB and 30 patients who underwent SDR were included for analysis. Patients in the ITB group were older and had lower baseline functional status, with greater burdens of spasticity, dystonia, pain, deformity, bladder dysfunction, and epilepsy than patients in the SDR group. In addition, children who underwent SDR had lower Gross Motor Function Classification System (GMFCS) levels and were less likely to experience complications than those who underwent ITB. However, children treated with SDR had fewer improvements in pain than children treated with ITB. A single significant latent variable explaining 88% of the variance in the data was identified. Considerable baseline differences exist within this pediatric CP patient population. Factors specific to individual children must be taken into account when determining whether ITB or SDR is the appropriate treatment.

Epilepsy syndromes in cerebral palsy: varied, evolving and mostly self-limited.

Seizures occur in approximately one-third of children with cerebral palsy. This study aimed to determine epilepsy syndromes in children with seizures and cerebral palsy due to vascular injury, anticipating that this would inform treatment and prognosis. We studied a population-based cohort of children with cerebral palsy due to prenatal or perinatal vascular injuries, born 1999-2006. Each child's MRI was reviewed to characterize patterns of grey and white matter injury. Children with syndromic or likely genetic causes of cerebral palsy were excluded, given their inherent association with epilepsy and our aim to study a homogeneous cohort of classical cerebral palsy. Chart review, parent interview and EEGs were used to determine epilepsy syndromes and seizure outcomes. Of 256 children, 93 (36%) had one or more febrile or afebrile seizures beyond the neonatal period and 87 (34%) had epilepsy. Children with seizures were more likely to have had neonatal seizures, have spastic quadriplegic cerebral palsy and function within Gross Motor Function Classification System level IV or V. Fifty-six (60%) children with seizures had electroclinical features of a self-limited focal epilepsy of childhood; we diagnosed these children with a self-limited focal epilepsy-variant given the current International League Against Epilepsy classification precludes a diagnosis of self-limited focal epilepsy in children with a brain lesion. Other epilepsy syndromes were focal epilepsy-not otherwise specified in 28, infantile spasms syndrome in 11, Lennox-Gastaut syndrome in three, genetic generalized epilepsies in two and febrile seizures in nine. No epilepsy syndrome could be assigned in seven children with no EEG. Twenty-one changed syndrome classification during childhood. Self-limited focal epilepsy-variant usually manifested with a mix of autonomic and brachio-facial motor features, and occipital and/or centro-temporal spikes on EEG. Of those with self-limited focal epilepsy-variant, 42/56 (75%) had not had a seizure for >2 years. Favourable seizure outcomes were also seen in some children with infantile spasms syndrome and focal epilepsy-not otherwise specified. Of the 93 children with seizures, at last follow-up (mean age 15 years), 61/91 (67%) had not had a seizure in >2 years. Children with cerebral palsy and seizures can be assigned specific epilepsy syndrome diagnoses typically reserved for normally developing children, those syndromes commonly being age-dependent and self-limited. Compared to typically developing children with epilepsy, self-limited focal epilepsy-variant occurs much more commonly in children with cerebral palsy and epilepsy. These findings have important implications for treatment and prognosis of epilepsy in cerebral palsy, and research into pathogenesis of self-limited focal epilepsy.

A unique case report of microcephaly and malnutrition in a child with spastic quadriplegic cerebral palsy

A unique case report of microcephaly and malnutrition in a child with spastic quadriplegic cerebral palsy

Prevalence and Risk Factors Associated With Pelvic Rod/Screw Radiographic Lucency Following Scoliosis Surgery in Spastic Cerebral Palsy: A Longitudinal Study.

Radiographic lucency around a smooth pelvic rod (Galveston/unit rod technique) or sacroiliac/iliac screw following spinal fusion in children with nonambulatory spastic cerebral palsy (CP) has been described as a "windshield wiper" phenomenon. We evaluated demographics, radiographs, and complications in 101 cases from a single center to determine prevalence, risk factors, and complications associated with persistent radiographic lucency from 1 to 5 years following spinal fusion. Inclusion criteria were diagnosis of nonambulatory spastic quadriplegic CP [Gross Motor Function Classification System (GMFCS) IV-V], under 18 years of age, scoliosis treated by posterior fusion from upper thoracic to sacrum with pelvic fixation (Galveston rod, iliac screw, or sacroiliac screw), adequate radiographs (preoperative, immediate postoperative, first-year, and second-year), and minimum 5-year follow-up. We evaluated demographics, radiographic parameters, comorbidities, scoliosis curve type, type of pelvic screw/rod, use of off-set connector, screw width, associated with posterior column osteotomy and/or additional anterior spinal release concurrent with posterior spine fusion, and infection over the follow-up period. Specific attention was given to the area and shape of the radiographic lucency. The logistic regression analysis was performed for continuous and categorical variables to define risk factors ( P =0.05). In 101 patients, data were collected at mean intervals of 1-year, 2-year, and >5-year follow-up and were 12.9±1.5, 25.8±2.5, and 81.5±23.0 months, respectively. Prevalence of pelvic rod/screw radiographic lucency was unchanged at 33%, 35%, and 24% at 1-year, 2-year, and >5-year follow-up, respectively, and radiographic parameters did not change ( P >0.05). Furthermore, no risk factors or complications were associated with radiographic lucency around pelvic rods/screws ( P >0.05). In patients with spastic nonambulatory CP who had scoliosis treated with posterior spinal fusion from upper thorax to pelvis, the prevalence of pelvic rod/screw lucency is high. Persistent lucency >2 mm around pelvic implants is not clinically significant, does not warrant advanced imaging, or indicate a complication if stable over time and wider distally than proximally. Level III.